HCCI Home Care Standards

National Standards for the

Provision of Home Care Support Services

The Home and Community Care Ireland standards have been drawn up from the 'HSE National Quality Guidelines for Home Care Support Services' and the 'HSE Agreement with Home Care Providers for the Provision of Home Care Services in LHO Dublin North West for Older Persons Service/for Disabilities Services'.

1.0 Standard 1 - Referral Assessment and Care Planning

Arrangements are in place to ensure that the identified needs of each client can be met and are kept under review.

The service requirements of clients and their personal or family carers are individually assessed before they are offered a home care support service.

Assessment should include a comprehensive needs/risk assessment which should be obtained prior to the commencement of the service or in an emergency within two days of the service commencing.

All assessments including private referrals should be completed in consultation with the client and/or their representative. With the client's agreement, assessment should be carried out in collaboration with the relevant members of the multidisciplinary team.

An appropriately qualified and experienced member of staff should visit the client in their home, preferably prior to commencement of service and no later than 2 days in an emergency situation.

During this initial visit the client's needs assessment, risk assessments and care plan are reviewed to ensure the client's identified needs can be met.

1.2 Assessment

Client assessment should include relevant details with respect to the following areas: (this list is not exhaustive)

• Physical wellbeing including the client's capacity for the activities of daily living and self-care
• Mental health, emotional wellbeing and cognitive ability
• Specific condition related needs and preferences of the client
• Contribution of informal carers
• Personal and social contacts and preferred routines
• Relevant information about the client's life history
• Social interests, religion and cultural needs
• Medication requirements
• Specific dietary requirements
• Mobility and dexterity (include use of specialised equipment)
• Risk assessments relating to all aspects of care delivery
• Risk assessments relating to the environment where the care is to be delivered (Home Safety Checklist)
• Details on services being provided by others

A record of the completed assessment must be stored in the client's personal file in the service provider's office.

1.3 Home Care Support Plan and Review

A comprehensive care plan to manage the needs and risks identified in the assessment must be drawn up in consultation with the client and/or their representative. The client or their representative should be requested to sign the care plan as evidence that they have been consulted and are in agreement with the plan of care. A copy of the care support plan should be stored in the client's home (with the client's agreement) and in the service provider's office.

The care plan will be reviewed by an appropriately qualified and experienced person at least three monthly or:

• On request by the client and/or their representative
• On request from the care worker or significant professionals
• In response to changing needs or circumstances

The formal review of the care plan should involve discussion with the client and/or their representative, relevant members of the multi-disciplinary team and staff involved in the provision of the service to the client. At each formal care review there should be an opportunity for a private discussion with the client and/or their representative.

Outcomes from reviews should be recorded, communicated to the relevant carers and implemented.

1.4 Client Personal File

Individual care files must be created for each client. All such records must be stored in a secure and confidential manner in accordance with the The Data Protection Act 1998 (amendment) Act 2003.

2.0 Standard 2 - Staff Recruitment and Selection

There is a rigorous recruitment and selection procedure which meets the requirements of the legislation and ensures the protection of service users and their relatives.

Before making an offer of employment

• Service providers must conduct face-to-face selection interviews with care workers and retain a written record of all such interviews
• The applicant's identity should be confirmed
• Two written references must be obtained. One reference should normally be from the most recent employer. If the individual has previously worked in the care sector then a reference should be sought from this employer. All references must be followed up by a documented telephone call prior to confirmation of employment.
• Any gaps in employment should be explored and evidence provided to ensure the provider is confident there were no convictions or issues during this period.
• Certificate of Garda clearance must be obtained. (if employing applicants from overseas appropriate criminal clearance checks must be sought)
• Evidence of professional and vocational qualifications should be obtained
• A pre-employment health screening questionnaire should be completed by the applicant
• Current status of work permit/employment visa must be confirmed (when applicable)
• A valid driving licence and insurance cover for business use of car should be confirmed (when applicable)
• Care workers are expected to write basic reports, react appropriately in the event of an emergency and be able to communicate reasonably with the client in order to ensure their comfort, dignity and needs. The service provider must therefore be able to demonstrate that the carer has sufficient command of the English language, both written and oral.
• All care workers must receive a tamper proof identity card which includes a photograph, the name of the carer, contact number, and date of issue and expiry.
• The identify card must be renewed every 24 months and there should be a formal arrangement for the withdrawal of the identification card from an employee when leaving the company. The care worker must sign a form to acknowledge receipt of the identity card.
• A Job Description must be issued prior to appointment.
• A Statement of main Terms and Conditions of Employment which complies with the relevant legislation must be issued within 13 weeks after appointment.

