How many staff should be on night duty in a 41-bed care home which looks after residents with dementia?

Answered by Lindsay Rees

This depends on the individual needs of the residents; you should also take into consideration the training and skills of the staff available, and the layout and design of the care home. You may wish to use a dependency tool to assess individuals’ needs. There is not a nationally recognised dependency tool for adult social care.

When assessing dependency/level of needs for your residents you may wish to take in to account the following questions for each individual service user. This list is not exhaustive and includes:

-How many staff members are needed to support with washing and dressing?

-What equipment is needed to support the resident’s needs? (Hoist/stand aid/high dependency chair)

-How long does washing and dressing take each day?

-Does the service user need assistance with comfort/hygiene during the day and night? How often do they need help in a 24 hour period, and how long does each episode of assistance take?

-Can they be left alone in their room or in communal areas without supervision/monitoring? (How much 1:1 time is needed to support needs?)

-Do they need assistance with eating and how long does this take?

-Do staff need to support with the management of risk of falls? Or, are they able to manage this independently? (Do staff need to support/prompt regularly/is assistive technology in place requiring immediate response e.g. sensor beam/alert mat?)

-Do they have any specific needs that take more time and/or specifically trained staff to support (e.g. wound dressings, complex medication, covert medication, tube feeding, behaviour that others may find challenging)?

You may find the Pool Activity Level (PAL) Instrument helpful when assessing the needs of people in your service living with dementia. It contains a valid and reliable assessment tool for assessing the overall level of individual cognitive and functional ability. A PAL Guide that describes how to support the person at that level of ability is produced from the completed assessment. There are four levels of ability possible; Planned, Exploratory, Sensory and Reflex. The PAL Instrument is a widely used framework in care settings across the UK and around the world. https://www.qcs.co.uk/digital-pool-activity-level-pal-instrument/

Dependency should be an ongoing process, reviewed at least monthly or when an individual’s condition changes.

When assessing if there are sufficient numbers of staff on duty in your care home, you may wish to consider the following (list not exhaustive):

-Do the residents appear well cared for? (Check appearance, clean clothes, tidy and clean hair, well kept clean nails, clean and healthy mouth)

-Do the residents appear happy? (Look for engagement in day-to-day activities, time spent out of bed/out of room, mood and ability to interact positively)

-What do the staff think? (1:1 meetings, staff meetings, surveys)

-The manager/person who is responsible for staffing levels should walk the floor regularly in the home at different times of the day and night to assess the quality of interactions and determine if the needs of the residents are being met

-Unannounced night visits from management should occur at regular intervals

-Review of indicators for quality of care and response to residents’ needs (e.g. number of falls, pressure wounds, behaviour related events, infections, call bell response times)

-Review of residents’ and relatives’ opinions (surveys, observations, concerns, complaints, and compliments)

-Review of visiting professional opinions (surveys, observations, concerns, complaints, and compliments)

Assessment of staffing levels (sometimes known as Establishment Hours) should be an ongoing process, reviewed at least monthly or when residents’ needs have changed.

The CQC states that: ‘Providers must deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to make sure that they can meet people’s care and treatment needs and therefore meet the requirements of Section 2 of these regulations (the fundamental standards).

• Providers should have a systematic approach to determine the number of staff and range of skills required in order to meet the needs of people using the service and keep them safe at all times. The approach they use must reflect current legislation and guidance where it is available. In determining the number of staff and range of skills required to meet people’s needs, they should consider the different levels of skills and competence required to meet those needs, the registered professional and support workers needed, supervision needs and leadership requirements
• Staffing levels and skill mix must be reviewed continuously and adapted to respond to the changing needs and circumstances of people using the service
• There should be procedures to follow in an emergency that make sure sufficient and suitable people are deployed to cover both the emergency and the routine work of the service’

You can also read more here:

https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-18-staffing