As a member of the Westminster Homecare Team, you are part of a highly professional organisation. We will give you all the help, back-up and support that you need. Our Philosophy We believe in respecting the wishes of individual clients at all times. We are aware of, and respect, clients’ ethnic backgrounds and their religious beliefs.


Joining Westminster Homecare: Your Employment Status.

When carrying out domiciliary work under contract for local authorities or similar bodies, or looking after private individuals in their own homes, Westminster Homecare contracts to act as a principal rather than an agent. In such circumstances, you may be invited to take up employment with Westminster Homecare for the time you spend on such work and will be given a contract of employment for that work. Note: Sometimes, Westminster Homecare acts as an employment agent and when you carry out such assignments arranged for you by Westminster Homecare, your employment status is that of a self-employed person. Westminster Homecare assumes no responsibilities as an employer when acting as an agent. When acting as an agent, Westminster Homecare gives no firm commitment to find or offer temporary or permanent work for any member; you, on the other hand, have the right to accept or decline any agency work offered to you by Westminster Homecare. When you join Westminster Homecare as a member, you are provided with a statement detailing the terms and conditions of membership. Those conditions should be read in conjunction with the contents of this handbook.


Interviews and References. Before you may be placed on an assignment of any kind through Westminster Homecare, you must have attended for a personal interview, had any qualifications verified and had your references checked and attended an induction session. Police Checks. If you are to be assigned work where you have access to children, we will be required to check for the existence of criminal records. We will not do this without your permission which we will normally require in writing. Equal Opportunities. Westminster Homecare is an equal opportunities organisation. Our position is to ensure that no applicant receives less favourable treatment on grounds of sex, marital status, race, religion, colour, nationality, ethnic origin, age or disability. Confidentiality. You are reminded that to comply with Westminster Homecare policy and the Data Protection Act, all information relating to clients, their treatment and their affairs regardless of source, is confidential. You should be aware that breaches of confidentiality can lead to your removal from membership of Westminster Homecare and/or to civil actions being brought against you for damages. Harassment. Any member experiencing harassment at work should always tell their manager or supervisor immediately. Westminster Homecare will not tolerate any form of sexual or racial harassment. We will always investigate any complaint of harassment immediately - sensitively and without prejudice. 2. Ceasing to be a Member of Westminster Homecare.

Resignation or Retirement. If, for any reason, you decide that you no longer wish to be a member of Westminster Homecare, please notify your Westminster Homecare branch in order that our records can be amended accordingly. At the same time, you should arrange to return to Westminster Homecare any name badge or identity card and also any equipment and uniform that may have been issued to you. 2

Removal from the Westminster Homecare Register of Members. There are a number of circumstances following which Westminster Homecare will normally remove you from membership:         3. disclosure of information confidential to a client or confidential to Westminster Homecare, or any similar breach of trust. failure to report non-attendance with a client after having accepted the assignment. failing to provide care in a manner appropriate to the client's needs and care plan. refusing to carry out the reasonable instructions of the client. drinking on duty or being under the influence of unprescribed drugs. stealing or misappropriating client's property. indulging in abusive or violent behaviour or harassment or using coarse language. habitual lateness. Staff Grievances.

Policy A grievance is a dissatisfaction with anything in Westminster Homecare which is thought to be inconsiderate, unjust or unfair. Westminster Homecare believes that employees should use the established grievance procedure freely so that management may be assisted in identifying sources of dissatisfaction and eliminate them. Procedure Step 1. The aggrieved employee should talk to his/her Co-ordinator / Branch Manager and explain his/her grievance. If the Co-ordinator / Branch Manager is unable to resolve the grievance immediately the he/she is required to report back, normally within one week. If, after discussion with the Co-ordinator / Branch Manager, it is felt that the matter has not been 3

satisfactorily resolved, and the employee wishes to proceed further, then he/she should go to Step 2. Step 2. At this stage the grievance should be discussed with the Client Services Manager who is obliged to report back, normally within one week. If the matter remains unresolved and it is wished to proceed further, then the employee should proceed to Step 3. Step 3. At this stage the employee should formally request, in writing, that his/her grievance be considered by the General Manager. The written request need not contain a detailed statement of the case. The employee will be given the opportunity to discuss the entire grievance, together with any replies. A written response will be prepared, normally within one week. Some individual cases may require additional time before a determination can be made, in which case the employee will be informed of the likely delay. The General Manager has been delegated full responsibility for Westminster Homecare operations. Accordingly his/her decisions must be regarded as final and binding. Notes. 1. At no time does the grievance have to be stated fully in writing. 2. An employee may invite a colleague to accompany him/her as a spokesperson to assist at any step in the procedure. 3. No employee will be reprimanded or made to suffer harassment or punishment from anyone within Westminster Homecare as a result of seeking resolution of a grievance through this procedure. 4. Grievances which arise from the implementation of the disciplinary procedures should be handled by the procedures. Whistleblowing    All members of staff, who have concerns about bad practice or wrongdoing should feel able to raise these issues. Every issue raised should be taken seriously and considered fully and sympathetically. No one should fear that they may be victimised or that their jobs or future prospects may suffer if their concerns are reported.

Sometimes, things can go wrong, Westminster Homecare need to know so that steps can be taken to put things right. It is important to raise concerns, 4

even if they cannot be proven or you feel you may be acting disloyally or unfairly to colleagues. What to do :  Tell your manager your concerns, making sure they are not based on rumour or malice and that they are accurate.  Find an alternative person like the training or recruitment manager to discuss your concerns if they involve your manager. When to raise concerns.  A client is being harmed or abused or denied a service because of some form of discrimination.  A policy is being wrongly implemented  You or your colleagues or clients are being put at risk by unsafe working or improper use of information.  Colleagues are not observing company policy or procedures.  Fraudulent, improper or unauthorised use is being made of money or assets belonging to company or clients.  Gifts (including legacies) or advantages have been obtained from clients. What happens.  A manager will investigate to decide action to be taken. If necessary, certain allegations may be reported to the police and precedings taken.  You will be informed about the investigation and its outcome.  Support will be available should you suffer any distress.     Where a concern involves you the manager will: Ensure you are fully informed about the investigation. You will be advised that you may seek support separate from the investigation. If you are not satisfied with the outcome you may contact the Social Services department that covers the area that you work in. The first approach is to the Standards Unit.


