DC154-New Service User Onboarding Policy

Registration Number: {{org_field_registration_no}}

New Service User Onboarding Policy

1. Purpose

The purpose of this policy is to ensure that all new service users experience a safe, timely, person-centred, lawful and well-coordinated onboarding process when joining {{org_field_name}}. The onboarding process must ensure that care and treatment are based on a comprehensive assessment of needs and preferences, reflect the service user’s choices, are provided with valid consent or other lawful authority, and are planned and delivered in a way that protects dignity, safety, wellbeing and human rights.

This policy is designed to support compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Act 2014, the Mental Capacity Act 2005, the Equality Act 2010, UK GDPR and the Data Protection Act 2018, and relevant Care Quality Commission (CQC) guidance. It also supports the organisation to demonstrate good governance, effective record keeping, accessible communication, safe care planning, safeguarding, and responsive complaint handling throughout the onboarding period.

The aims of this policy are to ensure that:

no package of care starts unless the provider is satisfied it can safely meet the person’s assessed needs;
service users and, where appropriate, those lawfully acting on their behalf are involved in assessment, planning, review and decision-making;
communication is accessible and information is provided in a format the service user can understand;
risks are identified, assessed, recorded, managed and reviewed before and after the service starts;
staff are given the information, training and support necessary to deliver the agreed care safely and consistently;
concerns, incidents, complaints and changes in need are acted on promptly and used to improve service quality.

2. Scope

This policy applies to:

all prospective and new service users referred to or accepted into {{org_field_name}}’s domiciliary care service;
family members, informal carers, advocates, attorneys, deputies and any other person lawfully acting on behalf of the service user;
the Registered Manager, Nominated Individual, care coordinators, supervisors, care workers and all other staff involved in assessment, care planning, allocation, introduction, review, record keeping and quality assurance;
external professionals and agencies involved in the safe commencement of care, including local authorities, hospitals, GPs, community nurses, occupational therapists, pharmacists and safeguarding teams.

This policy covers:

referral acceptance and pre-service suitability checks;
initial assessment, environmental and clinical risk assessment and package compatibility checks;
consent, mental capacity, best-interest decision-making and involvement of lawful representatives;
accessible information and communication needs;
development, agreement, implementation and review of the care and support plan;
medication, moving and handling, nutrition, hydration, skin integrity, falls, infection prevention and other relevant risk areas;
introduction of staff, continuity arrangements, contingency planning and emergency contacts;
recording, information sharing, confidentiality and data protection;
complaints, concerns, safeguarding and duty of candour;
monitoring, auditing, quality assurance and policy review.

3. Legal and Regulatory Framework

This policy is implemented in line with the following legislation, regulations and guidance, as applicable to domiciliary care services in England:

Health and Social Care Act 2008.
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 19: Fit and proper persons employed;
- Regulation 20: Duty of candour.
Care Quality Commission (Registration) Regulations 2009, where relevant to registration and notifications.
Care Act 2014.
Mental Capacity Act 2005 and associated Code of Practice.
Equality Act 2010.
UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.
Human Rights Act 1998.
Accessible Information Standard, where the service is required to have regard to it, including publicly funded adult social care.

{{org_field_name}} will also have regard to current CQC guidance and other nationally recognised guidance relevant to safe assessment, care planning, consent, safeguarding, complaints handling, governance and quality assurance.

4. Referral, Compatibility and Initial Assessment Process

Our onboarding process begins with a structured referral and compatibility process to determine whether {{org_field_name}} can safely, lawfully and effectively meet the prospective service user’s needs.

On receipt of a referral, the Registered Manager or delegated competent person will:

obtain sufficient information about the person’s needs, risks, wishes, communication requirements, current support arrangements, relevant diagnoses, prescribed medicines, mobility, home environment and any specialist interventions;
confirm the source of funding and whether the service is privately arranged, commissioned by a local authority, NHS-funded or otherwise supported through a third party;
identify whether any representative, advocate, Lasting Power of Attorney, deputy, court-appointed representative or other person lawfully acting on behalf of the service user is involved;
identify any immediate safeguarding concerns, known risks, unmet needs or urgent support requirements;
decide whether {{org_field_name}} has the staffing, competence, availability, equipment arrangements and organisational capacity to provide the proposed package of care safely.

Before the service starts, a suitably competent assessor will complete or arrange:

a person-centred needs assessment;
an assessment of communication and information needs, including preferred language, format and support required to understand information;
an assessment of capacity and consent where there is any doubt about the service user’s ability to make a relevant decision;
an environmental and home risk assessment;
any required moving and handling, falls, skin integrity, nutrition, hydration, continence, medicines, infection prevention and control, behavioural, lone working or other specific risk assessments;
confirmation of any support or equipment required from other professionals or agencies before safe commencement of care.

No care package will commence until the provider is satisfied that:

the proposed service is suitable;
risks have been assessed and can be managed safely;
care staff can be deployed with the required skills, knowledge and information;
consent or other lawful authority for care delivery has been established; and
the service user, and where appropriate those lawfully acting on their behalf, have been given the opportunity to be involved in planning the service.

