Care Certificate Workbook. Duty of Care
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2 3 3.1 Contents Understand how duty of care contributes to safe practice a) Define duty of care b) Describe how duty of care affects your own work role 3.2 Understand the support available for addressing dilemmas that may arise about duty of care a) Describe the dilemmas that may arise between the duty of care and an individual s rights b) Explain what you must and must not do within your role in managing conflicts and dilemmas c) Explain where to get additional support and advice about how to resolve such dilemmas 3.3 Deal with comments and complaints a) Demonstrate how to respond to comments and complaints in line with legislation and agreed ways of working b) Describe who to ask for advice and support in handling comments and complaints c) Explain the importance of learning from comments and complaints to improve the quality of service 2
3 3.4 Deal with incidents, errors and near misses a) Describe how to recognise adverse events, incidents, errors and near misses b) Explain what you must and must not do in relation to adverse events, incidents, errors and near misses c) List the legislation and agreed ways of working in relation to reporting any adverse events, incidents, errors or near misses 3.5 Deal with confrontation and difficult situations a) List the factors and difficult situations that may cause confrontation b) Describe how communication can be used to solve problems and reduce the likelihood or impact of confrontation c) Describe how to assess and reduce risks in confrontational situations d) Demonstrate how and when to access support and advice about resolving conflicts e) Explain the agreed ways of working for reporting any confrontations 3
4 3 How to use this workbook Do you need this workbook? You need to do all 15 Care Certificate Standards. This workbook is designed to support you to learn about Standard 3. Your manager is responsible for checking your knowledge, understanding and competence in your specific workplace(s). If you already have a good level of knowledge and experience, you could take an assessment instead and only do sections of the workbook (or sections of our elearning) that you need to. Your knowledge would be recorded and you can build an evidence portfolio. This will save you and your manager a lot of time. Your organisation may have free or funded access to our assessment system. Check with your manager before you start this workbook. More information can be found at The following symbols refer to actions you should take to achieve the outcomes. There is also an action checklist at the end of this workbook. LOCATE THINK Ask DISCUSS DEMONSTRATE Reference Manager We refer to manager through the workbook. This may mean something different in your role, for example: supervisor, line manager, coach, buddy, mentor, employer or assessor. This is the person responsible for checking you are competent and confident to work. 4
5 3.1 Understand how duty of care contributes to safe practice 5
6 3.1a Define Definition Everyone has what is known as a towards the individuals they support. This is a legal obligation whereby you must do everything you can to keep the individuals in your care safe from harm. Your employer also has a duty of care to provide working conditions that are safe for you to work in. It involves acting in the individual s best interests and in the best interests of others. It is about working within your competence and in line with your employers agreed ways of working. also involves working in line with legislation to protect individuals from harm, abuse and neglect. Whatever your role, you have a duty of care to all individuals you support. It is not a choice and should be the natural way in which you conduct yourself with everyone you have contact with. 6
7 3.1b Describe how duty of care affects your own work role Your responsibilities under the duty of care include: Support Supporting individuals to live in an environment that is free from prejudice Reduce Reducing the risk of harm, abuse and neglect Consent Gaining the consent of an individual if you are acting in their best interests (unless you have evidence that the person lacks capacity to make that particular decision at that particular time, Mental Capacity Act 2005) Provide Providing care and support to meet the needs of the individuals Promote Promoting individuals' wellbeing and independence Respect Involving and respecting the individual in any decision affecting their care and support 7
8 In your role you have a duty of care to raise any concerns you may have about any aspect of your work. These can range from inadequate working conditions, poor equipment, poor practice by other staff; to raising concerns about potential abuse cases and situations of neglect. It is your duty of care to safeguard individuals from harm and abuse. All employees should report any concerns of abuse they have. These might include evidence or suspicions of bad practice by colleagues and/or managers, or abuse by another individual, another worker, or an individual s family or friends. See Standard 10 for information on Safeguarding. 8
9 A negligent act or act of omission that results in abuse or injury could be unintentional, careless or intentional. A negligent act is breaching the duty of care. If an individual has evidence that you have been negligent, you are likely to be disciplined. You could lose your job and you could have legal action taken against you. This also applies if you witness such an act and fail to report it. If you are in any doubt at any time, you must discuss any issues you have with your manager. Ask Discuss with your manager any concerns you may have about your duty of care 9
10 3.2 Understand the support available for addressing dilemmas that may arise about duty of care 10
11 3.2a Describe the dilemmas that may arise between the duty of care and an individual s rights During your work you may find yourself in situations where the individuals you are supporting do not agree with what you believe is best for them. Who knows best? The individuals you support, you, another health and social care worker, or the family? 11
