Care Policy

Policy Owner: Care Management Team

Policy Approval Date: May 2024

Policy Review Cycle: Every 2 years

Policy Next Review Date: May 2026

Care is an integral part of our school and college and is delivered within the framework of our Statement of Purpose and mission statement; this is achieved by following all agreed policies and procedures.

Philosophy of Care

1. To uphold the Christian ethos in line with our Mission Statement.
2. Our priority at St Rose’s is the young person’s quality of life; our aim is to ensure that support is provided in a happy and caring, homely environment.
3. The young person has the right to have their personal dignity respected by others in every way possible and to be treated as individuals whatever their disabilities.
4. The young person has the right to privacy.
5. The young person has the right to independence and personal choice. Therefore, they are encouraged to take an active part with independence skills and to be involved in all aspects of their life, to enable them to become as confident and independent as they are able.
6. The young person has the right to be protected from the undesirable actions of others.

Personal care

St Rose’s is committed to ensuring that all staff responsible for the young person’s personal cares will undertake their duties in a professional manner at all times. We recognise that there is a need to treat all our young people with respect when personal care is provided. No young person should be supported in a way that causes distress or pain.

Personal care support is recognised as an assessed need and indicated in support plans, in ways that:

• Maintain the dignity of the young person.
• Are sensitive to their individual needs, preferences and aspirations.
• Maximise safety and comfort.
• Protect against intrusion and abuse.
• Respect the young person’s right to give or withdraw their consent or for their legal guardian to do so as deemed appropriate.
• Encourage the individual to direct their own care support as much as they are able.

Staff must be culturally sensitive and aware of different concepts of privacy, nudity, and inappropriate touch.

Intimate personal care is hands-on physical care; this may include personal hygiene, and/or physical presence or observation during such activities such as:

• Body bathing
• Toileting, wiping and care in the genital and anal areas.
• Continence care
• Placement, removal and changing of continence pads.
• Menstrual hygiene.
• Dressing and undressing.

Personal care support can be a sensitive issue and will require staff to be respectful of the young person’s needs. The young person’s dignity must always be preserved with a high level of privacy, choice, and control. There will be a high awareness of safeguarding issues. Staff behaviour must be open to scrutiny and staff must work in partnership with parents/carers to provide continuity of care to our young people wherever possible.

Staff who provide personal care are trained to do so (including safeguarding and health and safety training in manual handling) and are fully aware of best practice. Equipment will be provided to assist with required procedures following assessment from St Rose’s physiotherapists/occupational therapists. Staff are trained in the use of equipment used.

Staff will be supported to adapt their practice in relation to the needs of individual young people taking into account developmental changes such as the onset of puberty and menstruation.

The young person will be supported to achieve the highest level of autonomy that is possible given their age and abilities. Staff will encourage each young person to do as much for themselves as they can.

Each young person’s right to privacy will be respected. We will carefully consider the care needs of each young person to determine the correct amount of support required to assist them.

Wherever possible staff should only carry out personal cares for an individual of the same sex. However, in certain circumstances this principle may need to be waived where failure to provide appropriate care would result in negligence. Male carers can support female students and provide personal cares unless the student states a specific preference for female carers only and then we would aim to facilitate this request.

Personal care arrangements will be discussed with the young person, their parents/carers and recorded in support plans. The needs and wishes of the young person and their parents/carers will be taken into account wherever possible within the constraints of staffing and equal opportunities legislation.

Young People at St Roses are encouraged to take an active role in giving their consent to personal cares. If we believe they are unable to consent to requiring 24-hour care and support, and dependant on age we will carry out an assessment of capacity. If they did not meet the functional test, we would continue with our best interest process.

In the case specific procedures e.g. gastrostomy care, administration of rectal preparations only a member of staff suitably trained and assessed as competent by a health professional must undertake the procedure.

Personal Protective Equipment (PPE) – disposable gloves and aprons must be worn when carrying out all personal cares. PPE must be disposed of in a lidded bin.

Excellent hand hygiene is essential in protecting staff and students from the spread of infection.

