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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Delayed and Missed Visits Contingency Plan

1. Purpose

The purpose of this policy is to set out how {{org_field_name}} will prevent, identify, respond to and review delayed and missed care visits in order to maintain continuity of care and protect the health, welfare, safety, dignity, rights and wellbeing of the people we support.

{{org_field_name}} recognises that a delayed or missed visit may place a person at risk, particularly where the scheduled visit includes time-critical medication support, assistance with nutrition or hydration, continence care, repositioning, mobility support, personal care, access to essential healthcare or any other intervention necessary to maintain the person’s health, welfare or safety.

This policy must be implemented in accordance with:

• the Public Services Reform (Scotland) Act 2010;
• the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), including the requirements relating to quality and safety, the welfare of people using the service, personal plans and staffing;
• the Health and Care (Staffing) (Scotland) Act 2019;
• the Health and Social Care Standards: My support, my life; and
• the Scottish Social Services Council Codes of Practice for Social Service Workers and Employers, as amended from time to time.

All delayed or missed visits must be managed according to the individual circumstances of the person and the risks arising from the delay or missed visit. Fixed periods of delay must not be used as a reason to postpone necessary action where the person’s health, welfare or safety may be affected.

{{org_field_name}} will take prompt and proportionate action to minimise disruption, provide alternative support where required, communicate with the person and relevant others and record, report, review and learn from delayed and missed visits.

2. Scope

This policy applies to all staff, including management, care workers, and coordinators responsible for scheduling and delivering care services. It covers actions required when a visit is delayed or missed, ensuring prompt response and communication with the people we support, their families, and relevant professionals. This policy applies across all areas of care provision, including scheduled domiciliary care, overnight support, and emergency care visits.

3. Related Policies

• Emergency Response Plan
• Safeguarding Policy
• Lone Working Policy
• Communication Policy
• Personal Plans Policy
• Incident Reporting and Investigation Policy
• Staff Training and Development Policy
• Complaints and Feedback Policy

4. Definitions

• Delayed Visit: A scheduled visit that is expected to be more than 15 minutes late.
• Missed Visit: A scheduled visit that does not take place as planned due to unforeseen circumstances such as staff illness, transport issues, or administrative errors.
• High-Risk Visit: Any visit involving individuals who require time-sensitive medical assistance, essential medication, or critical mobility support.
• Non-Urgent Visit: Visits that provide companionship or general assistance but do not involve immediate health risks.

5. Responsibilities

• Registered Manager: Ensures implementation, monitoring, and staff compliance with this policy. Provides overall governance and reviews incidents for patterns requiring intervention.
• Care Coordinators: Oversee scheduling, identify risks, and take corrective action when visits are delayed or missed. Communicate effectively with care workers, families, and people we support to mitigate risks.
• Care Workers: Report any delays or missed visits immediately, ensuring alternative arrangements are in place. Follow the organisation’s escalation procedures to manage incidents effectively.
• On-Call Team: Available 24/7 to address urgent cases related to missed or delayed visits. Provide immediate support for critical incidents and liaise with emergency services if necessary.
• Administrative and Scheduling Team: Ensure the integrity of scheduling systems, manage backups, and respond to alerts regarding potential delays.

6. Preventative Measures

To minimise the risk of delayed or missed visits, {{org_field_name}} will maintain systems for planning, monitoring and responding to the delivery of scheduled care.

The following measures will apply:

• Safe and Appropriate Staffing: {{org_field_name}} will ensure that, at all times, suitably qualified and competent staff are available in numbers appropriate to the health, wellbeing and safety needs of the people using the service and to the provision of safe and high-quality care. Staffing arrangements will take account of the nature and size of the service, the number of people receiving care, their assessed needs, the timing and duration of required visits, geographical factors, travel time, staff competence and any identified risks.
• Risk-Based Scheduling: Visits will be scheduled with sufficient regard to travelling time, the assessed duration of visits and the individual needs of the people receiving support. Particular attention will be given to visits involving time-critical medication, food and fluids, continence support, repositioning, mobility assistance, personal care or any other task where delay could affect health, welfare or safety.
• Personal Plans and Risk Information: Where a delay or missed visit could create a foreseeable risk to a person’s health, welfare or safety, the relevant risks, required support and appropriate contingency arrangements will be identified within the person’s personal plan and associated risk assessments. Relevant information must be available to staff responsible for scheduling, on-call arrangements and emergency cover.
• Contingency Staffing: The service will maintain effective arrangements for responding to unexpected staff absence, sickness, emergencies or other circumstances affecting scheduled visits. This may include appropriately competent on-call, relief or other available staff. Any replacement worker must have sufficient information and competence to meet the person’s assessed needs safely.
• Monitoring of Visits: The service will maintain a reliable system for monitoring whether scheduled visits have commenced and been completed. Where electronic monitoring is used, alerts indicating that an expected visit has not commenced must be acted upon promptly in accordance with the person’s assessed level of risk.
• Travel and Route Planning: Scheduling arrangements will take reasonable account of travelling time, known transport disruption, geographical conditions and other foreseeable factors that may affect punctual attendance.
• Adverse Weather and Emergency Planning: The service will maintain contingency arrangements for severe weather, major transport disruption, utility failure or other emergencies that may affect the delivery of scheduled care.
• Communication: Care workers must notify the appropriate coordinator, manager or on-call person as soon as they become aware that they may be unable to attend a visit at the scheduled time. Staff must also report any staffing, resourcing or operational difficulty that may prevent safe delivery of care.
• Training and Competence: Staff involved in delivering, coordinating or managing visits will receive training and support appropriate to their role, including the service’s delayed and missed visit procedures, escalation arrangements, emergency response, record keeping and the management of risks associated with missed or delayed care.

