WCH6. Admissions and Commencement of Service in Care Homes
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Admissions and Commencement of Service in Care Homes (Wales) Policy
Policy Statement
This policy sets out:
- how the home handles referrals of prospective people receiving care
- to make sure that everyone is satisfied that the home will meet their needs
- to organise the admission in ways which gives the new people receiving care the best possible start to their life in the home.
{{org_field_name}} considers that much of the success of a period of residence lies in making the correct decisions and taking appropriate action at the time of a person receiving care’s referral and admission. It therefore works in its admission and referral policies to achieve the requirements of Regulation 14: Suitability of Service of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.
Regulation 14 requires {{org_field_name}} to have an “admissions and commencement of the service policy and procedure”, which includes reference to:
- arrangements for confirming that the service can or cannot provide a suitable service
- details about the consultation process involved and the information to be considered
- the assessment processes (including for emergency admissions), including who will undertake the assessment
- the circumstances where a service will not be provided
- opportunities to visit a care home which is under consideration
- the arrangements for start of service.
{{org_field_name}} has a suite of policies that meet these requirements, including Needs Assessment in Care Homes, Information Provision for Prospective People Receiving Care, Trial Visits, People Receiving Care Bringing Private Property Into the Home, Person Receiving Care’s Contracts and Key Workers.
The home’s approach to its referrals and admissions is also consistent with the Social Services and Well-being (Wales) Act 2014, and recommendations of A Place to Call Home (Wales Commissioner for Older People 2014).
The home will follow Wales Government and public health guidance in respect of admissions during emergencies such as outbreaks of Covid-19 and other infectious illnesses, including those referred through hospital discharge arrangements.
Policy on Referrals and Admissions
Referrals and applications*
*The sources of a given home’s referrals and applications will vary according to the type of home and local factors.
- Referrals from people following local authority/health services assessment — The home could receive enquiries or applications from or on behalf of people:
a. whose care and support needs have been assessed by their local authority and relevant health services
b. who have met national eligibility criteria
c. who have a care and support plan that indicates that a care home will be the best way of meeting their needs
d. who have agreed that the local authority should arrange their care
e. who could be receiving local authority funding to meet their care needs.
Note:
Such applications will usually be made to homes that have been contracted or commissioned by a local authority to provide care to its specifications by being on an approved list or direct contract. Such applications might also be made for people needing care and/or continuing nursing care following discharge from hospital. Local procedures will apply in these different circumstances.
In the event of any referral by these means, {{org_field_name}} manager will give an immediate reaction on the vacancy position, time scales and so on, and if appropriate, request information from their care and support plan, which should enable the home to assess its capacity to meet the person’s needs.
If the referral appears suitable, the home will then ask for the full written needs assessment (if not already supplied). For its part, the home will provide any information requested or needed by the applicant. A meeting with the prospective person receiving care, preferably in the form of a visit accompanied by their local authority social worker/relative/friend and/or lawful representative — as appropriate will then be arranged. If the person receiving care would like us to meet them in their own home or at another location, for example, hospital that can be arranged if practical. - Referrals made independently of the local authority — A prospective person receiving care who intends to pay for their own care might not have had a full needs assessment by their local authority although, in line with the Social Services and Well-being (Wales) Act 2014, they are entitled to one. Where the prospective person receiving care prefers not to have their needs assessed by the local authority and is acting independently of it, the home will employ a qualified person to carry out its own needs assessment equivalent to that provided by the local authority.
A key aim of the initial stage in all cases is to make sure that the home is fully aware of the person’s needs and has the resources to meet them. The home will decide about admitting the person in principle based on this assessment, and terms and conditions and/or a contract can then be agreed.
Procedures Following a Decision to Consider Admission
- Pre-admission assessments — Where a pre-assessment is required in a person’s own home, the manager or team dealing with the application will:
a. check that it has all available information from the referral to enable it to proceed, including such matters as the urgency of the potential admission and that it lies within the home’s scope and eligibility criteria
b. arrange with the prospective person receiving care and/or person(s) who are lawfully representing the person(s) dates and times for the assessment visit(s)
c. check that the person is giving their consent to the assessment/has been given through a best interests assessment in line with Mental Capacity Act 2005 requirements
d. check if there are any safety risks to the people carrying out the assessment and put appropriate measures in place if there are, for example, for assessor and/or the prospective person receiving care to be supported throughout the assessment
e. check if there are any specific requirements to enable the assessment to be carried out, eg if the person has communication difficulties
f. check the assessment on completion that it is sufficiently comprehensive including risk assessments to enable both parties to take informed decisions about the proposed care and support arrangements
g. check if any agreed move is with the consent of the person or if the person cannot give their informed consent that any decision taken meets the requirements of the Mental Capacity Act 2005. If the person is being deprived of their liberty because of the move that the decision is fully authorised in line with current requirements. - Pre-admission visits — We will try to give a prospective person receiving care as full and honest an impression of the home as possible. They will have the chance to talk with the manager and other appropriate staff, to speak with other people receiving care, to take a meal with people receiving care, to view the house and grounds, and then to talk privately with their relative or representative. We understand that they may be visiting more than one home and we want a person receiving care to make a positive choice to come to {{org_field_name}}.
- Meeting needs — In line with its registration requirements, the home must be satisfied that it has the capacity to meet the needs of any prospective person receiving care before agreeing to an admission. We will discuss this issue with the prospective person receiving care, and their relatives/lawful representative/local authority social worker as appropriate, and if it is necessary to decline to admit someone who wishes to come to the home we will frankly tell them the reasons. We believe that clarity at this stage can avoid a much more painful breakdown of a placement later.
- Trial visits — We offer every prospective person receiving care the possibility of a trial visit or period of residence and will discuss and agree the terms and conditions of the “trial period” with the person and their representatives as appropriate.
- Admissions — If everyone is satisfied that an admission to {{org_field_name}} is the right step, we will arrange for the person receiving care to be admitted. We suggest that, if possible, they should be accompanied by a friend or representative on the day of admission. We will allocate staff at the appointed time to make the new person receiving care welcome, to introduce them to other staff and people receiving care, to help them settle into their room providing whatever help is required, and to be a point of reference for any further information the person receiving care needs. Every new person receiving care is provided with a welcome pack [see Wales Commissioner for Older People (2014): A Place to Call Home].
- Emergency admissions — We try to avoid unplanned and emergency admissions, but recognise that situations sometimes arise which make rapid action necessary. In these instances, we apply the procedures governing planned admissions and gather and supply all necessary information as soon as practically possible. (See separate Emergency/Unplanned Admissions Policy.)
- Mental capacity — The home assumes that prospective people receiving care will give their written consent to their moving into the home and to its provisions. Where the person is unable to give their formal consent because of lack of mental capacity, the home will ensure that all due Mental Capacity Act processes have been followed and will ascertain if there will be any deprivation of liberty that requires safeguarding through the DoLS authorisation procedures.
- Settling in — We will provide all possible help to make the new person receiving care’s introduction to the home as comfortable an experience as possible, will introduce them gradually to the home’s policies and procedures, and will set in motion as soon as possible the drawing up of their person receiving care plan, which will be developed from the needs assessment.
- Provider assessment — The home proceeds by carrying out its own assessment in the first seven days of a person’s residence with the full involvement of the new person receiving care in line with the requirements of Regulation 18 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. The outcome is an agreed personal plan for that individual.
Training
All staff receive training in line with their roles and responsibilities in the handling of referrals and admissions.
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