Income Tax and National Insurance.

Although, as described in the note to section 1. above, your employment status maybe that of a self-employed person, Westminster Homecare is required by law, as an employment agent, to collect Pay As You Earn Income Tax (PAYE) and Class 1 National Insurance contributions from any income you receive for carrying out your Westminster Homecare 5

assignments. Consequently, tax and national insurance will be deducted from your earnings through Westminster Homecare. These deductions do not affect your self employed status when we are acting as your agent. 5. Tax Forms.

The P45 form. A P45 should be issued to you when you cease to work for an employer or an employment agency. You should give Parts 2 and 3 to your new employer or new employment agency. They can then handle your tax, national insurance and tax code properly. When you join Westminster Homecare, you should give your P45 Parts 2 and 3 to us. Should you leave Westminster Homecare, we will issue you with a P45. The P46 form. If you do not have a P45 to give us when you join, we will ask you to complete a form P46. On this form you will be required to state whether or not you have another employer. If you have another employer, Westminster Homecare will operate a BR/1 tax code on the assumption that your tax allowances are being set against your main employment. If you do not have another employer, Westminster Homecare will forward your P46 to the appropriate office of the Inland Revenue and they will issue you with the right tax code for your circumstances. Until your new code arrives we will deduct tax in accordance with whatever Emergency Code is in force at the time. The P2 form. When the Inland Revenue changes your tax code, they will send you a Form P2 which shows you how the new code has been calculated. At the same time they will advise Westminster Homecare of your new tax code. The P60 form. If you are on the Westminster Homecare register at the end of the Tax Year, Westminster Homecare will send you a P60 Form which is a statement of your total earnings for the year and of how much tax and national insurance has been deducted from those earnings. You will need this form when you do your tax return so take good care of it as duplicates cannot be issued. The P38S. If you are a student in full-time education, it may be possible for your earnings to be paid free of tax. If you think you may be eligible for this 6

concession, ask your tax office for a P38S in order that you may apply. This concession only lasts for the tax year during which it is applied so you may have to complete a P38S more than once. 6. National Insurance.

Make sure that your Westminster Homecare branch has your National Insurance Number. Your state benefits could be affected adversely if you do not provide your number. Westminster Homecare is required to deduct full National Insurance contributions unless provided with a valid certificate of reduced liability or a valid certificate of age exemption. 7. Timesheets.

It is essential that you submit the necessary copies of a properly completed timesheet as promptly as possible after your assignment or the pay week ends. Properly completed means that the correct times and places of duty are shown using the 24 hour clock, detailing lunch breaks and writing clearly and also making sure that any necessary approval signatures are on it. Where a client is unable to sign, separate arrangements are made. Delays in submitting your timesheets and inaccuracies in timesheets lead to delays in you receiving your pay. In extreme cases they can lead to Westminster Homecare not getting paid at all. Normally, valid timesheets received by Westminster Homecare by 5pm on Monday of a payroll week should be in time to meet payroll schedules. Note: In the case of domiciliary care,when the service user, or the service user's representative, contacts Westminster Homecare in the first instance, an assessment is made and agreement is reached as to the amount of care to be given. This is discussed with you before you go on the assignment. If you feel that the situation has changed and the level of care necessary should be re-assessed, you should contact your Westminster Homecare branch to make your views known. Under no circumstances should you add extra hours to your timesheet without clearance from the Westminster Homecare Branch manager who must have first agreed this with the service user or the service user's authorised representative. 8. Payment.

Rates of pay can vary, usually depending on the location and content of the work. You should check the rate for the job with the Westminster 7

Homecare office staff whenever you are sent out on a new job. Normally, this will be made known to you at the time you are allocated the work but, if it is not, please ask. This will avoid any misunderstandings. Westminster Homecare pays its members by means of the Bankers' Automated Clearing Service (BACS) which means that you need a bank account. You must give your Westminster Homecare branch full details of your bank otherwise they cannot process your pay. If you wish to have your pay credited to a building society account rather than a bank account, please allow another day or two for the money to be credited to your account. A payment advice will be sent to you showing how your pay has been calculated. 9. Travelling Expenses.

Travelling expenses are not normally payable. A certain amount of travel is usually necessary to get to work and your pay rates reflect that. We endeavour to limit the distance you travel. If you are travelling unacceptable distances you should discuss this with your Branch Manager. 10. Statutory Maternity Pay (SMP). If you require Maternity leave, you should obtain the latest explanatory Pamphlet from your local DSS Office. This will advise you on your eligibility for any Statutory Maternity Pay and how to claim benefits. The circumstances may be such that you are entitled to SMP through Westminster Homecare and, if so, payments will be made in accordance with the current regulations. Please advise your Westminster Homecare office of your expected week of confinement as soon as you are able. 11. Statutory Sick Pay (SSP). Staff working on an agency basis are not entitled to SSP. If you have paid enough national insurance contributions, you may be able to claim sickness benefit directly from the DSS if you are unable to work because of illness. 12. Personal Pension Plans. Perhaps you have set up a personal pension plan. Westminster Homecare is not able or required to make payments into any personal pension plan you may have. Also, under the legislation as it stands, Westminster Homecare is required to deduct full national insurance deductions from you as if no personal pension scheme were in existence. However, if you take this 8

