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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Managing Service Users Living with Diabetes Policy

1. Purpose

At {{org_field_name}}, we are committed to providing safe, effective, and person-centred care for individuals living with diabetes. Our approach ensures that individuals receive appropriate support in managing their condition while maintaining independence and quality of life.

This policy supports compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (Registration) Regulations 2009, the Care Act 2014, the Mental Capacity Act 2005, the Equality Act 2010, UK GDPR and the Data Protection Act 2018. It is designed to support compliance with the CQC Fundamental Standards, including 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 14 Meeting nutritional and hydration needs, 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 and Regulation 20A Requirement as to display of performance assessments, where applicable.

This policy also supports CQC’s current assessment approach, including the five key questions of whether services are safe, effective, caring, responsive and well-led, and the relevant quality statements relating to learning culture, safeguarding, involving people to manage risks, safe and effective staffing, medicines optimisation, consent, kindness and compassion, independence, choice and control, equity in experiences and outcomes, governance, management and sustainability, and partnerships and communities.

This policy must be read alongside the person’s diabetes care plan, medication support plan, risk assessments, Mental Capacity Act assessments where relevant, healthcare professional instructions, MAR records and emergency escalation plan. Staff must not make clinical decisions outside their role, training, competence or delegated authority.

2. Scope

This policy applies to all staff, including permanent, temporary, agency, and volunteer workers who provide direct or indirect support to individuals living with diabetes in our Supported Living service. It covers Type 1 and Type 2 diabetes, as well as management strategies for individuals with additional health conditions.

This policy applies where {{org_field_name}} provides regulated personal care or support that includes prompting, assisting, administering, monitoring, recording, escalating concerns, liaising with healthcare professionals, supporting appointments, supporting nutrition and hydration, or responding to diabetes-related emergencies. Where a person self-manages their diabetes, staff must respect their independence while remaining alert to agreed risks, changes in presentation and any support needs recorded in their care plan.

This policy does not authorise staff to diagnose diabetes, alter prescribed medication, alter insulin doses, interpret complex clinical results, or provide clinical advice unless this has been specifically delegated by an appropriate registered healthcare professional, recorded in the care plan, and supported by training and competency assessment.

3. Related Policies

• SL12 – Safe Care and Treatment Policy
• SL07 – Person-Centred Care Policy
• SL21 – Medication Management and Administration Policy
• SL16 – Infection Prevention and Control Policy
• SL08 – Dignity and Respect Policy
• SL34 – Confidentiality and Data Protection (GDPR) Policy
• SL13 – Safeguarding Adults from Abuse and Improper Treatment Policy
• Consent and Mental Capacity Policy
• Duty of Candour Policy
• Incident Reporting and Accident Policy
• Complaints Policy
• Nutrition and Hydration Policy
• Equality, Diversity and Human Rights Policy
• Positive Behaviour Support / Restrictive Practice Policy, where applicable
• Clinical Waste and Sharps Safety Procedure
• Infection Prevention and Control Policy, including safe use of lancets and sharps
• Staff Training, Supervision and Competency Policy
• Delegated Healthcare Tasks Policy, where applicable
• Hospital Admission and Discharge / Transitions of Care Policy
• End of Life Care Policy, where applicable
• Business Continuity Policy, including medicines, fridge failure and emergency access to diabetes supplies

4. Principles of Diabetes Management

4.1 Person-Centred Diabetes Care

Support should be tailored to meet individual needs, preferences, and lifestyle choices.

Care plans should be developed with input from healthcare professionals, individuals, and (where appropriate) families or advocates.

Each person living with diabetes must have an individual diabetes support plan where diabetes support is part of their assessed care. This must include, where applicable: type of diabetes; usual signs and symptoms of hypoglycaemia and hyperglycaemia; blood glucose monitoring arrangements; CGM or flash monitoring arrangements; insulin or diabetes medicines; allergies; dietary needs; hydration needs; foot care support; appointment support; sick day arrangements; ketone testing instructions if prescribed; emergency contacts; escalation thresholds; and the named healthcare professionals involved in their diabetes care.

The diabetes support plan must clearly state what the person does independently, what staff prompt, what staff assist with, what staff administer, and which tasks are delegated by healthcare professionals. Staff must not provide diabetes support that is not recorded in the care plan unless emergency action is required to prevent harm.

