Understanding Positive Risk Taking for Individuals with Disabilities in Social Care

4222-305 Understand positive risk taking for individuals with disabilities (LD 305) 1. Understand that individuals with disabilities have the same right as everyone else to take risks 1. 2 Explain why, traditionally, people with disabilities have been discouraged or prevented from taking risks. In Social Care there is an accountability for the welfare of the individual, whether they are being cared for or enabled to be independent. The enabler has responsibility for the individual, and the Company that provides the service to the client has responsibility towards both the enabler and the individual.

They are answerable to families, CQC, the local council, social care workers and the police. An individual, who has the mental capacity to know and understand what they are doing and the consequences, is bound by British Law. Risks are not just about accidents that may happen; they are also about behaviour and social awareness. When a person is not acting in a socially acceptable manner, members of the public may complain or at least interfere. They may get hurt, or their belongings damaged. There is a tension between the concept of “duty of care” and “empowerment and inclusion”.

It is not legal under British Law to put vulnerable people into a place of risk. However, it is not legal to imprison them either. There has been, and still is confusion and tension between the concepts of safeguarding, responsibility, duty of care, inclusion, empowerment, and enablement. In past generations, there was less inclusion for people with learning disabilities, and if a person is not included in everyday life, then they are not included in the risks taken in everyday life. Thinking about my own life - I cook: I cut my finger with a knife by accident. I iron: I catch myself and endure a shallow burn.

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I cross the road: I take safety precautions, but a random car may speed up, or a motorbike turn without signalling. These are risks I take several times daily. Why is a person with learning difficulties exempt? They are not exempt, but there is the understanding that their concept of risk could be quite different to mine. Because they have learning difficulties, they may not learn that the knives cut, the iron is hot, and vehicles kill. Therefore they are at greater risk if allowed to cut with sharp knives, iron with hot irons and cross roads alone, than I would be.

Do we experience an over-bureaucratisation of care in the Western part of the world? Is there a blame culture, arising from an increasingly litigious society? One mistake and a company is sued. The temptation is to do nothing that incurs risk; with no risks taken there is no chance of an accident. There is no chance of investigation, court proceedings, compensation, increased insurance charges and negative reputation adhering to the company. Companies who deliver Social Care are accountable. They need to follow British Law.

Risk assessments should be put in place for activities that incur reasonable risk, and these need to be followed. The individual with learning difficulties should be supported so that risks are minimal, documented, prepared for and no unnecessary risks take place through negligence. Andy Alaszewski et al (1999) Empowerment and Protection: a conclusion from this study was that organisations and agencies need to develop risk policies that embrace both protection and empowerment issues if individuals with a learning disability are to enjoy full lives in the community.

Another aspect of risk in the community is the right of people who do not have diagnosed learning difficulties to live their life with minimum disruption. I have taken a person with learning disabilities to a cafe where he put his hand in a person’s salad, and tried to sit on their knee. Thankfully the salad had been left by the customer, but they did not want anyone sitting on their knee. I had put risk assessments in place, and thought it a positive place to enter the community, but I had no forewarning that the cafe was far more full than usual, and that there would be no room to sit down immediately.

Here we have an example of risk that was assessed, taken, and culminated uncomfortably. The customer left the premises quickly. Do I take the individual again another time? Or should we abandon all attempts to visit the cafe? It would be easier with two enablers, so one could find out information when the individual arrived at the premises, whilst the other enabler supported the individual. But there is no funding for 2-1 care. This leaves a situation where risk will always be present, but the skills of the enablers will hopefully grow as they learn ways of promoting positive behaviour in the community. . 3 Describe the links between risk taking and responsibility, empowerment and social inclusion. Anybody who takes a full role in society takes risks: crossing the road, using a bus, driving a car, and talking to people they do not know. Risk may be physical (injury and accident), emotional (humiliation, sense of failure), or mental (stress). A person who is excluded from a group is disempowered. Inclusion is a strong and forceful need. Many people consider being part of a tribe, gang, clique or social group a necessary part of their life. Exclusion is disempowering.

