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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Stroke Awareness, Prevention, and Care Policy

1. Purpose

The purpose of this policy is to establish a structured and effective approach to stroke awareness, prevention, and care management within {{org_field_name}}. As strokes are a leading cause of disability and mortality, it is essential that our care teams are well-equipped with the knowledge, skills, and resources to prevent strokes, identify early warning signs, and deliver high-quality post-stroke care.

This policy supports compliance with the CQC Fundamental Standards and associated regulatory requirements by setting out how {{org_field_name}} will assess stroke risk, recognise possible stroke or transient ischaemic attack (TIA), respond to suspected stroke as a medical emergency, support safe post-stroke care, obtain and record consent, escalate concerns, safeguard people from avoidable harm, communicate openly with relevant persons after safety incidents, maintain accurate records, and monitor the quality and effectiveness of stroke-related care.

2. Scope

This policy applies to:

• All employees, including care workers, management, and administrative staff.
• Service users and their families, ensuring awareness and prevention.
• Multi-disciplinary teams (MDTs), including GPs, physiotherapists, occupational therapists, and stroke specialists.
• Regulatory bodies, ensuring compliance with statutory care standards.

It covers:

• Understanding stroke and its risk factors.
• Preventative measures and risk reduction strategies.
• Recognising and responding to stroke symptoms.
• Post-stroke care planning and rehabilitation.
• Emotional, cognitive, and physical support.
• Communication with families and healthcare professionals.
• Training and staff responsibilities.
• Continuous monitoring and quality improvement.

This policy applies to stroke prevention activity, routine observation and monitoring, care planning, emergency response to suspected stroke or TIA, post-stroke support in the home, communication and information-sharing, record-keeping, incident reporting, complaints handling, staff training, supervision, and quality assurance.

3. Legal and Regulatory Framework

This policy is implemented in accordance with current legislation, regulatory requirements, and recognised best-practice guidance applicable to domiciliary care services in England, including:

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including in particular:
  • Regulation 9 – Person-centred care
  • Regulation 10 – Dignity and respect
  • Regulation 11 – Need for consent
  • Regulation 12 – Safe care and treatment
  • Regulation 13 – Safeguarding service users from abuse and improper treatment
  • Regulation 16 – Receiving and acting on complaints
  • Regulation 17 – Good governance
  • Regulation 18 – Staffing
  • Regulation 20 – Duty of candour
• Care Quality Commission (Registration) Regulations 2009, including requirements to notify CQC of certain incidents and events.
• Care Act 2014, including duties relating to wellbeing, prevention, safeguarding, cooperation, and support for carers where relevant.
• Mental Capacity Act 2005 and its Code of Practice, where a person may lack capacity to make a specific decision.
• Equality Act 2010, to ensure non-discriminatory, inclusive and equitable care.
• UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018, for lawful and secure handling of personal information.
• NHS England Accessible Information Standard, where applicable, to ensure information is provided in ways people can access and understand.
• NICE Guideline NG128: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management.
• NICE Guideline NG236: Stroke rehabilitation in adults.

{{org_field_name}} will also have regard to current CQC guidance, CQC’s Single Assessment Framework, local safeguarding procedures, and relevant professional guidance when implementing this policy.

4. Understanding Stroke and Its Risk Factors

A stroke occurs when blood supply to the brain is disrupted due to a blockage (ischaemic stroke) or bleeding (haemorrhagic stroke). Key risk factors include:

• Uncontrolled hypertension (high blood pressure).
• Diabetes and high cholesterol.
• Smoking, excessive alcohol intake, and poor diet.
• Lack of physical activity and obesity.
• Atrial fibrillation (irregular heartbeat).
• Family history of stroke and ageing.

{{org_field_name}} implements proactive risk assessments to identify and address these factors through lifestyle interventions and medical coordination.

Staff must also be aware of transient ischaemic attack (TIA), sometimes referred to as a “mini-stroke”. Although symptoms may resolve quickly, a TIA is a serious warning sign of future stroke and must always be treated seriously and escalated promptly in line with emergency or urgent clinical advice.

5. Preventative Measures and Risk Reduction Strategies

To reduce stroke risk, {{org_field_name}} will, within the limits of the commissioned service and staff competence:

• identify known stroke risk factors during assessment, review, and care planning;
• record relevant diagnoses, prescribed medicines, allergies, risks, communication needs, and professional contacts;
• support service users to follow agreed care and treatment plans, including prescribed medicines, nutrition, hydration, activity, smoking cessation, and alcohol reduction advice where this forms part of their assessed needs and agreed support plan;
• encourage timely attendance at GP, specialist, or other health appointments where these relate to stroke prevention or recovery;
• escalate concerns promptly to the GP, NHS 111, community clinician, or emergency services where symptoms, observations, or deterioration indicate increased risk;
• review care plans following any stroke, TIA, hospital admission, medication change, new diagnosis, significant deterioration, or professional recommendation; and
• work in partnership with the person, and where appropriate their family, representative, or advocate, to promote prevention, independence, and wellbeing.