matter up directly with the DSS, it is likely that they will make a single payment - equal to any overpayment of national insurance contributions you have made - into your personal pension plan at the end of each financial year. 13. Your Tax Office. The address of the Inland Revenue Office which deals with your tax affairs in respect of your work through Westminster Homecare is as follows: H M Inspector of Taxes Bootle Maritime The Triad Stanley Road Bootle Merseyside L75 2TT Telephone: 0151 300 1217 If you have an enquiry about your tax code, this is where you should call or write. If you do so, you should quote the Westminster Homecare reference number which is: 992 WW 5341 14. Communicating with your Westminster Homecare Branch. For our relationship with you to work to your best advantage, you must give your Westminster Homecare branch as much notice as possible of the days and times that you are available to work or of any changes to your normal work pattern. Your Westminster Homecare branch works hard to find work for you and it can be very frustrating for them if, having found you work at the times you prefer, you cannot be contacted. So, if you are going to be out at the time when we are most likely to contact you, call the office and let us know either where you can be contacted or when you will be back. You must inform Westminster Homecare, in writing, when you intend to take holiday. If there is no work immediately available for you, unless you ask us not to, we will put you on a waiting list as being available for any work that comes in late and we will call you when we have something. It is very important that you let us know if you change your mind and do not want to work; 9

please call us and let us know if you want us to take your name off the waiting list. Westminster Homecare operates a 24-hour service to ensure continuity of cover for clients and service users. This is an emergency service and is not to be used for routine enquiries and you should call your branch (during normal office hours). However, should you need to contact us urgently outside these hours, telephone your Westminster Homecare branch and you will be put in direct touch with our on-call staff (or you will hear a recorded message advising you of the appropriate number to call). 15. Punctuality and Reliability. Westminster Homecare considers punctuality to be an essential requirement of your work with us. Always arrive on time, if not a little early, for your assignments. If, as the result of some emergency, you are going to be late for an assignment, you must let Westminster Homecare know. Once you have accepted an assignment from Westminster Homecare, we naturally expect that work to be carried out. Total reliability is expected from you and it is vital that clients or other service users are never let down in any way. 16. Uniforms and Dress Code. Carers assigned through Westminster Homecare must wear (white) uniforms unless an alternative has been agreed by Westminster Homecare with the client. You can buy these through your Westminster Homecare branch. Women: White Westminster Homecare uniform dress, sensible shoes.


White Westminster Homecare tunic, black trousers, black lace-up shoes.

When caring for clients, hair must be clean and tidy at all times. Shoulder length and longer hair must be tied back. No decorative grips, clips or hair accessories should be worn. Fingernails must be kept clean and short. No nail varnish may be worn. No jewellery may be worn other than wedding rings or plain gold ear studs.


17. Immunisation. Westminster Homecare members are responsible for their own immunisation needs. Your Westminster Homecare branch will advise you of any vaccine you are required to have before starting work. Normally, any vaccine will be administered by your GP, a statutory charge being payable for the cost of the vaccine. 18. Complaints and Quality Control.

The Westminster Homecare Quality System includes a grievance and complaints procedure. All complaints are investigated. Should you be found to have acted in an unprofessional manner, Westminster Homecare reserves the right to stop finding work for you until the matter has been investigated and resolved. Any complaints about you will be discussed with you in person. If you wish to make a complaint about a client or service user, you should make an appointment to see your Westminster Homecare Branch manager. Any anonymous complaint will be assumed to be malicious and will not be acted upon. It is part of the Westminster Homecare quality system, that clients will be asked on a regular basis to assess your work and the quality of our service. As part of the same quality initiative, you will be asked to assess the service provided to you by Westminster Homecare. 19. Insurance. Personal Accident and Illness. When working on an agency basis, you may not be fully insured against personal accident when you are at work. You are advised to insure yourself for personal accidents and against illness or injury which may prevent you from earning a living. Third Party Liability/Professional Negligence. Westminster Homecare clients expect, and frequently require, that appropriate insurance is in place to protect them in the event of damage caused to them by your actions, errors, omissions or any negligence. Consequently, in respect of assignments when you are employed by us, Westminster Homecare has arranged insurance cover for you in respect of public liability and professional negligence risks. 11

This insurance will indemnify you (up to a maximum of £3 million) for legal defence costs and claims made against you resulting from neglect, error or omission in providing care whilst on a work assignment arranged by Westminster Homecare as a principal. Motor Insurance. If you have a car and you wish to use it on a work assignment, you should check that your motor insurance policy covers you for business use. Normally your policy will cover you for journeys to and from work. 20. Suggestions. If you have a suggestion you would like to make which you believe would improve the service Westminster Homecare provides to its clients, service users or members then please let us know (by writing to your Westminster Homecare branch). 21. Records, Report Books, Data Protection Act. Records. It is recommended that you keep a diary and make notes of dates, times, service users' names and addresses and telephone numbers. Always keep your copy of the timesheet in a safe place. It is also useful to make a note of the dates when you post or hand in your timesheets and of when you are paid. This is particularly useful should you have a pay query or if there is a dispute with a client over whether or not work was carried out. Please make your branch aware as soon as possible of any relevant change in your personal circumstances. Data Protection Act. The Data Protection Act requires Westminster Homecare to adopt data protection principles as described by the Act in respect of personal data kept on computer and also to provide the subjects of the data with access to personal information relating to themselves. Should you wish to receive a copy of the personal data kept on computer, you should contact your Westminster Homecare Branch manager. Westminster Homecare will respond to any such request within the statutory period. You are asked, on receipt of such data, to check it carefully and to inform the Westminster Homecare Branch manager of any amendments which need to be made. Westminster Homecare reserves the right to make an appropriate charge for dealing with such requests to cover the costs involved. 12