We are aware of bullying in schools, and the words still resound in my ears, “You can’t be part of our gang! ” With inclusion and empowerment comes the responsibility and consequences of taking part in society in a socially acceptable way. This is laid out in British Law. A “gang” may not adhere to British Law, and so there are consequences including extra risk taking leading to injury, death and imprisonment. “The governing principle behind good approaches to risk is that people have the right to live their lives to the full as long as that does not stop others from doing the same. (Independence, choice and risk: a guide to best practice in supported decision making. Department of Health, May 2007) Duty of care requires everyone to “take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour. ” (Donoghue (or M’Alister) v. Stevenson case, Lord Atkin 26th May 1932). The duty of care requires a person, with or without learning difficulties to consider the consequences of their acts and omissions and to ensure that these do not give rise to a foreseeable risk of injury to another person.

The expectation is that a person is expected to act reasonably, not guarantee the safety of others at all times. Risk assessments should be put in place for those individuals who maybe cannot foresee the result of their acts, and would not understand the consequences. The duty of care rests with the social care providers. For a person with learning disabilities, they need social inclusion but are disempowered if they take part in social activities and yet do not behave in a socially responsible way. Therefore risk assessments are needed. I do a quick mental risk assessment when I cross the road.

A person with learning disabilities may need that risk assessment doing on their behalf, due to lack of traffic awareness. The risk assessment may also identify their need to be fully supported as they cross the road. Once the risk assessment is in place, and adhered to by enablers, the individual can be taken into the community, guided across the road safely and positive consequences experienced. An example of social inclusion and empowerment can be seen in a Cake Bake sale where a group of individuals with learning disabilities baked for the Cake Bake sale, and advertised it around the village.

It was held at the Church Hall and announced in the church service. Prior to the Cake Bake sale, two individuals had been regular members of the congregation and supported by enablers to take part in the service. The Cake Bake Sale was well attended by many members of the congregation, who also supported by bringing cakes and helping to wash up and put crockery away. There was a huge positive input from the local community. There were many risks involved – from cooking with hot ovens, to walking up the church hall and crossing busy roads to get there.

There were risks that the Cake Bake sale may not attract local community members because it was known to be run by people with disabilities. There were also risks in the handling of money and safekeeping of money. But these risks were assessed, catered for, the individuals supported properly and the Cake Bake sale was a resounding success. It raised money for a compost heap and tools for a garden project. 2. 1 Explain the process of developing a positive person centred approach to risk assessment. UBU’s policy is that a risk assessment should be completed when a person is involved in undertaking an opportunity that may put him or her at risk.

It does not stop the person taking part in that activity, but it does show that the risk element has been carefully calculated, evaluating the probability of the risk against the severity of the risk. It is to be discussed with all the parties involved and so becomes a multi-disciplinary approach. The risk is shown to be reasonable and will enhance the individual’s quality of life, but at the same time, all precautions are being considered and put into action. Being a person-centred approach to risk assessment, the person (not the activity, and not the staff or the premises) is at the heart of the risk assessment.

The person’s behaviour and (if applicable) condition are taken into consideration. It is considered if the risk will induce emotional harm. High risk areas may be highlighted. A risk is assessed, recorded and monitored to ensure consistency, good communication, and on-going assessment and review take place of any decision taken. This demonstrates that thorough discussions have taken place. Risks are discussed at the three monthly quality review, and six monthly service evaluation. They will be taken into account at any other discussions held to assess a person’s well being and progress.

People learn through being given or seeking out opportunities. This may involve different amounts of risk. The first time somebody does something may be more risky than the time they do the same activity six months later. Knowing the person and understanding them is crucial, and this is where risk assessment becomes positive. By knowing the person, their behaviour, medical condition, emotional welfare, habits, enjoyment, strengths as well as weaknesses, the risk assessment can be tailored to their individual needs. Sometimes expert advice from an external professional may also be needed to ensure the best risk assessment is created. . 2 Explain how to apply the principles and methods of a person centred approach to each of the different stages of the process of risk assessment. The first step in creating a risk assessment is to create a person centred Care Plan. This is called “Getting to Know Me” and is ideally created with the individual, keeping it as person-centred as possible. It documents practical information such as the name, address, date of birth, GP details, but also documents likes, dislikes, fears and other personal information. There are two small boxes for each relevant section that are ticked if necessary.

