1. Home
  2. Guidance
  3. Guidance for Service Providers
  4. Frequently Asked Questions for Service Providers

Frequently Asked Questions for Service Providers

How many staff should be on duty to care for 30 residents/service users?

Staffing levels should be based on the assessed need of the service user and their dependency levels at any given time. Further information in relation to nursing and residential care homes is provided below.

Nursing Homes

The responsibility for the management and operation of a registered nursing home lies with the registered persons (registered provider and registered manager) who are required to “carry on and manage the nursing home (as the case may be) with sufficient care, competence and skill”.

(Regulation 10 (1) of the Nursing Homes Regulations (Northern Ireland) 2005)Each registered nursing home is required to have a statement of purpose which provides information on a wide range of matters including staffing, admission criteria and facilities and services (Regulation 3(1) and Schedule 1 of the Nursing Homes Regulations (Northern Ireland) 2005).

Regulation 20 (1) (a) of the Nursing Homes Regulations (Northern Ireland) 2005 states that the registered person shall, having regard to the size of the nursing home, the statement of purpose and the number and needs of patients ensure that at all times suitably qualified, competent and experienced persons are working at the nursing home in such numbers as are appropriate for the health and welfare of patients. RQIA would expect that in considering staffing arrangements each registered nursing home would consider all relevant matters to ensure that patients receive safe, effective and compassionate care. This should include the following matters: the structure and layout of the home; the registered categories of care; the dependency levels of patients; the role of the manager and the experience and competencies of staff and staff training. Reference should also be made to Standard 41 – Staffing of the Care Standards for Nursing Homes and criteria 5 in particular which requires a skill mix of at least 35 per cent registered nurses and up to 65 per cent care assistants over 24 hours in nursing homes. Both the regulations and care standards referred to are available on the RQIA website.

Residential Care Homes


In keeping with Regulation 20 of The Residential Care Homes Regulations (Northern Ireland) 2005responsibility for determining the staffing levels / ratios for the home rests with the registered persons (registered person and registered manager). RQIA expect that in considering staffing arrangements each registered person would consider all relevant matters to ensure that residents receive safe, effective and compassionate care.

Regulation 20 (1) (a) of The Residential Care Homes Regulations (Northern Ireland) 2005 states that the registered person shall, having regard to the size of the residential care home, the Statement of Purpose and the number and needs of residents ensure that at all times suitably qualified, competent and experienced persons are working in the residential care home in such numbers as appropriate for the health and welfare of residents.

I’m employing a new staff member who had an Access NI check completed less than a year ago, do I need to do it again?

Yes, as part of recruitment procedures, each new member of staff should have an Access NI check completed prior to commencement of employment.

 

For further information click here

An incident has occurred in the home/service, do we need to report this to RQIA?

Each establishment agency has different events (incidents) which require to be notified to RQIA. These are found in the regulations for that service type.

I am a member of staff in a home and I have concerns about the care. I have reported them but nothing has changed what should I do?

Staff are reminded that within your professional code of conduct you are obliged to raise concerns and should do so without delay.

 

All staff working in any health or social care environment should raise their concerns with their line manager.

 

Guidance for whistleblowers and NIAO practice guide ‘Whistleblowing in the Public Sector’ is available on RQIA website.

 

RQIA is listed as ‘prescribed persons’ under the Public Interest Disclosure NI Order and so as a member of staff you can contact RQIA with your concerns.

 

RQIA will take details of whistleblowing disclosures. The information will be reviewed and a decision made if any regulatory action is required. This may include an unannounced inspection.

 

Click here Public Disclosure NI Order 1998


Click here Guide to Public Interest Disclosure NI Order 1998
 

Does RQIA have whistleblowing guidance if I wish to raise concerns? What will RQIA do?

RQIA has issued guidance for health and social care staff who wish to make a protected disclosure about wrong doing in their workplace. This can be found on our website.

RQIA will review all information provided and decide what action is required.

Click here for further information in relation to RQIA’s whistleblowing guidance
 

I have an issue around my working conditions and hours of work, who do I speak to?

RQIA does not get involved in any issues relating to terms and conditions of employment between staff and their employers.

 

Advice can be given by Labour Relations Agency and relevant unions
 

Click here to access the Labour Relations Agency website

How do I go about opening a regulated service?

If you wish to open a health and social care service which would be subject to regulation, you will be required to register with the RQIA. Application forms and all relevant documents can be found here or you can call us on (028) 9051 7500 and ask to speak with a member of our registration team.

For further information click here

As a provider I have a query about a variation of my registration, who do I speak to?

If you have a query or wish to vary your registration all relevant documents can be found here or you can call us on (028) 9051 7500 and ask to speak with a member of our registration team.

For further information click here

There’s an outbreak of vomiting in my home. Who needs to be contacted and who is allowed to enter the home?

The home will have its own procedures which it implements when an outbreak occurs which may include restricting visitors to the home.

 

There are certain outbreaks which need to be reported to RQIA as per notifiable events. Home Managers are also responsible for reporting outbreaks to other agencies including the Public Health Agency.

