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CHW50-Supporting Service Users with Learning Disabilities Policy

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Registration Number: {{org_field_registration_no}}

Supporting Service Users with Learning Disabilities Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides high-quality, person-centred support to service users with learning disabilities. This policy outlines our commitment to promoting independence, dignity, and inclusion while ensuring that individuals with learning disabilities receive the appropriate care and support they need to lead fulfilling lives.

This policy aligns with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 as amended, the Social Services and Well-being (Wales) Act 2014, the Equality Act 2010, the Human Rights Act 1998, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, the Welsh Government statutory guidance for care home and domiciliary support providers, the Welsh Government Reducing Restrictive Practices Framework, the Wales Safeguarding Procedures, Social Care Wales codes and safeguarding training standards, and CIW inspection requirements.

2. Scope

This policy applies to all staff, including care workers, nurses, management, and external professionals providing care and support to individuals with learning disabilities at {{org_field_name}}. It ensures that our care home meets the diverse needs of service users, providing equal opportunities, safeguarding, and a holistic approach to care.

3. Principles of Supporting Individuals with Learning Disabilities

{{org_field_name}} is committed to the following key principles:

4. Assessment, Suitability of Service and Personal Planning

Before agreeing to provide care and support, {{org_field_name}} will determine whether the service is suitable to meet the individual’s care and support needs and to support the individual to achieve their personal outcomes. This decision will take account of the individual’s care and support plan, any health or specialist assessments, communication needs, sensory needs, behaviour support needs, mental capacity considerations, risks to the individual’s well-being, risks to others, and any reasonable adjustments required under the Equality Act 2010.

Where the individual does not have a local authority care and support plan, {{org_field_name}} will complete its own assessment before agreeing to provide the service, unless the admission is urgent. The assessment will be completed by a person with the necessary skills, knowledge, competence and training. Where the person has complex learning disability, autism, communication, behavioural, mental health, nursing or sensory needs, specialist advice will be sought where required.

A personal plan will be prepared before the service starts, setting out how the individual’s care and support needs will be met on a day-to-day basis, how they will be supported to achieve their personal outcomes, how identified risks will be reduced, and how positive risk-taking and independence will be promoted. In an emergency admission, the personal plan will be completed within 24 hours of the service commencing.

Within 7 days of the service commencing, {{org_field_name}} will complete a provider assessment and review and update the personal plan as required. The provider assessment and personal plan will be co-produced with the service user, the placing authority where applicable, and any representative or advocate where appropriate.

The personal plan will be reviewed at least every three months, or sooner where the person’s needs, risks, communication, behaviour, health, mental capacity, preferences or personal outcomes change. A record of the personal plan, revised plans, provider assessments and review outcomes will be maintained, and copies will be provided in a format the individual can understand.

5. Communication and Engagement

Accessible Communication Methods

Use of communication tools such as Makaton, visual aids, easy-read materials, and speech-generating devices.

Staff trained to communicate effectively with individuals who have varied communication abilities.

Communication needs will be identified before admission and kept under review. Each service user’s personal plan will record their preferred language, communication method, level of understanding, sensory needs, communication aids, signs, symbols, objects of reference, visual timetables, technology, or support required to make choices and express concerns.

{{org_field_name}} will take reasonable steps to meet the Welsh language needs of service users and will actively offer Welsh language support to individuals whose first or preferred language is Welsh. Information will be provided in an appropriate language, style, presentation and format, including Easy Read, large print, pictorial, audio, translated or symbol-supported formats where required.

Staff will ensure that service users are given the information and support they need to participate in assessments, reviews, day-to-day decisions, complaints, safeguarding matters and decisions about their care and support.

Involvement in Decision-Making

Service users are encouraged to participate in their care planning and express their preferences.

Use of advocates where necessary to ensure their voices are heard.

Advocacy and Supported Decision-Making

Service users will be supported to make their own decisions wherever possible. This includes allowing enough time, using accessible information, involving trusted people where the individual agrees, and using the person’s preferred communication method. Where a service user has substantial difficulty being involved and has no appropriate person to support them, {{org_field_name}} will liaise with the placing authority or relevant professional to support access to independent advocacy. Advocacy information will also be made available for complaints, safeguarding concerns, care reviews, restrictions, best-interest decisions and significant changes to care.

