In the following report I will discuss about how the legislations in regards to empowerment help service user become more independent and feel confident in taking decisions in relation to their care plan and their life in general.
Empowerment is all about sharing information with the service users and giving them the power to take initiative and make decisions on how they want to be looked after.
The empowerment should also be given to staff so that they have the courage to challenge poor practice in their organizations and therefore promoting the service users rights.
As you will learn from the following report things don`t always go as planned and the solutions and decisions we take can impact on the wellbeing and safety of the service users.
Elderly people and people with disabilities need to feel that they are still valued in our society and as care workers and professionals we need to do as much as we can to give them the opportunity and empower them so they can live a life they want and not one that is chosen for them.
1.1 Explain how current legislation and sector skills standards influence organisational policies and practices for promoting and maximising the rights of users of Smart Care Residential Unit. Demonstrate the use of a range of sources of information from the literature.
Empowerment is a contested concept and is defined differently depending on people`s assumptions and perspective. Each person has different perception on what empowering is to them. It can be a situation or a certain experience but they all have the role to help people regain control of their own lives and make own choices and decisions (Warren, 2007).
The service users even though they are elderly people, people with disabilities, and people with learning disabilities have rights. Legislations have a big influence on the organization’s policies and procedures to maximize the rights of the service users and to ensure the minimum care standards are met.
Some of the service user`s rights are:
- Safe environment – the conditions the service users live in should meet the minimum standard of health and safety.
- Healthy lifestyle – the food given to the service users should be healthy and nutritious. Water should be available all the time so that service users do not suffer from dehydration. A variety of activities will improve the health of the service users and they should be encouraged to participate.
- Make their own choices – all service users should be encouraged and given the opportunity to make their own choices in regard to everything that concerns their persona.
- Equal opportunities – service users have the right to be treated equality and not being discriminated based on their personal choices.
- Effective communication – some service users might not speak fluently English or have learning disabilities therefore communication should be done using the appropriate methods to ensure the information is understood by both parties.
- To be treated with respect and dignity – regardless of the condition a service user is, they deserve the respect for what they are as human beings and should be treated with dignity.
- Have their privacy respected – privacy is a very important feeling for everyone regardless of the place or situation you are in. For the service user’s privacy is something that is breached every day in care homes because most of them require someone to care for them.
Current legislations are designed to ensure organizations respect and empower people to make their own choices and decisions. The following legislations are used by organizations as guideline to develop their own policies and procedures in their day to day work. They also ensure that care workers who don’t comply with the rules and regulations pay the consequences for their acts against the service users.
The Human Rights Act 1998 – human rights are the basic rights and freedoms that belong to everyone (Feldman, 1999). International law, including treaties, contains the provisions which give human rights legal effect. Ideas about human rights have evolved over many centuries and the formal protection of these rights gained strong international support after World War II, in order to protect future generations from a repeat of gross human rights abuses. Some human rights, such as the right to respect for family life, can be limited or qualified in certain well-defined circumstances. However, international law makes clear that certain rights can never be restricted. These include the right not to be tortured or enslaved (Equality and Human Rights Commission, 2016).
Equality Act 2010 – Disability is defined in the Equality Act 2010 as a ‘physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day to day activities’. The terms physical or mental impairment are not defined, but are intended to cover all forms of impairment, including sensory impairments (Lockwood, et. all, 2012). This Act ensures everyone has equal opportunities to express their wishes and have their rights taken into consideration regardless of their condition, education, religion or gender. People with disabilities should be treated with respect and dignity and supported to make own choices.
Health and Safety at Work Act – this act is meant to place a duty on all employers to protect the safety of the employees and on all the people that visited their premises. When it comes to the safety of the service users everyone is responsible to provide a safe environment for them. The organization needs to provide safe environment with good working equipment, sanitary facilities and sanitary items. Even with this law in place some organizations fail to protect their service users and their staff thus leading to serious cases of accidents, injuries even death (Health and Safety Executive, 2009).
