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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Dignity in Care Policy

1. Purpose

The purpose of this policy is to ensure that every person receiving support from {{org_field_name}} is treated with dignity, respect, compassion and kindness at all times. This includes respecting each person’s privacy, autonomy, independence, relationships, communication needs, culture, identity, choices, rights and home life.

This policy applies to the delivery of supported living services in England where {{org_field_name}} provides the regulated activity of Personal care. It recognises that people living in supported living settings live in their own home, whether alone or in shared accommodation, and that staff must respect the person’s tenancy, licence, occupancy agreement, private space and ordinary domestic rights.

This policy supports compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, CQC’s current provider guidance and CQC’s single assessment framework. It is particularly relevant to 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 16, Receiving and acting on complaints; Regulation 17, Good governance; Regulation 18, Staffing; and Regulation 20, Duty of Candour.

2. Scope

This policy applies to:

• All directors, the nominated individual, the registered manager, deputy managers, team leaders, care and support workers, agency workers, volunteers, students and contractors working on behalf of {{org_field_name}}.
• All people receiving supported living services from {{org_field_name}}.
• Family members, representatives, advocates and others lawfully involved in a person’s care and support.
• All settings where {{org_field_name}} provides support, including a person’s own room, shared areas, community settings, vehicles and digital or remote communication.

This policy covers:

• Respect for privacy, dignity, autonomy, independence and choice.
• Dignified delivery of personal care and intimate support.
• Respect for the person’s home, tenancy, possessions, keys, bedroom and shared living arrangements.
• Consent, mental capacity, best interests and supported decision-making.
• Equality, diversity, inclusion, human rights and reasonable adjustments.
• Communication, accessible information and advocacy.
• Confidentiality, records, digital dignity and data protection.
• Relationships, sexuality, family contact, visitors and social inclusion.
• Staff conduct, language, boundaries and professional behaviour.
• Reporting, investigating and learning from dignity concerns, complaints and safeguarding issues.

3. Related Policies

• Person-Centred Care Policy (SL07)
• Safeguarding Adults from Abuse and Improper Treatment Policy (SL13)
• Dignity and Respect Policy (SL08)
• Mental Capacity and Deprivation of Liberty Safeguards Policy (SL39)
• Confidentiality and Data Protection (GDPR) Policy (SL34)

• Equality, Diversity and Human Rights Policy.
• Accessible Information and Communication Policy.
• Consent to Care and Treatment Policy.
• Complaints Policy (SL14).
• Duty of Candour Policy.
• Staff Code of Conduct.
• Learning Disability and Autism Training Policy.
• Positive Behaviour Support and Restrictive Practice Policy, where applicable.
• Medication Policy, where support with medicines is provided.
• Records and Care Planning Policy.
• Lone Working Policy.
• Key Holding and Access to People’s Homes Policy, where applicable.
• Relationships and Sexuality Policy, where applicable.

4. Policy Statement

{{org_field_name}} is committed to ensuring that dignity is embedded in every aspect of care and support. People must be treated as individuals with their own life history, strengths, culture, beliefs, communication style, relationships, routines, preferences, risks, aspirations and rights.

Staff must support people to have choice and control over their daily lives and must not make assumptions based on disability, age, diagnosis, appearance, communication style, mental capacity, religion, ethnicity, sex, sexual orientation, gender reassignment, marital or civil partnership status, pregnancy or maternity, or any other personal characteristic.

In supported living, staff are entering or working within a person’s own home. Staff must behave as guests and professionals, not as people in control of the home. Staff must seek permission before entering private spaces, using possessions, opening cupboards, moving belongings, inviting others into the home, using keys, or discussing the person’s private affairs.

Dignity concerns will be taken seriously. Any concern involving humiliation, neglect, discriminatory treatment, avoidable distress, disregard of consent, unnecessary restriction, privacy breaches, abuse or improper treatment must be reported, recorded, investigated and acted upon in line with {{org_field_name}}’s safeguarding, complaints, duty of candour and governance procedures.

