Blog

3.1b Reporting and Recording Systems

Explain the difference between subjective and objective recording

Objective recording only contains the facts, whereas subjective recording also contains the individual’s own personal thoughts, feelings and views.

From your experience, identify three consequences of inaccurate or incomplete records
  1. An appointment is missed
  2. Time is spent doing something that has already been completed by someone else
  3. Medication overdose (given twice as first administration was not recorded)
Consider why and how you might share records with people who access care and support, carers and relatives

Personal information about a client should only be shared with their consent unless not doing so would result in harm or injury to themselves or others or result in the law being broken.

Information should then only be shared in a private setting and on a need-to-know basis and should also be in the client’s best interests.

What difference might this make to the format and storage of any records?

Records should be kept and archived until no longer needed.

Provide specific examples of how you might use accurate records to support positive outcomes for people who access care and support

Showing records of a clients meals and snacks to their dietitian so that they can offer the best health advice for the individual.

Informing a pharmacist of the conditions and current medications of a client  before supporting them to buy over-the-counter medication.

 

3.1a Think of a case study of someone that you have communicated with – a staff member or someone who accesses your service. Write a brief summary of the situation/circumstances and then answer the following questions.

Brief Description of situation

A member of staff called to say that she couldn’t do her shift because she had had some major personal issues that had put her in a precarious mental state.

how did you demonstrate empathy?

I told her that I was sorry to hear about her situation and expressed that I would not know what to do myself if it had happened to me. I told her not to worry about work as family is more important and I would arrange to get her shift covered.

What difference did it make to the person?

It gave her an opportunity to offload her personal issues, made her feel like she had a sympathetic ear and made her feel less guilty about taking time off work.

how did you demonstrate active listening?

She was very upset but just having someone to listen to her seemed to help a lot. I demonstrated I was listening by repeating back to her what she had said in my own words for confirmation that I had I understood.

How did that enhance effective communication?

She became less frantic and more relaxed.

2.4a Ask your line manager(s) what regulation and inspection processes your organisation might be subject to and complete the following exercise.

 

Regulation ProcessWho is involvedImpact on organisationFrequencyInformation/evidence required
e.g. RIDDOR – Reporting of injuries, diseases and dangerous occurrences regulations 2013
  • Employers
  • Registered Managers
  • Line Managers
  • Employers
  • Registered Managers
  • Line Managers
As and when incidents happen according to the RIDDOR regulationsOrganisations policy

RIDDOR reports needed

Accident book

CQC Inspection
  • Registered Manager
  • Line Managers
  • Employers
  • Employees
Benchmark how we are doing and how we can improveInfrequent but to be expected at any timeSpeaking with clients and staff

Viewing policies and procedures

Viewing other records

Internal Quality Assurance
  • Compliance Manager
  • Line Managers
Ensure we are providing support correctly and to a high standard

Highlight any areas that require improvement

Every 3-6 monthsCompliance checklist

Policies and procedures

Other records

2.2b KLOEs: Outline what each question might mean for your setting. Think about areas where this might apply and what evidence you may be able to provide for that. You may want to work with other members of your team or your line manager to review this plan and consider what evidence might be helpful.

 

Key lines of enquiry
AreaApplication in own settingEvidence
SafeClients are protected from avoidable harm and injury? Clients are safeguarded from abuse.   Accident book, property maintenance log, recorded smoke alarm, carbon monoxide and electrical safety tests, safeguarding policy, staff safeguarding training
EffectiveClients have a good quality of life and achieve good outcomes.      Speaking with clients, daily records, activity planner, meal planner, MAR sheets, support plans, well-trained staff
CaringClients are treated with compassion, kindness, dignity and respect.     Speaking to clients, observations, well-trained staff, policies and procedures, risk assessments, support plans  
ResponsiveClients needs are met and support is well-organised and flexible.Shifts based on client needs and wishes, client is able to go on regular holidays and other activities they wish to do, dialogue between staff and clients on their requirements, shifts can be changed when required, procedures and policies that provide support to staff for emergencies or unforeseen circumstances
Well ledGood leadership and management. A learning culture.   Staff training and personal development, organisational charts (hierarchy), regular supervision, appraisal, observations and professional discussions, honesty and transparency, company policies and procedures.

