Assignment brief

The health and social act 2012 requires health care practitioner and social care managers to be more innovate, more productive and more accountable while delivering the NHS, Adult Social care and Public health outcomes (quality, safety and patient experience)

The aim of this unit is to develop understanding of the values, theories and policies underpinning health and social care practice and the mechanism that exist to promote good practice.

Assignment:

For this assignment you must effectively demonstrate your understanding and skills in Principles of Practice in Health and Social Care Organisations. To do so you must carry out the tasks below in relation to the CQC report for Fleetwood Hall Home. Carefully read the CQC report for Fleetwood Hall Home. The CQC reports showed a need for urgent changes in the Residential Home. Then, imagine that you are appointed as a new Team Leader or Manager in the Fleetwood Hall Home and you are responsible for meeting all the requirements set by the CQC. You are required to identify and make required changes before the next CQC inspection. To carry out this task, you must carry out research on relevant available literature / data sources to answer the tasks below. It is advisable that you consult relevant sources of literature and data (e.g. free NHS or CQC online reports and texts) on the organization to fully understand the context.

Please note: CQC report for Fleetwood Hall Home is uploaded on STP Online and can be found in the folder titled ‘ Fleetwood Hall Home case Study for PP Assignment’.

Please see below the summary of the Fleetwood Hall Home:

The home was inspected in January 2015 and judged as ‘inadequate’ overall. We identified eight breaches of the regulations. The provider (owner) agreed not to admit any people to the home while the breaches in regulation were being addressed. We inspected the home again in July 2015 and judged it as ‘Requires improvement’ overall. While significant improvements had been made since the inspection in January 2015, we did not revise the ratings for each domain above ‘Requires improvement’. To improve a rating to ‘Good’ would have required a longer term track record of consistent good practice. However, we did identify one breach of the regulations.

Fleetwood Hall is a large care home set in its own grounds on the outskirts of Southport. The home is registered to provide accommodation for up to 53 people across three units. The units include:

• A mental health unit that can accommodate men and women with enduring mental health needs

• A dementia care unit that can accommodate six men and women

• A general nursing unit for up to 14 people, both men and women

At the time of the inspection 33 people were living at the home.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Effective recruitment processes were in place to ensure new staff were suitable to work at the home. Staff told us they had not received supervision or an appraisal for some time. Staff training was not up-to-date.

Women told us they did not feel safe living at the home. They said they felt unsafe around some of the men. The previous separate male and female mental health units had been brought together and men and women were sharing the same lounge areas and bathrooms/toilets. Women told us they did not like sharing these facilities with men. Although signs were put on doors on the second day of our inspection to separate out male and female toilets, staff said some men may not adhere to this due to needs associated with memory. Staff told us some people stayed in their bedrooms because of other people living there who presented with unpredictable behaviour that was challenging.

The system to manage and monitor incidents was not robust, including the process for analysing incidents as it did not lend itself to the clear identification of any emerging themes. The incident monitoring system was not identifying the level of risk that we identified during the inspection.

There was limited understanding amongst managers, registered nurses and care staff about what constituted adult safeguarding. Training records showed the majority of the staff team were not up-to-date with safeguarding training. We found numerous incident reports that should have been reported as safeguarding concerns but had not. The adult safeguarding policy did not reflect local area procedures.

Registered nurses and care staff working on the units could not definitively tell us how many people were being lawfully deprived of their liberty. Staff had not received awareness training regarding consent and mental capacity. Mental capacity assessments were completed in a generic way and were not specific to the decision the person needed to make.

People living at the home told us there were not enough staff on duty at all times. Equally, visiting families and staff said there were insufficient numbers of staff on duty at all times to ensure people’s safety and to facilitate recreational activities. From our observations, we concluded there were not enough staff on the mental health unit at all times to sufficiently minimise risk.

The management of medicines was not robust and we found numerous errors in relation to the administration, storage and monitoring of medicines. The home’s medicines audits had not identified the discrepancies we found. Covert (disguised in food or drink) medicines were not being given in accordance with the home’s medication policy and the principles of the Mental Capacity Act (2005).

People and families were satisfied with the quality of the food and the choice of meals available.

People told us they had access to a range of health care practitioners when they needed it. Families confirmed this. We found care records, including assessments and care plans did not always reflect people’s current needs and these discrepancies had not been identified through the home’s internal auditing processes.

People living at the home told us there was nothing much to do. They said they liked the group trips out in the mini-bus that happened sometimes but said they did not have activities planned specifically around their hobbies, interests and preferences.

People and families told us they were not involved in developing or reviewing care plans. In addition, they said their views about the service and how it could be improved upon had not been sought.

A complaints procedure was in place but it was not effective as there were mixed views about how many complaints had been received. A complaint made by a family in February 2016 had not been acknowledged.

Arrangements to monitor the safety of the environment were not rigorous. Parts of the flooring on the corridor in the mental health unit moved about, which was a risk to people who used mobility aids. Staff said it had been reported to maintenance but there was no record of this. We found fire doors wedged open on the mental health unit.

There had been a number of management changes in recent years and staff told this was unsettling and impacted on morale. The registered manager acknowledged that there were shortcomings with the service, particularly in relation to staff culture and out-dated practice. The registered manager and provider had already started to address these issues. However, it was too early to see the impact these changes were having in ‘turning the service around’.