Any staffing or scheduling problem that creates, or may create, a risk to the health, welfare or safety of a person receiving care must be escalated immediately and must not be left until a predetermined period of delay has elapsed.

7. Actions for Delayed Visits

Where a care worker becomes aware that they are likely to arrive later than the scheduled visit time, the following procedure must be followed.

1. Immediate Notification

The care worker must notify the Care Coordinator, manager or designated on-call person as soon as they become aware that they may be delayed. They must provide, as far as reasonably possible:

1. the name of the person whose visit is affected;
2. the expected length of the delay;
3. the reason for the delay;
4. their current location where relevant; and
5. any information known to them which may increase the risk associated with the delay.
6. Immediate Risk Assessment

The Care Coordinator, manager or designated on-call person must assess the potential effect of the delay on the person’s health, welfare and safety. The assessment must take account of the person’s personal plan, risk assessments and the purpose and timing of the scheduled visit.

Particular urgency must be given where the visit includes, or may affect:

2. time-critical medication or other medication support;
3. food or fluid intake;
4. diabetes care or other time-sensitive health needs;
5. continence support;
6. repositioning or pressure-area care;
7. mobility, transfers or assistance to leave or return to bed;
8. access to the toilet;
9. support required to prevent falls or other foreseeable harm;
10. support where the person cannot independently summon assistance;
11. any known vulnerability, safeguarding concern or risk of self-neglect; or
12. any other care task where delay could adversely affect the person’s health, welfare or safety.
13. Alternative Arrangements

Alternative arrangements must be considered as soon as the assessed risk indicates that waiting for the original care worker may adversely affect the person’s health, welfare, safety or essential care needs.

Action must not be delayed until a fixed number of minutes has elapsed.

Depending on the circumstances, alternative arrangements may include:

3. deployment of another suitably competent care worker;
4. attendance by a manager or appropriately competent member of staff;
5. re-prioritisation of other visits where this can be done safely;
6. contacting an appropriate healthcare professional or other relevant service; or
7. contacting the emergency services where there is an immediate or serious risk to life or health.
8. Communication With the Person

The person receiving care must be informed of the delay as soon as reasonably practicable and given an updated expected arrival time.

Communication must be provided in a way that meets the person’s identified communication needs.

Where appropriate and authorised, the person’s representative, family member, carer or other relevant individual must also be informed.

5. No Reduction or Omission of Essential Care

A delayed arrival must not automatically result in the visit being shortened or essential care being omitted.

The care worker must provide the support required by the person’s personal plan unless a change has been authorised following an appropriate assessment of the person’s needs and risks.

Where any planned care cannot be provided, this must be escalated immediately.

6. Emergency Escalation

If information obtained during the delay indicates that the person may be in immediate danger, has become unwell, has fallen, has missed essential medication or healthcare, or may otherwise require urgent assistance, staff must follow the emergency response procedure and contact the appropriate emergency or healthcare service without unnecessary delay.

7. Recording

The delayed visit must be recorded accurately. The record must include:

7. the scheduled visit time;
8. the actual arrival time;
9. the reason for the delay;
10. when and how the delay was identified;
11. the risk assessment undertaken;
12. who was informed;
13. alternative arrangements considered or implemented;
14. any effect on the person;
15. any care that could not be delivered as planned; and
16. any further action required.
17. Follow-Up

Following a delay that affected, or could reasonably have affected, the person’s health, welfare or safety, the manager or delegated senior member of staff must ensure that appropriate follow-up takes place.

Where the event demonstrates that the person’s existing contingency arrangements, risk assessment or personal plan are no longer sufficient, these must be reviewed and revised in consultation with the person and, where appropriate, their representative.