2.2a Ask your line manager if you can put together an action plan against one of the fundamental standards where you both agree that improvement is needed. Considering standard 1, how will you lead change/inspire your colleagues – what leadership style(s) will you consider using and what procedures and audit tools will you use to monitor/manage compliance.

Take a look at CQC’s Fundamental Standards here.

In brief, they are:

  • Person-centred care
  • Dignity & respect
  • Consent
  • Safety
  • Safeguarding from abuse
  • Food & drink
  • Premises & equipment
  • Complaints
  • Good governance
  • Staffing
  • Fit & proper staff
  • Duty of candour
  • Display of ratings
Fundamental standardDignity & Respect     
IssuesWhen a client gets upset he likes to go to his bedroom for some quiet time to calm down. He has complained that support staff constantly disturb him to ask him how he is and if he wants anything, which aggravates him further, despite him telling them that he wants to be left alone.

There is no valid reason to disturb him if he wants to be left alone and staff should respect his privacy whenever he wants it. There is also no associated risk with him being left alone.

Speaking to staff, the reasons for their actions are to try to help the individual and because they are worried about him when he is upset.

How will you inspire colleagues?During the next team meeting, the manager will raise the concerns of the client. Staff will discuss privacy, respect and choice. They will be asked to think about what it would be like to have constant support whether they want it or not and how it would feel to not be able to experience alone time without someone disturbing them regularly.     
Leadership style(s) to useDemocratic and coaching     
How will you monitor compliance?Weekly dialogue between client and manager to discuss the issue.

Client to keep a record of any disturbances to his alone time, including date, time, staff member, reason for disturbance etc. to be given to manager weekly.    

Audit tools required

 

 

Record sheet for client     

 

Aspiring Manager’s Pilot: What It Is & What I Have Learnt From It

Last year, I was nominated by my company to enroll on a course called the Aspiring Managers Pilot.

I was told that it was funded by the government and run by Skills for Care in an effort to ensure that the next generation of managers in the health and social care sector were prepared and well-trained for the challenges of the role. I would also receive high-quality training which would give me a sound foundation should decide to pursue my Level 5 Diploma in the future.

I’m a keen learner and always interested in working on my personal and professional development. As I’d almost completed my Level 3 Diploma, I was looking for something to work towards during 2017/2018 and this seemed to fit the bill.

I applied and was accepted. I started in October 2017 and am now about halfway through the year-long course. Below is a list of the components of the course and my thoughts about them (in bold).

  • Preliminary Face-to-Face Event in Oct 17: Meet and Greet for tutors and students, introduction to the course. Great way to kick off the course and meet everyone.
  • Learning Record: Reflection account to be filled in every month as well as separate reflections on specific parts of the course. Great way to think about what you’ve done and stay focused.
  • Lead to Succeed Course: 5-day Leadership Course (not 5 consecutive days, 1 day per month over 5 months). Fantastic course delivered by Coleman Training & ConsultancyTopics are:
    • Leaders & Managers
    • Developing a Positive Culture
    • Effective Supervision
    • Leading & Managing the Process of Change
    • Leading & Managing the Inspection Process
  • Manager Induction Standards: A giant folder packed with information and a lot of questions to answer. The industry-standard for managers. Fantastic information and very thought-provoking questions that inspire to do some research.  It is a lot of work to plough through and you have to do it in your own time with very little support but well worth it.
  • Experience Tour: You are assigned a “buddy” who is another student on the course and you visit each other’s workplace to learn from one another (just an hour or two and you arrange the visits between yourselves). It was interesting to see how other providers in health and social care work, however mine and my buddy’s workplaces are completely different so they were difficult to compare – I work in supported living and she works in a nursing home.
  • Mid-Point Meeting: Meet up with cohorts and Skills for Care to chat about progress and do a little reflection and learning. Quite useful to catch up with everyone and discuss our learning.
  • Online Forum: Participate in a Linked-In group with other students (nationwide). No-one really contributed to this and some had technical issues so it wasn’t useful at all.
  • Attend Registered Manager’s Meeting: Regular meetings for registered managers in your local area. I never knew these existed and think they are a great idea. The one I went to had an interesting talk from a couple of CQC inspectors. Also good for networking and keeping up to date with the industry.
  • Monthly Supervisions with Line Manager: I tried to keep up with this (we usually have quarterly supervisions) but once a month is a bit too frequent, I feel.

