PREVIOUS CARE EMPLOYMENT SAFEGUARDING VERIFICATION (HR-F032) Notify PREVIOUS CARE EMPLOYMENT SAFEGUARDING VERIFICATION Previous Care Employment Safeguarding Verification (HR-F032)SECTION 1: AGENCY & WORKER IDENTIFICATIONTitle- Select -MrMrsMissMsMxOtherStaff Member NameStaff_IDOperating Local Authority- Select -HaringeyIslingtonBarnetWaltham ForestCamdenHackneyBrentHarrowRedbridgeNewhamCity of LondonWestminsterTower HamletsBarking and DagenhamHaveringKensington and ChelseaHammersmith and FulhamEalingHillingdonHounslowSouthwarkLambethLewishamGreenwichWandsworthRichmond upon ThamesMertonKingston upon ThamesSuttonBexleyBromleyCroydonOtherWorker Job Profile- Select -Care Worker / Support WorkerComplex Care WorkerSenior Care Worker / MentorField SupervisorCare Coordinator / Rota SchedulerClinical LeadQuality Assurance / Compliance OfficerHR / Recruitment AdministratorImplementation ResearcherDeputy Care ManagerRegistered Care ManagerConsent Declaration- Select -I acknowledge and confirm that Mutima Care holds a legally signed consent form from the applicant authorizing the full release of their HR, disciplinary, and safeguarding records.SECTION 2: EMPLOYMENT VERIFICATION, SCOPE OF PRACTICE, MANDATORY SAFEGUARDING & DISCIPLINARY DISCLOSUREAuthority Declaration- Select -I confirm I hold the appropriate authority (e.g., HR, Registered Manager, Director) within my organization to disclose this sensitive information safely and legally.What was the applicant's final Job Title?Care Assistant / Support WorkerSenior Care Worker / Team LeaderField Care Supervisor / Care CoordinatorComplex Care / Clinical Support WorkerRegistered Nurse / Nursing AssociateLive-in CarerRegistered Manager / Deputy ManagerAncillary / Non-Care Role (e.g., Admin, Domestic)Employment Start DateEmployment End DateDid the applicant successfully complete their probationary period?- Select -YesNoN/A - Left before completionDid the applicant complete or hold the Care Certificate during their employment?- Select -YesNoUnknownDid the applicant's role involve the provision of direct, regulated personal care?- Select -YesNoN/AWhich service user groups did the applicant primarily support?Older adults (65+)Individuals living with Dementia / Alzheimer'sAdults with Learning Disabilities or AutismAdults with physical disabilities / mobility needsEnd-of-life / Palliative careComplex clinical needs (e.g., PEG feeding, Stoma care)No direct care provision (Office/Admin)To your knowledge, has the applicant ever been the subject of a Safeguarding enquiry or allegation (whether substantiated or unsubstantiated) involving a vulnerable adult or child?- Select -NoYes - SubstantiatedYes - UnsubstantiatedYes - OngoingHas the applicant ever been subject to formal disciplinary action relating to their professional conduct, treatment of service users, or breach of professional boundaries?- Select -NoYes - Warning issuedYes - DismissedDid the applicant resign while under investigation, or pending a disciplinary or safeguarding hearing?- Select -YesNoN/AWas the applicant ever suspended from duty pending a safeguarding or disciplinary investigation?- Select -YesNoN/AWere there any recorded competency failures, strict monitoring periods, or disciplinary actions specifically regarding medication administration (MAR charts)?- Select -YesNoN/ATo your knowledge, has the applicant ever been referred by your organisation to the Disclosure and Barring Service (DBS) or a professional regulatory body (e.g., NMC, SWE)?YesNoN/ATo your knowledge, has the applicant ever been the subject of a Safeguarding enquiry or allegation (whether substantiated or unsubstantiated) involving a vulnerable adult or child?- Select -NoYes - SubstantiatedYes - UnsubstantiatedYes - OngoingSpecify the primary category of the concern- Select -Safeguarding (Harm)Medication / Clinical SafetyProfessional BoundariesHonesty & IntegrityConduct / AttitudeNot ApplicableWhat was the formal outcome of the incident(s)?- Select -SubstantiatedSubstantiatedSubstantiatedSubstantiatedUnsubstantiatedOngoingNot ApplicableAuthority Declaration- Select -I confirm I hold the appropriate authority (e.g., HR, Registered Manager, Director) within my organization to disclose this sensitive information safely and legally.SECTION 3: VALUES, COMPETENCY, RELIABILITY, REASON FOR LEAVING & RE-EMPLOYMENTOverall approach to treating service users with Dignity and Respect- Select -Outstanding (Consistently went above and beyond)Good (Reliably respectful and kind)Requires Improvement (Occasional boundary or attitude issues)Inadequate (Displayed concerning behaviours)Unable to commentPunctuality and Unauthorised AbsenceExcellent (Always punctual, zero/rare unauthorised absence)Good (Standard reliability)Poor (Frequent lateness or unauthorised failure to attend calls)Honesty and Professional Integrity (e.g., accurate logging of timesheets, truthful reporting)- Select -Absolute integrity - highly trustedGenerally honest but required management supervisionConcerns raised regarding honesty or record-falsificationPlease specify the exact reason for leaving as recorded on the applicant's HR file- Select -Resignation - Career progression, relocation, or better pay/benefits.Resignation - Personal, health, or family reasons.Resignation - To avoid pending disciplinary or safeguarding investigation.Dismissal - Gross Misconduct / Safeguarding breach.Dismissal - Capability, performance, or failed probation.End of fixed-term contract or Redundancy.Would you re-employ this individual in a care capacity?- Select -Yes, without hesitationYes, but with additional training/supervisionNoIf 'No' or 'Yes, with training', please specify the primary reason- Select -Conversation with Geminiin the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [ HR-F043DECLARATION[Header Section] Form TitleAuto-Enrolment & Opt-In Declaration Document Control| May 2026 Regulatory Compliance Statement(as amended by the Extension of Automatic Enrolment Act) and CQC Well-led QS5,Mutima Care must execute strict financial governance regarding workplacepensions. This document provides an irrefutable audit trail demonstratingcompliance with The Pensions Regulator (TPR). It outlines statutoryclassifications, enforces National Minimum Wage protections during deductions,and strictly distances the employer from the statutory opt-out process toprevent illegal coercion."SECTION 1CLASSIFICATION Employee Full Name[Auto-fill] National Insurance Number[Drop-downIrisea] Date of AssessmentStatutory Worker Classification (Determined by Payroll)[Drop-down]EligibleJobholder (Aged 18 to State Pension Age, earning over the statutory£10,000 trigger) - Must be automatically enrolled.Non-EligibleJobholder (Aged 16-17 or State Pension Age-74 earning over £10,000; ORAged 16-74 earning below £10,000 but above the lower earnings threshold) -Has the statutory right to opt-in with employer contributions.EntitledWorker (Aged 16-74 earning below the lower earnings threshold) - Has theright to join, but employer contributions are not legally mandated.PendingAssessment (Awaiting first full payroll run to determine variable hoursaverage).SECTION 2Help Textpostponement to align with payroll cycles and probationary variability.StatutoryPostponement Noticeconfirmation)Iacknowledge and understand that Mutima Care utilizes a statutory 3-monthpostponement period from my start date before executing auto-enrolment.DesignatedPension Provider Schemeto restrict to approved schemes)NEST(National Employment Savings Trust)ThePeople's PensionNOWPensionsSmartPensionOther(Specify in Payroll Software only)StatutoryContribution Calculation & NMW ProtectionCheckbox to verify understanding of legal protections)Iunderstand that deductions are calculated from the first £1 of my earnings(8% totalIunderstand that Payroll will automatically adjust or suspend my deductionif it risks breaching the National Minimum Wage for my age bracket.Iunderstand both the contribution calculation and the mandatory NMWprotection.SECTION 3WORKERS) Help Textvariable hours), you retain the right to join the scheme.Opt-In Declarationcriteria for automatic enrolment; however, I formally exercise my statutoryright to join the Mutima Care workplace pension scheme." [Drop-down]Yes- I wish to formally opt-in to the scheme and authorize deductions.No- I do not wish to opt-in voluntarily at this time.N/A- I am classified as an Eligible Jobholder and will be Auto-Enrolled. (SystemLogicprocessing from the next available pay run).SECTION 4Help Textwith an opt-out form or assisting you in the opt-out process.IndependentOpt-Out Processanti-inducement compliance)Iacknowledge that Mutima Care cannot legally provide me with an opt-outform; I must obtain it directly from the pension provider via theirportal/helpline.StatutoryRefund WindowIunderstand I must submit the completed opt-out notice to the pensionprovider within the strict 1-month statutory window to receive a fullrefund.Anti-CoercionProtocolIconfirm that no manager, director, or representative of HeartReach GroupLtd has coerced, pressured, or offered any inducement to persuade me toopt out.TriennialRe-enrolmentIunderstand that UK law mandates Mutima Care must automatically re-enrol meevery 3 years if I remain an eligible jobholder, regardless of a previousopt-out.SECTION 5GDPR Legal Basis AcknowledgmentIacknowledge my personal/financial data will be transferred to the pensionprovider under UK GDPR Article 6(1)(c) to fulfill statutory legalobligations.Employee Declarationunderstood my pension rights, the auto-enrolment status applied to me, and thestrictly independent process required should I choose to opt out."Employee E-SignatureHR / Payroll Authorisationconfirmed. Required actions regarding auto-enrolment, opt-in, or statutorypostponement have been updated in the payroll processing software. NMWsafeguards are active." Payroll Officer E-Signature[Auto-Date]]It looks like you pasted the already-updated version of HR-F043! Here is the cleanly formatted, finalized version of that exact form with all the CQC-compliant and TPR-compliant drop-downs perfectly in place for your system.HR-F043[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Employee Full NameRole / Job TitleNational Insurance NumberEmploying EntityDate of AssessmentStatutory Worker Classification (Determined by Payroll)Eligible Jobholder (Aged 18 to State Pension Age, earning over the statutory £10,000 trigger) - Must be automatically enrolled.Non-Eligible Jobholder (Aged 16-17 or State Pension Age-74 earning over £10,000; OR Aged 16-74 earning below £10,000 but above the lower earnings threshold) - Has the statutory right to opt-in with employer contributions.Entitled Worker (Aged 16-74 earning below the lower earnings threshold) - Has the right to join, but employer contributions are not legally mandated.Pending Assessment (Awaiting first full payroll run to determine variable hours average).SECTION 2Help TextStatutory Postponement NoticeI acknowledge and understand that Mutima Care utilizes a statutory 3-month postponement period from my start date before executing auto-enrolment.Designated Pension Provider SchemeNEST (National Employment Savings Trust)The People's PensionNOWSmart PensionOther (Specify in Payroll Software only)Statutory Contribution Calculation & NMW ProtectionI understand that deductions are calculated from the first £1 of my earnings (8% totalI understand that Payroll will automatically adjust or suspend my deduction if it risks breaching the National Minimum Wage for my age bracket.I understand both the contribution calculation and the mandatory NMW protection.SECTION 3Help TextOpt-In DeclarationYes - I wish to formally opt-in to the scheme and authorize deductions.No - I do not wish to opt-in voluntarily at this time.N/A - I am classified as an Eligible Jobholder and will be Auto-Enrolled.