Complex Care Healthcare Assistant (Band 4) in London

To deliver safe, high-quality, person-centred care to clients with complex health and/or behavioural needs in their own homes, carrying out specific clinical tasks delegated by a Registered Nurse. The post-holder works on a 1:1 basis, strictly in accordance with each client's bespoke care plan and risk assessments, and undertakes delegated clinical tasks only after being assessed and signed off as competent by the Registered Nurse (RGN) or Clinical Lead. The role is central to Unicare's nurse-led, clinically governed model of complex care.

Working Under Nurse Delegation Scope & Clinical Governance

Unicare operates a nurse-led model of delegated care. A Registered Nurse or the Clinical Lead determines which clinical tasks may be delegated to you for each client, based on the client's care plan and your assessed competence. You will work under the clinical oversight of the Registered Nurse at all times.

Competency sign-off: you will not perform any delegated clinical task until you have completed the required training and been assessed and signed off as competent for that task and, where relevant, for the specific client and exact equipment in use by the Registered Nurse or Clinical Lead. Each sign-off is recorded and dated.

Working within scope: you must work strictly within the limits of your competence and the tasks you have been signed off to perform, and must never alter, deviate from, or exceed a delegated task or the established care plan without explicit, documented authorisation from the Registered Nurse or Clinical Lead.

Right and duty to decline: if at any time you do not feel competent or it is not safe to carry out a delegated task, you have both the right and the responsibility to decline and to escalate immediately to the Registered Nurse.

No solo practice until signed off: you will complete a client-specific induction and shadow shifts, and will not work solo on a package until your competency has been signed off by the Clinical Lead.

Accountability: The Registered Nurse remains professionally accountable for the decision to delegate and for confirming your competence. You are responsible and accountable for carrying out each delegated task safely, correctly and in line with the agreed protocol, for working within the limits of your sign-off, and for escalating any concern without delay.

Key Responsibilities

• Personal and daily support: Provide personal care, moving-and-handling support, nutrition and hydration, and assistance with activities of daily living, always promoting dignity, choice and independence. Build and maintain trusting, respectful, therapeutic relationships with clients and their families. Support each client's routines, social inclusion and wellbeing in line with their care plan.
• Delegated clinical tasks (following competency sign-off): Following training and written competency sign-off by the Registered Nurse, and strictly in accordance with the client-specific care plan, you may be delegated clinical tasks which depending on the package can include:
• Tracheostomy care and suctioning (oral and tracheal).
• Support and monitoring of invasive and non-invasive ventilation (e.g. CPAP/BiPAP), oxygen therapy and cough assist.
• Enteral feeding and pump management via PEG / RIG / NG.
• Stoma, catheter and continence care, and bowel care per protocol.
• Administration of prescribed medication in line with the MAR chart and Unicare's medication policy.
• Recording and reporting of clinical observations.
• Carrying out emergency and rescue protocols (e.g. seizure / rescue medication, autonomic dysreflexia response) precisely as set out in the client's plan.
• Positive behaviour support and de-escalation for clients with behavioural, mental health, learning disability or autism-related needs.
• You will carry out only those tasks for which you have been individually signed off, for the specific client and equipment concerned.
• Monitoring, safety and escalation: Continuously observe the client's condition, recognising and responding to changes from their baseline. Follow emergency protocols calmly and act promptly, summoning emergency help when required. Escalate clinical concerns, equipment failures and incidents immediately to the Registered Nurse or 24/7 on-call clinical support.
• Record-keeping and reporting: Maintain accurate, legible, contemporaneous records using Unicare's digital systems - handovers, daily notes, food/fluid and medication records, and observation charts. Report all clinical incidents, medication errors, equipment failures and safeguarding concerns through Unicare's incident reporting system without delay.
• Safeguarding, conduct and teamwork: Recognise and report safeguarding concerns in line with Unicare's policies and local authority procedures. Maintain confidentiality and comply with UK GDPR and Unicare's data protection policies. Work cooperatively with the Registered Nurse, Clinical Lead, families, commissioners and the wider team, and cooperate fully with spot checks, audits and investigations. Maintain professional boundaries and uphold Unicare's values at all times.

Person Specification

Essential:

• A relevant care qualification e.g. the Care Certificate and/or a Level 2 or 3 Diploma in Adult Care / Health & Social Care (or equivalent).
• Recent, demonstrable experience as a healthcare assistant or support worker, ideally in complex, community or domiciliary care.
• Willingness and ability to complete a client-specific induction and to be competency-assessed and signed off by a Registered Nurse before working solo.
• Ability to follow care plans, clinical protocols and risk assessments precisely, without deviation.
• Good standard of spoken and written English for accurate documentation and handover.
• Reliable and flexible - able to work a rolling 24/7 rota including nights, weekends and bank holidays.
• Right to Work in the UK (this role does not offer visa sponsorship).
• Hold, or be willing to undergo, an Enhanced DBS check registered on the Update Service.
• Caring, patient and respectful, with a genuine commitment to dignity and person-centred care.

Desirable:

• Existing competencies in complex care interventions (tracheostomy, ventilation, suctioning, cough assist, PEG/enteral feeding).
• Experience supporting people with learning disabilities, autism, mental health needs or spinal cord injury.
• Medication administration training.
• Current moving & handling and Basic Life Support training.
• Full UK driving licence and access to a vehicle (for community-based packages).

Induction, Competency & Ongoing Training

A full induction, including Care Certificate standards where not already held. A client-specific induction in the client's home, including familiarisation with the exact models of life-sustaining equipment in use (e.g. ventilators, tracheostomy tubes, cough assist). Shadow shifts prior to solo practice, with practical competency sign-off by the Registered Nurse / Clinical Lead for each delegated task and item of equipment, recorded and dated. Ongoing clinical supervision and periodic competency reassessment, with responsibility to keep all mandatory and client-specific training current.

General

This role is offered subject to satisfactory references, an Enhanced DBS check, occupational health clearance and successful clinical competency sign-off. The post-holder must comply with all Unicare policies and procedures, including safeguarding, infection prevention and control, health and safety, medicines management and data protection. This job description is not exhaustive and may be reviewed and amended in line with service needs. Unicare Complex Care Specialist Ltd is an equal opportunities employer and welcomes applications from all suitably qualified candidates.