5. Service User Needs Assessment and Care Planning

Following assessment and acceptance of the referral, {{org_field_name}} will develop a personalised care and support plan in partnership with the service user and, where appropriate, their family, advocate or lawful representative, and relevant professionals involved in their care.

The care and support plan must:

be based on the assessed needs, outcomes, wishes and preferences of the service user;
reflect the person’s strengths, routines, choices, cultural background, protected characteristics, religious or spiritual needs and communication preferences;
identify any reasonable adjustments required to ensure the person can access, understand and engage with the service;
set out clearly what support is to be provided, when, by whom, and any tasks that must not be undertaken without further assessment or authorisation;
include clear risk management instructions and escalation arrangements for identified risks;
include information about medicines support, where relevant, in line with the provider’s medicines policy and the assessed level of support required;
identify where care is shared with family members, other providers or professionals, and clarify roles and responsibilities;
include guidance for staff on what action to take if the service user declines support, becomes unwell, there is a missed visit, access cannot be gained, or an emergency occurs;
record any specific instructions relating to nutrition, hydration, skin care, mobility, transfers, continence, falls prevention, infection prevention and control, mental health, cognition or behaviours that challenge;
include the service user’s preferred methods of communication, consent arrangements and any capacity-related decision-making requirements;
include the date of issue, version control, review date and signatures or recorded agreement as applicable.

A copy of the relevant care and support information will be made available to the service user in an accessible format wherever possible and appropriate. Care plans must be reviewed before or at the point of service commencement if circumstances change, after the initial settling-in period, and thereafter at planned intervals or sooner where needs, risks or preferences change.

6. Consent, Mental Capacity and Lawful Decision-Making

{{org_field_name}} will only provide care and treatment with the valid consent of the service user or another person lawfully able to make the relevant decision on their behalf, except where the law provides another lawful basis for action.

During onboarding:

consent to assessment, information sharing and the proposed care package will be sought in a manner that is appropriate to the service user’s communication needs;
staff will presume that the service user has capacity unless there is a proper reason to doubt this;
where there is doubt about capacity in relation to a specific decision, a decision-specific mental capacity assessment will be carried out by a suitably competent person in line with the Mental Capacity Act 2005;
where the service user lacks capacity for a specific decision, any action taken will be in their best interests and in accordance with the Mental Capacity Act 2005 and the provider’s consent and capacity procedures;
the involvement of attorneys, deputies, executors of advance decisions, advocates or other lawful representatives will be identified, verified and recorded;
any refusal, withdrawal or limitation of consent will be respected and documented unless another lawful basis applies;
staff will not assume that family members can automatically consent on behalf of an adult service user unless they hold the relevant legal authority.

Records must clearly show:

what consent was sought and obtained;
how consent was communicated;
whether the person had capacity for the relevant decision;
who was involved in best-interest decision-making where applicable;
any legal documents relied upon, including Lasting Power of Attorney or court orders;
any refusal or withdrawal of consent and the action taken in response.

7. Introduction to Care Staff and Service Expectations

A structured introduction and orientation process will be used to help the service user feel safe, informed and confident before routine visits begin.

Before or at commencement of service, {{org_field_name}} will:

provide the service user with key contact details for the office, out-of-hours contact arrangements where applicable, and guidance on how to raise urgent concerns;
explain the planned service, visit times, tasks to be undertaken, arrangements for missed or delayed visits, and how changes will be communicated;
introduce the assigned care worker or small regular team wherever possible in order to promote continuity and consistency;
provide information about staff identification, lone working arrangements and what the service user should do if an unexpected person attends;
consider preferences relating to gender, culture, language or other relevant characteristics, where reasonably practicable and safe to do so;
ensure staff receive the current care plan, risk information, communication guidance and any other essential onboarding information before they deliver care;
complete introductory or shadow visits where required to support a safe and confident start to the package.

The service user must also be given clear information about:

their rights and responsibilities;
confidentiality and information sharing;
consent and decision-making;
complaints and compliments;
safeguarding and how to report abuse or neglect;
how to request changes to their care.

8. Communication, Accessible Information and Information Sharing

{{org_field_name}} will communicate with service users in a way they can understand and will identify, record, share and meet any information or communication needs that affect their ability to engage with the service safely and effectively.

During onboarding we will:

ask the service user how they prefer information to be communicated and recorded;
identify whether the person needs information in large print, easy read, translated format, audio, braille, visual prompts, hearing support, interpreter support or another accessible format;
record communication needs prominently within the care record and make sure relevant staff are informed;
provide information about the service, the care plan, complaints process, consent and key contacts in a format that is as accessible as reasonably practicable;
share information with staff and external professionals on a need-to-know basis, in line with confidentiality, data protection law and information governance requirements;
maintain accurate, complete, secure and contemporaneous records of assessment, planning, decisions, contacts, incidents and reviews.

Information sharing must be lawful, proportionate, relevant and secure. Staff must follow the organisation’s confidentiality, record keeping and data protection procedures at all times.

9. Ongoing Support, Monitoring, and Review

Onboarding continues beyond the first visit and includes active monitoring of whether the package remains safe, effective and acceptable to the service user.