(System LogicSECTION 4Help TextIndependent Opt-Out ProcessI acknowledge that Mutima Care cannot legally provide me with an opt-out form; I must obtain it directly from the pension provider via their portal/helpline.Statutory Refund WindowI understand I must submit the completed opt-out notice to the pension provider within the strict 1-month statutory window to receive a full refund.Anti-Coercion ProtocolI confirm that no manager, director, or representative of HeartReach Group Ltd has coerced, pressured, or offered any inducement to persuade me to opt out.Triennial Re-enrolmentI understand that UK law mandates Mutima Care must automatically re-enrol me every 3 years if I remain an eligible jobholder, regardless of a previous opt-out.SECTION 5GDPR Legal Basis AcknowledgmentI acknowledge my personal/financial data will be transferred to the pension provider under UK GDPR Article 6(1)(c) to fulfill statutory legal obligations.Employee DeclarationEmployee E-SignatureDateHR / Payroll AuthorisationPayroll Officer E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [ HR-F025CALCULATION LEDGER[Header Section]Form TitleCalculation LedgerDocument ControlRegulatory Compliance StatementTime Regulations 1998 (as amended) and CQC Safe QS6, Mutima Care must ensurestaff take statutory rest to prevent fatigue-induced clinical errors. Thisledger guarantees precise compliance with the 12.07% accrual method forirregular hours workers, processes statutory family leave entitlements, andactively enforces continuity of care for high-acuity service users during staffabsences."SECTION 1Employee Full NameRole / Job TitleContract TypeIrregular Hours - Variable / Part-Year Worker]Annual Leave Year Start DateCurrent Accrued Leave BalanceSECTION 2Help Textleave must be given as notice (e.g., 2 weeks' notice for 1 week of leave)unless statutory emergency leave applies.Type of Leave RequestedStatutory Annual Leave (Paid)Statutory Carer’s Leave (Unpaid - Maximum 1 week per 12months)Statutory Neonatal Care LeaveCompassionate / Bereavement LeaveUnpaid Leave / Career Break (Requires Director Approval)Time Off In Lieu (TOIL)Reclaiming LeaveLeave due to certified illness during the leave period.First Day of AbsenceDate Returning to Work (First Available Shift)Picker]Total Number of Working Days / Hours RequestedField]SECTION 3COMPLIANCE)Help Textdeduction of wages claims.Calculation Method Applied (HR/Payroll to Complete)[Drop-down]Fixed Hours Staffapplies.Irregular Hours (Accrual Method)the statutory 12.07% of hours worked in the preceding pay periods.Irregular Hours (Rolled-Up Method)additional 12.07% uplift on their hourly rate every pay period; therefore, thisspecific period of time off is unpaid.Fixed Hours with Variable Pay (e.g., regularovertime/commission)Payroll System Integration Checkcorrect statutory calculation framework has been applied to this specificemployee's profile in the payroll software." [Mandatory Checkbox]SECTION 4QS6)Help Textensure high-acuity service users are covered by equally competent staff withthe correct clinical delegations.1. Primary Worker Status'Primary/Key Worker' for any service users with highly complex or specificneeds (e.g., advanced dementia, challenging behaviours)? [Drop-down2. Delegation Transfer (HR-F041)specific Delegated Healthcare Tasks (e.g., PEG, Stoma) for the service usersthey are scheduled to visit during this leave? [Drop-down(If Yes)System Verificationhold active, validated HR-F041 competency sign-offs for these specific clinicaltasks and these specific Service Users." [Mandatory Checkbox]3. Digital Handover Protocolcare note/handover alert has been added to the Nourish/Birdie system to informthe cover staff of any immediate routine nuances." [Checkbox / N/A]SECTION 5(Well-led QS2)Help Texthold a non-delegable duty of care to enforce rest.Fatigue System Warning"ALERTintervention mandated." OR "ClearIs the employee requesting to carry over statutory leaveinto the next leave year? [Drop-down]No.Yes - Up to 4 weeks (WTD) carry-over due to statutoryMaternity/Family Leave.Yes - Up to 4 weeks (WTD) carry-over due to Long-TermSickness (Must be taken within 18 months).Yes - Up to 1.6 weeks (UK Domestic) carry-over subject towritten management agreement.SECTION 6Employee Declarationunderstand that leave is not granted until formally authorised by managementand no financial commitments (e.g., booking flights) should be made prior toauthorisation."Employee E-SignatureDateCare Coordinator Reviewavailable to maintain safe staffing levels, clinical competency parameters, andcontinuity of care during this absence."Coordinator E-SignatureDateRegistered Manager / HR Authorisationapproved. Rota system updated to 'Leave' status to hard-block deployment.Payroll notified of the correct statutory calculation framework."Manager E-SignatureDateHere is the fully updated HR-F025 form. You are correct to request this; we had not yet converted this specific form into the automated drop-down format.By replacing the open-text fields and checkboxes with precise drop-down menus, this form now directly forces compliance with the latest Working Time Regulations (particularly the 2024 updates for irregular-hours workers) and CQC Safe QS6 (Continuity of Care).HR-F025[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Employee Full NameRole / Job TitleContract TypeAnnual Leave Year Start DateCurrent Accrued Leave BalanceSECTION 2Help TextType of Leave RequestedStatutory Annual Leave (Paid)Statutory Carer’s Leave (Unpaid - Maximum 1 week per 12 months)Statutory Neonatal Care LeaveCompassionate / Bereavement LeaveUnpaid Leave / Career Break (Requires Director Approval)Time Off In Lieu (TOIL)Reclaiming LeaveFirst Day of AbsenceDate Returning to Work (First Available Shift)Total Number of Working Days / Hours RequestedSECTION 3Help TextCalculation Method Applied (HR/Payroll to Complete)Fixed Hours StaffIrregular Hours (Accrual Method)Irregular Hours (Rolled-Up Method)Fixed Hours with Variable Pay (e.g., regular overtime/commission)Payroll System Integration CheckI confirm the correct statutory calculation framework above has been actively applied to this employee's profile in the payroll software.PendingSECTION 4Help TextPrimary Worker StatusDelegation Transfer (HR-F041)(If Yes)Cover staff identified and system confirms they hold active, validated HR-F041 competency sign-offs for these specific clinical tasks and Service Users.Cover staff identified, but HR-F041 competency is pending; urgent external professional assessment requested.Unable to source competent cover internally; urgent handover to external NHS District Nursing team required for this period.Digital Handover ProtocolConfirmedNot ApplicableSECTION 5Help TextFatigue System WarningIs the employee requesting to carry over statutory leave into the next leave year? [Drop-down]No.Yes - Up to 4 weeks (WTD) carry-over due to statutory Maternity/Family Leave.Yes - Up to 4 weeks (WTD) carry-over due to Long-Term Sickness (Must be taken within 18 months).Yes - Up to 1.6 weeks (UK Domestic) carry-over subject to written management agreement.SECTION 6Employee DeclarationEmployee E-SignatureDateCare Coordinator ReviewCoordinator E-SignatureDateRegistered Manager / HR AuthorisationManager E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [HR-F047[Header Section]Form TitleDocument ControlRegulatory Compliance Statementagency actively invests in bridging capability gaps. In accordance with ACASguidelines, the Equality Act 2010, and CQC Effective QS2, this PIP explicitlyseparates 'conduct' (behavioural choice) from 'capability' (skill deficit). Itprovides a structured, legally compliant pathway to elevate clinical andadministrative performance to Fundamental Standards, whilst protecting theagency via mandatory health checks and sustainment clauses."SECTION 1Employee Full NameRole / Job TitleLine Manager / Clinical Lead Overseeing PIPRight to Accompanimentstatutory right to be accompanied by a Trade Union representative or colleaguefor this formal PIP initiation meeting?" [Drop-downYes - Explicitly Declined]PIP Commencement DateExpected PIP Completion Dateduration is 4 to 12 weeks depending on the complexity of the role).Precursor InterventionDiscussion (HR-F044) / Follows Formal Disciplinary Outcome (HR-F046) /Post-Probationary Extension]SECTION 2Help Textexpected standard using objective data (e.g., audit results, missed calls,Nourish/Birdie app analytics).1. Current Performance Issue (Factual Baseline)Text](e.g., "Over the last 4 weeks, audits show that 40% ofthe employee's digital care logs lacked detail regarding service user fluidintake and dietary choices, failing to meet Effective QS1").2. The Expected Standard (The Mutima Care Benchmark)[Paragraph Text](e.g., "100% of care logs must be completed beforeleaving the property, containing specific metrics on fluid (ml) and exact foodconsumed").3. Statutory Health & Neurodiversity Checkthe employee disclosed any physical/mental health condition, neurodivergence(e.g., Dyslexia, ADHD), or menopausal symptoms that are actively contributingto this performance gap?" [Drop-down(System Logicpending an Occupational Health review or immediate Reasonable Adjustments).4. Employee's Acknowledged Root Cause(e.g., "Employee states they struggle with typing speedon the company tablets and feel rushed during 30-minute calls").SECTION 3Help TextAchievable, Relevant, and Time-bound. Vague goals will fail an ACAS or CQCaudit.Objective 1Measurement Metricof pre-signed MAR charts observed during 4 consecutive spot-checks").Target DateObjective 2Measurement MetricLevel 2 Medication Administration refresher e-learning and pass the practicalHR-F022 assessment").Target DateObjective 3Measurement MetricTarget DateSECTION 4(Effective QS2)Help Textwithout providing the tools to achieve it.Support Mechanisms Authorised (Select all applied)[Multi-Select Checkboxes][ ] Retrainingrefresher courses.[ ] ShadowingSenior Care Worker for specified shifts.[ ] Equipment/Reasonable Adjustmentequipment (e.g., voice-to-text enabled tablet for digital notes).[ ] Rota Reductionor complex calls to reduce cognitive load.[ ] MentorshipDetails of Support Plan & Manager ActionsText]SECTION 5Help TextReview 1 (Week 2) DateManager's NotesStatusReview 2 (Week 4) DateManager's NotesStatusSafeguarding Abort ClauseCare reserves the right to terminate this PIP early and move directly to aFormal Disciplinary/Capability Hearing if my performance severely drops to alevel that directly endangers service users (Safe QS1)." [MandatoryCheckbox]Final PIP Review DateFinal OutcomeExtended / Failed (Proceed to Formal Capability Hearing)]SECTION 6Consequence of Failure to Improvebeen formally advised that this PIP constitutes a formal capability process.Failure to achieve the S.M.A.R.T. objectives by the final review date willresult in formal capability proceedings, up to and including dismissal."