Download management induction unit one

PREFACE
This Model Answer Manual is a guide to how answers can be made. Each candidate should
interpret the headings and make their own judgments, though when stuck for what to write,
should use this Model Answers to aid their answers, instead of having to start with a blank
page.
This information is the “Knowledge and Understanding” required for the NVQ for all units.
All elements are covered. This information should meet the knowledge and understanding for
Management NVQ’s.
Because this is a comprehensive document, information may appear more than once. This
allows the candidate to look at issues from various angles and come up with similar answers.
In using this information you must ensure that the information is up to date, as changes in
law, first aid, and standards change over time.
Whilst care is taken in the production of this document, you should seek confirmation from
other suitably qualified people before taking, or failing to take, any specific course of action.
We cannot accept responsibility for action taken, or not taken, based on the contents to our
documentation alone
Some parts of this In-Service Training Specimen answers will relate directly to the Home
where this information was created, so you should put your own homes information as an
answer, such as ‘Statement of Facilities’ in UNIT ONE Item 2 below.
This enables competence to be proved beyond doubt. I wish you every success in your
training.
John Eaton September 2009
MANAGEMENT INDUCTION UNIT ONE
1. Introduction to Staff and Clients
All new members of staff are introduced to existing staff and Clients at The Home as part of their
job interview and again in more detail during their Induction.
2. Tour of Premises
The Home provides Clients with 24 hour care, with support. The facilities of the Home are:
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14 Single Rooms
4 Twin Rooms with On Suite Bathroom and WC Facilities)
1 Large Lounge (Ground Floor)
1 Large Lounge (Ground Floor)
1 Quiet Lounge ( First Floor)
1 TV Lounge (Second Floor)
TOTAL 4 LOUNGES
2 Dining Areas (Activity Areas between Meals)
Fully Fitted Kitchen
1 Tea Room
1 Utility Room
1 Sluice
Bathrooms with WC
Separate Toilets
1 Shower room with WC
1 Staff Office
1 Managers Office
1 Satellite Television lounge
Use of 12 seater Minibus
Full Double Glazing
Smoke Detectors in ALL Rooms
Front and Rear Landscaped Garden Areas
1 Patio Area
3. Quality Standards
ISO 9000 series of standards
ISO 9001 is one of a series of quality management system standards. It can help bring out the best
in your organisation by enabling you to understand your processes for delivering your
products/services to your customers. The ISO 9001 series of standards consist of:
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ISO 9000 – Fundamentals and Vocabulary: this introduces the user to the concepts behind
the management systems and specifies the terminology used.
ISO 9001 – Requirements: this sets out the criteria you will need to meet if you wish to
operate in accordance with the standard and gain certification.
ISO 9004 – Guidelines for performance improvement: based upon the eight quality
management principles, these are designed to be used by senior management as a
framework to guide their organizations towards improved performance by considering the
needs of all interested parties, not just customers.
Investor in People
The Investors in People Standard is a national quality standard which sets a level of good practice
for improving an organisation's performance through its people. It provides a framework for
improving organisational performance and competitiveness through a planned approach to
setting and communicating business objectives and developing people to meet these objectives.
The Standard was developed in 1990 by a group of organisations representing both employees
and employers, and was launched nationally in 1991. In October 1993 Investors in People UK (IIP
UK) was established as the body that would take responsibility for the Standard. Its purpose is to
provide national ownership of the Standard and is responsible for its promotion, quality
assurance and development
Total Quality Management (TQM)
Total Quality Management is a business management strategy aimed at embedding awareness of
quality in all organizational processes. TQM has been widely used in manufacturing, education,
hospitals, call centres, government, and service industries, as well as NASA space and science
programmes.
Definition
When used together as a phrase, the three words in this expression have the following meanings:
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Total: Involving the entire organisation, supply chain, and/or product life cycle
Quality: With its usual definitions, with all its complexities
Management: The system of managing with steps like Plan, Organize, Control, Lead, Staff,
provisioning and organising
As defined by the International Organization for Standardization (ISO):
"TQM is a management approach for an organization, centred on quality, based on the
participation of all its members and aiming at long-term success through customer satisfaction,
and benefits to all members of the organization and to society."
4. Temperatures 1) Bath 2) Fridge 3) Freezer 4) Food
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Bath Up to 43°Centigrade at outlet point
Fridge Up to 8°Centigrade
Freezer 18 to 20°Centigrade
Food Above 63°Centigrade to kill off any microorganisms
5. Basic Food Hygiene
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Purchase food from reputable suppliers.
Place food in a refrigerator as soon as possible.
Store foods at the correct temperature.
Keep stored foods in original wrappers as far as possible.
Wash hands before and after handling food.
Limit exposure to room temperature during preparation.
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Separate raw foods from cooked foods in storage.
Cook convenience foods to a temperature of 75°C.
Reheat foods to a temperature at 75°C.
Maintain hot food to a temperature of 63°C.
Cool foods as quickly as possible.
Check sell/use by dates on all foods before use.
Do not refreeze frozen foods.
Do not put hot food into a refrigerator.
Keep food work surfaces and areas clean.
Check refrigerator and freezer temperatures regularly.
6. Induction, In-Service Training, NVQ and Education & Training Support
Induction
All members of staff are given a comprehensive introduction to The Home on
commencement of employment:
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Introduction to existing members of staff and Clients.
Tour of premises.
Full explanation of the rules and values laid down by The Home.
Awareness of The Home’s quality procedures, its policies, rules and responsibilities.
Location of fire alarm and emergency call systems.
Completion of job application forms. The names and addresses of two referees are required.
Explanation of job description, responsibilities and accountabilities.
In-Service Training
All staff are trained to a level to enable them to carry out their duties in a competent and skilled
manner in order to maintain the quality of care within The Home.
Training includes Health and Safety, Food Hygiene and the correct procedure in the case of fire or
accident.
Each new member of staff is allocated a key trainer and support trainer and is required to
complete an induction programme within the three months of their probationary period.
NVQ and Educational Training
The Government has responded to the need for education and training, to meet the increasing
demands of employers, by setting up the National Council for Vocational Qualifications.
Employers are taking on more and more responsibility for the education and training of their staff,
with the emphasis on continued improvements in performance, resulting in employees being able
to perform their duties to the required standards by way of practical experience as well as a
learning process.
The Home’s Educational and Training Manual provides comprehensive training and education for
staff under the following headings:
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Psychiatric Diagnosis
Mental Illness
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Drugs used in Psychiatry
Treatments and Therapies in Psychiatry
Medical Matters
7. Emotional Responses, Aggression, Mood Swings etc
Emotional responses, aggression and mood swings etc. form a significant role in defining physical
or mental illness and provide analysis for other purposes.
Variations of feelings, reactions, awareness, perception and behaviour include the following:
Depression, Elation, Mood, Anxiety, Hopelessness, Emptiness, Coping efficiency, Violence,
Activity, Major retardation, Impulsiveness, Aggression, Suicidal tendencies, Drug/Alcohol abuse,
Relationships (including sexual), Hallucinations, Personalisation, Illusions, Temper tantrums,
Cruelty, Mutism, Hyperactivity, Incontinence, or Pain.
Patterns of emotional response and behaviour are consistent with different forms of mental illness:
Schizophrenia
There are four different types of schizophrenia:
1. Simple 2. Paranoid 3. Catatonic 4. Hebephrenic
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Simple: Appears emotionless and uncaring, is withdrawn and has an inability to think.
Odd behaviour and short attention span.
Paranoia: Hallucination, delusions, persecution complex, difficulty with relationships, high
incidence of violence, suspicious nature.
Catatonic: Sudden conflicting states of emotional behaviour, ranging from displaying an
extreme lack of violation and an ability to remain motionless for an exorbitant amount of
time to being wild and uncontrollable with disturbed behaviour and capable of extreme
violence.
Hebephrenic: Confused thoughts. Out of place emotions. Highly excitable and hyperactive
with incoherent and negative thoughts. Silly and childish. Repetitive, excitable, overactive
and impulsive. May become violent without warning, but over just as quickly. Delusions
and hallucinations occur.