Clients/Service User Files. It is usual when caring for someone in their own home for records to be kept of the care to be given. Unless some other system has been agreed or is required, a Westminster Homecare File should be left in the service user's home until care ceases and then returned to the Westminster Homecare branch. When making entries in these documents, you should always bear in mind that the service user, GP and family may read it. 22. Health and Safety at Work. You have a responsibility under the Health and Safety at Work Act to ensure that your actions endanger neither yourself or others. You must comply with all rules and procedures relating to safety at your place of work. You should be on the lookout for and report to your Westminster Homecare Branch Manager potential hazards in equipment and furniture e.g. before using electrical equipment, look for any evidence of damage or exposed wires. Do not use anything you are doubtful about - arrange to have it checked or repaired. We at Westminster Homecare will notify you of any specific hazards relating to your place of work which have been notified to us. 23. Accidents. It is essential that all accidents to clients or service users be reported to the Westminster Homecare branch and recorded accurately with a minimum of delay. It is imperative that any incident or injury, however minor, sustained during the course of your work, must be reported to your Westminster Homecare branch. An accident form must be completed whether or not any injury is immediately apparent. 24. Smoking and Drinking at Work. Smoking. Smoking is not permitted on Westminster Homecare premises or on a client’s premises under any circumstances. Members of Westminster Homecare contravening the conditions of membership are liable to have their membership withdrawn. Whenever possible, clients should be discouraged from smoking in bed. 13

Note: The existence of our non-smoking policy does not imply that only non-smokers can work through or for Westminster Homecare. Whether or not you choose to smoke is a matter of personal choice. Drinking. The drinking of alcohol on days (or nights) when you are carrying out, or due to carry out Westminster Homecare assignments is not allowed. To attempt to care for vulnerable people at a time when your judgement might be impaired would be to put your clients at risk. Drinking on clients’ premises is also forbidden and any drinks offered to you are to be politely declined by simply stating that you are not allowed to drink when on duty. Any carer breaking these rules will be liable to loss of Westminster Homecare membership. 25. Concerns About Levels of Care. Whilst it is not your responsibility to assess the client’s needs, your views and suggestions are welcome. If you are ever concerned about the client’s condition and/or the level of care being given, please communicate your concerns to the care manager and/or the Westminster Homecare office and note them in the Client’s File. 26. Death of a Client or Service User. In the event of the death of the client/service user, you must contact the deceased's GP and the Westminster Homecare Branch manager at once. The deceased's next-of-kin should be notified as soon as possible. 27. Industrial Relations. Whilst Westminster Homecare does not formally recognise trade(s) unions for bargaining purposes, it does recognise that you have the right, as an individual, to belong to a trade union. Nothing in the Company’s systems or activities should discourage your membership of or participation in a trade union or its activities. The nature of Westminster Homecare’s work is such that there will always need to be close liaison with local and health authorities. In maintaining relations with these authorities, Westminster Homecare will wish to be sensitive to and refrain from undertaking any activity which might impede the maintenance of good industrial relations. 14

Should you ever be prevented from access to the workplace by, for example, a picket line, you must contact your branch at once for guidance. 28. Gifts and Gratuities. Westminster Homecare at all times undertakes to reimburse employees adequately for work completed by them to the standard set. The receipt by any employee of gifts or gratuities from service users, service providers or any source related to employment is strictly forbidden. Where these are offered, they are refused, explaining that the Company does not allow receipt of the same. If pressure is brought to bear on the employee, he/she must immediately inform the immediate manager. Any employee involved in the receipt of gifts or gratuities will be subject to the Company’s disciplinary practice.




The Clients Rights and Expectations.

Westminster Homecare, as a professional provider of homecare, expects to deliver excellent service and complies with the codes of practice of the UKHCA, FRES and the RCN Nursing & Care Agency Managers’ Group. As a care giver, sent to a client by Westminster Homecare, it is of great importance that you remember, at all times, that the client has a right to expect (whether they appear to expect it or not):  To have the level of care specified in their care plan delivered to them in a friendly, helpful and respectful manner by care givers whose training, experience and attitudes ensure that they are competent to carry out those duties. To be involved in discussions on their care plan and any proposed modifications to that plan. To be involved in the selection of the care giver assigned to them and to ask for the care giver to be replaced if there are good grounds for doing so. To be respected as an individual, to be listened to and to have their views considered and their opinions respected. Not to be discriminated against for any reason e.g. colour, race, age, religion, disability, sexual orientation, financial circumstances. Total confidentiality in respect of all their personal affairs and in relation to the care provided to them. To be encouraged to be as independent as possible in their particular circumstances and to have access to friends and relatives. That their home will be treated with proper respect and consideration.

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That the care giver will arrive, appropriately dressed and with proper identification, at the agreed time and that should the care giver be delayed for any reason, every effort will be made to advise the client accordingly.

It is absolutely vital that, if you are going to be unable to attend a client to whom you have been assigned, you contact the Westminster Homecare office as a matter of urgency at the earliest possible moment. 2. At the Clients’ Home.

Presentation Care givers should arrive at the client’s home at the agreed time, dressed in accordance with the Westminster Homecare dress code and will wear a Westminster Homecare identity badge or carry a Westminster Homecare identity card. Personal Hygiene A high standard of personal hygiene is essential. The use of deodorants is recommended. If you have a cut, scratch or broken skin, the affected area should be covered with a waterproof dressing. Procedure in the event of No Reply If you are unable to obtain a reply from the client, you must immediately try to find out why. You should investigate the client’s premises as extensively and safely as possible. At no time should you put yourself at risk in the course of your investigations. If you discover that the client is in a collapsed state or similarly unable to answer the door, you should call the emergency services and ask for the police to gain entry to the premises. You should then contact the Westminster Homecare office for further guidance. If your initial investigations do not identify the whereabouts of the client, you should immediately check with any neighbours or caretakers or any contacts known to you who might have information about the client. If these enquiries establish that the client is safe elsewhere, this information must be passed to the Westminster Homecare office. You must leave a note for the client saying that you called but were unable to get a reply and asking them to contact the Westminster Homecare office. 17