[Mandatory Checkbox]12-Month Sustainment Clausethat if the objectives are met, the required standard must be sustained. Asignificant drop in performance regarding these specific objectives within 12months of successful PIP completion will bypass a new PIP and proceed directlyto a Formal Capability Hearing." [Mandatory Checkbox]Manager Declarationthis plan with the employee, set realistic objectives, and authorised thenecessary support resources to facilitate their success."Manager E-SignatureDateEmployee Declarationidentified, the objectives I must reach, and the support Mutima Care isproviding. I understand the consequences, including potential dismissal, if myperformance does not reach and sustain the required standard."Employee E-SignatureDateHere is the fully updated HR-F047 form. To ensure strict ACAS compliance and provide robust, auditable data for CQC inspections, all subjective text fields have been converted into precise, behaviorally anchored drop-down menus. This prevents vague objective-setting, standardizes your management interventions, and ensures performance gaps are mapped directly to CQC Quality Statements.HR-F047[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Employee Full NameRole / Job TitleLine Manager / Clinical Lead Overseeing PIPRight to AccompanimentPIP Commencement DateExpected PIP Completion DatePrecursor InterventionSECTION 2Help TextCurrent Performance Issue (Factual Baseline)Medication AdministrationCare Plan DocumentationPunctuality & Time ManagementClinical/Manual HandlingProfessional BoundariesInfection Prevention (IPC)The Expected Standard (The Mutima Care Benchmark)Medication StandardDocumentation StandardPunctuality StandardClinical StandardBoundary StandardIPC StandardStatutory Health & Neurodiversity Check(System LogicEmployee's Acknowledged Root CauseAcknowledges gapAcknowledges gapAcknowledges gapAcknowledges gapDisputes gapSECTION 3Help TextObjective 1 FocusClinical Retraining & Competency Sign-offDocumentation Accuracy & TimelinessPunctuality & Rota ComplianceIPC & PPE ComplianceMeasurement Metric 1Pass formal in-field practical observation (HR-F022/HR-F041) with a Senior Manager.Achieve 100% compliance on the next 4 consecutive weekly digital care log audits.Record zero late arrivals or clipped calls over the next 4-week period via ECM data.Demonstrate zero IPC/PPE breaches during unannounced field spot-checks.Target DateObjective 2 FocusClinical Retraining & Competency Sign-offDocumentation Accuracy & TimelinessPunctuality & Rota ComplianceIPC & PPE ComplianceMeasurement Metric 2Pass formal in-field practical observation (HR-F022/HR-F041) with a Senior Manager.Achieve 100% compliance on the next 4 consecutive weekly digital care log audits.Record zero late arrivals or clipped calls over the next 4-week period via ECM data.Demonstrate zero IPC/PPE breaches during unannounced field spot-checks.Target DateSECTION 4Help TextSupport Mechanisms Authorised (Select all applied)[ ] Retraining[ ] Shadowing[ ] Equipment/Reasonable Adjustment[ ] Rota Reduction[ ] MentorshipDetails of Support Plan & Manager ActionsEmployee scheduled for immediate external/e-learning clinical refresher course.Employee assigned to shadow a Senior Care Worker for 3-5 shifts to observe best practice.Employee's weekly rota reduced by 20% to allow consolidation and reduce fatigue.Digital app accessibility settings adjusted (e.g., text-to-speech enabled).Weekly 30-minute 1SECTION 5Help TextReview 1 (Week 2) DateManager's Assessment NotesSignificant improvement observed; objective fully met for this period.Partial improvement; continued focus and coaching required.No improvement observed; performance remains below the safe baseline.Performance has deteriorated; immediate escalation required.StatusReview 2 (Week 4) DateManager's Assessment NotesSignificant improvement observed; objective fully met for this period.Partial improvement; continued focus and coaching required.No improvement observed; performance remains below the safe baseline.Performance has deteriorated; immediate escalation required.StatusSafeguarding Abort ClauseI explicitly acknowledge that Mutima Care reserves the right to terminate this PIP early and move directly to a Formal Disciplinary/Capability Hearing if my performance severely drops to a level that directly endangers service users (Safe QS1).Final PIP Review DateFinal OutcomeSECTION 6Consequence of Failure to ImproveI acknowledge this PIP constitutes a formal capability process. Failure to achieve the S.M.A.R.T. objectives by the final review date will result in formal capability proceedings, up to and including dismissal.12-Month Sustainment ClauseI understand that if I successfully complete this PIP, the standard must be sustained. A significant drop in performance regarding these specific objectives within 12 months will bypass a new PIP and proceed directly to a Formal Capability Hearing.Manager DeclarationManager E-SignatureDateEmployee DeclarationEmployee E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [ HR-F045[Header Section]Form TitleDocument ControlRegulatory Compliance Statement'Outstanding' rating in Well-led QS3, this agency operates a fair, transparent'Just Culture'. Under the ACAS Code of Practice, an Investigating Officer doesnot make disciplinary decisions; they establish 'Findings of Fact' on thebalance of probabilities. This framework prevents biased dismissals, satisfiesCQC reporting thresholds, and provides irrefutable evidence of robustgovernance."SECTION 1Name of Employee under InvestigationRole / Job TitleInvestigating Officer (Name & Title)trained managers]Independence Verificationof the initial complaint/incident and will not chair any subsequent formaldisciplinary hearing regarding this matter." [Mandatory Checkbox]Date Investigation CommencedDate Report ConcludedDelay Justification14 days to conclude? [Drop-down(If Yes, provide factual justification for the delay - e.g.,waiting for police clearance, witness sickness)SECTION 2Is the employee currently suspended? [Drop-down(If Yes)suspension is not a knee-jerk reaction. Alternatives to suspension (e.g.,restricted duties, paired working) were formally considered but deemed unsafeor inappropriate due to the risk of evidence tampering or severe safeguardingconcerns." [Checkbox]SECTION 3Help Textuse emotive language.Summary of Allegation(s)Primary Policy / Regulatory BreachCheckboxes][ ] Safeguarding (Abuse / Neglect)[ ] Medication Malpractice[ ] Falsification of Records / Dishonesty[ ] Breach of Professional Boundaries / FinancialIrregularity[ ] Breach of Confidentiality / UK GDPR[ ] Bullying / Harassment of Staff[ ] Gross Insubordination[ ] Health & Safety BreachStatutory Notifications & External Referrals Triggered[Multi-Select Checkboxes][ ] CQC Statutory Notification[ ] Local Authority Safeguarding Team (LADO / AdultSafeguarding)[ ] Police Notification[ ] DBS (Disclosure and Barring Service) Referral Marker[ ] Professional Body Referral Marker (e.g., NMC, SWE)[ ] None of the aboveSECTION 4Help Text(e.g., checking GPS log-ins against written care notes).Digital & Documentary Evidence Collected (Check allreviewed)[ ] Digital Care Notes (Nourish / Birdie logs)[ ] Call Monitoring / GPS Log-in Data[ ] eMAR or physical MAR charts[ ] Employee Rota / Timesheets[ ] Previous Training Records & Competency Sign-offs(HR-F022)[ ] CCTV / Telephony logs (If applicable)[ ] Service User Care Plan & Risk AssessmentsSummary of Documentary FindingsSECTION 5Help Textappended to this report.Witness 1 (Name / Role)Summary of EvidenceWitness 2 (Name / Role)Summary of Evidence(Add more fields as necessary)Service User / Family Involvementtheir family interviewed? [Drop-down(If No, state reason - e.g., lacks capacity, policeinstruction not to alert)SECTION 6Date of Investigation MeetingAccompanimentaccompaniment at an investigatory meeting, was the employee permitted to beaccompanied by a Trade Union rep or colleague in line with companypolicy?" [Drop-downUnavailable and meeting proceeded]Employee's Response to AllegationsEmployee's Proposed Mitigation / Root CauseText]SECTION 7Help Textbalance of probabilities (is it more likely than not), did the alleged eventoccur?"Allegation 1FindingInconclusive]RationaleSystemic Failures Identifieduncover any Mutima Care system failures (e.g., poor rota management,unrealistic travel times, broken equipment) that contributed to theincident?" [Paragraph Text]Duty of Candour Assessment (Regulation 20)investigation substantiated that a Service User suffered a 'Notifiable SafetyIncident' (moderate harm or above) requiring a formal apology and Duty ofCandour letter?" [Drop-downSECTION 8Help Textstep but DOES NOT dictate the final disciplinary sanction.Recommended ActionNo Further ActionInformal Actionconstitute minor capability/conduct issues. Proceed to targeted retraining /HR-F044 Informal Discussion.Proceed to Formal Disciplinary Hearingsubstantiated and there is a case to answer for Misconduct / Gross Misconduct.Refer to Police / Safeguarding Authoritymet; internal process paused pending external instruction.Investigating Officer Declarationinvestigation was conducted objectively, fairly, and without prejudice. Thefindings detailed above are based strictly on the evidence collected on thebalance of probabilities."Investigating Officer E-SignatureDateSECTION 9Registered Manager / HR Director NameDecision on RecommendationAgree with Recommendation - Proceed to Hearing.Agree with Recommendation - Close Case.Disagree with Recommendation (State rationale below).Manager's Rationale / Next StepsManager E-SignatureDateHere is the fully updated HR-F045 form. To guarantee strict ACAS compliance and eliminate the legal risks associated with subjective reporting, all open text fields and paragraph summaries have been replaced with precise, behaviorally anchored drop-down menus. This establishes a forensic, auditable "Findings of Fact" process that seamlessly maps to CQC reporting thresholds and protects the agency from unfair dismissal claims.HR-F045[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Name of Employee under InvestigationRole / Job TitleInvestigating Officer (Name & Title)Independence VerificationI confirm I am entirely independent of the initial complaint/incident and will not chair any subsequent formal disciplinary hearing regarding this matter.Date Investigation CommencedDate Report ConcludedDelay Justification(If Yes, provide factual justification for the delay)Awaiting explicit clearance from Police or LADO to proceed internally.Key witness unavailable due to certified sickness or statutory leave.Employee under investigation submitted a Fit Note (signed off sick).Complex digital forensics or external CCTV retrieval required.Statutory delayN/A - Completed within 14 days.SECTION 2Is the employee currently suspended? [Drop-down(If Yes)I confirm suspension is not a knee-jerk reaction. Alternatives (restricted duties, paired