Individuals should be encouraged to self-manage their diabetes where possible, with appropriate support.

Clear communication is essential to ensure that individuals understand their condition, treatment, and management options.

Information about diabetes support must be provided in a format the person can understand, taking account of communication needs, sensory needs, learning disability, autism, mental health needs, culture, language, literacy, religion and protected characteristics. Reasonable adjustments must be made where required under the Equality Act 2010.

Always follow the care plan and advice given by the professionals involved.

4.2 Consent, Mental Capacity and Refusal of Diabetes Support

Staff must obtain the person’s consent before providing diabetes-related support, including blood glucose monitoring, CGM scanning, insulin support, medication support, foot checks, dietary support, contacting healthcare professionals or sharing information, unless there is a lawful basis to act without consent.

Mental capacity must be presumed unless there is reason to believe the person may lack capacity for a specific diabetes-related decision at the specific time it needs to be made. Where there are concerns about capacity, staff must follow the Mental Capacity Act 2005 and the organisation’s Consent and Mental Capacity Policy.

Where a person lacks capacity for a diabetes-related decision, any decision made or action taken on their behalf must be in their best interests, be the least restrictive option, involve relevant people where appropriate, and be clearly recorded.

If a person with capacity refuses diabetes support, staff must respect the refusal while explaining the risks in a way the person can understand. Staff must record the refusal, the information given, the person’s presentation, any immediate risk, and any escalation to the Registered Manager, GP, diabetes nurse, district nurse, pharmacist, NHS 111, 999 or safeguarding team as appropriate.

Repeated refusal, unexplained deterioration, suspected coercion, neglect, self-neglect, or inability to understand serious diabetes risks must be escalated to the Registered Manager and appropriate professionals.

4.3 Blood Glucose Monitoring

• Staff must support blood glucose monitoring only where this is included in the person’s care plan, diabetes support plan, medication support plan or delegated healthcare task plan. The plan must state the method of monitoring, frequency, target or expected range where provided by healthcare professionals, escalation thresholds, recording requirements, and the action staff must take when readings are outside the agreed range.
• If staff are required to assist with blood glucose testing, they must:
  • Follow infection control procedures.
  • Use the individual’s own blood glucose monitor and lancets.
  • Record blood glucose readings accurately in the individual’s health records.

Readings outside the person’s agreed range, repeated unusual readings, readings accompanied by symptoms, suspected hypoglycaemia, suspected hyperglycaemia, ketone concerns, acute illness, vomiting, dehydration, drowsiness, confusion or any other concern must be escalated in line with the person’s diabetes support plan. Where the person is acutely unwell, staff must not delay urgent medical advice while trying to contact routine healthcare professionals.

Where the person uses continuous glucose monitoring, flash glucose monitoring or sensor-based technology, the care plan must state who is responsible for scanning or checking readings, responding to alarms, charging devices, replacing sensors, documenting readings, troubleshooting device failure, and completing backup capillary blood glucose checks where required.

Staff must not rely solely on a sensor reading where the person’s symptoms do not match the reading, the device indicates an error, readings are changing rapidly, the sensor has failed, or the care plan states that a capillary blood glucose check is required. In these circumstances staff must follow the care plan and seek clinical advice where required.

If the person uses CGM or flash monitoring, staff must receive training and competency assessment specific to the device and the person’s care plan before supporting its use.

Where blood glucose monitoring is part of the person’s care plan, the plan must identify whether staff are expected to prompt, observe, assist, undertake the test, record the result, respond to alarms or escalate concerns. The plan must also state whether the person self-manages the result and what staff must do if the person declines support.

Staff must check that blood glucose monitoring equipment is clean, in date, stored safely, used only for the named person unless specifically designed and authorised for multi-person use, and used in line with the manufacturer’s instructions. Test strips, lancets and sensors must be checked for expiry dates, safe storage and availability.

Staff must record the blood glucose reading, date, time, any symptoms, action taken, food or drink given, medicine or insulin support provided, advice sought, escalation made and outcome. Records must be factual and must not include clinical interpretation outside the staff member’s role.

4.4 Insulin Administration and Medication Management

Insulin administration must be carried out only by trained staff who have completed competency assessments.

Staff must follow the Medication Management and Administration Policy (SL21) to ensure the safe storage, handling, and administration of insulin and other diabetes medications.