Manic Depressive Psychosis
Conflicting periods of elation and depression. Warm and friendly but predisposed to moods.
Unrealistic and inconsistent. Rapid rhyming speech. Intolerant of noise. Irritable and aggressive.
Hyperactive and flamboyant and easily distracted.
Hypomania
Elation, restlessness, rapid speech, delusions, rhyming words. Irritability and aggression.
Depression
Morbidity, lack of response and poor concentration, lethargic, self-neglect and low esteem.
Anxiety, lack of sex drive and feelings of worthlessness and persecution. Loss of appetite and
erratic sleep patterns with moods tending to improve as the day progresses. Suicidal tendencies.
Anxiety
Fear, irritability, restlessness and poor concentration. Panic attacks loss of self-control, Alcohol
and Alcoholic Dependancy, Tremors, anxiety, depression, moods, restlessness, irritability,
hallucinations, anger, suspicion, guilt, deviousness. Poor memory, lack of perception,
disorientation, incomprehensibility and self-neglect. Lack of concentration, feelings of jealousy.
Hallucinations.
During bouts of drinking a personality change may take place and in extreme cases abuse may
occur. Any abuse must be reported to the person in charge without delay.
Epilepsy (during an attack)
Disturbed recognition and sense of reality. Visual disturbances and unrealistic behaviour.
Disorientation, hallucinations and possible violence.
8. Accountability
Owner is accountable to the Registering Authority
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Manager to Owner
Person-in-Charge to Manager
Chef to Manager
Site Manager to Manager
Senior Health Care Assistant to Manager
Health Care Assistant to Senior Health Care Assistant and Person-in-Charge
9. Advocacy / Client’s Rights
The Home encourages care workers to take on the role of advocates to promote the awareness of
Clients’ rights and help them gain access to the services they need.
The following set of values is supported for all Clients:
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The freedom of choice on personal matters and preferences.
The opportunity to fulfil personal ambitions and develop knowledge and skills.
The right to the fullest expression of citizenship.
The right to lead as independent a life as possible.
The right to privacy and personal space without hindrance.
To be treated with respect and dignity in a caring manner at all times.
To be recognised as an individual with regard to personal needs irrespective of
circumstances.
The right of freedom of movement from one place to another without restriction.
10. Basic Manual Handling Rules
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Use correct lifting techniques to minimise the risk of injury and discomfort to yourself and
others.
Employ the help of another person if necessary, with one taking the lead part.
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Wash your hands before and after lifting or moving a person and wear appropriate
clothing and footwear.
Use the correct equipment as required.
Position your body, with back, hips and feet in a straight line.
Maintain the dignity and privacy of a person and talk the person through each stage of the
procedure.
Encourage independence where possible.
Moving and Repositioning a Person
A person confined to bed and unable to move themselves needs frequent repositioning to help
prevent tightening of the muscles and pressure sores. Avoid using synthetic bedding materials as
this can cause friction. The person should be rolled or slid rather than lifted.
Always roll or slide a person towards you rather than away from you. A person confined to a
chair for long periods of time should be regularly checked for proper body alignment for their
comfort. Ensure a person has good circulation. The use of a circular sponge cushion and a fleece
can help prevent friction.
Moving a Person from One Place to Another
A person requiring help in moving from one place to another should be encouraged to assist
themselves as far as is possible. To help a person from a lying to a sitting position, move their feet
over the edge of the bed and sit them up – allow the person a few moments to regain their balance
as the blood pressure is lower when in a lying position. Stand in front of the person and place
your arms under the person’s arms. Slowly turn the person and ensure their comfort, or
alternatively walk supporting them to the desired place and lower them into a chair.
11. Fire Alarm System
A fire instruction video is kept in the duty office and shown to all new members of staff during
their induction.
The fire alarm system and equipment held at The Home is consistent with British and
International Standards
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For information on where your Home’s fire panel is: Consult your fire safety instructor
Zones: for information on various zones: Again consult your fire safety instructor
Fire exits: Again consult your fire safety instructor
Emergency exit: Again consult your fire safety instructor
Fire equipment: Each zone is equipped with emergency fire alarm and fire extinguishers.
A fire blanket and fire extinguisher is kept in the kitchen.
12. Fire Alarm Drill and Procedure in Event of Fire, Location of Fire Equipment
All staff must be familiar with the location of the fire alarm and equipment, exits from the
building and the procedure in the event of fire. High standards are required in the prevention of
and in the event of a fire.
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Smoke and heat detectors connected to the central alarm
Emergency lighting
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Fire doors self-closing and open outwards
Exit door open inwards
Escape routes visible
Fire points, fighting equipment and instructions close to exits
Fire can be a frightening experience for anyone, especially for those with reduced mobility or in a
confined situation.
In an emergency it is important to stay calm and take immediate action. Any unnecessary delay
could cause fatalities. The seriousness of a situation should always be determined and if there is
any doubt, action should be left to the fire brigade.
In the event of a fire, Clients and staff should be moved in an orderly fashion to a place of safety,
moving the people nearest the fire and in most danger first, closing all fire doors behind them (a
fire door is resistant to smoke and heat for a period of 30 minutes).
Similarly, if there is any doubt about opening a fire door – leave it closed.
If a person has to be left in a room then the door should be kept closed. If a person is left in a bath,
the plug should be pulled and the door closed. The fire brigade, on arrival, will always liaise with
senior staff and advise.
In the Case of Fire
Discovering a Fire:
• Operate the nearest fire alarm call point.
• Attack the fire if possible, using the fire equipment provided, but without taking personal
risk.
On Hearing the Alarm:
Remain calm and alert.
Summon assistance. Encourage staff to use their own initiative and discretion, but the procedure
is to dial 999, and then report to the Fire Zone Panel for instructions and prepare for possible
evacuation.
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Report to the fire zone for instructions.
Person-in-Charge will be responsible for calling the emergency services.
Prepare for possible evacuation.
If evacuation is called for, leave by the nearest exit, closing all doors and windows behind
you.
Report to The Home’s assembly point.
At this point, the Person-in-Charge will call a register and the fire brigade, on arrival, will
be notified of any missing person.
Fire drills must be carried out at least every six months. All staff must attend annual fire lectures.
Post-fire reviews are held to aid in the prevention of future occurrences of fire and for learning
experience purposes.
Location of Fire Equipment
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For information on where your Home’s fire panel is consult your fire safety instructor.
Zones: for information on various zones: again consult your fire safety instructor
Fire exits: again consult your fire safety instructor
Emergency exit: again consult your fire safety instructor
Fire equipment:
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Each zone is equipped with emergency fire alarm and fire extinguishers. A fire blanket and
fire extinguisher is kept in the kitchen.
Fire doors should be kept closed at all times.
Fire doors and emergency exits should be kept free from obstruction at all times.
All staff must attend fire lectures every year.
Staff should ensure, where practicably possible, that Clients are familiar with fire drills and
the use of equipment.
13. Accident, Violent Incident, Missing Person, Complaints
Accidents
Any accident or incident occurring at The Home must be reported immediately to the Person-inCharge, who will take the appropriate action.
Minor injuries can be dealt with within The Home. Accidents requiring hospital treatment will be
dealt with at the nearest casualty department, and a member of staff will accompany the injured
party.
Accidents of a more serious nature requiring ambulance assistance will be dealt with by the
Person-in-Charge, using the emergency services. A member of staff will accompany the injured
party with the crew in the ambulance. In all cases, the Person-in-Charge will complete an accident
report and notify any relevant persons.
Violent Incident
The Home’s staff will attempt to limit any violent incidents by using admissible precautionary
methods. Health care staff will be given advice and support and will be fully aware of and adhere
to the procedures that are laid down in the course of such action and in such a way that ensures
no unacceptable risk to themselves.
Where a Client or others are at risk, the Person-in-Charge will use minimum force to avert the
situation and, if appropriate, administer prescribed medicines. A Violent Incident form will be
completed after any such incident.
Attempts should be made to minimise the effects on others.
Missing Persons
If a person is suspected missing and is a known risk, the Person-in-Charge will check with other
staff and Clients before arranging a thorough search of the premises and surrounding areas.