12 In situations where there is a conflict of interest or a dilemma between your duty of care and an individual s rights, it is best practice to make sure the individual is aware of the consequences of their choice and that they have the mental capacity to understand the risks involved in their choice. It is their right as an individual to be able to make informed choices about their own lives even if you disagree with their choice. It is the right of every individual receiving support to make choices and take risks. It is your role to assist them in making those choices and reducing the risks without compromising the individual s rights. An individual may be restricted if their behaviour presents a serious risk of harm to themselves or to other people (including you). 12
13 If an individual you support is considered to be at risk, the law requires that an assessment be carried out to look at any possible risks there might be to the individual or to others. The aim of this assessment is not to remove the individual s right to take risks, but to recognise and reduce them where possible to an acceptable and manageable level. Note Mental Capacity Act Mental Capacity Act (MCA) 2005 has four steps to determining capacity. Capacity means whether a person is able to make informed decisions and choices. See Standard 9 Outcome 6 for more information. 13
14 The term a person who lacks capacity means a person who is unable to make a particular decision or take a particular action for themselves at the time the decision or action needs to be taken. Individuals who could lack capacity include: Stroke victims Dementia sufferers Individuals who have an acquired brain injury (trauma) Individuals with learning disabilities Substance misusers It is important you are familiar with the Mental Capacity Act (MCA). You may be concerned that an individual you are working with shows signs of lacking the capacity to make decisions for themselves. This could happen to an individual at any time and you will need to ask for professional support to assess if the individual does lack capacity. 14
15 3.2b Explain what you must and must not do within your role in managing conflicts and dilemmas If individuals insist on doing something that you think is risky, you can only advise them and encourage them to make an informed decision. You cannot force them to do (or not do) anything. Example If an individual refuses to take medication and their wellbeing depends on this medication, you cannot force them to take the medication. You should immediately contact your manager or the prescriber (usually the GP) and ask for advice. You should also make sure you record what has happened and the action taken in the support plan. 15
16 Scenario A physically disabled individual you are working with asks you to support him to go to a café every day so he can eat burger and chips, which is his favourite food. You believe that burgers are unhealthy and shouldn t be eaten that regularly. The individual has the mental capacity to make this kind of decision. Which of the following should you do? 1. Refuse to take the individual to the restaurant and insist they go somewhere else. 2. Accept it is the individual s choice and support them to go to the restaurant. 3. Engage the individual in a conversation about healthy food and ask them if they would like to try somewhere different. Then support them to go to the fast food burger restaurant if this remains their choice. 16
17 Scenario Answer You should help the individual to understand the health risks of eating burger and chips every day. Help them to understand the importance of a balanced diet and ask if they would like to try something different for a change. Then support them with their choice, even if it remains the same. This allows the individual to make an informed choice about where and what they eat. Use an encouraging and supportive tone of voice and words that do not make the individual feel bullied or harassed into doing something that you think they should do. Don t forget to consider whether the individual has the capacity to make decisions. Your manager is there if you need additional advice and support to manage conflicts and dilemmas. 17
18 3.2c Explain where to get additional support and advice about how to resolve such dilemmas PERSONAL PROFESSIONAL You should know the limits of your role and not do or say anything outside of this. 18
19 It is important that you know where to go if you need additional support and advice about how to resolve dilemmas. Advice Support Resolution If you are in a situation that you are not comfortable with, contact your manager. They will support you and help you resolve such dilemmas whilst still maintaining your duty of care. 19
20 Other sources of additional support and advice include: Online resource Pages Literature Internet e-learning Training courses Supervision Work Shadowing Other Professionals Individual's family Individual's friends Advocates Assessment 20
21 Think about similar situations which have happened to you when supporting an individual Ask Discuss any outstanding issues or concerns you may have with your manager 21
22 3.3 Deal with comments and complaints 22
23 3.3a Demonstrate how to respond to comments and complaints in line with legislation and agreed ways of working Comments and complaints can be made by: Individuals Workers Carers Family In fact, comments and complaints can be made by anyone who feels there is something wrong that needs to be addressed in line with legislation and agreed ways of working. It is important to remember that the individuals you support may not know how or may be reluctant to make comments or complaints. Some individuals will feel uncomfortable about making complaints as they do not want to cause trouble and they do not want to risk services being reduced or removed. It is therefore important that you know what the procedures are and can advise them what to do. Every employer should have a complaints procedure (usually part of the Policies and Procedures Manual) in place that you can follow. This will enable people to express their displeasure of a service, person, situation etc. It is useful if the procedure includes a flowchart of how a complaint is dealt with so you can see and follow the process. 23