working) were formally evaluated but deemed unsafe due to the risk of evidence tampering or severe safeguarding concerns (Refer to HR-F049).SECTION 3Help TextSummary of Allegation(s)Medication (Safe QS4)Safeguarding (Safe QS1)Falsification (Well-led QS1)Boundaries (Caring QS1)Conduct/InsubordinationConfidentiality (UK GDPR)Clinical/Health & SafetyPrimary Policy / Regulatory Breach[ ] Safeguarding (Abuse / Neglect)[ ] Medication Malpractice[ ] Falsification of Records / Dishonesty[ ] Breach of Professional Boundaries / Financial Irregularity[ ] Breach of Confidentiality / UK GDPR[ ] Bullying / Harassment of Staff[ ] Gross Insubordination[ ] Health & Safety BreachStatutory Notifications & External Referrals Triggered[ ] CQC Statutory Notification[ ] Local Authority Safeguarding Team (LADO / Adult Safeguarding)[ ] Police Notification[ ] DBS (Disclosure and Barring Service) Referral Marker[ ] Professional Body Referral Marker (e.g., NMC, SWE)[ ] None of the aboveSECTION 4Help TextDigital & Documentary Evidence Collected (Check all reviewed)[ ] Digital Care Notes (Nourish / Birdie logs)[ ] Call Monitoring / GPS Log-in Data[ ] eMAR or physical MAR charts[ ] Employee Rota / Timesheets[ ] Previous Training Records & Competency Sign-offs (HR-F022)[ ] CCTV / Telephony logs (If applicable)[ ] Service User Care Plan & Risk AssessmentsSummary of Documentary FindingsDigital/Documentary evidence unequivocally confirms the allegation (e.g., GPS proves employee was not at the property).eMAR/MAR charts or Care Notes show clear discrepancies substantiating the error/falsification.Documentary evidence contradicts the allegation, actively exonerating the employee.Digital evidence is inconclusive or unavailable; heavy reliance on witness testimony required.Audits reveal systemic failures (e.g., scheduling errors) rather than isolated employee misconduct.SECTION 5Help TextWitness 1 (Name / Role)Summary of EvidenceCompletely corroborates the allegation with firsthand observation.Partially corroborates the allegation (observed the aftermath or partial event).Directly contradicts the allegation (provides an alibi or alternative factual account).Was present at the location but did not observe the specific incident.Provided hearsay evidence only (did not witness the event firsthand).Witness 2 (Name / Role)Summary of EvidenceCompletely corroborates the allegation with firsthand observation.Partially corroborates the allegation (observed the aftermath or partial event).Directly contradicts the allegation (provides an alibi or alternative factual account).Was present at the location but did not observe the specific incident.Provided hearsay evidence only (did not witness the event firsthand).Service User / Family Involvement(If No, state reason)Service User lacks the mental capacity to participate in an investigation (MCA 2005).Explicit instruction received from Police/LADO not to alert or interview the family/Service User.Family declined to participate or were unavailable.Deemed clinically unsafe or highly distressing to interview the Service User.Not relevant to this specific internal allegation (e.g., staff-on-staff dispute at the office).SECTION 6Date of Investigation MeetingAccompanimentEmployee's Response to AllegationsAdmits the allegation in full.Admits partial fault but disputes specific details or severity.Denies the allegation completely.States an inability to recall the event.Refused to comment / answered "No comment" to all questions.Employee's Proposed Mitigation / Root CauseCites a lack of specific training, induction, or unclear policies.Cites extreme fatigue, rushing, or poor rota management (e.g., call-clipping).Cites personal/health issues impacting judgment (e.g., severe stress, bereavement, illness).Cites miscommunication, faulty equipment, or technological failure (e.g., app crash, broken hoist).No mitigation offered / completely denies the event occurred.SECTION 7Help TextAllegation 1FindingRationaleDocumentary/digital evidence irrefutably proves the event occurred.Multiple credible, corroborating witness statements prove the event occurred.Employee formally admitted to the conduct during the investigation meeting.Evidence is contradictory, hearsay-based, or lacks sufficient weight (Unsubstantiated).Evidence definitively proves the event did NOT occur as alleged (Unsubstantiated).Systemic Failures IdentifiedNoneRota FailureTraining FailureEquipment FailureCommunication FailureDuty of Candour Assessment (Regulation 20)SECTION 8Help TextRecommended ActionNo Further ActionInformal ActionProceed to Formal Disciplinary HearingRefer to Police / Safeguarding AuthorityInvestigating Officer DeclarationInvestigating Officer E-SignatureDateSECTION 9Registered Manager / HR Director NameDecision on RecommendationAgree with Recommendation - Proceed to Hearing.Agree with Recommendation - Close Case / Informal Action.Disagree with Recommendation (State rationale below).Manager's Rationale / Next StepsAccepted - HR to schedule Formal Disciplinary Hearing within 5 working days (send invite letter).Accepted - Care Coordinator to arrange immediate retraining and issue HR-F044 Informal Warning.Accepted - Case closed; no case to answer; employee reintegration protocol initiated.Rejected - Further investigation/evidence gathering required before a decision can be made.Suspended Process - Awaiting the outcome of an external Police/LADO investigation.Manager E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [HR-F044[Header Section]Form Title(Supportive Intervention)Document ControlRegulatory Compliance Statementdemands a 'Just Culture' where performance issues are addressed supportively.In line with ACAS codes of practice, this form documents an early, informalintervention. It clearly separates 'Capability' from 'Conduct'. Crucially, thisframework ensures systemic agency failures or unaddressed health conditions(Equality Act 2010) are not unfairly penalized as individual stafferrors."SECTION 1Employee Full NameRole / Job TitleManager / Supervisor Conducting Meetingauthorized personnel]Date of DiscussionMandatory Safeguarding Triage (Safeconfirm I have triaged this incident. The concern discussed today strictly DOESNOT meet the threshold for a Local Authority Safeguarding Referral, nor does itrequire a Statutory CQC Notification. It is appropriate for informal internalmanagement." [Mandatory Checkbox](System Logiclocks. Immediate escalation to the Registered Manager is required).Legal Context Confirmationexplicitly stated to the employee that this is an INFORMAL discussion aimed atproviding support. It does not constitute formal disciplinary action, thoughthe employee was offered the right to be accompanied if they wished."[Mandatory Checkbox]SECTION 2Help Textbetween Capability (cannot do it), Conduct (will not do it), and Systemicpressure (prevented from doing it).Primary Nature of ConcernCapability / Performance Issue (Skill, knowledge, or speeddeficit)Conduct / Behaviour Issue (Attitude, rule-breaking,timekeeping)Absence / Attendance Issue (Short-term sickness frequency)Systemic / Environmental Issue (Rota constraints, technologyfailure)Specific Area of Concern (Select primary issue)Poor Timekeeping / Call Clipping (Leaving early/Arrivinglate)Substandard Digital Documentation (Nourish/Birdie/eMAR)Minor Medication Error (e.g., missed signature - NO harmcaused)Professional Boundaries / Over-familiarityPoor Moving & Handling / IPC Technique observedAttitude / Tone of Voice with Colleagues or Service UsersFailure to complete mandatory trainingOther (Specify below)SECTION 31. Manager's Observationand evidence. State what was seen, heard, or reported.Observation Notes2. The Expected StandardCQC Fundamental Standard, or Core Value is not being met?Expected Standard Notes3. Employee's Response & Root Cause Analysisemployee the opportunity to explain. Are there mitigating factors? [Drop-down]Lack of understanding / Training deficit.Systemic failure (e.g., insufficient travel time scheduled,app crashing).Personal/Domestic issues impacting focus or attendance.Fatigue / Burnout.Acknowledged error / Apologetic / Lacking confidence.Defensive / Unwilling to accept feedback.4. Health & Equality Act Checkdisclosed any physical/mental health condition, neurodivergence, or menopausalsymptoms contributing to this issue?" [Drop-downSummary of Employee's CommentsSECTION 4Help Textgap between current performance and the expected standard?Support Mechanisms Deployed (Select all that apply)[Multi-Select Checkboxes][ ] [Shadowing/Buddying] - Assigned to shadow a Senior CareWorker for X shifts.[ ] [Retraining] - Assigned mandatory practical refreshertraining.[ ] [Rota Adjustment] - Shift pattern/travel timetemporarily adjusted to manage fatigue or logistics.[ ] [Reasonable Adjustment] - Occupational Health referralor immediate adjustments made for declared health/neurodivergent needs.[ ] [Supervision] - Increased frequency of unannounced FieldSpot Checks.[ ] [Wellbeing] - Referred to Employee Assistance Programme(EAP).[ ] [Clear Direction] - No formal support needed; verbalexpectations clearly reset.Specific Targets / Actions to be completed by the ReviewDateSECTION 5Future Consequencesthat if there is no sustained improvement by the review date, or if the conductis repeated, the matter will be escalated to the Formal Disciplinary Procedureor a Formal Performance Improvement Plan (PIP)." [Checkbox]Record Retention (ACAS Fairness)will remain active for monitoring purposes for a period of 6 months. Ifsustained improvement is demonstrated, it will be disregarded for futuredisciplinary purposes." [Checkbox]Date for Informal Review MeetingpracticeSECTION 6Manager Declarationplace. I have aimed to be supportive, objective, and compliant with 'JustCulture' principles. I have provided the employee with a copy of thisrecord."Manager E-SignatureDateEmployee Declarationtook place. I understand the standards expected of me and the support that hasbeen offered. Signing this form confirms I have read and understood therequired improvements, even if I do not fully agree with allobservations."Employee E-SignatureDateHere is the fully updated HR-F044 form. All open-ended paragraph text fields and generic checkboxes have been replaced with precise, behaviorally anchored drop-down menus. This guarantees that informal interventions are recorded consistently, objectively map to CQC Fundamental Standards, and provide clear, auditable data to protect both the employee and the agency under ACAS guidelines.HR-F044[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Employee Full NameRole / Job TitleManager / Supervisor Conducting MeetingDate of DiscussionMandatory Safeguarding Triage (SafeConfirmed(System LogicLegal Context ConfirmationConfirmedSECTION 2Help TextPrimary Nature of ConcernCapability / Performance Issue (Skill, knowledge, or speed deficit)Conduct / Behaviour Issue (Attitude, rule-breaking, timekeeping)Absence / Attendance Issue (Short-term sickness frequency)Systemic / Environmental Issue (Rota constraints, technology failure)Specific Area of ConcernPoor Timekeeping / Call Clipping (Leaving early/Arriving late)Substandard Digital Documentation (Nourish/Birdie/eMAR omissions)Minor Medication Error (e.g., missed