Key Holding & Access

Purpose
To provide employees with an understanding of their obligations in respect of key holding, problems with access etc.
Statement
The Alpine care provides homecare. Our Service users are often elderly, live alone, and are vulnerable. We may be the only visitors on any particular day. Our service is often an essential lifeline to the outside world. As such, it is imperative that when we visit, in order to provide services, we are able to gain access, and if not, to question why, and deal with the situation professionally and without delay.
Procedure and Guidance
Key Holding
On occasion, and solely in order to gain access to a Service user’s home to provide agreed care services, the Alpine care may be given keys, or access codes. This will be done only after discussion with, and the agreement of, the Service user, or his/her representative. Such arrangements will be recorded on the Service user’s Personal Care Plan, and any other supporting documentation.
Each key in the Alpine care’s possession will be marked so as to identify it to a particular Service user. Information will be entered onto a database or register identifying the address the key belongs to and the number of keys in possession by staff. The Alpine care will also keep a record of who has possession of keys at any one time. Keys will not have information on them which specifies the addresses of individual Service users. It will not be possible, therefore, for a lost key to be used to gain access to a Service user’s home.
In general, the Alpine care wishes to avoid situations where it holds keys for access to Service user’s premises. If keys held by the Alpine care are lost, then the Service user and possibly the Police, will be informed without delay.
When keys are given to the Alpine care’s staff, then this will be recorded. Unless operationally inconvenient (for example the Service user is visited daily by the same Carer) keys will be returned to the office and kept securely. Keys are never to be left outside the Service user’s home (for example in a flower pot).
Entry codes which provide access to a Service user’s home will be kept secure at all times and will not be written down in such a way that they can be associated with a particular Service user, and/or their address.
On occasion, such as circumstances where the Service user is deaf, the Alpine care may seek the permission of the Service user to hold keys or to have access codes.
Gaining access to a Service user’s home
The preferred method for gaining access to a Service user’s home will be to knock on the door, and to request and gain entry with the permission of the Service user.
Where the Alpine care has been given keys, or access codes, then the Alpine care’s Carer will announce their arrival by ringing the bell or knocking on the entry door prior to opening. Where the Service user is deaf, or otherwise incapable of indicating their willingness to, and acceptance of, the Carer’s entry, then some other approach will be agreed and adopted at the time the service begins. Entry without permission is only acceptable in a clear emergency situation or where there are concerns regarding the safety of the Service user.
No answer
In the event of not being able to gain access to a Service user’s home at a time that they are due to deliver care or support or have a pre-planned appointment to see the Service user but they are not answering the door the Carer should without delay:
Check all the doors (one might be unlocked), look through windows and call out through the letterbox.
If the Service user can be seen or heard, but appears to be in difficulty, then the Carer must contact the emergency services immediately, inform them that a vulnerable person is at risk and then contact the office to notify the situation.
The Carer must make a note of the time of initially trying to gain access and the time of the call to the emergency services.
The Carer must remain at the Service user’s property until the emergency services arrive.
If the Service user cannot be seen or heard then the Carer should in the first instance contact the Alpine care office who will try telephoning the Service user.
The Carer can also speak with neighbours to establish whether they are aware of the Service user’s whereabouts whilst being mindful of confidentiality.
If it is not possible to gain useful information as to the whereabouts of the Service user, and the Alpine care’s Carer has reason to believe that the Service user is in the home, but is incapable of answering, then the Carer is advised to seek further advice from the office. This situation may escalate to contacting the emergency services and/or the Police.

Security issues

a)  Check with the Service user that they are comfortable;
b)  Confirm the date/time of the next visit;
c)  Advise the Service user if there is to be a change of Carer, either on a permanent or temporary basis, and provide details.

Equality and Diversity

Alpine care promotes a culture of regard for the needs of the people who use our service, wants and interests which takes into account their personal preferences and to the way in which they wish to conduct their lives. All Alpine Care work is underpinned by equality, diversity and human rights legislation and our striving for justice and fair play. In order to maintain our compliance with equality and diversity legislation we will utilise our knowledge and experience of the legal and national policy on equality, diversity and human rights.

