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Stroke Awareness, Prevention, and Care Policy

1. Purpose

The purpose of this policy is to ensure that our domiciliary care service effectively supports service users who have experienced a stroke or are at risk of stroke. We aim to promote stroke awareness, prevention strategies, early recognition of symptoms, emergency response, and high-quality ongoing care to enhance recovery and independence.

This policy supports the service’s compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the associated Welsh Government statutory guidance, the Social Services and Well-being (Wales) Act 2014, the Mental Capacity Act 2005, the Equality Act 2010 and applicable data protection legislation. Stroke-related care and support will also take account of the Welsh Government Quality Statement for Stroke 2026, the National Clinical Guideline for Stroke adopted in Wales through WHC/2024/006 and NICE guideline NG236, Stroke rehabilitation in adults.

Our organisation efficiently manages stroke care by:

• Raising awareness of stroke risk factors and prevention strategies.
• Training staff to recognise early warning signs of stroke and respond swiftly.
• Ensuring timely medical intervention and emergency support.
• Providing person-centred post-stroke rehabilitation and long-term care.
• Coordinating care with NHS stroke services, physiotherapists, speech therapists, and occupational therapists.

2. Scope

This policy applies to:

• all staff, managers, agency workers, contractors and volunteers involved in assessing, planning, delivering, monitoring or reviewing care and support for an individual who has experienced a stroke or is considered to be at risk of stroke; and
• the service provider and Responsible Individual in relation to the governance, monitoring and oversight of stroke-related care and support.

The service will work in partnership, where appropriate and with lawful authority, with the individual’s representative, family members, informal carers, service commissioner and relevant health and social care professionals. Those persons are not employees of the service and are not themselves subject to the service’s internal employment procedures.

It covers:

• Stroke awareness and prevention strategies.
• Recognising the signs of stroke and emergency response.
• Acute care and rehabilitation following a stroke.
• Long-term support for stroke survivors.
• Multi-agency collaboration in stroke care.

3. Stroke Awareness and Prevention

3.1 Understanding Stroke and Risk Factors

A stroke occurs when blood flow to the brain is blocked or reduced, leading to brain damage. There are two main types:

• Ischaemic Stroke – caused by a blood clot blocking an artery in the brain.
• Haemorrhagic Stroke – caused by a burst blood vessel leading to bleeding in the brain.

Risk factors include:

• High blood pressure, diabetes, high cholesterol, and heart disease.
• Smoking, excessive alcohol consumption, and obesity.
• Lack of physical activity and poor diet.
• Atrial fibrillation (irregular heartbeat).
• A family history of stroke.

3.2 Stroke Prevention Strategies

Our home care service promotes preventative measures by:

• Supporting healthy lifestyle choices, including balanced diets, regular exercise, and smoking cessation.
• Assisting service users in monitoring their blood pressure and managing diabetes.
• Supporting individuals to take or manage prescribed medicines only where this is recorded in the individual’s personal plan and medication records, and only in accordance with the prescriber’s instructions, the service’s Medication Management and Administration Policy, the individual’s consent or lawful best-interests decision, and the staff member’s assessed competence. Staff must not recommend, start, stop, alter or withhold anticoagulants, antiplatelet medicines, statins, antihypertensive medicines or any other prescribed treatment unless instructed by an authorised healthcare professional.
• Providing education and awareness sessions on reducing stroke risks.

4. Recognising Stroke Symptoms and Emergency Response

4.1 Identifying Stroke Warning Signs (FAST Test)

Staff must be trained to recognise stroke symptoms using the FAST Test:

• Face – Is one side of the face drooping? Can the person smile?
• Arms – Can they lift both arms, or is one weak?
• Speech – Is their speech slurred or confused?
• Time – If any of these signs appear, call 999 immediately.

Staff must treat any sudden new FAST symptom as a medical emergency, even where the symptom is mild, fluctuates or resolves before an ambulance arrives. Staff must not delay calling 999 while contacting a manager, relative, GP, NHS 111 Wales or any other person.

Additional symptoms may include:

• Severe headache, dizziness, blurred vision, confusion, or loss of coordination.
• Sudden numbness or weakness in the limbs or face.
• Loss of consciousness or seizures.

