Community equipment in care homes

Care home responsibilities

Find out who is responsible for providing and maintaining care equipment in care homes in Surrey.

Care homes are generally responsible for providing standard equipment to help residents increase or maintain functional independence. They must also assess and ensure the safety and wellbeing of residents and staff.

Care homes must meet the Care Quality Commission standards.

They must ensure they can meet a resident's needs before admitting them to the care home.

They must ensure that residents have access to the equipment they need and that it is:

• safe
• available
• comfortable
• suitable for people's needs
• properly maintained.

Find out more: Regulation 15: Premises and equipment Care Quality Commission website

Moving and handling assessments

Care home staff should carry out a moving and handling risk assessment as soon as a resident moves into the home.

They should review the assessment regularly, especially when a resident's health or functional ability changes.

Key staff members should be trained to assess and recommend which moving and handling equipment is appropriate for the range of needs within the home.

Range of standard equipment

The range of standard equipment provided by the care home should include equipment such as handling belts and slide sheets, hoists, and slings, in different styles and sizes.

Complex cases

Care home staff should refer to other suitable professionals (moving and handling advisors or occupational therapists) for complex cases, or when a resident needs bespoke equipment.

Local authority and NHS responsibilities

Care homes should have a variety of equipment and furniture to meet the needs of most residents. However, some residents may have needs that require specialist equipment to help them.

In these cases, a health or social care professional will assess and prescribe non-standard community equipment tailored to help an individual.

Individual tenancies

If an individual has their own tenancy within a supported living environment, this is considered as living within the community. This means the Community Equipment Service (CES) will fund any necessary equipment following an assessment by a clinical professional.

Extra care schemes

General equipment in extra care schemes which is available to several different residents to use must be funded by the Extra Care Housing Provider.

NHS Continuing Healthcare

Care homes may be required to provide certain equipment as part of regulatory standards for people who are receiving NHS Continuing Healthcare.

Care homes must provide a certain level of standard equipment to all residents appropriate to their registration. However, some residents in homes will require bespoke equipment to meet specific assessed needs identified in their NHS Continuing Healthcare care plan. The Clinical Commissioning Group should make appropriate arrangements to assess for and meet these needs.

Paying for equipment

Individuals can pay for their own equipment before they move into a care home.

Where a local authority or the NHS provide a direct payment instead of the equipment itself, the individual is responsible for buying and maintaining the equipment themselves.

Where an individual moves to a care home and is assessed:

• If they no longer need the equipment, they will be responsible for its maintenance.
• If there is still a need for equipment, the local authority or NHS will still be responsible for it.

Process for referral

If a client needs equipment, the care home needs to identify whether it falls under health or social care.

Health needs

Contact client's GP to make appropriate referral.

Social care needs

Contact the client's duty locality team, based on their normal home address.

Community Equipment Service (CES) loans

The Community Equipment Service (CES) loans specialist or temporary equipment to individuals who have been assessed by an approved health or social care professional.

The equipment should not be used by anyone else.

The CES is not responsible for the general provision of equipment. However, they can supply temporary items for a short period in case of emergency. For example, to facilitate an urgent hospital discharge or where there is a safeguarding concern.

How to identify equipment from the CES

Most CES items will have an ID sticker on them, usually put somewhere away from the main working parts. Here is an example of a sticker used by Millbrook Healthcare

A PUK (product) number will be written in permanent ink on slings and other equipment where it's not possible to have a sticker.

Repairs and maintenance

The CES provider or authorised sub contractor will carry out all repair and maintenance of its equipment.

The CES is responsible for maintaining a list of all loan equipment requiring ongoing and regular testing and maintenance. The care home needs to give the local CES provider access to check and maintain the equipment.

Care home staff should take note of any other stickers on equipment.

If they see a sticker with a date on it, they should not use the equipment if the date has passed.

Electrical items not associated with lifting a person must also have an in-date PAT (Portable Appliance Test) sticker. This is normally attached to the plug. They should not be used if the date has passed.

The care home is responsible for maintaining and servicing their own equipment.