After a reasonable amount of time, the Person-in-Charge will contact any relevant persons to try
and determine the whereabouts of the missing person, before contacting the relevant authorities.
The Person-in-Charge will complete a Missing Person’s form. The form should be completed
accurately, and legibly.
Complaints
The Person-in-Charge will attempt to settle any complaint made by a Client. In the event of
failure, a Complaint form will be completed legibly, accurately and signed. The Manager will be
informed.
If the Client wishes to take the complaint further, the Owner will become involved, and will
attempt to resolve the situation. If the Owner cannot resolve the situation, he will contact the
appropriate Authority. If still unsuccessful the Owner will take it a stage further by assisting
the Client in taking legal action.
14. Case Entries and their Confidentiality
Individual case files are kept for each Client at The Home and are updated regularly through
meetings, G.P. outpatient appointment or as circumstances change. All documents when not in
use are held in a secure place and are private and confidential. Files contain recorded information
with regard to Clients’ medical and psychiatric diagnoses and the treatments there of. All known
data relating to family, personal, social and financial circumstances are also detailed.
All entries are regularly updated. All staff have a legal, moral and organisational responsibility to
treat all information gained during the course of carrying out their duties as strictly confidential.
Advice should be sought with regard to any concerns or suspected abuse of confidentiality.
Only valid records are kept, and are accurate, legible, and complete.
15. Safe keeping of Clients’ Money, Articles and Valuables
When a person takes up residence at The Home, an inventory of personal property, cash and
valuables is taken. Wherever possible, items of property and of a personal nature are
accommodated with the Client.
Cash and valuables may be handed in for safe keeping. The amount of cash and a description of
the valuables will be recorded in duplicate by the Person-in-Charge. Signatures must be
exchanged. One copy of the document will be retained and the other passed to the Client or held
in his/her file as appropriate.
If the amount of cover for cash and valuables provided by the insurance policy is inadequate, then
alternative arrangements can be made.
Clients’ cash allowances will be drawn weekly by the Manager. The Person-in-Charge will be
responsible for the safe keeping and distribution of the allowances.
The record of any allowance paid to a Client, either on a daily, weekly or lump sum basis will be
signed by the Client and countersigned by the Person-in-Charge.
If a third party is involved in the management of Clients’ money then the transactions will be
recorded in triplicate.
Any discrepancies will be brought to the attention of the person in charge.
16. Sickness Procedure
Staff must notify the Duty Office as soon as possible (at least 24 hours) if they are unable to work
through illness so that cover can be arranged. A similar procedure must be carried out when staff
are able to return to work. A doctor’s certificate is required after 3 days absence.
17. Client Call System
The Home operates an emergency call alarm system. The alarm panel when activated shows the
location of where the call is coming from. A list of the locations of the alarm units are kept
together with the alarm panel.
18. Diary and Message Book
Kept in the Duty Office. All messages and enquiries must be entered in the message book. All
appointments for staff and Clients must be entered in the diary, and this includes dates for
Clients’ depot injections.
On admission the level of care for a Client is assessed and the medication established and
recorded in their file. During residency, reviews are regularly carried out by the Person-in-Charge
and details of, and any changes in, medication are recorded.
All recording must be consistant with the clients equality and diversity.
19 Care/Support Planning System
Needs Assessment
All client’s who moves into the home have had his/her needs assessed and been assured that these
will be met.
New client’s are admitted only on the basis of a full assessment undertaken by people trained to
do so, and to which the prospective service user, his/her representatives (if any) and relevant
professionals have been party. Individuals referred through Care Management arrangements, the
registered person obtains a summary of the Care Management (health and social services)
assessment and a copy of the Care Plan produced for care management purposes. For individuals
who are self-funding and without a Care management assessment/Care Plan, the registered
person carries out a needs assessment covering:
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personal care and physical well-being;
diet and weight, including dietary preferences;
sight, hearing and communication;
oral health;
foot care;
mobility and dexterity;
history of falls;
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continence;
medication usage;
mental state and cognition;
social interests, hobbies, religious and cultural needs;
personal safety and risk;
carer and family involvement and other social contacts/relationships.
All client’s have a plan of care for daily living, and longer term outcomes, based on the Care
Management assessment and Care Plan or on the home’s own needs assessment
20. Health and Safety Policy
The Health and Safety Act 1974 places responsibilities for Health and Safety on the employer,
employee and management. The Home protects, as far as is possible, the Health and Safety of all
staff and other persons within:
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Staff are familiarised with the location of safety, first aid and fire equipment.
Staff receive the necessary training before being allowed to operate any machine or
equipment.
Staff receive training in connection with safe working practices and are made aware of any
risks associated with these tasks.
Staff must possess knowledge of Basic Food Hygiene.
The fire alarm system and nurse call systems are tested weekly.
All buildings are inspected regularly.
Clients are made aware, as far as is practicably possible, of procedures and policies
regarding Health and Safety.
Any matter relating to Health and Safety must be reported to the Person-in-Charge.
All accidents, injuries and dangerous occurrences must be reported.
All incidences must be recorded.
21. Admission, Transfer and Discharge Procedure
Admission
Prior to admission to The Home the Person-in-Charge will visit the prospective Client to assess
suitability and the level of care required. Medical, psychiatric and social reports are also inspected,
where appropriate and available.
After all the facts have been considered, the prospective Client is invited to look around The
Home and meet the staff. If the visit is successful, an admission date, on a one month trial basis, is
agreed with the Admission Authority. Financial agreements are signed and all relevant persons
notified.
Following the trial period (during which time further assessments will have been made, and a
case file completed) a review will be held and firm contracts with the relevant parties agreed and
exchanged.
On admission to The Home, an inventory will be taken of the Client’s personal belongings, cash
and valuables, and entered into the appropriate file.
Client care-plans are reviewed six monthly and contracts reviewed annually, or sooner if
appropriate.
In the event of an “emergency” admission, as much information as possible will be obtained. The
normal admission procedure and assessments will follow and the necessary funding arranged.
Transfer/Discharge
Agreement between all the relevant parties relating to Transfer/Discharge will result in the
Client’s personal belongings, cash and valuables being returned. Details will be recorded in the
relevant files. In the event of a dispute, discussions will take place between The Home and the
relevant parties. If the dispute remains unresolved, then the Registering Authority will become
involved.
22. G.P. Policy
A weekly G.P. meeting is held on a Thursday morning in the Managers Office for the benefit of
Clients requiring a consultation; an annual check-up; or if the Person-in- Charge feels an
appointment is necessary; or ifthe Client wishes to be seen by the G.P.
The clinic is held in private and the Person-in-Charge remains with the G.P. throughout. Notes are
taken and any change in medication recorded.
Surgery appointments will be arranged with the Client’s G.P. if necessary or desired.
23. Care Staff Work Procedure
A daily report is completed by a Health Care Assistant at the end of each shift. This shows the
present position with regard to domestic duties performed, and records any relevant issues
relating to Clients’ care.
The worksheet is a quality document and must be recorded accurately and in a professional
manner. It must be completely filled in, signed and dated and available for inspection by the
Person-in-Charge by each Sunday evening. The Person-in-Charge will then file it.
24. Using the Telephone, Internal Calls, Handling Enquiries
The Home’s policy for answering external calls and handling enquiries:
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Calls should be answered within six rings.
Response: “Good morning (as appropriate), The Home, Can I help you?”
Any enquiries regarding a Client must be referred to the Person-in-Charge.
Personal information regarding either staff or Clients may not be given without prior
consent from the person concerned.
A caller’s name must be obtained before a call is transferred.
Message policy:
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The caller’s name and number obtained
Who the message is for
The urgency of the message
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If there is a time limit for a reply
Figures included in the message repeated simultaneously
The message repeated back to the caller
The caller thanked and assured that the message will be passed on as soon as possible
The message recorded in the message book
The message pointed out in the message book to the person concerned as soon as possible,
accurately and legibly to ensure there is no misunderstanding
Internal Calls:
Recognised by a series of long, single rings may be answered less formally but using the same
standards as external calls.
25. Relationship with Registering Authority
The Care Quality Commission is the independent regulator of health and social care in England.
