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DC103-Live-in and Overnight Care Policy

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Registration Number: {{org_field_registration_no}}

Live-In and Overnight Care Policy

1. Purpose and Commitment

The purpose of this policy is to outline how {{org_field_name}} ensures the efficient, safe, and effective delivery of live-in and overnight care services. Our commitment is to provide high-quality, person-centred care that meets the individual needs of service users while ensuring the well-being and safety of both service users and staff.

This policy aligns with the Health and Social Care Act 2008, the Care Act 2014, the Care Quality Commission (CQC) standards, and the Working Time Regulations 1998. We strive to promote independence, dignity, and respect while delivering continuous care in the comfort of service users’ homes. Our commitment extends to ensuring care workers are supported with the necessary resources, training, and supervision to deliver exceptional care while maintaining their own health and well-being.

2. Scope

This policy applies to all employees involved in the provision of live-in and overnight care, including care staff, administrative staff, and contractors. It covers:

The policy applies across all domiciliary care settings, ensuring consistency in care delivery and adherence to best practices. It covers both short-term and long-term care arrangements, including respite care and palliative support.

3. Policy Statement

{{org_field_name}} is committed to:

We adopt a person-centred approach, ensuring that care is tailored to individual needs and preferences. Our goal is to empower service users to maintain independence while receiving the care they require in a familiar environment.

4. Understanding Live-In and Overnight Care

4.1 Live-In Care

Live-in care is an arrangement in which a care worker resides temporarily in the service user’s home for an agreed period in order to provide planned care and support in accordance with the service user’s assessed needs, preferences, care plan and risk assessments.

Live-in care does not mean that one care worker is expected to provide continuous active care or remain available for work for 24 hours a day. The care arrangement must provide the care worker with appropriate periods when they are free from work and with appropriate daily and weekly rest in accordance with the Working Time Regulations 1998, subject to any lawful exceptions and requirements for compensatory rest.

Before a live-in care arrangement begins, {{org_field_name}} will assess the amount, timing and nature of care required during both the day and the night. The care plan will clearly identify:

Where a service user’s needs cannot safely be met by the staffing arrangements in place, additional staffing or an alternative care arrangement must be implemented. A live-in care worker must not be expected to continue an arrangement that results in unsafe levels of fatigue or insufficient staffing.

4.2 Overnight Care

Overnight care may be provided as a sleeping-night arrangement or a waking-night arrangement, depending on the person’s assessed needs.

Sleeping-night care

In a sleeping-night arrangement, the care worker is provided with suitable sleeping facilities and is normally expected to sleep during the agreed sleep period but is available to respond when required.

The expected frequency, nature and duration of night-time interventions must be established during assessment and recorded in the care plan.

There is no fixed organisational rule that a sleeping-night arrangement may have a particular maximum number of interruptions. Where actual night-time interventions become more frequent, prolonged or materially different from those assessed, the arrangement must be reviewed promptly. Where the worker is routinely required to remain awake or provide substantial care during the night, {{org_field_name}} will consider whether waking-night or additional staffing is required.

Waking-night care

In a waking-night arrangement, the care worker is expected to remain awake and available to provide care and support throughout the agreed night shift.

The worker’s hours, workload, rest arrangements and night-working requirements must comply with the Working Time Regulations 1998 and applicable employment legislation.

4.3 Safe Staffing

{{org_field_name}} will ensure that sufficient numbers of suitably qualified, competent, skilled and experienced staff are deployed to meet each service user’s assessed needs safely.

Staffing arrangements will be reviewed whenever:

No service user’s care package will depend upon a worker routinely foregoing the rest necessary to perform their duties safely.

5. Care Planning, Risk Assessment, Consent and Capacity

5.1 Initial Assessment

Before live-in or overnight care begins, {{org_field_name}} will complete a comprehensive assessment of the service user’s needs.

The assessment will include, where relevant:

The service user will be involved in planning their care to the fullest extent possible. Where appropriate and lawful, people chosen by the service user and relevant health and social care professionals will also be involved.

5.2 Personalised Care Plan

A personalised care plan will be developed from the assessment and will clearly describe how the service user’s assessed needs are to be met.

The care plan will include, where applicable:

Care plans must be kept accurate, current and accessible to staff who require the information to provide care safely.

Care plans will be reviewed at appropriate intervals and whenever there is a significant change in the person’s needs, circumstances, preferences, risks or ability to make relevant decisions.