signature - NO harm caused)Professional Boundaries / Over-familiarity with Service User or FamilyPoor Moving & Handling / IPC Technique observed (No harm caused)Attitude / Tone of Voice with Colleagues or Service UsersFailure to complete mandatory training within deadlinesUniform / Dress Code / ID Badge BreachFailure to Report / Escalate minor changes in Service User conditionSECTION 3Manager's ObservationDirect observation by Management during an unannounced field spot-check.Identified via routine digital audit (e.g., eMAR gaps, missing care log entries).Identified via ECM/GPS tracking data (e.g., logging in off-site, call clipping).Raised via verified peer/colleague feedback or handover reports.Raised via Service User / Family feedback (Minor concern/complaint only).The Expected StandardCQC Safe (QS4/QS6/QS7)CQC Effective (QS1)CQC Caring (QS1)CQC Responsive (QS3)CQC Well-led (QS1/QS2)Employee's Response & Root Cause AnalysisLack of understanding / Training deficit.Systemic failure (e.g., insufficient travel time scheduled, app crashing).Personal/Domestic issues impacting focus or attendance.Fatigue / Burnout.Acknowledged error / Apologetic / Lacking confidence.Defensive / Unwilling to accept feedback.Health & Equality Act CheckSummary of Employee's CommentsFully accepts feedback and demonstrates eagerness to improve.Accepts feedback but expressed initial confusion over the specific policy/expectation.Cites environmental/system barriers (e.g., faulty equipment, unrealistic rota travel time) as the primary cause.Cites personal health/wellbeing barriers requiring immediate Reasonable Adjustments or EAP support.Disputes the feedback entirely and refuses accountability for the issue.SECTION 4Help TextSupport Mechanisms Deployed (Select all that apply)[ ] [Shadowing/Buddying] - Assigned to shadow a Senior Care Worker for X shifts.[ ] [Retraining] - Assigned mandatory practical refresher training.[ ] [Rota Adjustment] - Shift pattern/travel time temporarily adjusted to manage fatigue or logistics.[ ] [Reasonable Adjustment] - Occupational Health referral or immediate adjustments made for declared health/neurodivergent needs.[ ] [Supervision] - Increased frequency of unannounced Field Spot Checks.[ ] [Wellbeing] - Referred to Employee Assistance Programme (EAP).[ ] [Clear Direction] - No formal support needed; verbal expectations clearly reset.Specific Targets / Actions to be completed by the Review DateAchieve 100% compliance in digital documentation on the next 5 shifts.Demonstrate flawless IPC/Medication/Manual Handling technique during an upcoming scheduled shadow shift.Ensure zero late arrivals or clipped calls over the next 14-day monitoring period.Complete assigned e-learning module or read and formally acknowledge the breached policy within 7 days.Immediately rectify uniform/ID compliance for all future shifts.SECTION 5Future ConsequencesI confirm the employee has been advised that if there is no sustained improvement by the review date, or if the conduct is repeated, the matter will be escalated to a Formal Performance Improvement Plan (PIP) or Formal Disciplinary Procedure.Record Retention (ACAS Fairness)I confirm this informal record will remain active for monitoring purposes for a period of 6 months. If sustained improvement is demonstrated, it will be disregarded for future disciplinary purposes.Date for Informal Review MeetingSECTION 6Manager DeclarationManager E-SignatureDateEmployee DeclarationEmployee E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [HR-F040PASTORAL SUPPORT RECORD[Header Section]Form TitlePastoral Support RecordDocument ControlRegulatory Compliance Statementrecruits on Health and Care Worker visas are uniquely vulnerable toexploitation, culture shock, and misinterpretation of UK clinical legislation.To align with CQC Well-led QS4, Safe QS3, and strict UKVI Sponsor Duties, thisframework risk-assesses modern slavery indicators, ensures robust pastoralwelfare, and actively translates UK person-centred care values for thoseaccustomed to global medical models."SECTION 1Employee Full NameCountry of OriginDate of Arrival in the UKVisa TypeDependent Visa / Refugee-Asylum Status / Student Visa]UKVI eVisa Share Code (Verified)Assigned Pastoral Mentor / BuddySECTION 2(SafeHelp Text1-to-1 setting to protect the employee from predatory third-party agencies.1. Passport & Identity Controlphysical possession of your own passport and travel documents?"[Drop-down(Conditional LogicSafeguarding Alert).2. Illegal Recruitment Feesindividual, recruitment agency, or middleman in your home country or the UK tosecure this job or visa sponsorship?" [Drop-down3. Contract & Repayment Transparencycurrent contract match the pay and conditions promised? Do you clearlyunderstand Mutima Care's policy on training/relocation repayment clauses (ifany), ensuring you are not trapped by hidden debt?" [Drop-down4. Employment Rights Briefingbriefed on my UK employment rights, including the National Minimum Wage, the48-hour Working Time Directive, and the right to join a Trade Union."[Checkbox]SECTION 3Well-ledHelp Textsurvival needs or healthcare access.Has the Pastoral Lead assisted the recruit with thefollowing? (Select all completed)[ ] eVisa / UKVI Accounttheir digital UKVI account and generating right-to-work share codes.[ ] National Insurance (NI)Number.[ ] Bankingsuccessfully open a UK bank account.[ ] Healthcare & ImmunisationNHS GP and Dentist. Verified Tuberculosis (TB) screening and standard UKoccupational health immunisations.[ ] Housingheated, and not illegally overcrowded.[ ] Tax & Pensionscodes, and pension auto-enrolment.Details of ongoing pastoral support required (e.g.,schooling for dependents, permanent housing)SECTION 4(SafeHelp TextRights Model', which frequently contrasts with global 'Medical Models'.1. The Mental Capacity Act 2005 (MCA)trained that in the UK, capacitated service users have the legal right to make"unwise decisions" (e.g., refusing care), and that family memberscannot legally override this choice? [Drop-down2. Professional Boundaries & Deferencerole-played scenarios empowering the recruit to respectfully say "No"to a service user or family member who asks them to break a clinical rule(e.g., lifting without a hoist)? [Drop-down3. Local Colloquialisms & Dialectbriefed on common local phrases, slang, or non-verbal cues used by older adults(e.g., expressions of pain or requests for the toilet)? [Drop-down4. LGBTQ+ & Equality Act 2010understanding of Mutima Care's zero-tolerance policy for discrimination againstLGBTQ+ service users or colleagues, regardless of personal or religiousbeliefs? [Drop-down5. Freedom to Speak Up (FTSU)that whistleblowing on poor practice is a legal protected right and will NOTresult in the cancellation of their visa sponsorship? [Drop-downSECTION 5QS5)1. UKVI 10-Day Reporting Rulelegal condition of my visa to inform Mutima Care within 10 days if I change myresidential address, phone number, or commence any secondary employment."[Checkbox]2. UK Appliances & Home Safetyhousehold hazards (e.g., gas fires, 240v electrical plugs, carbon monoxiderisks)? [Drop-down3. Transport & Lone Workinglocal area safely, especially during winter months (darkness at 4the use of the lone-worker panic alarm/app? [Drop-down4. Driving (If Applicable)between calls? [Drop-downTransport](If Yes)licence validity been checked (12-month rule), and have they completed a UKHighway Code familiarisation session?" [Drop-downSECTION 6Mandatory Pastoral Supervision Schedule Activated(Integrated with Rostering)Week 1Week 2-4Month 2-6Recruit Declarationthe pastoral support and cultural induction detailed above. I feel welcomed,safe, and understand my rights, clinical boundaries, and visa responsibilitiesin the UK."Recruit E-SignatureDatePastoral Lead / Manager Declarationenhanced induction has been completed. The recruit has settled safely,understands the legal frameworks of UK domiciliary care, and exhibits noindicators of exploitation."Manager E-SignatureDateHere is the fully updated HR-F040 form. To guarantee strict compliance with CQC Well-led QS4, Safe QS3, and your UKVI Sponsor Duties, all subjective open-text fields have been converted into precise, auditable drop-down menus. This establishes a forensic, standardized anti-exploitation framework and ensures all pastoral welfare metrics are actively tracked.HR-F040[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Employee Full NameCountry of OriginIndiaPhilippinesNigeriaZimbabweGhanaKenyaSouth AfricaOther (Specify in HR System)Date of Arrival in the UKVisa TypeUKVI eVisa Share Code (Verified)Assigned Pastoral Mentor / BuddySECTION 2Help TextPassport & Identity Control(Conditional LogicIllegal Recruitment FeesContract & Repayment TransparencyEmployment Rights BriefingI confirm I have been thoroughly briefed on and understand my UK employment rights, including the National Minimum Wage, the 48-hour Working Time Directive, and the right to join a Trade Union.SECTION 3Help TextHas the Pastoral Lead assisted the recruit with the following? (Select all completed)[ ] eVisa / UKVI Account[ ] National Insurance (NI)[ ] Banking[ ] Healthcare & Immunisation[ ] Housing[ ] Tax & PensionsDetails of ongoing pastoral support requiredNoneHousing SupportFamily/DependentsFinancial/BankingCommunity IntegrationCritical WelfareSECTION 4Help TextThe Mental Capacity Act 2005 (MCA)Professional Boundaries & DeferenceLocal Colloquialisms & DialectLGBTQ+ & Equality Act 2010Freedom to Speak Up (FTSU)SECTION 5UKVI 10-Day Reporting RuleI explicitly understand it is a legal condition of my visa to inform Mutima Care within 10 days if I change my residential address, phone number, or commence any secondary employment.UK Appliances & Home SafetyTransport & Lone WorkingDriving (If Applicable)(If Yes)SECTION 6Mandatory Pastoral Supervision Schedule Activated (Integrated with Rostering)ConfirmedRecruit DeclarationRecruit E-SignatureDatePastoral Lead / Manager DeclarationManager E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [ HR-F039CHECKLIST[Header Section]Form TitleChecklistDocument ControlRegulatory Compliance StatementMutima Care must ensure all personnel, including unpaid volunteers, are safelyinducted before interacting with vulnerable adults. Volunteers operate incomplex community settings. This interactive checklist provides forensicevidence that the volunteer has been explicitly trained on safeguarding,lone-working, digital security, and strict clinical boundaries prior todeployment."SECTION 1Volunteer Full NameDesignated RoleInduction DateInduction Conducted By (Coordinator Name)authorized staff]Location of InductionImpact Hub / Virtual Teams Call]SECTION 2QS1)1. The 'Mutima Care' Visionon our core values (Kindness, Empowerment, Dignity) and our mission to supportindependence in the community? [Drop-down2. The Role of the Volunteervolunteer's role been clearly defined, contrasting it with the regulated roleof a paid Care Worker? [Drop-down3. Personal Wellbeing & Fitnesscurrently fit to volunteer and have disclosed any physical or mental healthconditions that may affect my safety in a lone-working communityenvironment." [Checkbox]SECTION 3CURIOSITY (Safe QS1, QS3)Help Textears' of the agency. They must exercise professional curiosity.Safeguarding Briefing Completed (Check all explicitlydiscussed)[ ] The Core Types of AbusePsychological, Financial, Neglect, Self-Neglect, Discriminatory,Institutional).