Data Protection Act – controls how your personal information is used by organizations, businesses or the government. Everyone responsible for using data has to follow strict rules called ‘data protection principles’. They must make sure the information is: used fairly and lawfully; used for limited, specifically stated purposes; used in a way that is adequate, relevant and not excessive; information is accurate; kept for no longer than is necessary; handled according to people’s data protection rights and the most important that is kept safe and secure (UK Government, 2017). When it comes to more sensitive information such as: ethnic background, political opinions, religious beliefs, health, sexual health and criminal records there is stronger legal protection. This sensitive information should under no circumstances disclosed to avoid stigmatizing and persecution against these people.
National Minimum Standards for Care – these standards acknowledge the unique and complex needs of individuals, and the additional specific knowledge, skills and facilities needed in order for a care home to deliver an individually tailored and comprehensive service (Great Britain; Department of Health, 2003).
1.2 Analyse factors that may affect the achievement of promoting and maximising the rights of service users, critically reflecting on the routine practice of your health and social care setting and suggesting realistic improvement based on your identified criteria for good practice.
Every organization that is part of the Health and Social Care sector should promote and maximize the rights of the service users on the day to day practice. However this doesn’t always happen due to certain factors.
Organizational policies and procedures – all the policies and procedures that exist in an organization are meant to give guideline to care workers on how to do their work and what is expected from them. They also ensure that the rights of the service users are respected and taken into consideration (Lasserre, 2012). For example, the Health and Safety Policy is meant to safeguard service users from harm and abuse but also to protect the care workers against harm and injuries. Sometimes all the new legislations can be a little restrictive when it comes to doing the right thing for the service users although these policies are meant to protect against any forms of abuse. In the organization I work I believe that there are certain procedures that could be improved as they look very good on paper but they are not very practical on our daily work. One of these procedures is the end of shift handover. Because our shifts start when the other one` s finishes there is no time for proper handover and because of that numerous mistakes had happened. A 10 minute early start could prevent this from happening as it will allow enough time to handover all the important information to the next shift avoiding many mistakes in this way. Another procedure that prevents the care workers in my organization from promoting the service users rights is the morning personal hygiene. All the clients need to be washed and prepared for breakfast by 8am which does not allow service users’ personal wishes and preferences to be respected. This procedure restricts the rights and wishes of the service users. Allowing the service users to decide if they want to have a shower in the morning or in the afternoon would not make such a big difference in the care workers schedule and therefore the managers should consider reviewing each clients care plan and take into consideration their wishes.
Staffing – This is an ongoing problem in our organization because the owners of the care home are more interested in profit than the staff and service user. To be able to promote and maximize the rights of the service users a good number of staff needs to be available (Dowling, et. all, 2006). Because we do not have enough staff available we do not have time to encourage service users to do things for themselves as this requires more time. It also puts a lot of stress on us because we want to do what is right for the service users and involve them in the daily activities more however we cannot always do it. More staffing even if they are volunteers that can teach basic things would help so much in empowering the service users. Managers should look for volunteers that are interested in working with elderly people and encourage them to help even a few hours. This would make such a big difference not only for the service users but also for us the care workers. A good level of staffing would reduce the stress of the care workers and would allow more time to focus on the needs and wishes of the service users.
Another issue that we struggle with is the lack of trainings in our organization. We only do the required trainings and nothing else. The owner is not willing to invest in the development of the staff therefore a lot of people come and go after few months. The development of staff should be considered as extremely important because learning new skills is only beneficial for the organization. Having a skilled team, that goes beyond and above the minimum standards, improves the reputation of the organization. Internal training is a cheaper option that should be considered by the owners.
Individual service user – the level of dependence affects promoting the rights of the service users because if a person cannot move their body almost entirely there are only a few things that can be done to promote their independence. However even allowing the client to hold their cup of water if possible will allow him to drink as much as he wants and not as much as I would give him. If their level of dependence is low than the service users should be allowed to do as much as they are able to and they should be encouraged to learn new skills that would give them more independence. Because we care for elderly people and also people with mental health problems we consider their health condition every time we review their care plan. Some of our clients get better therefore their level of dependence decreases however some get worse and their level of dependence increases. My organization reviews the care plan every 3 months and this is very good however this is done only by the managers and the person who is on duty on that day. One thing that they could do is to speak to all the carers that have contact with the clients as they could provide more valuable information in regard to the client`s condition and progress.