Your note should include the Westminster Homecare office telephone number. If your enquiries fail to establish the whereabouts of the client, you should contact the Westminster Homecare office immediately to let them know. They will try to make contact with the client’s known connections and advise you what to do next. Communicating with the Client. When meeting a client or service user for the first time, introduce yourself clearly, stating your full name and where you are from. Show the client your Westminster Homecare identity card or badge. Although your reason for being there is to help, it is important to realise that in many cases, at least initially, your arrival may be resented and regarded as an unwanted intrusion. It is quite possible that calling you in was not their idea. Many clients will have valued their previous independence highly and be resentful of the fact that there are now a number of things they can no longer cope with by themselves. Sometimes then, it can be difficult to establish good communication in the course of the first visit. It is important that you begin by finding out how your client would prefer to be addressed. Many people do not like anyone other than family or close friends to call them by their first name and might consider it a sign of disrespect for you to do so. Similarly, you should not call clients "love" or "dear" unless you are certain that to do so would not be found offensive. You should ensure that you speak clearly and not too quickly. However, take care not to talk to the client as if he or she were a child, or talk too slowly, as this can appear very patronising. Listen carefully to clients and show an interest in their problems and interests. In this way you will be better able to treat each client as an individual Lending – Borrowing – Buying – Selling. Westminster Homecare at all times undertakes to reimburse employees adequately for work completed by them to the standard set.


Lending – Borrowing – Buying or Selling between Client and Carer is strictly forbidden. Any employee involved in any of these practises will be subject to the company disciplinary procedure. If there are any concerns or issues regarding this the Branch Manager should be informed immediately. Signatories to Legal Documents. No employee of Westminster Homecare will act as an Executor or Witness to a client’s will. The handling of client’s finances as an appointee, agent, receiver or attorney is not part of the role of any employee. Where clients experience difficulties in managing their financial affairs and discuss this with the employee, this matter should be immediately referred to the Branch Manager who in turn informs the Local Authority. Where the client is of private means, he/she must be advised to consult a Solicitor to discuss these matters. In some instances where the client is no longer able to decide, the matter is referred by the Branch Manager to the County Council who in turn will take steps to have a Receiver appointed. 3. Interpersonal Skills - Communication

Deafness More than half of the population over the age of 80 suffer from hearing difficulties. Wax can cause this, but it is easily removed.The hearing loss is greatest for high frequency sounds, i.e. consonants, and many old people hear only low frequency vowel sounds. In this way many old people may miss much of the conversation and give answers that appear inappropriate. The situation is made worse if the client is already mentally impaired. Severe deafness is a great handicap and may provoke exasperation. A deaf person may misinterpret what he/she hears, and his/her voice may change when he/she cannot hear himself/herself speak. It becomes harder for the client to be understood, as well as understand. The greatest danger is that the person may become isolated and withdraw into a world of their own, rather than struggle to communicate. Conversation with Deaf People Even if the client does not appear to hear anything, carers should never talk about a client as if he/she was not there. The client may hear just enough to feel aggrieved and this will add to frustration and distress. To speak with the client is an important way to boost morale. 19

When speaking to a deaf client, the carer must be prepared to listen as well as talk. This communication will lessen the client’s feeling of isolation. The carer should speak slowly and distinctly, emphasising consonants - but the carer should not shout. Some deaf people find a loud voice very distressing. The carer should stand in the client’s line of vision and should make sure that they have the client’s attention before speaking. The carer should make gestures to be more expressive. Often a client hears better from one side than the other, so the carer should stand on the client’s “good side”. Hearing aids help some people, and it is important for carers to know how to place them in the ear and change the batteries. Some people are too deaf to be helped by any form of hearing aid - they may be able to lip-read or use sign language. Otherwise, writing may be the only effective method of communication, and a writing pad and a pencil should always be nearby. A few people are deaf and blind. Problems can be overcome to some extent by the sense of touch. Blindness One person in four has some visual impairment and two thirds of the 120,000 blind people in Britain are over the age of 65 years. People with a visual impairment, even those who are totally blind, may still retain their independence and be able to move around freely once they are familiar with their environment. The person will have developed their memory and other senses to compensate for their loss of vision. The client blinded in old age is in a much more difficult position. They will probably be apprehensive and lack confidence. Good lighting is vital for the visually handicapped person. Personal possessions should all have their place, and the carer should never reorganise any items. Care should be taken that no unfamiliar hazard is left in the way of the client. Cleaning a client’s glasses should be a regular part of personal care. Many gadgets and adaptations may be available to help the client. When approaching a blind person, always speak before you reach them, to avoid startling the person. Introduce yourself, so that the client learns to recognise your voice. 20

Never do anything for the client without explaining what you’re going to do. Sometimes a client can see more on one side than the other. If so, always address them from their “good side”. Confused Clients The carer should always treat clients who suffer from confusion with tact and kindness. Accept them for what they are, without becoming irritated, or trying to change their ways. If the client is hostile, the carer should ask herself whether she did anything to provoke the situation, e.g. did she perhaps fail to give the client sufficient explanation. The client who is difficult is often the one who needs the most assurance. Confused elderly clients remain sensitive to emotional atmosphere. Never attempt to hurry them as this might cause the client to become more muddled and irritable. Key Holding Sometimes in order to provide care to clients with disabilities, arrangements have to be made to allow carers access to the client’s home. As often as possible, your client is to be encouraged to let you in and the holding of keys to clients’ homes is to be avoided. If it is necessary to have access to a key to a client’s home:  avoid arrangements to hide keys near the door and, if possible, collect keys from a key holder approved by your client before each visit and return them immediately after you visit. copies of keys are to be kept to a minimum and never have attached to them the client’s name and/or address. Clients’ keys are never passed to any other person unless authorised by your supervisor or the Westminster Homecare Branch manager. Secure records are held at the branch of all keys and of who currently holds them. next of Kin and other relevant contacts, e.g. GP, are made aware of any key-holding arrangements. any keys held are kept in a secure place when not in use. 21

