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Registration Number: {{org_field_registration_no}}

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Supporting Service Users with Learning Disabilities Policy

1. Purpose

At {{org_field_name}}, we are committed to delivering high-quality, person-centred care to individuals with learning disabilities. Our approach ensures that people receiving support are treated with dignity and respect, empowered to make choices, and provided with opportunities to develop skills for independent living while being safeguarded from harm.

This policy supports compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (Registration) Regulations 2009, CQC Fundamental Standards, CQC’s current assessment framework and quality statements, the Care Act 2014, the Mental Capacity Act 2005, the Human Rights Act 1998, the Equality Act 2010, the Autism Act 2009 and the Health and Care Act 2022 requirement for role-appropriate learning disability and autism training.

This policy must be read alongside CQC’s statutory guidance Right Support, Right Care, Right Culture, which requires services for people with a learning disability and autistic people to maximise choice, control and independence; provide person-centred care that promotes dignity, privacy and human rights; and maintain a culture where leaders and staff enable people to live confident, inclusive and empowered lives.

2. Scope

This policy applies to all staff, including permanent, temporary, agency, and volunteer workers who provide support to individuals with learning disabilities in our Supported Living services. It applies across all service settings, including accommodation-based support, community engagement, and day-to-day activities.

For supported living services, this policy applies where {{org_field_name}} provides regulated activity, including personal care, to people living in their own homes or tenancies. Staff must respect that the person’s accommodation is their home and must not use tenancy, housing, staffing or support arrangements to restrict rights, choice, visitors, relationships, community access or day-to-day autonomy unless this is lawful, necessary, proportionate, documented and reviewed.

3. Related Policies

• SL07 – Person-Centred Care Policy
• SL08 – Dignity and Respect Policy
• SL09 – Consent to Care Policy
• SL39 – Mental Capacity and Deprivation of Liberty Safeguards Policy
• SL13 – Safeguarding Adults from Abuse and Improper Treatment Policy
• SL34 – Confidentiality and Data Protection (GDPR) Policy
• SL21 – Medication Management and Administration Policy
• SL42 – Communication and Engagement with Service Users and Families Policy
• Positive Behaviour Support and Restrictive Practice Policy
• Complaints, Compliments and Feedback Policy
• Duty of Candour Policy
• CQC Notifications Policy
• Equality, Diversity and Human Rights Policy
• Staff Supervision, Training and Competency Policy
• Accessible Information Standard Policy
• Infection Prevention and Control Policy
• Risk Assessment and Risk Management Policy
• Tenancy and Supported Living Boundaries Policy
• Whistleblowing Policy

4. Principles of Supporting Individuals with Learning Disabilities

4.1 Right Support, Right Care, Right Culture

{{org_field_name}} will deliver support in line with CQC’s statutory guidance Right Support, Right Care, Right Culture. This means:

• Right Support: Support will maximise each person’s choice, control and independence. People will be supported to live in ordinary homes, access ordinary community opportunities, maintain relationships and develop skills in a way that reflects their own preferences, communication, culture and aspirations.
• Right Care: Care and support will be person-centred and will promote dignity, privacy, equality, human rights, safety and wellbeing. Staff must understand the person’s needs, preferred communication, sensory needs, health needs, risks, strengths and goals.
• Right Culture: Leaders and staff will promote values, attitudes and behaviours that enable people to live confident, inclusive and empowered lives. The service will actively challenge low expectations, institutional practice, closed cultures, blanket restrictions and decisions made for organisational convenience rather than the person’s rights and preferences.

The service will be able to evidence to CQC how support arrangements meet the needs of people with a learning disability, including through care plans, risk assessments, communication plans, staff training records, supervision, quality audits, feedback from people and families, and examples of positive outcomes.

4.2 Person-Centred Care

• Support is tailored to the needs, abilities, and preferences of each individual.
• We actively involve individuals in designing and reviewing their own care plans.
• Individuals are supported to communicate their needs and wishes, using accessible formats such as Easy Read, pictures, or assistive technology where needed.
• Staff must ensure that the voice of the individual is at the centre of decision-making processes.
• Care and support plans must record the person’s preferred name, communication needs, sensory needs, routines, strengths, wishes, cultural and spiritual needs, relationships, health needs, risks, goals and what a good day and bad day look like for them.
• Plans must be written in a way that is meaningful to the person and, where appropriate, supported by Easy Read, pictures, objects of reference, communication passports, technology or other personalised communication tools.
• Reviews must focus on outcomes, not only tasks. Staff must evidence how support is helping the person to achieve greater choice, control, independence, inclusion, health, safety and wellbeing.