Lack of resources – because of financial constraints and also because our owner is not very involved in raising funds for the care home the equipment we work with is quite old and not adequate. More mobility aids should be purchased for the service users that have mobility issues and also the wheelchair ramp should be refurbished to make their movement easier and safer. Organizing fund raising charity events where the service users could be involved will not only bring the necessary funds for the organization but will also make the service users feel useful and valued for their skills.
Reduced staff commitment – due to the small salary, stress level and shift patterns staff feel that they are not valued therefore they do not have the will to do more than their actual job description. Because the salaries are not very high in my organization the staff employed don’t have the skills to do the job and are also not interested to stay longer after their shift has finished, to help if required. Staff members don’t want to do anything that is not in their job description to help the service uses become more independent because that will mean they have to stay a bit longer to finish their work. Increased salary and recognition from the managers with awards and incentives would make the staff feel more valued and commit more to their job.
Leadership – managers play such an important role in promoting and maximizing the rights of the service users however not all of them do it. A good manager knows how to motivate staff to do a great job and knows how to get funds for the organization if they care about the work they do and the service users. Poor management on the other hand means no funds, stressed staffs, poor care standards and poor health and safety conditions. My manager unfortunately does not have the skills to be a good manager. He only became a manager because he is the son of the owner and not because he has the knowledge and the skills to be a manager. The day to day activity is run by our deputy who is very good but when it comes to making crucial decisions he has no power over the manager. I think that if the owner will replace the manager our organization would do much better in finding new ways of promoting the rights of the service users.
1.3 Analyse how communication between your care workers and individuals contribute to promoting and maximising the rights of users of health and social care services.
Speaking to people respectfully and listening to what they have to say; ensuring clear dialogue between workers and service users is a small thing that care workers can do that will have a big impact on the service users (Social care Institute for Excellence, 2014) .
Communication is very important in any environment and in any situation in our everyday life. However for people that are dependent on others and people that require assistance from others like elderly people who require medical treatment, children and people with disabilities communication can be difficult, therefore care workers need to find a suitable way to communicate effectively.
In London, there are so many nationalities that speak different languages therefore for a care worker it could be difficult to understand the needs and the wishes of a client that doesn’t speak English very well or at all. Even though these clients don’t speak English they have the right to be cared for and staff has to find different communication aids to overcome this barriers.
Methods to overcome differences in communication:
Use of translators, computers or other staff that speaks the same language as the service user to obtain the correct information from the client to facilitate the communication and avoid frustration and distress to the client are some of the methods the communication can be improved.
Using communication aids for the hearing impaired clients such as hearing aids, written information and visual materials will assist service users to understand the information and reply in the same way. If this aids are not available than the communication would be very difficult and the wishes and needs of the service users will not be met.
Provide training for staff to communicate with people who have cognitive or communication difficulties. Learning to develop communication skills is not easy but all the staff should be sent for trainings to learn the basic steps in communicating with people that have learning difficulties or physical disabilities that prevents them from communicating.
Staff should not make assumptions on what people want because of their culture, ability or any other factor – always ask. This is very important in care homes like in all other sectors because people might misinterpret information and errors can happen. Every person is different and communicates in particular ways therefore staff should only rely on facts and not assumptions.
Involve people in the production of information resources to ensure the information is clear and answers the right questions. For example when staff have the role of an advocate the information that is researched for the service user should be clear and the research done in the presence of the service user if possible.
Recording information for continuous improvement:
Make records of the health improvement of the service users and modify the care plan accordingly this will help service users to receive the best care for them. Failure to do this could lead to service users feeling treated wrongly and not taken into consideration as an individual. Person-centered approach requires a lot of individual work with the service users and all the information should be recorded and made available to all the carers that look after that client. If information is not passed on than all the service users will be treated the same and their own personal wishes will not be taken into consideration.
Make records of all the health and safety issues and concerns and discuss them with managers. In case a service users is raising a concern than the information should be recorded and passed on further. Failure to do so could lead to unnecessary accidents. Reviewing that actions were taken is also very important because sometimes managers might not consider it a priority and might need a reminder.
Proper handover needs to be given to other staff to ensure everyone knows the correct and updated information. Handover should be done together with the team leader and passed on to the manager in writing to make sure information is not lost. A lot of mistakes can happen if handover is not done correctly and if staff does not understand what is told to them. Asking question during handover is an efficient way to ensure everyone understands the information.