When to contact the CES

Care home staff are responsible for notifying the CES immediately when a resident:

• no longer needs a loaned item of equipment
• has died or moved to another location (the care home must inform the CES of the resident's new address)
• needs alternative equipment if their needs have changed (a further assessment will be required)
• has equipment that has broken down or needs repairing.

Equipment that is no longer needed by the resident for whom it was prescribed must never be transferred for use by another resident.

Rehab and Discharge to Assess (D2A)

Equipment prescribed for rehabilitation or for the Discharge to Assess (D2A) process will be prescribed for a specific resident.

The Community Equipment Service (CES) will arrange collection when the equipment is no longer needed.

Where a resident leaves the home but still needs the equipment, they will take the equipment with them. Please give the CES the new address so they can continue to maintain the equipment.

Palliative care equipment

The CES can load equipment for emergency, short term palliative care to ensure resident is comfortable and dignified.

The care home must ask the CES to arrange collection of the equipment when it's no longer required.

Bariatric and plus size equipment

Bariatric and plus size equipment is considered standard equipment which should be provided by the care home.

Care homes should ensure they have the right equipment to meet a variety of care needs and to fulfil their health and safety obligations to their own care staff.

Liability

Where equipment is provided by the CES, it will include instructions on how to use it and maintain it.

Care staff must use the equipment within the manufacturer's guidance, complete any daily checks and keep the item clean and in good condition.

Care staff must be trained in the use of the equipment. This is a mandatory requirement under the Health & Safety at Work Act 1974, the Provision and Use of Work Equipment Regulations PUWER 1998 and MDA DB 2006.

If the equipment provided for a specific individual is subsequently used with another resident and an incident or accident occurs, the care home will be liable – the liability does not transfer to the prescriber or CES.

The care home must agree to meet the cost of all repairs arising from negligence, damage, or inappropriate use of loan equipment (this includes defacing the equipment or permanent marking with a resident's name), or the full cost of replacement if damage is beyond repair.

Care homes will be charged the full replacement cost for all equipment not returned within any required timeframe or deemed 'lost'.

Check who provides and maintains equipment

• Administration of medicines
• Bathing equipment
• Standard Tilt in space shower chairs
• Bespoke equipment
• Beds
• Bed accessories
• Chair raising and getting dressed in care homes
• Help with feeding
• Gardening support
• Mobility equipment
• Wheelchairs
• Chairs
• Nursing equipment and care
• Moving and handling equipment
• Pressure care
• Breathing and respiration equipment
• Sensory impairment equipment
• Telecare
• Telehealth
• Toileting
• Fall prevention

Administration of medicines

Bathing equipment

Standard equipment in care homes

Care homes are responsible for providing and maintaining all standard bathing equipment in care homes. These include standard:

• Bath seats
• Bath boards
• Powered bath lift
• Shower chairs
• Shower stools

Standard Tilt in space shower chairs

Care homes should provide standard "off the shelf" Invacare Aquatec Ocean VIP, which is a tilt in space shower chair.

It accommodates a range of widths as standard which would not be specifically for a named individual. This shower chair is height adjustable (no tools required) and has head support as standard.

Where a standard, "off the shelf" tilt in space shower chair (such as Invacare) will not meet an individual's needs, a clinical practitioner will assess the resident's needs and may provide the equipment. This will be supplied by the Community Equipment Service or an NHS Continuing Healthcare team.

Bespoke equipment

The Community Equipment Service or NHS Continuing Healthcare teams are responsible for providing and maintaining all bespoke bathing equipment for individual use.

Bespoke equipment is usually provided after a clinical practitioner has assessed an individual. For example, a moulded shower chair.

Beds

Powered (electric) beds, including height adjustable, profiling, and ultra-low beds

Nursing homes are responsible for providing and maintaining electric beds.

In residential homes, this can vary, depending on an assessment by an approved practitioner for health needs. NHS Continuing Healthcare may fund these beds in some cases. For example:

• Where the client has a severe chest infection and needs the profiling function to sit upright and other solutions like a back rest, bed wedge, pillow lift have been tried unsuccessfully.
• Where the profiling function is essential to assist in the management of pressure care.
• As part of a prescribed rehabilitation programme where the profiling and variable height functions will enable client to transfer independently and prevent the use of a hoist.