And that’s it. There will be an end-point meeting in September to finish.

I can highly recommend this course for anyone wishing to climb the ladder of management in the health and social care sector should they decide to re-run it in the future (after all, the one I am doing is just the pilot).

2.1b Choose one key piece of legislation or driver that’s relevant to your organisation and do a brief overview that could be shared with others in your organisation to enhance their learning.

 

Name of legislationMental Capacity Act 2005   
Summary of key areasCapacity should be assumed until proven otherwise.

An individual cannot be said to lack capacity until all reasonable steps to support them to make a decision have been tried.

Making unwise decisions does not mean lack of capacity.

Decisions made on behalf of an individual must be done in their best interests.

Before a decision is made about an individual, the situation must be reviewed to check that the results cannot be achieved in a less restrictive way.

Relevance to your organisation/settingSome clients may lack capacity to make decisions in certain areas.  
What it means for your team/organisationRead Care Plans!

Assume clients have the capacity to make a decision unless it is documented that they cannot.

Actions needed to be taken by members of your team/organisationIf in doubt about a client’s capacity to makes a decision, this should be raised with senior staff or management.

Staff should support clients to make informed decisions where they have been deemed to have capacity.    

Who else might need to know about this legislation – people who access care and support/carers?Clients

Client’s family and friends

Other professionals     

Who else does the legislation apply to?Everybody    

2.1a Choose three pieces of legislation that might be particularly relevant to your organisation and the setting in which you work and explore the impact in more detail

Consider the following list of legislation taken from the CQC website page referenced above. Choose three pieces of legislation that might be particularly relevant to your organisation and the setting in which you work and explore the impact in more detail using the table to record your findings.

 

LegislationRelevant sectionsMust haveNice to know
 Safeguarding Vulnerable Groups Act 2006 AllAll staff (both paid and unpaid) must have a DBS check. This is a legal responsibility of the employer. There are two types of DBS check – one for working with vulnerable adults and another for working with children.
 Equality Act 2010 AllAll staff must be treated equitably and given the same opportunities.The Equality Act supercedes several other pieces of legislation including the Disability Discrimination Act, Equal Pay Act, Sex Discrimination Act etc.
 MCA Code of Practice AllIndividuals should be assumed to have capacity to make decisions unless it has been proved otherwise. Making unwise decisions does not mean lack of capacity,Individuals must be assessed on a decision-by-decision basis. Individuals should be given all the support they need to make informed decisions before being assessed as lacking capacity.

1.3a Knowledge Sharing Within the Team

 

How is knowledge shared with the team?
Informal discussions on shift

Regular team meetings

Notice board

Communications book

Other paperwork

What are the ways used for sharing practice issues?
Team meetings, training 
How often is knowledge shared by team members rather than just leaders and managers?
Regularly – everybody is encouraged to contribute during team meetings and share their ideas with the rest of the team.
How do groups of front line staff meet to share practice experiences and develop their learning?
Team meetings, informal discussions whilst on shift
How could you develop a shared approach to problem solving?
 We already do
Silhouettes of many individuals with speech bubbles above their heads representing the giving of feedback

1.2a How does your organisation encourage and respond to feedback from a range of partners?

Organisations in the health and social care sector should always strive for excellence and one of the best ways of achieving this is to ask for feedback from others. Historically, if organisations do ask for feedback, it tends to be from their customers. Whilst this can give a useful insight from the perspective of the clients, some companies are now requesting feedback from everyone that interacts with them; this includes clients, employees, managers, shareholders, other professionals, partners and client families. Known as 360-degree feedback, this can provide a lot of valuable information from all viewpoints.

