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All Age Personal Care Guidance - Draft

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Good Practice guidelines for all settings and schools supporting children and young people with personal care needs in Staffordshire mainstream settings and schools.

This policy and guidance has been developed to ensure best practice is promoted within all settings in Staffordshire.  Personal care and dignity are of the utmost importance.  Guidance on safeguarding children and staff is also incorporated.

This guidance and policy support the fundamental principles of The Children and Family Act 2014, the Code of Practice 2015 and the Equality Act 2010.  It is helpful to read this guidance in conjunction with the Accessibility Strategy and the Accessible school and settings pathway.

We trust you will find it appropriate in your settings.

 This guidance is meant to answer questions regarding “why you should, and how to do it”.

Introduction

This document needs to be considered in association with (where appropriate) the current guidance on supporting the needs of children and young people with physical needs or disability and any relevant Health and Safety Guidance.

This guidance provides information about meeting personal care needs in pre-school, primary, middle, high schools and Further Education in Staffordshire. It is relevant for adults who are working with:

  • Children and young people who have a developmental delay and who may achieve independence in personal care later than their peer group
  • Children and young people  who have a disability or who require special arrangements for personal care due to medical, emotional or social needs

The guidance is based on good practice and is designed to support the implementation of effective procedures.  It aims to:

  • Ensure that all children and young people are included in their local community school regardless of their personal care needs
  • Provide advice to staff
  • Assure parents and carers that staff are provided with guidance to help them be knowledgeable about personal care, and that their individual concerns are taken into account
  • Safeguard (Keeping Children Safe in Education: September 2019) the rights and well-being of the children and young people
  • Reassure and protect the interests of staff working in a personal care capacity

Regardless of age, children and young people who have personal care needs fall within the terms of Equality Act and the setting must make ‘reasonable adjustments’ to support them, i.e. “due diligence”.

All children and young people have an educational entitlement irrespective of their difficulties with personal care. Additionally they have the right to be safe, treated with courtesy, sensitivity, dignity and respect.

Principles

Staffordshire County Council believes that children and young people with personal care needs should be admitted into school with their cohort.  These children and young people have an educational entitlement irrespective of their difficulties with personal care.  It is not acceptable to deny, delay or reduce attendance at any school simply because a child has individual personal care requirements. 

Parents have a key role to play in the management of personal care needs.  It is particularly important to ask for parental guidance on cultural or religious issues and the child’s or young person’s preferences for comfortable and appropriate care.  Parents can expect to work in partnership with schools and settings and to have clear written information on policies and personal care plans. 

It is important to recognise that people may feel judged or blamed if their child is not independent in personal care.  It is not appropriate to expect parents or carers to be on emergency stand by to change children and young people during the school day or during educational (including residential) visits.

Managers and head teachers in settings and schools have a responsibility to set the tone for the way in which the issue of personal care is addressed.  Managers, head teachers and governors should be aware of their duties to comply with the Equality Act, and should pass this awareness on to all staff.  Practice in settings/schools should be consistent with Staffordshire’s vision for the continued development of inclusive practice, so enabling a greater number of children and young people to be educated in their local community schools. 

Children and young people must not be left wet or soiled or expected to be responsible for cleaning/changing themselves without agreed independence targets in place in liaison with parents and school.

Parents must not be expected to dispose of soiled items

Definition of Personal care

Personal care can incorporate all those tasks of an intimate nature associated with bodily functions, bodily products and personal hygiene. These may include:-

  • Dressing and undressing
  • Helping someone to use the toilet
  • Changing continence pads/nappies
  • Bathing/showering
  • Washing intimate parts of the body
  • Changing sanitary wear
  • Changing stoma bag (following training from Stoma Nurse)

Respecting Personal Dignity

Where staff are involved on a daily basis in providing personal and intimate care to young people with special educational needs arising from learning difficulties, sensory impairments and physical disabilities they are placed in a position of great trust and responsibility.

Children and young people with special needs and/or disability can lack confidence and assertiveness.  Activities related to intimate care should offer opportunities for personal development and choice. 