One is for Support Plans where extra support is needed. The other is for Risk Assessment, where a formal risk is pin pointed. The Getting to Know Me is kept on Sharepoint, the confidential electronic (computer based) system of UBU. By ticking the box, a risk assessment document is created for the individual and is filled in by the individual and person doing the assessment. The person doing the assessment will have received training to enable them to do this correctly. They will be a Deputy Manager or Team Leader, or higher manager. At the centre of Getting to Know Me, the support plans and the risk assessment lies the individual.

The documents allow for individuality, whilst presenting a consistent approach throughout UBU. A risk assessment is headed with the following sections: * Subject * Issue * What has happened in the past? * What could happen in the future and is there anything that could make it worse or make it more likely to happen? * Who would be at risk and how would they be affected? * What is already happening to reduce or remove this risk? Have any other management plans been used or been effective previously? (if not why not) * Based on all the information that has already been considered how likely is it that something will happen? A number is given scaled 1 – 5) * What makes you think this? * Based on all the information that has already been considered if something did happen then how serious could it be? (A number is given scaled 1 – 5) * What makes you think this? * A risk value is then produced by the document * What is the risk from this issue? * Are there any benefits to my quality of life from this issue? * What needs to be done to remove this risk or make it less serious * Is there anything else that needs to be done to reduce this risk? * How, when and by whom will this be monitored? * My comments about this assessment (I agree with this assessment, I disagree with this assessment because? ) (The individual is asked to fill this part in). * Where I disagree with any part of this assessment (The individual is asked to fill this part in). * The reason my enabling team feel that this should be included in my plans is... * Does this present a specific risk to my enabling team? There is then room for planning a review. As it can be seen, the individual is part of the risk assessment process and consulted on their agreement or disagreement with it. 2. 3 Explain how a service focussed approach to risk assessment would differ from a person centred approach.

Rather than focussing on the individual, their objectives, dreams and their life, the risk assessment is based on statistics. Instead of giving room for the individual and their team to comment on the risks, the assessment and the prevention of undue risk being undertaken leading to danger, tick boxes are provided which do not allow for comment. The focus is on what can go wrong, not what can go right. The person is seen as a problem to be managed instead of a person to be enabled, and an individual who can fulfil ambitions and offer a contribution to society.

At worst the person becomes an “object” for assessment. 2. 4 Identify the consequences for the individual of a service focussed approach to risk assessment. Individuals being supported in social care environments may seem to have less power and status than those who enable them, support and care for them. If they want to take a risk, the question that is most pertinent might be that of, “How does the risk affect the more powerful people who enable, support, care and manage the place where they are (live). If there is a risk involved that may affect the perceived “powerful” people, then it is more likely that the individual will be prevented from taking the risk. Sometimes the risk that is feared is more imagined than real. Unpredictable actions from individual can have an impact on the reputation of the service provided by the company. This has happened at Mayfield Court, where a complex individual was taken out into the community where he caused some disruption. An member of the community complained to head office about the treatment of the individual as he was “saved” from rushing into a road with oncoming traffic.

They did not like the way the enabler dealt with the situation. The enable was acting within the boundaries of the Care Plan, Support Plan and Risk Assessments for that individual, but the member of the community was not used to the complex and unsocial behaviour of the individual. Should he then not be allowed to go walking and bike riding around reasonably safe areas of the locality? As a result companies providing support and care risk assess everything quite intrusively and obsessively focus on every aspect of the lives, behaviours and potential behaviours of the people they support. Proceduralisation” is increased, defensive practices become the norm, and there is a culture of blame avoidance. The parties involved have very different interests from each other. Conflict can result. Cooperation, agreement and action is needed so that individuals do lead the lives they dream of. 3. Understand the legal and policy framework underpinning an individual with disabilities’ right to make decisions and take risks. The Human Rights Act 1998 states: * the right to life * freedom from torture and degrading treatment * freedom from slavery and forced labour the right to liberty * the right to a fair trial * the right not to be punished for something that wasn't a crime when you did it * the right to respect for private and family life * freedom of thought, conscience and religion, and freedom to express your beliefs * freedom of expression * freedom of assembly and association * the right to marry and to start a family * the right not to be discriminated against in respect of these rights and freedoms * the right to peaceful enjoyment of your property * the right to an education * the right to participate in free elections the right not to be subjected to the death penalty Many of these rights incur risk. Liberty means no imprisonment against the will. But taking part in freedom does incur risk. We all have the freedom to express our beliefs. Some people may express harsh or discriminatory beliefs. They will have to balance their responsibility to other people, their right to express their beliefs and the consequences that come of their expression. This is harder sometimes for a person with learning difficulties. Hence the risk assessments that may need to be in place. Everyone has the right to assembly and association.