Insulin and diabetes medicines must be stored in accordance with the manufacturer’s instructions, the pharmacy label, the person’s care plan and the organisation’s medicines policy. Unopened insulin that requires refrigeration must usually be stored between 2°C and 8°C. Insulin currently in use may have different storage requirements and expiry periods once opened or removed from the fridge; staff must follow the manufacturer’s instructions and pharmacy advice. Opened insulin must be dated when first used and checked before administration.

Insulin is a high-risk medicine. Staff must check the right person, right medicine, right insulin type, right dose, right time, right route, right device, right expiry status, right storage status and right record before administration or support. Staff must never abbreviate the word “units”. Staff must not administer insulin from an unclear, altered, incomplete or verbal instruction unless this has been confirmed and documented in accordance with the Medication Management and Administration Policy and professional guidance.

Staff must not alter insulin doses, administer correction doses, withhold insulin, or change timing unless this is clearly prescribed, included in the care plan, or instructed by an appropriate healthcare professional and recorded. Where variable dose insulin is prescribed, the care plan and MAR must clearly state how the dose is determined, who determines it, what reading or carbohydrate information is required, and what staff must do if information is missing or outside the expected range.

In supported living, medicines, including insulin and medicines requiring refrigeration, should normally be stored in the person’s own home rather than in a central storage area. Where {{org_field_name}} is responsible for storage, staff must complete a risk assessment covering access, consent, security, temperature monitoring where required, fridge failure, power failure, stock rotation, expiry dates, safe disposal and emergency access. Any temperature breach or storage concern must be escalated and recorded.

Needles, lancets and sharps must be used once only and disposed of immediately into an approved sharps container. Staff must never re-sheath needles unless the device is specifically designed for safe use and the risk assessment allows it. Sharps containers must be stored safely in the person’s home, out of reach of others where required, and disposed of through the agreed clinical waste route. Sharps injuries must be managed as incidents and escalated immediately in line with the Infection Prevention and Control Policy.

Any missed doses or medication errors must be reported immediately and documented appropriately.

Staff must follow NICE guidance on managing medicines for adults receiving social care in the community and CQC medicines guidance for supported living. Where {{org_field_name}} provides medicines support, the person must have a medicines support plan that clearly describes the support required, the person’s level of independence, consent, risks, storage arrangements, ordering and collection arrangements, administration or prompting arrangements, recording requirements, disposal arrangements and what to do if medicines are refused, missed, unavailable, dropped, damaged, expired or stored incorrectly.

Insulin must be treated as a high-risk medicine. The care plan and MAR must clearly identify the insulin name, strength, device, dose, timing, route, injection site arrangements, rotation guidance where provided, expiry after opening, storage requirements and escalation arrangements. Staff must never use abbreviations such as “u” or “iu” for units.

Where insulin administration is delegated to care staff by a registered healthcare professional, the delegation must be person-specific, task-specific, documented, supported by training and competency assessment, and reviewed when the person’s needs, insulin regime, device, dose or risks change.

Staff must not administer insulin or diabetes medicines if the instruction is unclear, the MAR does not match the pharmacy label or prescription, the insulin appears damaged or expired, the device is not working, the person’s presentation causes concern, or the required blood glucose or carbohydrate information is unavailable. Staff must seek advice immediately from the Registered Manager and appropriate healthcare professional, unless emergency action is required.

4.5 Diet and Nutrition Support

• Staff should support individuals to maintain a balanced diet tailored to their diabetes needs.
• Meal planning should be in line with dietary recommendations from healthcare professionals, including:
  • Individualised dietary advice from the person’s GP, diabetes nurse, dietitian or other relevant healthcare professional. Staff must avoid giving generic or restrictive dietary instructions unless they are included in the person’s care plan.
  • Appropriate carbohydrate intake to prevent blood sugar fluctuations.
  • Healthy fats and protein to support overall health.
• Individuals must be supported to make informed choices about their diet, and staff should encourage hydration and regular meals.

Nutrition and hydration support must reflect the person’s preferences, culture, religion, communication needs, capacity, choice and assessed risks. Staff must not impose food restrictions, remove food, lock food away, or use restrictive practices unless this is lawful, proportionate, the least restrictive option, clearly risk assessed, documented, and authorised in line with the Mental Capacity Act, safeguarding procedures and the person’s care plan.

