Risk Management and Service User

Understand the current legislative frame and organisational health, safety and risk management policies, procedures and practices that are relevant to health and social care or children and young peoples setting. As an organisation that manages health and safety we recognise that the relationship between controlling risks and general health is at the very centre of the business itself.

The starting point for managing health and safety in the workplace which:

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• demonstrates the practices commitment to health and safety and sets out aims and objectives in relation to this
• identifies the individual health and safety roles and responsibilities and the communication channels with-in the practice
• Summarises the practical way in which health and safety is managed and objectives met. The organisation is required to have a health and safety policy in place in order to comply with the health and safety at work act 1974.

The act is the primary piece of health and safety legislation within the UK. It is an enabling act often referred to as the umbrella act, which means that regulations can be introduced with-out eh need for additional primary legislation. The Health and Safety at Work Act also says that employers must, so far as is reasonably practicable provide

• a safe place to work
• a safe environment and adequate welfare facilities
• safe equipment and systems of work safe arrangements for using, handling, storing and transporting articles and substances associated with work
• sufficient information, instruction, training and supervision for employee

The act is supported by many other regulations and pieces of legislation, one of the most significant being the Management of Health and Safety at Work regulations (MHSWR) 1999. A crucial element of these regulations is the requirement for employers to have in place systems to manage health and safety.

The technique of risk assessment – used to identify hazards, evaluate risks, support planning and put effective control measures in place – underpins such systems. In recent years, the risk management has been influence by the growing awareness of the number of errors, incidents and near misses that happen in social care practice and the effect of the safety of service user’s and the consequence has been the development of service user safety initiatives which have given a ‘service user focus’ to the management of risk within the social care setting.

The health and safety at work act underpins this aim and clearly describes the employer’s duty of care not only for staff but towards the persons other than employees such as service user’s, attached staff visitors, and member of the public, contractors and delivery personnel. The principals and duties outlined in this policy apply, therefore, to anyone affected by the practices activities.

1. 2 analyse how policies, procedures and practices in own setting meet health, safety and risk management requirements. The main piece of legislation affecting the management of health & safety is the Health & safety act at work 1974. This act provides a framework for ensuring the Health & safety of all employees in any work activity. It also provides for the Health & safety of anyone:

• Risk assessments with the working environment
• Adult protection & safe guarding
• Person centre planning & risk management

When working in line with the organisations policies and procedures to ensure that the staff team create a safe working environment and service user care plans and risk management plans don’t impact on their freedom of choice but they ensure that they are safe with the life style they choose to live, I need to balance those choices against our risk management plans for example we have a service user who lives in her own flat within the complex of the home and feels that her bed is to high and asked her family to put the mattress on a pile of bricks rather than have the bed frame lowered.

When staff discovered this, they informed senior staff who tried to explain why their actions could not be allowed to carry on as staff who helps the service user make her bed may sustain an injury. The family could not see that we have a legal requirement to work within the safety of the health and safety legislation. I did suggest that we highlight a repair/maintenance job for the bed to be lowered that is safe to use for both the service user and staff.

Also within the workplace before an activity can be undertaken we are required to complete a risk assessment and any areas where we need to put safety measures in to limit the potential risks then this must be done before the activity can take place as well as demonstrating that we need to monitor staff’s working practices and review and update the risk assessment at the appropriate times. In delivering a registered care service all staff must have mandatory health and safety training before completing any given task whether this be fire safety, food hygiene, manual handling, infection control, first aid etc. f staff have not received this training then they cannot complete the task, thus ensuring that all service user’s welfare are giving top priority in line with quality and safety outcomes.

As the acting registered care manager I need to complete regular health and safety audits and maintain clear records to demonstrate competence and that we are meeting the requirements of the law. At times when carrying out an audit I have noticed that a food safety check as not been completed or a fire test got missed and in line with my roles and responsibilities I must address my findings with the senior team, the kitchen staff etc.

This will be done in our staff and team meetings. Minutes of these meetings will be taken and stored in the named files so that they can be used for further audits and inspections that are required in line with our policies and procedures, duty of care and relevant legislation. 4. 3 evaluate own practice in promoting a balanced approach to risk assessment. A good standard of record keeping is imperative to support our quality audits and framework for our risk management plans, risk assessment and person centre practice to lead a lifestyle of their choice.

When evaluating our own practice and our documentation I will look at:- • Policies, protocols and guidelines to keep staff and management informed

• Information regarding, health and safety, care delivery and CQC outcomes for best practice and positive outcomes for service users
• Information about systems, for example risk management plans, incident reporting. Complaints. Service user care plans Other ways to evaluate own practice is through regular audits and regulatory inspections which enables a systematic assessment or estimation of the process or outcome of a work activity, to determine whether it is : Effective: making progress towards a particular goal
• Efficient: achieving a particular target with the least effort
• Economic: achieving a successful outcome with the minimum cost Essentially audits measure what the staff team are doing against what they should be doing.