5.3 Risk Assessment

Risk assessments will be completed and kept under review in relation to risks relevant to each person’s care, including where applicable:

Risk management must balance safety with the person’s rights, independence, preferences and choices. Risk assessments must not be used to impose unnecessary restrictions.

Where a risk changes or increases, staff must report this promptly and appropriate action must be taken without waiting for the next scheduled review.

5.4 Consent

Care and treatment must only be provided with the consent of the relevant person unless there is another lawful basis for providing it.

Staff must:

Consent must never be obtained through coercion, undue pressure or inappropriate restriction.

5.5 Mental Capacity

Where there is reason to doubt a person’s capacity to make a particular decision at the time the decision must be made, {{org_field_name}} will act in accordance with the Mental Capacity Act 2005 and its Code of Practice.

The following statutory principles must be applied:

Capacity assessments must be decision-specific and time-specific.

Where a person lacks capacity for a particular decision, any best-interests decision must be made in accordance with the Mental Capacity Act 2005. Appropriate consultation must take place with people involved in the person’s welfare and with any attorney or Court of Protection deputy who has lawful authority in relation to the relevant decision.

The existence and scope of any Lasting Power of Attorney, deputyship or other lawful decision-making authority must be verified and recorded before relying upon it.

6. Roles and Responsibilities

6.1 Care Staff Responsibilities

Care staff providing live-in and overnight care must:

6.2 Manager Responsibilities

Managers are responsible for:

6.3 Service User and Family

Responsibilities Service users and families are encouraged to:

7. Staff Training and Competency

7.1 Induction and Role-Specific Training

All staff must receive induction, training, supervision and support appropriate to their role and responsibilities.

Before undertaking care tasks without appropriate supervision, staff must have the knowledge, skills and competence necessary to perform those tasks safely.

Training will include, where relevant to the person’s role:

7.2 Mandatory Learning Disability and Autism Training

In accordance with section 20 of the Health and Social Care Act 2008, as amended by the Health and Care Act 2022, {{org_field_name}} will ensure that every person working for the purpose of the regulated activities receives training on learning disability and autism that is appropriate to their role.

This requirement applies across the service and is not limited to staff working specifically with people who have a learning disability or autistic people.

Training must comply with the applicable statutory requirements and the current Oliver McGowan Code of Practice on statutory learning disability and autism training.

{{org_field_name}} will determine the level and content of training required according to each person’s role, responsibilities and contact with people who use services.

Staff must also receive appropriate supervision to ensure that they demonstrate and maintain competence in understanding and responding appropriately to the needs of autistic people and people with a learning disability.

Completion of training and evidence of competence must be recorded.

7.3 Specialist Tasks

Staff must not undertake specialist or delegated healthcare tasks unless they have:

This includes, where applicable, catheter care, enteral feeding, delegated healthcare procedures and other specialist interventions.

7.4 Competency Assessment

Competence will be assessed at induction, following relevant training and thereafter at appropriate intervals or when concerns arise.

Competency assessments will include, where relevant:

Where a worker has not demonstrated competence, they must not undertake the relevant task unsupervised until competence has been established.

7.5 Supervision, Appraisal and Refresher Training

Staff will receive appropriate supervision and appraisal and will be provided with refresher or additional training when required.

Additional training or competency assessment must be arranged where:

8. Working Hours, Rest, Night Work and Staff Well-Being

8.1 General Principles

{{org_field_name}} will organise live-in and overnight care arrangements so that working hours do not expose service users or workers to avoidable risks arising from fatigue.

Working-time arrangements will comply with the Working Time Regulations 1998 and any other applicable employment legislation.

Staffing arrangements will not rely upon a worker routinely foregoing the rest necessary to perform their duties safely.

8.2 Maximum Weekly Working Time

Unless a lawful exception or valid individual opt-out applies, a worker’s average working time must not exceed the statutory maximum average of 48 hours per week calculated over the applicable reference period.

Any opt-out from the 48-hour average weekly limit must be voluntary and documented in accordance with the Working Time Regulations 1998.

Workers must not be subjected to detriment because they decline to agree to an opt-out.

Working hours will continue to be monitored even where an opt-out exists so that excessive hours do not compromise the health and safety of the worker or the safety and quality of care.

8.3 Daily and Weekly Rest

Workers will normally receive at least 11 consecutive hours’ rest in each 24-hour period and the applicable statutory weekly rest.