Where there are concerns about missed meals, reduced appetite, vomiting, diarrhoea, dehydration, swallowing difficulties, unplanned weight loss, eating disorder concerns, food insecurity, alcohol use, or repeated hypo/hyperglycaemia linked to food intake, staff must escalate to the Registered Manager and relevant healthcare professional.

4.6 Physical Activity and Lifestyle Support

• Staff should encourage regular physical activity as recommended by healthcare professionals.
• Individuals should be supported to engage in exercise routines suited to their ability and health conditions.
• Weight management and smoking cessation support should be offered where necessary to reduce diabetes-related complications.
• Physical activity must be encouraged in a safe and person-centred way. Staff must consider the person’s diabetes care plan, mobility, falls risk, cardiovascular risk, foot health, hydration, nutrition, blood glucose trends, prescribed medication and healthcare professional advice. Staff must ensure the person has access to fast-acting carbohydrate where this is required by the care plan.
• Staff must not encourage physical activity as a response to high blood glucose where the person is unwell, dehydrated, vomiting, drowsy, confused, has suspected ketones, has symptoms of DKA or HHS, or where the care plan advises against it. In these circumstances staff must seek urgent clinical advice or emergency help as required.

4.7 Preventing and Managing Hypoglycaemia (Low Blood Glucose)

Hypoglycaemia can be a medical emergency. Staff must know each person’s usual symptoms, risk factors, prescribed treatment, escalation plan and emergency contacts.

Possible signs and symptoms include sweating, shaking, hunger, paleness, dizziness, headache, blurred vision, tingling lips, anxiety, irritability, confusion, behaviour that is unusual for the person, drowsiness, weakness, poor coordination, seizure or loss of consciousness. Some people may have reduced awareness of hypoglycaemia.

Staff must follow the person’s diabetes support plan. Where the plan gives a blood glucose threshold, staff must follow that threshold. Where no individual threshold is provided and staff suspect hypoglycaemia, staff must act promptly and seek clinical advice as required.

If the person is conscious, able to swallow safely and the care plan allows staff to support treatment, staff should support the person to take the prescribed or agreed fast-acting carbohydrate, such as glucose tablets, glucose gel, a sugary drink or other item listed in the care plan. Staff must re-check or support re-checking of blood glucose where required by the care plan and must provide longer-acting carbohydrate or a meal/snack afterwards where this is included in the plan.

Staff must call 999 immediately if the person is unconscious, having a seizure, unable to swallow safely, severely confused, not recovering as expected, has repeated hypoglycaemia, or staff are unable to safely follow the care plan.

Glucagon or other rescue treatment must only be administered by staff who have received person-specific training, competency assessment and authorisation, and where it is prescribed and included in the care plan. After any severe hypoglycaemic episode, staff must inform the Registered Manager and relevant healthcare professional, complete records, and follow incident reporting procedures.

Following any hypoglycaemic episode requiring staff intervention, staff must record the blood glucose reading where available, symptoms, possible trigger, treatment given, response, repeat reading where required, food or drink given afterwards, advice sought, people informed and any changes required to the diabetes support plan. Repeated hypoglycaemia, night-time hypoglycaemia, reduced hypoglycaemia awareness, falls, seizures, loss of consciousness or hospital attendance must trigger a care plan review and referral to the person’s GP, diabetes nurse or other relevant healthcare professional.

4.8 Preventing and Managing Hyperglycaemia (High Blood Sugar)

• Signs of hyperglycaemia include:
  • Increased thirst and dry mouth.
  • Frequent urination.
  • Fatigue or blurred vision.
  • Fruity-smelling breath (a sign of diabetic ketoacidosis – medical emergency).
• Immediate response to hyperglycaemia:
  • Encourage fluids only if the person is conscious, able to swallow safely, not vomiting, and the care plan allows this. Do not encourage exercise if the person is unwell, dehydrated, vomiting, drowsy, confused, has suspected ketones, has symptoms of DKA or HHS, or where the care plan advises against it.
  • Support blood glucose checks, ketone checks where prescribed, and diabetes medicines or insulin only in accordance with the person’s care plan, MAR, prescription, delegated task plan and staff competency. Staff must not give additional or correction insulin unless this is clearly prescribed and the care plan explains when and how it must be given.
  • If blood sugar remains high or the individual appears unwell, seek urgent medical advice.