5. Principles of Dignity in Care

The following principles must guide all care and support:

• Respect and compassion: People must be treated with kindness, empathy, patience and courtesy.
• Choice and control: People must be supported to make decisions about their daily lives, routines, care, support, relationships, activities and home.
• Privacy: People’s bodies, personal care, rooms, possessions, correspondence, finances, records, conversations and digital information must be protected from unnecessary intrusion.
• Independence: Staff must do with, not do for, unless the person asks for help or assessed needs require support.
• Equality and human rights: Staff must respect protected characteristics, cultural identity, personal beliefs, lifestyle, sexuality, relationships and family life.
• Communication: Information must be provided in a way the person can understand, including accessible formats, communication aids, interpreters, advocates or involvement of people lawfully acting on the person’s behalf.
• Consent and capacity: Care and support must only be provided with valid consent, unless the person lacks capacity for the specific decision and lawful best interests processes are followed.
• Safety without unnecessary restriction: Any restriction, supervision or intervention must be lawful, necessary, proportionate, the least restrictive option and clearly recorded.
• Inclusion: People must be supported to maintain relationships, access the community and take part in meaningful activities of their choosing.
• Accountability: Staff must report poor practice, dignity concerns, abuse, neglect, discrimination and privacy breaches immediately.

5.1 Legal and CQC Framework

{{org_field_name}} will ensure that dignity in care is delivered in line with the following legal and regulatory requirements:

• Health and Social Care Act 2008: Establishes CQC’s regulatory role and the requirement for providers of regulated activities to be registered.
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:
  • Regulation 9: Care and treatment must be appropriate, meet needs and reflect preferences.
  • Regulation 10: People must be treated with dignity and respect, including privacy, autonomy, independence and regard to protected characteristics.
  • Regulation 11: Care and treatment must only be provided with consent, unless lawful exceptions apply.
  • Regulation 12: Care and treatment must be provided safely.
  • Regulation 13: People must be protected from abuse and improper treatment.
  • Regulation 16: Complaints must be received, investigated and acted upon.
  • Regulation 17: Systems must assess, monitor and improve the quality and safety of services.
  • Regulation 18: Staff must be suitably trained, competent, skilled and supported.
  • Regulation 20: The provider must act in an open and transparent way where notifiable safety incidents occur.
• Mental Capacity Act 2005: People must be presumed to have capacity unless established otherwise, supported to make their own decisions, and any act or decision made for a person who lacks capacity must be in their best interests and the least restrictive option.
• Equality Act 2010: People must not be discriminated against and reasonable adjustments must be made where required.
• Human Rights Act 1998: Staff must respect people’s rights, including respect for private and family life, freedom of thought, conscience and religion, freedom of expression, liberty and security.
• Care Act 2014: Staff must promote wellbeing and act to prevent, identify and respond to abuse or neglect.
• Data Protection Act 2018 and UK GDPR: Personal information must be processed lawfully, fairly, securely and confidentially.

This policy also supports CQC’s current single assessment framework. Evidence of dignity in care may be considered under the Safe, Effective, Caring, Responsive and Well-led key questions and relevant quality statements, including kindness, compassion and dignity; independence, choice and control; equity in experiences and outcomes; person-centred care; consent to care and treatment; safeguarding; governance, management and sustainability; and learning, improvement and innovation.

6. Ensuring Dignity in Daily Care

6.1 Personal Care and Intimate Support

When providing personal care or intimate support, staff must:

• Ask the person how they want support to be provided before care starts.
• Gain consent before each intervention, including washing, dressing, continence care, oral care, shaving, hair care, support with menstrual care, support with medicines or any other personal task.
• Explain what they are doing before and during support, using communication methods the person understands.
• Close doors, curtains or blinds and ensure the person’s body is covered as much as possible.
• Avoid unnecessary exposure of the person’s body.
• Offer choices about timing, clothing, toiletries, grooming, appearance and who provides support, where reasonably practicable.
• Respect the person’s gender, cultural, religious or personal preferences about intimate care.
• Use respectful language and avoid comments, jokes, facial expressions or gestures that could embarrass, shame, infantilise or distress the person.
• Encourage the person to do as much as they can safely do for themselves.
• Record any refusal of care, change in preference, distress, pain, injury, concern or dignity issue and escalate where required.