6. Mental Capacity, Consent and Deprivation of Liberty

{{org_field_name}} will work in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Service users will be assumed to have capacity unless it is established that they lack capacity for a specific decision at the specific time the decision needs to be made. Staff will support service users to make decisions by using accessible information, communication aids, additional time, familiar staff and other reasonable support.

Where there is reason to believe that a service user lacks capacity for a specific decision, a decision-specific mental capacity assessment will be completed by an appropriate person. Any best-interest decision will involve the service user as far as possible and will take account of their wishes, feelings, beliefs, values, known preferences, family or representative views, and relevant professional advice.

Any restriction, supervision or control used in the delivery of care must be lawful, necessary, proportionate and the least restrictive option. Where the arrangements may amount to a deprivation of liberty, {{org_field_name}} will ensure that lawful authorisation is sought and maintained. Staff must not deprive a service user of liberty without lawful authority.

Mental capacity assessments, best-interest decisions, DoLS applications, authorisations, conditions and reviews will be clearly recorded and reflected in the service user’s personal plan and risk assessments. Staff will receive training appropriate to their role in the Mental Capacity Act, DoLS, consent, best-interest decision-making and restrictive practice.

7. Daily Living Support

Support with Personal Care

Support with Daily Tasks

Medication Management

Medicines will be ordered, received, stored, administered, recorded, audited, reviewed and disposed of safely in accordance with the Medication Policy and current legislation and guidance. Staff must be trained and assessed as competent before administering medication or supporting a service user with medication.

Service users will be supported to understand and manage their own medication where this is safe and appropriate, including self-medication arrangements recorded in the personal plan and risk assessment.

Covert medication will only be used where the service user lacks capacity to consent to the medication, a best-interest decision has been made, relevant professionals have been involved, and the arrangement is clearly recorded, reviewed and administered in line with current guidance. Medication errors, refusals, omissions, side effects or concerns will be reported, recorded, investigated and acted upon promptly.

Access to Health and Specialist Services

Service users will be supported to access health and allied health services, including GP, dentist, optometrist, audiology, podiatry, speech and language therapy, occupational therapy, physiotherapy, psychology, psychiatry, community learning disability services, epilepsy services, dysphagia support, dietetics and other relevant services.

Where appropriate, service users with learning disabilities will be supported to access annual health checks, health screening, immunisations, medication reviews and reasonable adjustments for healthcare appointments. Outcomes and recommendations from health appointments will be recorded and reflected in the personal plan, risk assessments and staff guidance.

Staff will monitor and respond to changes in physical health, mental health, communication, behaviour, pain, eating and drinking, swallowing, mobility, continence, oral health, skin integrity, sleep and emotional well-being. Concerns will be escalated promptly to the appropriate healthcare professional and, where relevant, the placing authority or representative.

8. Promoting Social Inclusion and Community Engagement

Encouraging Social Interaction

Access to Education and Employment

Social inclusion will be based on the service user’s own goals, interests, relationships, identity and preferred routines. Support may include friendships, family contact, intimate and personal relationships where appropriate, faith or cultural activities, volunteering, education, employment, hobbies, exercise, community facilities, digital inclusion and accessible transport.

Personal plans will identify any support required for safe community access, including communication support, sensory needs, road safety, financial safety, vulnerability to exploitation, hate crime, mate crime, online safety and positive risk-taking. Restrictions on community access must not be applied as blanket rules and must be individually assessed, lawful, proportionate and regularly reviewed.

9. Safeguarding Individuals with Learning Disabilities

{{org_field_name}} will provide care and support in a way that keeps service users safe and protects them from abuse, neglect and improper treatment. This includes physical, sexual, psychological, emotional and financial abuse, discrimination, unlawful restraint, inappropriate deprivation of liberty, neglect, exploitation, mate crime, hate crime, domestic abuse, modern slavery, radicalisation, organisational abuse and any other concern affecting the person’s safety or well-being.

Staff and volunteers must follow the Safeguarding Adults from Abuse and Improper Treatment Policy, Wales Safeguarding Procedures, local safeguarding arrangements and whistleblowing procedures. Staff must take immediate action where there is an allegation, disclosure, evidence or suspicion of abuse, neglect or improper treatment. This includes protecting the person from immediate risk, reporting the concern internally, making appropriate safeguarding referrals, preserving evidence where necessary, recording the concern accurately, and cooperating with safeguarding enquiries.