This leaves vulnerable people open to potential abuse (we all are – property theft, verbal abuse to name two). They also need to be aware that other people have rights and there may be consequences to their actions that are not comfortable or pleasant. If a person with learning difficulties hits a member of public they may end up being arrested, or hit back. These are just some examples of Human Rights, the risks associated and the necessity to make risk assessments for vulnerable people to safeguard them as they do enjoy their full Human Rights as set out in British Law. The Mental Capacity Act 2005, Code of Practice states: 1.

Every adult has the right to make their own decisions if they have the capacity to do so. You must assume that a person has capacity unless it can be established otherwise. 2. Individuals should receive support to help them make their own decisions and all possible steps should be taken to try to help him or her to reach a decision themselves. 3. Individuals have the right to make decisions that others might think are unwise. Making an unwise decision does not mean that a person lacks capacity. 4. A person’s capacity must not be judged simply on the basis of their age, appearance, condition or an aspect of their behaviour. 5.

It is important to take all possible steps to try to help people make a decision for themselves. 6. Any act or decision should be the least restrictive in relation to its purpose. The Mental Capacity act promotes independence for people and also allows for the making of mistakes and learning through making mistakes. Without experiences people do not develop and learn. However, it also suggests that people are given the support needed, so that they do not come to harm whilst doing so. Risk assessments should not unreasonably restrict a person. They should safeguard them, but should be relevant to the real risk, not feared and imagined risks.

NHS and Community Care Act 1990 sets out how the NHS should assess and provide for patients based on their needs, requirements and circumstances. Each individual has different needs, requirements and circumstances and therefore the provision for each individual should be different. The Act introduced an internal market into the supply of health care, making the State an “enabler” of health and social care provision, not a provider. The duty for assessing people for social care and support rests on the local authorities, so people who need community care, get the services they are entitled to.

People giving care follow a set of rules called “The Care Value Base. ” The care value base is a set of rules and guidelines that every care practitioner has to follow in order to provide services to their clients. The seven principles are: 1. Promoting anti-discriminatory practice 2. Maintaining confidentiality of information 3. Promoting and supporting individuals’ right to dignity, independence, choice and safety 4. Acknowledging people's personal beliefs and identities 5. Protecting individuals from abuse 6. Providing effective communication and relationships 7. Providing individualised care

When all these principles are in balance individuals should receive the support needed to live full and interesting lives, make their own choices and decisions to the extent of their mental capacity and yet be protected from abuse if vulnerable. They have a right to safety, and this is why risk assessments are put in place. Equality Act 2010 requires equal treatment in access to employment as well as private and public services, regardless of the characteristics of age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex, and sexual orientation.

This ensures that people with learning disabilities should be able to make choices and decisions freely about seeking jobs and accessing all aspects of life. There should be no restrictions. Support should be given appropriately after assessment with support plans and risk assessments to ensure this can take place. General Social Care Council Code of Practice A social care worker must protect the rights and promote the interests of the service users and strive to maintain trust and confidence. The independence of the service users should be promoted, whilst protecting them as far as possible from danger or harm.

This is where risk assessments and the adherence to such plays its part. A social care worker must respect the rights of the service user whilst seeking to ensure that their behaviour does not harm themselves or other people. There are consequences to actions, and responsibility lies both with the individual (if they have the mental capacity) and the social care worker. Public trust and confidence from the public with regards to social care services must be upheld. Members of the public should be able to see people with learning difficulties out in the community, but in a safe and sensible way.