4.3 Promoting Independence

• Individuals are encouraged to develop daily living skills, such as cooking, budgeting, and self-care.
• Support must be progressive, helping individuals to work towards greater independence where possible.
• We provide access to education, training, and employment opportunities tailored to the person’s ability and aspirations.
• Staff must foster an environment where individuals feel confident to try new activities and build social connections.
• Staff must not do things for people that they can do for themselves with appropriate support, time, encouragement, equipment or reasonable adjustments.
• People must be supported to understand and exercise their rights as tenants or occupants, including privacy, visitors, relationships, choice over routines and involvement in decisions about their home.
• Any restriction on ordinary day-to-day choice must be based on an individual risk assessment, lawful decision-making and the least restrictive option. Blanket restrictions must not be used.

4.4 Communication and Engagement

• Staff must use appropriate communication methods, including Makaton, British Sign Language (BSL), and pictorial aids.
• Training in active listening skills is provided to staff to ensure effective and respectful communication.
• Regular care review meetings include individuals, their families, and advocates where appropriate.
• Staff must promote inclusive decision-making, ensuring people have the information they need to make informed choices.
• Each person must have a communication profile or communication passport where this is required. This must describe how the person communicates, how they show pain, distress, anxiety, refusal, consent, enjoyment and choice, and how staff must adapt their communication.
• Information about care, support, complaints, safeguarding, medicines, health appointments and choices must be provided in a format the person can understand wherever practicable, including Easy Read, pictures, symbols, large print, audio, video, objects of reference, translated information or support from an interpreter, advocate or family member where appropriate.
• Staff must not assume that a person lacks capacity or is refusing support because they communicate differently. Staff must adapt their approach and give the person enough time and support to understand, decide and respond.

4.5 Health and Well-Being

• We work closely with health professionals to support individuals with learning disabilities in accessing primary and specialist healthcare services.
• Annual health checks are facilitated to promote early detection of medical conditions.
• We ensure individuals receive reasonable adjustments when accessing healthcare services, in line with the Equality Act 2010.
• Individuals are supported to make informed choices regarding healthy eating, exercise, and lifestyle habits.
• People with a learning disability will be supported to access annual health checks, health action plans, screening appointments, dental care, eye care, hearing checks, immunisations and specialist health services where needed.
• Where appropriate, staff will support the person to maintain a hospital passport or health passport that explains their communication needs, reasonable adjustments, health conditions, medicines, sensory needs, pain indicators, risks and how best to support them during appointments or hospital admission.
• Staff must escalate concerns promptly where there is a change in presentation, behaviour, communication, eating, drinking, mobility, sleep, continence, pain, mental health or physical health. Changes must not be dismissed as “just the person’s learning disability”.
• Where a person with a learning disability dies, the service will cooperate with any statutory notifications, safeguarding enquiries, coroner processes, commissioner requests and LeDeR-related review processes, as applicable.

4.6 Positive Behaviour Support, Distress and Restrictive Practice

{{org_field_name}} recognises that behaviour described as challenging is often a form of communication and may indicate unmet need, pain, distress, anxiety, trauma, sensory overload, environmental factors, communication barriers or unsuitable support. Staff must seek to understand the reason for distress rather than only managing the behaviour.

• People who require support with behaviours of concern must have an individualised Positive Behaviour Support plan, developed with the person and, where appropriate, their family, advocate, commissioner and relevant professionals.
• Behaviour support plans must focus on prevention, communication, environmental adaptation, sensory needs, skill development, emotional regulation, de-escalation and quality of life.
• Staff must use the least restrictive option and must not use punitive, degrading, abusive, blanket or convenience-based restrictions.
• Any restrictive practice, including physical intervention, environmental restriction, locked doors, restrictions on food, money, technology, visitors, movement or community access, must be lawful, necessary, proportionate, time-limited, individually risk assessed, recorded, reviewed and authorised through the correct legal process where required.
• Physical intervention must only be used as a last resort to prevent harm, by staff trained and assessed as competent, and must be recorded, reported, reviewed and used to inform learning and reduction plans.
• The service will monitor incidents, restraint, restrictions, safeguarding concerns, injuries, medication used for behaviour, complaints and staff practice to identify patterns and reduce restrictive practice.
• Where psychotropic medication is prescribed for behaviour, staff must support regular multidisciplinary review in line with STOMP principles, ensuring medication is used for the right reason, at the right dose, for the shortest appropriate time and alongside non-medication support. Medication must never be used as a substitute for skilled support, staffing, communication, healthcare assessment or environmental change.