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Note: the holding of a key does not remove your Client’s right to privacy. Remember to knock or announce your imminent arrival in some other way. The Client's Home and Property. Familiarise yourself with the layout of the client's home as soon as possible and find out where the essentials are kept. Always treat the client's home with respect and their personal possessions with care. Clients will usually have their home arranged in the way that they prefer. If you feel that rearranging the furniture to some degree might be in the client's interest, or that it is necessary to do so in order for you to do your job properly, don't just do it - discuss your reasons with the client. If you simply move things to make things easier while you are there, put them back where they were before you leave. Personal Carers; other People in the Home. Although many clients live alone, many will have a spouse, friend or relative living with them who has been acting as a personal carer, looking after them free of charge. Should a family or personal carer exist, it may well be that they have been providing care for a long time without much assistance and are quite exhausted. Many personal carers are elderly and infirm themselves. You should therefore show interest in and understanding of the needs of the personal carer as well as the client. The presence of a personal carer or other member of the family is usually of considerable benefit and you should get to know them well. They will, of course, tend to know the client better than anyone else and be an excellent source of information on the client's abilities, needs, likes and dislikes. Ethnic and Cultural Considerations. When you are caring for a client from an ethnic minority community, it is important that you respect their cultural and religious requirements. For a number of elderly people living in ethnic minority communities, English is not their first language. Should that be the case, in order that you can communicate effectively with the client, you need to establish at an early stage the extent to which the client can understand and speak English unless, that is, you are able to communicate with the client in their own first language. 22

If you have a situation where you and the client cannot understand each other, you must try to get an interpreter. Some clients may not speak English at all. Different cultures have different Holy Days and sometimes have quite long periods of religious observance which are very strictly observed in some cases. It is important that you take note of any effect of religious observance or cultural differences on the client's dietary requirements. Take care to understand your client's preferred or appropriate modes of dress for occasions or times of day and learn how to assist your client with his or her clothing. 4. On leaving the Client’s Home.

Make sure the client is comfortable and settled with everything they are likely to need within easy reach. If a commode is used, ensure that it is readily accessible and clean and that there is sufficient toilet paper within reach. Check that any telephone alarm or security device available is within easy reach. Check the telephone is working. If your client is confused, make sure that any potential sources of danger are not too accessible. Any unnecessary medication should be put away and any appliances not required are turned off. If you are leaving during the day, it may be necessary to leave some of the lights on depending on when the client is next likely to be visited. If any of the windows are to be left open, make sure that the client is aware of this and satisfy yourself that the client or someone else will be able to close them later if necessary. If you are leaving at night, make sure that any fires or stoves are out, off or made safe. If the client is in bed, all electrical appliances should be made safe and turned off or unplugged if necessary. Check all doors and windows are secure. Ensure that there is adequate ventilation where the client is sleeping. Discourage the client from smoking in bed if they are likely to do so. 23


Make sure that any pets are in the right place and secure. Satisfy yourself that everything you were supposed to do has been completed, tell the client that you are leaving and close the door securely on leaving the premises. 5. Bathing.

How frequently and when the client takes a bath or shower, if not specified in their care plan, should depend on their needs and preferences. The timing or frequency of bathing should not be determined independently by you. Clients should be encouraged to bath themselves if possible, with help from you to help them in and out of the bath if necessary. However, they may feel more secure having someone else around when they are having a bath and, if so, this should be taken into account when planning their care. Having a bath should be a pleasant experience for the client. As far as possible, assistance with having a bath should be carried out by a regular carer; this will minimise any embarrassment to the client, many of whom feel awkward about needing help to have a bath and are uncomfortable with the level of intimacy involved. Be sensitive to the intimacy of the situation; treating the client with respect will do much to help them preserve their dignity in what they might find an awkward situation.. Test the temperature of the water before allowing the client to get in the bath. Ensure that it is within the safety margins set out in your Health and Safety booklet. Be very careful helping the client in and out of the bath. If a hoist is available, you must use it and take care to use it in the manner in which you have been instructed. Allow the client time to relax and enjoy their bath. If it is safe to do so, leave them alone for a while but remain fairly close by so that you can hear if help is needed. It may be the case that the client may forget to have a bath or even to wash or may not realise the need to do so. In such circumstances, an occasional tactful reminder may be necessary.



Help with Dressing.

Do not automatically assume that the client needs help dressing and undressing. You should only assist when it is obviously necessary or when you are requested to do so. You must always respect the client's right to privacy; it is not necessary to stay in the room if clients can dress or partly dress themselves. If the client has difficulty dressing, be aware of how frustrating this must be. Do not rush them or show impatience; make proper allowance for their level of disability. Allow the client to choose what they want to wear and, where necessary, encourage an interest in personal appearance. Give advice where necessary, particularly in cases where the client has poor sight. 7. Personal Hygiene; Washing, Shaving, Dental Care.

The majority of clients will prefer to wash themselves and look after their own hair and teeth if they are able to do so. This should be encouraged. Sometimes clients may forget about some of these matters or not appear to be aware of the need to attend to them. A suitably tactful reminder may sometimes be necessary. In some cases you will be required to help clients with washing, shaving and the care of hair and teeth. Helping with such tasks inevitably brings you in close contact with the client.If you should notice any abnormal signs indicating illness or injury, you should bring these to the attention of the personal carer, if there is one, and to your manager and other members of the care team. Essentially, you should ensure that there is regular washing of hands and face, combing and washing of hair, cleaning of teeth and dentures and spectacles if worn. Men without beards should shave or be assisted with shaving as often as deemed necessary.


Care for the Incontinent Client.

There are many causes of incontinence, and an individual may be affected by more than one cause. Incontinence generally arises from a combination 26

of both physical and environmental factors, most of which are not irreversible. Always  Change pads four-hourly when wet.  Wash the skin thoroughly with soap and water where it may have come into contact with urine. This is due to the acidic nature of urine and its tendency to burn and irritate the skin, making it sore. Barrier cream may be prescribed where appropriate, but should not be used in excessive amounts (even though this is sometimes tempting). Ensure that the skin is dried thoroughly after washing to prevent further sores and irritation. Ensure that the pads fit and do not rub. Ensure that the pads are suitably wrapped before disposal. Contact the office where you experience any problems; staff will advise you what is best to do. If the client develops a sore that will not heal - contact the office where a member of staff will advise you what is best to do.