Safeguarding information will be provided to service users in accessible formats so they understand their right to be safe, how to raise a concern, who they can speak to, and how to access advocacy. Outcomes from safeguarding referrals will be communicated to the service user in a way they can understand, unless this would place them or others at risk.

Safeguarding referrals, outcomes, lessons learned and actions will be monitored by the Registered Manager and Responsible Individual. Themes will be reviewed through audits, supervision, staff meetings and the quality-of-care review to improve practice and prevent recurrence.

Staff will receive safeguarding training at induction and at regular intervals in line with Social Care Wales national safeguarding training, learning and development standards and local safeguarding board requirements.

10. Staff Training, Competence and Development

All staff will receive an induction appropriate to their role and will complete training required by {{org_field_name}}, Social Care Wales, CIW expectations, and the needs of the people living at the service. Staff must be competent to support service users with learning disabilities before working unsupervised.

Training will include, as relevant to role and service user needs: learning disability awareness; autism awareness; person-centred practice; communication methods; Welsh language awareness and the Active Offer; safeguarding; Mental Capacity Act and DoLS; equality, diversity and human rights; positive behaviour support; reducing restrictive practices; medication; epilepsy; dysphagia and choking risk; nutrition and hydration; moving and handling; infection prevention and control; health and safety; fire safety; food safety; oral health; continence; skin integrity; mental health; self-harm and suicide awareness where relevant; record keeping; complaints; whistleblowing; duty of candour; and professional boundaries.

Where a service user has specialist needs, staff will receive additional training, guidance or competency assessment before providing that support. This may include delegated healthcare tasks, specialist communication systems, enteral feeding, diabetes care, rescue medication, epilepsy protocols, sensory support, trauma-informed support, or bespoke behaviour support plans.

Staff will receive supervision at least quarterly, annual appraisal, competency checks where required, and opportunities for ongoing learning and reflective practice. Safeguarding, restrictive practice, incidents, complaints, communication needs, mental capacity and person-centred outcomes will be discussed in supervision where relevant.

11. Partnership Working with Families and External Agencies

Family Involvement

Collaboration with Professionals

Partnership working will include clear communication about roles, responsibilities, agreed actions and timescales. Where recommendations are made by health, social care or specialist professionals, these will be recorded, implemented where appropriate, and reflected in the personal plan.

Where {{org_field_name}} identifies that a service user’s needs have changed, or that the service may no longer be able to meet the person’s assessed needs safely even after reasonable adjustments, the Registered Manager will promptly seek professional advice and notify the service user, representative, commissioner and placing authority where applicable in writing.

12. Positive Behaviour Support and Reducing Restrictive Practices

{{org_field_name}} will not describe service users as “challenging”. Behaviour that may challenge will be understood as communication of distress, unmet need, pain, fear, sensory overload, trauma, frustration, environmental stress, or difficulty understanding or being understood.

Staff will use person-centred positive behaviour support to understand the function of behaviour, reduce triggers, improve quality of life, promote communication, and prevent distress. Behaviour support plans will be based on assessment, involve the service user and relevant people, and include proactive strategies, communication guidance, early warning signs, de-escalation, post-incident support and review arrangements.

Restrictive practices must be avoided wherever possible. They must never be used for staff convenience, punishment, coercion, blanket rules, or because of a diagnosis of learning disability. Any restrictive practice, including physical restraint, environmental restriction, locked doors, lap belts, bedrails, surveillance, chemical restraint, restrictions on contact, restricted access to possessions, communication restrictions, or blanket house rules, must be lawful, necessary, proportionate, the least restrictive option, and clearly justified in the person’s assessment, personal plan and risk assessment.

Control or restraint must only be used where it is necessary to prevent a risk of harm to the individual or another person and where it is a proportionate response to that risk. It must only be carried out by staff trained in the method used. Any incident involving control, restraint or restrictive practice must be recorded within 24 hours, reviewed by the manager, considered in relation to safeguarding and mental capacity, and used to update the person’s support plan where required.