8. Actions for Missed Visits

A missed visit must be treated as a potential welfare and safety incident until the circumstances and the person’s wellbeing have been established.

The following procedure must be followed.

1. Immediate Reporting or Identification

A care worker who knows that they will not be able to attend a scheduled visit must inform the Care Coordinator, manager or designated on-call person immediately.

Where the scheduling or monitoring system identifies that a visit has not commenced as expected and no prior explanation has been received, the Care Coordinator, manager or designated on-call person must investigate without unnecessary delay.

2. Immediate Risk Assessment

The person’s personal plan, risk assessments, scheduled care tasks and known current circumstances must be checked immediately to determine the potential consequences of the missed visit.

Particular consideration must be given to whether the person:

2. requires time-critical medication or other medication support;
3. requires food, drink or support with nutrition or hydration;
4. requires continence care;
5. requires repositioning or pressure-area care;
6. requires assistance with transfers, mobility, getting into or out of bed or accessing the toilet;
7. has a health condition requiring time-sensitive support;
8. is unable to summon assistance independently;
9. is at risk of falls, self-neglect, abuse or other harm;
10. is known to be particularly vulnerable if left without support; or
11. has any other need which may make the missed visit a risk to their health, welfare or safety.
12. Contact With the Person

The service must attempt to contact the person without unnecessary delay using the agreed contact arrangements recorded in their personal plan.

Where appropriate and authorised, the service may also contact the person’s representative, family member, carer, keyholder or other agreed contact.

A telephone response must not be treated as sufficient where the information available indicates that an in-person welfare check or care intervention is required.

4. Replacement Care

Where the person still requires the scheduled support, the Care Coordinator, manager or designated on-call person must arrange attendance by a suitably qualified and competent member of staff as soon as required by the assessed level of risk.

Essential care must not simply be cancelled or deferred because the original care worker is unavailable.

5. Unable to Establish Contact or Welfare

If staff cannot establish that the person is safe and well, the matter must be escalated according to the level of risk.

This may include contacting:

5. an authorised representative, family member, carer or keyholder;
6. an appropriate health or social care professional;
7. the relevant local authority service;
8. NHS 24 or another appropriate healthcare service;
9. Police Scotland where there is a welfare or safety concern; or
10. the Scottish Ambulance Service through 999 where there is an immediate threat to life or a medical emergency.

Staff must not assume that a person is safe solely because they do not answer the telephone or door.

6. Medication and Health-Related Support

Where the missed visit has resulted, or may result, in medication being omitted, delayed or administered outside the planned time, staff must follow the organisation’s medication procedure and obtain appropriate professional advice where required.

Staff must not independently alter a prescribed dose, timing or medication regime unless authorised to do so by an appropriate healthcare professional.

7. Management Escalation

The Registered Manager, or the person delegated to act on their behalf, must be informed where:

7. essential care has been missed;
8. immediate replacement cover cannot be provided;
9. the person cannot be contacted or their welfare cannot be confirmed;
10. medication or healthcare has been affected;
11. harm has occurred or may have occurred;
12. emergency services or another statutory agency have been contacted;
13. there is a safeguarding or adult protection concern; or
14. the event may require external notification.
15. Incident Recording

Every missed visit must be recorded through the organisation’s incident reporting system.

The record must include:

8. the person affected;
9. the scheduled date and time;
10. the care that should have been provided;
11. how and when the missed visit was identified;
12. the reason, where known;
13. the assessed risks;
14. attempts made to contact the person;
15. replacement arrangements;
16. people or agencies contacted;
17. any effect or potential effect on the person;
18. any medication or healthcare implications; and
19. the immediate and longer-term corrective actions taken.
20. Review of Personal Planning and Risk

Where a missed visit has identified a new risk, a change in the person’s needs or an inadequacy in existing contingency arrangements, the person’s personal plan and relevant risk assessments must be reviewed and revised as appropriate.

10. Management Review and Learning

The manager must review missed visits to establish the cause and determine whether further action is required.

Where relevant, this must include action relating to staffing, scheduling, electronic monitoring, communication, staff competence, training, supervision, disciplinary processes or organisational systems.

Repeated missed visits or recurring causes must be escalated through the service’s quality assurance arrangements.

9. Communication and Reporting

Monitoring of Visits

Where {{org_field_name}} uses an electronic call monitoring or scheduling system, staff must use the system in accordance with organisational procedures.

Alerts indicating that a scheduled visit may be late, has not commenced or may have been missed must be reviewed and acted upon promptly. Electronic monitoring does not replace professional judgement, direct communication or the requirement to respond to known risks.