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Toe Nail Care.

For the protection of both staff and clients Westminster Homecare will not provide toe nail care. Clients requesting the service may be assisted in making their own private arrangements. State Registered Chiropodists can be found listed in Yellow Pages. If a person is known to have diabetes, or is felt to be vulnerable for other health reasons such as poor circulation they should be referred via their GP for chiropody assessment. This referral would be made by the District Nurse if already involved with the client. The reasoning behind this policy is :


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Where older and / or disabled people are immobile, there are likely to be circulation problems. The person may have undiagnosed diabetes.


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The person may have a transmittable infection, and even if the home carer wore gloves, a scissor cut could produce a wound. Incorrect cutting can lead to more serious problems e.g. ingrowing toe nails. The correct equipment is unlikely to be in the client’s home and older people commonly have very tough nails. People with impaired mental capacity and / or involuntary movements would also be at increased risk.

10. Shopping. If you are required to do the shopping for your client, involve them in the process as much as possible. It is preferable to involve the client in the preparation of the shopping list. It is better still if they can write it themselves. Ideally, the list should show not only what they want but from where it should be bought (within reasonable limits). Review the list with the client before you go, to check that no essentials have been forgotten. It is very important to communicate clearly when handling client's money e.g. make sure they are aware of how much of their money you are taking for the shopping. Record the amount on the document provided in the client file for this purpose. Obtain receipts for the money spent in order that you can account for it later. If it is possible for your client to come shopping with you, this can provide an ideal opportunity for them to get out of the house for a while in safety. It also enables them to see what is available in the shops. If your client has very poor sight, establish how they would like you to guide them. Take care to warn them of kerbs and steps sufficiently in advance to give them time to react to your warning. If the client has a wheelchair, try to give them as smooth a ride as you can. Take great care not to give them a painful jolt when going up or down kerbs. When you return with the shopping, the client should participate in putting the food away. They will be used to having things in particular places and you should not change this other than for reasons of safety. Should you wish to change the normal storage arrangements, you should involve the client in the discussion. 29

Be aware that bleach and some other household cleaning agents are potentially dangerous as are some medicines. Appropriate care should be taken in the storage, handling and disposal of these substances.





What you must not do:   Do not administer medicines other than by mouth or external application. Do not administer medicines against your client’s wishes.

What you must do:   make sure you know of any regular or prescribed medication your client is receiving. record details of any medicine administered i.e. what it is, when it was given, how much and how it was administered. Normally there will be a Westminster Homecare Care Plan or other document for this purpose. make sure you understand clearly the identity, dosage and frequency of any medicines you are asked to give. Normally, this will be on the Care Plan. Read labels and instructions on the containers carefully. If in doubt, ask your client, your supervisor, the GP or the personal carer if there is one. let your supervisor know immediately if there is any difficulty or incident arising from the administration of any medicine.



What you may do:    encourage your client to administer their own medicine. give prescription-only medicine by mouth or external application if asked to do so by a GP or a qualified nurse. by agreement with the client or their personal carer, give medicines for which no prescription is required by mouth or external application. 31

Note: It is important to note and report any reaction by the client to any medicine given. 2. Electrical Equipment.

Check that the cables taking power to or from any appliance appear to be in good condition, i.e. not cut, worn or chafed. Check that the connections are secure, paying attention to power points and plugs. Be alert for loose wires and for any cables that may have been joined by any means other than a proper cable connector. Be alert to the possible overloading of power sockets. If possible, only have one plug per socket. If extra sockets are needed, a fused multi-socket outlet should be used. Only use electrical appliances for the purpose for which they were intended. If an appliance is visibly damaged or you are doubtful about it, do not use it until it has been checked by a person competent to do so e.g. an electrician. If any switches, sockets or plugs get hot, do not use them. Turn off the power to them and have them checked. Make sure that cables running from sockets to appliances do not cause a hazard. Note: Electrical accidents are very common and you should treat electricity with respect. Unsafe electrical appliances and overloaded sockets and cables can constitute a fire hazard. Repairs and maintenance should be carried out by an electrician or other competent person. DO NOT TOUCH ANYTHING ELECTRICAL WHEN YOUR HANDS ARE WET. Action in case of electric shock    Call for help Switch off power if possible. If not, pull or push casualty clear with wooden object - e.g. chair. Stand on lino, rubber or wood. If casualty is breathing, place in recovery position and call ambulance to take casualty to hospital. 32


If casualty is not breathing, give mouth to mouth resuscitation. Apply chest compression if pulse absent only if you have had recognised First Aid training. Food Handling.


Personal hygiene is of the utmost importance when cooking, handling and serving food. The most likely causes of contamination to food leading to food poisoning are:        unwashed hands hair and rings dirty work surfaces dirty utensils and containers flies, pests, rodents and sometimes pets dust and dirt dirty dish cloths and tea towels.

Also, some foods are regarded as more high risk than others e.g.       all cooked meats and poultry anything containing cooked meat or developed from it, like gravy stock shell fish and seafood dairy products cooked eggs and products containing eggs cooked rice

You should prevent the spread of contamination by:      always washing your hands before and after handling food and after using the lavatory always wash the working surface before and after preparing food knives used for cutting raw meat should either be kept separate from other knives or be thoroughly cleaned before being put to another use keep uncooked meats separate from all other food wash dish cloths and tea towels regularly 33

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empty rubbish daily; if waste bins do not contain disposal liners, they should be washed in hot, soapy water daily control flies, pests and rodents and keep family pets away from surfaces where food is stored or prepared pay attention to any “use by” dates on stored food. Infectious Diseases.