 

Remember that the best way to prevent the spread of any infection is to wash and dry your hands thoroughly.

What forms of restraint and restriction are allowed to be used in registered services?

Only those restrictive practices that have been outlined within the HSC trust risk assessment and care plan should be implemented in the homes’ of service users. Service providers must be able to evidence that the restrictive practice being implemented is necessary, that it is the least restrictive and that it is used for the shortest time possible.

 

Service users’ consent must be evident within the care records and where this can’t be obtained, there should be evidence of the service user’s best interests being discussed and agreed with their representatives (including HSC trust professionals).

 

The establishment or agency should ensure that any changes in the circumstances of the service user are referred to the relevant HSC trust and participate in the regular review of any restrictive practice.

I am the registered provider/manager of a dental practice. Why am I being inspected again when it hasn’t been 12 months since my last inspection?

RQIA has a statutory duty to inspect dental practices a minimum of once in every inspection year. The inspection year runs from 1 April to 31 March and your annual inspection will be carried out at some time within this timeframe.

 

If there are ongoing concerns, or if information comes to the attention of RQIA we may carry out additional inspections.
 

What are SOPs?

These are Standard Operating Procedures (SOPs) for controlled drugs. It is a requirement by legislation that all registered facilities have written detailed SOPs for controlled drugs. This is usually a separate document.

 

For further information click here

 

For further information click here

 

For further information click here

Which type of controlled drug cabinet do nursing homes, residential care homes and children’s homes need?

Nursing homes – metal cabinet with specific locking system as per Misuse of Drugs (Safe Custody) legislation.

Residential Care Homes/ Children’s Homes – a separate locked cabinet from other medicines.

 

For further information click here

 

For further information click here

 

For further information click here

How should the controlled drug cupboard keys be stored?

The controlled drug cupboard key should be held separately from the other medicine keys and held by the person in charge of the shift.

 

For further information click here

 

For further information click here

 

For further information click here

Which controlled drugs require storage in the controlled drug cupboard?

Schedule 2 (e.g. morphine, fentanyl, oxycodone) Schedule 3 (e.g. temazepam, buprenorphine (BuTrans patches)

 

For further information click here

 

For further information click here

 

For further information click here

Do tramadol, buccal midazolam, zopiclone and zolpidem require storage in the controlled drug cabinet?

No, though this may be in the registered facilities’ policies and procedures.

 

For further information click here

 

For further information click here

 

For further information click here

Do staff have to count Schedule 4 (Part 1) controlled drugs (e.g. diazepam, lorazepam, zopiclone, zolpidem at every shift change?

No, however it is considered good practice, and this may be within the registered facilities’ policies and procedures.

 

For further information click here

 

For further information click here

 

For further information click here

If two trained staff are not on duty to administer controlled drugs and only one trained member of staff is on duty, e.g. at 10pm, can another member

Yes, provided that the second member of staff has been deemed competent in the management of controlled drugs and understands the responsibility.

 

For further information click here

 

For further information click here

 

For further information click here

If a controlled drug patch is missed and administered late, does this need to be reported to RQIA?

Yes. A Form 1(a) must be completed and include details, e.g. if the person has had any ill effects or pain expressed during the period of non-administration of the medicine.

 

For further information click here

 

For further information click here

 

For further information click here

Who can administer medicines? (All registered facilities)

Only staff who have been trained and deemed competent to administer medicines may do so. There is no requirement that only nurses must administer medicines.

For further information click here

Can care staff administer injections, enemas or medicines through enteral feeding tubes?

Only staff who have been trained and deemed competent in the specific areas of medicines management may administer medicines. In registered facilities, records to demonstrate competency should be maintained. The manager should also consider the facilities’ statement of purpose and insurance arrangements. Residents in residential care homes are entitled to receive services from district/community nursing team.

For further information click here

In relation to domiciliary care agencies (DCAs), can care workers administer medicines which are not supplied in the 7 day blister packs?

This will depend on the DCA and their policies and procedures. In some cases this will occur, in other cases, the care worker is not permitted to administer any medicines which are not supplied in the 7 day blister packs. Contact the DCA for clarification of the care package.

Who can self-administer medicines?

Medicines may be self-administered by the service user, provided a risk assessment has been undertaken which shows that the person is competent, understands the prescription and stores the medicine safely. This arrangement must be recorded in a care plan, which is reviewed regularly. There should be systems in place to monitor the compliance and ongoing competency of the service user.

For further information click here

Do all medicines require denaturing before disposal?

No - only controlled drugs require denaturing prior to disposal in nursing homes. This must occur on the premises, before the controlled drugs are removed from the home. This includes Schedule 4 (Part 1) controlled drugs e.g. benzodiazepines ( diazepam, nitrazepam, lorazepam), zolpidem and zopiclone.

In residential care homes and children homes, the medicines should be returned to the community pharmacy for disposal.

For further information click here

Can medicines in nursing homes be returned to the community pharmacy for disposal?