A social care worker is accountable for the quality of their work. They have the responsibility for maintaining and improving their knowledge and skills. The managers and deputies have the overall responsibility for Care Plans, Support Plans and Risk Assessments, but the enablers also have the responsibility to read them, understand them and put them into practice. Also, when they are reviewed and change, to re-read them and understand the new documents. Valuing People, White Paper 2001 covers four key principles: civil rights, independence, choice and inclusion.

It takes a life-long approach starting with an integrated approach to services for disabled children and their families, then, providing new opportunities for a full and purposeful adult life. The proposals should result in improvements in education, social services, health, employment, housing and support for people with learning disabilities and their families and carers. Valuing People underpins the individual’s right to make their own decisions, act independently and be included into society. A person with learning disabilities has the same civil rights as everyone else.

They also share the same responsibilities, actions have the same consequences, and British Law applies. Whilst British Law strives to promote independence for people with disabilities, it does not protect them from the consequences of risk taking. This is where a balance is needed between duty of care (for both the individual and others), consequences of actions, learning from successes and mistakes, and ensuring an overall wellbeing for all concerned through risk assessment. 4. 1 Analyse why individuals with disabilities may be at risk of different forms of abuse, exploitation and harm in different areas of their lives.

An individual who is in supported living is often a more vulnerable person. The term vulnerable person refers to anyone over 18 who is or may be in need of community care services by reason of mental or other disability, age, illness, may be unable to take care of him or her, or is unable to protect him or her against significant harm or exploitation. Who Decides, Lord Chancellor’s Office 1997 Such people may be elderly, physically or mentally frail, suffer from a mental illness including dementia, have a physical or sensory disability, have learning disabilities, or have a severe illness.

Abuse is a violation of an individual’s human rights by any other person or persons. It may consist of a single or a repeated act. It is the maltreatment, physical, emotional or financial, of a vulnerable adult. It may comprise threatening behaviour, neglect, sexual abuse, or the misappropriation of finances or material assets. Abuse can be physical, sexual, psychological, financial or material, neglect and acts of omission, and discriminatory abuse. At Mayfield Court different individuals have different risk assessments in place to safeguard them in situations where perceived abuse could take place.

One individual has been risk assessed that he should never be allowed to go to the pub alone, and must always have support. Incidents have happened when clients of pubs use threatening behaviour towards him. Another individual has a risk assessment that he cannot go alone into the community because he stares at children, especially young boys. Parents perceive him to be a risk to their children, although there are no grounds for this. He would like to play with the children, as he never could do so as a child due to his medical condition. So he looks longingly at them, and becomes a perceived risk in the community.

As a result he could be abused by those who take action to protect their children (quite understandably). Another individual has no competent money and financial awareness. He has been risk assessed so that he must be supported in the community with regards to shopping. He would spend all his money on goods that were not necessary, often repeat purchases of a single item (one diary is good, several of the same diary is better! ) and would waste his money. This would lead to a situation where bills cannot be paid and the quality of his life would be compromised, so his risk assessments are in place to ensure it does not happen.

Whilst this would be his choice, he could easily be abused financially by shopkeepers, or members of the public who take advantage of his good nature and vulnerability. It would also be abusive to pretend to provide support for him, whilst not safeguarding him to manage his money in a reasonable and sensible way. Stopping him buying items that he actually enjoys, would also be abuse. On supporting one individual with severe Down’s Syndrome through the streets of York, a school trip of children aged approximately 10 years old went by. Several of the children pointed their fingers and shouted out, “Look at that little man! This could be construed as abuse (although they are children, and probably more interested than abusive). But highlighting a person’s differences negatively is discrimination and bullying. When managers consider the Care Plans for individuals, they need to consider such risks, and write risk assessments to safeguard individuals as they go about their normal, everyday life in community situations, because unfortunately there are risks in life by simply being out in the community for everybody and anybody. 4. 2 Explain how to support individuals to recognise and manage potential risk in different areas of their lives.

