A duty of care is a legal obligation imposed on a carer requiring that they adhere to a good quality and standard of care. It is my duty to take care of vulnerable adults and to ensure that their needs and well-being are looked after. I exercise reasonable care with respect to individuals’ best interests, this includes protecting service users from any harm or abuse that may occur and avoiding any acts that could result in injury but it also means respecting service users and giving them choices.
I am proficient enough to ensure that every service user is taken care of in a reasonable, responsible and respectful manner. It is my role to ensure that my duty is carried out safely and effectively working alongside my organisation’s policies and procedures
‘My organisation and I have a duty of care to ensure that the service users we care for are safe, protected from abuse by other service users, staff, carers, friends and family. I therefore work within the safeguarding policies and procedures and it is important that I receive adequate training so that I can recognise and understand signs of abuse.
It is my duty to record of all relevant information when an accident or incident occurs in the workplace. It is my responsibility to report any improper conduct or suspicion that I think may contribute to abuse. Duty of care and safeguarding work together because it’s my duty of care to provide protection and safety for a vulnerable adult whilst at the same time respecting their needs and choices.
The Whistleblowing policy in my workplace makes it clear to me and to staff that it is staff’s responsibility to report improper conduct that compromises service user safety whilst ensuring confidentiality and protection from abuse for service users.’
Describe dilemmas that may arise between the duty of care and an individual’s rights: It is my duty of care to support service users with their medication and to ensure that they are in good health. I support an individual with her medication and on one occasion she refused for me to administer the tablets. I encouraged her and explained to her that she needs to take her medication so that she can keep in good health but she still refused. I therefore gave her some time and space for her to reconsider and calm down; approximately half an hour later I returned back to support her with her medication but she said again that she didn’t want her tablets.
I therefore recorded what happened, entered this also in the message book and completed an incident sheet. Her doctor was then contacted to explain that she refused her morning medication and to check that everything will be alright although she missed her morning medication.
It is the service user’s right to refuse this service if they want to. It is my duty of care to ensure that service users are supported accordingly and when they refuse a service that I record and report this. People with a learning difficulty have the same rights as anyone else in deciding whether or not to engage in a particular activity. It is important as it is my duty to ensure service users’ safety.
For example a service user may be a smoker and insist on smoking in her bedroom at night instead of in the smoking room and ignores all advice from staff who are concerned about the safety of everyone. Another example could be a service user who is a little unsteady on his feet but decides he wants to go out and use a bus or train instead of a taxi; he may be at risk of falling and injuring himself, staff and/or others around him.
Explain where to get additional support and advice about how to resolve such dilemmas: I can get additional support and advice about how to resolve dilemmas from training, supervision, from my Manager, the internet and also from appropriate professionals such as the GP or the person’s advocate. For example it is my responsibility to ensure that I assist service users in making complaints and to make sure that their complaint is taken seriously and that they are listened to. An advocate could be a person that supports a service user when needed and help with advising about how to resolve dilemmas.
Describe how to respond to complaints:
All complaints and concerns are dealt with fairly in my workplace and we respond to individuals’ needs. It is important that all complaints are reported to a senior staff member and logged. Once logged it looked into by the Manager who will try and resolve it. All complaints received are important and must be taken seriously. The Care Quality Commission (CQC) requires my organisation to gather, evaluate and generate reports about complaints – this is to ensure the continual improvement of the service.
The main point of these procedures is for service users to exercise their rights. Staff should also respond appropriately to any complaint they receive from service users or their families. If an informal complaint is made this should be discussed and this may stop it becoming a formal issue. The staff member receiving the complaint should listen carefully, take everything into consideration that is said and let the service user know what will then happen. If complaints are not responded to by staff appropriately then the service and the service provider will not improve.
The main points of agreed procedures for handling complaints and how to respond to complaints: There are stated steps to follow when a complaint is made. In my workplace we first have to make sure that the service user is given the correct form to complete; and sometimes staff help service users to complete these when they are not able to especially when they have been given poor services.
All complaints must be dealt with quickly and fairly. In my workplace the Manager is responsible for conducting the investigation when a complaint is received and a written letter is sent out to the service user to inform them that the complaint is being dealt with and timescales are given to them for a response.
The complaints policy ensures that service users are given a good service and protected from harm and abuse as all complaints have to be responded to and regulatory bodies notified.
SAFEGUARDING AND PROTECTION IN HEALTH AND
Define the following seven types of abuse and for each include their associated signs and symptoms: physical, sexual, emotional/psychological, financial, institutional, self-neglect and neglect by others
1) Physical abuse is deliberate physical force that may result in bodily injury, pain, or impairment. Both old and young people can be physically abused. There are signs or indicators to show physical abuse and there are ways in which victims and abusers act or interact with each other.