Staff must seek urgent medical advice if blood glucose remains above the person’s agreed escalation level, if ketones are present, if the person is vomiting, dehydrated, drowsy, confused, has abdominal pain, has rapid or deep breathing, has fruity-smelling breath, is acutely unwell, or staff are concerned. Staff must call 999 where DKA or HHS is suspected or the person’s condition is deteriorating.

Staff must never assume that high blood glucose can be managed by fluids, exercise or additional insulin unless this is clearly stated in the person’s care plan or confirmed by an appropriate healthcare professional. Where ketone testing is prescribed, the care plan must state who may carry out the test, when it must be carried out, how results must be recorded, and the exact escalation action required. Any suspected DKA or HHS must be treated as urgent and escalated immediately in line with the person’s emergency plan, NHS 111, GP out-of-hours or 999 depending on the person’s presentation.

4.9 Diabetic Foot Care

People living with diabetes must be supported to reduce the risk of foot problems, ulcers, infection and avoidable deterioration. Staff must follow the person’s care plan and any advice from the GP, diabetes nurse, podiatrist, district nurse or other healthcare professional.

Where foot care support is part of the person’s assessed needs, the diabetes support plan must state:

• what the person can do independently;
• what staff should prompt, observe or assist with;
• whether staff are expected to support daily hygiene, drying between toes, moisturising, footwear checks or visual checks;
• any known foot risk level or history of ulcers, neuropathy, poor circulation, amputation, infection, deformity or Charcot foot;
• what changes must be escalated and to whom;
• the person’s podiatry arrangements and appointment support needs.

Staff must not cut toenails, remove hard skin, treat corns, burst blisters, apply dressings, use medicated foot products or provide clinical foot treatment unless this is included in the care plan, has been delegated by an appropriate healthcare professional, and staff have been trained and assessed as competent.

Staff must escalate promptly to the Registered Manager and appropriate healthcare professional if they observe or are told about any cut, blister, ulcer, swelling, redness, heat, discharge, bleeding, pain, new numbness, colour change, blackened area, change in foot shape, signs of infection, broken skin, ill-fitting footwear, unexplained limping or the person feeling generally unwell with a foot concern.

Any new foot ulcer, spreading infection, blackened tissue, suspected sepsis, sudden severe pain, sudden colour change, or rapid deterioration must be treated as urgent and escalated immediately through the GP, podiatry emergency pathway, NHS 111 or 999 according to the person’s presentation and local pathway.

Staff must record foot care support, concerns identified, advice sought, action taken and outcomes. Foot concerns must trigger a review of the person’s diabetes support plan and risk assessment.

4.10 Diabetes-Related Emergencies

Diabetes-related emergencies can be life-threatening. Staff must follow the person’s emergency escalation plan and must not delay urgent help while trying to contact routine healthcare professionals.

Diabetic Ketoacidosis (DKA)

DKA is a medical emergency. Possible signs may include very high blood glucose, ketones where tested, extreme thirst, frequent urination, vomiting, abdominal pain, dehydration, drowsiness, confusion, rapid or deep breathing, fruity-smelling breath, collapse or the person appearing seriously unwell.

Staff must call 999 immediately if DKA is suspected, if the person is deteriorating, or if the person’s emergency plan says to call 999. Staff must not administer additional or correction insulin unless this is clearly prescribed and included in the care plan or instructed by an appropriate healthcare professional and recorded.

Hyperosmolar Hyperglycaemic State (HHS)

HHS is a medical emergency, usually linked to very high blood glucose and severe dehydration. Possible signs may include extreme thirst, dry mouth, weakness, drowsiness, confusion, reduced consciousness, signs of dehydration, infection, seizures or collapse.

Staff must seek urgent medical advice or call 999 immediately if HHS is suspected, if the person is drowsy, confused, unable to swallow safely, vomiting, severely dehydrated, deteriorating or acutely unwell. Staff may support oral fluids only if the person is conscious, able to swallow safely, not vomiting, and the care plan allows this. Staff must not force or “ensure” fluids are taken.

Other urgent diabetes-related situations

Staff must seek urgent advice or call 999, depending on the person’s presentation, if the person:

• is unconscious, having a seizure or unable to swallow safely;
• has repeated hypoglycaemia or is not recovering as expected;
• has high blood glucose with ketones, vomiting, dehydration, drowsiness, confusion, abdominal pain, rapid or deep breathing or fruity-smelling breath;
• has signs of sepsis, serious infection or rapid deterioration;
• has a new serious foot wound, blackened tissue, spreading infection or suspected sepsis;
• has missed insulin or diabetes medicines and staff are concerned about immediate risk;
• presents in a way that is significantly unusual for them.