Nail and Hair Care

• Staff will not cut a young person’s fingernails/toenails; unless this is required in circumstances whereby not doing so will cause harm. Parents/carers must be informed if there is a problem. Staff must be vigilant and check nail lengths, using nail files where needed.
• Staff will not cut a young person’s hair. We can take them to have their haircut, by arrangement with the young person, their parent/carer.

Hearing Aids

• Once taught the proper technique by an appropriate person, staff may assist the young person to insert and adjust hearing aids.
• Following training staff may clean hearing aids.

Restrictive practices

We will always consider whether the support offered to a young person is the least restrictive way of providing that support, and a blanket approach to restrictions on liberty will never be used. We may need to use equipment to keep our young people safe that may be deemed as restrictive, such as wheelchair belts, high-sided beds and listening monitors. If equipment is used it will be risk assessed and supported by all professionals involved in the support planning for the young person.

If required, we will apply for Deprivation of Liberties Safeguards (DoLS) authorisation for each young person where restrictive practices are used. This would be following individual mental capacity assessments and best interest meetings.

Emergency Procedures

• An emergency is defined as a life-threatening situation so there will be occasions when a young person’s personal safety may be at risk and where urgent intervention is required. However, whatever the circumstances, staff should not put themselves at risk.
• If a staff member is seriously concerned about a young person’s physical condition and they have had the appropriate training from a health care professional or qualified trainer in emergency procedures, and feel confident to intervene in an emergency situation, they can do so only as a first aid measure, and whilst ensuring that a school/college nurse and an ambulance is called first through the 999 emergency service.
• Designated staff are trained in the administration of rectal diazepam or buccal midazolam. We have individual protocols from the young person’s medical teams which are kept with the medication and within support plans (if applicable)

Cardiac and Respiratory Resuscitation/Do Not Resuscitate (DNR) notices.

In the event of a young person suffering a cardiac or respiratory arrest, an ambulance must be called using the 999 emergency services. In addition, emergency life-saving procedures should be carried out by a trained staff.

St Rose’s has 2 automated external defibrillators (AED) onsite, 1 is situated outside the Principal’s office, the other situated in the bedroom corridor of St Martin’s bungalow

Staff receive annual basic life support training which includes the use of an AED.

If a young person in our care has a DNR) and/or a wishes document or a ReSPECT plan (Recommended Summary Plan for Emergency Care and Treatment) in place this is recorded in his/her notes and responsible staff will be made aware.

Bedrooms and personal belongings

• The young people in our care have the right to have a comfortable bedroom and their own personal space.
• They have a right to privacy and dignity, and this should be always be respected. Each young person has a personalized privacy and dignity plan within their support plan (if residential)
• Their clothing and personal belongings should be treated in a respectful manner.
• They should have a choice where they place their belongings within their bedroom, providing it does not contravene Health and Safety Regulations.
• If the young person’s belongings are moved for any reason, they should be informed. They should have a choice, within reason, to who enters their bedroom.
• The young person has the right to expect those entering their bedroom to knock on the door prior to entering.
• Where possible, the young person has a right to privacy, with regards to mail, emails and telephone calls.

Activities and free time

Young people in our care have regular meetings to decide what they would like to do in their free time.

There is a wide range of extra-curricular activities available to them. These may include Boccia, Rebound, Scouts/explorers, art club. Activities frequently change.

Key workers and support plans

All young people in our residential care have been allocated key workers. The young person has a right to decide who their keyworker is, and it is open to change as needed.

The keyworker is responsible for developing, reviewing and updating support plans with the young person and working in partnership with therapists, parents/carers.

The support plans include:

• Medical needs
• Care needs
• Feed regimes
• Manual handling plan
• Dysphagia risk assessments
• Eating and drinking guidelines
• Risk assessments
• Communication passports

Care of students who are acutely unwell.

• Contact Nurse or senior member of care team on duty.
• They will make a decision about further care.
• If the Nurse is not available, the on-call Senior Manager can be contacted for advice.
• If a Nurse is on shift, they will inform the on-call Senior Manager.
• If a doctor is needed staff can contact a local surgery or call 111. Surgery numbers available (depending on time of day) in Nurses Room and St Martin’s medicines room. Students can be seen as temporary residents.
• If the young person needs to be isolated, they should be supported in their bedroom, supported by a staff member.