Where a statutory exception applies and normal rest cannot be provided, equivalent compensatory rest will be provided where required by the Working Time Regulations 1998.

Managers must consider the cumulative effect of live-in periods, sleeping-night work, waking-night work, additional shifts, overtime and other known employment when assessing fatigue and working-time risks.

8.4 Rest Breaks During Work

A worker whose working day exceeds six hours will normally be entitled to an uninterrupted rest break of at least 20 minutes.

Where a statutory exception applies and the normal rest break cannot be taken, appropriate compensatory rest must be provided where required.

A break must be a genuine opportunity to rest. A period during which the worker remains required to perform duties must not be recorded as an uninterrupted rest break.

8.5 Sleeping-Night Arrangements

Where a worker is expected to sleep during a sleeping-night arrangement, suitable sleeping facilities must be available.

Any period during which the worker is required to wake and perform duties must be recorded accurately.

There is no fixed maximum number of permitted interruptions that determines whether an arrangement remains safe. Managers must monitor the frequency and duration of interruptions and their effect on the worker’s ability to obtain adequate rest.

Where night-time interventions become frequent, prolonged or predictable to the extent that the existing sleeping-night arrangement no longer safely meets the person’s needs or permits adequate worker rest, the care arrangement must be reassessed. This may require waking-night support, additional staff or other changes to the care package.

8.6 Waking-Night Arrangements

Workers undertaking waking-night duties are expected to remain awake and available throughout their shift.

Where a worker meets the statutory definition of a night worker, {{org_field_name}} will comply with the applicable statutory limits on night work.

Night workers must not normally work more than an average of eight hours in each 24-hour period, calculated over the applicable reference period. Where night work involves special hazards or heavy physical or mental strain, the specific statutory restrictions applying to such work must be observed.

8.7 Night-Worker Health Assessments

Workers who undertake night work will be offered the health assessments required by the Working Time Regulations 1998.

Where a health assessment identifies health problems connected with night work, appropriate action will be considered in accordance with the Regulations and occupational-health advice.

8.8 Records

{{org_field_name}} will maintain the records necessary to demonstrate compliance with applicable working-time and night-work requirements.

Actual working arrangements, including significant night-time interruptions, must be reported and recorded accurately.

8.9 Fatigue and Well-Being

Workers must report when fatigue, repeated sleep interruption, excessive hours or workload may affect their ability to provide safe care.

Managers will respond promptly by reviewing:

No worker will be expected to continue providing care where fatigue creates an unacceptable risk to the service user, the worker or another person.

9. Safeguarding and Emergency Procedures

9.1 Safeguarding Responsibilities

{{org_field_name}} has a zero-tolerance approach to abuse, neglect and improper treatment.

All staff must remain alert to possible abuse, neglect, exploitation or improper treatment, including:

Any safeguarding concern, disclosure, allegation or witnessed abuse must be taken seriously and acted upon without avoidable delay.

9.2 Immediate Action

Where a safeguarding concern arises, staff must:

9.3 External Safeguarding Referrals

Safeguarding concerns must be referred to the relevant local authority safeguarding service where the applicable safeguarding criteria are met.

The registered manager or delegated responsible person must ensure that referrals are made without avoidable delay and that appropriate co-operation is provided to the local authority, police, CQC and other relevant agencies.

A staff member who believes that a safeguarding concern has not been acted upon appropriately may escalate the matter directly through safeguarding or whistleblowing arrangements.

9.4 CQC Notification

Where an incident constitutes abuse or an allegation of abuse, or otherwise meets the requirements for a statutory notification, the registered person must ensure that the Care Quality Commission is notified in accordance with the Care Quality Commission (Registration) Regulations 2009.

Internal reporting does not replace the requirement to make a statutory external notification.

9.5 Emergency Response

In an emergency, staff must:

Following an emergency, the care plan and relevant risk assessments must be reviewed where the incident indicates that needs or risks have changed.

10. Infection Prevention and Control

10.1 General Requirements

{{org_field_name}} will maintain effective systems for preventing, detecting and controlling the risk of infection in accordance with applicable legislation, the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and current national adult social care infection prevention and control guidance.

Staff must apply standard infection prevention and control precautions appropriate to the care being provided.

10.2 Hand Hygiene

Staff must perform effective hand hygiene at the appropriate times, including before and after direct care and after exposure or potential exposure to blood, body fluids, secretions, excretions or contaminated items.