24 Every complaint should Be taken seriously and dealt with promptly and fully Be acknowledged within a specific time Have time limits for preliminary investigation Be monitored and progress reported to the complainant 24
25 The Care Quality Commission (CQC) provide details on how complaints should be dealt with in their Fundamental Standards Regulations. The regulations state that complaints must be appropriately investigated and appropriate action taken in response and systems and processes must be established to ensure compliance with the fundamental standards CQC state this will happen because providers who comply with the regulations will: Have systems in place to deal with comments and complaints including providing people who use services with information about that system Support people who use services or others acting on their behalf to make comments and complaints Consider fully, respond appropriately and resolve, where possible, any comments and complaints 25
26 3.3b Describe who to ask for advice and support in handling comments and complaints Larger employers may have a comments and complaints specialist who you can refer people to. In smaller organisations or if you work with an individual in their own home, you may be responsible for dealing with the complaint yourself. Your employer should give you clear and precise information about your role and responsibilities in dealing with complaints. If you are unsure, ask your manager. Some individuals may need an Independent Advocate to support them to make a complaint and to support them until the complaint has been dealt with or resolved. They will be able to give impartial advice, help to write letters, attend meetings and make sure that the person complaining s views are heard, especially if the person has communication difficulties. 26
27 If you receive positive comments about your service or any aspect of the service your employer provides, it is important that you record these comments and pass them on to your manager. If the individual making the comment is able to write, it is worth asking them to put the comment in writing or you might be able to help them to do this. Positive comments are motivating and supportive so people know they are doing things right. Independent Advocates can usually be provided by voluntary organisations. If you use a search engine on the internet and type in Independent Advocates you will find lots of different organisations providing advocacy services. Advocates may specialise in Mental Health or Mental Capacity. It would also be worth finding out what organisations can provide Independent Advocates locally. The Local Authority Social Services and NHS Complaints (England) Regulations 2009 is the legislation for complaints in health and social care. 27
28 3.3c Explain the importance of learning from comments and complaints to improve the quality of service Comments and complaints are really important because they enable you to learn how people perceive the support and service you provide. This enables you to make improvements to the overall quality which leads to better outcomes for the individuals you work with. Learning from complaints can be something that is discussed in supervision. Your employer might ask the individuals you support for feedback about the quality of the support and services they receive, or you might participate in a 360 degree feedback* about your own Assess Knowledge Check Understanding Feedback from the people we support and Observe Practice performance. You can use the responses to look at how well you are doing and what areas can be improved upon. Whilst it might seem like a negative thing to receive a complaint, if it is handled well, it can lead to great improvements and benefits for everyone involved. * is a performance feedback tool offered by The Grey Matter Group 28
29 Think about comments and complaints. Did you respond in line with legislation and agreed ways of working? What have you learnt? 29
30 3.4 Deal with incidents, errors and near misses 30
31 3.4a Describe how to recognise adverse events, incidents, errors and near misses Incident Definitions This is something that has happened, whether it is an accident or not. Accident This is an unfortunate incident that happens unexpectedly and unintentionally, which results in injury, ill health or death. Adverse Event This is an accident or incident. A mistake. Error Near Miss A situation that has narrowly avoided becoming an incident, accident or error. 31
32 Whilst working, it is important that you can recognise incidents, accidents, errors and near misses likely to affect the wellbeing of the individuals you support. It is also important to recognise near misses so that steps can be put in place to ensure they do not become incidents, errors or accidents in the future. Support plans should have formal risk assessments that will guide you. However, circumstances can change every day and you will make judgments about the risks of what you are doing before undertaking all tasks. Risks must be identified before tasks are undertaken. Support Plan 32
33 Think about the four main areas you are working in: What you have to do The individual and their capability The task that needs to be done Your surroundings Note You should always record any changes and contact your manager or the person responsible for the individual s care and support plan if you feel a risk assessment should be formally changed. 33
34 3.4b Explain what you must and must not do in relation to adverse events, incidents, errors and near misses You should only take action and become involved in certain situations if you have been appropriately trained, observed and signed off as competent. If you are unsure it is important to seek help. Example Emergency First Aid If you are the first person to attend an incident where an individual may need Emergency First Aid, you can only do what you are safe and competent to do. You should never go straight to the casualty without making sure the area is safe. This is called a primary survey. 34