4.7 Safeguarding from Abuse and Neglect

• People with learning disabilities may be at greater risk of abuse. Staff must be trained to recognise signs of financial, emotional, physical, and institutional abuse.
• All concerns must be reported following the Safeguarding Adults from Abuse and Improper Treatment Policy (SL13).
• We actively promote a zero-tolerance approach to abuse and poor care practices.
• Where individuals are unable to communicate abuse, advocacy and alternative communication methods must be used to ensure concerns are identified.
• Staff and managers must be alert to closed cultures, institutional practice, poor staff attitudes, restrictive routines, disrespectful language, unexplained injuries, repeated incidents, isolation, people appearing withdrawn or fearful, lack of community access, over-reliance on restraint or medication, and people not being listened to.
• Any concern about abuse, neglect, discriminatory abuse, organisational abuse, closed culture, professional abuse or a breach of human rights must be reported immediately in line with the Safeguarding Adults from Abuse and Improper Treatment Policy and whistleblowing procedures.
• Managers must ensure safeguarding concerns are referred to the local authority safeguarding team, CQC, commissioners, police or other relevant bodies where required.

4.8 Supporting Decision-Making and Capacity

• Staff must follow the Mental Capacity Act 2005 to ensure that individuals are supported to make their own decisions wherever possible.
• Where capacity is in doubt, a decision-specific mental capacity assessment must be completed.
• If an individual lacks capacity for a particular decision, it must be made in their best interests, involving family, advocates, and professionals as necessary.
• In supported living, staff must recognise that DoLS authorisations do not generally apply to a person’s own home or supported living tenancy. Where support arrangements may amount to a deprivation of liberty, this must be escalated to the Registered Manager, commissioner and local authority so that legal advice and, where required, authorisation from the Court of Protection can be sought. Any restriction must be necessary, proportionate, the least restrictive option, in the person’s best interests where they lack capacity for the specific decision, and kept under regular review.
• Capacity must never be assessed globally. It must be assessed for the specific decision, at the specific time, after the person has been given all practicable support to decide.
• Staff must presume capacity unless there is evidence to the contrary and must not treat a person as unable to decide merely because they make a decision others consider unwise.
• Best interests decisions must involve the person as far as possible and must consider their wishes, feelings, beliefs, values, history, communication, relationships and less restrictive alternatives.
• Where the person has no appropriate family or friend to consult and the decision meets the criteria for advocacy, an Independent Mental Capacity Advocate or other relevant advocate must be considered.

4.9 Community Inclusion and Social Engagement

• We support individuals to engage in community activities, hobbies, and leisure pursuits.
• Individuals should be encouraged to form relationships, access public services, and participate in social events.
• Where individuals face barriers to participation, reasonable adjustments must be made to facilitate inclusion.
• Staff must promote social confidence, ensuring individuals feel safe and valued in their community.
• People must be supported to develop and maintain friendships, family relationships, intimate relationships and community networks, subject to individual consent, capacity, safeguarding and risk assessment.
• Staff must support people to access digital technology, social media and online communities safely, without imposing blanket bans. Any restrictions must be individually assessed, lawful, proportionate and reviewed.
• Community participation must be based on the person’s own interests and identity, not only group activities arranged for service convenience.

4.10 Supporting Families and Carers

• Families and carers are recognised as partners in care and are encouraged to be involved in care planning (with consent).
• Regular meetings and communication with families provide updates on well-being and progress.
• Where family relationships need mediation or support, we will provide access to family liaison workers or external services.
• Involvement of families and carers must be based on the person’s consent where they have capacity to decide. Where the person lacks capacity, involvement must be considered as part of a best interests approach and must be balanced with confidentiality, safeguarding, known wishes and the person’s human rights.
• Staff must record who the person wants involved, what information may be shared, any restrictions on sharing information, and how the person wishes family or carers to be contacted.

4.11 Advocacy, Complaints and Speaking Up

People with a learning disability must be supported to understand their rights, raise concerns, make complaints and access advocacy.