It is vital that schools seek to engage with parents, and children and young people, prior to enrolment and at any transition to discuss the normal routines of the school and staff most likely to be involved in delivering aspects of intimate care.

A Personal Care Risk Assessment form is available in our download section to the right of the page.

Where appropriate the following can assist in promoting positive attitudes to intimate care:

  • Get to know the child beforehand in other contexts to gain an appreciation of his/her verbal and non-verbal communication
  • Have a knowledge and understanding of any religious and/or cultural sensitivities related to aspects of intimate care related to this individual child and take full account of these
  • Give explanations of what is happening in a straightforward and reassuring way including visual cues where appropriate, e.g. step by step symbol sheet
  • When washing, always use a sponge or flannel and where possible encourage the child to attempt to wash private parts of the body him/herself
  • Speak to the child or young person by name (using age-appropriate language) and ensure that they are aware of the procedures involved
  • Provide facilities which afford privacy and modesty
  • Respect a child's preference for a particular carer where possible and sequence of care
  • Keep confidential records which note responses to intimate care and any changes in behaviour that giver cause for concern
  • Agree appropriate terminology for private parts of the body and functions to be used by staff and encourage children to use these terms as appropriate
  • Best practice would involve keeping a home/school communication record to ensure continuity, identifying patterns and reassurance and transparency for parents/carers.  An examplar home school communication record is available in our download section to the right of the page.

Process

A number of children and young people may need assistance with their personal care.  It should not be assumed that failure to achieve independence with personal care is in itself an indication of special educational needs.

Schools should ensure that additional resources and finances are allocated to ensure that children and young people’s individual needs can be met. 

Children and young people with long-term personal care requirements as part of complex medical or physical needs may require additional assistance to manage these needs in settings and schools.  Settings and schools are required to contact the appropriate external agencies working with the child for advice. 

It is recommended that all schools/settings should have a policy on managing personal care issues, whether or not they currently support children and young people with these needs.  The guidance should show a commitment to including all children and young people with personal care needs and should be placed in the context of the Equality Act.

The guidance should make explicit the roles and responsibilities of staff in a school/setting and should clarify for parents, children and young people what they can expect from the school and what should be expected from them. It should also link to the SEN information report and accessibility plan the setting/school have.

It is likely that most personal care tasks will be undertaken by teaching/support assistants within schools and settings. All new and reviewed contracts for teaching assistants should include personal care in their remit.  This would include support in promoting independent personal care and other self-care skills

However, all staff are expected to promote personal dignity and care and teachers may take responsibility for assisting children and young people with personal care needs. This is undertaken voluntarily as part of duties regarding reasonable adjustments/due diligence.

In addition, managers and headteachers should ensure implementation of the following requirements:

Resources and Facilities

Whenever possible, the existing toilet areas should be used.  If these are inappropriate then choose a private, safe location that protects the dignity of the child or young Person without compromising staff.  Do not change pupils in educational, play or public areas, or in any location used for the preparation of food and drink.

The minimum facilities would comprise:

  • Sink with ideally lever taps and hot and cold running water
  • Dedicated bin with lid
  • Paper roll or wet wipes for cleansing the body, cleaning the surface of the changing area and mopping up spillages. (Settings should liaise with parents about the use of wipes and agree who will provide these, bearing in mind the possibility of allergies). 
  • Wipes/pads/nappies provided for individuals should be labelled with the child or young person’s name and stored discretely
  • Antibacterial spray/Milton/liquid soap and water are all suitable for cleaning surfaces and the changing area
  • Non-latex gloves and disposable aprons – fresh ones should be used each time for each child

Consideration should be given to storage arrangements for the resources listed.  In addition, arrangements should be confirmed for spare clothing to be available within the setting and the transfer of wet or rinsed, soiled clothing back home.

If children and young people are able to stand independently, it is acceptable to change them whilst they are standing up. It is not appropriate to do so if they are soiled.

In the short term it may be necessary to change children and young people on the floor.