6. Recognising and Responding to Stroke Symptoms

All staff must be trained to recognise the signs of possible stroke and respond immediately. Staff should use the FAST approach and remain alert to any sudden change in face, arm or speech function, as well as sudden confusion, visual disturbance, severe headache, dizziness, loss of balance, numbness, weakness, or collapse.

Any suspected stroke or TIA must be treated seriously. Where stroke is suspected, staff must:

1. Call 999 immediately and state that the person is having a suspected stroke.
2. Record the exact time symptoms started, or the last time the person was known to be well.
3. Remain with the person, reassure them, and monitor their condition until emergency assistance arrives, unless this places anyone at immediate risk.
4. Not offer food, drink, or oral medication if the person has facial weakness, reduced consciousness, swallowing difficulty, choking risk, or other signs that swallowing may be unsafe.
5. Ensure emergency responders have essential information, including the person’s name, date of birth, address, known medical conditions, allergies, medicines, next of kin details, baseline communication needs, and the time symptoms started.
6. Inform the office/manager without delay in accordance with internal emergency reporting procedures.
7. Inform family, lawful representative, or next of kin where appropriate and in line with the person’s wishes, best interests, confidentiality requirements, and immediate safety needs.
8. Make a full contemporaneous record of observations, actions taken, times, advice received, people contacted, and the outcome.

Following any suspected stroke or TIA, {{org_field_name}} will review the incident, update the care plan and risk assessment, consider whether statutory notifications or safeguarding referrals are required, and identify any learning for staff and the service.

7. Consent, Mental Capacity, Best Interests and Communication

{{org_field_name}} will always presume that a person has capacity to make their own decisions unless it is established otherwise in relation to a specific decision at the time it needs to be made. Staff must seek and record valid consent before providing care and support, sharing information, or involving others, unless urgent action is needed to protect life or prevent serious deterioration and it is lawful to act without prior consent.

Where a person may have difficulty understanding, retaining, weighing, or communicating information because of stroke-related cognitive impairment, aphasia, confusion, or another condition, staff must follow the Mental Capacity Act 2005 and the service’s Mental Capacity policy. Staff must take all practicable steps to support the person to make their own decision, including use of clear language, repetition, visual prompts, hearing or visual aids, communication boards, interpreters, speech and language advice, or other reasonable adjustments.

If the person lacks capacity to make a specific decision, any act done or decision made on their behalf must be lawful, necessary, proportionate, and in the person’s best interests. Staff must involve those lawfully entitled or appropriate to be consulted, such as attorneys under a valid Lasting Power of Attorney, court-appointed deputies, family members, advocates, and relevant professionals, in accordance with the law and internal policy.

Information must be provided in a way the person can understand, in line with the Accessible Information Standard where applicable. The person’s communication needs, preferred format, and any support required must be recorded in the care plan and communicated to staff.

8. Post-Stroke Care Planning and Rehabilitation

Effective post-stroke support in domiciliary care will be based on an individualised assessment and care plan that reflects the person’s current needs, goals, strengths, risks, preferences, communication needs, and rehabilitation programme.

{{org_field_name}} will, where this falls within the agreed care package and staff competence:

• support the person to follow professional advice and prescribed rehabilitation programmes;
• promote independence, choice, dignity, and realistic rehabilitation goals;
• monitor for changes in mobility, transfers, falls risk, continence, skin integrity, nutrition, hydration, communication, mood, cognition, fatigue, pain, and swallowing difficulties;
• escalate deterioration, new symptoms, or concerns about safety promptly to the appropriate health professional;
• support safe medicines administration or prompting in line with the care plan and medicines policy;
• work with physiotherapists, occupational therapists, speech and language therapists, GPs, community nurses, and other relevant professionals; and
• ensure care plans and risk assessments are reviewed promptly after discharge, reassessment, deterioration, incident, or professional advice.

9. Emotional, Cognitive, and Physical Support

Stroke can affect emotional wellbeing, cognition, communication, behaviour, identity, confidence, relationships, and physical functioning, and support must therefore be holistic and person-centred.

Our support includes:

• Counselling and mental health support to address depression and anxiety.
• Cognitive therapy for memory, problem-solving, and concentration issues.
• Social engagement activities to prevent isolation and promote well-being.
• Carer support services to assist family members coping with the impact of stroke.