We recognise that individuals are not defined by a single equality strand; often straddling many different strands such as individuals who experience combined discrimination as a result of age, sexual orientation, gender or disability.

Alpine Care embed equality, diversity and human rights into its core business.

We understand that every service user has their own independent choice and possible variation of culture and religion. Therefore care packages will be personalized to meet the needs of the service users, which will include needs around gender specific carer, communication and information needs, dietary, religious and spiritual needs, dress code etc.

This will result in personal care and support being provided in a way, which maintains and respects the privacy, dignity and lifestyle of the people who Short-term medical treatment, usually in a hospital, for patients with an acute illness or injury or recovering from surgery.

PERSONAL CARE

Assistance with personal care can involve assistance to wash, shower, bathe or wash in bed. Consult the care plan and risk assessments and follow the Service User’s wishes. The following information offers some guidance for delivering personal care. It is important to remember that whatever method is used the independence of the service user should always be encouraged and everything you do should be discussed with or explained to them.
Assisting to Bathe
Ensure you have any Personal Protective Equipment which is deemed necessary – e.g. gloves and plastic apron
When helping someone to undress, ensure that curtains and doors are closed. Ensure you have a towel or robe to hand and the service user is never unnecessarily exposed.
Ensure that heating in the bathroom is adequate and there are no draughts
Gather all your items for bathing, towel, soap, sponge, clean clothes etc…ensure the service user is involved in this process – never assume When running the bath, ALWAYS ensure the cold water is put into the bath first. Top the bath up with hot water to a comfortable temperature (no more than 43°C); this should be a comfortable temperature for your elbow when tested.
If equipment is required for bathing, e.g. a bath chair or hoist, ensure that you are familiar with the risk assessments and that you have had training from a competent individual and that this training is up to date. Check and ensure that the equipment is in safe working order.
Once you have checked the temperature of the bath water, ask the service user if the temperature is suitable for them and adjust as necessary. Do not adjust the temperature while they are in the bath and remember it should not be above 43°C
Bathing gives staff an opportunity to notice any skin changes on the service users, e.g. bruises, moles changing, pressure sores, rashes etc. If you notice any of these, or any other change to the service users’ skin, it should be reported to the Service User and your line manager as soon as possible. An incident form should be completed with the details of your observations. A diagram may be useful in this situation
If the Service User is able to, they should be left to wash independently, however, this would be based on a risk assessment of whether it would be safe to leave them alone in the bath, the risk assessment will advise on whether the bathroom door should be locked. If risk assessments and care plans state that the service user is able to wash alone, you should be within calling distance and check their safety at regular intervals (as directed in the care plan)
If the person needs assistance to wash ensure you encourage them to participate as much as they can particularly genital areas. Where possible use different cloths for genital areas.
When the service user is finished in the bath, you should ensure that they are thoroughly dried (pay particular attention to drying areas under the breast or in other skin folds)
Offer assistance with dressing, avoiding any unnecessary exposure of the service user
Make the service user is comfortable in the room of their choice
Ensure that the bathroom is left clean and tidy for the next use.
Assisting to Shower
As for bathing, ensure you are equipped with the necessary Personal Protective Equipment, and are aware of all risk assessments and care plans
Ensure that curtains and doors are closed and the temperature in the room is comfortable. Ensure that the service user is not exposed unnecessarily whilst undressing
If necessary assist individual to sit on the seat in the shower, as per moving and handling risk assessment.
Check that he or she is able to reach of all the areas that require washing, such as the genitals, the feet, the backs of the legs and the back
The person may be glad of assistance or may prefer to shower alone, simply calling you when he or she is finished and requires further assistance for leaving the shower, always refer to the Care Plan as this will offer guidance for each individual
If you are going to leave someone in the shower alone, make sure that you explain to him or her how to adjust the temperature.) Advising no more than 43o C. Ensure that you are within calling distance
After the shower ensure the individual is thoroughly dry, (as above) providing assistance if requested
Assist the person to the room he or she requests and ensure that he or she is comfortable
Ensure the shower room is left clean, tidy and dry for next use
Assisting to Wash
As previously mentioned, ensure you are equipped with the necessary Personal Protective Equipment, and are aware of all risk assessments and care plans
Place a chair at the sink (if necessary)
Assist the Service User to sit on the chair
Allow the Service User to wash areas of their body which they can reach
Assist the Service User to wash the parts they cannot manage
Pay attention to the back, genital area and the feet (using different cloths for genital area)
Assist to dry and dress
Leave the bathroom clean and tidy
Assisting to Wash in Bed
A wash in bed is sometimes the preferred option. There may be occasions when your Service User is too ill to get up and you wish to make them comfortable while in bed.
Collect large bath towel, hand towel, soap, two cloths (where possible) and basin of water to bedside
Ensure dignity is maintained at all times during this practice
Remove top covers from bed and leave a sheet/towel over the Service User
Remove service users clothing
Begin by washing and drying the face and neck with the designated cloth Change the water if necessary
Exposing only the areas that need to be uncovered for washing: Use the second cloth, wash and dry the arms and chest area.
Work your way down to the legs and feet, placing a towel under the legs With assistance turn Service User onto side and wash and dry the back While on their side wash buttocks and genital area
Help Service User to change into clean clothes
Re-make the bed and leave the Service User comfortable. Tidy away the dirty clothes and used equipment
Oral Care
Mouth Care (oral hygiene) is extremely important for everyone. Many individuals are able to maintain their own mouth care, perhaps with a little assistance. However, you will need to carry out mouth care for people who are seriously ill or have special needs. The care plan will specify this need.
Some mouth care occurs naturally because, with sufficient intake of fluids, the saliva in the mouth carries out a great deal of cleaning. However, various illnesses and conditions, as well as the natural ageing process can change the way in which the mouth works. Saliva production can be reduced and people may suffer from dry, crusted mouths and infections, such as thrush (a fungal infection). Sore tongue or ulcerated gums or cheeks may develop. A reduction in saliva production also increases the incidence of bad breath (halitosis).
Provide the individual with a bowl of water or assist him or her to the washbasin