• Information about complaints, safeguarding and advocacy must be available in accessible formats.
• Staff must recognise non-verbal signs of dissatisfaction, distress or concern and must treat these as feedback requiring action.
• People must not experience retaliation, reduced support, intimidation or disadvantage because they complain, challenge decisions or express dissatisfaction.
• Where appropriate, the service will support access to Care Act advocacy, Independent Mental Capacity Advocacy, Independent Mental Health Advocacy, local advocacy services or other specialist support.
• Complaints and concerns must be recorded, investigated, responded to and used to improve the service.

4.12 Equality, Human Rights and Reasonable Adjustments

{{org_field_name}} will uphold the rights of people with a learning disability under the Equality Act 2010 and Human Rights Act 1998. Staff must promote equality, dignity, privacy, family life, liberty, safety, freedom from degrading treatment, and freedom from discrimination.

• Reasonable adjustments must be identified, recorded, implemented and reviewed.
• Staff must challenge discrimination, diagnostic overshadowing, hate crime, bullying, harassment and exclusion.
• Support must reflect the person’s age, disability, race, religion or belief, sex, sexual orientation, gender reassignment, pregnancy or maternity, marriage or civil partnership status, culture, language and identity.
• Any restriction affecting a person’s rights must be lawful, necessary, proportionate, individually assessed, documented and reviewed.

4.13 Supported Living, Tenancy Rights and Separation of Housing and Care

In supported living, people must be supported to exercise rights associated with their own home and tenancy. Care and support must not be delivered in a way that treats the person’s home as an institutional setting.

• Staff must knock before entering bedrooms or private spaces and must respect privacy and possessions.
• People must be supported to choose their routines, meals, visitors, activities, relationships and how they spend their time.
• Staff must not impose house rules for staff convenience. Any shared living arrangements must respect each person’s rights and tenancy.
• The service must not use threats about tenancy, housing or withdrawal of support to control behaviour.
• Where housing-related concerns arise, the provider must work appropriately with the landlord, commissioner, advocate and local authority while respecting confidentiality, consent, tenancy rights and safeguarding duties.

5. Legal and Regulatory Framework

This policy is underpinned by the following legislation, regulations and guidance:

• Health and Social Care Act 2008
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Care Quality Commission (Registration) Regulations 2009
• CQC Fundamental Standards
• CQC assessment framework and quality statements
• CQC statutory guidance: Right Support, Right Care, Right Culture
• Health and Care Act 2022
• Oliver McGowan Code of Practice on statutory learning disability and autism training
• Care Act 2014
• Mental Capacity Act 2005 and Mental Capacity Act Code of Practice
• Human Rights Act 1998
• Equality Act 2010
• Autism Act 2009 and statutory autism guidance
• Data Protection Act 2018 and UK GDPR
• Safeguarding Adults principles and local safeguarding adults board procedures
• NICE guidance relevant to learning disability, autism, behaviour that challenges, mental health, medicines and community support.

Staff must follow the most current version of applicable legislation, statutory guidance, CQC guidance, NICE guidance, local safeguarding procedures and commissioner requirements.

6. Definitions

Learning disability means a significantly reduced ability to understand new or complex information, to learn new skills, and a reduced ability to cope independently, which started before adulthood and has a lasting effect on development.

Autism is a lifelong developmental difference that affects how a person communicates, interacts with others and experiences the world. Some autistic people also have a learning disability, but autism and learning disability are not the same.

Behaviour of concern means behaviour that may indicate distress, unmet need, communication difficulty, pain, trauma, environmental stress or risk. Staff must seek to understand the cause and function of the behaviour.

Restrictive practice means any practice that limits a person’s movement, liberty, choices, contact with others, access to possessions, access to activities or ordinary rights. Restrictive practice may include physical restraint, chemical restraint, mechanical restraint, environmental restraint, seclusion, constant supervision, locked doors, restrictions on money, food, internet, relationships or community access.

Reasonable adjustments are changes to communication, environment, practice, information or support that reduce barriers for disabled people and enable equal access to care, support and services.

7. Staff Training, Competence and Supervision

{{org_field_name}} will ensure staff are trained, supervised and assessed as competent to support people with a learning disability safely, respectfully and effectively.