Systems to monitor the quality and safety of the service were ineffective. Audits and checks of the service had not picked up on serious issues we identified. Operational policies we looked at did not always reflect local practice and/or local/national guidance.

The provider was not informing the Care Quality Commission (CQC) of all the events CQC are required to be notified about.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We are taking action to protect people due to the significant concerns found at this inspection and will report on our action when it is completed.

1.1 Explain how principles of support are applied to ensure that service users are cared for in Fleetwood Hall Home

1.2 Outlines the procedures that are adopted in Fleetwood Hall Homefor protecting clients and colleagues from harm.

1.3 Analyse the benefit of following a person-centred approach with the service users of Fleetwood Hall Home. (M1 1.3)

1.4 Explain any ethical dilemmas and conflict that may have arisen when providing care, support and protection to the elderly clients in Fleetwood Hall Homecare home. (For example) (D1 1.4)

Ethical Dilemma: One of the given scenario of Mrs Y and Mrs Z need to be used to answer 1.4. OR

You can also give your own example of ethical dilemma when answering 1.4

Scenario 1 Fleetwood Hall Home: Mrs Y

Mrs Y is her late 70s and has Alzheimer’s. She used to be a very active individual and had a love for dancing. Nowadays she has difficulty walking and spends a lot of time in her room where she is supported by care workers. She used to be a dance teacher as well and many visitors who come to see her are her ex-pupils.

One of these visitors, Susan, notices that Mrs Y is somewhat distressed. Susan asks her what is wrong and Mrs Y is unable to tell her. It is then that Susan notices some bruises on Mrs Y’s legs. She asks one of the care workers what had happened. The staff member tells Susan that normally when Mrs Y is moved from her bed to a chair in the sitting room a wheelchair is used and that normally transit straps are used to stop Mrs Y from falling. The worker says that Mrs Y doesn’t like the straps and earlier in the day she had refused to allow the straps to be used. Unfortunately, when being moved Mrs Y had a slight tumble and had bruised herself as a result.

Susan tells the care worker that it is in Mrs Y’s own best interest to have the straps on while being moved, even if she does not want them. Susan gets the distinct impression that as she is not Mrs Y’s relative she is not being listened to.

The potential human rights at stake here are:

·         Article 3 – Mrs. Y may feel that the straps are degrading. However, not using the straps and causing injury could also be ill treatment if sufficiently serious. It is unlikely that these measures will meet the threshold of seriousness required for Article 3

·         Article 8 may also be applied as it covers the right to well-being through retaining autonomy, choice and dignity.

Scenario 2 Fleetwood Hall Home: Mrs. Z

Mrs Z has mild learning disabilities who lives in Fleetwood Hall Home. She is the youngest resident by a considerable age and is certainly the fittest and most mobile. She has been placed there because there was no other provision for her support.

Mrs Z has a history of starting fires. She loves the bright colours of the flames. She calls fire the ‘dancing lights.’ Although this has not occurred for over three years now, care home staff are instructed by her psychiatrist to routinely carry out a search on her each time Mrs Z returned after being out unsupervised, to ensure she did not have matches or a lighter with her.

Mrs Z is increasingly annoyed at having to endure the intrusion of a personal search every time she comes back to the home and her family complains to the manager and staff on her behalf. Their justification is that they are not only following medical advice but that their actions are primarily for the protection of other residents to whom they have a duty of care to ensure that Mrs Z does not increase the risk of a fire starting in the home. The manager also suggests that Mrs Z might not be allowed out at all if she does not consent to the search upon her return.

Mrs Z has a mild learning disability and it seems she is capable of being involved in decisions about her. However, decisions have been made without involving her and without her views being taken into account.

Mrs Z is being searched every time she enters the care home which she finds to be an invasion on her privacy rights.

The potential human rights at stake here are:

The potential human rights at stake here are:

·         Article 8 – the searches undermine Mrs. Z’s privacy

·         Article 2 – the purpose of the searches is to protect the right to life of the care home residents

TASK 2

In the context of above mentioned scenario,

2.1 Explain the implementation of policies, legislation, regulations and codes of practice that are relevant to own work in Fleetwood Hall Home.

2.2 Explain how policies and procedures can be developed in Fleetwood Hall Home in accordance with national policy requirements. (D3 4.2)

2.3 Evaluate the impact of policy, legislation, regulation, and codes of practice on policies and practices of Fleetwood Hall Home. (M1 2.3)

In context of above scenario….

3.1 Explain the theories that underpin your work as care worker in Fleetwood Hall Home. (D2 3.1)

3.2 Analyse how social processes impact on your service users in Fleetwood Hall Home.

3.3 Evaluate the effectiveness of inter-professional working for your service users in Fleetwood Hall Home. (D1 3.3)

Note: Do not use the case the study to answer LO4. Please relate this to your own work experience.

4.1 Explain your own role, responsibilities, accountabilities and duties in the context of your work within and outside your own Care/nursing Home.

4.2 Evaluate your own contribution to the development and implementation of organisational policy in your own Care/Nursing Home. (D3 4.2)

4.3 Make recommendations to develop own contributions to meeting good practice requirements in your won care/nursing home in the future. (D2 4.3)

You need to produce one written piece of work between 3000 to 4000 words (+/- 10%) covering all the assessment criterion in LO1-LO4 as one document.