Records of restrictive practice will be monitored for frequency, duration, type, reason, impact, injuries, staff involved, debrief, lessons learned and reduction plans. Themes will be reviewed through governance and quality assurance arrangements.

13. Duty of Candour, Openness and Learning

{{org_field_name}} will act in an open and transparent way with service users, their representatives and, where applicable, placing authorities. Where something goes wrong, staff and managers will be honest, provide appropriate information about the incident, explain what action is being taken, offer an apology where appropriate, and support the person in a way they can understand.

The service will promote a culture where staff can raise concerns, report mistakes, learn from incidents and improve practice without fear of victimisation. Any obstruction of candour, bullying, harassment or victimisation relating to raising concerns will be investigated and addressed.

Incidents, complaints, safeguarding concerns, medication errors, restrictive-practice incidents and other significant events will be reviewed to identify lessons learned, actions required, and whether notifications or referrals are required to CIW, safeguarding bodies, commissioners, professional regulators or other agencies.

14. Complaints, Concerns and Feedback

Service users with learning disabilities will be supported to raise concerns, complaints, compliments and suggestions in ways that are accessible to them. This may include Easy Read forms, symbols, pictures, communication aids, talking mats, advocacy, family or representative support, keyworker support, meetings, observation of non-verbal distress, or other personalised methods.

Staff must recognise that a complaint may be expressed through words, behaviour, withdrawal, distress, refusal, body language or changes in presentation. Any such concern must be taken seriously, recorded and escalated in line with the Complaints Policy.

The complaints process will explain who to contact, how to make a complaint, how the complaint will be investigated, timescales, how the person will be kept informed, and what to do if the person is dissatisfied with the response. Information will include access to advocacy and external routes such as the placing authority, CIW, the Public Services Ombudsman for Wales and Llais where relevant.

A written response will be provided where practicable and in a format the complainant can understand. Service users will not be victimised, disadvantaged or have their care reduced because they have made a complaint. Complaints, concerns and feedback will be analysed to identify themes, learning and service improvements.

15. Compliance, Quality Assurance and Continuous Improvement

{{org_field_name}} will monitor, review and improve the quality and safety of care and support provided to service users with learning disabilities. Audits and quality checks will include, where relevant, personal plans, provider assessments, communication plans, safeguarding records, medication, restrictive practice, behaviour support plans, mental capacity and DoLS records, complaints, incidents, accidents, health appointments, staff training, supervision, staffing levels, infection prevention and control, and service user outcomes.

The views of service users, representatives, advocates, families, staff, commissioners and relevant professionals will be sought in accessible ways and used to improve the service. Feedback from service users with communication difficulties will be gathered using personalised methods, observation, preferred communication tools and involvement of people who know the person well where appropriate.

The Registered Manager and Responsible Individual will review themes, risks, incidents, complaints, safeguarding concerns, restrictive practices, staffing, training and outcomes. Actions will be recorded, allocated, monitored and reviewed for effectiveness.

CIW inspection findings, ratings, notifications, enforcement learning, statutory guidance updates and changes in legislation will be reviewed and used to update this policy and improve practice. Inspection reports and quality findings will be shared with staff and used in team meetings, supervision, training and service improvement planning.

16. Records, Reporting and Notifications

Accurate, timely and factual records will be maintained for each service user. Records will include assessments, personal plans, reviews, communication needs, health appointments, medication, incidents, accidents, safeguarding concerns, complaints, mental capacity assessments, best-interest decisions, DoLS authorisations, restrictive practice, behaviour support, professional advice and outcomes.

Records will be written respectfully and will reflect the person’s voice, choices, outcomes and support needs. Service users and representatives will be supported to access records where appropriate and in line with confidentiality and data protection requirements.

The Registered Manager will ensure that notifiable events are reported to CIW and other relevant bodies in line with regulatory requirements and organisational procedures. This includes safeguarding matters, serious injury, death, outbreaks, events affecting the safe running of the service, and other incidents requiring notification.

17. Related Policies

This policy should be read in conjunction with:

18. Policy Review

This policy will be reviewed at least annually and sooner where there are changes in legislation, Welsh Government statutory guidance, CIW requirements, Social Care Wales guidance, safeguarding procedures, service user needs, the statement of purpose, inspection findings, complaints, safeguarding themes, incidents, restrictive-practice trends, or organisational learning.

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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