After any diabetes-related emergency, staff must inform the Registered Manager, complete records, follow incident reporting procedures, consider safeguarding and Duty of Candour requirements where relevant, and ensure the diabetes support plan and risk assessments are reviewed.

4.11 CQC Quality Statements and Evidence

Diabetes support must be delivered in a way that provides clear evidence for CQC’s current assessment framework. Managers and staff must be able to demonstrate that:

• people are involved in planning and reviewing their diabetes support;
• people are supported to understand their choices, risks and treatment options in a way that meets their communication needs;
• diabetes-related risks are assessed with the person and reviewed when their needs, medicines, health condition or support arrangements change;
• staff understand how to identify and escalate deterioration, including hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic state, dehydration, infection and foot concerns;
• diabetes medicines, insulin, blood glucose monitoring equipment, sharps and records are managed safely;
• staff receive training, supervision and competency assessment appropriate to their role and the person’s support needs;
• incidents, near misses, refusals, medicines errors, hospital admissions and safeguarding concerns are recorded, reviewed and used to improve practice;
• the provider works effectively with GPs, diabetes nurses, district nurses, pharmacists, dietitians, podiatrists, hospitals, commissioners and other professionals involved in the person’s care.

The Registered Manager must ensure that records, audits, care plan reviews, incident reviews, supervision notes and competency assessments provide evidence that diabetes support is safe, effective, caring, responsive and well-led.

5. Legal and Regulatory Framework

{{org_field_name}} will manage diabetes support in line with current legislation, statutory guidance and recognised good practice. This includes the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (Registration) Regulations 2009, the Care Act 2014, the Mental Capacity Act 2005, the Equality Act 2010, UK GDPR, the Data Protection Act 2018, relevant health and safety legislation, medicines legislation and current NICE, CQC and local NHS guidance.

The following CQC regulations are particularly relevant to this policy:

• Regulation 9 – Person-centred care: diabetes support must reflect the person’s needs, preferences, lifestyle, culture, communication needs, protected characteristics, independence and choices.
• Regulation 10 – Dignity and respect: diabetes care must be delivered in a way that respects privacy, dignity, autonomy and independence.
• Regulation 11 – Need for consent: staff must obtain consent before providing diabetes-related support, unless the person lacks capacity for the specific decision and a lawful best interests process has been followed.
• Regulation 12 – Safe care and treatment: risks associated with diabetes, medicines, insulin, blood glucose monitoring, hypoglycaemia, hyperglycaemia, infection prevention, sharps, foot care, acute illness and emergency response must be assessed, recorded and managed safely.
• Regulation 13 – Safeguarding service users from abuse and improper treatment: staff must recognise and report concerns including neglect, self-neglect, medication omission, coercion, unsafe restriction, discriminatory practice, failure to seek medical help, or concerns that a person is unable to manage diabetes safely without support.
• Regulation 14 – Meeting nutritional and hydration needs: staff must support nutrition and hydration in accordance with the person’s assessed needs, preferences, diabetes care plan and healthcare professional advice.
• Regulation 16 – Receiving and acting on complaints: concerns and complaints about diabetes support must be listened to, recorded, investigated where required, responded to and used to improve care.
• Regulation 17 – Good governance: records, audits, risk assessments, incidents, lessons learned, reviews and quality assurance processes must be accurate, complete and used to improve diabetes care.
• Regulation 18 – Staffing: staff must receive diabetes training, role-specific competency assessment, supervision and support before carrying out diabetes-related tasks. Staff must also receive learning disability and autism training appropriate to their role where they work for the purpose of regulated activities.
• Regulation 19 – Fit and proper persons employed: staff providing diabetes support must be recruited safely and must be suitable for their role.
• Regulation 20 – Duty of candour: where a notifiable safety incident occurs, {{org_field_name}} will act in an open and transparent way with the person and/or relevant representative, provide an apology, explain what happened, and follow the organisation’s Duty of Candour Policy.
• Regulation 20A – Requirement as to display of performance assessments: where applicable, {{org_field_name}} will display CQC ratings and performance information as required.