Nursing and related care tasks occasionally involve risk of exposure of communicable disease. Westminster Homecare wishes to minimise risk to you, your client and your family, colleagues and others with whom you may be in contact. Carers (and other employees) with communicable diseases: Whilst Westminster Homecare recognises that carers with communicable diseases may be capable of carrying out care assignments, the first consideration must be the safety of the client. This remains the case even when the risk is deemed to be low. So, this principle should be borne in mind by you when you consider accepting an assignment. It will be borne in mind by Westminster Homecare staff allocating work and we may consider you unsuitable for certain assignments. When you apply to join Westminster Homecare you are required to disclose any infectious diseases. We also require that you disclose any subsequent exposure to or contraction of any communicable disease. For the avoidance of doubt, this includes any communicable disease including HIV, AIDS, MRSA and Hepatitis B. Having an infectious disease, or having had exposure to one, will not automatically preclude you from joining or being offered assignments. However, it may make you temporarily or permanently unsuitable for assignments or limit the assignments for which you may be deemed suitable. Some clients who are particularly frail or who have lowered immunity should not be cared for by people with colds, influenza or other minor ailments.


Clients with infectious diseases: In order that Westminster Homecare can plan appropriate care routines and ensure your safety, we expect clients to disclose any communicable diseases and to give their consent for us to discuss their condition with their GP or other relevant healthcare professionals if deemed necessary. However, Westminster Homecare recognises the right of all clients to receive appropriate care regardless of their condition. The company are not always aware of infectious diseases that a client may carry. In the event that you are assigned to care for a client who has, or has been exposed to, a communicable disease, we will brief you appropriately. You are reminded that any information given to you regarding a client’s condition must be treated as confidential. You must take proper precautions to protect yourself from communicable diseases. If you do not know what to do, you must consult your supervisor who will advise you or provide a suitable source of advice. It is most important to avoid risks of cross-infection, so any incident which you feel may lead or have led to the spreading of a disease must be reported to your supervisor. You will then be advised as to any further action necessary. 5. Aims These guidelines are aimed at helping you to achieve a safer method of patient handling, thus avoiding any injury to yourself, your colleagues or the patients. Think       Assess client/load. Move the client, do not lift. Are there any lifting aids available e.g. hoist, transfer board if so use them. Do you need help? If so ask for it and wait for it to arrive. Decide on transfer to be used. Explain procedure to client and/or colleague and enlist their cooperation. 35 Client Handling.

Prepare Arrange the area:  Space to manoeuvre.  Move furniture/equipment if necessary.  Check floor for slip/trip hazards.  Check height of surfaces i.e. beds etc. One Person Principles.            Keep patient (load) close to body. Foot position - feet apart. Facing in direction of movement. Keep back straight. Bend at the hips and knees. Check your grip, is it firm? Use body momentum to help with the moving of clients. Be aware of the method used to move the client. Move in stages. Never twist or turn the body as you move the client (turn by moving your feet). Lower load with equal care.

More than One Person. Choose a partner of same height if possible. Decide:  Method of transfer.  Who will be leader.  Which grasp to be used.  What commands will be given. (Suggest ready, steady, rock). Ensure you are confident to move the client and always seek advice if you are unsure.



Falls in the Home.

Falls are the most common form of accident in the home and you should take any precaution you believe will reduce the risk of anyone tripping, slipping or falling from any other cause. For example you should:  Pay particular attention to stairs as this is where many serious falls occur. Make sure that they are free from any obstruction and that handrails are robust and secure. Report any defect. Make sure that the general level of lighting is adequate and that the client has access to the necessary switches. Make sure that floors, particularly tiled floors, are kept dry and that there are no slippery patches. Make sure that there is a minimum of clutter and there are no loose rugs in places where they could cause someone to trip on things like loose floorboards, for example. Animals.

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Many clients will have pets and their pets will be a great comfort to them as well as, occasionally, a cause of concern. Dogs, particularly, tend to be protective of their owners and their territory. The best way to handle this is to ask the client’s advice as to how to approach the animal and to befriend it. Regardless of its size (and its first reaction to you if it appears aggressive), do your best not to appear nervous. Most animals will soon recognise you as a friend and will welcome you on your visits. Never-the-less, it is always a good idea to put a dog in another room when you are working with the client.



Your Personal Safety.

Sometimes, you may have to visit clients at a late hour in difficult areas. If so, keep to well-lit paths and do not take short-cuts through dark areas. It is recommended that you carry a personal alarm. If you go by car, leave it parked within sight of the client’s home if you can. Do not leave valuable items in clear view, e.g. on the car seat, put them in the boot if there is one. Always tell someone where you are going and when you expect to be back. Don’t forget to call them if you are delayed! 9. Physical Violence and Abuse.

Should you ever be subjected to the threat of physical violence by a client or by a client’s family or associates, you must report this immediately to your Westminster Homecare manager. Westminster Homecare will take the appropriate action which may include refusing to provide further service.


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CONTENTS part no 1 1 sect no 2 1

ceasing to be a member joining Westminster Homecare: your employment status

1 1 1 1 14 19 3 20 communicating with your branch insurance staff grievances suggestions

1 1 1 1 22 17 15 16 health and safety at work immunisation punctuality and reliability uniforms and dress code

1 1 3 1 18 27 9 21 complaints and quality control industrial relations physical violence and abuse records, report books, data protection act

1 3 3 3 3 3 3 3 1 3 23 17 5 2 6 3 4 1 24 8 accidents animals client handling electrical equipment falls in home food handling infectious diseases medicines smoking and drinking at work your personal safety


1 1 1 1 1 1 1 1 1 1 1 28 4 6 8 12 10 11 5 7 9 13 gifts and gratuities income tax and national insurance national insurance payment personal pension plans statutory maternity leave statutory sick pay tax forms timesheets travelling expenses your tax office

2 2 2 1 1 2 2 2 2 2 2 2 2 5 8 25 26 6 3 4 7 10 9 1 at the client’s home bathing care for the incontinent client concerns about levels of care death of a client help with dressing interpersonal skills – communication on leaving the client’s home personal hygiene: washing, shaving, dental care shopping toe nail care the clients’ rights and expectations


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