(Eearly Year aged!) if no other surface is available.  In these circumstances, an easy-to-clean mat should be placed under a changing mat and other pupils should be prevented from accessing the area whilst changing is underway, e.g. an appropriate sign on the door.  A risk assessment should be completed for the adult responsible for changing and they should be provided with a kneeling pad.

If making adaptations, schools and settings should try to create a facility that will be suitable for children and young people who may be included in the school or setting in the future.  The Accessibility Plan should, if appropriate, include the upgrading of toilets to meet the needs of a range of users.

When upgrading, consideration should be given to providing changing facilities that minimise lifting and avoid staff having to kneel down on the floor to change children and young people.  Ideal facilities would include:

  • Emergency call system
  • Extractor fan
  • Rise and fall changing table
  • Toilet
  • Disposal system for clinical waste (for example via an existing sanitary bin disposal contract)
  • Sufficient room to store and operate a mobile or tracking hoist and to accommodate a powered wheelchair.

Health and Safety Issues

Headteachers and managers have a duty to safeguard the health and safety of both Children and young people and staff.  It is imperative that the following health and safety concerns are addressed before the pupil begins attending.

Disposal of pads and other soiled waste should be negotiated with the company that collects usual refuse from the settings.  SCC Infection Control Policy (reference:- states the recommended cleaning procedure for Catheters/Stoma Bags:

“Single use – Empty contents down sluice or toilet, and dispose of bag as hazardous/offensive waste”.

Offensive waste includes faeces, nasal secretions, sputum, tears, urine, vomit, etc.  If offensive waste contains visible blood or a clinical assessment has identified that infection exists from the waste, this should be considered infectious (hazardous) waste.

In homes and schools, hazardous waste should be placed in a yellow bag and collected by an approved contractor.  Offensive waste should be placed in a yellow and black striped bag and collected by an approved contractor.

Certain conditions and disabilities may bring with it early onset of puberty. Menstruation can be alarming for girls if they are not prepared. Schools should make adequate and sensitive preparation to help girls cope with menstruation and with requests for sanitary protection. Provision of sanitary wear should be done in a sensitive and discreet way.

Risk assessments should be completed to anticipate or address concerns raised by children and young people, parents or staff.  Personal care plans should include a risk assessment.  Staff training on risk assessment should aim to encourage staff to ‘think safety’ when considering situations and identifying potential risks.  Support for the creation of Personal Care Plans can be obtained from ideally a health professional if relevant. 

The following documents are available in our download section to the right of the page:

Staff training

Staff should have access to appropriate training to meet the needs of individual children and young people. This could include:

  1. Health and safety regulations
  2. Medical conditions (School Health Advisor, Continence Service)
  3. Physiotherapist/ Occupational Health
  4. Lifting and handling (County Health and Safety, Moving and Handling trainers)
  5. Child protection/safeguarding  issues (First Response/LADO)
  6. Personal hygiene (School Nurse)
  7. Vulnerability to abuse and Child Protection

Children and young people with disabilities may have an increased vulnerability to abuse and discrimination.  It is essential that all staff are familiar with the setting’s Safeguarding/Child Protection policy and procedures, with agreed procedures within this policy and with the child/young person’s Care Plan.

The normal process of supporting personal care needs should not raise child protection/safeguarding concerns, and there are no regulations that indicate that a second member of staff must be available to supervise this process in order to ensure that abuse does not take place.  

‘Few settings/schools will have the staffing resources to provide two members of staff for personal care and DBS checks are carried out to ensure the safety of children and young people with staff employed in childcare and education settings.’

Jeannie Carlin, Council for Disabled Children and Young People 2005

Including Me:  Managing complex health needs in schools and early years settings, page 75

Some unions recommended that in schools two members of staff are present when personal care is undertaken.  This however does need to be balanced with issues around maintaining staff/pupil ratios and ensuring privacy.  If there is a known risk of false allegation by a pupil or parent a risk assessment should be undertaken and appropriate action taken.

Section 18 in the government guidance, Safe Practice in Education, states that

“Staff should ensure that another appropriate adult is in the vicinity and is aware of the task to be undertaken.”

At all times the privacy and dignity of the child or young person should be respected, especially if more than one member of staff is present.