The enabler is in a key position to support an individual to recognise potential risk in everyday living situations. Once the risk has been recognised the enabler can work with the individual, and possibly Deputy Managers and Team Leaders to manage the risk. It depends on the type of risk presented. Deputy Managers and Team Leaders at UBU write the risk assessments that are recorded in risk assessment documents on the Computer System Sharepoint. These may have been flagged up by enablers or keyworkers, but training is needed before the senior staff formally write them.

The risk can be recognised by the individual, or by staff supporting them. Risk assessments are often written for an individual from their Care Plan (Getting to Know Me). The individual may be introduced to the perceived risks after the risk assessment has been created. It depends on their own awareness level. One individual thought she knew all about money and could not understand why she could not countersign her own finance records. She has been assessed as having no concept of the value of money, or any recognition of coins and notes.

She does know money exists, it is in her purse, and it can be exchanged for goods, but the value is not understood. She has had a risk assessment put in place to state this, and Deputy Managers and Enabler Plus staff members sign and countersign the finance records. She has gently been taught to understand that although she loves to sign her name, and she wants to take on independence in this area of her life, it is too risky, and she has had to come to terms with the recognition of money usage and a potential area of abuse that has to be covered by risk assessments that must be adhered to by staff.

Talking to individuals and explaining in ways they can understand is a way to help them recognise areas of risk. An individual wanted to use the Spa pool at a hotel near to his home. But he was nervous of the water and use of the pool, due to a perceived bad experience years previously. I took him to the spa pool where he could view the pool area and where he could created his own risk assessment of the facilities and activity. He talked me through his perceived risks, and I wrote them down.

Sometimes I pointed out a risk to him, and he decided how to deal with the risk safely. Together we created a detailed risk assessment, that I typed up and put in his folder so all staff could see it. I also gave a copy to the Team Leader so she could type it up onto Sharepoint. (Ref. Swimming Risk Assessment Reflective Statement 205/305/306) I use a “Stop and Check” method of risk recognition, using open questioning techniques before doing an activity. I ask, “What shall we do? ” “How shall we do this safely? ” This gives the individual chance to come up with the answers.

The recall of past experience ingrains the knowledge, it gives them practice in thinking through a situation and safety awareness, and empowerment because they were not told, and they came up with the answer themselves. Some individuals learn through habitual practice and learn by rote. Verbal communication is not a primary method of communication for these individuals. When crossing a road I always enable them to STOP and CHECK before crossing – whether or not there is traffic coming. We ALWAYS walk on the pavement. We ALWAYS use the “little green man” at the crossings.

This way, they learn the habit of safely. I plan with a person in advance, and as we plan activities, we think about and discuss safety, accidents, the best way of doing something, and what the consequences might be if we did not do something. Going to a garden centre on Sunday becomes a risky business if an enabler does not have a bus timetable that is up to date, and shows the Sunday bus service. The consequence could be no transport home, and no money to pay for a taxi. I explain why to those who can understand the concept. An individual wants to iron, and seems very capable.

He has cerebral palsy. I have explained to him that because of his mobility issues, and because an iron is hot and unwieldy, it is better that he lets me iron, whilst he puts away. I make sure he feels praised by his putting away skills, rather than undermined because I have not let him try ironing. At Pastimes (a day care centre) individuals have had access to Advocacy Meetings, where they learn about their rights, responsibilities and the consequences of their actions. Education (formal) be it at a college, evening or day class may supply teaching about risky situations.

There are many ways to help an individual recognise the risks in their lives, and manage them. But tactfulness, support, and inclusion in the risk management activity is a way of enabling the individual to learn what risks are pertinent to themselves and how to circumvent difficult situations, accidents and injury, humiliation and stress. 4. 3 Explain the importance of balancing the choices of the individual with their own and others’ health and safety. When an individual makes choices, they take responsibility for their actions, and need to think ahead about the potential consequences.

Thinking ahead does not always come naturally to everyone, including those who are not assessed as having learning difficulties. An individual wanted to go upstairs at Mayfield Court, to visit a friend who lived on the upper floor. She has been assessed as being at high risk of falling down the stairs. She has had it written into a formal risk assessment that she should not go up stairs. The reasons given are that she may fall and hurt herself badly, she may fall and land on top of somebody else, and she may damage property.