35 Fire Example If you discover a Fire, you should immediately raise the alarm. You should not tackle a fire with an extinguisher unless you are safe and competent to do so. You must not put yourself or others in any danger. It is essential that you leave the building as quickly as you can supporting others to leave where you can. Note It is essential to write down what happened immediately after the event so you will be able to refer to your notes about what happened rather than rely on your memory which might not be accurate, particularly if you felt stressed. 35
36 You should always reflect on situations to consider if you could have handled things differently or behaved in a different way. Would the outcome have been any better for anyone involved? This gives you the opportunity to consider your level of skill and your confidence, and whether you need any further learning and development. 3.4c List the legislation and agreed ways of working in relation to reporting any adverse events, incidents, errors or near misses Each piece of legislation in the list below provides guidance on how to help maintain a safe workplace, and the agreed ways of working for reporting any adverse events, incidents, errors or near misses. The Health and Safety at Work etc. Act 1974 The Management of Health and Safety Regulations 1999 The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) The Control of Substances Hazardous to Health Regulations 2002 (COSHH) The Provisions and Use of Work Equipment Regulations 1998 (PUWER) Further information on each can be found: 36
37 Informing individuals of their options and the risks involved enables you to support their empowerment and independence. If you witness anything you feel is risky or unsafe, it is necessary to report your concerns to your manager. It takes a great deal of courage for an individual to raise concerns about poor practice or abuse in their organisation. It is your duty of care to report anything that is likely to affect the wellbeing of the individuals you support. If you have suspicions or evidence that an individual or individuals might be being abused, you have a duty to report this. The Public Interest Disclosure Act 1998 and the Whistle-blowers Charter protects employees from victimisation if they should need to report abuse or neglect. 37
38 Whistleblowing Definition Your organisation MUST have a Whistleblowing policy. This will protect you and your employment if you report your concerns. Whistleblowing is about reporting incidents of suspected or actual abuse or neglect. If you have a concern and want to report an incident or a suspicion, it is recommended that you read the Whistleblowing policy. To Blow the Whistle on a wrong-doing means to report a person or persons for doing something wrong, illegal or in contrary to the agreed ways of working within an organisation. The Fundamental Standards state that individuals must be protected from abuse and improper treatment and it is your duty of care to report all concerns are soon as possible. If your concerns are not taken seriously, you must try another route. You must ask for help if you feel out of your depth with a particular individual or issue. 38
39 An approach of Zero Tolerance must be taken to ensure that adults at risk are protected, and any adverse events, incidents, errors and near misses are reported. Locate, list and read legislation and agreed ways of working in relation to reporting any adverse events, incidents, errors and near misses 39
40 3.5 Deal with confrontation and difficult situations 40
41 3.5a List the factors and difficult situations that may cause confrontation Most people do not like confrontation and may try to avoid difficult situations and conversations. People often find it easier to avoid bringing up issues that they think are going to be controversial or may cause confrontation, putting off the communication and letting the situation fester. Factors which may cause confrontation include: A difference in can also cause confrontation. 41
42 Many difficult situations may cause confrontation such as Example A change in routine A death of a family member New mobility equipment Dislike of a new environment These examples can provoke confrontation in people who 42
43 3.5b Describe how communication can be used to solve problems and reduce the likelihood or impact of confrontation By speaking up and dealing with a difficult situation or confrontation, you are more likely to reduce the impact they have and solve any issues. Different communication techniques and conflict management procedures can be used. For example: Use comminication that is positive and constructive Outline issues in full so each person involved is aware of all implications Establish good rapport Set a time frame for the discussion Make sure you are in a suitable environment Work to cool down the debate in a tense confrontation Acknowledge emotions and different styles of expressing pain / upset / anger etc. Use names and, if appropriate, titles throughout 43
44 Also remember to recognise the importance of non-verbal communication when dealing with emotional situations! Physical injury Personal dislike Disengage from work Satisfaction Teamwork breaks down Feeling intimidated Resentment Upset Impact of Confrontation Problem solving 44
45 3.5c Describe how to assess and reduce risks in confrontational situations It is important to recognise when a situation may escalate and responding positively can help reduce the impact of the situation. Assess the situation. Is it going to escalate? Is one person threatening another? Is it going to turn nasty or physical? Is it a healthy debate? Is each party keen to meet and thrash things out? Once you have determined the level of confrontation, you must adopt an appropriate initial response as this can impact on the whole outcome of the situation. Try to understand the reasons why a situation is occurring. observant to the wider picture. Be If you are unable to calm the situation or you are worried that it is going to get worse, you will probably need someone else to help. Ask your manager for advice and support. 45