Physical abuse includes the smashing of furniture and personal belongings, being pushed or shoved, being held against your will, slapped, bitten, kicked, pinched, punched, choked or ducked under water, threatened or hurt with a weapon, threats of violence, locked in or out of the house, hair pulled …burnt with cigarettes, acid, an iron, hot food or water … Signs of physical abuse in adults are: bruising, particularly in well-protected and covered areas, fractures, sprains or dislocations, lacerations, burns – including friction burns and scalds, drowsiness, pressure sores, cowering and flinching, unexplained hair loss, significant weight loss, etc….
Symptoms include feeling low, angry and in pain.
2) Sexual abuse is when a person is forced or tricked into taking part in any kind of sexual activity. When sexual contact is non-consensual, it is an abuse. It can happen to men and women of any age that is both old and young. It can include sexual penetration of any part of the body with a penis, finger or any object, sexual exploitation, making threats about sexual activities, exposure to pornographic material, touching of breast or genitals, kissing, etc. Activities such as showing pornographic material, forcing the person to watch sex acts or forcing the person to undress are also considered sexual abuse.
The signs and symptoms of sexual abuse in the elderly can be bruises around breasts or genitals, genital infections, unexplained vaginal or anal bleeding, torn, stained, or bloody underwear, disturbed sleep patterns, vulnerable adult appears withdrawn and fearful, inappropriate dressing, etc…
3) Emotional Abuse is where one person gains power and control over another through words and gestures which gradually undermine the other’s self-respect…Emotional abuse can be name-calling, blaming, screaming, making threats, yelling….neglecting, manipulation, not listening, withholding affection…belittling and untrue accusations. Signs of emotional abuse are depression, anxiety, withdrawing or refusing affection, fearful or agitation, lower self-esteem and self-confidence, shouting or swearing, behaviours such as rocking, hair twisting and self-mutilation, vulnerable adult withdrawn and fearful…
4) Financial abuse is stealing or defrauding someone of money, goods and/or property, allowing others to steal money or property, tricking or threatening individuals into giving away money or property, withholding money, refusing to allow individuals to manage their finances, etc. for example when a support worker is taking money from a service users’ purse without his or her knowledge.
Signs of financial abuse are signatures on cheques that do not resemble the service users’ signature, or signed when the service user cannot write, unexplained withdrawals of large sums of money by a person accompanying the service user, lack of amenities, such as TV, personal grooming items, appropriate clothing, that the service user should be able to afford, deliberate isolation of service user from friends and family, resulting in the support worker alone having total control, the unexplained sudden transfer of assets to a family member or someone outside the family…. Symptoms include the person feeling fearful, anxious, embarrassed and belittled.
5) Institutional abuse happens when the lifestyles of service users are sacrificed in favour of the routines and/or restrictive practices of the home. Institutional abuse comprises neglect, physical abuse, sexual abuse, verbal abuse, discriminatory abuse, psychological and emotional abuse, financial abuse, service users not being allowed to go out, their personal letters are opened and read, their privacy not respected, their interest not at the centre of every decision being made, excessive medication and complaints procedure not made available for the service users.
Signs and symptoms include lack of own personal clothing and possessions, …no flexibility of bedtimes, eating times or waking times, dirty clothing or bed linen, misuse of medication, lack of care plans, lack of heating, staff entering into service users’ rooms without knocking.
6) Self-neglect is when a person does not pay attention to their health and well-being. Service users can neglect themselves due to illness or depression or might intentionally neglect themselves. The signs and symptoms include: living in dirty conditions, poor personal hygiene, poor nutrition…not getting medical help, not being interested in the way they look, long toe nails not taking medication.
7) Neglect is when a carer does not carry out their duty of care and fails to care for a service user this can be deliberate or unintentional due to the carer being ill or stressed… Signs and symptoms of neglect include absence of food, water, and heat… poor personal hygiene including soiled clothing, dirty nails and skin…inappropriately dressed for cold or hot weather, bedsores….constant hunger, withdrawn, illness…
Different factors that may contribute to an individual being more vulnerable to abuse: Living with the carer may increase the chances for abuse to occur as this may cause stress and resentment if the carer feels they cannot cope. If an individual is looked after staff who do not have the right training, any supervision at work or support, are stressed, have personal problems or do not like working in care then this can increase the risk of an individual being abused.
If an individual is not mobile, is confused, has dementia, or is aggressive or challenging then this can increase the risk of abuse as the carer might not know how to deal with this, get frustrated and might take it personally and abuse the individual. Domestic violence can also play a part as can the relationship between the individual and their parent or spouse if it was poor and involved abuse.