Staff must never use personal care as a task to be completed quickly at the expense of dignity, comfort, consent or emotional wellbeing.

6.2 Eating, Drinking and Mealtime Dignity

• People must be supported to choose what, when and where they eat and drink, subject to assessed risks and agreed care plans.
• Staff must respect cultural, religious, ethical, sensory, health-related and personal dietary preferences.
• Where a person needs support to eat or drink, staff must provide support discreetly, patiently and at the person’s pace.
• Staff must not rush people, stand over them unnecessarily, talk over them, or discuss personal matters while supporting them to eat.
• Adaptive equipment must be offered where it promotes independence and dignity.
• Where there are risks of choking, aspiration, malnutrition, dehydration or eating disorders, staff must follow the care plan, speech and language therapy guidance, dietetic guidance or other professional advice.
• Any concern about nutrition, hydration, weight loss, swallowing, refusal of food or distress at mealtimes must be recorded and escalated.

6.3 Communication and Engagement

Staff must communicate in a way that promotes dignity, involvement and understanding. Staff must:

• Address people by their preferred name and pronouns.
• Speak directly to the person, not about them as though they are not present.
• Use plain language and avoid jargon.
• Allow the person enough time to process information and respond.
• Use the person’s preferred communication method, including objects of reference, pictures, signs, gestures, communication books, digital aids, interpreters or advocates where required.
• Check understanding without patronising the person.
• Support people to express choices, feelings, concerns, complaints and preferences.
• Avoid shouting, dismissive language, sarcasm, threats, blaming, infantilising language or labels.
• Record communication needs and ensure staff understand them before providing support.

Where a person has communication needs, {{org_field_name}} will make reasonable adjustments and provide information in a format the person can understand.

6.4 Supported Living and Respect for the Person’s Home

Supported living is provided in a person’s own home. Staff must always respect that they are entering or working in the person’s private living space. Staff must:

• Knock or seek permission before entering the person’s room, flat or private space, unless there is an immediate risk of serious harm.
• Use keys, key safes or access codes only as authorised in the care plan and risk assessment.
• Never use a person’s belongings, food, drink, telephone, television, internet, toiletries, money or household items without permission.
• Never move, dispose of or search a person’s possessions unless the person consents or there is a lawful and recorded reason.
• Respect the person’s right to visitors, relationships and private time, unless there is a lawful safeguarding or risk-based reason for agreed restrictions.
• Maintain dignity in shared accommodation by respecting house agreements, privacy, personal boundaries and the rights of each tenant or occupier.
• Avoid institutional routines, staff-centred rules or restrictions that are not based on the person’s assessed needs, wishes and lawful care plan.
• Ensure staff discussions, handovers and telephone calls do not compromise privacy in shared areas.
• Support the person to raise concerns about housing, repairs, neighbours or tenancy matters, while recognising that care and housing arrangements must remain separate.

7. Promoting Autonomy, Independence and Choice

{{org_field_name}} will support people to exercise choice and control over their daily lives. Staff must:

• Support people to make ordinary daily choices, including when to get up, what to wear, what to eat, how to spend their time, who to see and when to receive support.
• Encourage people to develop and maintain skills, rather than creating avoidable dependence.
• Use strengths-based approaches that recognise what the person can do, what matters to them and what outcomes they want to achieve.
• Offer adaptive equipment, assistive technology and environmental adjustments where these promote independence.
• Support positive risk-taking where risks are assessed, discussed, proportionate and reviewed.
• Avoid blanket restrictions, rigid routines or staff-led rules that reduce independence without lawful justification.
• Review care and support plans regularly to identify opportunities for increased independence, community involvement and personal development.
• Record the person’s goals, preferences, strengths and decisions in their care plan.