46 Here are some key points to help you assess and reduce the risks of confrontational situations: Identify Intervene Demonstrate Identify early signs and take action Intervene effectively in the early stages Demonstrate an understanding of the attitude and reason for the confrontation Recognise Research Recognise the difference between assertion and aggression Research ways to prevent escalation 46
47 3.5d Demonstrate how and when to access support and advice about resolving conflicts After calming a difficult situation, recognise the importance of providing exit routes and space for everyone involved. Many different emotions and reactions can follow a difficult situation. It is good practice to reflect on what has happened and learn from it. Create an environment or plan a conversation where each person involved can express their feelings and concerns and where everyone feels equally listened to. If it is a repeated situation, identify the conditions and behaviours that trigger an angry response in a person and what will help them overcome this response. 47
48 3.5e Explain the agreed ways of working for reporting any confrontations Your manager should be able to support you to understand the agreed ways of working for reporting any confrontation in your organisation. Ask your manager where these can be found. The confrontation should be recorded in the support plan and any actions taken and consequences should also be logged. If a confrontation has resulted in physical injury or assault, you may need to involve the police. This will depend on the victim s wishes and the extent of any injuries sustained. It is important to resolve conflicts as soon as possible and reflecting and learning from the experience(s) will help you develop in your role. Conflict and confrontation mean different things to different people. A person s personality and style will impact how they respond to situations and information. Some people enjoy a heated discussion whilst others find it upsetting or intimidating. It is important to react and deal with any confrontations as explained in your agreed ways of working. 48
49 Locate your organisations agreed ways of working for reporting and dealing with confrontation. The Care Quality Commission (CQC) expect all staff to know where these can be found. Think about whether you could have handled a situation better? What have you learnt? Ask Discuss situations with your colleagues and manager. Talking things through can help you overcome issues, feelings and help you progress in your work 49
50 Your checklist. Outcome Symbol Description Tick 3.1b 3.2c Ask Ask Discuss with your manager any concerns you may have about your duty of care Think about similar situations which may have happened to you when supporting an individual Discuss any outstanding issues or concerns you may have with your manager 3.3a 3.3c 3.4c 3.5d Demonstrate how to respond to comments and complaints in line with legislation and agreed ways of working Think about comments and complaints. Did you respond in line with legislation and agreed ways of working? What have you learnt? Locate, list and read legislation and agreed ways of working in relation to reporting any adverse events, incidents, errors and near misses Demonstrate how and when to access support and advice about resolving conflicts 50
51 Your checklist continued. Outcome Symbol Description Tick 3.5e Locate your organisations agreed ways of working for reporting and dealing with confrontation. The Care Quality Commission (CQC) expect all staff to know where these can be found Think about whether you could have handled a situation better? What have you learnt? Ask Discuss situations with your colleagues and manager. Talking things through can help you overcome issues, feelings and help you progress in your work 51
52 Well done! You have completed this workbook. What s next.. An essential part of the Care Certificate is to assess, evidence and record what you have learnt. You may be entitled to use our assessment and evidence recording system. Your manager is responsible for supporting you with this, observing your practice and ensuring you are competent in your workplace, with the people you support. Checking your knowledge, competence and practice will be a regular part of your ongoing Continuous Professional Development. By taking an assessment first, you may find you already have some, most, or all of the knowledge required and you can save time by avoiding repeating subjects and courses unnecessarily. More information about our resources can be found at Important Copyright Note: This workbook is provided free of charge by The Grey Matter Group to people providing health and social care to support a blended learning approach towards learning and achieving competence. It is subject to the following criteria: You cannot copy, reproduce or use any part of this workbook for financial gain or as part of a training event that you are charging for or profiting from. You cannot use this workbook to create elearning. You cannot copy any of the images in this workbook as they are used under a license agreement. We strongly recommend that you use it electronically to save paper. If you pay to (or are funded to) use our online assessment system, you are welcome to have a free Microsoft Word version of this workbook so you can make changes, personalise it, add your organisation s details and logo, provided The Grey Matter Group is credited for creating the workbook and our logo remains on each page. For more info Support@TGMGroup.net. Every effort has been made to ensure the information contained in this workbook is accurate. We cannot guarantee completeness or accuracy for all work settings. If you download an electronic version from our website, these will be kept updated as appropriate. We are not responsible for keeping any versions you have previously downloaded and amended up to date. 52
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