The table below shows the Manager Induction Standards questions for question 1.2a along with example answers. Obviously answers will vary from organisation to organisation.

QuestionsReflection
What systems are in place for receiving, analysing and acting on feedback from different partners? 3C’s form – Compliments, Comments and Complaints

Regular formal and informal discussions with all stakeholders

How do you value the contribution of people who access care and support, their carers and relatives? Contributions are always taken into account and acted on.

All 3C’s forms are thoroughly investigated by Senior Management

In what ways can they be encouraged to contribute even more? By asking them for feedback 
How is everyone in the organisation equally committed to the idea of participation? By knowing that all ideas and contributions will be taken seriously.

By being encouraged to take calculated risks

What can you do to ensure that other members of the team understand the key importance of involving people who access care and support, their carers and relatives?Regular coaching, supervision and training

1.1d Describe one area where you’ve demonstrated leadership skills and one where you’ve demonstrated management skills.

Consider the role of a manager in your social care organisation. Describe one area where you’ve demonstrated leadership skills and one where you’ve demonstrated management skills. Give reasons for your choice of style.

 

Area of responsibilityReasons for choice
LeadershipExploring ways to help a client lose weight in collaboration with the client and team. Ideas were discussed in a team meeting.Democratic – everyone involved discussed ideas and decided the way forward. This meant that staff and the client had ownership of the ideas and would be more likely to follow through with the plan.
Management Telling a member of staff they are not allowed to use Facebook on their phone whilst at work as part of their Supervision.Autocratic – this is company policy and non-negotiable. I had already spoken to the member of staff about this in an informal setting but they continued to do so, so was forced to bring this up formally and in writing.

1.1c Use this table to think about your own approach to delegation and see if you can plot the qualities you adopt naturally.

Consider ‘delegation’ – a task we all need to do at regular times in our role. Use this table to think about your own approach to delegation and see if you can plot the qualities you adopt naturally. Some will have more of a leadership approach and some more managerial. Reflect on how this affected the success of the delegation activity.

 

Delegation taskDelegation of weekly drug stock check to a member of the team.

I told the staff member it was an important responsibility that I believed they would be good at because they are meticulously good with paperwork. Rather than telling them they had to do it, I asked if they would like to do it. They said they didn’t feel very confident about doing it, so I said that I would do it with them until they felt confident enough to do it on their own. After I had helped remove some of their doubts, they agreed to do it.

Natural qualities demonstratedOffering choice

Negotiation

Coaching

Building confidence in others

Positive reinforcement

Outcome of delegation taskI showed them how to do it the first time, then observed them do it themselves the second time. They then felt confident enough to do it by themselves but I made sure they were aware that I was available to contact if they had any difficulties.
How would a different approach have improved the outcome further?I could have delegated the task of training the staff member in doing the drug stock check to another staff member that already knew how to do it, therefore freeing up more time for myself.

I could have trained all staff members to do the drug stock check at the same time and made the task a team responsibility.

1.1b Can you recognise a particular management style that you tend to adopt?

Can you recognise a particular management style that you tend to adopt? You may find it’s a combination of some of the styles mentioned above. Think of particular decisions or management tasks you’ve been involved in and how you managed the decision making or task process.

 

Using different management styles
Describe a situation where you have managed a decision making or task process

A team member called me because a client had angrily walked out of his house and into the community and didn’t want staff to accompany him. I advised that staff should stay at the house and await his return when he had calmed down, but to call me back if he hadn’t returned within 30 minutes.

     
What style(s) can you identify in this situation?

Autocratic – I decided the best course of action.

     
Consider how using an alternative style may have affected the situation and outline the effects this may have had on the situation – both positive and negative
Alternative style:      Consultative – I could have asked the staff member what they thought the best of action would be.
Positives: Staff would be forced to think about the situation and themselves, contributing towards their development, self-confidence and motivation.
     
Negatives: Would have taken longer to discuss options. Inexperienced staff may have made the wrong call (e.g. following the client outside when he wanted to be alone may have increased his levels of anxiety).

1.1a Can you name three great leaders and identify why they inspire you?