Offer to put toothpaste on the toothbrush, if necessary

Assist with brushing only if required. If you do need to assist you
should brush gently but firmly, ensuring that all teeth are brushed on all surfaces, if the person is sitting it is easier to stand behind the person brush teeth from behind, always explaining what you are doing.

Give the individual a glass of water to rinse the toothpaste out of his or her mouth.

Offer the individual dental floss if available to clean between his or her teeth. Be prepared to assist with flossing if required (ensure you wear gloves)

Note whether any parts of the person’s mouth are painful, bleed or are ulcerated and report to your Line manager

Offer the person a mouth wash if available

If the service user wears dentures, they should be encouraged to
remove them independently and the instructions on the dental products packaging followed. The individual may prefer to have them soak overnight (ensure you wear gloves if handling dentures)

If you are caring for Service Users with a very high degree of dependency then you may need to carry out regular mouth care for that Service User, this would be detailed in Care Plans and Risk Assessments.
Foot Care
You may need to assist your Service User with care of the feet. You are not permitted to cut toenails, but you should report nails which need cutting or are red / sore to your Field Supervisor. Also record this in your communication sheet.
Elderly people’s skin may be fragile so care must be taken when applying stockings.
If you are required to apply support stockings, and have not done this before, please ask your Supervisor for guidance.
Dressing and Undressing
When assisting a Service User with dressing you must encourage them to choose their clothing. Service Users should have their independence maintained, and should be encouraged to do as much as possible for themselves. When required to assist, the following advice may help you to provide the appropriate support
Dress the upper body with vest, shirt/blouse and cardigan
Assist with underwear, socks/ stockings, trousers/skirt and footwear If the Service User can stand, help them to do so and help pull up clothes
If the Service User cannot stand, it is easier to dress him/her while they are lying on the bed
If the Service User has restricted movement in their arm / leg it is easier to put these into clothing first, as the individual will be able to move the other limb to aid dressing
Toileting/Continence Care
Assisting the Service User to use toilet facilities and dealing with incontinence may be part of the general care of service users.
You should be familiar with problems that may arise and report any abnormalities that you observe. Urine is generally straw coloured and not offensive to smell. Urine, which is dark and foul smelling, may indicate that something is wrong. Observations such as these must be recorded and reported to your line manager. With the service users consent, this information should be reported to the GP/ District Nurse in consultation with your Field Supervisor.
If your Service User requires assistance to walk to the toilet, you should be aware of the space constraints and any equipment that may be needed. (Risk assessments and training should be in place for any such equipment) Mobility problems may affect their ability in getting to the toilet on time so allow plenty of time for your Service User to get there.
If your Service User suffers from incontinence then perhaps they use a pad to manage this. Incontinence can be both faecal and urinary. You may be required to assist the Service User to change their pad. This is a sensitive situation and you should preserve the Service User’s dignity and consider their privacy.
These good practice guidelines should be followed:
Always wear gloves and apron
Assist the Service User to wash their genital area after removing the pad
