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{{org_field_name}}

Registration Number: {{org_field_registration_no}}


Live-in and Overnight Care Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, high-quality, and person-centred live-in and overnight care services to meet the needs of individuals requiring 24-hour support. This policy outlines how live-in and overnight care is managed effectively, ensuring staff well-being, compliance with regulatory requirements, and the safety and dignity of service users.

The service will be provided in a way that protects, promotes and maintains the individual’s safety, dignity, rights, independence and well-being. Care and support must be delivered in accordance with the individual’s care and support plan, where one exists, and the provider’s personal plan. The service must support the individual to achieve their personal outcomes and must be delivered with sufficient care, competence and skill, having regard to the service’s statement of purpose.

This policy supports compliance with the following legislation, regulations, statutory guidance and regulatory expectations applicable to domiciliary support services in Wales:

For the purposes of this policy, live-in and overnight care is treated as part of the regulated domiciliary support service where personal care and support are provided to an individual in their own home. The individual’s home does not become an accommodation-based regulated service solely because a care worker sleeps or rests there; however, the home must be assessed as a safe working environment for the care worker and a safe care environment for the individual.

2. Scope

This policy applies to:

It covers:

This policy does not authorise the provision of continuous active care by one worker for a 24-hour period. Where an individual requires frequent night-time intervention, continuous observation, two-worker support, nursing care, or support that prevents the live-in worker from receiving adequate rest, the package must be reviewed by the Registered Manager. Additional staffing, a waking-night worker, a second worker, assistive technology, health professional input, or a revised care package must be considered.

This policy must be read alongside the service’s Statement of Purpose. The service must only agree to provide live-in or overnight care where the assessed needs of the individual can be safely met within the staffing, skills, competence and resources available to the service.

3. Suitability, Eligibility and Assessment for Live-in and Overnight Care

Before agreeing to provide live-in or overnight care, {{org_field_name}} must 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 must be made before the service starts, except in an emergency where urgent arrangements are required to protect the individual’s safety and well-being.

The suitability decision must take into account:

Where no local authority care and support plan is available, including where the individual funds their own care, {{org_field_name}} must complete its own assessment before agreeing to provide the service. The assessment must be completed by a person who has the skills, knowledge, competence and training to carry out assessments.

The Registered Manager, or a competent person delegated by the Registered Manager, must record the decision that the service can or cannot meet the individual’s needs. Where the service cannot safely meet the individual’s assessed needs, this must be explained to the individual, their representative where appropriate, and the commissioner where applicable.

4. Personal Plan and Provider Assessment

Before live-in or overnight care begins, {{org_field_name}} will prepare an initial personal plan for the individual. In an emergency, where there is not enough time to prepare the personal plan before care starts, the personal plan must be prepared within 24 hours of the commencement of care and support.

The personal plan must set out:

Within 7 days of the commencement of live-in or overnight care, {{org_field_name}} will complete or review the provider assessment. The assessment will consider how the individual’s care and support needs can best be met, how the individual can be supported to achieve their personal outcomes, the individual’s views, wishes and feelings, and any risks to the individual or others. The personal plan must then be reviewed and revised as necessary.

The personal plan must be reviewed at least every three months, or sooner where there is a change in the individual’s needs, risks, outcomes, staffing arrangements, night-time support needs, health condition, medication, moving and handling needs, mental capacity, safeguarding concerns, or the suitability of the home environment.

The individual must be given a copy of the personal plan and any revised personal plan in a format and language appropriate to their needs, unless there is a recorded reason why this would not be appropriate or would be inconsistent with their well-being.

5. Roles and Responsibilities of Live-in Carers

5.1 Duties and Responsibilities

Live-in care workers provide agreed care and support during the day and, where specified in the personal plan and service agreement, limited night-time support. Live-in care does not mean that one worker is available to provide continuous active care for 24 hours. The level of day-time and night-time support must be clearly assessed, planned, recorded and reviewed.

Responsibilities include:

Care workers must only support medication, delegated healthcare tasks or specialist interventions where this is included in the individual’s personal plan, risk assessed, authorised, and the worker has received appropriate training and competency assessment. Where a task falls outside the worker’s competence or authorisation, the worker must not undertake the task and must escalate this to the Registered Manager or on-call manager immediately.

5.2 Maintaining Boundaries and Professionalism

6. Working Hours, Rest Breaks, and Accommodation

6.1 Live-in Care Worker Working Hours, Breaks and Rest

Live-in care arrangements must be planned so that the care worker is not required to provide continuous active care over a 24-hour period. The agreed active care hours, rest breaks, sleep arrangements and night-time expectations must be recorded in the personal plan, risk assessment, rota and service agreement.