Their aim is to make sure better care is provided for everyone, whether that’s in hospital, in care
homes, in people’s own homes, or elsewhere.
They regulate health and adult social care services, whether provided by the NHS, local
authorities, private companies or voluntary organisations. And, they protect the rights of people
detained under the Mental Health Act.
All homes are registered with the Registering Authority. The home has two inspections a year, one
announced and one unannounced. The Home has to display its certificate where it can be seen
which has the type of client plus the maximum number of clients allowed in The Home.
26. Injections and Recording
Intramuscular injection is a “shot” of medicine given into a muscle. A syringe with medicine in it,
is attached to a needle. The needle goes through the skin and into a muscle. The medicine is
pushed into the muscle by pressing on the syringe plunger. When the medicine has been pushed
into the muscle, the needle is removed.
The Person-in-Charge administers the drugs into the appropriate muscle which if the injection is
given regularly, into a different muscle such as thigh, arm stomach, to prevent muscle damage
and abscesses.
The Person-in-Charge is responsible for the recording of the injections on the Client’s depot
injection chart and forwarding an entry in the appointment diary.
A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly
below the dermis and epidermis, collectively referred to as the cutis. Subcutaneous injections are
highly effective in administering vaccines and such medications as insulin, morphine,
diacetylmorphine or goserelin.
A person with Type I diabetes mellitus typically injects insulin subcutaneously. Places on the body
where people can inject insulin most easily are:
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The outer area of the upper arm.
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Just above and below the waist, except the area right around the navel (a 2-inch circle).
The upper area of the buttock, just behind the hip bone.
The front of the thigh, midway to the outer side, 4 inches below the top of the thigh to 4
inches above the knee.
These areas can vary with the size of the person. Changing the injection site keeps lumps or small
dents called lipodystrophies from forming in the skin. However, people should try to use the
same body area for injections that are given at the same time each day-for example, always using
the abdomen for the morning injection or an arm for the evening injection. Using the same body
area for these routine injections lessens the possibility of changes in the timing and action of
insulin.
27. Staff/Client Reviews Staff/Client Meetings
Staff reviews - training records reviewed periodically to ascertain training requirements are met.
Client reviews – care-plans reviewed 6 monthly or as the Person-in-Charge feels necessary. Staff
meetings – held 6 monthly to resolve staffing problems and ensure that staff participate in the
smooth running of The Home.
Staff Supervision
Staff are appropriately supervised.
The registered person ensures that the employment policies and procedures adopted by the home
and its induction, training and supervision arrangements are put into practice. Care staff receive
formal supervision at least 6 times a year.
Supervision covers:
• all aspects of practice;
• philosophy of care in the home;
• career development needs.
All other staff are supervised as part of the normal management process on a continuous basis.
Volunteers receive training, supervision and support appropriate to their role and do not replace
paid staff.
Client meetings – periodic to air grievances, discuss problems and resolve difficult situations,
make suggestions for better understanding, care and facilities. They give the feel of involvement
and participation
28. Medicine Policy/Medicine System
Administration of Residents Medication
(a) It will be the responsibility of the Person-in-Charge to administer medication to the
resident.
(b) The Person -in-Charge will be a registered or enrolled nurse and will hold a current
drugs certificate.
(c) When administering medication to residents the Person-in-Charge will use the
prescription as directed by the General Practitioner and check:
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The right resident
The correct drugs
The correct route
The correct time
The correct Solution - ie tablet, liquid etc
(d) The Person-in-Charge will sign the Medication Administration Record when the
medication has been taken.
(e) If the medication is refused, the resident is unwell or on short leave etc., the Personin-Charge will make the appropriate entry on the Medication Administration
Record and will use the appropriate codes as listed on the bottom of the sheet.
(f) The Person-in-Charge will always be aware of any possible side effects and or
hypersensitive reactions to medication and take the required action.
(g) After administration all medication will be kept secured in a locked cupboard in a
locked room or office.
(h) The client will on no account be forced to take medication against their will (except
where the law prescribes for someone subject to an order). All such action
constitutes an assault.
(i) Medications such as paracetamol and cough linctus may be administered as
appropriate by the Person-in-Charge without being prescribed by the General
Practitioner as per the Non-Prescription Medication Letter.
(j) Completed Medication Administration Records will be filed by the Person -inCharge in a suitable location and retained as a Quality record for a period of three
years.
Storing and returning of unused medication
The Nurse-in-Charge will ensure that any unused medication remains in a locked cupboard until
it is collected by the dispensing Chemist at the end of each month.
Client’s, where appropriate, are responsible for their own medication, and are protected by the
home’s policies and procedures for dealing with medicines.
The registered person ensures that there is a policy and staff adhere to procedures, for the receipt,
recording, storage, handling, administration and disposal of medicines, and service users are able
to take responsibility for their own medication if they wish, within a risk management framework.
The Client, following assessment as able to self-administer medication, has a lockable space in
which to store medication, to which suitably trained, designated care staff may have access with
the service user’s permission.
Records are kept of all medicines received, administered and leaving the home or disposed of to
ensure that there is no mishandling. A record is maintained of current medication for each Client
(including those self-administering).
Medicines in the custody of the home are handled according to the requirements of the Medicines
Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of
Drugs Act 1971 and nursing staff abide by the UKCC Standards for the administration of
medicines.
Controlled Drugs administered by staff are stored in a metal cupboard, which complies with the
Misuse of Drugs (Safe Custody) Regulations 1973.
Medicines, including Controlled Drugs, for Client’s, receiving nursing care, are administered by a
medical practitioner or registered nurse.
In residential care homes, all medicines, including Controlled Drugs, (except those for selfadministration) are administered by designated and appropriately trained staff. The
administration of Controlled Drugs is witnessed by another designated, appropriately trained
member of staff.
The training for care staff must be accredited and must include:
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basic knowledge of how medicines are used and how to recognise and deal with problems
in use;
the principles behind all aspects of the home’s policy on medicines handling and records.
Receipt, administration and disposal of Controlled Drugs are recorded in a Controlled Drugs
register.
The registered manager seeks information and advice from a pharmacist regarding medicines
policies within the home and medicines dispensed for individuals in the home.
Staff monitor the condition of the Client on medication and call in the GP if staff are concerned
about any change in condition that may be a result of medication, and prompt the review of
medication on a regular basis.
When a Client dies, medicines should be retained for a period of seven days in case there is a
coroner’s inquest.
30. Job Description- Person Specification
Care Assistant: responsible to Senior Health Care Assistant and Person-in-Charge
The role of a care worker is to share with others, as part of a team, in the provision of continual
quality care. The values and principles that a carer carries with them into their work are the
elements of good caring.
A carer should act in a responsible and sympathetic manner in responding to the personal and
individual needs of persons entrusted to their care, and must respect their dignity and privacy at
all times. Confidentiality also applies.
A care worker needs to recognise each person in their care as an individual and respect
their choices and preferences.
Good communication skills are important in promoting the physical and mental well-being of
a person. Talking to and listening to is as important as taking part in social activities and
sharing in interests and hobbies. A carer should be enthusiastic in helping to promote new
ideas and interests and assist persons to achieve their own goals.
The responsibilities of a Health Care Assistant employed at The Home include:
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To keep the Clients’ home environments clean and tidy.
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To launder clothes and keep in good state of repair.
To serve meals, teas and coffees, wash up and wipe down afterwards.
To greet Clients’ family and visitors with politeness.
To assist with medication as required.
To take part In-Service Training, Staff/Client Meetings, Staff/Client Reviews.
To complete a Care Assistant’s worksheet and attend handover meetings at the end of
a shift and before commencing a new shift.
To perform any other appropriate duty as required ensuring the continuity of standards of
care within The Home.
Person Specification
What is a person specification?
A person specification describes the requirements a job holder needs to be able to perform the job
satisfactorily. These are likely to include:
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Education and qualifications
Training and experience
Personal attributes / qualities
How does this compare with a job description?
A job description describes the job ; a person specification describes the person needed to do the
job. A person specification can, therefore, form the basis for the selection of the most suitable
person to fill the job.