Dispose of the pad in a double plastic bag and place in Service User’s outside dustbin
Assist the Service User to wash their hands
Wash your hands after removal of gloves
Soiled clothing should be rinsed soaked if necessary and placed in the washing machine.
Ensure toilets/ commodes are emptied and clean, and returned to the appropriate place
If a Service User, who did not previously suffer from incontinence, becomes incontinent, it should be reported to the Field Supervisor who will arrange to contact the GP or district nurse, with his/her permission. The cause may be a urinary infection, which can be treated. Fear of incontinence may stop your Service User from drinking sufficient fluid. 6-8 cups or glasses of fluid per day should be encouraged.
Management of a Urinary Catheter
Trained nursing staff are responsible for the sterile procedure of catheterisation and will fit a day collection bag to the catheter. Your role as a support worker involves ensuring the collection bag is emptied at regular intervals, changed on a weekly basis, and connected, if necessary to a night collection bag.
Equipment required
Disposable wipes
Container which can be washed with warm soapy water.
Gloves Apron
Procedure
Explain the procedure to the service user
Wash hands, put on gloves & apron
Clean the outlet valve with a wipe
Observe urine in bag and tube for colour/ blood / odour (as above). Record concerns and report to your manager.
Open valve and drain contents into container
Close valve, clean with wipe
Dispose of contents in accordance with Infection Control Policy Remove gloves and apron, wash hands
You may be required to record the amount of urine collected.
Leg bags connected to the catheter in a closed system should be changed every 5-7 days in line with manufacturer’s recommendations (Department of Health 2007). If the bag becomes disconnected from the catheter, a new one should be attached.
When disconnecting overnight bag from leg bag, procedure as above, taking care not to dispose of tubing which attaches overnight bag to leg bag.
Numerous devices are available to support the leg bag and thus prevent damage to the urethra and bladder neck.
If the Service Users’ bed or clothing is wet, make a record in the communication sheet, and with the service users consent, inform your Field Supervisor who will contact district nurse.
Stoma Care (Colostomy)
Many service users manage their own care without assistance; however some may need some support with this.
If the service user is no longer able to manage, you should inform your Field supervisor who will inform the district nurse and arrange support for you to assist with this.

Dictionary

Anaemia
Anaemia is a condition where the amount of haemoglobin in the blood is below the normal level, or there are fewer blood cells than normal. (Haemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs). Iron deficiency anaemia is the most common type of anaemia.
Arthritis
Arthritis is a common condition that causes pain and inflammation in a joint. In the UK, around 10 million people have arthritis. It affects people of all ages, including children. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.
Asthma
Asthma is a common lung condition that causes occasional breathing difficulties. It affects people of all ages and often starts in childhood, although it can also appear for the first time in adults. There’s currently no cure for asthma, but there are simple treatments that can help keep the symptoms under control so it doesn’t have a significant impact on your life. Some people, particularly children, may eventually grow out of asthma. But for others it’s a lifelong condition.
Bronchitis
Bronchitis is a common infection causing inflammation and irritation to the main airways of the lungs. Symptoms of bronchitis include coughing up yellow-grey mucus, sore throat, wheezing and having a blocked nose.