4.2 Emergency Response Procedure

If an individual develops sudden symptoms that may indicate a stroke, staff must:

1. Call 999 immediately, state that a stroke is suspected and follow the emergency call handler’s instructions. The call must not be delayed while staff contact a manager, relative, GP or any other person.
2. Record, as accurately as possible, the time the symptoms started. Where the start time is unknown, record the last time the individual was known to be without the new symptoms. Give this information to the ambulance service.
3. Keep the individual safe, calm and under continuous observation. Support a conscious person in a comfortable position and do not move them unnecessarily. If the individual becomes unresponsive but is breathing normally, place them in the recovery position where it is safe to do so and follow the emergency call handler’s instructions.
4. If the individual is not breathing normally, commence cardiopulmonary resuscitation in accordance with the staff member’s training and the emergency call handler’s instructions, and arrange access to an automated external defibrillator where one is available.
5. Do not give food, fluids, oral medication or anything else by mouth unless specifically instructed by an attending authorised healthcare professional. Staff must not give aspirin for a suspected stroke unless expressly instructed by an authorised healthcare professional.
6. Provide the ambulance service with relevant information available at the visit, including the individual’s current medicines, known allergies, relevant diagnoses, anticoagulant or antiplatelet treatment, baseline communication or mobility difficulties, advance decisions and emergency care documentation.
7. Notify the Registered Manager or on-call manager as soon as the emergency response permits. Notify the individual’s representative or emergency contact in accordance with the personal plan, the individual’s wishes, lawful authority and any immediate instructions from emergency professionals.
8. Remain with the individual until responsibility has been transferred to the ambulance service or another authorised person, unless remaining would place the individual or worker at risk.
9. Make a complete, factual and contemporaneous record of the symptoms observed, times, observations, advice received, persons contacted and actions taken.
10. The Registered Manager must review the event and determine whether safeguarding, commissioner, health professional, CIW or other statutory notification is required under the applicable regulations and notification procedures.

5. Stroke Rehabilitation and Long-Term Care

5.1 Supporting Recovery and Rehabilitation

Many stroke survivors require ongoing support to regain independence. Our service ensures:

• Person-centred care plans tailored to the individual’s post-stroke needs.
• Supporting an individual with a rehabilitation activity or exercise only where the activity has been assessed and prescribed or agreed by an appropriately qualified healthcare professional, is recorded clearly in the individual’s personal plan, falls within the service’s agreed role and the worker has received the necessary instruction and has been assessed as competent. Staff must not independently devise, progress, discontinue or materially alter a rehabilitation programme.
• Supporting access to speech and language therapy and implementing agreed communication or swallowing recommendations within the limits of the service’s role and staff competence. The service must not describe ordinary care-worker support as speech and language therapy unless the intervention is delivered by, or under an appropriate arrangement with, a suitably qualified speech and language therapist.
• Cognitive and emotional support, addressing memory loss, depression, and anxiety.

We work closely with:

• Physiotherapists and occupational therapists to assist with mobility and daily activities.
• Speech and language therapists to support recovery of communication and swallowing.
• Social workers and community teams to ensure access to benefits, support groups, and specialist care.

5.2 Assisting with Daily Living and Mobility

Staff provide practical support in:

• Helping with personal care and hygiene, ensuring dignity and comfort.
• Encouraging safe mobility, using walking aids and fall-prevention strategies.
• Supporting eating and drinking where dysphagia is known or suspected only in accordance with the current swallowing assessment, speech and language therapy recommendations, prescribed food and fluid texture, positioning instructions, equipment requirements, level of supervision and emergency arrangements recorded in the individual’s personal plan. Staff must not independently change food or fluid consistency, introduce a swallowing technique, remove a restriction or give food, fluid or oral medication where the person is recorded as nil by mouth. Only staff who have received relevant training and have been assessed as competent may provide this support.
• Where an individual coughs, chokes, develops a wet or gurgly voice, becomes breathless, shows distress, has recurrent chest infections or demonstrates another change suggesting swallowing difficulty, staff must stop the activity, make the person safe, obtain urgent clinical advice in accordance with the personal plan and call 999 where choking, breathing difficulty or another medical emergency is present. The concern and action taken must be recorded and reported without delay.
• Promoting independence, allowing service users to do as much for themselves as possible.

5.3 Mental Health and Emotional Wellbeing Support

Stroke survivors often experience frustration, depression, or anxiety. We provide:

• Emotional reassurance and companionship to reduce isolation.
• Access to counselling and support groups.
• Encouragement in setting achievable goals, maintaining motivation in recovery.

5.4 Personal Plans, Risk Assessments and Review

Stroke-related care and support must be delivered in accordance with the individual’s current personal plan and relevant risk assessments. The personal plan must contain sufficient detail to enable staff to provide safe and consistent care and must address, where applicable:

• the individual’s personal outcomes, abilities, preferences and usual routines;
• baseline mobility, transfers, posture and use of equipment;
• communication needs, including aphasia, dysarthria, cognitive impairment and the individual’s preferred language and communication method;
• eating, drinking, nutrition, hydration and any current dysphagia recommendations;
• medication-related support and the limits of staff responsibility;
• continence, skin integrity, pain, fatigue, sensory loss and falls risks;
• emotional wellbeing, mood, behaviour, cognition and the risk of self-neglect or harm;
• agreed rehabilitation activities and the healthcare professional responsible for reviewing them;
• signs of deterioration and the action staff must take;
• emergency contacts and relevant emergency care documentation; and
• reasonable adjustments required to promote independence, dignity and equal access to the service.