Where suitable handwashing facilities are not immediately available, staff must follow current infection prevention and control guidance regarding appropriate alternatives.

10.3 Personal Protective Equipment

The use of personal protective equipment must be based on an assessment of the task, anticipated exposure and risk of transmission.

Staff must:

PPE must not be used as a substitute for effective hand hygiene or other infection-control measures.

10.4 Equipment, Environment, Laundry and Waste

Staff must:

10.5 Suspected or Confirmed Infection

Where a service user has symptoms of, or has been diagnosed with, an infectious disease, staff must:

Restrictions must not be imposed automatically. Any additional precautions or restrictions must be proportionate to the assessed infection risk and consistent with current public-health guidance.

10.6 Staff Illness and Exposure

Staff must report relevant symptoms, infectious illness or significant occupational exposure in accordance with {{org_field_name}}’s infection-control and sickness-reporting procedures.

Following an occupational exposure, including a sharps injury or exposure to blood or body fluids, immediate first aid, medical advice, reporting and follow-up must be undertaken in accordance with applicable guidance.

11. Record-Keeping, Incident Reporting, Statutory Notifications and Duty of Candour

11.1 Care Records

Staff must maintain an accurate, complete, legible and contemporaneous record of the care and treatment provided to each service user.

Records must include, where relevant:

Records must be completed without undue delay.

11.2 Security and Confidentiality of Records

All records, whether paper or electronic, must be stored securely and protected against unauthorised access, alteration, loss, destruction or disclosure.

Access must be limited to people who are authorised and have a legitimate need to access the information.

Records must be handled in accordance with applicable data-protection and confidentiality requirements.

11.3 Incident and Accident Reporting

Staff must report and document incidents, accidents, near misses and concerns without avoidable delay.

This includes, where applicable:

Immediate action must be taken to protect the service user and other people from continuing or further harm.

Incidents must be reviewed to identify required changes to care plans, risk assessments, staffing arrangements, training or organisational systems.

11.4 Statutory Notifications to the Care Quality Commission

The registered person must ensure that the Care Quality Commission is notified of events and incidents for which notification is required under the Care Quality Commission (Registration) Regulations 2009.

Notifications must be made within the statutory timescale and using the method required by CQC.

Events requiring consideration for notification include, but are not limited to:

The registered manager must ensure that there is a clear system for identifying notifiable events and confirming that required notifications have been submitted.

Delegating the administrative task of submitting a notification does not remove the registered person’s responsibility for ensuring compliance.

11.5 Duty of Candour

{{org_field_name}} will act in an open and transparent manner with service users and relevant persons in relation to care and treatment.

Where an incident meets the statutory definition of a notifiable safety incident under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, {{org_field_name}} will, as soon as reasonably practicable:

Where the relevant person cannot be contacted or declines to speak with the provider, attempts to contact or communicate with them must be recorded as required by Regulation 20.

The duty of candour process is separate from, and does not replace, any requirement to report an incident internally, make a safeguarding referral or submit a statutory notification to CQC.

12. Communication and Collaboration

12.1 Internal Communication

Effective communication ensures continuity of care. This includes:

12.2 Collaboration with Healthcare Professionals

We work closely with healthcare providers, including GPs, district nurses, and therapists, to ensure holistic care. This includes:

13. Monitoring and Quality Assurance

13.1 Regular Audits

We conduct regular audits to assess:

13.2 Feedback and Continuous Improvement

Service user and staff feedback informs continuous improvement. This includes:

14. Complaints and Conflict Resolution

14.1 Complaint Procedure

We encourage open communication and address complaints promptly. This includes:

14.2 Conflict Resolution

If conflicts arise between staff and service users, we:

15. Compliance and Policy Review

15.1 Legal and Regulatory Framework

This policy must be implemented in accordance with applicable legislation and regulatory requirements in England, including:

The service will have regard to applicable CQC statutory guidance and relevant statutory codes of practice when determining how regulatory requirements will be met.

15.2 Relevant CQC Fundamental Standards

In relation to live-in and overnight care, particular regard will be given to the requirements concerning:

Compliance with this policy does not replace the requirement to comply with any other applicable organisational policy, statutory obligation or condition of CQC registration.

15.3 Policy Review

This policy will be reviewed at least annually and sooner where necessary following:

Changes affecting staff responsibilities will be communicated to relevant staff and additional training or competency assessment will be provided where necessary.

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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