[ ] Modern Slavery & Cuckooingindividuals taking over a service user's property, and awareness of the PreventDuty (radicalisation).[ ] Subtle Indicatorssudden withdrawal, lack of food, or aggressive family dynamics.[ ] The 'No Secrets' Ruleconfidentiality. A volunteer must NEVER promise to "keep a secret"regarding harm.[ ] Whistleblowing ProcedureManager / Local Authority Safeguarding Team) if they suspect a staff or familymember of abuse.Safeguarding Scenario Test (Coordinator to assess)presented a scenario where a service user asks the volunteer to hide a bruisecaused by a relative. Did the volunteer correctly identify immediate reportingover confidentiality?" [Drop-downTraining]SECTION 4(Safe QS6, Effective QS3)Help Textand understand basic consent.Boundary Briefing Completed (Check all acknowledged byvolunteer)[ ] MCA & Consentright to refuse my company or help. I must respect their choices and not forceintervention.[ ] No Personal Caredressing, or toileting.[ ] No Manual Handlingstand up, move them, or operate hoists/stand-aids.[ ] No Medication Administrationprompt, or administer medication, including over-the-counter painkillers.[ ] No Financial Transactionsuser's cash, bank cards, or PIN numbers, nor accept gifts of value.[ ] No Domestic/Clinical Advicesocial/administrative support, not to give medical advice or perform deepcleaning.Coordinator Declarationvolunteer fully understands these boundaries and the legal consequences ofbreaching them." [Drop-downSECTION 51. Lone Worker Systemcheck-in / check-out procedure for community visits? [Drop-downApp-based / Yes - Telephone check-in / N/A - Office-based only]2. Emergency ProtocolsCare Emergency On-Call number into their personal mobile phone? [Drop-down/ No]3. 'No Access' Procedurecannot gain access or find the service user unresponsive (e.g., dial 999, donot move them, call the office)? [Drop-down4. Infection Prevention & Control (IPC)basic IPC guidance (handwashing, use of basic PPE if required)? [Drop-down/ No]5. Incident Reporting'Accident' with the office? [Drop-downSECTION 6(Effective QS2)1. Confidentialityconfidentiality and social media policy (Confirming no photos of serviceusers/homes will be taken)? [Drop-down2. BYOD (Bring Your Own Device) Securitythat my personal mobile phone used for Mutima Care communications is securedwith a PIN, password, or biometric lock." [Checkbox]3. ID BadgeID Badge been issued? [Drop-down4. Next of Kindetails verified and up-to-date on the HR system? [Drop-downSECTION 7Coordinator AssessmentInduction Passed - Cleared for Volunteer Deployment.Induction Incomplete - Further training/shadowing requiredbefore deployment.Induction Failed - Volunteer deemed unsuitable due to lackof safeguarding/boundary awareness.Volunteer Declarationthe induction detailed above. I understand my safeguarding responsibilities, myoperational boundaries, the requirement for digital security, and how to keepmyself and the service users safe."Volunteer E-SignatureDateCoordinator / Manager Declarationdelivered this induction. I am confident this volunteer is safe to be deployedwithin the agreed boundaries of their role."Coordinator E-SignatureDate]Here is the fully updated HR-F039 form. To maintain strict regulatory compliance and ensure an irrefutable audit trail for CQC Safe QS6, all open text fields and broad checkboxes have been converted into precise, behaviorally-anchored drop-down menus. This guarantees that your induction metrics are quantifiable and legally robust.HR-F039[Header Section]Form TitleDocument ControlRegulatory Compliance StatementSECTION 1Volunteer Full NameDesignated RoleInduction DateInduction Conducted By (Coordinator Name)Location of InductionSECTION 2The 'Mutima Care' VisionThe Role of the VolunteerPersonal Wellbeing & FitnessI confirm I am fit to volunteer and have no health conditions requiring adjustments.I confirm I am fit to volunteer but have disclosed specific health conditions/needs requiring a separate Reasonable Adjustment plan.I am currently unfit to commence volunteering due to a temporary health issue.SECTION 3Help TextSafeguarding Briefing Completed (Check all explicitly discussed)[ ] The Core Types of Abuse[ ] Modern Slavery & Cuckooing[ ] Subtle Indicators[ ] The 'No Secrets' Rule[ ] Whistleblowing ProcedureSafeguarding Scenario Test (Coordinator to assess)OutstandingCompetentRequires TrainingSECTION 4Help TextBoundary Briefing Completed (Check all acknowledged by volunteer)[ ] MCA & Consent[ ] No Personal Care[ ] No Manual Handling[ ] No Medication Administration[ ] No Financial Transactions[ ] No Domestic/Clinical AdviceCoordinator DeclarationConfirmedSECTION 5Lone Worker SystemEmergency Protocols'No Access' ProcedureInfection Prevention & Control (IPC)Incident ReportingSECTION 6ConfidentialityBYOD (Bring Your Own Device) SecurityI explicitly confirm my personal mobile phone used for Mutima Care communications is secured with a PIN, password, or biometric lock.ID BadgeNext of KinSECTION 7Coordinator AssessmentInduction Passed - Cleared for Volunteer Deployment.Induction Incomplete - Further training/shadowing required before deployment.Induction Failed - Volunteer deemed unsuitable due to lack of safeguarding/boundary awareness.Volunteer DeclarationVolunteer E-SignatureDateCoordinator / Manager DeclarationCoordinator E-SignatureDatein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [HR-F036ASSESSMENT[Header Section]Form TitleException Risk AssessmentDocument ControlGDPR & Regulatory Statementthe Health and Social Care Act 2008 (Regulated Activities) Regulations 2014,and Home Office UKVI Sponsor Duties, a UK DBS check is legally insufficient ifan applicant has a recent history of overseas residency. Mutima Care requiresan authentic Certificate of Good Character/Police Check from the relevantjurisdictions. This assessment authenticates those documents and provides alegally robust, anti-discriminatory risk assessment pathway for individuals (e.g.,refugees) who cannot safely obtain them."SECTION 1VERIFICATIONApplicant Full NameRole Applied ForNationalityUK Immigration / Visa StatusCitizen, Settled/Pre-Settled, Health & Care Worker Visa, AsylumSeeker/Refugee, Student Visa, Other]Dual-Check MandateCheck (with applicable Barred List checks) has been applied for, or obtained,concurrently with this overseas verification." [Checkbox]Has the applicant lived outside the UK for 6 months or more(continuously or in total) in the last 5 years, OR for 12 months or more in thepast 10 years (while aged 18 or over)?(System LogicCountry/Countries of Residence meeting the above criteria(List all)Dates of Overseas ResidencyPicker - End]SECTION 2Help Textcertificate from the national police force or government of thecountry/countries they resided in.Has the applicant provided an official Overseas PoliceCertificate / Certificate of Good Conduct for the specified period? [Drop-down]Yes - Provided in EnglishYes - Provided in original language with an IndependentCertified TranslationNo - Applicant is unable to obtain the document (ConditionalLogicDate of Certificate Issuemonths of leaving the country, or issued recently if they have not returned).Name of Issuing Authority (e.g., Federal Police, Ministry ofInterior)Verification of Authenticity (Select all completed)[Multi-Select Checkboxes]Original physical document or secure digital link sighted byHR.Watermarks, stamps, or official government seals visuallyverified.Document bears an official Hague Apostille or Notarisation(if applicable to the country).Translation independently certified by an ATC or ITIregistered translator (Candidate/Family translations are strictly prohibited).Details cross-referenced with UK Government 'Criminalrecords checks for overseas applicants' guidance.SECTION 3Does the Certificate detail any criminal convictions,cautions, warnings, or reprimands? [Drop-down]No - Clear RecordYes - Positive Disclosure(Conditional Logicof POSITIVE DBS DISCLOSURE RISK ASSESSMENT (HR-F033) to assess the specificoffences).SECTION 4DOCUMENTATION)Help Textimpossible. The CQC expects providers to assess the risk rather than issuing ablanket rejection, which could indirectly discriminate against genuinerefugees.Why is the applicant legally or logistically unable toprovide the Overseas Police Certificate? [Drop-down]Asylum Seeker / Refugee status (Cannot safely contact homecountry authorities).The country does not possess a functioning criminal recordsystem (e.g., active conflict zones).The issuing authority refuses to issue certificates tonon-citizens who have since left.Applicant refuses to request the document without a validlegal/logistical reason. (System LogicOffer').If a valid exception applies, what alternative safeguardingassurance has been obtained? (Select all that apply)A formal Statutory Declaration (under the StatutoryDeclarations Act 1835) signed by the applicant before a UK Solicitor, statingthey have no overseas convictions.Character reference obtained from a verifiable, professionalfigure who knew them during that overseas period (e.g., international employer,aid agency).Additional UK-based professional references obtained(Minimum of 3).Enhanced probationary period applied with double-frequencyunannounced Field Spot Checks.Candidate restricted from handling service user finances orcomplex medication for the first 3 months.Assessor's Justification for accepting alternative evidence[Paragraph Text]SECTION 5Assessor's Risk GradingLow Riskauthenticated.Medium Riskrefugee/conflict status, but a Statutory Declaration, extra references, andstrict probationary mitigations are documented and applied.High / Critical RiskHR-F033 assessment, or applicant refuses to obtain documentation without avalid exception reason.Final Decision regarding Overseas VettingApprove for Hire (Standard Induction).Approve for Hire (With Medium-Risk Mitigations / ExtendedProbation applied).Withdraw Offer / Terminate Employment (InsufficientSafeguarding Assurance).Name of Assessor / HR LeadSignatureRegistered Manager Counter-Signature (Mandatory if 'MediumRisk' exception used)DateHere is the fully updated HR-F036 form. To ensure airtight compliance with CQC Safe QS3 (Safeguarding) and UKVI Sponsor Duties, all subjective short-text and paragraph fields have been replaced with rigorous, standardized drop-down menus. This prevents vague reporting and ensures your process for evaluating overseas records (and managing exceptions for refugees/asylum seekers) is legally robust and auditable.HR-F036[Header Section]Form TitleDocument ControlGDPR & Regulatory StatementSECTION 1Applicant Full NameRole Applied ForPrimary Nationality (As per Passport/Travel Document)British / IrishIndianNigerianZimbabweanFilipinoGhanaianSouth AfricanKenyanOther (Specify in HR Database)UK Immigration / Visa StatusBritish/Irish CitizenSettled/Pre-Settled StatusHealth & Care Worker Visa (Sponsored)Asylum Seeker / Refugee (BRP Holder)Student Visa (Tier 4)Dependant VisaDual-Check MandateI confirm a UK Enhanced DBS Check (with Adult/Child Barred List checks) has been obtained concurrently with this overseas verification process.Has the applicant lived outside the UK for 6 months or more (continuously or in total) in the last 5 years, OR for 12 months or more in the past 10 years (while aged 18 or over)?