The personal plan must be reviewed at least every three months and sooner whenever there is a change in the individual’s condition, ability, risk, treatment, swallowing status, rehabilitation instructions, communication needs, personal outcomes or circumstances. Any change following a stroke, hospital attendance or hospital discharge must prompt a review of the provider assessment, personal plan, risk assessments and staff competency requirements before the revised support is delivered.

Where the service cannot safely meet the individual’s changed assessed needs, even after reasonable adjustments, the Registered Manager must immediately follow the escalation and written notification requirements under Regulation 21(4).

5.5 Consent, Mental Capacity and Decision-Making

Staff must seek the individual’s valid consent before providing care, support or sharing information unless another lawful basis applies. Mental capacity is decision-specific and time-specific. Staff must not assume that an individual lacks capacity solely because the person has aphasia, dysarthria, cognitive impairment, physical disability or difficulty communicating following a stroke.

The service must take all practicable steps to support the individual to make the relevant decision. This may include allowing additional time, using simple language, pictures, communication aids, gestures, writing, a preferred language, an interpreter or support from a person familiar with the individual’s communication method.

Where there is reason to doubt the individual’s capacity to make a particular decision, the concern must be referred promptly to the Registered Manager and the service’s Mental Capacity Act procedure must be followed. Any assessment of capacity and any best-interests decision must be undertaken and recorded in accordance with the Mental Capacity Act 2005 and the applicable Code of Practice. Staff must establish whether a valid lasting power of attorney, deputyship, advance decision or other lawful authority applies.

Any restriction on the individual’s movement, choices, eating and drinking, medication, access to the community or other aspects of daily life must be necessary, proportionate and lawfully authorised. Restrictions must not be introduced merely for staff convenience or because an individual has experienced a stroke.

5.6 Communication, Accessible Information and Welsh Language

The individual’s communication needs and preferred language must be assessed and recorded in the provider assessment and personal plan. The service must take reasonable steps to enable the individual to understand information, express choices, participate in decisions and communicate concerns.

Information must be provided in a language, format and manner appropriate to the individual. This may include Welsh, easy-read information, large print, pictures, writing, gesture, communication boards, electronic communication aids or other methods recommended by a speech and language therapist. Communication aids must be accessible, maintained and used by staff who understand their purpose.

The service must make an active offer of Welsh-language care and support and must not require an individual to request Welsh-language provision repeatedly. Where the individual’s preferred language or specialist communication needs cannot immediately be met, the Registered Manager must identify and record reasonable interim arrangements and seek appropriate professional or interpreting support.

Staff must address the individual directly, allow sufficient time for a response, avoid finishing sentences without permission and verify understanding rather than assuming agreement.

6. Multi-Agency Collaboration in Stroke Care

Our organisation works in partnership with healthcare providers to ensure coordinated stroke care, including:

• GPs and hospital stroke teams for medical follow-ups.
• Community rehabilitation teams for therapy and equipment provision.
• Pharmacists for medication management and adherence support.
• Local authority and social care teams for financial and home adaptation assistance.

Information will be shared only where there is a lawful basis and where the sharing is necessary, relevant and proportionate for the individual’s care, treatment, safety or safeguarding. Staff must seek consent where required, verify the identity and authority of the recipient, use an approved secure communication method and record what information was shared, with whom, when, why and under what authority. Where the individual lacks capacity to decide about the disclosure, the Mental Capacity Act 2005 and the service’s information-sharing procedure must be followed. Information may be shared without consent where this is required by law or is necessary to protect the individual or another person from serious harm, but only the minimum necessary information must be disclosed.

7. Training and Staff Responsibilities

Before working without direct supervision with an individual whose care is affected by stroke, staff must receive induction, information, training, instruction and competency assessment proportionate to their role and to the individual’s assessed needs. This must include, where relevant:

• recognising possible stroke or transient ischaemic attack symptoms and initiating the emergency response;
• understanding the individual’s baseline presentation and recognising deterioration or a significant change;
• safe mobility, transfers, positioning and use of prescribed equipment;
• dysphagia, choking and aspiration risks, including the individual’s prescribed eating and drinking plan;
• communication support for aphasia, dysarthria and cognitive communication difficulties;
• supporting agreed rehabilitation activities without exceeding the worker’s role;
• medication-related responsibilities and the limits of the worker’s authority;
• consent, mental capacity, best-interests decision-making and lawful restrictive practice;
• emotional wellbeing, post-stroke depression, anxiety, fatigue and cognitive changes;
• recording, reporting, escalation, safeguarding and emergency procedures; and
• the individual’s language and communication requirements, including Welsh-language needs.