Overnight medical emergencies

If a young person becomes seriously unwell overnight and you need to call for an ambulance.

• Call 999 requesting an ambulance.
• Contact Senior Manager on-call to inform them of the situation.
• The senior member of staff on duty (Night Nurse) should decide who will escort the young person to hospital. The escort should take their own mobile phone to keep in touch with staff here.
• Take the students hospital information pack which includes their Medication Administration Records (MAR)
• If appropriate, send feed supplement/feed pump (if used).
• When the young person is with the paramedics, or the senior manager arrives parents should be contacted to inform them.

Security procedures

• It is the responsibility of all staff to ensure security within the residential areas.
• Windows have limited opening ability; where this is not the case, windows should remain locked.
• Where possible, the downstairs windows should be locked during the holidays and at the weekend when school is closed.
• It is the responsibility of all staff to ensure all windows are closed and doors locked, prior to going out.
• It is the responsibility of everyone to stop and check anyone seen wandering around St Rose’s grounds. However, staff should not endanger themselves.
• We have external CCTV on site that staff have access to view and should inform the police of this if we report an intruder on site.

After school/college visitors

Quentin House

• Parents/visitors to the Quentin House in the evening must come in via the main entrance to Quentin House
• All visitors must sign the visitor’s book, located in the front hall on arrival and sign out when they leave.
• Visitors must be issued with a visitor information leaflet and a name badge on a yellow lanyard which must be worn at all times during their visit.
• Visitors, with the exception of family and friends, should not be left alone with the young person.
• Access to bedrooms by visitors may be restricted at certain times.
• Visitors should be advised to park in the main car parks.

St Martin’s

• Parents and visitors must report to a member of staff and then sign the visitor’s book, located in the entrance hall on arrival and sign out when they leave.
• Visitors must be issued with a visitor information leaflet and a name badge on a yellow lanyard which must be worn at all times during their visit.
• Visitors, with the exception of family and friends, should not be left alone with the young person.
• Access to bedrooms by families may be restricted at certain times.
• Visitors should be advised to park in the main car park.

Missing persons protocol

If a student goes missing the senior staff on duty must follow the missing persons protocol (Appendix 1)

Procedure for accidents and injuries to the young person

• Staff must be familiar with the St Rose’s policy for accidents or injuries.
• All accidents and injuries to the young person must be reported.
• Depending on the severity of the accident/injury a senior manager should be notified. They will inform the principal as necessary.
• Accidents must be recorded on the CPOMS system. All staff have a CPOMS log in.
• CPOMS entries must be reviewed the by the Care Management Team, Principal or Vice-principal or who will decide if risk assessments or processes need to be amended following the accident.
• The Senior Manager will contact the parents in the event of a serious accident.
• Parents should be informed of any accidents the young person may have.
• A clear report must also be written in the young person’s contact notes. All entries must be dated and signed.
• RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) and Ofsted/CQC regulations will be followed as required.
• The Leadership Team and School and College Management Team review the accident and incident reports at least half-termly.
• The Principal is alerted to all accidents via the CPOMS system and patterns can be reviewed and acted upon.
• All CPOMS accident and incident records are reviewed by the school and college management team. The health and safety lead and will report to the Health and Safety Executive if required.

This Policy Statement is considered part of the Terms and Conditions of Employment for all staff at St Rose’s

Appendix 1

Missing persons protocol for residential students

Main Principles of this protocol

• The safety and welfare of the student is paramount.
• Locating and returning them to a safe environment is the main objective.
• Safeguarding procedures will be initiated whenever there are concerns that a student who is missing may be at risk of significant harm.
• The protocol should be read as guidance as it cannot anticipate every situation.
• Interventions are important in attempting to address repeat missing episodes and must be reflected in any support plan.
• The student’s view will be a crucial consideration in determining the best method of engagement and intervention to prevent further issues occurring.