Cancer
Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place. When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumours. Many cancers form solid tumours, which are masses of tissue. Cancers of the blood, such as leukaemia’s, generally do not form solid tumours. Cancerous tumours are malignant, which means they can spread into, or invade, nearby tissues. In addition, as these tumours grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumours far from the original tumour. Unlike malignant tumours, benign tumours do not spread into, or invade, nearby tissues. Benign tumours can sometimes be quite large, however. When removed, they usually don’t grow back, whereas malignant tumours sometimes do. Unlike most benign tumours elsewhere in the body, benign brain tumours can be life threatening.
Cerebral Palsy
Cerebral palsy is the general term for a number of neurological conditions that affect movement and co-ordination. Neurological conditions are caused by problems in the brain and nervous system.
Specifically, cerebral palsy is caused by a problem in the parts of the brain responsible for controlling muscles. The condition can occur if the brain develops abnormally or is damaged before, during or shortly after birth. Causes of cerebral palsy include:
an infection caught by the mother during pregnancy;
a difficult or premature birth;
bleeding in the baby’s brain;
changes (mutations) in the genes that affect the brain’s development.
Cystic Fibrosis
Cystic fibrosis is an inherited condition in which the lungs and digestive system can become clogged with thick, sticky mucus. It can cause problems with breathing and digestion from a young age. Over many years, the lungs become increasingly damaged and may eventually stop working properly.
Most cases of cystic fibrosis in the UK are now identified through screening tests carried out soon after birth. It’s estimated that 1 in every 2,500 babies born in the UK has cystic fibrosis. A number of treatments are available to help reduce the problems caused by the condition, but unfortunately average life expectancy is reduced for people who have it.
Dementia
The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. These changes are often small to start with, but for someone with dementia they have become severe enough to affect daily life. A person with dementia may also experience changes in their mood or behaviour.
Diabetes
Diabetes is a serious life-long health condition that occurs when the amount of glucose (sugar) in the blood is too high because the body can’t use it properly. If left untreated, high blood glucose levels can cause serious health complications. There are two main types of diabetes: Type 1 and Type 2.
Type 1 diabetes
Type 1 diabetes is an autoimmune condition where the body attacks and destroys insulin- producing cells, meaning no insulin is produced. This causes glucose to quickly rise in the blood. Nobody knows exactly why this happens, but science tells us it’s got nothing to do with diet or lifestyle. About 10 per cent of people with diabetes have Type 1.
Type 2 diabetes
In Type 2 diabetes, the body doesn’t make enough insulin, or the insulin it makes doesn’t work properly, meaning glucose builds up in the blood. Type 2 diabetes is caused by a complex interplay of genetic and environmental factors. Up to 58 per cent of Type 2 diabetes cases can be delayed or prevented through a healthy lifestyle. About 90 per cent of people with diabetes have Type 2
Dysphasia
One in a group of speech disorders in which there is impairment of the power of expression by speech, writing, or signs, or impairment of the power of comprehension of spoken or written language. More severe forms of dysphasia are called aphasia.
Epilepsy
An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Epilepsy is a disease characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. Translation: a seizure is an event and epilepsy is the disease involving recurrent unprovoked seizures.
Gangrene
Gangrene is the term used to describe the decay or death of an organ or tissue caused by a lack of blood supply. It is a complication resulting from infectious or inflammatory processes, injury, or degenerative changes associated with chronic diseases, such as diabetes mellitus