How should a person specification be created?
The most common approach now used by recruiters is to use what are known as "competencies"
to design the person specification. These are then classified as "essential" or "desired" to determine
which are most important.
Competencies might include some or all of the following:
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Physical attributes (e.g. state of health, age, speech)
Attainments (e.g. highest level of education completed, relevant market experience, ability
to supervise/manage)
Aptitudes (e.g. verbal reasoning; numerical aptitude)
Interests (social activities; sporting activities)
Personal circumstances (e.g. ability to work shifts; full or part time)
Person specifications have to be prepared and used with great care. In particular, it is important to
ensure that the list of essential or desired competencies does not lead to unlawful discrimination
against potential employees.
31. Who pays your salary? (Hotel guest example)
The private sector has become involved in Community Care and it is new business. Almost every
decision regarding care and placement has financial implications.
A Client requiring care is entitled to benefits through loss of earnings from illness and
contributions paid in the past. Benefits are means tested and charges for a Client’s care and full
board are deducted from the Client’s benefits at source.
Care Homes, in today’s market, need to provide high standards of quality care combined with
value for money at competitive rates. A good Care Home, like a good hotel, is usually full to
capacity and without the “hotel guest”, there would be no salary cheque, the clients pay the staff
salaries.
MANAGEMENT UNIT 2.
QUALITY PROCEDURES
1. CONTRACT REVIEW
The home produce a Statement of Purpose and other information materials (Welcome Pack)
setting out its aims and objectives, the range of facilities and services it offers to residents and the
terms and conditions on which it does so in its contract of occupancy with residents. In this way
prospective residents can make a fully informed choice about whether or not the home is suitable
and able to meet the individual’s particular needs. Copies of the most recent inspection reports are
made available. The statement of purpose will enable inspectors to assess how far the home’s
claims to be able to meet resident’s requirements and expectations are being fulfilled. While it
would be unreasonable and unnecessary to expect every home to offer the same range of facilities
and lifestyle, older people do want a range of choice when they decide to move into a care home.
There can be no room for doubt either on the part of the prospective resident, the inspector or the
proprietor. In this way diversity and range of choice across the care home sector can be
maintained.
The registered person produces and makes available to client’s an up-to-date statement of purpose
setting out the aims, objectives, philosophy of care, services and facilities, and terms and
conditions of the home; and provides a clients’ guide to the home for current and prospective
residents. The statement of purpose clearly sets out the physical environment standards met by a
home, and a summary of this information appears in the home’s client’s Welcome Pack guide.
The client’s guide is written in plain English and made available in a language and/or format
suitable for intended residents and includes:
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a brief description of the services provided;
A description of the individual accommodation and communal space provided;
relevant qualifications and experience of the registered provider, manager and staff;
the number of places provided and any special needs or interests catered for;
a copy of the most recent inspection report;
a copy of the complaints procedure;
clients’ views of the home;
Clients and their representatives are given information in writing in a relevant language and
format about how to contact the local office of the Care Quality Commission and local social
services and health care authorities.
Contract
Each client has a written contract/statement of terms and conditions with the home.
Each client is provided with a statement of terms and conditions at the point of moving into the
home (or contract if purchasing their care privately). The statement of terms and conditions
includes:
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rooms to be occupied;
overall care and services (including food) covered by fee;
fees payable and by whom (client, local or health authority, relative or another);
additional services (including food and equipment) to be paid for over and above those
included in the fees;
rights and obligations of the client and registered provider and who is liable if there is a
breach of contract;
terms and conditions of occupancy, including period of notice (e.g. short/long term
intermediate care/respite).
Trial Visits
Prospective clients and their relatives and friends have an opportunity to visit and assess the
quality, facilities and suitability of the home.
The registered person ensures that prospective clients are invited to visit the home and to move in
on a trial basis, before they and/or their representatives make a decision to stay; unplanned
admissions are avoided where possible. Prospective clients are given the opportunity for staff to
meet them in their own homes or current situation if different. When an emergency admission is
made, the registered person undertakes to inform the client within 48 hours about key aspects,
rules and routines of the service, and to meet all other admission criteria 4 within five working
days
Pre-Admission Assessment
Questioning would be on the following issues:
Mobility
Does poor mobility affect person's independence?
Personal Care
Are there any problems with managing personal care?
Daily Living Skills
Is dependency affected by poor skills?
Health Problems
If yes, list physical problems?
Sensory Loss
Does impairment of sight or hearing affect independence?
Social Behaviour
Does social behaviour give rise to problems?
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Communication skills
Orientated to time, place, person
Tends to wander
Behaviour likely to upset others
Social isolation
Smoker
Fire risk
Alcohol
Mental State
Give details of concerns regarding mood, memory, behaviour, etc.
Current Medication
List all medication, including details of depot injections.
Ongoing Assessments
No client moves into the home without having had his/her needs assessed and been assured that
these will be met.
New clients are admitted only on the basis of a full assessment undertaken by people trained to do
so, and to which the prospective client, his/her representatives (if any) and relevant professionals
have been party. For individuals referred through Care Management arrangements, the registered
person obtains a summary of the Care Management (health and social services) assessment and a
copy of the Care Plan produced for care management purposes. For individuals who are selffunding and without a Care Management assessment/Care Plan, the registered person carries out
a needs assessment.
2. DOCUMENT AND DATA CONTROL.
This ensures that all quality systems and supporting documentation are reviewed for adequacy
before being released and that any actions or changes made to any information are effectively
implemented.
Detailed information is made available to required personnel to ensure that each person is capable
of carrying out their duties to the standard that is required.
The preparation, issue and amendments of all documents are controlled so that the necessary
correct documents are used. Any quality related information is reviewed for its adequacy and is
approved for release by authorised persons. Prior to issue the Person in Charge reviews all quality
documents. Any changes are recorded to maintain a controlled document system. Out of date
quality related documents are removed and either destroyed or archived for the required amount
of time.
Documents include:
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Quality manual
Quality procedure
Training records
Quality and other forms
Medication records
Care plans
Current edition of quality standards
Work routines.
All controlled documents should be made available to all people who need to use them whilst
carrying out duties for references purposes. All documents that are obsolete should be clearly
marked as such for identification or removed from the relevant files and destroyed.
3. PURCHASING
To ensure that all purchased goods and services conform to the specified requirement and
determine that all such purchases are from approved sources.
Purchased goods and services are considered vital to the Quality of services and care provided by
the Home.
The provision of these items will be given the same level of planning verification and control as
other activities within the Home. The purchasing requirement of the business will be carried out
on the basis of
• Quality
• Delivery
• Cost
Suppliers will be selected and evaluated on their past performance, availability of product,
geographical location and cost.
A list of approved suppliers/subcontractors will be maintained by the Person in Charge and will
include:
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Products/Services approved to supply
Name and address telephone number/fax number
Name of contact at company
Details of any accreditation held
Quality system registration number
Purchase Orders when required, will be completed clearly and define the requirement, which
includes:
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Supplier name
Brand (if applicable)
Grade
Size or quantity
Quality standard
Purchase Orders will be completed by the person requiring the product and will be authorised by
the Manager.
4. CONTROL OF CUSTOMER SUPPLIED PRODUCT
On admission into the Home the Care Assistant will make an inventory of resident’s property and
the details entered in the Property Book.
Special treatment or services for clients will be identified in the Clients File.
Any special medical or mobility equipment will be identified and maintained in the approved
manner.
Residents’ property will be periodically examined by the Person-in-Charge for deterioration or
damage. The results will be recorded in the Property Book and the client informed.
Cash and Valuables
If on admission a client hands in cash or valuables for safe keeping, the amount of cash and a
description of the valuables will be entered in the Cash and Valuables Book. The Person-in-Charge
and the client will sign the book in the relevant space. A copy will be given to the client or placed
in the Resident’s File as appropriate.
Any cash received will also be recorded on the Resident’s Weekly Cash Audit sheet and the
Person-in-Charge will sign in the appropriate space.
If a client hands in items, which are of greater value, than is covered by the Home’s insurance,
provision for additional cover will be discussed with the client.