KNOW HOW TO RESPOND TO SUSPECTED OR ALLEGED ABUSE
The actions to take if there are suspicions that an individual is being abused: If I suspect abuse through noticing a sign of physical abuse or change in the behaviour of an individual, I will make sure that I ask the individual what has happened telling the individual the changes that I have noticed. If it is in my place of work and the name of the person that abused the individual is known, whether staff or another service user, I must also record and report this. I will listen to the individual carefully; it is up to them to tell me, I would not ask them any questions about this as this is not part of my job role and would stay calm.
I will make sure that I record what the individual tells me using the individual’s own words. I will make sure that I reassure the individual and explain that their safety is the most important and that it is my duty of care to tell the manager. I will make sure that I let my manager know what has happened immediately and pass this information on in private and make sure my report is also confidential. I will only report and record the facts – what the individual has told me. Depending on what is found out the individual might need to continue to be monitored and a plan of care will be put in place that must be followed to protect the service user.
‘I will make sure that I let my manager know and report and record this in private but if the allegation is about my manager or the manager is unwilling to do anything, I will follow my company policy of reporting abuse and report to CQC.
The actions to take if an individual alleges that they are being abused: If an individual alleges that they are being abused, I will make sure that I listen to the individual carefully to know exactly what happened. If it is in my place of work and the name of the person that abused the individual is known, whether staff or another service user, I must also record and report this.
I will make sure that I record the detail of all allegations that the
individual tells me using the individual’s own words; I will not ask any questions or make any judgements about what I have been told and I will stay calm. I will make sure that I record the date and time when the abuse was reported and then sign this record.
I will make sure that I take the allegations seriously and reassure the individual that they are right to tell me as their safety is the most important. I will make sure that I let my manager know and report and record this in private but if the allegation is about my manager or the manager is unwilling to do anything, I will follow my company policy of reporting abuse and report to CQC.
Different ways to ensure that evidence of abuse is preserved:
Ways to ensure that evidence of abuse is preserved are as follows: By leaving things as they are and not touching anything. By not removing, cleaning or washing what the individual is wearing and by not handling the individual’s clothes or bedding. By keeping the area safe and not allowing anyone to enter into the area. By recording and reporting carefully, confidentially and in full all that was told to me by both the individual and others if present at the time and also what I noticed; stating the facts only.
By preserving any first aid items used.
UNDERSTAND THE NATIONAL AND LOCAL CONTEXT OF SAFEGUARDING AND PROTECTION FROM ABUSE
National policies and local systems that relate to safeguarding and protection from abuse and explain the roles of different agencies:
National policies – ….’Safeguarding Vulnerable Groups Act 2006, the Vetting and Barring Scheme run by the Independent Safeguarding Authority (ISA), Criminal Records Bureau, Human Rights Act 1998. Local Systems – Safeguarding Adults Boards, Safeguarding policies and procedures for vulnerable adults.’ Safeguarding Adults Boards – these bring together a number of different local agencies that work with vulnerable adults to share information and monitor their work i.e. local agencies like the police, MIND, housing teams, advocacy groups. The Police – their role is to safeguard vulnerable adults, investigate all reports of vulnerable adult abuse and protect and uphold the rights of vulnerable adults.
CQC – to monitor and provide guidance on what all health and social care providers must do to safeguard vulnerable adults from abuse; the safeguarding policies, procedures and systems developed are in place to prevent vulnerable adults from being abused
Reports into serious failures to protect vulnerable adults from abuse:
A report about Castlebeck Care Ltd which failed to ensure that the vulnerable living at Winterbourne View were adequately protected from risk, including the risks of unsafe practices by its own staff. Individuals in Winterbourne View which is a home owned by Castlebeck Care Ltd were pinned down, slapped, doused in cold water and repeatedly taunted and teased by staff in the home. Castlebeck Care Ltd failed to notify the Care Quality Commission of these incidents, injuries to individuals and of occasions when individuals had gone missing.
A report about the murder of Steven Hoskin, a young man with learning difficulties who was abused and murdered in July 2006. In addition to being pushed over the railway and falling from a great height, it was also found that Steven had taken paracetamol tablets, had been drinking alcohol and had sustained recent injuries from cigarette burns. In addition he suffered appalling treatment from his abusers who took over his bed sit and he had neck bruises from having been hauled around his home by his own pet’s dog-lead and the backs of his hands had the marks of foot-prints.
Where can you go to get information and advice about your role in safeguarding and protecting individuals from abuse?:
Local authority Adult Services Department like Social Services My manager, colleagues
My company’s policies and procedures on safeguarding
Care Quality Commission
Independent Safeguarding Authority
Training and advice from training centres.’
