Safe Care and Treatment
Scope of this chapter
We have a duty of care to ensure that that every person we support is provided with care and treatment that is safe and carried out in a way that prevents avoidable harm or risk.
Providing safe care and treatment is not just important but a legal requirement and fundamental standard under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This chapter explains what is meant by safe care and treatment and provides guidance on how to meet legal requirements in practice. Much of the chapter links to other areas of the Handbook, as this is where detailed information can be found.
Providing care and support that is safe is a legal requirement, but also a core principle and value. This means that it applies to everyone and is always relevant when planning for or providing care and support.
Relevant Regulations
Regulation 12: Safe care and treatment
Regulation 13: Safeguarding service users from abuse and improper treatment
Related Chapters and Guidance
Safe care and treatment is care and support that prevents avoidable harm or risk to the person being supported.
The regulation identifies key areas and steps that should be taken to ensure care and support is safe.
Note: Safe care and treatment is not limited to these areas. All care and support must be safe.
Assessing risks to the people we support is an essential part of the regulation.
To meet the regulation, risk assessments must be carried out by people with the necessary skills, competence and experience. Normally, this is the registered person or Designated Health and Safety Lead, although can be delegated to anyone else that is suitably skilled.
Once risks have been assessed, plans must be developed for managing those risks.
Risk assessments should be reviewed regularly, and whenever there has been a change in someone’s needs or wishes about how risk is being managed.
All staff must have the qualifications, skills, competence and experience to keep people safe. The registered person must make sure training and supervision is provided before allocating related tasks to staff.
Nobody must carry out tasks they have not been trained to do.
If anyone has concerns about their ability to carry out the tasks they have been asked to do safely, those concerns must be raised swiftly to a manager or the registered person. The manager or registered person must take those concerns seriously and arrange any appropriate training or supervision to develop competence.
Whilst developing skills and competence, staff must receive appropriate levels of supervision or support from colleagues or a relevant professional. That person must be able to assess when the staff member is able to complete the task independently.
The service must have systems and processes in place to ensure that premises and equipment are safe. These processes must reflect any requirements around specific types of equipment e.g., lifting equipment.
The overall responsibility for ensuring premises and equipment are safe is the responsibility of the registered person. This cannot be delegated, even when an external contractor carries out maintenance works or repairs.
Nobody must use equipment until they have been appropriately trained and supervised. Induction plans should set out training requirements.
Staff must never use equipment that appears to be faulty. Systems must be in place to report such concerns and rectify the problem. If problems cannot be rectified, a contingency plan must be in place.
All staff must know how to report accidents, injuries and incidents relating to premises or equipment.
See: Accidents, Injuries and Incidents
The financial plans of the service must factor in costs for maintaining premises and equipment.
Nobody must use equipment until they have been appropriately trained and supervised. Induction plans should set out training requirements.
Staff must never use equipment that appears to be faulty. Systems must be in place to report such concerns and rectify the problem. If problems cannot be rectified, a contingency plan must be in place.
All staff must know how to report accidents, injuries and incidents relating to premises or equipment.
Nobody must administer medication until they have received the appropriate training and are skilled to do so. This may mean specialist training for some medication types e.g., medication administered non-orally. The registered person must take steps to ensure that medication training is refreshed and does not expire.
Policies and procedures around medication must reflect current national guidance and include the following areas:
- Supply and ordering;
- Storage, dispensing and preparation;
- Administration;
- Disposal;
- Recording.
All staff must follow policies and procedures about managing medication.
For further guidance see: Medication Support
Medicines that are prescribed should not be allowed to run out.
The amount of prescribed medication available should be enough to cover any emergency periods. For example, if a pharmacy delivery is late or weather has prevented the pharmacy from getting a delivery.
Medical devices and equipment must be available when the person needs them and in good working order.
For further guidance see: Medication Support
The policies, procedures and processes to prevent and control infection should follow the Health and Social Care Act 2008 Code of Practice:
However, if the registered manager wishes to implement equivalent or better measures than those in the Code, they can do so if the safe care and treatment regulation continues to be met.
When assessing risks from infection, the link between infection, cleanliness, medication management and antimicrobial stewardship (the use of antibiotics and similar medicines) should be clear.
For further guidance see: Infection Prevention and Control
If the person being supported is also using another service, we must make sure that we work with that service to ensure that care and treatment is safe across all provision.
This includes sharing relevant information about risk, planning joint contingencies, making sure equipment and medication is available and any other action to ensure care and treatment is safe.
This also applies if a person is transitioning from one service to another, goes into hospital, is arrested, is sectioned under the Mental Health Act etc.
Note: The legal responsibility for making sure care and treatment is safe across all provision lies with the principal provider - the one that provides the most support to the person.
Note: Information sharing must take place in line with legal requirements.
The following are just a few examples of unsafe care and treatment:
- Disregarding the person’s wishes about how support is provided;
- Not providing care and support in line with a care or support plan;
- Carrying out tasks without having had appropriate training or supervision;
- Not providing medication as prescribed, administering too much medication or allowing medication to run out;
- Using unsafe manual handling techniques e.g., using the wrong equipment or physical lifting without equipment;
- Using equipment that is faulty or that you know has not been maintained;
- Not using PPE as instructed;
- Not complying with risk assessments;
- Not reporting an accident, injury, risk, hazard or the unsafe practice of a colleague.
All incidents of unsafe care or treatment must be properly recorded and reported in line with the process for reporting accidents, injuries and incidents.
If the incident of unsafe care or treatment is or may be abuse or neglect, a safeguarding concern should also be raised to the local authority.
There may be a legal requirement to report incidents of unsafe care or treatment to the Health and Safety Executive, CQC or commissioning body.
See: Accidents, Injuries and Incidents
If serious physical or psychological harm has occurred, the duty of candour may also apply.
See: Duty of Candour
All CQC inspections will look for evidence that the care and treatment being provided across all areas of the service is safe.
If an issue is identified, further action is unlikely if the service can prove that all reasonable steps are being taken to ensure the health and safety of people being supported.
If the CQC is not satisfied that this is the case, the registered person can be prosecuted if the failure to provide safe care and treatment has resulted in avoidable harm to one or more person's being supported, or if they have been exposed to significant risk.
The service has a legal responsibility to keep up to date with changes in national guidance around any aspect of safe care and treatment.
The best way to do that is to register for email alerts from key agencies, including gov.uk, the Department of Health and Social Care, CQC and Skills for Care. Anyone can do this.
Whenever national guidance changes, risk assessments and relevant procedures should be updated accordingly. Changes should be effectively communicated throughout the service.
All concerns about unsafe care or treatment should be properly investigated using relevant procedures, and appropriate action should be taken to reduce the risk of a future occurrence.
Anyone that feels a concern about unsafe care or treatment has not been taken seriously, properly investigated or rectified can whistleblow to the Care Quality Commission directly.
See: Raising a concern with CQC
Tel: 0300 061 6161
Email: enquiries@cqc.org.uk
Last Updated: September 12, 2022
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