Feedback and complaints are the service users right and it should be taken into consideration, by the staff and the managers. Use of feedback and complaints is an efficient way to improve the quality of the service provided in care homes. Service users know best what is better for them and also what works and doesn’t work for them therefore their opinions should be valued and respected.
The inspection reports should be available to everyone that is affected by the result of the inspection. Keeping an open communication with the staff, clients and their family builds relationships based on trust and transparency. Any required improvement should also be communicated, recorded and acted upon. These inspections are very good because they ensure a good care standard is provided to the service users.
Keeping all the service users information confidential and secured is a matter of security and all the measures to avoid information leeks should be in place.
Do not discuss anything that happens within the work place outside work. Having discussions about the service users, their problems, staff discussions and other information from the workplace is a breach of confidentiality and if discovered serious consequences can follow.
Do not give information about the service users to unauthorized people without consent. Disclosing information about the health, medical records, drugs or preferences is not permitted because it can harm the service user. A good example, are the celebrities that could face huge scandals if any information is leaked to the press.
Only discuss information about the service user with their doctor, nurse or manager in case of having concerns about their health. Care workers should only discuss their service user`s health with professionals and not make decisions by discussing with other care workers or family. Only discuss about their care plan with authorized people and their family. Any changes in their care plan should only be done with authorized people and with the service user`s participation.
Only relevant information about their health and their progress should be stored and not irrelevant information that only concerns them. If there is information about the service user that does not affect their health such as certain hygiene preferences, than this information should not be stored and kept as it is not relevant for their wellbeing or safety.
1.4 Review current legislation, codes of practice and policy that apply to the handling of medication.
Medicines are powerful tools of modern therapeutics. They are all potentially dangerous if used improperly and some are liable to misuse and to drug related crime. The general principles associated with the safe and secure handling of medicines have been set out. These relate to the three R’s – Responsibility, Record-keeping, and Reconciliation, which forms the basis of the ‘Medicine Trail’, or the ability to account for a medicine from the time of ordering through to the administration to a patient (NHS Tayside, 2016).
To avoid the misuse of medicines a strict legal framework regulates the supply, prescription and administration of medicines. This framework protects the patient`s safety and controls in certain way how the medicines are distributed. If professionals are discovered opening capsules or inappropriately crushing tablets they could face prosecution as they are putting the patient`s life at risk. All medicines should be taken as instructed by the manufacturer and in the dosage that the doctor prescribed it. The law requires that the: Right medicine is given to the Right patient at the Right time, in the Right dose in the Right formulation. The five rights are the patient`s rights to receive the treatment in a correct manner.
The following laws and professional codes of conduct govern the prescription and administration of medicines in UK:
* Data protection Act – In the case of pharmacy patient medication records, the data are classed as sensitive personal data, for which either explicit consent must be obtained from the patient or such consent may not be needed if the processing is “necessary for medical purposes and is undertaken by a health professional. Information should not normally be disclosed without patient`s consent unless it has been established that the patient is incapable of managing his or her own affairs and the person requesting disclosure has been appointed by a court to manage those affairs. Parents, guardians and carers may seek disclosure of information about patients other than themselves for whom they undertake parental or carer responsibility. If the data subject is a child who is likely to understand fully his or her rights to confidentiality, then consent should be established if at all possible (Wingfield, 2000). Medical information is very sensitive and it should be kept secured to avoid stigmatizing and marginalization.
* The Medicine Act 1968 – regulates the licensing, supply and administration of medicines. Prescription only medicines can only be given in accordance with the directions of an appropriate practitioner. Unless instructed, there is no scope to alter the dose or change the form of a prescription only medicine, for example, by crushing or opening a capsule (Rosemont Pharmaceuticals Ltd., 2017). If for any reason the doctor or pharmacist recommends patients to crush medication then they are in breach of the Act and could be prosecuted. Medicine should not be crushed or dissolved because they could cause severe side effects, overdose or even death.