The Person in Charge will draw residents’ allowances on a weekly basis. The total amount will be
checked by the Person-in-Charge for accuracy.
Special Payments
When a third party is involved with the Home in the management of a resident’s money, the
amount paid to clients will be entered on the Special Payments Form by the Person-in-Charge and
endorsed by the client. At the end of each payment period the Person-in-Charge will sign the form
and fax a copy to the third party for payment. On receipt of this payment the Special Payment
Form will be completed and a copy of acknowledgement faxed to the third party.
The completed forms will be filed under the resident’s name and retained as Quality records.
5. PRODUCT IDENTIFICATION AND TRACEABILITY.
This ensures that all records and treatment of each individual client can be identified and traced
when needed by staff to complete entries on records.
Clients have their own individual file. These are established during the assessment and admission
process. Whilst receiving care at the Home any incidents, actions taken, and treatment are
recorded in the client’s file. Accurate records are maintained by recording events on the
appropriate forms and placing them in the correct files.
All forms and files should be clearly marked and be put in the correct place so that they are easily
traced when needed. All health care assistants are trained in using the correct method and
procedures for maintaining accurate records.
The records include; event sheets, care assessments, clinic attendances, medical records, GP care
plans, medication records and contracts.
This procedure ensures that identification and tractability of clients is maintained and at all times
is subject to the ongoing care of each individual client.
6. PROCESS CONTROL.
This procedure ensures that each phase of the care process is controlled.
Each client’s care programme is planned and developed with input from outside authorising
bodies, the individual concerned and senior members of staff at the Home.
All information concerning the client’s care programme is recorded in the care plan in the client’s
file. The Person in Charge records further development of care. by completing the event sheets.
All care staff should carry out work routines by using the methods specified by the Home and the
methods to be used are available to staff. Any standard work routines that are found to be
unsuitable for specific individuals, due to various reasons, must be recorded in the resident’s file
and reported at the shift handover meetings and at the beginning of each shift.
Alterations to work routines should not be made without authorisation by the management. Any
alterations should be carried out in the approved manner.
7. CONTROL OF INSPECTING, MEASURING AND TESTING EQUIPMENT.
Any equipment used is checked periodically. Any faults found should be reported in writing,
dated, and signed on the Home maintenance forms. This system is used to determine that
sufficient equipment is available and to control and monitor the care routines at all times by
checking the efficiency of all equipment.
Routine servicing by outside-qualified bodies is certified quoting the name of the certification
body. The date of the service, the equipment service number and a report on the condition of
equipment is obtained and filed in the appropriate place.
Equipment used to store food, check fridge temperatures and client’s physical and mental
conditions should be maintained by following the recommended manufacturers’ or suppliers’
instructions.
Records should be kept to monitor the shelf life of food and medications by labelling and dating
provisions and medications.
8. INSPECTION AND TEST STATUS.
Marking each individual’s clothes and belongings should identify all clients’ clothing and
possessions. Care staff should report any deterioration in the condition of a client’s clothes so
those items can be replaced.
Records should be maintained of the sell-by dates for medication, provisions and perishables, so
these products are not used after the manufacturers’ recommended dates.
Any items, which have broken packaging or have not been stored at the correct temperature,
should be disposed of immediately. The system also covers the disposal of all types of waste
generated by the Home.
Any visitors that are involved in the ongoing care of the individual client, i.e. GP, Social Worker,
Occupational Therapist, and Psychiatrist should record any specific information in the
individual’s medical notes when appropriate. The Person in Charge will then amend the
resident’s personal file by entering any changes that have been authorised by the visiting
specialist.
9. CONTROL OF NON-CONFORMING PRODUCTS.
Non-conformances can be identified during periodic checks or through internal auditing. A nonconformance can also be identified through staff meetings, complaints from a client, by relatives,
external audits, or by documentation that has not been completed correctly. Once a nonconformance has been identified all staff are made aware of the non-conformance.
10. CORRECTIVE AND PREVENTATIVE ACTION
To ensure that reviews of non-conforming care, associated services, client or staff complaints and
Quality system failures are formally investigated, the cause identified and the necessary corrective
action taken to prevent any recurrence.
Corrective actions will be carried out when:
• Clients complain of unsatisfactory service
• Items from suppliers/subcontractors are regularly found to be non-conforming
• Residents’ care records are found to be non-conforming or unsuitable
Deficiencies are highlighted in the Quality System during internal or external audits.
The Person in Control will be responsible for investigating the cause or non-conformances.
Corrective action will take the following stages:
Immediate or direct action taken during any stage of the health care process to resolve the cause of
non-conformances as they occur.
Long-term corrective action relating to Quality of health care. Client and staff complaints are
recorded and actioned and records analysed at regular periods to identify non-conformances and
the related problems which cause them.
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Client Care File
Non-Conformance Log
Internal External Audit
Inspection, Measuring and Testing Records
Client Medication Records
Complaint Records
Inspection and Testing Records
Training Records
11. HANDLING, STORAGE, PACKAGING, PRESERVATION AND DELIVERY.
This system, when recognized by all staff, identifies the ways work routines should be carried out
to prevent and protect employees and clients from injury and the equipment from deterioration,
which can be caused through poor handling.
It ensures that precautions are taken by everyone to prevent these situations from occurring.
Materials such as medication, drugs, food provisions, clothing, bedding and hazardous substances
are kept in strictly controlled conditions such as: safe storage and lifting and handling such
products to conform with the current Health and Safety Legislation. It ensures that the principles
of the stock rotation system are followed:
Any equipment or goods to be returned or repaired should be packed using a method, which will
protect any items during the transportation process.
Transportation of clients should be such that the method used ensures safety and correctness.
All meals delivered to satellite houses are packed and handled to reach clients at the correct food
temperature, adhering to Food Safety Control Act 1995, as amended.
Any incidents of transportation, which adversely affect the individual client, should be recorded
so that suitable methods of transportation can be determined for the individual in future.
Environmental conditions in the Home should be maintained to ensure that the quality of services
and the possessions of individual clients are kept at the level of high standards required by the
management at the Home.
12. CONTROL OF QUALITY RECORDS.
All quality records should be maintained in the appropriate manner by entering them legibly
written, with clarity of detail, correct dates, signed by the person concerned and filed in the correct
place so that easy access can be gained when necessary. For legal reasons these quality records are
proof that all work routines have been carried out in the correct manner and that the quality of
care given has reached the high standards as required by the Health Authority, local authority
guidelines. The management representative maintains a list of all quality records. This includes
details of where records are held. The person responsible ensures that all quality records are
complete and maintained correctly. Any records that leave the building should be recorded and
knowledge of the whereabouts of such records noted by Person in Charge.
A receipt for any records handed over to an outside body should be obtained. For example, in the
case of a client needing hospitalisation a receipt should be obtained for their care plan and
personal file so that these records can be traced.
13. INTERNAL QUALITY AUDITS.
An Internal Audit is necessary to ensure that the quality management system is functioning in the
manner intended.
The person who is responsible for the audit prepares the annual audit schedule outlining the
section of the manual procedures that are to be covered by the audit, then will assign a trained
person to carry out the auditing.
That person will carry out the audit using a previously prepared checklist, the quality procedures
and a current edition of the quality standards.
The health care staff responsible for the area being audited will accompany the auditor.
A check will be made in compliance with the quality procedures and quality manual by
examining the current activities, equipment, selected records and the knowledge of the staff
working in that particular area.
Any non-conformances will be raised in the audit report, listing any corrective actions that are
agreed during the audit.
Meetings between all care staff will be arranged so that the Person in Charge can discuss any
recommended actions requested; agree any changes that have to be made to the system; and will
also ensure that all corrective action is implemented within a reasonable amount of time.
Once all corrective actions have been carried out and completed and a report has been returned, a
follow up audit will be arranged to assess the effectiveness of the actions taken.
This should take place not less than the three months after any actions were implemented,
depending on the seriousness of the noted non-conformances.
All records of the audit reports will be maintained by the Person Administrator and will contain:
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Audit report number.
Area /procedure being audited.
Auditor.
Result of audit non- conforming/conforming.
Actions agreed.