Staff must be alert to signs of depression, anxiety, emotional lability, social withdrawal, carer strain, self-neglect, increasing dependence, communication frustration, or cognitive decline, and must record and escalate concerns appropriately.

10. Communication with Families and Healthcare Professionals

{{org_field_name}} will communicate with service users, families, representatives, advocates, commissioners, and healthcare professionals in a timely, respectful, accurate, and confidential manner.

Information-sharing must be based on the person’s consent where they have capacity, or otherwise be carried out in accordance with the Mental Capacity Act 2005, best interests decision-making, safeguarding duties, and data protection law.

Communication must take account of any aphasia, cognitive impairment, hearing loss, visual impairment, sensory need, language need, or other communication barrier. Staff must use the person’s preferred communication methods and record these clearly in the care plan.

Important updates, professional advice, escalation decisions, and communications with family or professionals must be recorded clearly and without delay.

11. Training and Staff Responsibilities

{{org_field_name}} will ensure that staff receive training, supervision, and competency assessment appropriate to their role in relation to stroke awareness, emergency response, safe care, record-keeping, consent, safeguarding, infection prevention and control, medicines support where applicable, moving and handling where applicable, communication needs, and duty of candour.

Training for relevant staff must include, as a minimum:

• recognising signs and symptoms of stroke and TIA;
• immediate emergency action and escalation procedures;
• recording the onset time and essential information for emergency responders;
• safe support pending emergency attendance;
• post-stroke risks including falls, swallowing difficulties, pressure damage, communication barriers, and cognitive changes;
• person-centred care planning and risk assessment;
• consent, mental capacity, and best interests;
• safeguarding adults procedures;
• incident reporting, complaints handling, and duty of candour.

Managers are responsible for ensuring that staff are competent for the tasks delegated to them, that learning is refreshed at appropriate intervals, that supervision identifies any performance or knowledge gaps, and that staff do not undertake tasks outside their competence.

Staff are individually responsible for following this policy, acting within the limits of their role and competence, reporting concerns immediately, keeping clear and accurate records, and seeking guidance whenever they are unsure.

12. Safeguarding, Incident Reporting, Duty of Candour and Statutory Notifications

Any concern that a service user is experiencing, or is at risk of, abuse, neglect, avoidable harm, self-neglect, organisational abuse, discriminatory abuse, or unsafe care following stroke or suspected stroke must be acted on immediately in accordance with the Safeguarding policy and local authority safeguarding procedures.

All stroke-related incidents, near misses, emergencies, medication concerns, unexplained injuries, falls, deterioration, hospital admissions, missed care, communication failures, or complaints must be reported internally in line with the incident reporting procedure and reviewed by management to identify immediate action and learning.

Where a notifiable safety incident occurs, {{org_field_name}} will act in an open and transparent way with the relevant person in line with the statutory Duty of Candour. This includes giving an honest account of what is known, an apology where appropriate, reasonable support, and follow-up information and records in accordance with law and policy.

{{org_field_name}} will make any required statutory notifications to the Care Quality Commission and other relevant bodies without delay and in accordance with legal requirements. This includes, where applicable, notifications relating to serious injury, abuse or allegations of abuse, police involvement, events affecting the safe running of the service, and other incidents required under the Care Quality Commission (Registration) Regulations 2009.

Managers must ensure that actions arising from incidents, safeguarding concerns, complaints, professional feedback, audits, or investigations are documented, implemented, reviewed, and used to improve the quality and safety of care.

13. Continuous Monitoring and Quality Improvement

{{org_field_name}} will maintain governance systems to assess, monitor, and improve the quality and safety of stroke-related care and support. This will include, where relevant:

• care plan and risk assessment audits;
• incident, accident, safeguarding, complaint, and emergency-response review;
• review of response times, documentation quality, and escalation practice;
• staff supervision, spot checks, competency review, and refresher training;
• feedback from service users, relatives, advocates, professionals, and commissioners;
• review of hospital admissions, readmissions, deteriorations, and lessons learned; and
• action plans with named responsibility and timescales where improvements are identified.

Records relating to stroke prevention, recognition, escalation, care delivery, consent, communication, and review must be complete, contemporaneous, accurate, secure, and auditable.

14. Policy Review and Updates

This policy will be reviewed at least annually and sooner where required by:

• changes to legislation, regulations, or CQC guidance;
• updates to NICE guidance or other recognised clinical guidance;
• learning from incidents, complaints, safeguarding concerns, audits, inspections, or inquests;
• changes to service delivery, commissioned activity, or workforce responsibilities; or
• identified need through governance, supervision, or quality assurance processes.

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