* Consumer Protection Act 1987 – The crushing of a tablet or opening of capsules before administration in most cases renders its use unlicensed. As a result the manufacturer will not be liable for any harm that may come to the patient or the person administering it. Where harm is caused as a result of the tablet being altered by crushing, it will not be the producer who is liable but the person who crushed it or the person that advised the crushing of the tablet (Cartwright, 2001). The expiration date on medicines should be checked by the pharmacist and by the patient and returned if the expiration date has passed. Medicines should not be consumed after the expiration date as they could cause harm and the company will not be liable because they clearly state on the package not to be consumed after the expiration date.
* Misuse of Drugs Act 1971 – The main purpose of the Act is to prevent the misuse of controlled drugs and achieves this by imposing a complete ban on the possession, supply, manufacture, import and export of controlled drugs except as allowed by regulations or by license from the Secretary of State (Department of Health, 2017). The act creates three classes of controlled substances, A, B, and C, and ranges of penalties for illegal or unlicensed possession and possession with intent to supply are graded differently within each class. Drugs such as cocaine, methamphetamine, heroin and other addictive and dangerous drugs are strictly illegal in UK and anyone caught using or selling them can face serious consequences.
* Equality Act 2010 – the Act brought together various pieces of anti-discriminatory legislation, including the Disability Discrimination Act 1995. Under the Equality Act there are a number of “protected characteristics” to ensure that people are treated fairly, these include: age, race, religion/belief, gender, sexual orientation, pregnancy/maternity and disability (Norfolk County Council, 2014). If a person cannot take a medicine in its current form due to a disability than the doctor or nurse should prescribe an alternative to the medicine that can be taken much easier by the patient. People that have mobility issues and cannot open the package to take the medicine should be assisted in taking the medicines or suitable medicine containers provided.
* Human Rights Act 1998 – the Act clearly states that the “right to life” is fundamental and it should be recognized all around the world. The Act also states that “Care must be given with respect and be proportionate to the needs of the person.” Medication should be given in its safest form to protect patients from any adverse clinical outcome. By producing expensive drugs to treat different diseases such as cancer, HIV and other conditions certain pharmaceutical organization are breaching the Human Rights Act because the people in poor countries cannot access those medicines that could safe or just prolong their lives (Social Care Institute for Excellence, 2013).
“Quite simply we cannot hope to improve people’s health and wellbeing if we are not ensuring that their human rights are respected. Human rights are not just about avoiding getting it wrong, they are an opportunity to make real improvements to people’s lives”(Winterton, 2007).
1.5 Evaluate the effectiveness of policies and procedures within a health and social care setting for administering medication.
Older people in care homes are among the most vulnerable people in society and rely on the care workers for many of their everyday needs. Help in taking their medication is a need that should be carefully observed and attended. People that suffer from multiple conditions require a combination of medicines that should be carefully organized and administered by a designated nurse or professional. This increases the risk of medication error, however errors occur sometimes as a result of failure in prescription, dispensing, administering or monitoring medication.
In the Care Home I work respecting the dignity and the rights of the patient remains in the medication process and all medication is given on behalf of the patient rather than to the patient.
The principle of the five R`s is very strongly applied in our organization and all medication is given only by designated personal. To avoid any misuse of the medication these are kept in secured lockers. Clients that can administer their own medication are provided with small lockers in their room and are responsible for the key. A spare key is kept in the nurse`s cabinet in case of emergencies.
All the patient`s have the right to be informed of the medication that is prescribed to them and how this medication will help with their condition. Also the side effects are clearly explained in case there are any. The patient has the right to refuse to take medication if they consider it doesn’t do them any good or think it makes their condition worse.
When it comes to administering medication to a patient the nurse that provides this should have the knowledge and the skills in administering the drugs. That is why in our organization the only people that can administer medication are the nurses, us as care workers are not allowed to give any medication to a patient without having been trained in medication administering.
For the clients that take their own medication a risk assessment is done to asses if the service user has the capacity to administrate their own medication efficiently. Where service users are independent with regards to managing their medication, staff will maintain a flexible service including information, education and support at an appropriate level, taking into account the changing needs of the service user
The nurses need to make sure the service user doesn’t suffer of any allergies before administering a new medicine as this could cause the severe reaction and lead to possible death. Any time nurses receive a new medicine they check the label to ensure it states clearly the name of the patient, how it needs to be administered, the condition in which needs to be kept and the expiration date. All the medicines need to be double checked by a witness and sign the register unfortunately due to shortage in staff this doesn’t always happens and sometimes mistakes occur. To avoid this type of mistakes the managers should employ more staff or train the current staff on medication so that they can witness the registration of the medicines as this will minimize the risk of errors.