Variable height, profiling bariatric bed

Care homes are generally responsible for providing and maintaining these beds.

In residential homes, where the client's weight is above the maximum weight limit of a standard variable height profiling bed, then the CES may provide a bariatric bed following a full documented risk assessment.

In some cases, this may be funded by NHS Continuing Healthcare.

Bespoke beds for complex needs, including extra-long beds

The NHS, CES and the care home should work together to find the best solution.

Bespoke beds for people with complex treatment and care needs

These are funded by NHS Continuing Healthcare.

Bed accessories

Bed rails and bumpers

Nursing homes are responsible for providing bed rails and bumpers.

In care homes, bed rails and bumpers are only provided by CES and subject to full documented risk assessment.

Bumpers to be used on powered profiling beds provided by CES only. If a person is CHC funded and requires a bespoke bed rail this would be funded by CHC/CCG

CES will only provide rails when CES has provided a bed.

Chair raising and getting dressed in care homes

Care homes are responsible for providing and maintaining all chair raising equipment and items to help people get dressed in care homes. These include:

• Standard chairs
• Chair blocks and raisers
• Dressing equipment
• Stocking aid
• Tights aid
• Long handled shoehorn

Help with feeding

Gardening support

Care homes are responsible for providing and maintaining:

• Grabbers to pick up garden waste
• Garden trolley to move garden waste or tools
• Perching stools

Mobility equipment

These items may be available through your local CES or other health professional.

People need to be assessed first by an appropriate practitioner.

• Walking stick
• Fisher walking stick
• Walking frames with/without wheels
• Gutter walking frame
• Elbow crutches
• Gutter crutches
• Standing frame
• 3 or 4-wheeled walkers
• Heavy-duty mobility equipment

Care homes are responsible for providing and maintaining:

• Ramps
• Grab rails

Wheelchairs

The Wheelchair Service provides wheelchairs for long term conditions (six months or over) and only to help people move independently.

Care homes in Surrey have access to 'Wheelchair Services'.

They are for people who appear to have a "physical impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities" (as stated in the NHS Act).

Depending on the type of referral, a wheelchair assessment may be completed.

Care homes may need to provide or fund a chair if the required chair is deemed a standard provision. Find out more below.

Postural management

The Wheelchair Service will only provide postural management if it is part of the wheelchair solution.

The CES can provide postural and positional support as a non-standard equipment order.

Chairs

Nursing equipment and care

Moving and handling equipment

Bariatric hoists

In nursing homes, the care home is responsible for these.

In residential homes, these can be provided after a risk assessment by a clinical practitioner.

In some cases, this could be funded by NHS continuing Healthcare.

The CES will only consider requests where the resident's weight is above the maximum weight limit of a standard hoist.

The CES does not hold stock of these. To order one, you need to go through a special orders process and authorisation.

Bespoke slings

These be provided by the CES after a risk assessment by a clinical practitioner. In some cases, this could be funded by NHS continuing Healthcare if the client is eligible and has been assessed for a bespoke sling.

Sling manufacturers do not routinely stock these. To order one, you need to go through a special orders process and authorisation with the CES.

Standing hoist

These should be provided by the care home for general use.

A CES prescriber may provide these for a named individual if considered essential as part of a short-term need where the client is expected to progress to the use of a non-mechanical stand aid or independent transfers.

Pressure care

Breathing and respiration equipment

Sensory impairment equipment

Care homes are expected to provide a range of standard equipment, such as flashing fire alarms/flashing doorbells.

Other sensory items may be available through referrals to local Sensory Impairment Service teams.

Telecare

Care homes are expected to provide calls systems and monitors.

Other telecare items may be available through referrals to local Telecare Services.

Telehealth

The NHS provides a range of telehealth items through local telehealth providers. Vital signs monitoring, for example.

Toileting

Care homes are responsible for providing and maintaining:

• Bedpans and urine bottles
• Range of commodes - standard and mobile
• Raised toilet seats
• Toilet frames

Continence pads – there are local policies in place. It will either be the care home or NHS. Patients must be assessed and meet the eligibility criteria for the continence service.

Fall prevention