UNDERSTAND WAYS TO REDUCE THE LIKELIHOOD OF ABUSE
How working with person centred values can reduce the likelihood of abuse: Person-centred values include the individuality of the person, the rights of the individual, the individual’s choice, the individual’s privacy, the individual’s independence, the individual’s dignity and the individual being respected If person centred values are taken into consideration when supporting an individual there is less likely to be abuse as all the staff will be working in the same way and will feel shamed if they abuse because of the way that they have been taught to work. If an individual is considered to have a say in what he or she wants and is at the centre of any decision, it will be more unlikely that there is abuse.
The individual will know what suits him or her and will not get so frustrated. I always put the service users I work with, their families and friends at the centre of any decision about them and they are an active partner in their own care. Individuals decide what to do, where to go, what clothes to wear and are treated with dignity, respect, confidentiality and are able to make their own choices.’
How encouraging active participation can reduce the likelihood of abuse: Active participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient.
So if the individual participates actively in their daily activities, which is what I practice, then the risk of abuse is low. For example in choosing the kind of meal to prepare I support individuals to make the lists of what they want to buy and go shopping with them so that they can choose the brand they want. The individual cooks the food the way they want it with little or no support. This is the same with all choices of clothes and outings.
How promoting choice and rights can reduce the likelihood of abuse: Individuals are supported to make their choices in anything they want like in choosing food or drink, in what to wear, whether to use hot or cold water to bathe, etc. No individual will choose what will hurt him or her therefore abuse is reduced to the minimum. Individuals’ rights are promoted throughout the service.
My service user has the right to do anything that they wish to do and if it is what they want as long as it is not dangerous; a risk assessment is then done to stop any abuse happening. I ensure that I promote service users’ rights and choices by allowing them to make their own choices and support them to have the rights of anyone else.
Why an accessible complaints procedure is important for reducing the likelihood of abuse’: The complaints procedure gives the complainant the right to be heard and supported to make their views known. An accessible complaints procedure is understandable and easy to use. It sets out clearly how to make a complaint, the steps that will be taken when the complaint is looked into.
It also provides flexibility in relation to target response times. An accessible complaints procedure resolves complaints more quickly as the complainant feels that they are being listened to and their complaint taken seriously. This sets up an open culture of making sure that abuse will not be tolerated in any form and encourages the complainant to not accept this.
I remember when Mr R felt very happy when his complaint of being denied sleep was recorded in the complaints procedure. I supported him to write down the complaint and this was taken seriously….
Unsafe practices that may affect the wellbeing of individuals’: Unsanitary conditions can spread infection as cross-contamination can occur and can affect the well-being of the individual and others. Improper hand washing can also pose a risk. Dirty kitchen surfaces and equipment can spread infections, not covering hair when cooking can pose a risk to individual as can not reporting faulty equipment when working or not having cleaning materials can also be unsafe.
In terms of health and safety not having risk assessments in place when a service user hurts themselves. Staff not checking when a service user is ill or unsteady on their feet. Staff not recording in care plans about a service user’s wellbeing and health and not monitoring them.
Other unsafe practices which also amount to abuse can occur such as leaving a service user on the toilet too long, ignoring or not listening to them. Marks on body not taken seriously and complaints not taken seriously can put them at more danger, harm and risk of abuse. I ensure that I keep to all the procedures for checking for abuse and the wellbeing of the individuals that I work with; by following these and the individual’s care plan I keep within the minimum standards of care and also work in a person centred way to make sure all individuals are happy and safe.
The actions to take if unsafe practices have been identified ’: If I identify unsafe practices then I must follow the whistle-blowing procedure and report to the appropriate person(s). I will report to my manager immediately or if it involves my manager then to another appropriate person(s).
I will monitor all unsafe practices and make sure that I record and report in full all the evidence and then will talk to my manager because all unsafe practices are dangerous practices that could cause harm to the individual and others. For example, I talked to my manager last week about things being left on the stairs that may cause service users and others to fall over and hurt themselves. She has talked to the staff and now this has stopped.
The actions to take if suspected abuse or unsafe practices have been reported but nothing has been done in response: If suspected abuse or unsafe practices have been reported but nothing has been done in response or if it has to do with my manager then I will report to the next level or manager. If it has to do with my manager then I will report to management, then to the social worker and safeguarding team and to the care quality commission and even to the police depending on the response I get.
When I worked in a nursing home there was some abuse of service users being left too long on the toilet and I talked to the nurse in charge and changes were made immediately. I had to record the information and give the nurse and manager a copy of my confidential report. If the nurse or manager had not done this then I would follow the whistle blowing procedure.
Courtney from Study Moose
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