Communication With People Receiving Care

People receiving care must be informed as soon as reasonably practicable about a significant delay, missed visit or change of care worker.

Information must be communicated in a way that is appropriate to the person’s communication needs.

Where appropriate and authorised, relevant representatives, relatives, carers or advocates must also be informed.

Internal Incident Reporting

Every missed visit must be recorded through the organisation’s incident reporting arrangements.

Delayed visits must also be reported as incidents where the delay:

• caused or had the potential to cause harm;
• resulted in essential care not being provided as planned;
• affected medication, nutrition, hydration, continence care, mobility, repositioning or another health or safety need;
• required emergency or healthcare intervention;
• involved a safeguarding or adult protection concern; or
• indicates a recurring staffing, scheduling or operational problem.

Records must be clear, accurate, contemporaneous and sufficiently detailed to demonstrate the circumstances, risks identified, decisions made and actions taken.

Care Inspectorate Notifications

The Registered Manager, or delegated senior person, must assess each relevant delayed or missed visit against the Care Inspectorate’s current notification requirements.

A delayed or missed visit is not automatically notifiable solely because it occurred. However, where the circumstances or consequences meet a Care Inspectorate notification category, the appropriate notification must be submitted within the timescale specified by the Care Inspectorate.

This includes, where applicable, an accident, incident or injury that meets the Care Inspectorate’s notification criteria or another notifiable event arising from the delayed or missed visit.

Where the Care Inspectorate requires an accident or incident notification within 24 hours, {{org_field_name}} will ensure that the notification is submitted within that period.

All other incidents must still be recorded and retained in accordance with the service’s record-keeping requirements, whether or not a Care Inspectorate notification is required.

Where there is uncertainty about whether an event is notifiable, the Registered Manager must check the current Care Inspectorate notification guidance and, where necessary, seek advice from the Care Inspectorate.

Adult Support and Protection

Where a delayed or missed visit gives rise to a concern that an adult may be at risk of harm, staff must immediately follow the organisation’s Adult Support and Protection procedures and make the appropriate referral or report to the relevant local authority or other statutory agency.

Internal reporting or a Care Inspectorate notification must not delay any action required to protect the person from immediate harm.

Complaints

People receiving care and their representatives must be informed of their right to make a complaint about delayed or missed visits.

Any complaint received must be dealt with in accordance with the organisation’s Complaints Policy and the applicable Scottish regulatory requirements.

Management Oversight

Management must review patterns and trends involving delayed and missed visits and take corrective action where recurring issues are identified.

This must include consideration, where relevant, of staffing levels and deployment, scheduling arrangements, travelling time, staff competence, training, communication systems, monitoring systems and contingency arrangements.

10. Quality Assurance and Review

Policy Review: This policy will be reviewed at least annually and sooner where there is a relevant change in legislation, Care Inspectorate requirements or guidance, an identified pattern of incidents, a significant adverse event, or evidence that existing arrangements are not effectively protecting people receiving care.

Monthly Audits: The Registered Manager will ensure that delayed and missed visits are audited at least monthly. The audit must consider frequency, duration, causes, people affected, risks, outcomes, actions taken and whether required internal or external reports and notifications were completed.

Staffing and Deployment: Where delayed or missed visits are associated with staffing capacity or deployment, the Registered Manager must review whether staffing arrangements remain sufficient to ensure that suitably qualified and competent staff are working in numbers appropriate to the health, wellbeing and safety of people using the service and the provision of safe and high-quality care. Corrective action must be taken where staffing arrangements are insufficient.

Trend Analysis: Repeated delays, missed visits and recurring causes must be identified and investigated. The review must consider whether changes are required to rotas, travelling time, geographical allocation, staffing arrangements, contingency cover, staff competence, training, supervision, communication or monitoring systems.

Impact on People: Quality assurance must consider the actual and potential effect of delayed and missed visits on the health, welfare, safety, dignity, rights and wellbeing of people receiving care, rather than considering punctuality data alone.

Personal Plans and Risk Assessments: Where an incident identifies that a person’s existing personal plan, risk assessment or contingency arrangements do not adequately address the risk associated with delayed or missed care, those documents must be reviewed and revised as appropriate.

Staff Practice: Where an individual worker is repeatedly late or fails to attend scheduled visits, the circumstances must be investigated fairly. Appropriate management action may include supervision, additional training, support, capability procedures or disciplinary action in accordance with the organisation’s relevant policies.

Feedback: The views and experiences of people receiving care and, where appropriate, their representatives will be considered when reviewing the reliability and continuity of the service.

Improvement Actions: Actions arising from audits, incidents or reviews must be clearly recorded, allocated to a responsible person, given an appropriate completion date and followed up to confirm that the required improvement has been achieved.

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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}}
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