{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Purpose
This policy outlines the procedures for managing and responding to care-related issues outside of standard office hours. It ensures that clients continue to receive safe, effective, compassionate care and that staff feel supported to respond confidently to any situation, in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the CQC’s Fundamental Standards.

Scope
This policy applies to all staff, clients, their families, and external professionals involved in our care service.

Standard Office Hours
Our office is open:
Monday to Friday: 9:00am – 5:00pm

Out of Hours Service
Our out of hours service is in place to provide continuous support and ensure that urgent care matters are dealt with promptly and appropriately. The service covers:

• Weekdays: 5:00pm – 9:00am
• Weekends: from 5:00pm on Friday to 9:00am on Monday
• All bank holidays and public holidays
  
  

Out of Hours Contact Number:
{{out_of_hours}}

Key Principles

1. Safety First
   • We prioritise the health, safety, and wellbeing of our clients and staff at all times, ensuring urgent needs are addressed without delay.
2. Responsiveness
   • All out of hours calls will be responded to promptly, with clear advice and action to resolve issues or minimise risks.
3. Confidentiality and Respect
   • All discussions and information shared are treated confidentially and respectfully, in line with data protection and safeguarding requirements.
4. Regulatory Compliance
   • Our out of hours arrangements support compliance with CQC’s Key Lines of Enquiry (KLOEs), particularly:
     • Safe (S1, S2): How we keep people safe from avoidable harm.
     • Responsive (R1): How we respond to people’s needs.
     • Well-led (W1, W2): How we ensure governance and continuous improvement.

Procedure for Staff

When to Use the Out of Hours Service

Staff must use the out of hours service for:

• Medical emergencies or urgent health concerns requiring immediate assessment or action.
• Any safeguarding concerns, allegations, or suspicions of abuse or neglect.
• Sudden changes in a client’s condition or behaviour that pose a risk.
• Unplanned staff absences impacting client safety (e.g., last-minute sickness or no-shows).
• Medication errors or missed doses requiring urgent advice or action.
• Equipment failures that affect care delivery or safety.
• Any serious incident or near miss that could compromise client wellbeing.

How to Contact the Out of Hours Manager

Call the out of hours number: {{out_of_hours}}

• Clearly state:
  • Your name and job role.
  • The client’s name and address (if applicable).
  • The nature of the issue and any immediate risks.
• Remain calm, factual, and provide clear information.
• Follow any instructions or guidance provided.

Out of Hours Manager Responsibilities

• Assess the Situation: Gather all relevant information to understand the issue.
• Provide Advice and Support: Offer clear guidance and reassurance to staff, ensuring that urgent needs are met promptly.
• Take Action:
  • Where appropriate, liaise with external services (e.g., 111, ambulance, emergency GP, social services).
  • If needed, arrange for a senior staff member to visit the client’s home to support care delivery.
  • Escalate to emergency services when immediate medical intervention is required.
• Record Keeping:
  • Document the details of the call, actions taken, and the outcome in the appropriate records (e.g., client care notes, incident forms).
  • Ensure that accurate, factual information is passed to the registered manager the following working day.

Follow-Up and Handover

• All out of hours contacts must be logged using our incident reporting and communication systems.
• The out of hours manager must ensure that any actions requiring further follow-up (such as medication reviews, safeguarding referrals, or staff absences) are clearly handed over to the registered manager or responsible staff member at the start of the next working day.
• The registered manager will review out of hours logs to ensure compliance, identify patterns or trends, and make improvements where needed.

Additional Staff Responsibilities

• Be familiar with this policy and attend any relevant training on out of hours procedures and incident reporting.
• Never ignore or delay escalating an issue that may compromise the safety or wellbeing of clients.
• Ensure that you understand how to access and use the out of hours number and follow all instructions given by the out of hours manager.
• Document and report any actions taken, in line with our policies on record-keeping, confidentiality, and data protection.

Safeguarding and Duty of Candour

In line with Regulation 13 (Safeguarding) and Regulation 20 (Duty of Candour), staff must:

• Immediately report any safeguarding concerns to the out of hours manager.
• Be honest and transparent about any incidents or errors that occur, ensuring that the client or their representative is informed promptly and appropriately.
• Co-operate fully with any investigation or review of an out of hours incident.

Training and Support

• All staff receive training on using the out of hours service as part of their induction and ongoing refresher training.
• Out of hours managers receive specific training in decision-making, risk assessment, and escalation procedures to ensure they are confident in managing urgent situations.
• We promote a culture of openness, where staff feel safe to raise concerns and know they will be listened to and supported.

Registered Manager’s Responsibilities

The registered manager has overall responsibility for:

• Ensuring the out of hours arrangements meet the Fundamental Standards.
• Reviewing all out of hours logs and incident reports to ensure quality, safety, and learning.
• Supporting staff to build their confidence in managing out of hours situations.
• Making improvements to policies and procedures based on feedback and lessons learned.

Contact Details
For urgent out of hours support, please contact:
Out of Hours Number: {{out_of_hours}}

For routine enquiries or non-urgent matters, please contact the Registered Manager:

Registered Manager Name: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Registered Manager Email: {{org_field_registered_manager_email}}

This policy will be reviewed annually or any time when changes in the current legislation account.

---

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.