Internal and external audits involve systematically looking at the procedures within the practice that are used for diagnosis, care and support measures to our service user that enable them to lead a life of their choice, by examining how associated resources are used and nvestigating the effect carer has on the outcome and quality of life for the service user.

Conversely, research is concerned with the identification of best practice, where a audit establishes, whether agreed best practice is being followed, and according to Smith (1992) Research is concerned with discovering the right thing to do:” audit with ensuring that it is done right “ and that we are involving service users in line with our person centred approach.

Another system that we use to evaluate our practice for promoting a person centred practice that includes a balance approach to risk management is in our statutory care review meetings where the service user, their family, staff and other professionals will review the care plan and risk management plans to ensure that we are sill meeting the service user needs and that they are happy with the level of activities and levels of support they are receiving.

Also these meetings may raise concerns and these concerns will be addressed to ensure that safety and wellbeing of the service user is being met either from staff within the home or by others. These changes will be recorded in their care plan and reviewed in line with our evaluation procedures. Any changes to a service users care plan will be discussed in our daily handover sessions and staff meetings to make sure that all staff who support the service user know of these changes and the additional resources and support that is being put in by the people who are supporting the service user.

As the manager I will also use staff meetings, supervisions and training sessions to evaluate my own and others within the teams performance to ensure that we are meetings our health and safety requirements as well as promoting a person centred approach that ensure a balanced approach to risk assessments that cover the working activities in running a registered care home. 4. 4 analyse how helping others to understand the balance between risk and rights improves practice.

To analyse and help to understand the balance of service users and the public involvement is part of everyday practice in the NHS (DH 2005b) who have identified a number of principles that underpin the delivery of resident – led services. PRINICIPLES OF RISK AND RIGHTS FOR IMPROVMENTS HAVE BEEN TO UNDERPIN THE DELIVERY OF RESIDENT LED SERVICES

• Provide residents with the correct information and choices that allow them to feel in control – understanding that they are the best judge of their life/how they wish to live their life
• Ensure everyone receives not just high quality care, but care with consideration for their needs at all times. Treat people as human beings and as individuals, not just people to be processed
• Ensure people always feel valued by the service and are treated with respect, dignity, and compassion
• Explain what’s happening if things go wrong and why, and agree a way forward At the home when we complete our risk management plans we will involve the service user, their family and others who maybe supporting them from the wider community.

I will discuss each task and outline any concerns that we may have and how these concerns can be addressed without imposing on the service users rights, dignity, choice etc. ut I must make sure that I protect the service user and the staff in carrying out the task etc. I feel this process of informing others, discussing the issues can go a long way in helping others to understand why things can be done and or cannot be undertaken unless additional measures are put in place. This process also assists others in seeing where the potential risk of harm may take place and why we are constantly reviewing our work activities and the abilities of the service users to cooperate with staff when carrying out an activity etc.

The same process will be used in staff meetings to ensure that the team can fully understand their roles and responsibilities and reasons why additional measures have been put in place. Also when staff understand the culture of the organisation and the home they themselves will undertake the process without thinking and therefore ensure that the working environment is safe for everyone. By allowing others to understand the balance between risks and rights, you improve practice because they know what is acceptable and what isn’t.

This makes work more positive and makes the care that is given more effective and more suitable to the service users that require it. By helping others to do this, you are helping them improve their job, and helping them develop with their own knowledge, which they can pass on to other employers; this is peer learning. 5. 1 obtain feedback on health, safety and risk management policies, procedures and practices form individuals and others. The polices, procedures and practices at the home have been developed, reviewed and updated in line with health and safety legislation and our CQC registration requirements.

This ensures that the homes working practices are monitored, audited and inspected throughout the year and feedback from the records and reports are discussed and recommendations are implemented. These are reviewed yearly by the organisation and any feedback given is used to promote and improve the services within the home. The context of feedback can be used as a learning tool. The practice of over-learning produces reinforcement of a sense of achievement before moving on to the next stage, it can enable a person to move towards independence in a particular skill.

The principles of feedback include beginning and ending with positive comments, any suggestion for development that focus on negative aspects of the skills should be included in the middle. The reason for that learning is closely associated with self-esteem and motivation for ensuring that the working environment is safe. CQC’s the essential standards of quality and safety consist of 28 outcomes that are set out in two pieces of legislation: The health and social care Act 2008 (regulated activities) Regulation 2012 and the Care Quality Commission (registration) regulations 2009 and for each regulation, there is an associated outcome – the xperiences that will be expected of healthcare professionals as a result of the service and care provided and feedback for each outcome must be addressed by the manager.

I will also get feedback from various health and safety contractors, visitor’s to the home who carry out regular maintenance work within the home, environmental health inspections etc. With all these visits to the home I will receive feedback on our good practice and compliance as well as areas in which we need to improve upon and non-compliances.