People have the right to make choices that others may consider unwise, provided they have capacity for the specific decision and there is no lawful basis for intervention.

8. Privacy, Confidentiality and Digital Dignity

Staff must protect each person’s privacy and confidential information. This includes:

• Personal care and intimate support.
• Health, care and support records.
• Medication information.
• Financial information.
• Relationships, sexuality and family matters.
• Correspondence, telephone calls, emails, photographs and digital messages.
• Conversations with professionals, advocates, family members or representatives.
• Information about complaints, safeguarding concerns or incidents.

Staff must not discuss confidential information in public areas, shared accommodation, vehicles, corridors, shops, cafés, online spaces or anywhere they may be overheard. Information must only be shared where the person has consented, where a lawful representative is involved, where sharing is necessary for safe care, or where there is a legal safeguarding, regulatory or public interest requirement.

Staff must not take photographs, videos or audio recordings of people, their home or their possessions on personal devices. Any approved use of images or recordings must follow {{org_field_name}}’s consent, confidentiality and data protection procedures.

Care records must be factual, respectful, necessary, accurate and written in language that the person would not find humiliating or disrespectful.

9. Relationships, Social Inclusion and Community Life

People must be supported to maintain relationships and take part in community life in ways that matter to them. Staff must:

• Support contact with family, friends, partners, advocates and chosen networks, unless there is a lawful safeguarding or best interests reason to restrict contact.
• Respect people’s right to private and family life.
• Support people to access education, employment, volunteering, faith groups, hobbies, leisure, health appointments and community facilities.
• Respect people’s sexuality, gender identity, personal relationships and choices about intimacy.
• Provide support with digital inclusion where this is part of the person’s care and support plan.
• Avoid making assumptions about a person’s relationships, lifestyle, culture or capacity to form relationships.
• Report any concern about coercion, exploitation, abuse, domestic abuse, mate crime or undue influence in line with safeguarding procedures.

10. Staff Training and Responsibilities

10.1 Training and Awareness

All staff must receive induction, supervision and refresher training relevant to dignity in care. Training must include, as appropriate to role:

• Dignity, respect, compassion and person-centred care.
• Privacy and confidentiality.
• Consent and the Mental Capacity Act 2005.
• Safeguarding adults and recognising abuse, neglect, discrimination and improper treatment.
• Equality, diversity, inclusion, human rights and reasonable adjustments.
• Communication needs and accessible information.
• Positive behaviour support and least restrictive practice, where relevant.
• Supporting independence, choice and positive risk-taking.
• Professional boundaries and conduct in a person’s own home.
• Data protection and digital dignity.
• Complaints, whistleblowing, duty of candour and incident reporting.
• Learning disability and autism training appropriate to the staff member’s role.

Staff must not provide care or support unless they have the skills, knowledge, competence and supervision required for their role.

10.2 Staff Behaviour, Language and Professional Boundaries

Staff must behave in a way that protects dignity at all times. Staff must:

• Be polite, kind, patient and respectful.
• Treat adults as adults and avoid infantilising language or behaviour.
• Avoid gossip, sarcasm, ridicule, shouting, swearing, threats, intimidation or dismissive comments.
• Avoid speaking about people as tasks, conditions, room numbers, behaviours or dependency levels.
• Respect the person’s home, possessions, routines and private life.
• Maintain professional boundaries and not use the person’s home for staff convenience.
• Avoid unnecessary use of mobile phones while providing support.
• Wear appropriate clothing and identification in line with {{org_field_name}}’s policy.
• Challenge and report poor practice by colleagues.
• Apologise when dignity has not been upheld and take immediate steps to put things right.