Training alone does not establish competence. Where staff undertake an individual-specific activity, the provider must retain evidence that the worker has received the relevant instruction, understands the individual’s personal plan and has been assessed as competent. Competence must be reassessed where the individual’s needs or professional instructions change, following an incident or concern, or where the worker has not undertaken the activity for a significant period.

Staff must ensure that:

• Care and support is provided in accordance with the individual’s current personal plan, provider assessment, risk assessments and current instructions from authorised health and social care professionals. Staff must report any inconsistency, omission or outdated instruction before continuing with an activity that could place the individual at risk.
• Staff must respond to deterioration according to its urgency. A medical emergency must be reported immediately to 999 and must not be delayed while seeking management approval. Urgent but non-emergency concerns must be escalated promptly to the appropriate healthcare professional in accordance with the personal plan and service procedure. The Registered Manager or on-call manager must also be informed as soon as it is safe and practicable to do so.
• The individual must be involved in assessment, planning and review. A family member, informal carer or representative may be involved where the individual consents, where that person has lawful authority, or where involvement is otherwise justified under the Mental Capacity Act 2005. A family member must not be treated automatically as having authority to make decisions or receive confidential information. The individual’s wishes regarding family involvement must be recorded and respected unless doing so would be unlawful or would expose the individual or another person to serious harm.

Failure to adhere to this policy may result in disciplinary action, in line with the Disciplinary and Grievance Policy (DCW31).

7.1 Recording, Reporting, Review and Duty of Candour

All stroke-related emergencies, significant changes, choking or aspiration concerns, medication incidents, falls, injuries, hospital attendances and failures to follow a professional instruction must be recorded and reported in accordance with the service’s incident procedure. Records must be factual, legible, accurate, contemporaneous and sufficiently detailed to show what occurred, what action was taken, what advice was received and what follow-up is required.

The Registered Manager must ensure that relevant incidents are reviewed to determine whether:

• the individual’s provider assessment, personal plan or risk assessments require amendment;
• additional healthcare advice or referral is required;
• staff training, supervision or competency reassessment is required;
• a safeguarding referral is required;
• the service commissioner, representative or another relevant body must be informed;
• a statutory notification to CIW or another authority is required; and
• learning must be shared or service improvements implemented.

Where an act or omission by the service has caused, or may have caused, harm, the provider must act openly and transparently with the individual and, where appropriate and lawfully authorised, their representative. This includes explaining what is known, providing information about any investigation, offering an appropriate apology and explaining the action taken to reduce the risk of recurrence.

8. Related Policies

This policy should be read alongside:

• Medication Management and Administration Policy (DCW21).
• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13).
• Risk Management and Assessment Policy (DCW18).
• Confidentiality and Data Protection (GDPR) Policy (DCW34).

• Emergency Response, First Aid and Cardiopulmonary Resuscitation Policy.
• Nutrition, Hydration and Dysphagia Policy.
• Mental Capacity, Consent and Best-Interests Decision-Making Policy.
• Moving and Handling Policy.
• Incident Reporting, Investigation and Duty of Candour Policy.
• Hospital Admission, Discharge and Transfer of Care Policy.
• Communication, Accessible Information and Welsh Language Policy.
• Record Keeping Policy.
• Delegated Healthcare Activities Policy, where applicable.

9. Policy Review

This policy will be formally reviewed at least annually and sooner where required. An earlier review must take place following:

• a change to applicable legislation, regulations, statutory guidance, CIW requirements or national stroke guidance;
• publication of relevant Welsh Government, NICE or nationally adopted clinical guidance;
• a stroke-related emergency, serious incident, safeguarding concern, complaint or identified failure to follow the policy;
• an audit identifying a gap in practice, recording, training or staff competence;
• a material change to the service’s statement of purpose or the needs of individuals using the service; or
• learning arising from professional advice, inspection, enforcement action or quality-of-care review.

The Registered Manager is responsible for ensuring that the policy is implemented, made available to relevant staff, incorporated into induction and training, and monitored through supervision, incident review and quality-assurance processes. The Responsible Individual must maintain oversight of the service’s compliance with the applicable Regulations and must ensure that identified improvements are completed and reviewed.

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