As an organisational standard, live-in care should normally be planned on the basis that the worker provides no more than 10 hours of active care in a 24-hour period, unless this has been specifically risk assessed, authorised by the Registered Manager, and remains compliant with employment law, working time requirements, the worker’s contract and the safe delivery of care.

The worker must have planned rest breaks during the day. The timing of breaks must be agreed in advance wherever possible and recorded in the care plan or daily notes where relevant. If the individual cannot safely be left alone during the worker’s break, alternative cover or contingency arrangements must be put in place.

A live-in worker must have a suitable opportunity for sleep and rest. Where the individual requires frequent night-time intervention, unpredictable support, continuous monitoring, or support that regularly prevents the worker from sleeping, the arrangement must be reviewed immediately. The Registered Manager must consider whether the package should be changed to a waking-night arrangement, whether an additional worker is required, whether assistive technology or health input is required, or whether the service can continue to meet the individual’s needs safely.

All working time, rest arrangements, sleep interruptions and additional support provided during the night must be recorded accurately. Pay and compensatory rest arrangements must be managed in line with the worker’s contract, employment law, Working Time Regulations and National Minimum Wage/National Living Wage requirements.

6.2 Sleeping Night and Waking Night Arrangements

Overnight care must be clearly assessed and agreed as either a sleeping night or a waking night. The arrangement must be recorded in the personal plan, risk assessment, rota and service agreement.

A sleeping night means the worker is expected to sleep and is available only for occasional, brief and unpredictable support. Sleeping-night arrangements are only suitable where the assessment shows that the individual does not usually need planned or frequent support during the night and where the worker can reasonably expect to sleep.

A waking night means the worker is expected to remain awake and alert throughout the night to provide planned, frequent, continuous or safety-critical support. A waking-night arrangement must be used where the individual requires regular night-time personal care, repositioning, continence support, medication, observation, behaviour support, falls monitoring, dementia-related support, or other interventions that mean the worker cannot reasonably sleep.

If a sleeping-night worker is called more often than expected, is required to provide prolonged support, or is unable to obtain adequate sleep, this must be recorded and escalated to the Registered Manager or on-call manager. The care package must be reviewed. Repeated disturbance must not be treated as normal sleeping-night work without review of staffing, risk, payment and rest arrangements.

Where two workers are required for any task during the night, including moving and handling, personal care, behaviour support or emergency evacuation, this must be stated in the personal plan and staffing arrangements must ensure that two competent workers are available. A lone live-in or sleeping-night worker must not carry out a two-worker task alone.

6.3 Accommodation, Facilities and Safe Working Environment for Live-in Care Workers

Before a live-in care package begins, {{org_field_name}} must assess whether the individual’s home provides a safe and suitable working and resting environment for the care worker. This assessment must be reviewed if the home environment changes or if the worker raises concerns.

The individual, or their representative where appropriate, must provide the live-in worker with:

Where the environment is not safe or suitable, the Registered Manager must decide whether the package can start or continue. The service may refuse, suspend or vary the package where risks to the individual or worker cannot be reduced to an acceptable level.

6.4 Schedule of Visits, Travel Time, Care Time and Rest Breaks

Where live-in or overnight care forms part of the domiciliary support service, {{org_field_name}} will prepare and provide the relevant worker with a rota or schedule of visits. The schedule must clearly identify the time allocated for care and support, travel time where applicable, handover time where applicable, and rest breaks where applicable.

The time allocated for care must be sufficient to enable care and support to be provided in accordance with the individual’s personal plan. Care visits must not be planned for less than 30 minutes unless one of the statutory exceptions applies and the reason is recorded.

Where a worker travels between individuals, travel time must be realistic and must take account of distance, traffic, parking, rurality, weather and other factors that may reasonably affect travel. Records must be kept of time spent on care, travel and rest breaks.

Rotas must be planned to promote continuity of care, safe staffing, punctuality, worker well-being and the individual’s personal outcomes. Missed, late, shortened or extended visits must be recorded, investigated where necessary, and reviewed as part of quality monitoring.

7. Emergency Procedures and Safeguarding

7.1 Responding to Medical Emergencies

The Registered Manager and Responsible Individual must consider whether the incident is notifiable to CIW, the local authority, the commissioner, safeguarding team, police, Health and Safety Executive, Social Care Wales, DBS, or any other relevant body. CIW notifications must be made without delay and in the manner required by CIW where the event falls within the notification requirements. A record must be kept of the incident, action taken, people informed, notifications made, lessons learned and any changes required to the personal plan or risk assessment.

7.2 Safeguarding and Risk Management

All live-in and overnight care workers must follow the Safeguarding Adults from Abuse and Improper Treatment Policy, the Wales Safeguarding Procedures, local safeguarding arrangements, and the service’s whistleblowing procedure.