In our care home because medication is administered for some service users staff use MAR charts that include: Service user’s name, medicine name, quantity, dosage, form and strength, what the medicine is for, prescription instructions, date and time of administration, who administered the medication, or if it was withheld / refused and who witnessed this. Staff only record administration once they have confirmed that the person has taken their medicine, not when the medicine has been removed from the dispenser.
A record of all current medication and emergency contacts is kept for each service user so that these can be quickly passed to the hospital or paramedics should an emergency occur.
When a person refuses to take their medication, they should not be forced to take it but should only be encouraged to take it.
Each one of us holds different experiences of being empowered, which will have informed our understanding of what empowerment means for us.
Empowerment can mean our own point of view being listened and considered, gaining more control over own life, using personal strengths or engaging in collective action to challenge discrimination and oppression in our lives. Having the possibility and the freedom to make own choices and having our rights respected is something that every human being needs, wants and has the right to have.
Just because certain people end up needing care and attention from someone else and even depend entirely on a person to look after them it doesn’t mean that their rights should be ignored or disregarded. They are still human beings and have the same rights just like everyone else.
Respect and dignity should be at the core of all organizations that look after less fortunate people.
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Department of Health, 2017. Legislation around medicine regulation; Misuse of Drugs Legislation. Available online at: https://www.health-ni.gov.uk/articles/misuse-drugs-legislations. Accessed on: 06/06/2017
Dowling S., Manthorpe J., Cowley S., 2006. Person-centred Planning in Social Care: A Scoping Review. Joseph Rowntree Foundation.
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Task 3 Risk Management
3.1 Usethecasestudyfromahealthorsocialcaresettingtoidentify the extent towhich individuals areat risk ofharm demonstrating effective judgment in justifying your conclusions.
Significant harm is the key concept within safeguarding adult work which helps practitioners to determine how serious or extensive abuse must be to warrant intervention. Safeguarding adults is increasingly acknowledged as a critical issue for society, with continuing discoveries of abusive practices which challenges care workers and professionals who work with vulnerable adults. Increased awareness and reporting have raised the alarm that this problem is much higher than anyone thought (Mantell, Scragg, 2011).
Our case study refers to severe problems like malnutrition and pressure sores in a care home for elderly people which resulted in a number of 5 people dying due to pressure sores. In this case we are talking about neglect which is a form of physical abuse. The care workers and the managers have failed to give the people the care and support they have the right to. When it comes to elderly people and people with disabilities it is very important that the care workers look after them in a suitable manner and attend their needs as they cannot do it for themselves. Unfortunately, in this case we are talking about the negligence from these care workers and managers in the care home and their failure to do their job and protect this elderly people from harm and abuse. The pressure sores of the patients could have been avoided if the care workers would have regularly change their position in bed. Service users who are confined in bed will need to have their position changed at least once, every two hours to avoid pressure sores occurring. However, in the case of the elderly people that unfortunately passed away this did not happen due to the severe neglect shown from care workers. Another factor that increases the chances in getting pressure sores in elderly people is the nutrition. Eating a healthy, balanced diet that contains an adequate amount of protein and a good variety of vitamins and minerals can help prevent skin damage and speed up the healing process of pressure sores. Malnutrition reflects on the failure of the care home to provide healthy and enough food to satisfy the needs of the service users. A good knowledge on how the nutrition helps with improving the health of the service users is crucial as a worker in a care home.
We do not know what lead to this situation and to the poor care standard given to the service users but whatever the reasons were this should have been prompted to an external organization that could have actioned and prevent the suffering and the death of those people. Poor management is most certainly one of the causes that led to this situation because most of these people do not care about the people they have the duty to safeguard but are more interested in money. Shortage in staff and staff without the right qualification to work in care homes are some of the reasons why so many cases of abuse occur. Lack of staff means the care home cannot provide the minimum care standard and attend the needs of the service users. It also affects the existing care workers commitment to give proper care to patients. Having too many patients to look after, means less time dedicated to every patient therefore the quality of the service would be a poor one (House of Commons, 1992). It is obvious therefore in the case study that the standards were poor and because the dependency level of the clients was very high and they required care from a system that was not working, this led to their horrific death. High dependency disempowers the service users as they cannot speak up or take care of their individual personal care needs. In a failing health and social care system, the level of dependency determines the extent to which clients are at risk of harm and abuse.
