Complete LO2: (2.1, 2.2, 2.3 and 2.4) using the ‘’ Fleetwood Hall Home Case Study” below.

2.2 Analyse the impact of One aspect of practice to individuals in relation to Health and safety policies in the case study.

2.3 Discuss how dilemma encountered in relation to implementing systems and policies for health, safety and security may be addressed, using the case study.

2.4 Analyse the effects of non-compliance with health and safety legislation and relate to the case study.

Complete LO 3 (3.1, 3.2) using the ‘Fleetwood Hall Home Case Study below.

3.2 Analyse the effectiveness of Health and Safety policies and practices and also use the ‘case study’ in promoting a positive, healthy and safe culture.

3.3 Evaluate your contribution in placing health and safety needs of individuals at the centre of your practice. (You have to relate to your own experience at the place of work).

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

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

Assignment:

For this assignment you must effectively demonstrate your understanding and skills in Health and Safety in Health and Social Care Organizations. In order to do so you must carry out the tasks below in relation to the CQC report for Fleetwood Hall Home. The CQC reports showed a need for urgent changes in the Residential Home. Read relevant sources of literature and data (Health and Safety Executive website, NHS or CQC online reports and texts) on the organization to fully understand the context.

Please note: CQC report for Fleetwood Hall Home is uploaded on STPMOODLE and can be found in the folder titled ‘ Fleetwood Hall Home Case Study for Health and Safety (HS) Assignment’.

Please see below the summary of the Fleetwood Hall Home:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2.3 Discuss how dilemma encountered in relation to implementing systems and policies for health, safety and security may be addressed, using the case study below:

Dilemma: One of the given scenario of Mrs Y need to be used to answer 2.3.

Scenario 1 Fleetwood Hall Home: Mrs Y

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

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

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

The potential human rights at stake here are:

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

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