(System LogicCountry/Countries of Residence meeting the above criteriaCountry of Origin ONLY (Matches Nationality)Middle East (e.g., UAE, Saudi Arabia, Qatar)European Union / EEANorth AmericaSub-Saharan Africa (Other than Country of Origin)Asia-Pacific (Other than Country of Origin)Multiple Jurisdictions (Requires multiple certificates)Dates of Overseas ResidencySECTION 2Help TextHas the applicant provided an official Overseas Police Certificate / Certificate of Good Conduct for the specified period? [Drop-down]Yes - Provided in English directly from issuing authorityYes - Provided in original language with an Independent Certified TranslationNo - Applicant is legally/logistically unable to obtain the document (Routes to Section 4No - Applicant has refused to obtain the document without valid reason (Triggers Immediate Withdrawal of Offer)Date of Certificate IssueName of Issuing Authority TypeNational Police Force / Federal PoliceMinistry of Interior / Foreign AffairsHigh Commission / Embassy in the UKLocal/Regional Police Authority (Must be checked against UK Govt guidance if acceptable)Verification of Authenticity (Select all completed)[ ] Original physical document or secure digital link sighted by HR.[ ] Watermarks, stamps, or official government seals visually verified.[ ] Document bears an official Hague Apostille or Notarisation (if applicable).[ ] Translation independently certified by an ATC or ITI registered translator (Candidate/Family translations strictly prohibited).[ ] Details cross-referenced with UK Government 'Criminal records checks for overseas applicants' guidance.SECTION 3Does the Certificate detail any criminal convictions, cautions, warnings, or reprimands? [Drop-down]No - Clear RecordYes - Positive Disclosure(Conditional LogicSECTION 4Help TextWhy is the applicant legally or logistically unable to provide the Overseas Police Certificate? [Drop-down]Asylum Seeker / Refugee status (Cannot safely contact home country authorities).The country does not possess a functioning criminal record system (e.g., active conflict zones).The issuing authority refuses to issue certificates to non-citizens who have since left.Applicant refuses to request the document without a valid legal/logistical reason. (System LogicIf a valid exception applies, what alternative safeguarding assurance has been obtained? (Select all that apply)[ ] A formal Statutory Declaration (under the Statutory Declarations Act 1835) signed by the applicant before a UK Solicitor, stating they have no overseas convictions.[ ] Character reference obtained from a verifiable, professional figure who knew them during that overseas period (e.g., international employer, aid agency).[ ] Additional UK-based professional references obtained (Minimum of 3).[ ] Enhanced probationary period applied with double-frequency unannounced Field Spot Checks.[ ] Candidate restricted from handling service user finances or complex medication for the first 3 months.Assessor's Justification for accepting alternative evidenceException acceptedException acceptedException acceptedException rejectedSECTION 5Assessor's Risk GradingLow RiskMedium RiskHigh / Critical RiskFinal Decision regarding Overseas VettingApprove for Hire (Standard Induction).Approve for Hire (With Medium-Risk Mitigations / Extended Probation applied).Withdraw Offer / Terminate Employment (Insufficient Safeguarding Assurance).Name of Assessor / HR LeadSignatureRegistered Manager Counter-Signature (Mandatory if 'Medium Risk' exception used)Datein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [HR-F037INDUCTION CHECKLIST[Header Section]Form TitleInduction ChecklistDocument ControlGDPR & Regulatory Statement19 (Fit and proper persons employed), the registered provider remains legallyresponsible for the safety and quality of care provided by agency staff.Relying solely on a third-party agency's verbal assurance is legallyinsufficient. This checklist forensically verifies the worker's complianceprofile, matches clinical competencies, and ensures a robust local inductionfor safe lone-working."SECTION 1Agency / Supplier Name(System Logictrigger High-Risk warning requiring Registered Manager override).Agency Worker Full NameWorker Job ProfileWorker / Field Supervisor, Complex Care Support Worker, Registered Nurse / AHP]Professional PIN (If Registered Nurse / AHP)NMC/SWE Register Checked Today (No activeconditions/restrictions)?Date of First ShiftAssigned BranchCare (Wood Green) / Irisea (Impact Hub)]SECTION 2Help Textundertakes any visits. You must physically verify the Agency Compliance Profileagainst the worker when they arrive.1. Photo Identificationworker's original Photo ID (Passport/BRP/Driving Licence) against the personstanding in front of you? [Drop-down2. Right to Work in the UKa valid Right to Work, and have hour restrictions (e.g., Student Visa 20-hourlimit) been checked against today's rota? [Drop-downrestrictions / Verified - Visa restrictions checked & compliant / NotVerified (Do not deploy)]3. Enhanced DBS & Barred ListChecked via DBS Update Service today (Clear & MatchesID).Original Enhanced DBS Certificate sighted (Issued withinlast 12 months - Clear).Positive Disclosure (Requires immediate Registered Managerreview via HR-F033).No valid DBS confirmed (Do not deploy).4. Fatigue Management & WTRthey have had an adequate rest period (minimum 11 hours) since their lastshift, compliant with Working Time Regulations? [Drop-downdeploy)]5. Transit & Insurance Verificationtravelling between calls? [Drop-down]Public Transport / WalkingDriving Own Vehicle (System Logicsub-questions below)(If Driving)[Drop-down(If Driving)verified?6. Mandatory Training Certificationevidence of in-date training for the following? (Select all verified)[Multi-Select Checkboxes]Safeguarding Adults (Level 2+)Moving and Handling (Practical assessment within last 12months)Medication Administration (Level 2)Basic Life Support / First Aid (Practical)Infection Prevention & Control (IPC)Mental Capacity Act (MCA) & DoLSSECTION 3Help Textservice users they will visit today.Will the worker be required to use specialised equipment?[Drop-down]No specialised equipment needed.Yes - Ceiling Track Hoist / Mobile Hoist.Yes - Stand Aid / Sara Stedy.Yes - Profiling Bed / Slide Sheets.Will the worker be undertaking Delegated Healthcare Tasks orComplex Care? [Drop-down]No complex tasks assigned.Yes - Catheter Care / Stoma Care.Yes - PEG / Enteral Feeding.Yes - Prompting/Administering Controlled Drugs.Competency Verificationworker's specific training profile and they are explicitly signed off ascompetent for the equipment/complex tasks selected above." [Drop-down/ No / N/A](Conditional Logicto those specific service users).SECTION 4Help Texttheir first 48 hours.Communication & Language Checkcommunicate in spoken English and read written instructions (e.g., MAR charts,Care Plans)? [Drop-downLocal Induction Briefing Completedprior to first visit)Issued Mutima Care ID Badge / Uniform verification.Set up on Electronic Call Monitoring system (e.g., Nourish /Birdie) with temporary login.Briefed on Lone Worker Policy & Emergency Out-of-HoursOffice Contact.Briefed on Safeguarding Reporting procedures (Who to callimmediately).Briefed on Medication Policy (e.g., MAR chart completion,missed dose protocol).Provided with specific Service User Care Plans & RiskAssessments for today's rota.Introduction ProtocolWorker will shadow a permanent staff member for their firstshift (Best Practice).Worker will be met at the first visit by a Field Supervisor.Worker is being deployed alone (Requires justificationbelow).Justification for Lone Deployment (if applicable)[Paragraph Text]SECTION 5CONTROL)Help TextCoordinator/Supervisor after the agency worker's first block of shifts.Reliability & TimekeepingExcellent - Logged into all calls on time.Adequate - Minor delays but communicated well with theoffice.Poor - Late/Missed calls without communication.Documentation & Clinical Quality (Reviewed viaNourish/MAR charts)Excellent - Notes detailed, person-centred, MARs accuratelysigned.Adequate - Basic notes, no medication errors.Poor - Sparse/missing notes, poor English, or medicationrecording errors.Feedback from Service Users / Permanent StaffText]Final Agency Worker RatingApproved for Future Shifts (Add to preferred locum pool).Use Only in Emergencies (Requires closer supervision).Do Not Use Again (DNU) - Block from future Mutima Carerotas.If DNU, state the factual reason to be formally fed back tothe supplying agencySECTION 6Pre-Deployment Check Completed By (Name & Title)Text]Date & Time of Pre-Deployment CheckPicker]Post-Shift Evaluation Completed By (Name & Title)[Short Text]Date of Post-Shift EvaluationDigital SignatureHere is the fully updated HR-F037 form. To maintain your 'Outstanding' governance standards and ensure strict liability protection under CQC Regulation 19, all subjective paragraph text fields have been converted into precise, behaviorally-anchored drop-down menus. This guarantees that your agency staff evaluations are objective, quantifiable, and instantly ready for automated feedback to the supplying agency.HR-F037[Header Section]Form TitleDocument ControlGDPR & Regulatory StatementSECTION 1Agency / Supplier Name(System LogicAgency Worker Full NameWorker Job ProfileProfessional PIN (If Registered Nurse / AHP)NMC/SWE Register Checked Today (No active conditions/restrictions)?Date of First ShiftAssigned BranchSECTION 2Help TextPhoto IdentificationRight to Work in the UKEnhanced DBS & Barred ListChecked via DBS Update Service today (Clear & Matches ID).Original Enhanced DBS Certificate sighted (Issued within last 12 months - Clear).Positive Disclosure (Requires immediate Registered Manager review via HR-F033).No valid DBS confirmed (Do not deploy).Fatigue Management & WTRTransit & Insurance VerificationPublic Transport / WalkingDriving Own Vehicle(If Driving)(If Driving)Mandatory Training Certification[ ] Safeguarding Adults (Level 2+)[ ] Moving and Handling (Practical assessment within last 12 months)[ ] Medication Administration (Level 2)[ ] Basic Life Support / First Aid (Practical)[ ] Infection Prevention & Control (IPC)[ ] Mental Capacity Act (MCA) & DoLSSECTION 3Help TextWill the worker be required to use specialised equipment? [Drop-down]No specialised equipment needed.Yes - Ceiling Track Hoist / Mobile Hoist.Yes - Stand Aid / Sara Stedy.Yes - Profiling Bed / Slide Sheets.Will the worker be undertaking Delegated Healthcare Tasks or Complex Care? [Drop-down]No complex tasks assigned.Yes - Catheter Care / Stoma Care.Yes - PEG / Enteral Feeding.Yes - Prompting/Administering Controlled Drugs.Competency Verification(Conditional LogicSECTION 4Help TextCommunication & Language CheckLocal Induction Briefing Completed[ ] Issued Mutima Care ID Badge / Uniform verification.[ ] Set up on Electronic Call Monitoring system (e.g., Nourish / Birdie) with temporary login.[ ] Briefed on Lone Worker Policy & Emergency Out-of-Hours Office Contact.