No. Any medicines which are deemed unfit for use or are discontinued in nursing homes are classed as clinical waste. Therefore, in nursing homes, these medicines may only be uplifted by a person who has obtained a clinical waste licence. There may be occasions, where the community pharmacy has a clinical waste licence. Where a nursing home is registered to accommodate persons receiving residential care, the disposal of medicines prescribed for residents should be the same as patients’ discontinued medicines – they cannot go back to the community pharmacy for disposal.

For further information click here

Can medicines be administered covertly/crushed to assist administration?

Every person has the right to refuse the administration of their medicines. Covert administration should not be undertaken unless there has been a multidisciplinary meeting to decide if this is in the best interests of the patient. Clear documentation should be in place in relation to the decision making process. This should be reviewed regularly.

 

Prior to crushing any medicines, alternative forms of the medicine should be considered by the prescriber, e.g. liquid formulation, patches. If this practice is undertaken, a risk assessment should be in place and professional advice needs to be sought as not all medicines can be administered with food and not all medicines can be crushed prior to administration

Who is authorised to give medicines management training?

This is not explicit – training may be done within the service by a competent manager/member of staff, the supplying pharmacist, an outside agency and or by the HSC trust.

 

Records of the training, the person providing the training and a competency assessment for the relevant staff should be maintained. It is the responsibility of registered manager to ensure staff members are trained and competent to carry out all designated tasks.

How often should training be provided?

Training should be provided at least every three years and following any medicine related incident. Specialist training should be provided where more complex administration of medicines is prescribed i.e. buccal midazolam, rectal diazepam, enteral feeding, subcutaneous fluids, syringe drivers.

Who is responsible for deeming staff competent in the management of medicines?

Usually the registered manager. Training maybe provided by an external person e.g. community pharmacist or district nurse but the manager has to be satisfied that the staff member is competent for the task.

How often should staff competency be assessed? What are the guidelines?

Staff competency in medicines management should be reviewed annually and after each medicine related incident.

Do medicines have to be supplied in 28 day blister packs or 7 day blister packs?

There is no requirement that medicines have to be supplied into 28 day or 7 day blister packs. However, this may be the facility’s policy. Any medicine supplied in 28 day or 7 day blister packs must be readily identifiable and appropriately labelled.

Is it better to have medicines supplied in 28 day blister packs in nursing and residential care homes?

This is dependent on the training and competency of the staff. The medicine system must be robust and therefore some homes prefer 28 day blister packs and other homes prefer the traditional supply of bottles and boxes. If using a 28 day blister system, staff must be aware that there will be medicines which cannot be blistered e.g. liquids, light or moisture sensitive medicines.

Does RQIA favour the use of 28 day blister packs?

RQIA has no preference on the system use. Staff should be trained and deemed competent to use the system in place. RQIA emphasises that where blister packs containing more than one medicine per blister are used, there must be robust arrangements in place to identify each medicine and manage any medicine changes.

Can family/friends fill the dosette/pill mill/egg box with medicines for the service user to be administered by care worker from a DCA?

No. If medicines are supplied in a compliance aid (pill mill, dosette box, 7 day blister pack) these must be filled and labelled by the pharmacist.

If medicines are supplied in 7 day blister packs, can staff record the receipt and administration and any disposal/transfer as ‘per blister pack/pack

No. All medicines must be individually receipted, signed as administered and recorded as disposed or transferred. Therefore all medicines must be easy to identify by the labelling.

If medicines are out of stock does this have to be reported to RQIA as an incident?

Yes, if the person has missed more than one dose. RQIA requires information detailing how this occurred and what mechanisms have been put in place to prevent reoccurrence. The ongoing non-administration of medicines may affect the person’s health and well-being.

In nursing homes, residential care home and children’s homes, does the GP have to sign the kardex/personal medication record (PMR)?

No – the GP’s legal obligation is to sign the prescription form. Two members of trained staff should transcribe the information onto the kardex/PMR and initial the entry. It is good practice to keep a photocopy of each prescription or an up to date list of currently prescribed medicines. Some GPs may oblige and sign the kardex/PMR.

Where can I find Fire Safety information?

If you have a general fire risk assessment query then you should refer to the RQIA website. Site specific queries should be submitted to a competent fire safety consultant.

 

Click here for information on Fire Safety


Click here for information on HTM 84
 

What is the policy on Smoking in regulated premises?

General information on the restrictions applied to tobacco/cigarette smoking in regulated premises can be viewed on the RQIA website. Site specific restrictions will be listed in the facility's policy documents and fire risk assessment.

Click here for guidance on service users who smoke

How can I protect patients/residents from Legionella?

General information on the control of legionella bacteria in water systems may be obtained from the HSE website. Site specific controls will be determined by completing a robust legionella risk assessment.

Approved Code of Practice L8:
Click here for information on Approved Code of Practice L8

Click here for information on HSG274 Part 2 – Control of legionella bacteria

Where can I find health and safety advice for regulated premises?

General Health and safety advice can be viewed on the HSE website.

 

Click here to access the Health and Safety Executive’s website