• All staff, including permanent, temporary, agency, bank, volunteers and ancillary staff who may have contact with people using the service, must receive learning disability and autism training that is appropriate to their role.
• Training must include how to interact appropriately with people with a learning disability and autistic people, communication, reasonable adjustments, human rights, person-centred support, safeguarding, Mental Capacity Act, equality, health inequalities, distress and behaviour as communication.
• The service will follow the Oliver McGowan Code of Practice on statutory learning disability and autism training and will use the Oliver McGowan Mandatory Training as the preferred and recommended training package where appropriate to the role.
• Staff competence must be checked through induction, observation, supervision, appraisal, competency assessment, reflective practice, feedback from people using the service and review of incidents or concerns.
• Staff supporting people with behaviours of concern must receive appropriate training in Positive Behaviour Support, de-escalation, trauma-informed practice, communication, sensory needs and restrictive practice reduction.
• Staff administering or supporting with medicines must be trained and assessed as competent in line with the Medication Management and Administration Policy.
• The Registered Manager must maintain a training matrix showing completion, renewal dates, role-specific requirements, competency checks and actions where training or competence is not up to date.
• Agency and temporary staff must receive an appropriate service induction and person-specific guidance before supporting people.

8. Monitoring, Quality Assurance and CQC Evidence

{{org_field_name}} will monitor the quality and safety of support for people with a learning disability through audits, observation, feedback, care plan reviews, incident analysis, safeguarding monitoring, supervision and governance meetings.

Quality assurance will include review of:

• care and support plans, communication plans, health action plans, risk assessments and mental capacity records;
• evidence that support reflects Right Support, Right Care, Right Culture;
• outcomes for people, including choice, control, independence, relationships, community access, health and wellbeing;
• incidents, accidents, safeguarding concerns, complaints, restrictions, restraint, medicines used for behaviour and patterns of distress;
• staff training, supervision, competency and values-based practice;
• feedback from people using the service, families, advocates, staff, commissioners and professionals;
• evidence against CQC’s five key questions and quality statements: safe, effective, caring, responsive and well-led.

Where audits or feedback identify shortfalls, the Registered Manager must ensure that an action plan is developed, implemented, monitored and reviewed. Learning must be shared with staff and used to improve practice.

8.1 CQC Notifications, Duty of Candour and External Reporting

The Registered Manager must ensure that statutory notifications are submitted to CQC where required under the Care Quality Commission (Registration) Regulations 2009, including relevant deaths, serious injuries, abuse or allegations of abuse, incidents reported to or investigated by the police, events that stop or may stop the service from operating safely, and other notifiable incidents.

Where a notifiable safety incident occurs, {{org_field_name}} will follow the Duty of Candour Policy. This includes acting in an open and transparent way, informing the relevant person, providing a truthful account of what is known, offering an apology, explaining what further enquiries will take place and keeping records of actions taken.

Safeguarding referrals, commissioner notifications, police referrals, RIDDOR reports, medication incident reporting, LeDeR-related information and other external reporting must be completed where applicable.

8.2 Evidence of Good Practice

The service will maintain evidence that demonstrates safe, effective, caring, responsive and well-led support for people with a learning disability. Evidence may include:

• person-centred care plans and accessible versions;
• communication passports and hospital passports;
• annual health check and health action plan records;
• mental capacity assessments and best interests records;
• Court of Protection escalation records where supported living restrictions may amount to deprivation of liberty;
• Positive Behaviour Support plans and restrictive practice reduction plans;
• incident analysis and lessons learned;
• medication reviews, including psychotropic medication review where relevant;
• safeguarding referrals and outcomes;
• complaints and compliments;
• feedback from people, families, advocates and professionals;
• staff training records, including Oliver McGowan training;
• supervision, competency checks and observations of practice;
• quality audits and action plans;
• evidence of community inclusion, relationships, independence and improved outcomes.

9. Confidentiality and Data Protection

• Personal records of individuals must be stored securely and accessed only by authorised personnel.
• All data handling must comply with the Confidentiality and Data Protection (GDPR) Policy (SL34).
• Individuals have the right to access their own information and to decide who it is shared with.
• Where required, people must be supported to understand information about them in an accessible format.
• Information may be shared without consent where there is a lawful basis, including safeguarding, serious risk, legal obligation, vital interests or regulatory requirements. Any sharing must be necessary, proportionate and recorded.
• Staff must record information respectfully, factually and without discriminatory, judgemental or institutional language.

10. Policy Review

This policy will be reviewed at least annually or sooner where there are changes to legislation, statutory guidance, CQC requirements, Right Support Right Care Right Culture guidance, the Oliver McGowan Code of Practice, safeguarding learning, serious incidents, complaints, commissioner feedback, CQC inspection findings, audit outcomes or changes in best practice. The Registered Manager is responsible for ensuring that staff are informed of changes and that practice is updated accordingly.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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