Corrective actions status.
The nominated person to carry out the audit must have the authority of the Person Administrator;
be independent of the area that is to be audited; and have the training and ability to complete the
audit. Each procedure will be audited.
14. TRAINING.
NVQs in Care and Management, Knowledge Sets and In-Service training is given to all staff and is
ongoing at all levels of staff, from care assistants right through to management. This is so the
company can maintain quality standards of care.
The requirements are periodically and systematically reviewed and the policy of investment in
people through appropriate training ensures that training objectives are reached. The aim of InService training is that all staff carries out work tasks and duties relating to each individual’s job
description to the best of their ability, thus reaching a better understanding of what is required
both legally and professionally.
The aim of the Homes’ training programme is to give all trainee care staff the opportunity to
enhance their own knowledge of the care setting and give a better service to the clientele, thus
providing the best possible care to the Home’s clients. Training also gives staff more confidence in
ways to deal with an individual’s needs.
All staff training achievements is recorded after each unit; both support and key trainers giving a
review. An assessment letter and certificate is given after each completed unit. Any comments
made by the trainer are noted in the letter.
Health care staff are only assigned tasks according to their skills, knowledge and experience of
training given after the individual has reached the required competence.
MANAGEMENT UNIT 3
1. ORGANISATIONAL CHART. USE FLOW CHART TO SHOW LEVELS OF AUTHORITY:
WHERE DO YOU FIT IN?
• Senior Care Assistants provide or assist in the managing of housekeeping within the Home.
• They take delegated responsibility to be in charge of the clients under care, to the
appropriate level.
• They manage Care Assistants, and advise qualified staff of situations and concerns.
• They are flexible in working time and practices to ensure continuity of care.
• They keep overall control of all Care Assistants, and are involved in the training of all new
Care Assistants,
• They are responsible to the Manager or Person in Charge Organisational Chart
SPECIMEN ORGANISATIONAL CHART
GENERAL MANAGER
CHEF
REGISTERED MANAGER
KITCHEN STAFF
DEPUTY MANAGER
DOMESTIC SUPERVISOR
MAINTENANCE STAFF
SENIOR CARE
DOMESTIC STAFF
DAY
NIGHT
CARE STAFF
DAY
2. MANAGEMENT MEETINGS.
Who may attend:
• General Manager
NIGHT
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Employee Administrator
Community Nurse/Officer
Registered Manager/ Person in Charge
Site Manager
Community Resource Care Assistant
Senior Care Assistant
Days
• Care Workers/Assistants
Nights
• Care Workers/Assistants
Days
•
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•
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Domestic Supervisor
Gardener
Chef
Kitchen Assistant
Domestic Staff
Laundry Staff
Management meetings are held every three months. The meetings involve the Directors,
Administrator and any other senior members of staff.
The reason for the management meeting is to review the overall effectiveness of the care that is
being provided and to meet the needs required by the people in the care setting.
It includes the top level of the documented quality system, which is assessed and analysed. It also
includes quality policy; quality documents; form purchaser satisfaction; evaluation of internal and
external audits; residents’ complaints and ongoing improvements to the service and applied
quality system; and any other topics that may need to be discussed, e.g. external assessment,
changes to standards, client feedback, complaints and referrals, and measurements of quality care.
Any changes to the service offered, staff training developments and needs, and disposal of quality
records, should be discussed.
Following the meeting any required preventive or correction actions are identified and recorded
in the meeting report.
Any changes or improvements are actioned and when required made binding in the Homes
quality management system. The scheduling of the management meeting is identified on the
internal audit schedule.
3. CARE STAFF MEETINGS.
These meetings are held every six months. All care staff are expected to attend. Also in attendance
will be the Person in Charge and the Administrator who will chair the meeting.
Any problems the care staff may be experiencing will be discussed during the meeting. Nonconformance, if any, will be reported and ways to rectify the situation will be discussed. Any other
problems which staff feel need to be discussed will be noted and reviewed by top management.
All minutes of the meeting are recorded and signed by those present.
4. STAFF HANDOVER MEETINGS.
These meetings are held at the start and finish of every shift. The progress, problems and
occurring incidents in relation to each individual client are discussed with the members of staff
who are resuming duties, so that they are aware of any matter of concern.
Information about any appointments or recreational activities is passed on so that arrangements
can be made for individuals to attend these functions. Any work-related duties which have not
been completed for different reasons are relayed to care assistant. staff as uncompleted.
5. SELECTION AND RECRUITMENT.
The selection of staff is the responsibility of the Nurse Administrator and the directors. All vacant
positions are advertised in the appropriate manner.
Suitable applicants will be required to complete an application form, which must be accompanied
by two references.
During an interview the suitability of the applicant will be determined, taking into account any
previous experience. Where a qualified member of staff is to be recruited the Registered Manager
will check that details provided by the applicant are authentic. This will include registration cards,
and personal identification number with the Nursing and Midwife Council. for nursing.
All referees will be contacted. The successful applicant will be sent a standard letter informing
them of their appointment and will request confirmation in writing of their acceptance with the
date on which they wish to take up the position.
Unsuccessful applicants will be informed by a standard letter from the management.
6. STATISTICAL TECHNIQUES.
Statistical techniques are used to confirm conformance levels in the workplace whilst maintaining
a cost-effective system of Quality Assurance Control. Data collection methods are used to carry
this out. Once sufficient data is collected the information is analysed to help carry out corrective
and preventive actions.
To determine what statistical data analysis is, one must first define statistics. Statistics is a set of
techniques that are used in collecting, analyzing, presenting, and interpreting data. Statistical
methods are used in a wide variety of occupations and help people identify, study, and solve
many complex problems. Statistics is also widely used in the business and economic world.
Statistics makes complex data more understandable to decision makers and managers, who are
then able to make better informed decisions.
There is a lot of information available in today's environment because of continual improvements
in computer technology. To compete successfully and on a global scale, managers and decision
makers need to be able to understand the information collected and use it effectively. Statistical
data analysis provides hands on experience to promote the use of statistical thinking and
techniques to apply in order to make educated decisions in the business world.
Computers play a very important role in statistical data analysis. Studying a problem through the
use of statistical data analysis usually involves four basic steps.
Data such as:
• Accidents
• Violent Incidents
• Staff Sickness and absence
Can show trends, such as accidents, day or night, staff on duty may inform about the nature of
what is going on and how to improve, the same with violent incidents, and with staff sickness and
absence, see that a member of staff takes one Sunday off a month, and analyse that this may be
due to e.g. child care issues.
7. SERVICING.
Servicing is not normally required by any of our purchasers and is not required at the present
time.
Servicing is needed if a purchaser wishes the Home to continue ongoing support for a client who
has completed their contracted programme with the Home. In such a case, following release into
the community, arrangements will be made to visit the client’s home, if needed.
IN HOUSE POLICY AND PROCEDURE.
8. RESIDENT ADMISSION.
In the event of an emergency admission request from a general practitioner or social worker team
that is outside normal office hours, the member of staff taking the call must carry out the
following procedure.
• No client moves into the home without having had his/her needs assessed and been
assured that these will be met.
• New clients are admitted only on the basis of a full assessment undertaken by people
trained to do so, and to which the prospective client, his/her representatives (if any) and
relevant professionals have been party
• As much information as possible should be gained about the client, name of GP, social
worker etc.
• The client will then be admitted as a normal admission procedure.
• The following morning the Person in Charge should notify the professionals involved to
discuss and determine the level of care required.
• The Person in Charge and other professionals will then assess the level of care required.
• During the day the client should be encouraged to spend time looking around the Home.
• Members of staff will observe the client. Observations will be used to form the initial
assessment. This will determine the needs, interaction and suitability of the individual. At
the end of the day the Person in Charge will enter a record of the assessment into the
referral book
• Any concerns or problems will be noted. These will then be discussed with the individual,
the present carer and social worker.