2.1 Individual Personnel Files

All of the above information relating to the recruitment process, including the completed application form must be stored securely and confidentially in the carer's individual personnel file.

3.0 Standard 3 - Staff Training and Development

Staff receives the necessary training; ongoing development and supervision to ensure the necessary competency levels are achieved and sustained.

3.1 Training and Development Plan

There is a written training and development plan that is kept under review, is updated at least annually and reflects the identified training needs of staff.

3.2 Induction Programme

Newly recruited carers must complete a structured induction programme prior to starting any care assignment. Induction programmes should include both tutor lead classroom teaching and supervised practice in the following areas: (this list is not exhaustive)

• Introduction to the service providers staff handbook
• Policies and procedures of the service provider
• Description of services provided and not provided
• The ageing process and common illnesses of older people
• Delivery of personal care to clients
• Management of clients medicines
• Communication and listening skills
• Record keeping
• Protection of children and vulnerable adults awareness, protocols and reporting procedures
• Client privacy, dignity and confidentiality
• Moving and Handling
• Complaints procedures
• Safe working practices including protection of client, security in the home, protocol for entering the client's home and use of identification card
• Emergency procedures and incident reporting
• Basic personal and food hygiene
• Infection control procedures
• Handling client's money and property
• Complaints procedure
• Staff supervision protocol
• Quality assurance arrangements

3.3 Competency

All carers must be trained to a level which is commensurate with the activities they are assigned. Competency assessments are completed on staff prior to them taking responsibility for the provision of personal care services and working alone. Specialist advice, training and information is provided for staff working with clients with specific healthcare needs

3.4 Training Records

Records are maintained of all training and development activities undertaken by staff.

3.5 Staff Supervision and Appraisal

Staff are supervised and have their performance appraised by an appropriately qualified or experienced person.

Supervision should be provided at least twice yearly and more frequently to a newly recruited member of staff. Records should be maintained of all supervision sessions.

Staff appraisal should be conducted at least annually to enable a review of the individual staff member's performance and to agree personal development plans.

4.0 Standard 4 - Protection of the Person

from Abuse or Exploitation

Service users are protected from abuse

An organisation concerned with maintaining standards in the provision of professional care services must at all times be concerned with the welfare of the people for whom they are responsible. Care workers play an important role in the lives of their clients and should be very aware of the responsibility they have in both recognising and protecting clients from abuse.

4.1 Staff Training

The service provider should ensure all care workers receive training where appropriate in the Protection of Children and Vulnerable Adults. Training should be in accordance with legislation and HSE guidance and include the following:

• Prevention of abuse
• Protection from abuse
• Indicators of abuse
• Responding to suspected, alleged or actual abuse
• Reporting responsibilities
• Procedures for protecting clients with particular vulnerabilities

Refresher training should be provided at least every two years.

4.2 Responding to Allegations of Abuse

All suspected, alleged or actual incidents of abuse should be reported to the relevant persons or agencies.

All suspected, alleged or actual incidents of abuse are fully investigated in accordance with procedures and records maintained.

All relevant persons are notified of the outcome of any investigation undertaken by the agency.

Where shortcomings in systems are identified as a result of any investigations, additional safeguards are implemented.

4.3 Financial Transactions

It is essential that appropriate procedures are followed in all financial transactions undertaken on behalf of the client and a full written record kept to safeguard both the client and the care worker.

4.4 Gifts or Bequests

All care workers must never seek to profit from the home care support service they provide to clients by the acceptance of significant gifts or bequests.

4.5 Safety and Security

The safety and security of clients and care workers is important and for this reason care must be taken when entering or leaving the premises of people receiving care. This includes the need to carry proper identification at all times and to show this identification as required.

5.0 Standard 5 - Quality Assurance

The service is run in the best interests of its clients The service provider must have a robust mechanism for ensuring the quality of the service it is providing and taking the necessary action if the service falls below expected standards.

This quality assurance mechanism must be based on client outcomes and be clearly understood and monitored by care staff, supervisors and managers on an ongoing basis.

All staff must be fully aware of the standard of service they are required to provide at all times.

Care workers should receive one to one supervision with a supervisor or manager at least 6 monthly or more frequently if required.

