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Equipment in a Care Home (Occupational Therapy)

1. The General Responsibility of Care Homes to Provide Equipment

Under the Care Standards Act (2000) a care home must be 'fit for purpose' to meet the general needs of the residents that it supports and it cannot agree to provide Care and Support to any individual whose needs it cannot meet.

Under the Act there is a statutory requirement for all care homes to produce and make available a statement of purpose, setting out how they intend to meet the needs of its residents and be 'fit for purpose'. This statement of purpose should, amongst other things include details about the general equipment and adaptations that the care home will provide, and this should reflect the general needs of all its residents.

It is reasonable for the care home to provide:

  1. Basic moving and handling equipment (for example a self propelling wheelchair);
  2. General mobility equipment (for example appropriate seating);
  3. General lifting equipment (for example hoists and banana boards); and
  4. Adaptations (for example doors widened to accommodate wheelchairs and grab rails in common areas).

2. The Responsibility of Care Homes in Specific Circumstances

Specific circumstances in the statement of purpose

If the statement of purpose sets out that the care home will provide equipment and adaptations to meet the individual needs and specific circumstances of each resident as required (or words to this effect) they have a responsibility to do so.

Specific circumstances in a Care and Support Plan

When plans are being made for a person with likely needs for equipment or adaptation of their environment to be placed into a particular care home the social care practitioner responsible for arranging the placement should:

  1. Review the statement of purpose to establish whether the provision of specific equipment and adaptations to meet the individual needs of a resident is included; and
  2. If not discuss with the care home whether the provision of any future equipment or adaptations can be included in the service (if so this will need to be reflected in the weekly cost of the care home).

If it is agreed (either through the statement of purpose or through negotiation) that specific equipment or adaptations will be provided by the care home this should be clearly recorded in:

  1. The Care and Support Plan;
  2. Any care plan that the home uses; and
  3. The contract between the care home and the Local Authority.

Where this is clearly recorded the care home has a responsibility to provide specific equipment or adaptations to meet an individual's needs.

Specific circumstances in a care contract

Where a person who is self funding requires specific equipment or an adaptation it is the responsibility of the care home to provide this whenever this provision is included in the contract between the care home and the resident.

3. The Responsibility of the Local Authority to Provide Equipment

The duty to assess

In all cases the Local Authority has a duty to carry out an assessment of needs on the appearance of need alone whenever:

  1. The person requests an assessment; or
  2. If the person lacks capacity, the Local Authority deems it in their best interests to have an assessment.

It does not matter whether:

  1. The Local Authority will ultimately meet any needs; or
  2. The person is self funding their care home placement.

The assessment will determine:

  1. The eligible needs that the person has; and
  2. The nature of equipment or adaptation that is most appropriate and proportionate to meet the need.

When the Local Authority must provide equipment

The Local Authority must provide equipment and minor works when:

  1. An appropriate and proportionate assessment of need has been carried out; and
  2. The person has eligible needs under the Care Act; and
  3. The provision of equipment is the most appropriate and proportionate way to meet eligible needs; and
  4. It is not the responsibility of the NHS to provide the equipment;
  5. The equipment is for the sole use of the individual who has been assessed; and
  6. The equipment is not going to benefit other residents; and
  7. The statement of purpose does not set out that the care home will undertake to provide the equipment under its responsibility to be 'fit for purpose'; and
  8. The statement of purpose does not indicate that the care home will provide equipment to meet the specific needs of individual residents; and
  9. The Care and Support Plan (or contract for a self funding resident) does not set out that the care home will provide the equipment to meet the specific needs of the individual.

In any other circumstance it is likely that the care home should provide the equipment or adaptation as part of its responsibility to be 'fit for purpose' and meet the general needs of all residents.

The provision of major adaptations

If the care home environment requires a major adaptation to meet the needs of the person this indicates that:

  1. A significant change in need has likely occurred; and
  2. The person's needs may be beyond those that the care home is fit to meet under its statement of purpose;
  3. Needs may be more appropriately met in a different care home or environment.

Careful consideration needs to be given to determine whether a major adaptation:

  1. Is the most appropriate and proportionate response to meet the person's eligible needs; and
  2. Is an appropriate and proportionate use of available Local Authority financial resource; and
  3. Will not benefit other residents in general.

Some factors to consider when deciding whether an adaptation will be appropriate and proportionate include:

  1. The views of the person and the impact on Wellbeing;
  2. How long the person is likely to benefit from the adaptation;
  3. What the changes have been in the person's needs and whether the care home is still able to meet their needs (now and in the future);
  4. Alternative options to meet the person's needs that are available.

In all cases you must refer to available local policy and guidance before making a decision.

Major adaptations in a care home cannot be carried out under the Housing Grants, Construction and Regeneration Act 1996. The HGCRA only applies to adaptations in the community. If they take place this is only possible under the Care Act, which means:

  1. The person must have eligible needs; and
  2. If the person is self funding, there is no duty to meet eligible needs in a care home.

4. When the Care Home Arranges Equipment

This guidance explains what steps a care home should take to arrange equipment or works when it has a responsibility to do so (as set out above).

Providing the right equipment and works

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 the care home has a legal responsibility to make sure that any equipment it provides is suitable for the purpose of which it is being used. The only reasonable way for a care home to fulfil this responsibility is to make arrangements based on the assessment and recommendations of a suitably skilled person. This could be:

  1. An Occupational Therapist at the Local Authority;
  2. An Occupational Therapist in the employ of the care home; or
  3. An independent Occupational Therapist commissioned by the care home.