The failure to act upon findings of risk assessment, lack of appropriate equipment, poorly maintained equipment, staff not trained in using equipment, staff not trained in manual handling, staff not having an awareness of pressure ulcer prevention and management, nutritional assessments not completed, repositioning charts not used or not clearly completed, specialist advice has not been sought, care plans and no clear, concise and up to date records were kept. They failed to notice pressure areas or skin damage, or did not even care about them when they saw it. These staff and their managers had hidden their neglectful, unskilled, inadequate care work but when the service users died it became obvious what was happening behind closed doors.
Organizations such as local authority, which places people in care homes, rely on the grading given by the Care Quality Commission (CQC), but where the quality of a home is considered marginal, information should be sought from elsewhere, for instance, GPs or district nurses. Furthermore, those organizations that place people in care homes have the duty to undertake regular reviews to ensure people’s needs are being met safely and contractual obligations are being discharged. This review in our case study wasn’t done. Since malnutrition and pressure sores do not occur overnight, in my opinion organizations such as the social services, CQC and NHS failed to protect the clients from harm and abuse. This is because the NHS and Community Care Act advocates that regular assessment should be done by a case manager assigned by the Local Authority of individuals placed in care (Titterton, 1994). The service users should be involved in the assessment and the care plan should be tailored according to the needs of the service users. In case of a change in the service user`s condition then this assessment should be reviewed and improved accordingly.
As we can see the review also stressed the importance of good communication between relevant agencies, such as the local authority, the NHS and the CQC. It also noted that a meeting held to share concerns about the care home at an earlier date was of indeterminate status, and nobody appeared to know what to do as a result. Not making decisions at the right time lead to more suffering to the service users that could have been avoided if the organizations would have made the decision about the care home in real time and most of all effective. Delaying decisions that concern the wellbeing and safety of the service users should not happen and someone should be made responsible for failure to protect those people.
A number of staff was referred by the local authority and CQC to the Nursing and Midwifery Council (NMC) and/or the Independent Safeguarding Authority (ISA). This reaction was done unfortunately too late and we are not even sure if they are solely responsible for what happened. Their fault is however their failure to raise the alarm on what type of practice the organization is doing. This might have costed their job but it could have saved the service users.
For the first time, companies and organizations can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care according to The Corporate Manslaughter and Corporate Homicide Act 2007 (Gobert, 2008). The Act establishes a statutory offence of manslaughter through gross negligence for organizations whose acts or omissions, in breach of a duty of care, cause the death of a person. It has swept away the common law and provided for an offence, liability for which is part decided by the judge and part by the jury at trial. For the first time, Crown immunity has been removed and named departments and government bodies can face prosecution where such a death has occurred (Matthews, 2008).
3.2 Write an Essay to analyzetheeffectivenessofpolicies,proceduresandmanagerialapproachwithinyour healthorsocialcaresettingforpromotingthemanagementofrisks, demonstrating your ability to generate ideas and make effective decisions and suggestions for improvement.
It is very important to recognize that no care home can hope to offer service users and staff a totally safe environment. Care homes cannot guaranty it`s staff and service users that accidents would not happen while on their premises however everyone together can work on minimizing the risks of accidents from happening. People with responsibilities for health and safety within the organization have to strike a balance between offering an enabling environment and a safe environment. To do this, managers, staff and service users must work together in developing policies that identify potential risks and determine acceptable levels of risk (Nazarko, 2009).
Government has formulated various policies and procedures within health and social care for the purpose of promoting the management of risk. In the care home where I work management of risk means empowering people by giving them the opportunity to express their wishes and needs and working in partnership with the service users, families, social workers, advocates and other organizations for the benefit of the service user. All the staff and managers clearly understand their role and responsibility when it comes to safeguarding and empowering service users. Trainings are done throughout the entire period of employment and new skills are learned to ensure the service users receive the best possible care according to their needs. Because not all the service users have the same health condition the managers ensures that all staff that come in contact with them are aware of their needs by implementing a proper handover procedure that is designed to minimize the errors and accidents.