This feedback is important to ensure that the team and I meet the required standards and that the home and our activities are undertaken in a safe manor. 5. 2. evaluate the health and safety and risk management policies and procedures and practices within the work setting At the Manor House, we have numerous policies and procedures in place, all spread over a wide variety. They include –

• Accident and Incident Reporting and Investigation
• Asbestos
• Building Maintenance
• Care Services Construction Management ~ Site Access and Surveying
• Consultation and Communication
• Contractors
• Electrical Safety
• Fire Safety
• First Aid
• Food Hygiene ~ Safety in Food Preparation Areas
• Gas Safety
• Grounds Maintenance
• Handling and Disposal of Waste
• Hazardous Substances ~ COSHH, Radon
• Health and Safety Information and Training
• Health and Safety Management ~ Monitory and Review, Inspections and Surveys
• Health and Wellbeing at Work ~ Alcohol, Drugs, Communicable
• Disease, Immunisation, Pre-employment medical, Pregnant Women, Smoking, Stress, Work related absenteeism and Young persons.
• Manual handling
• Office safety ~ display screen equipment
• Personal Protective Equipment
• Personal safety, violence and lone working
• Property management ~ security and visitors, workplace standards, welfare facilities
• Risk Assessment
• Safe use and maintenance of equipment at work ~ lifts and lifting equipment, vehicles at work
• Sheltered schemes
• Water management
• Other guidance
• Definitions
• Amendment record

Accidents and incidents – index of incident records form, RIDDOR reporting form, servite incident reporting form, care services residents incident reporting form o Workplace moving and handling assessments – moving and handling operations preliminary risk assessment form, moving and handling operations risk assessment form, moving and handling care plan o Workplace risk assessments and young person at work risk assessments – scheme/office/kitchen/staff room workplace risk assessment forms, copy of schemes contractors risk assessments or method statements, young persons at work risk assessment form, new and expectant mothers risk assessment, night worker health assessment form

Moving and handling equipment inspection record, moving and handling equipment inspection record, moving and handling equipment defects record o First aid records – first aid record sheet, first aid kit maintenance defects record o Water treatment records (including temperature monitory, flushing and de-scaling) – shower/spray flushing and de-scaling record sheet, water temperature record sheet

Food safety records – fridge and freezer temperature record sheet o Electrical test records (portable appliances and building installation – visual electrical inspection of void properties form, portable electrical equipment visual inspection record sheet, record of portable test, redundant equipment disposal form, dopy of building installation report and certificate o DSE assessment records Asbestos survey reports – scheme asbestos survey report

Gas safety records – record of reasonable steps taken (when no access granted) form, regional committee report on the progress of gas safety inspections form, gas servicing report, copy of gas certificate o Control of substances hazardous to health assessments and safety data sheets – copies of safety data sheets for every cleaning product used at the scheme

Health and safety audit and survey reports – health and safety survey form, schemes health and safety audit report completed by the health and safety team o Passenger lift inspection records – copy of certificate, passenger lift inspection and insurance reports o Personal protective equipment maintenance records – reports

Lone worker alarm maintenance record – reports Remote alarm/pendant checks – pendant check form, remote alarm check form o 3rd party forms o Waste o Pest o Business continuity arrangements The positives of having all these policies, procedures and risk managements in place is that it covers everything, meaning that we know what is considered wrong and what is considered correct.

The negatives are that because there are so many in place, some can be left out or not remembered, leaving the work setting unsuitable for service users perhaps, or leaving the standard of care low; but because we have them all, and are all used frequently, they are all understood, this is a positive out of the negative situation. SEE AC 1. 2 5. :- identify areas of policies, procedures and practice that need improvement to ensure safety and protection in the work setting Here, there are few areas of policies and procedures of/and practice that may need improvement, this is because they are good, but not at the best standard I think they could be.

These are: health and safety audits, the medication rounds, maintenance of equipment and staff training. The medication rounds could be improved by making them faster, or by having more staff working on it, to increase the speed of residents getting their required medication. The maintenance of equipment could be improved by having it done sooner rather than later, so there isn’t as much of an issue if the equipment is required and cant be used as it isn’t working.

Health and safety audits can be improved by making them more frequent and detailed, so you can understand the issues more and also notice where the good aspects are. Staff training can be improved by making it more important and motivational, and by making it more frequent to allow better development of career work. 5. 4 recommend changes to policies. procedures and practice that ensure safety and protection in the work setting The changes that I recommend would only be improvements, and the improvements would be to make the policies and procedures more ‘spread out’, so they cover more areas of the work setting, so everything has a policy or procedure to make it more effective and reliable.

Reviewing the policies and procedures would be a start to see where the changes could happen and be recommended, to ensure safety I would recommend a change to the health and safety act policy, to give it a wider variety of protection of the work setting, to add more ‘safer’ equipment and make the environment safer, by having less dangerous objects around that could be harmful in anyway to a resident, visitor or staff member.

I would recommend a change in the frequency of procedures dealing with forms and assessments, to make sure everything is checked frequently, to make sure there are no problems or issues that are missed if they are only checked every now and then, this would be like risk assessments, fire safety, equipment checks or kitchen assessments etc. There isn’t a lot I would recommend to change, but if I had to, it would be most likely to do with frequency or variety.

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