She may not be able to get down the stairs. This may lead to a hospital visit, and the unnecessary usage of NHS ambulance and paramedic time. When in hospital, she may use more than her allotted support hours and then have to do without support another day, or pay for the extra support hours. Alternatively, she may have to go to hospital unaccompanied. UBU are accountable for her safety to her parents. The individual does not have the right to chose activities or make decisions that put another person into danger. The worst case scenario is manslaughter.

The person can be supported to lead a full life, but not one which puts others into unnecessary danger, or may lead to someone’s injury or death. UBU do not have the right to allow the individual to freely do whatever they want without any regard to their own and other’s safety. However, if an individual has the full capacity to make decisions and understand the decisions s/he is making, and chooses to do the activity knowing that they are putting themselves at risk, then there is nothing a UBU enabler can do to stop them.

They can encourage them not to, point out the risks, point out the consequences and make very detailed records, but the enabler cannot lock the person up and refuse to allow them out. Thus it was that the individual, who was not allowed to access the upstairs floor, went up anyway, knowing full well she should not do this, having been asked not to, and having had the consequences fully explained to her. She did get up and down the stairs without accident but she did also put herself into an area of potential risk.

She did not have an enabler’s support at that point in the evening and made the decisions by herself. 4. 4 Describe how own values, belief systems and experiences may affect working practice when supporting individuals to take risks. I believe in freedom of choice, as long as it does not affect other people adversely, and as long as it is not obviously going to put the individual in a situation of danger or difficulty. I am a great believer in try it and see, and have a go. I have a very person-centred approach to life and try to include individuals in decisions and choices made.

I support individuals to action and complete activities they have chosen to do. But I do adhere to risk assessments that are formally in place, and created risk assessments either formally (e. g. for a holiday proposal) or mentally as a situation of perceived risk arises (e. g. crossing the road/entering a cafe that seems quite full). I do not take unnecessary risks. I do think and plan ahead in great detail. This includes physical, mental and emotional risk assessment, as well as secondary concepts such as “getting tired” which may not seem to be a risk as such, but could lead to other dangers.

A tired person, who has been walking more than normal, is more likely to suddenly refuse to go anywhere else, and they and their enabler may end up stuck in town, or far away from bus stops, without the ability to return home. My experiences have been mixed as I have learnt my job. The risk assessment completed for the swimming activity at the Spa pool was a very positive activity. This lead to the individual using the pool facilities and overcoming his nervousness of water. The risk assessments completed before tenants holidays proved detailed and more than adequate to keep the individuals safe.

However, there are always ad hoc experiences that one cannot plan for, and risk assessments must be done at the time of the risk being presented. I supported an individual to go to a supermarket and use the bus as transport. As it was the first time she had ever been, and she was new to Mayfield Court, the Deputy Manager went with me (we risk assessed that it was safer to have two of us supporting her, as she can present volatile behaviour). We took enough money for a taxi home if necessary. We went there, shopped successfully and had a fun time as well.

We got on the bus home, and as we approached our stop, the individual rang the bell. The bus driver shot straight past the bus stop and we were a long way down the road before he could stop at the next bus stop. We disembarked but the individual lost heart and decided she would not move. We risk assessed at that point that getting a taxi the seemingly (to us) short way home was better than forcing her to try to walk, or creating a great fuss about walking, as we thought it necessary to complete the trip positively. Fortunately a taxi pulled up at a nearby shop, and we asked the driver to take us back to the individual’s home.

The risk of the bus over-shooting and missing the bus stop was not foreseeable, but because we had to make quick decisions with regards to the physical, mental and emotional welfare of the individual, and we risk assessed the situation immediately, the decision we did make turned out very positively. On an individual’s holiday the individual asked for the freedom of the hotel, to go round, talk to people she had met, and have a drink with them. I risk assessed the situation as safe as long as I stayed within view, although minding my own business. I could be called on if necessary.