A key factor in the management of risk is the selection of the service users that will live in the care home. This selection is influenced by the assessment that is done prior to their admission. The managers do this assessment to find out if the service users are ok to move in or their admission needs to be done gradually to avoid any regress in the service user`s health. Our managers are avoiding a lot of distress for the patients in this way as it allows them to accommodate with the new setting however the local authority believes this is a waste of time and money on their behalf (Kemshall, Pritchard, 1997).
Even though the policies and the procedures are clearly explained to people when they are admitted into the care home or start working in the care homes sometimes breach of those policies happen therefore clients and staff need to be aware of the consequences they will face if this happens. Everything is clearly explained to them by our managers and the senior team leaders so that everyone knows their responsibilities and rights. By doing this our care home empowers the service users to claim for their rights and makes them aware of what they should expect from the care workers in regards to their care.
Understanding acceptable and unacceptable risk is something that our managers are trying to enforce within the organization. By allowing a client to take his own cup of water even if it takes them longer or they could spill it we give them the opportunity to feel useful. Allowing them to take their shower by themselves not only makes them feel more independent but it also gives them the privacy that is so valued by everyone. Providing them with the assisting aids that will minimize the risk of them getting injured our organization promotes the independence of the service users. Families are not all the time ok with this practice because they fear for their relatives, however making them understand the positive outcome of this practice is the job of the care workers.
Our organization does condemn unacceptable risks that are taken by care workers when it comes to the safety of the service user. By monitoring and reviewing constantly the service users care plan and their development, the activities they are doing and the overall health condition they are able to take actions if any concerns arise.
To minimize the risk of harm the managers have invested in Surveillance Cameras to make sure that in the case of any accidents evidence can be easily provided to investigators. By using CCTV organization can also prevent abuse such as neglect, physical and sexual abuse. The families of the service users saw this investment as very beneficial because it gives them more security on how their relatives are being cared for.
The people have the right to complain if they believe that an injustice is being done to them or that they do not receive the quality of care they have the right to (Great Britain: Parliament: Joint Committee on Human Rights, 2007).
Complains policy and procedure is well developed and is taken very seriously by our managers. For any complaint, small or serious an investigation is carried out by the manager in charged with the health and safety and actions are taken on the spot. If a complaint is done by a service user than the family is also notified after the investigation has ended.
One thing that our organization does not approve with is the Whistle Blowing Policy because they believe it is not necessary and that any concerns can be dealt with within the organization. Even though we have good managers this policy should be implemented as it gives people the opportunity to raise the alarm outside the company in the case things are not going in the right direction.
The key for best practice is to understand legal principles and legislation that will help to make informed decisions that promote both the involvement and interests of adults with a disability and older people, and their families. It will also support and promote best practice for professional staff involved in supporting positive risk management.
Gobert J., 2008. The Modern Law Review; The Corporate Manslaughter and Corporate Homicide Act 2007 – Thirteen years in the making but was it worth the wait?, Volume 71, Issue 3. John Wiley & Sons Inc.
Great Britain: Parliament: Joint Committee on Human Rights, 2007. The human rights of older people in healthcare: eighteenth report of session 2006-07, Vol. 2: Oral and written evidence. The Stationary Office.
House of Commons, Great Britain Parliament, 1992. Official Report of the Standing Committees: Session, Volume 6, H.M. Stationery Office, Pennsylvania State University
Kemshall H., Pritchard J., 1997. Good Practice in Risk; Assessment and Risk Management 2: Protection, Rights and Responsibilities, Volume 2. Jessica Kingsley Publishers.
Mantell A., Scragg T., 2011. Safeguarding Adults in Social Work. Second Edition. SAGE. Great Britain
Matthews A. Richard, 2008. Blackstone’s Guide to the Corporate Manslaughter and Corporate Homicide Act 2007. Oxford University Press.
Nazarko L., 2009. Nursing in Care Homes; Risk management. Second Edition. John Wiley & Sons.
Titterton M., 1994. Caring for People in the Community: The New Welfare. Jessica Kingsley Publishers.
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