{{org_field_name}} will:

complete an early review after service commencement to confirm that the package is meeting assessed needs, visit times are workable, staff understand the plan, and any initial concerns have been addressed;
seek feedback from the service user and, where appropriate, relatives, advocates or lawful representatives during the settling-in period;
review the care plan and risk assessments at planned intervals and whenever there is a change in health, functioning, home circumstances, medication, mobility, cognition, mental wellbeing, communication ability or family support;
review care records, incident reports, missed calls, late calls, complaints, compliments and staff feedback to identify whether the package remains safe and person-centred;
carry out immediate reassessment where there is evidence that needs have changed or the service may no longer be suitable or safe;
record all reviews, decisions, actions and follow-up arrangements clearly.

Where the review identifies that the package can no longer be delivered safely or no longer meets the service user’s needs, the Registered Manager will take prompt action, which may include revised planning, referral to other professionals, safeguarding referral, commissioner notification or lawful termination/transition arrangements.

10. Equality, Dignity, Human Rights and Fair Treatment

{{org_field_name}} is committed to providing care that is inclusive, respectful and free from discrimination, harassment, victimisation and unfair treatment.

During onboarding and ongoing service delivery we will:

respect the service user’s dignity, privacy, autonomy and individuality;
make reasonable adjustments to remove barriers to access, understanding and participation;
take account of protected characteristics, cultural identity, beliefs, sexuality, gender identity, disability, age, language and communication needs;
ensure that a person is not disadvantaged because they raise concerns, make choices, decline aspects of care, need advocacy support or require information in an alternative format;
challenge discriminatory practice and take action where discriminatory behaviour is identified.

11. Staff Training, Competence and Support

All staff involved in onboarding, assessment, care planning, allocation, review and care delivery must be suitably trained, competent and supported to carry out their roles.

{{org_field_name}} will ensure that:

staff receive induction, mandatory and role-specific training relevant to the needs of the people they support;
only staff with the appropriate competence undertake assessments, care planning, medicines-related tasks, moving and handling tasks, capacity assessments within their role boundaries, and other higher-risk activities;
competency checks, observations, supervision and spot checks are used to confirm staff can implement care plans safely and consistently;
staff understand person-centred care, consent, the Mental Capacity Act 2005, safeguarding, infection prevention and control, complaints handling, record keeping, confidentiality, equality and communication needs;
staff receive updates whenever a service user’s care plan or risk profile changes;
managers provide supervision and escalation support where a member of staff identifies that a new package is unsafe, unclear or outside their competence.

12. Monitoring, Governance and Policy Review

The Registered Manager is responsible for implementing this policy and for ensuring that onboarding arrangements are monitored through the organisation’s governance systems.

Monitoring will include, where applicable:

audit of assessments, care plans, consent records, risk assessments and review records;
audit of communication needs and accessible information arrangements;
monitoring of missed or late visits, incidents, safeguarding concerns, medicines errors, complaints and compliments relating to new service starts;
review of whether staff allocated to new packages had the required training, information and competence;
review of whether action was taken promptly when concerns, changes in need or quality issues were identified;
analysis of trends and learning arising from onboarding activity, complaints, incidents and feedback.

This policy will be reviewed at least annually and sooner where there is a change in legislation, regulation, CQC guidance, case law, organisational learning or operational practice.

13. Complaints, Concerns, Safeguarding and Duty of Candour During Onboarding

{{org_field_name}} will ensure that all service users and those acting on their behalf are given clear, accessible information about how to raise a concern, make a complaint, report abuse or neglect, or tell us when something has gone wrong.

During onboarding:

staff must explain how concerns and complaints can be made verbally, in writing or with support from another person;
complaints information must be available in accessible formats and staff must offer support, including interpreter or advocacy support where required;
all complaints and concerns must be recorded, acknowledged, investigated and responded to in line with the provider’s complaints procedure;
no person will be disadvantaged, treated differently or have their care negatively affected because they raise a complaint or concern;
where a complaint identifies a failure in care, necessary and proportionate action must be taken and any lessons learned used to improve the service;
safeguarding concerns identified during onboarding or after commencement must be escalated without delay in line with safeguarding procedures;
where a notifiable safety incident occurs, the provider will act in an open and transparent way in line with the statutory duty of candour and the organisation’s incident and duty of candour procedures.

14. Records Required for Each New Service User Start

For each new service user onboarding process, the provider should maintain, as applicable:

referral and acceptance decision records;
pre-start needs assessment;
communication/accessibility assessment;
consent records and any capacity/best-interest documentation;
environmental and service-specific risk assessments;
care and support plan and contingency arrangements;
staff allocation and competency confirmation;
service user information/welcome pack issue record;
first-visit record and early review record;
records of incidents, concerns, complaints or changes during the onboarding period.

15. Conclusion

By implementing this New Service User Onboarding Policy, {{org_field_name}} ensures that all service users receive timely, respectful, and high-quality support. Our structured assessment, care planning, communication, and monitoring processes enable service users to experience a smooth transition into care services, with ongoing support to maintain their independence, dignity, and well-being.

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.