Heart Disease
Any disorder that affects the heart. Sometimes the term “heart disease” is used narrowly and incorrectly as a synonym for coronary artery disease. Heart disease is synonymous with cardiac disease but not with cardiovascular disease which is any disease of the heart or blood vessels. Among the many types of heart disease, see, for example: Angina; Arrhythmia; Congenital heart disease; Coronary artery disease (CAD); Dilated cardiomyopathy; Heart attack (myocardial infarction); Heart failure; Hypertrophic cardiomyopathy; Mitral regurgitation; Mitral valve prolapse; and Pulmonary stenosis.
HIV and Aids
Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). There are two variants of the HIV virus, HIV-1 and HIV-2, both of which ultimately cause AIDS.
Hypothermia
Hypothermia, a potentially fatal condition, occurs when body temperature falls below 95°F (35°C). .
Motor Neurone Disease
A degenerative disease of unknown cause; affects upper and lower motor neurones of spinal cord, motor nuclei of cranial nerves and motor cortex; characterized by progressive muscular atrophy, amyotrophic lateral sclerosis and progressive bulbar palsy
Multiple Sclerosis
A chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, whose symptoms may include numbness, impairment of speech and of muscular coordination, blurred vision, and severe fatigue.
Parkinson’s Disease
A progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.
Pneumonia
A lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid. Inflammation may affect both lungs (double pneumonia), one lung (single pneumonia), or only certain lobes (lobar pneumonia).
Stroke
A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow.
Abuse
There are many forms of abuse and neglect, including:
Sexual abuse
This includes indecent exposure, sexual harassment, inappropriate looking or touching, as well as rape. Sexual teasing or innuendo, sexual photography, subjection to pornography, witnessing sexual acts, and sexual acts that you didn’t agree to or were pressured into consenting to all count as sexual abuse.
Physical abuse
This can include being assaulted, hit, slapped, pushed, restrained, being denied food or water, or not being helped to go to the bathroom when you need to go. It can also include misuse of your medication.
Psychological abuse
This includes someone emotionally abusing you or threatening to hurt or abandon you, stopping you from seeing people, and humiliating, blaming, controlling, intimidating or harassing you. It also includes verbal abuse, cyber bullying and isolation, or an unreasonable and unjustified withdrawal of services or support networks.
Domestic abuse
This is typically an incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse by someone who is, or has been, an intimate partner or family member.
Discriminatory abuse
This includes some forms of harassment, slurs or similar unfair treatment relating to race, gender and gender identity, age, disability, sexual orientation, or religion.
Financial abuse
This could be someone stealing money or other valuables from you, or it might be someone who is appointed to look after your money on your behalf using the money inappropriately or coercing you into spending it in a way you are not happy with. Internet scams and doorstep crime are also common forms of financial abuse.
Neglect
Neglect is also a form of abuse. Neglect includes not being provided with enough food or the right kind of food, or not being taken proper care of. Leaving you without help to wash or change dirty or wet clothes, not getting you to a doctor when you need one, or not making sure you have the right medicines all count as neglect.

Adult Social Care
There is no simple definition of adult social care. However, it is agreed it covers a wide range of services provided by local authorities and the independent sector to adults either in their own homes or in a care home. It also covers day centres, which help people with daily living. Services like help with washing, dressing, feeding or assistance in going to the toilet are also included, as are meals-on- wheels and home help for people with disabilities.
Advanced directive
An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.
Advocate and Advocacy support service
An advocacy service is provided by an advocate who is independent of social services and the NHS, and who isn’t part of your family or one of your friends. An advocate’s role includes arguing your case when you need them to, and making sure the correct procedures are followed by your health and social care services.
Ambulatory Care
Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services
Approved Mental Health Professional
An appropriately qualified and competent professional with specialist training in mental health who is approved under the Mental Health Act 1983 and acts independently but on behalf of the Local Authority. AMHP’s are responsible for assessing mental health service users and making decisions relating to their detention and treatment under the Mental Health Act 1983. Professionals qualified to train as AMHP’s include social workers, psychiatric nurses, clinical psychologists and occupational therapists.
Assessment
A conversation held with a Service user, sometimes using a questionnaire, which is used to work out what social care support a Service user needs. An assessment takes place when a Service user first applies for social care services. The assessment is reviewed at least once a year to make sure that the Service user continues to receive the right support, but reviews may happen more frequently depending on an individual Service user’s circumstances. Please also see Financial Assessment.
Assistive Technology (AT)
The use of technology or equipment by a Service user to enable or promote her/him to live independently. It allows people to perform tasks, which, they would otherwise be unable to do, or increases the ease or safety with which the task can be performed. Telecare is an example of Assistive Technology.
Broker / Brokerage
An organisation or person that helps a Service user to arrange the support they need. Brokerage can be done by a council, a voluntary organisation/charity, a private alpine care, or an individual such as a family member or friend.
Whether a person can make a decision to agree to (or refuse) a treatment, or course of action affecting them. This involves the ability to sufficiently understand and retain information about their condition. Capacity applies to each decision and is not a one-off judgment. The Mental Capacity Act offers guidance on this and assumes a person has capacity unless proven otherwise.