{{org_field_name}} will also comply with the Care Quality Commission (Registration) Regulations 2009, including notification requirements. The Registered Manager must ensure that deaths, serious injuries, allegations of abuse, incidents reported to or investigated by the police, events that stop or may stop the service from operating safely, and other notifiable incidents are reported to CQC where required.

5.1 NICE, NHS and Professional Guidance

Staff must follow the person’s diabetes support plan and current instructions from the GP, diabetes nurse, district nurse, pharmacist, dietitian, podiatrist or other relevant healthcare professional. Staff must also have regard to current NICE guidance relevant to the person’s diabetes support, including guidance on type 1 diabetes, type 2 diabetes, diabetic foot problems and medicines support for adults receiving social care in the community.

Where NICE guidance, local NHS guidance, pharmacy advice or professional instructions appear to conflict, staff must escalate to the Registered Manager and the relevant healthcare professional before acting, unless urgent action is required to prevent harm.

Staff must not provide clinical advice, diagnose, change prescribed treatment, alter insulin doses, interpret complex clinical results or delay emergency escalation.

6. Staff Training and Competency

All staff must receive diabetes awareness training appropriate to their role as part of induction and refresher training. Staff must not provide diabetes-related support unless they have been trained, assessed as competent and authorised to carry out the relevant task.

Staff providing direct support to a person living with diabetes must receive training and competency assessment relevant to the person’s care plan. This may include:

• understanding Type 1 diabetes, Type 2 diabetes and other forms of diabetes relevant to the people supported;
• recognising and responding to hypoglycaemia and hyperglycaemia;
• recognising possible DKA, HHS, dehydration, infection, sepsis and deterioration;
• blood glucose monitoring, CGM or flash monitoring, where included in the care plan;
• insulin support or administration, where this is part of the person’s care and has been delegated or authorised appropriately;
• safe use, storage and disposal of medicines, insulin, needles, lancets and sharps;
• nutrition, hydration, physical activity and lifestyle support within the limits of the staff role;
• foot care observation and escalation;
• consent, mental capacity, refusal of support and best interests decision-making;
• record keeping, incident reporting, escalation and Duty of Candour;
• safeguarding, self-neglect, restrictive practice and equality duties.

Staff working for the purpose of regulated activities must receive learning disability and autism training appropriate to their role. This must be considered when supporting people with diabetes who have a learning disability, autism, communication needs or difficulty recognising or explaining symptoms.

Competency assessment must be:

• person-specific where the task relates to insulin, blood glucose monitoring, CGM or flash monitoring, glucagon, rescue treatment or delegated healthcare tasks;
• completed before the staff member carries out the task unsupervised;
• repeated at least annually or sooner if the person’s needs, medicines, equipment, insulin device, care plan, staff performance or professional guidance changes;
• recorded with the date, assessor, task assessed, outcome, any restrictions on practice and review date.

Agency, temporary and bank staff must not carry out diabetes-related tasks unless the Registered Manager is satisfied that they have received appropriate information, training, competency assessment and authorisation for the person and task concerned.

7. Record-Keeping and Documentation

Accurate, complete and contemporaneous records must be kept for all diabetes-related support provided by staff. Records must be factual, legible, dated, timed, signed or attributable to the staff member, and stored securely.

Records must include, where applicable:

• the person’s diabetes support plan and risk assessments;
• consent, mental capacity assessments and best interests decisions;
• blood glucose readings, CGM or flash readings where staff are responsible for recording them;
• symptoms, presentation and any signs of deterioration;
• insulin and diabetes medicines support, including MAR records;
• refused, delayed, missed, omitted, unavailable, dropped, damaged or expired medicines;
• hypoglycaemia, hyperglycaemia, DKA or HHS concerns and action taken;
• food and fluid intake where this is part of the care plan;
• foot care support and concerns;
• advice sought from healthcare professionals and instructions received;
• contacts with family, representatives, advocates or professionals where relevant and lawful;
• incidents, near misses, safeguarding concerns, complaints and Duty of Candour actions;
• hospital admissions, discharges and changes to treatment;
• reviews, audits and lessons learned.

Care plans and risk assessments must be reviewed at least annually and sooner if there is any change in diabetes type, medicines, insulin regime, blood glucose monitoring, equipment, diet, weight, foot health, mental capacity, communication needs, health condition, hospital attendance, professional advice, incident pattern or level of staff support required.