The process of providing personal care may, in rare circumstances, lead to a level of concern for staff regarding child protection. The usual procedures for sharing concerns with the nominated child protection members of staff or First Response should be followed.

Good Practice Guidance for Admission/Inclusion of Children and Young People requiring personal care

Individual Needs

It is good practice to establish a child’s or young person’s personal care needs at entry to a school or setting.  Transition arrangements offer an opportunity to support parents in establishing personal care needs in the new setting. Close liaison with parents and carers is vital.

When families visit the setting/school prior to entry, it is appropriate to discuss personal care issues with the parents and carers.  A leaflet to support parents in Early Years toilet training is available.  A printable version is available in our download section to the right of the page.

The Care Plan should cover the following.  A printable Personal Care Plan for Toileting (where toileting and additional needs requires considering) is available in our download section to the right of the page. Guidance notes are also available.

  • Procedures
  • Facilities
  • Resources and equipment
  • Staffing
  • Training
  • Curriculum specific needs
  • Educational visits
  • Arrangements for the review and monitoring of the Care Plan
  • Emergency procedures/contact

Staffing levels need to be considered carefully. There needs to be a balance between maintaining privacy and dignity of the child/young person and protection both for them and staff involved.

Preparation should include discussion with parents, confirmation of arrangements and plans for monitoring and review.  The personal care plan should make reference to:

  • Signed consent from parents/carers to allow support
  • Signed consent of the child where appropriate
  • Signature of school nurse where their advice has been sought/included
  • Clear arrangements for staffing and access to facilities
  • Specialist advice, training or resources required
  • Record keeping such as personal care diary and/or reward system if appropriate
  • Any relevant and appropriate multi-agency involvement/information
  • Risk assessments
  • Liaison and review with parents and outside agencies

When setting up a care plan, the child or young person and his/her parents/carers should feel comfortable with the staff members who are providing the personal care.  Gender issues, religious and cultural values should always be taken into account.  It is important to adopt consistent approaches at home and school

The SENCo for the setting/school should be aware of the personal care plan and link this intervention with other monitoring completed under Code of Practice procedures. 

There are a number of other issues which it is helpful for staff to consider and agree with parents and carers prior to the child starting at the setting.  These include:

Clothing  

Parents should be asked to provide clothing that is easy to manage.  Clothing with elasticated waists and no zips or buttons is most helpful.  Whenever possible it is better to support the child with appropriate clothing rather than relying on nappies or training pants. Parents should also be asked to provide plenty of changes of clothing.  Setting/school should provide spare clothes in an emergency, but it is always better for a child or young person to wear his/her own clothes.  Finally, the setting should agree with parents and carers what will happen to wet or soiled clothing.

Routines

Parents should be asked to ensure that the child is changed or taken to the toilet at the latest possible time before leaving home.  In school, prompting may be necessary as a reminder.  If a member of staff is required to support personal care, ensure arrangements are confirmed for cover if the member of staff concerned is unavailable. Consider the possibility of shared responsibility for supporting personal care needs e.g. job share to enable flexible cover in the event of absence. Careful observations may identify when the pupil requires personal support.  Ensure that the routine established in setting/school is strictly maintained from the start and try hard to avoid accidents. Reminders to use the toilet should be discreet and appropriate and staff should make use of signs, pictures or code words to facilitate understanding. 

Accidents  

Children and young people may be anxious but usually respond to praise, encouragement and confidence building.  It is important to promote self-esteem in other areas of learning.  Ensure that personal care needs are provided swiftly, appropriately, sympathetically and in a calm, low-key way.  If accidents do occur sensitivity for children, young people and others in the group/class needs to be managed.  

Children and Young People’s Views

It is essential that children and young people’s views and preferences are taken into consideration in management of personal care needs.  This includes consideration of non-verbal communication and visual cues.  Staff involved in meeting children and young people’s personal care needs should endeavour to:

  • Get to know the child or young person beforehand as appropriate e.g. systems of communication
  • Have a knowledge of and respect for any cultural, gender or religious sensitivities related to aspects of personal care.