Examples of unacceptable practice include:

• Ignoring a person while providing care.
• Discussing a person’s personal care in front of others.
• Leaving a person exposed during personal care.
• Entering a person’s room without permission.
• Mocking, teasing or belittling a person.
• Withholding choices as a punishment.
• Using blanket rules without individual assessment.
• Sharing images, videos or information about a person without lawful authority.
• Treating the supported living setting as a workplace controlled by staff rather than the person’s home.

10.3 Managers’ Responsibilities

The registered manager and senior staff must ensure that:

• Dignity standards are explained during induction and supervision.
• Staff rotas, deployment and matching take account of people’s preferences, communication needs, cultural needs and privacy needs.
• Care plans include clear information about dignity, privacy, consent, personal care preferences, communication and independence.
• Dignity concerns are recorded, investigated and used for learning.
• People are asked about their experience of dignity, respect and involvement.
• Audits, spot checks, observations and feedback are used to monitor whether dignity is being upheld.
• Staff who fail to uphold dignity are supported, retrained, supervised, performance managed or subject to disciplinary action, depending on the seriousness of the concern.
• Safeguarding referrals, CQC notifications, complaints responses and duty of candour processes are completed where required.
• Lessons learned are shared with staff and embedded into practice.

11. Handling Dignity Concerns, Complaints and Safeguarding Issues

People must be supported to speak up if they feel their dignity, privacy, choice, independence or rights have not been respected. Concerns may be raised by the person, a family member, advocate, representative, staff member, professional or any other person.

Staff must:

• Listen respectfully and take the concern seriously.
• Support the person to raise the concern in their preferred communication format.
• Reassure the person that they will not be treated unfairly for speaking up.
• Record the concern factually and promptly.
• Report the concern to a manager without delay.
• Take immediate action to protect the person from further distress, harm, humiliation, abuse or privacy breaches.
• Follow the Complaints Policy where the person wishes to complain.
• Follow the Safeguarding Adults from Abuse and Improper Treatment Policy where the concern indicates abuse, neglect, discrimination, improper treatment or organisational abuse.
• Follow the Duty of Candour Policy where a notifiable safety incident has occurred.
• Consider whether CQC, the local authority safeguarding team, commissioners, police or other bodies need to be notified.

Dignity concerns must be reviewed for themes and learning. {{org_field_name}} will use complaints, safeguarding concerns, incidents, compliments, surveys, audits and feedback to improve practice.

11.1 Consent, Capacity and Advocacy

Staff must seek consent before providing care or support. Consent must be voluntary, informed and specific to the decision or intervention.

Staff must assume that a person has capacity unless it is established that they lack capacity for the specific decision at the specific time. Staff must support the person to make their own decision by providing information in a way they can understand, allowing time, using communication aids and involving people who can support communication where appropriate.

Where there is reason to believe that a person may lack capacity for a specific decision, staff must follow the Mental Capacity Act 2005 and {{org_field_name}}’s Mental Capacity Policy. Any best interests decision must:

• Be decision-specific.
• Involve the person as much as possible.
• Consider the person’s wishes, feelings, beliefs and values.
• Consult relevant people, where appropriate and lawful.
• Choose the least restrictive option.
• Be recorded clearly.

Advocacy must be offered or arranged where the person has substantial difficulty being involved, has no appropriate person to support them, or where advocacy is required under the Care Act 2014, Mental Capacity Act 2005 or other applicable process.

Staff must not assume that family members or others can consent on behalf of a person unless they have lawful authority, such as a relevant lasting power of attorney, deputyship or another recognised legal basis.

11.2 Equality, Diversity, Inclusion and Human Rights

{{org_field_name}} will promote dignity by respecting each person’s equality, diversity, inclusion and human rights. Staff must not discriminate, harass, victimise or treat people less favourably because of any protected characteristic or personal circumstance.

Staff must consider and respect:

• Age.
• Disability.
• Gender reassignment.
• Marriage and civil partnership.
• Pregnancy and maternity.
• Race, nationality, ethnic origin and language.
• Religion or belief.
• Sex.
• Sexual orientation.
• Culture, identity, lifestyle, family arrangements and personal history.