 

Name What makes them inspirational?
GhandiAchieved major political change using peaceful means.
Dalai LamaCreated Tibetan parliament and educational system after being exiled from Tibet.

Promotes peace, loving kindness and tolerance.

Albert EinsteinMade many scientific discoveries that changed the way we think about the world.  

Explain how to ensure that actions from a review happen

Support staff should do everything they can to ensure that the actions agreed upon in a review happen, however in some cases a third-party may be responsible for certain actions. Support staff should chase up any third-parties and if there is still no luck, it should be reported to a senior member of staff or the service manager.

Ensure that the individual is central to the person-centred review process

An individual has to be central to the person-centred review process because otherwise it isn’t a person-centred review. All individuals should be present at their review and,they should have had some time to prepare for it beforehand. The individual should be the primary person that is addressed during the review and others should not talk about the individual as if they are not there. Everything the individual says should be taken seriously and recorded. Assistance in communication should be provided to the individual if needed.

Support the individual in their relationships and in being part of their community using person-centred thinking

I use person-centred thinking to support individuals in their relationships and in being part of their community. I do this by ensuring that individuals are free to make their own choices, although I will offer advice when I deem it necessary. I encourage individuals to play an active role in their local communities by providing assistance with things like finding a job or participating in local events. I help individuals with their relationships by offering guidance if they ask me and helping them to pursue and stay connected to the relationships that are most important to them.

Be responsive to how an individual makes decisions to support them to have maximum choice and control in their life

When an individual makes a choice, I have full respect for their decision so that they can have full control over their lives although sometimes it is necessary for me to give them some guidance as they may not have considered all the ramifications of their choice. I will offer practical advice about how an individual can proceed with their choice, no matter how difficult it may appear to achieve and am careful to ensure that my own personal bias does not interfere with the individual’s free will.

Use person-centred thinking to know and respond to how the individual communicates

Person-centred thinking means communicating with an individual in a way that they are comfortable with and allows messages between one another to be understood. For some individuals, this may mean speaking slowly and in simple terms and for others may mean using body language and signs. I adjust the way I communicate based on the individual’s needs and preferences.

Establish with the individual how they want to be supported

I establish with an individual how they want to be supported by asking them. If they are unsure I will try to offer some ideas so that they have choices about the support they receive. I will then work with the individual and other health and social care professionals to make this a reality.

Use person-centred thinking to know and act on what is important to the individual

I use person-centred thinking to know what is important to an individual by regularly conversing with them and asking them what is important to them. In some cases, I will use person-centred tools to document what is important to them. I will then work with the individual to create a plan of action regarding what we can do to pursue these things that are important and regularly review our progress paying particular attention to what is working and not working and doing my best to answer any questions they have.

Describe how to prepare for own person-centred review

I would prepare for my own person-centred review by asking myself the following questions:

  • What do I like/admire about myself?
  • What is important to me now and in the future?
  • What additional support do I need in achieving my aims?
  • What is working and not working for me and others?
  • Any questions/struggles I have?
  • What actions should I take?

Describe how helpful using a person-centred thinking tool was to identify actions in relation to own life

The 4 Plus 1 Questions Tool above was very helpful in identifying what actions I should take to stop smoking completely because it outlined what I have done so far, the progress I have made in cutting down my smoking and the belief I have gained in my ability to stop smoking completely. This information allowed me to make the decision that I really can stop smoking over the coming weeks, which I never would have dreamed of a month ago.

Describe own relationship circle

My own relationship circle has my girlfriend and my kids at the centre. Just outside of that ring is where my mum, dad, brother and best friends are located. The next most important people to me are my auntie, cousin, grandad and other friends and the outer rim has my work colleagues and other professional acquaintances in it.

Demonstrate how to use a person-centred thinking tool in relation to own life to identify what is working and what is not working

This is an example of using the 4 Plus 1 Questions Tool in my own goal to stop smoking:

  1. What have you tried? Cutting down on the number of cigarettes I smoke and replacing some cigarettes with an NRT inhalator
  2. What have you learned? I do not need to smoke as many cigarettes as I do and nothing bad happens when I don’t smoke for a prolonged period of time.
  3. What are you pleased about? That I am beginning to genuinely believe that I can actually stop smoking
  4. What are you concerned about? That I continue to smoke some cigarettes even though I know that they are not useful or good for me.

