Service-delivery continuity policy (domiciliary care)

1. What the regulation says

Systems or processes must be established and operated effectively to ensure compliance with the requirements in this Part. (Reg 17(1): the umbrella duty)

assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity (including the quality of the experience of service users in receiving those services) ... assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity. (Reg 17(2)(a) and (b): quality and risk)

Regulation 12 adds the safe-care duties that this policy operationalises:

Care and treatment must be provided in a safe way for service users. (Reg 12(1) (the headline duty))

assessing the risks to the health and safety of service users of receiving the care or treatment, (Reg 12(2)(a) (risk assessment))

doing all that is reasonably practicable to mitigate any such risks, (Reg 12(2)(b) (risk mitigation))

Regulation 18 adds the staffing duty that underpins continuity of cover:

Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed in order to meet the requirements of this Part. (Reg 18(1): the headline duty)

The full text is at https://www.legislation.gov.uk/uksi/2014/2936/regulation/17, https://www.legislation.gov.uk/uksi/2014/2936/regulation/12 and https://www.legislation.gov.uk/uksi/2014/2936/regulation/18. Where this policy and the regulation diverge, the regulation wins.

2. Plain-English summary

You have to run effective systems and processes to comply with everything else in Part 3. The regulation lists six things those systems must enable in particular: quality assessment and improvement, risk management, accurate service-user records, accurate employment and management records, seeking and acting on feedback, and continually evaluating and improving how you process all this. If CQC requests a written report on quality and risk plus your improvement plans, you have 28 days from the day after the request.

Care and treatment must also be provided in a safe way. Regulation 12 lists the areas a provider must address, including risk assessment, risk mitigation and staff competence, and Regulation 18 requires sufficient numbers of suitably qualified, competent, skilled and experienced staff to be deployed. Keeping essential home care going through disruption is how a service shows it is assessing and mitigating the risks to people's health, safety and welfare.

3. Purpose

People who depend on home care still need that care when things go wrong: when staff are off sick, when the weather is severe, when a phone system or rosters fail, or when demand suddenly rises. This policy sets out how the Service keeps essential care going through disruption, decides who must be visited first, and gets back to normal afterwards.

The Service must verify this policy against its commissioning contracts, which often set their own business continuity requirements, before adoption.

In practice, that continuity plan has to line up with the visit scheduling, missed and late visits policy and, where people need medicines support, the domiciliary care medication support policy template.

4. Scope

This policy applies to:

• events that disrupt the Service's ability to deliver visits
• the steps that keep essential care going during disruption
• everyone with a part to play, from the office and on-call staff to care workers

5. Roles and responsibilities

• Registered Manager: owns the continuity plan, approves priority rules, leads post-event review and ensures improvement actions are completed.
• Nominated Individual or provider representative: ensures the provider has enough resources, insurance, commissioner communication and governance oversight for continuity risks.
• Care coordinator or office lead: keeps visit priority information, contact lists, staff availability and offline access arrangements current.
• On-call lead: makes out-of-hours continuity decisions, redeploys workers and records the decision trail.
• Care workers: report disruption early, follow redeployment instructions, protect records and tell the office when a person's care is at risk.
• Medicines or clinical lead, where appointed: advises when continuity disruption affects time-critical medicines, nutrition, hydration, clinical care or safeguarding risk.

6. Continuity operating procedure

The Service follows this procedure when continuity is threatened:

1. Identify the disruption. Record what has happened, which rounds or people are affected, and whether the disruption is office, staffing, travel, system, premises or outbreak-related.
2. Triage critical visits. Check the care plans for time-critical medicines, food and fluids, personal care that cannot wait, people living alone, people who lack capacity, and people without informal support.
3. Redeploy cover. Move available workers to critical visits first, using workers who know the person where possible.
4. Communicate early. Tell the person, family or representative, commissioner and relevant professionals what is happening, what will be late, and what alternative cover is arranged.
5. Escalate risk. Where a visit cannot be covered and the person may be harmed, seek urgent health, social care, safeguarding or emergency support.
6. Protect records. Use the approved offline or backup record route, keeping access details and personal information secure.
7. Record decisions. Keep a live log of decisions, affected visits, contacts, cover arranged, residual risk and actions.
8. Recover and review. Return to normal rota, check that no person's care was missed, review impact and open improvement actions.

7. The risks this policy plans for

The Service plans for the disruptions most likely to affect home care, including:

• staff shortage through sickness, including several staff at once
• severe weather, flooding or problems with travel or fuel
• failure of the phone system, rosters, or the call-monitoring system
• loss of the office or its records
• a sudden rise in demand

The Service keeps its own list of risks up to date and reviews it.

