England

Guidance for Local authorities about their market shaping duties under section 5 Care Act 2014 states they should ensure that their functions and systems can ensure the local care market has sufficient capacity and capability of trained and qualified staff.

Paragraph 4.32 Department of Health and Social Care, Care Act Guidance, Updated 2^ndMarch 2020

Any registered service provider is required by regulation 18 (staffing) to ensure that ‘sufficient numbers of suitably qualified, competent, skilled and experienced persons [are] deployed in order to meet all the requirements of [the fundamental care standards].

This means that the training and supervision of staff underpins compliance with all fourteen of the fundamental care standards.

The CQC guidance expects that staff will receive the ‘support, training, professional development, supervision and appraisals’ necessary for them to carry out their responsibilities.

Breach of regulation 18 is not a criminal offence. However, the CQC has powers to take [enforcement action], including imposing conditions on registration, suspending or cancelling registration of a provider.

They can use these powers if service users have suffered harm, been put at risk of harm or been receiving care which is substantially below standard. The [Guidance issued by the CQC] states that the CQC ‘must refuse registration if providers cannot satisfy [it] that they can and will continue to comply’ with regulation 18.

The general requirement imposed by regulation 18 is strengthened by regulation 12 (safe care and treatment), which requires service providers to ensure that ‘persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely’ (emphasis added).

This reinforces the focus in the Regulations on the safety of ‘service users’.

Breach of regulation 12 is an offence if it results in avoidable physical or psychological harm to a ‘service user’ or the significant risk of such harm.

CQC Enforcement Policy (2015)

CQC Guidance for Providers on Meeting the Regulations (2015)

Regulation 18(2) imposes a general duty on service providers to ensure that workers receive the support, training, professional development, supervision and appraisal that they need to enable them to carry out their duties. The CQC guidance expects staff to be supported to participate in statutory and mandatory training, any additional training identified as necessary to carry out their duties and meet the needs of those they care for; and other learning and development opportunities, including first aid training.  The necessary training, learning and development of individual staff members is expected to be carried out at the start of employment and reviewed ‘at appropriate intervals’ thereafter. Training should be monitored, with appropriate action taken if training requirements are not met.

This is enhanced by regulation 12(2)(c). The CQC guidance to regulation 12 expects staff to work only ‘within the scope of their qualifications, competence, skills and experience and should be encouraged to seek help when they feel they are being asked to do something that they are not prepared or trained for’.

Breach of regulation 18 is not a criminal offence, but, the CQC has powers to take [enforcement action].  Breach of regulation 12 is an offence if it results in avoidable physical or psychological harm to a ‘service user’ or a significant risk of such harm.

Ongoing or further training is anticipated.

Regulation 18 requires service providers to enable existing employees to obtain further qualifications ‘appropriate to the work they perform’ (where this is appropriate).

The CQC guidance expects providers to support staff to obtain further qualifications and not to act in a way that prevents or limits staff from so doing.

CQC Guidance for Providers on Meeting the Regulations (2015) (guidance to reg 12).

The CQC guidance expects providers to ensure that they have an induction programme, and that this follows the Care Certificate standards ‘to make sure new staff are supported, skilled and assessed as competent to carry out their roles’. The Care Certificate is a 12-week induction training course developed by Skills for Health, Skills for Care, and Health Education England.

It is not accredited as a qualification and completion is not a legal requirement for careworkers. The CQC guidance includes expectations that inductions will include training on certain specific matters (see further below).

There are specific expectations on service providers to provide training in relation to the safe operation of premises and equipment. These are contained in the CQC guidance rather than the regulations themselves.

The guidance expects providers to include this in induction and training plans, which must be up to date, and to include incident reporting and emergency and contingency planning in these plans. There is also an expectation that staff using equipment will have the necessary training, competence and skills. Staff undertaking cleaning duties are also expected to be appropriately trained.

The guidance also contains specific training requirements in relation to safeguarding.  It expects that as part of their induction staff will receive training on safeguarding that is suitable for their role. This should be updated at appropriate intervals and enable staff to ‘recognise different types of abuse and the ways they can report concerns’.

The guidance contains further detailed expectations, including that staff must understand and adhere to the requirements of the Mental Capacity Act 2005.

Similarly, the guidance expects that staff will receive training on control and restraint that is relevant to their role and ‘at a suitable level to make sure any control, restraint and restrictive practices are only used when absolutely necessary, in line with current national guidance and good practice, and as a last resort’.  This training should be kept up to date.

The guidance requires specific training in relation to the safe management and administration of medicines.

Staff responsible for this are expected to be suitably trained and competent, and this should be kept under review.

Supervision and appraisal are explicitly mentioned in the Regulations. The general duty under regulation 18(2) is that workers receive the support, training, professional development, supervision and appraisal that they need to enable them to carry out their duties.

The guidance expects staff to be supervised until they can demonstrate the required or acceptable level of competence, and to have ongoing or periodic supervision to make sure competence is maintained. In addition, the guidance to regulation 12 expects staff to be supervised when they are learning new skills. Staff should also receive regular appraisal of their performance, and any training, learning and development needs ‘should be identified, planned for and supported.’

The guidance also expects staff to be supported to join Accredited Voluntary Registers if they wish.

In addition to the above, the insistence in regulations and guidance that staff only work within the scope of their competence and skills has resonance for training needs throughout the regulatory framework.

For example, regulation 11(need for consent) requires care workers to act within the provisions of the Mental Capacity Act 2005, to be familiar with the principles and codes of conduct under the Act and able to apply them when needed, and able to balance expression of consent with the need to provide safe care or treatment.