What next? Continue to try and reduce the number of cigarettes I smoke with the aim of going a whole day without a cigarette next month.

From this exercise I have learned that my process of cutting down the number of cigarettes I smoke is working and giving me more self-confident that I could stop smoking completely, however it has not worked in allowing me to stop smoking yet.

A person pushing a green arrow with the word 'challenges' on it

Describe How Challenges in Implementing Person-Centred Thinking, Planning and Reviews Might be Overcome

To be successful in implementing person-centred thinking, planning and reviewing requires commitment, tenacity and the ability to ‘think outside the box’. At the heart of the process is the client that you are supporting and it is your responsibility to help them reach their goals and achieve their dreams, sometimes using innovative ideas to lead to success. And if one idea fails, it is important to have the resilience to not give up and keep trying.

Challenges can come in myriad forms.

Overprotective Family

The family/friends of a client may be overprotective or disagree with the desires of the individual. Although family, friends and relations may be well-meaning and play an important part in the support a client needs, it is important to remember that it is the client’s choice about what they want to do with their lives and your job to support them in doing it. You may have to explain this to family and should do it in a sensitive and empathetic manner. Or, if the client themselves is able to speak to their family about this, you should explain that it is their choice what they do and they may need to weigh up the pros and cons of doing so with upsetting their family.

Practically Difficult or Impossible

Some things may be too dangerous or difficult for a client to participate in. For example, a client may wish to get their driving licence and buy a car but not have the physical capability to learn to drive. Of course, you should look into whether it would be possible for the individual to learn to drive and maybe have external assessors meet them to make a decision but it may be that this is not an option. You could then tell the client that getting a driving licence is impossible but they could still buy a car, maybe under the motability scheme, and their care staff or family could drive them around in it.

Dangerous

A client may want to go to a night club but there is a real risk of them having an epileptic seizure from the lights. In this case, you may look at specialised discos for people with epilepsy that do not have flashing lighting. Or it may be that they very rarely get seizures, in which case it may be worth risk-assessing the activity and having a contingency or safeguards in place just in case they have a seizure (for example having a member of staff accompany them).

Indecision

A client may be indecisive and express a desire to do something one day and be totally against it the next. This can make person-centred planning very difficult as the wishes and plans of the individual would be constantly changing. By working with the client regularly, conversing with them and getting to know them well, you may learn to distinguish real long-term goals from flitting whims and only pursue the objectives that they regularly discuss whilst discarding the rest.

Lack of Interest

If a client is lethargic and appears to have no interest in planning their future, it is important to talk to them about the reasons why it is a good thing and encourage them to take some responsibility for their goals in life. It may be that the individual really does have no interest in achieving anything other than participating in the same routine every day until the day they die – and this is their choice – but it is a support workers job to try to motivate and offer opportunities that the individual may not be aware existed.

Identify challenges that may be faced in implementing person-centred thinking, planning and reviews in own work

In my own work, a challenge that is often faced when implementing a person-centred approach is that a particular client regularly changes their mind and an idea that they love one day, they might hate the next. Another challenge that I have faced is a lethargic client that had absolutely no interest in personalising the support he receives.

Describe own role in person-centred thinking, planning and reviews when supporting individuals

My own role in person-centred thinking, planning and reviews when supporting individuals is to communicate with and observe individuals to discover their needs and what is important to them. I may then offer suggestions as to how they might want to pursue their interests or ambitions and help them to devise a plan of action to achieve them.

As I am the Key Worker for a particular individual, I will take responsibility for ensuring that their needs and interests are met and have tri-annual reviews with them to discuss their achievements, what is working and not working and if there is anything they would like to change or anything new that they would like to pursue. I also make myself available for an hour each week for them to discuss anything that is on their mind.

Identify ways that person-centred thinking can be used in teams

Person-centred thinking can be used with teams to create a shared purpose. Because the team knows what is important to its members, roles and tasks can be allocated according to a person’s strengths and interests.