Policies, procedures, standards and the quality assurance process should be reviewed and revised as necessary, and/or at least annually.

5.1 Client Service File

Clients and/or their representatives should also be fully aware of the standards they can reasonably expect from the service provider and should be given a Client Service File at the commencement of service delivery. The Client Service File must include information such as company objectives, service delivery arrangements, key policies, details of home care support services, contact numbers and information on how to raise a concern or a complaint about any aspect of service delivery. This file must be available in the client's home and must also be available in the service provider's office.

5.2 Consultation with Clients

The service provider should have a process and a procedure for consulting with clients and/or their representatives on a regular basis and quality assuring and monitoring performance including:

• a three monthly visit to clients undertaken by a supervisor or manager, this may be combined, where appropriate, with a review of the home care support plan or monitoring the performance of the care worker

• an audit of working practices to ensure they are consistent with the service provider's policies and procedures and to ensure corrective action is taken when necessary

• the completion of an annual quality assurance survey to seek the views of clients and/or their representatives. The outcome of the quality assurance survey should be shared with all relevant stakeholders.

All quality assurance processes must adhere to the HSE National Quality Guidelines for Home Care Support Services.

6.0 Standard 6 - Premises, Management

and Planning Systems

The business operates from premises with a management structure in place, including clear lines of accountability, enabling the service provider to deliver services effectively on a day to day basis.

The service is managed and provided from suitable premises which are appropriate and designated for the purpose, providing a safe working environment for staff.

The premises are located appropriately for the management and provision of home care support services to the clients it supports in their own homes.

The premises contain equipment and resources necessary for the efficient and effective management of the service.

The management structure reflects the size of the service provider and the volume and complexity of the home care support services provided.

The service provider can at all times provide adequate staff cover to ensure safe delivery of care.

7.0 Standard 7 - Handling Complaints

All complaints are taken seriously and dealt with promptly and effectively

The service provider ensures that there is an easily understood, well publicised and accessible procedure to enable clients and/or their representatives to make a complaint and for complaints to be investigated.

The procedure includes the stages and timescales for the process.

Positive action is taken to encourage, enable and empower clients and/or their representatives to use the complaints procedure including access to appropriate interpretation and methods of communication.

Staff know how to receive and deal initially with complaints.

Complaints are investigated and responded to in accordance with the service provider's procedure and timescales.

Records are kept of all complaints, the outcomes of any investigation and the action taken.

Information and learning from complaints is used to improve the overall quality of the service.

8.0 Miscellaneous Employment Related Issues

8.1 Minimum Wage

The service provider must ensure staff are not paid below the national minimum wage or nationally agreed rates for similar employment categories. All service providers must ensure they comply with all legislation listed below in relation to this issue*.

8.2 Smoking/Alcohol Consumption

The service provider must prohibit staff from smoking in the client's home or consuming alcohol at any time while on duty. It is also prohibited to work or attempt to work while under the influence of alcohol. The service provider must ensure that all support workers are informed of this policy during induction training.

8.3 Health and Safety Legislation

The service provider must have systems and procedures in place to comply with the requirements of Health and Safety legislation including: Safety, Health and Welfare at Work (General Application) Regulations 2007 Part 2 Chapter 4 'Manual handling of loads' and Food Safety Authority of Ireland Act 1998.

8.4 Insurance

Members of the Association must have adequate and appropriate insurance in place before service is commenced. Public liability insurance should amount to at least €13m while employer's liability should amount to at least €6m and must cover all staff members.

8.5 Tax Clearance

All members must have a current tax clearance certificate.

Service providers must ensure their standards are in accordance with the HSE National Quality Guidelines for Home Care Support.

All service providers must ensure that they comply with the following legislation:

* Terms of employment (Information) Acts 1994 and 2001. Unfair Dismissals Acts 1977 to 2007. Maternity Protection Acts, 1994 and 2004. Adoptive Leave Acts 1995 and 2006. The Protection of Employees (Part-time) Act, 2001, Parental Leave Acts, 1998 and 2006. Redundancy Payment Acts, 1967 to 2012. Protection of Employment Acts, 1977 to 2007.Carer's Leave Act, 2001. Employment Equality Acts, 1998 to 2011. Employment Permits Acts, 2003 and 2014. Protection of Employees (Fixed Term Work) Act, 2003. Organisation of Working Time Act, 1997. Minimum notice and Terms of Employment Acts, 1973 to 2005, or any other legislation which is applicable.

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