Any allegation, evidence, suspicion or disclosure of abuse, neglect, exploitation, financial abuse, discriminatory abuse, domestic abuse, coercive control, self-neglect, organisational abuse, improper treatment or unlawful restraint must be reported immediately to the Registered Manager or on-call manager. Where there is immediate danger, emergency services must be contacted without delay.

The service must take immediate action to protect the individual and any other person at risk. This may include contacting emergency services, seeking medical advice, contacting the local authority safeguarding team, notifying the commissioner, preserving evidence, removing a worker from duty, arranging alternative care, or escalating to the Responsible Individual.

A clear record must be kept of the concern, evidence or allegation, action taken, referrals made, advice received, people informed, outcomes and any changes required to the personal plan or risk assessment.

Live-in and overnight workers are lone workers and must receive regular welfare checks and access to management support. The frequency and method of check-ins must be proportionate to the risks of the package and must be recorded.

7.3 Fire and Security Procedures

The home safety assessment must include fire safety, escape routes, smoke alarms, carbon monoxide risks, smoking, oxygen use, electrical safety, heating, clutter, hoarding, mobility equipment, pets, security, access arrangements, night-time evacuation and lone worker risks.

Where the individual would need support to evacuate in an emergency, the personal plan must clearly state what support is required, whether one or two workers are needed, and what the worker must do if safe evacuation cannot be achieved without additional assistance.

Care workers must not place themselves at unreasonable risk. If the home becomes unsafe due to violence, threats, environmental hazards, fire risk, intoxication, visitors, unsafe equipment or any other serious concern, the worker must contact the Registered Manager or on-call manager immediately and, where necessary, emergency services.

8. Mental Capacity, Consent and Restrictive Practice

Care and support must be provided with the individual’s consent wherever the individual has capacity to make the relevant decision. Where there is doubt about the individual’s capacity to make a specific decision, the Mental Capacity Act 2005 must be followed. Capacity must be considered decision-specifically and time-specifically.

Where an individual lacks capacity to make a specific decision, any act of care or support must be in the individual’s best interests, must be the least restrictive option available, and must be recorded in the personal plan. The views of the individual, their representative, attorney, deputy, family members and relevant professionals must be considered where appropriate.

Care workers must not use restraint, control, restriction, locked doors, bed rails, chemical restraint, surveillance, or any restriction of liberty unless it is lawful, necessary, proportionate, risk assessed, authorised and recorded. Restrictive practice must only be used to prevent harm and must be the least restrictive option. Any incident involving restraint, control or restriction must be recorded and reported to the Registered Manager immediately.

If the live-in or overnight care arrangements may amount to a deprivation of liberty, the Registered Manager must seek advice and ensure that lawful authority is in place. The service must not provide care in a way that unlawfully deprives an individual of their liberty.

9. Staff Training, Support, and Monitoring

9.1 Mandatory Training, Registration and Competence

All live-in and overnight care workers must complete an induction appropriate to their role before working alone. The induction must include the service’s statement of purpose, policies and procedures, code of conduct, safeguarding, whistleblowing, duty of candour, complaints, lone working, record keeping, confidentiality, infection prevention and control, medication, moving and handling, fire safety, emergency procedures, health and safety, equality and diversity, Welsh language and communication needs, mental capacity, restraint and restrictive practice, and the specific needs of the individuals they support.

All care workers must complete training and competency assessment relevant to the care they provide. This may include, depending on the individual’s needs: dementia care, nutrition and hydration, continence care, skin integrity and pressure area care, end-of-life care, diabetes, epilepsy, Parkinson’s disease, catheter care, stoma care, behaviour support, autism, learning disability, acquired brain injury, mental health, falls prevention, oral care, delegated healthcare tasks, assistive technology and specialist equipment.

Workers must not undertake any task for which they have not been trained, assessed as competent and authorised. Competence must be reviewed through supervision, spot checks, direct observation, feedback, incident review and appraisal.

Domiciliary care workers must be registered with Social Care Wales within the required timescale. The service must monitor registration status, renewal dates, conditions of registration and qualification requirements. Where a worker is not yet registered but is within the permitted registration period, this must be monitored and recorded.

9.2 Recruitment, DBS Checks and Fitness to Work

{{org_field_name}} must only deploy live-in and overnight care workers who are fit to work at the service. Recruitment and deployment checks must include identity, employment history, references, right to work, qualifications, skills, competence, health suitability, DBS checks, Social Care Wales registration where required, and any other checks required by regulation or organisational policy.

Enhanced DBS checks must be completed before employment or deployment, unless a lawful risk-assessed exception applies. Where a worker is registered with the DBS Update Service, their DBS certificate status must be checked at least annually. Where the worker is not registered with the DBS Update Service, a new DBS certificate must be obtained at least every three years.