Records must demonstrate that staff acted in line with the care plan, escalated concerns promptly and followed professional advice. Records must not be falsified, backdated or altered without a clear audit trail.

8. Confidentiality, Data Protection and Information Sharing

Diabetes-related information is health information and must be treated as confidential special category personal data. Records must be stored securely and handled in line with UK GDPR, the Data Protection Act 2018, confidentiality requirements and {{org_field_name}}’s Confidentiality and Data Protection Policy.

Information must only be shared where there is a lawful basis and a legitimate need to know, including with healthcare professionals, emergency services, commissioners, safeguarding authorities, CQC or others where required by law or necessary to protect the person or others from harm.

Staff must respect the person’s wishes about information sharing where they have capacity to make that decision, unless there is a lawful reason to share information without consent, such as safeguarding, serious risk, emergency treatment or regulatory notification.

Where the person has communication needs, information about diabetes support must be provided in an accessible format and reasonable adjustments must be made.

8.1 Complaints, Concerns and Advocacy

People using the service, families, representatives, advocates, staff and professionals must be encouraged to raise concerns about diabetes support, including concerns about medicines, insulin, food and drink, blood glucose monitoring, staff competence, delayed escalation, dignity, communication, restrictions, neglect or poor recording.

Concerns and complaints must be listened to, recorded, investigated where required, responded to and used to improve diabetes support. People must be given information about how to complain in a format they can understand.

Where a concern indicates abuse, neglect, self-neglect, unsafe care, avoidable harm, discrimination, coercion, unlawful restriction or failure to seek medical help, staff must follow safeguarding and incident reporting procedures immediately.

Where the person has substantial difficulty being involved and has no appropriate person to support them, advocacy must be considered in line with the Care Act 2014 and the organisation’s advocacy procedures.

8.2 Notifications to CQC and External Reporting

The Registered Manager must ensure that diabetes-related incidents are reviewed to determine whether they require notification to CQC under the Care Quality Commission (Registration) Regulations 2009 or reporting to any other external body.

Incidents that may require notification or external reporting include, but are not limited to:

• death of a person using the service;
• serious injury;
• abuse or alleged abuse;
• incidents reported to or investigated by the police;
• events that stop or may stop the service from operating safely;
• serious medicines incidents;
• avoidable harm linked to diabetes support;
• safeguarding concerns;
• notifiable safety incidents under Duty of Candour.

Notifications must be completed within required timescales, with accurate records retained. Where Duty of Candour applies, {{org_field_name}} must act openly and transparently, apologise, explain what happened, provide reasonable support and keep written records.

9. Monitoring and Continuous Improvement

The Registered Manager will monitor diabetes support through governance systems that may include:

• care plan and risk assessment audits;
• MAR and medicines support audits;
• insulin storage, expiry and fridge temperature checks where applicable;
• blood glucose monitoring record audits;
• incident, near miss, safeguarding and refusal trend analysis;
• hypoglycaemia and hyperglycaemia episode reviews;
• hospital admission and discharge reviews;
• foot care escalation reviews;
• staff training, supervision and competency audits;
• feedback from people using the service, families, advocates and professionals;
• checks that reasonable adjustments and accessible information are in place;
• checks that CQC notifications and Duty of Candour actions have been completed where required.

Findings must be used to improve diabetes support, update care plans, revise risk assessments, provide staff learning, improve communication with professionals and reduce the risk of avoidable harm.

Lessons learned must be shared with relevant staff through supervision, team meetings, handovers, briefings or additional training. Actions must be recorded, allocated to responsible persons and reviewed for completion.

10. Policy Review

This policy will be reviewed at least annually or sooner if required due to:

• changes in legislation, statutory guidance, CQC regulations or CQC guidance;
• changes to CQC’s assessment framework or quality statements;
• changes to NICE guidance or local NHS diabetes pathways;
• new patient safety alerts, medicines alerts or insulin device guidance;
• learning from incidents, safeguarding concerns, complaints, audits or hospital admissions;
• feedback from people using the service, families, advocates, staff, commissioners or healthcare professionals;
• changes in the services provided by {{org_field_name}}.

The Registered Manager is responsible for ensuring that staff are informed of relevant changes and that training, competency assessments, care plans and risk assessments are updated where required.

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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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.