Reasonable adjustments must be made where required. This may include changes to communication, staff approach, timing of support, equipment, environment, information format, routines or involvement of advocates and representatives.

Any discriminatory behaviour by staff, people using the service, visitors, professionals or others must be challenged, recorded and escalated.

11.3 Restrictions, Restraint and Least Restrictive Practice

Any restriction on a person’s privacy, liberty, movement, contact, choices, possessions, access to the community, food, drink, money, visitors, phone, internet or personal space must be lawful, necessary, proportionate, risk assessed, recorded and reviewed.

Staff must not impose blanket restrictions for staff convenience, organisational routine or generalised risk avoidance. Any restriction must be based on the person’s individual needs and must be the least restrictive option available.

Where restrictive practice, restraint, continuous supervision or deprivation of liberty may be involved, staff must escalate this immediately to the registered manager and follow the Mental Capacity and Deprivation of Liberty Safeguards Policy, safeguarding procedures and any applicable legal process.

12. CQC Compliance and Evidence

This policy supports compliance with the following Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

• Regulation 9 – Person-centred care: Care and support must be appropriate, meet the person’s needs and reflect their preferences.
• Regulation 10 – Dignity and respect: People must be treated with dignity and respect, including respect for privacy, autonomy, independence and protected characteristics.
• Regulation 11 – Need for consent: Care and support must only be provided with valid consent, unless lawful exceptions apply.
• Regulation 12 – Safe care and treatment: Dignity must not be compromised by unsafe, rushed, poorly planned or poorly communicated care.
• Regulation 13 – Safeguarding service users from abuse and improper treatment: Humiliation, neglect, discriminatory abuse, unauthorised restraint, degrading treatment and privacy breaches may amount to safeguarding concerns.
• Regulation 14 – Meeting nutritional and hydration needs: Where {{org_field_name}} supports eating and drinking, this must be done safely, respectfully and in line with the person’s needs and preferences.
• Regulation 16 – Receiving and acting on complaints: People must be able to raise dignity concerns and have them investigated and acted upon.
• Regulation 17 – Good governance: Dignity must be monitored through care plan reviews, audits, feedback, complaints, incidents, safeguarding reviews and quality assurance systems.
• Regulation 18 – Staffing: Staff must be competent, skilled, trained, supervised and deployed in a way that protects dignity.
• Regulation 20 – Duty of Candour: Where a notifiable safety incident occurs, {{org_field_name}} must act openly, apologise and provide required information and support.

This policy also supports CQC’s current single assessment framework. Relevant quality statements include, but are not limited to:

• Kindness, compassion and dignity.
• Independence, choice and control.
• Person-centred care.
• Consent to care and treatment.
• Safeguarding.
• Equity in experiences and outcomes.
• Responding to people’s immediate needs.
• Workforce wellbeing and enablement.
• Governance, management and sustainability.
• Learning, improvement and innovation.

Evidence that may demonstrate compliance includes:

• Person-centred care plans and reviews.
• Mental capacity and best interests records.
• Consent records.
• Communication passports or accessible information records.
• Staff training records.
• Supervision and competency checks.
• Spot checks and observations.
• Quality audits.
• Complaints and compliments.
• Safeguarding records.
• Incident reports and learning actions.
• Feedback from people, relatives, advocates and professionals.

13. Policy Review

This policy will be reviewed at least annually, or sooner if:

• There are changes to legislation, statutory guidance or CQC requirements.
• CQC publishes relevant changes to provider guidance or assessment methodology.
• A dignity-related complaint, safeguarding concern, incident, audit or quality review identifies required improvements.
• Feedback from people using the service, families, advocates, staff or professionals indicates that the policy requires amendment.
• {{org_field_name}} changes the type, scope or delivery model of its supported living services.

The registered manager is responsible for ensuring that the policy remains current, implemented in practice and understood by staff.

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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.