If concerns arise about a worker’s fitness, conduct, competence, honesty, safeguarding practice, health, registration or suitability, the Registered Manager must take immediate and proportionate action to protect individuals. This may include supervision, retraining, suspension, removal from the package, disciplinary action, referral to safeguarding, referral to DBS, referral to Social Care Wales, or notification to CIW where required.

9.3 Supervision, Appraisal and Welfare Support

Live-in and overnight care workers must receive regular management support, including welfare check-ins, direct observations, spot checks and formal supervision. Formal one-to-one supervision must take place at least quarterly, and more frequently where the package is complex, risks are high, performance concerns exist, or the worker is new to live-in or overnight care.

Each worker must receive an annual appraisal. Supervision and appraisal must consider competence, conduct, safeguarding, record keeping, medication practice, moving and handling practice, lone working, well-being, working time, sleep disturbance, training needs, Social Care Wales registration, feedback from individuals and representatives, and any incidents, complaints or concerns.

The service must support worker well-being and must respond promptly where a live-in or overnight worker reports fatigue, stress, isolation, harassment, unsafe conditions, excessive night disturbance, unclear boundaries, or concerns about the individual’s changing needs.

9.4 Monitoring Quality, Safety and Outcomes

The quality and safety of live-in and overnight care must be monitored through a combination of announced and unannounced spot checks, review of daily records, medication audits, care plan reviews, risk assessment reviews, incident and accident analysis, safeguarding review, complaints and compliments, worker feedback, individual and representative feedback, commissioner feedback where applicable, and Responsible Individual oversight.

Monitoring must consider whether:

Findings from monitoring must be recorded and used to improve the service. Any concern that the service can no longer meet the individual’s needs must be escalated immediately to the Registered Manager and, where applicable, the Responsible Individual, commissioner, individual and representative.

10. Duty of Candour, Openness and Transparency

{{org_field_name}} will act in an open and transparent way with individuals, their representatives and commissioners where applicable. Where something goes wrong with live-in or overnight care, the service will provide appropriate information, explain what happened, apologise where appropriate, investigate concerns, share relevant outcomes, and take action to reduce the risk of recurrence.

Staff must report mistakes, incidents, near misses, poor practice, safeguarding concerns and any concern that the individual’s needs are not being safely met. Staff will be supported to raise concerns and must not be victimised for doing so. Any attempt to discourage, conceal or obstruct the reporting of concerns may be treated as a disciplinary matter.

11. Welsh Language, Communication and Accessible Information

The individual’s language and communication needs must be assessed before live-in or overnight care begins and must be recorded in the personal plan. This includes whether the individual wishes or needs to receive care and support through the medium of Welsh.

{{org_field_name}} will take reasonable steps to meet the individual’s language needs and will work towards actively offering Welsh language support where Welsh is the individual’s language of need or choice. The service will also identify and use communication aids, formats or approaches required by the individual, including large print, easy read, hearing aids, visual prompts, communication passports, British Sign Language, Makaton, translation, interpretation or assistive technology where appropriate.

Information about the service, care arrangements, complaints, safeguarding and advocacy must be provided in a format and language the individual can understand. Staff must be informed of the individual’s communication needs and must use the agreed communication methods.

12. Compliance with CIW, RISCA and Responsible Individual Oversight

The Registered Manager is responsible for the day-to-day operation of live-in and overnight care arrangements and must ensure that care is provided in accordance with this policy, the statement of purpose, the individual’s personal plan, risk assessments, Welsh legislation, CIW expectations and Social Care Wales requirements.

The Responsible Individual must maintain effective oversight of the service, including live-in and overnight care arrangements. This includes oversight of quality, safety, staffing, safeguarding, complaints, incidents, notifications, staff support, training, supervision, regulatory compliance and improvement actions.

Live-in and overnight care arrangements must be included within the service’s quality assurance systems and quality of care review. The service must be able to demonstrate to CIW that live-in and overnight care is safe, person-centred, rights-based, well-led, properly staffed, effectively monitored and delivered in line with the individual’s personal outcomes.

The service must notify CIW of notifiable events in accordance with regulatory requirements. Notifications must be made without delay, in writing and in the manner required by CIW, unless a different timescale or method is specified.

13. Related Policies

This policy should be read in conjunction with:

14. Policy Review

This policy will be reviewed at least annually or sooner where required because of legislative change, Welsh Government guidance, CIW guidance, Social Care Wales requirements, safeguarding learning, complaints, incidents, inspection findings, changes to the statement of purpose, changes to the nature of live-in or overnight care provided, or operational learning. The review must consider whether the policy remains consistent with Welsh legislation, RISCA statutory guidance, CIW inspection expectations and current good practice.


Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on:
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Next Review Date:
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