Care Funding Calculator (CFC)
A tool to support local councils, health trusts and other public bodies across England and Wales to deliver care services efficiently. It has a similar purpose to a price comparison website, but for social care services. It is used by social care practitioners and people who commission social care services to understand the cost of a person’s care package. The practitioner inputs the person’s daily support needs into the calculator, and based on a range of market costs, it works out a cost range, from which Councils negotiate a fair price for the package.
Carers (unpaid)
When we talk about carers we do not mean someone who is paid to provide care as part of a contract of employment – for example, a care worker or care staff. A carer is someone, who, without payment, provides help and support to a partner, child, relative, friend or neighbour, who could not manage without their help. This could be due to age, physical or mental illness, addiction or disability. A young carer is someone who is under the age of 18 and may be looking after his/her parents, brother or sister, grandparent or other relative who needs support.
Care Package
A range of community care services, a person will receive for their assessed need.
Care plan
A care plan (sometimes called a care and support plan, or support plan if you’re a carer) sets out how your care and support needs will be met.
Care Programme Approach (CPA)
Providing people with serious mental health problems an individual agreed care plan.
Care Quality Commission (CQC)
The health and social care regulator for England. It looks at the ‘joined up picture’ of health and social care and promotes the rights and interests of people who use the services. It is an independent body which bases its’ actions on high quality evidence. Its work brings together independent regulation of health, mental health and adult social care.
Commissioning
Commissioning is the process by which local authorities decide how to get the best possible value for money whilst providing good quality services for local people.
Community Care
Community care enables people to maintain their independence within their own homes wherever possible. Where necessary i.e. following an assessment or review, assistance is provided to arrange long-term care in residential or nursing establishments.
Consultation
Provides an opportunity for people to express their views and opinions about a service area in a constructive manner.
Continuing Health Care
Continuing health care is a package of care arranged and funded solely by the NHS. It is awarded depending on whether a person’s primary need is a health need. It can be provided in a range of settings, including an NHS hospital, a care home or someone’s own home.
Day Opportunities
Day Opportunities help Service users to make the most of their day. In the past, giving eligible Service users the chance.
Direct Payments
Are cash payments made directly to eligible Service users who choose to make their own care arrangements, rather than receiving services provided a local authority, for example.. Direct Payments are one way Service users can choose to manage a personal budget . They provide greater choice and control.
Discretionary Services
These are services which local authorities are not required to provide by law. They are also sometimes referred to as Non-statutory services.
Domiciliary Care (also known as Home Care)
Domiciliary Care can help people with personal care and some of the practical household tasks that help them to stay at home and be as independent as possible.
Extra Care Housing (ECH)
Extra Care Housing offers people the opportunity to live independently in self-contained units but with access to a flexible and responsive 24-hour care support service on site. They are suitable for accommodating the use of Assistive Technology and offer facilities and services to the wider community.
Fair Access to Care Services
This document is published by the Department of Health and issues guidelines on how councils should determine whether a Service user is eligible for adult social care services. It covers how local authorities should carry out assessments and reviews and support individuals through the assessment process.