Decisions about carrying out an assessment following a request from the care home should be made taking into account:

  1. Whether the person has an appearance of need;
  2. The level of risk to the person from the current situation;
  3. Whether the person has been previously assessed as having eligible needs under the Care Act; and
  4. If so, whether those eligible needs are still being met in the current situation; and
  5. Whether it is clear that the care home has a responsibility to provide the likely equipment.

If an assessment has been carried out by a Local Authority Occupational Therapist

If the Local Authority carries out an assessment this should be done in the normal way. Following assessment eligibility does not need to be applied by the Local Authority unless the equipment to be provided is not the responsibility of the care home to provide.

The care home should be provided with:

  1. Information about the person's needs;
  2. Advice about the nature of the equipment or works most appropriate and proportionate to meet needs; and
  3. Information about local manufacturers and providers of the equipment or works recommended.

It is the responsibility of the care home to make suitable arrangements based upon the recommendations and information that has been provided to them.

The Local Authority should take steps as it deems appropriate to:

  1. Establish whether the equipment has been provided as per recommendations made; and
  2. If not, whether the equipment that has been provided is appropriate to meet the person's needs; and
  3. If not, consider the need to raise a concern about the suitability of the care home to meet the person's needs; or
  4. Consider the need to raise a safeguarding concern.

If an assessment has not been carried out an independent Occupational Therapist

If the care home has made its own arrangements to assess the person's needs for equipment or works the Local Authority has no role.

Using equipment safely

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 the care home has a legal responsibility to ensure that the equipment it provides is:

  1. Secure;
  2. Suitable for the purpose for which it is being used;
  3. Appropriately located; and
  4. Used as instructed by the organisation providing it.

If the person themselves has provided their own equipment the care home has a responsibility to ensure that it is:

  1. Secure; and
  2. Used as instructed by the organisation providing it.

Maintaining equipment

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 the care home has a legal responsibility to ensure that the equipment it provides is:

  1. Clean; and
  2. Properly maintained.
If the person themselves has provided their own equipment the care home has a responsibility to ensure that it is clean. It is the responsibility of the person to maintain the equipment when they have provided it.

5. When the Local Authority Arranges Equipment

Arranging equipment

If the Local Authority will be arranging equipment or works for a care home resident following assessment the process for doing so is the same as the process for arranging equipment and works in the community.

Using equipment safely

The role of the Local Authority

If the Local Authority has provided equipment it must take steps to ensure that anyone who will be using the equipment is able to do so safely and properly.

These steps should be appropriate and proportionate and could include:

  1. Monitoring how equipment is being used;
  2. Agreeing with the care home how it will support carers to use equipment safely;
  3. Direct support.

The nature of the steps taken should consider:

  1. Whether similar equipment is already present in the care home and being used effectively by carers;
  2. The complexity of the equipment;
  3. The level of risk to the person from improper use;
  4. The likelihood that the person's needs will change in the future; and
  5. The level of support provided by the manufacturer when the equipment was provided.

See: Providing Direct Support.

The role of the care home

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 the care home has a legal responsibility to ensure that the equipment:

  1. Is used as instructed by the Local Authority (or the organisation providing it if instruction was provided by them); and
  2. Remains suitable for the purpose for which it was intended.

If the care home feels that the equipment is no longer fit for purpose they should request or arrange further appropriate assessment of need.

The care home is responsible for ensuring that any new carers that are going to be using the equipment are suitably skilled to do so. If the care home requires support to provide training to a new carer the Registered Manager should contact the Local Authority and further direct support should be considered.

Maintaining the equipment

The role of the Local Authority

It is the responsibility of the Local Authority to ensure that effective mechanisms to maintain equipment are in place. This could be through:

  1. Maintaining equipment itself; or
  2. Agreeing with the care home suitable arrangements for them to maintain the equipment (for example arranging annual health-checks with the manufacturer).

In all cases the Local Authority is liable for the cost of any repairs or replacement equipment unless:

  1. Damage or fault has occurred through improper use of the equipment by carers; or
  2. Damage or fault has occurred because the care home has not kept the equipment clean; or
  3. Damage of fault has occurred because the equipment has not been maintained by the care home as agreed.

The role of the care home

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 the care home has a legal responsibility to ensure that:

  1. Any equipment provided by the Local Authority is clean; and
  2. The safety of the equipment is assessed prior to each use; and
  3. That any maintenance tasks that the care home has agreed to carry out are carried out; and
  4. That the Local Authority is notified should the equipment be deemed unsafe or no longer fit for purpose.

Where an agreement is reached that the care home will maintain the equipment the care home must:

  1. Make the necessary arrangements to maintain the equipment as agreed; and
  2. Notify the Local Authority if it is no longer able to do so.

Reviewing the equipment

The care home can request that the suitability of the equipment to meet the person's needs is reviewed at any time and the Local Authority must:

  1. Consider the request; and
  2. Carry out a review of the equipment if the request is deemed reasonable.

See: Monitoring and Review.

Changes in circumstances

The Local Authority should make appropriate and proportionate arrangements to monitor the equipment that it has provided when:

  1. It is likely that the person's needs may change; and
  2. It is likely that the person's circumstances may change (for example they may leave the care home).

The care home should notify the Local Authority whenever:

  1. Equipment that the Local Authority has provided may no longer be appropriate to meet needs (if needs have increased or decreased);
  2. Equipment is no longer be required (if needs no longer exist or the person has died); or
  3. The person is likely to be moving from the care home.

The Local Authority must then decide the most appropriate course of action to ensure that eligible needs continue to be met. This could be:

  1. Carrying out a reassessment of need;
  2. Carrying out a review of the existing equipment;
  3. Removing the equipment from the care home and returning it to stores; or
  4. Transferring the equipment to the new living environment (subject to an assessment of the new environment).

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