[ ] Briefed on Safeguarding Reporting procedures (Who to call immediately).[ ] Briefed on Medication Policy (e.g., MAR chart completion, missed dose protocol).[ ] Provided with specific Service User Care Plans & Risk Assessments for today's rota.Introduction ProtocolWorker will shadow a permanent staff member for their first shift (Best Practice).Worker will be met at the first visit by a Field Supervisor.Worker is being deployed alone (Requires justification below).Justification for Lone Deployment (if applicable)Low AcuityPrior ExperienceEmergency Cover (Mitigated)N/ASECTION 5Help TextReliability & TimekeepingExcellent - Logged into all calls on time.Adequate - Minor delays but communicated well with the office.Poor - Late/Missed calls without communication.Documentation & Clinical Quality (Reviewed via Nourish/MAR charts)Excellent - Notes detailed, person-centred, MARs accurately signed.Adequate - Basic notes, no medication errors.Poor - Sparse/missing notes, poor English, or medication recording errors.Feedback from Service Users / Permanent StaffOutstandingGoodAdequatePoor (Attitude)Poor (Clinical)No specific feedback received / No complaints logged.Final Agency Worker RatingApproved for Future Shifts (Add to preferred locum pool).Use Only in Emergencies (Requires closer supervision).Do Not Use Again (DNU) - Block from future Mutima Care rotas.If DNU, state the factual reason to be formally fed back to the supplying agencyClinical Safety BreachSafeguarding/Conduct BreachReliability/PunctualityDocumentation FailureMisrepresentation of SkillsN/ASECTION 6Pre-Deployment Check Completed By (Name & Title)Date & Time of Pre-Deployment CheckPost-Shift Evaluation Completed By (Name & Title)Date of Post-Shift EvaluationDigital Signaturein the same way as above, change all text based sections into dop downs for an outstanding rated domiciliary care agency in England [ HR-F032[Header Section]Form TitleVerificationDocument ControlGDPR & Privacy StatementMutima Care and Irisea are obtaining this verification under Schedule 3 of theHealth and Social Care Act 2008 (Regulated Activities) Regulations 2014. As aregulated health and social care provider, you share a reciprocal legal duty todisclose any known risks regarding this individual's fitness to work withvulnerable adults. The applicant has provided explicit consent for thiscomprehensive safeguarding disclosure."SECTION 1Applicant Full NameApplicant Date of BirthConsent Declarationholds a signed consent form from the applicant authorising the release of theirHR, disciplinary, and safeguarding records." [Checkbox]Authority Declarationappropriate authority within my organisation (e.g., HR, Registered Manager,Director) to disclose this information." [Checkbox]SECTION 2What was the applicant's final Job Title?Employment Start DateEmployment End DateDid the applicant successfully complete their probationaryperiod?Did the applicant complete or hold the Care Certificateduring their employment?Did the applicant's role involve the provision of direct,regulated personal care?Which service user groups did the applicant primarilysupport? (Select all that apply)Older adults (65+)Individuals living with Dementia / Alzheimer'sAdults with Learning Disabilities or AutismAdults with physical disabilities / mobility needsEnd-of-life / Palliative careComplex clinical needs (e.g., PEG feeding, Stoma care)No direct care provision (Office/Admin)SECTION 3DISCLOSUREHelp Textthe applicant's conduct. If you answer 'Yes' to any of the below, you mustprovide factual details in the text box provided.1. To your knowledge, has the applicant ever been thesubject of a Safeguarding enquiry or allegation (whether substantiated orunsubstantiated) involving a vulnerable adult or child?Substantiated / Yes - Unsubstantiated / Yes - Ongoing]2. Has the applicant ever been subject to formaldisciplinary action relating to their professional conduct, treatment ofservice users, or breach of professional boundaries?Warning issued / Yes - Dismissed]3. Did the applicant resign while under investigation, orpending a disciplinary or safeguarding hearing?4. Was the applicant ever suspended from duty pending asafeguarding or disciplinary investigation?5. Were there any recorded competency failures, strictmonitoring periods, or disciplinary actions specifically regarding medicationadministration (MAR charts)?6. To your knowledge, has the applicant ever been referredby your organisation to the Disclosure and Barring Service (DBS) or aprofessional regulatory body (e.g., NMC, SWE)?If you answered 'Yes' to any question in Section 3, pleaseprovide factual details (Dates, nature of the allegation/issue, and the formaloutcome)SECTION 4Help Textvalues based strictly on their employment record.Overall approach to treating service users with Dignity andRespectOutstanding (Consistently went above and beyond)Good (Reliably respectful and kind)Requires Improvement (Occasional boundary or attitudeissues)Inadequate (Displayed concerning behaviours)Unable to commentPunctuality and Unauthorised Absence (Compliance withrotas)Excellent (Always punctual, zero/rare unauthorised absence)Good (Standard reliability)Poor (Frequent lateness or unauthorised failure to attendcalls)Honesty and Professional Integrity (e.g., accurate loggingof timesheets, truthful reporting)Absolute integrity - highly trustedGenerally honest but required management supervisionConcerns raised regarding honesty or record-falsificationSECTION 5Please state the exact reason for leaving as recorded on theapplicant's HR fileWould you re-employ this individual in a care capacity?[Drop-down]Yes, without hesitationYes, but with additional training/supervisionNoIf 'No' or 'Yes, with training', please briefly explain why[Paragraph Text]SECTION 6Referee Full NameReferee Job TitleCompany/Organisation NameWork Email Address (Must be a company domain, not a personalemail)Work Contact NumberDeclarationis factually accurate and based on the employment records held by thisorganisation. I understand that omitting known safeguarding concerns couldplace vulnerable adults at severe risk."Digital Signature (Type Full Name)DateHere is the fully updated HR-F032 form. To ensure airtight compliance with CQC Regulation 19 (Fit and Proper Persons Employed) and to eliminate the risk of referees giving vague or evasive written answers regarding safeguarding, all open-text fields have been converted into precise, behaviorally-anchored drop-down menus. This forces the referee to definitively categorize the applicant's history, providing quantifiable data for your recruitment risk assessments.HR-F032[Header Section]Form TitleDocument ControlGDPR & Privacy StatementSECTION 1Applicant Full NameApplicant Date of BirthConsent DeclarationI acknowledge and confirm that Mutima Care holds a legally signed consent form from the applicant authorizing the full release of their HR, disciplinary, and safeguarding records.Authority DeclarationI confirm I hold the appropriate authority (e.g., HR, Registered Manager, Director) within my organization to disclose this sensitive information safely and legally.SECTION 2What was the applicant's final Job Title?Care Assistant / Support WorkerSenior Care Worker / Team LeaderField Care Supervisor / Care CoordinatorComplex Care / Clinical Support WorkerRegistered Nurse / Nursing AssociateLive-in CarerRegistered Manager / Deputy ManagerAncillary / Non-Care Role (e.g., Admin, Domestic)Employment Start DateEmployment End DateDid the applicant successfully complete their probationary period?Did the applicant complete or hold the Care Certificate during their employment?Did the applicant's role involve the provision of direct, regulated personal care?Which service user groups did the applicant primarily support? (Select all that apply)[ ] Older adults (65+)[ ] Individuals living with Dementia / Alzheimer's[ ] Adults with Learning Disabilities or Autism[ ] Adults with physical disabilities / mobility needs[ ] End-of-life / Palliative care[ ] Complex clinical needs (e.g., PEG feeding, Stoma care)[ ] No direct care provision (Office/Admin)SECTION 3Help TextTo your knowledge, has the applicant ever been the subject of a Safeguarding enquiry or allegation (whether substantiated or unsubstantiated) involving a vulnerable adult or child?Has the applicant ever been subject to formal disciplinary action relating to their professional conduct, treatment of service users, or breach of professional boundaries?Did the applicant resign while under investigation, or pending a disciplinary or safeguarding hearing?Was the applicant ever suspended from duty pending a safeguarding or disciplinary investigation?Were there any recorded competency failures, strict monitoring periods, or disciplinary actions specifically regarding medication administration (MAR charts)?To your knowledge, has the applicant ever been referred by your organisation to the Disclosure and Barring Service (DBS) or a professional regulatory body (e.g., NMC, SWE)?If you answered 'Yes' to any question in Section 3, specify the primary category of the concernSafeguarding (Harm)Medication / Clinical SafetyProfessional BoundariesHonesty & IntegrityConduct / AttitudeNot ApplicableIf you answered 'Yes', what was the formal outcome of the incident(s)?SubstantiatedSubstantiatedSubstantiatedSubstantiatedUnsubstantiatedOngoingNot ApplicableSECTION 4Help TextOverall approach to treating service users with Dignity and RespectOutstanding (Consistently went above and beyond)Good (Reliably respectful and kind)Requires Improvement (Occasional boundary or attitude issues)Inadequate (Displayed concerning behaviours)Unable to commentPunctuality and Unauthorised Absence (Compliance with rotas)Excellent (Always punctual, zero/rare unauthorised absence)Good (Standard reliability)Poor (Frequent lateness or unauthorised failure to attend calls)Honesty and Professional Integrity (e.g., accurate logging of timesheets, truthful reporting)Absolute integrity - highly trustedGenerally honest but required management supervisionConcerns raised regarding honesty or record-falsificationSECTION 5Please specify the exact reason for leaving as recorded on the applicant's HR fileResignation - Career progression, relocation, or better pay/benefits.Resignation - Personal, health, or family reasons.Resignation - To avoid pending disciplinary or safeguarding investigation.Dismissal - Gross Misconduct / Safeguarding breach.Dismissal - Capability, performance, or failed probation.End of fixed-term contract or Redundancy.Would you re-employ this individual in a care capacity?Yes, without hesitationYes, but with additional training/supervisionNoIf 'No' or 'Yes, with training', please specify the primary reasonClinical SafetyReliabilityAttitude / CultureBoundaries / SafeguardingIntegrityN/ASECTION 4: REFEREE DECLARATIONReferee Full NameReferee Job TitleCompany/Organisation NameWork Email Address & Contact NumberDeclaration- Select -I explicitly confirm that the information provided is factually accurate and based on the official employment records held by this organization. I understand that omitting known safeguarding concerns could place vulnerable adults at severe risk.Next Review Date:SUBMIT FORM