The hotel staff’s job was not to look after and support the individual’s on holiday, but the hotel was for people with disablement, and part of their job description is to liaise with enablers and carers, and communicate any needs to them. Therefore I decided that it was a reasonable situation for the individual’s development and although risk (of falling over, having a seizure, annoying staff or guests) was involved, because I was somewhere near and could be sought easily, the risk was minimal. I adhere very strictly to one individuals risk assessment with regards to road safety.

He has no traffic sense and would walk in front of a vehicle. I ensure I position myself between him and the traffic. Another individual has no traffic sense, but has been taught to walk on pavements. He does this and only needs strict supervision when nearing road crossings. However, I still do remain mindful and vigilant when out in the community with him. One individual for the most part enjoys going into cafes, but if they are crowded or have the wrong sort of music on, he can display socially unacceptable behaviour. I plan a cafe trip, take the necessary equipment (his bowl, mat, wipes, cutlery, plastic beaker) with us.

But when we arrive I make a judgement as to whether to proceed with the cafe activity dependent on his mood presentation, the circumstances within the cafe, and any other factors that need accommodating. The whole purpose of the cafe experience is for the individual to enjoy it, and the risk assessment highlights whether he is likely to enjoy the situation or not. If not, there is no point in doing it. Part of my risk assessment practice is to “tune into” the individual’s mood and analyse whether he is in the right mind-set to cope with a particular set of circumstances at that particular time.

What is a positive experience on one day may be quite disruptive and negative the next day. 4. 5 Explain the importance of recording all discussions and decisions made. When I make decisions on behalf of an individual, especially ones that may have far reaching consequences, I need to evidence why I made them, and in what circumstances. I therefore record my support in a Daily Log, and if there are any incidents, these are recorded in a specific record for violent incidents or other incidents.

The Daily Log is mostly used, and here we record what the individual chose to do, what they did, how they did it, what happened, and what the outcome was. When decisions are made, I evidence why that decision was made. The enabler is responsible for the welfare and the safety of the person they are supporting and this includes the physical, mental and emotional welfare and safety. UBU is also accountable, and hence have a full set of Policies and Procedures, Care Plans, Support Documents and Risk Assessments in place for each person.

The nature of the job as an enabler is to support individuals so that accidents and injury, abuse and harmful decisions are not made. Risks are taken, but the Daily Log can show that the risk was reasonable, and assessment had taken place. The risk assessments can be referred to. The enabler is responsible for adhering to risk assessments, support plans and care plans. If the individual chooses and forces a decision to discount the risk assessment, or ignore it, it must be documented that reasonable persuasion took place. In some cases it can also be documented in the communication book and the individual can sign it.

Two tenants decided to share support for the evening so they could go together to a pub for a drink. This meant that one tenant would have to forgo support, in the event of the other, more vulnerable tenant’s safety or health being compromised. I wrote out a contract in both their communication books which stated that they both understood what they were doing, what they were doing, what the consequences would be. They signed their own and each others’ books, and it was also fully recorded in the daily logs. They went out and had a good time.

An individual whose risk assessment states he must be supported in the community at all times due to his lack of regard for traffic (after being run over by a car), ignored his risk assessment at a time when he was not supported, and went on a bus to a pub about 2 miles away. He then met another tenant who was there with his supporting enabler. He completed his journey in safety, but had put himself at considerable risk to do the journey. This was explained to him, but his attitude was that he wanted to socialise and have a drink, and he should not have to stay in all evening just because he did not have support.

This is a difficult situation, but the individual did present the capacity to understand his decision, to know it went against his risk assessment, and that it may have had severe consequences. He did not show remorse. Some individuals have the mental capacity to choose to disregard their risk assessments knowing the consequences, and others have not. They cannot decide to disregard the risk assessments that have been put in place for their own welfare. They will act on what they think at the present moment. This capacity should also be risk assessed by professionals.

A social care manager may have to be brought in to review and put support plans in place if a person repeatedly brought undue risk to them self or to others. A person who has the capacity to make a decision with understanding is accountable to British Law and the consequences of breaking it. UBU and I, as Enabler Plus, must evidence and record that all reasonable steps have been taken, policies and procedures followed, advice sought and followed, and authorities notified in accordance with UBU’s policies and procedures. Susanna Fox 4. 7. 12

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