8. Deciding who must be visited first

When the Service cannot deliver every visit, it protects the people who would be harmed first. The Service:

• identifies, in advance, the people whose care is critical, for example those who need time-critical medicine, who cannot eat or drink without help, or who have no one else
• records this priority in the care plan, so that in a crisis staff know who must be seen and in what order
• delivers critical visits first and keeps non-critical visits under review

9. Keeping enough staff to cover

The Service builds resilience into its staffing:

• it keeps enough workers, including bank or relief workers, to cover normal absence
• it has an on-call arrangement that can call in cover and redeploy workers to priority visits
• it agrees with workers, in advance, how it will ask for extra help in a crisis

10. Keeping in touch during disruption

During disruption the Service communicates clearly and promptly:

• it tells people receiving care, and their families or representatives, what to expect and when care will come
• it keeps workers informed and supported
• it tells commissioners and, where needed, other services, in line with its contracts

11. Information and systems

The Service makes sure the information needed to keep care going is available even if a system fails:

• staff can reach an up-to-date list of who must be visited, with addresses, access details and key contacts, including when the main system is down
• contact details for staff, people receiving care, families, commissioners and emergency services are kept current and reachable
• records are backed up and protected so they survive the loss of the office

12. The business continuity plan

The Service holds a written business continuity plan that names who does what in a disruption, how decisions are made, and how the steps above are carried out. The plan is kept up to date, shared with the people who need it, and tested so that staff know it works rather than meeting it for the first time in a crisis.

13. Records and register links

During and after any disruption, the Service records what happened, what care was affected, and how it responded. The continuity record should include:

• date, time and type of disruption
• people, rounds, visits, medicines or essential care affected
• triage decisions and priority visits protected
• workers redeployed and visits covered
• people, families, representatives, commissioners and professionals contacted
• care that was late, shortened or missed
• safeguarding, health, emergency or commissioner escalation
• incidents, complaints or data-breach records opened
• lessons learned and improvement actions
• whether the risk register or business continuity plan was updated

Continuity events that affect care are linked to the incident register. Repeated disruptions, weak controls or unresolved dependencies are added to the risk register. Corrective work is tracked in the improvement-actions register and reviewed through governance.

14. Training and exercises

Office staff, on-call staff and supervisors must know how to activate the continuity plan, identify critical visits, use backup records, contact commissioners and record decisions. Care workers must know how to report disruption, protect records, follow redeployment instructions and raise immediate risk to a person.

The Service tests the plan on a stated cadence using realistic scenarios such as staff sickness, system outage, severe weather and failure to reach a critical visit. Lessons from tests are recorded and actioned.

15. Audit cadence

The Service checks, on a stated cadence, that:

• the risk list and the business continuity plan are current
• critical people are identified in care plans and would be visited first
• staffing and on-call cover are adequate, and contact lists are current and reachable offline
• the plan has been tested, and lessons from any real disruption have been acted on

The Registered Manager reviews the results and records the improvement actions that follow.

16. Sources and further reading

This template is based on CQC's guidance for providers and managers, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and other topic-specific legislation and guidance listed below. It is a starting point for adaptation, not a substitute for legal, clinical, HR, safeguarding or specialist professional advice.

• CQC Regulation 17: Good governance (https://www.legislation.gov.uk/uksi/2014/2936/regulation/17)
• CQC Regulation 12: Safe care and treatment (https://www.legislation.gov.uk/uksi/2014/2936/regulation/12)
• CQC Regulation 18: Staffing (https://www.legislation.gov.uk/uksi/2014/2936/regulation/18)
• Local authority continuity expectations
• UKHSA severe weather and outbreak guidance
• The Service's commissioning contracts and any local authority business continuity requirements
• Local emergency planning and adverse-weather arrangements

17. Related reading

• Guide: Domiciliary care compliance guide
• Article: CQC compliance for domiciliary care: the evidence inspectors expect
• Related policy: Visit scheduling, missed and late visits
• Related policy: Domiciliary care medication support policy template
• Related policy: Lone working and personal safety policy

18. When to seek further advice

Seek specialist advice where the issue involves serious harm, safeguarding, deprivation of liberty, restraint, children, professional misconduct, controlled drugs, radiation, termination of pregnancy, infection outbreak, water safety, employment dismissal, DBS barring referral, or regulatory enforcement.

19. Document control

This sample policy template was issued by Verivius. It is a template, not a substitute for legal advice or the tenant's own policy-development process. Where this template and live law or regulator guidance diverge, the live source wins.