Preventing missing persons incidents

Staff must remain vigilant at all times and be aware of where vulnerable students are at any given time. Residential students who are prone to wandering, or who may be at risk of getting lost must have this identified within their support plan.

Action taken to avoid false alarms includes the simple precaution of encouraging students, and their relatives and visitors, to inform a member of staff when they are leaving to go on an outing or a walk and to give both a time they expect to return and a contact name and telephone number.

All such arrangements should be entered in the students’ contact notes.

Raising the alarm

Staff should raise the alarm immediately if they suspect that a student might be missing by initially informing the senior on shift.

Procedure in the event of a student being reported as missing.

When it becomes clear that a student is missing it is vital that all the members of staff work as a team and follow a clearly defined procedure. Upon receiving a missing person’s report, the senior on shift should carry out the following procedure.

• Check in the contact notes that the person is not on a prearranged outing, activity or walk. If they are, and are overdue, then the senior should make efforts to contact the person or the place they are visiting.
• Contact the on-call manager to inform them of the missing student.
• Where contact with the student or the person/place they are visiting cannot be made and the judgment of the on-call manager is that they may be at risk, then the police should be contacted. A clear entry must be made in the student’s contact notes.
• Where the student is not on a prearranged outing, activity or walk then the following procedure should be followed.

The on-call manager should carry out the following.

• Alert all staff to the possibility of the student being missing and ask for information/sightings.
• Check who last saw the student and question them about their known plans and movements.
• Where appropriate, carefully question other relevant students about the missing student’s plans and movements.
• Check on-site CCTV for possible sightings.
• Carry out a thorough search of the school, college, and grounds, checking that the student has not become lost or trapped. Knowledge of the student and their usual movements and habits should be employed (i.e staff should search their favourite places and, if they are used to visiting people nearby, then they should be contacted, and staff may be dispatched to tour the vicinity.
• It is important that the on-call manager has a structured plan for their search and does not just send staff off in a haphazard way. At the end of the search the manager must be confident that all areas have been systematically searched.
• For searches in the dark torches are kept in all residential areas, along with a first aid kit and space blanket for treating hypothermia. (Team Leaders are responsible for ensuring torches are charged and first aid kits kept stocked)
• Staff must not put themselves at risk when carrying out the search.
• Sufficient staff should always remain with the other students to ensure their safety.
• Inform parents/carers.

Where the police are involved, the Principal must be informed, as should members of the missing person’s family if they have not already been contacted.

Families should be requested to telephone the nurse phone (24hr) if the missing person contacts them, and parents/carers should be kept informed at each stage of the search.

The on-call manager should, at the earliest opportunity, fill out an entry on CPOMS and make a note of events in the missing student’s contact notes. Times of actions and decisions should be noted as accurately as possible.

Once the student has been found, it is essential that all the parties who were informed that the student was missing are contacted again and informed that the search has been concluded.

If the student has a social worker and they have not already been informed of the incident they should be contacted. If not available, then contact should be made via the duty desk.

Procedure to follow after a missing person incident.

Care staff must record any significant incident/potential further risk in the student’s support plan.

All incidents should be reviewed by the care management team to learn lessons from them and to prevent reoccurrence.

If the person was injured or harmed or was seriously at risk of being harmed because of going missing, the Registered Manager will notify the Care Quality Commission (CQC) (for St Martin’s students), and our Local Authority Safeguarding Board who may wish to investigate further depending on the circumstances.

If we have acted in error or negligently, we must exercise our Duty of Candour (to be open and honest) when we communicate with the parents/carers.

If going missing results in the student’s death, there will be a range of procedures to be followed, which could include a police investigation, Coroner’s Inquest, and a Serious Case Review.

Ofsted must be informed if the outcome is a child’s death.

If a complaint is made against a care staff member as a result of a student going missing, the matter will be investigated through our complaints procedure. The investigation will include any possible misconduct by the care staff responsible.

Staff training and support

All staff and students involved in the missing person alert should be offered a chance to debrief and reflect on the incident.

All staff are fully informed of the missing persons procedure and know their roles in the event of a search.