For individuals referred through Care Management arrangements, the registered person obtains a
summary of the Care Management (health and social services) assessment and a copy of the Care
Plan produced for care management purposes. For individuals who are self-funding and without
a Care Management assessment/Care Plan, the registered person carries out a needs assessment
covering:
• personal care and physical well-being;
• diet and weight, including dietary preferences;
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sight, hearing and communication;
oral health;
foot care;
mobility and dexterity;
history of falls;
continence;
medication usage;
mental state and cognition;
social interests, hobbies, religious and cultural needs;
personal safety and risk;
carer and family involvement and other social contacts/relationships.
Each service user has a plan of care for daily living, and longer term outcomes, based on the Care
Management assessment and Care Plan or on the home’s own needs assessment The registered
nursing input required by service users in homes providing nursing care is determined by NHS
registered nurses using a recognised assessment tool, according to Department of Health
guidance.
On admission the person in charge will complete a client file and enter details on the admission
sheet. All the person’s possessions will be listed in the property book, if possible with the client
present. The client will be given the choice of handing in any valuables for safekeeping.
9. DRESSING.
All clients should be encouraged to be as self-managing as possible when required, or in
accordance with the resident’s care file or directed by the Person In Charge. Care Assistant. will
assist the client to dress or undress.
An explanation of the procedures should be given to the client before commencing. Hands should
be washed before and after carrying out the task.
All Care Assistants should follow this procedure wherever possible and practical:
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Assist clients in choosing clothing items.
Prepare clothing and provide privacy.
Be aware of mobility or disability problems.
Assist clients to dress, taking care to minimise stress and pain to any sensitive areas.
Follow correct procedures when removing soiled clothing from area.
Report any changes to resident’s condition to Person in Charge and record on a daily report
sheet.
10. BATHING.
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Ensure all Care Assistants. are aware of which clients need assistance when bathing.
Prepare toiletries and clean garments before commencing.
Explain procedures to clients before commencing.
Wash hands before and after carrying out task.
Assist client when bathing using resident’s preferred method where possible.
Check bath temperature 38° with available thermometer.
Assist with drying, powdering and dressing.
Report any changes in resident’s condition and enter the details in the bath book.
Remove soiled clothing and follow correct procedures.
Ensure all Care Assistants check bath books daily to establish which clients need bathing.
• Ensure all Care Assistants are aware of the correct procedure before bathing a client and are
competent to carry out the task.
11. TRANSFER / DISCHARGE.
All the relevant parties are informed and in agreement with the transfer or discharge. The Home
and the relevant agencies will discuss any disputes. A full case discussion will take place in the
event of the situation not being resolved by the directors of the Home, Social Services, Health
Professionals and any other interested parties. If an agreement has been reached following the
correct procedure, the Person in Charge will complete:
• Resident’s personal profile.
• The admission / discharge sheet.
• The event sheet.
It is the duty of the Person in Charge to ensure that all the resident’s personal possessions, cash
and any valuables are returned to the person. Both the Person in Charge and client should sign the
property book. All administration in relation to the client will then be placed in the previous
residents’ file and placed in the designated place in case of future reference.
12. INFECTION CONTROL.
Infection control and health care epidemiology is the discipline concerned with preventing the
spread of infections within the health-care setting. As such, it is a practical (rather than an
academic) sub-discipline of epidemiology. It is an essential (though often under recognised and
under supported) part of the infrastructure of health care. Infection control and hospital
epidemiology are akin to public health practice, practiced within the confines of a particular
health-care delivery system rather than directed at society as a whole.
Infection control concerns itself both with prevention (hand hygiene/hand washing,
cleaning/disinfection/sterilization, vaccination, surveillance) and with investigation and
management of demonstrated or suspected spread of infection within a particular health-care
setting (e.g. outbreak investigation). It is on this basis that the common title being adopted within
health care is "Infection Prevention & Control".
Hand washing: An easy way to prevent infection
Hand washing is a simple habit that can help keep you healthy. Learn the benefits of good
hand hygiene, when to wash your hands and how to clean them properly.
Hand washing is a simple habit, something most people do without thinking. Yet hand washing,
when done properly, is one of the best ways to avoid getting sick. This simple habit requires only
soap and warm water or an alcohol-based hand sanitizer — a cleanser that doesn't require water.
Do you know the benefits of good hand hygiene and when and how to wash your hands
properly?
The dangers of not washing your hands
Despite the proven health benefits of hand washing, many people don't practice this habit as often
as they should — even after using the toilet. Throughout the day you accumulate germs on your
hands from a variety of sources, such as direct contact with people, contaminated surfaces, foods,
even animals and animal waste. If you don't wash your hands frequently enough, you can infect
yourself with these germs by touching your eyes, nose or mouth. And you can spread these germs
to others by touching them or by touching surfaces that they also touch, such as doorknobs.
Infectious diseases that are commonly spread through hand-to-hand contact include the common
cold, flu and several gastrointestinal disorders, such as infectious diarrhea. While most people will
get over a cold, the flu can be much more serious. Some people with the flu, particularly older
adults and people with chronic medical problems, can develop pneumonia. The combination of
the flu and pneumonia, in fact, is the eighth-leading cause of death among Americans.
Inadequate hand hygiene also contributes to food-related illnesses, such as salmonella and E. coli
infection. According to the Centers for Disease Control and Prevention (CDC), as many as 76
million Americans get a food-borne illness each year. Of these, about 5,000 die as a result of their
illness. Others experience the annoying signs and symptoms of nausea, vomiting and diarrhea.
Proper hand-washing techniques
Good hand-washing techniques include washing your hands with soap and water or using an
alcohol-based hand sanitizer. Antimicrobial wipes or towelettes are just as effective as soap and
water in cleaning your hands but aren't as good as alcohol-based sanitizers.
Antibacterial soaps have become increasingly popular in recent years. However, these soaps are
no more effective at killing germs than is regular soap. Using antibacterial soaps may lead to the
development of bacteria that are resistant to the products' antimicrobial agents — making it even
harder to kill these germs in the future. In general, regular soap is fine. The combination of
scrubbing your hands with soap — antibacterial or not — and rinsing them with water loosens
and removes bacteria from your hands.
Proper hand washing with soap and water
Follow these instructions for washing with soap and water:
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Wet your hands with warm, running water and apply liquid soap or use clean bar soap.
Lather well.
Rub your hands vigorously together for at least 15 to 20 seconds.
Scrub all surfaces, including the backs of your hands, wrists, between your fingers and
under your fingernails.
Rinse well.
Dry your hands with a clean or disposable towel.
Use a towel to turn off the faucet.
Proper use of an alcohol-based hand sanitizer
Alcohol-based hand sanitizers — which don't require water — are an excellent alternative to hand
washing, particularly when soap and water aren't available. They're actually more effective than
soap and water in killing bacteria and viruses that cause disease. Commercially prepared hand
sanitizers contain ingredients that help prevent skin dryness. Using these products can result in
less skin dryness and irritation than hand washing.
Not all hand sanitizers are created equal, though. Some "waterless" hand sanitizers don't contain
alcohol. Use only the alcohol-based products. The CDC recommends choosing products that
contain at least 60 percent alcohol.
To use an alcohol-based hand sanitizer:
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Apply about 1/2 teaspoon of the product to the palm of your hand.
Rub your hands together, covering all surfaces of your hands, until they're dry.
If your hands are visibly dirty, however, wash with soap and water, if available, rather than a
sanitizer.
Personal Protective Equipment - Standard Infection Control Precautions (SICP)
When considering infection control, a risk assessment can be required in order to decide which
PPE is most appropriate for the task/situation, depending on what the wearer might be exposed
to, e.g. blood/other body fluids.
For the purposes of this policy, the PPE described, which might be used in general care settings,
includes:
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Gloves
Aprons/gowns
Face, mouth/eye protection, e.g. masks/goggles.
Theatre/surgery apparel is often more comprehensive due to the risks encountered, e.g. the use of
head and foot wear. Detail on the use of these items is not included within this policy.
WASTE DISPOSAL.
The Environmental Health Protection Act of 1990 states that waste must be disposed of as
follows:
• Black bags – normal household waste.
• Yellow bag – waste destined for incineration, i.e. body waste, used pads, dressings and
soiled tissues etc.
The correct procedure is to ensure that adequate arrangements are made for the disposal of waste.
Arrangements for the prompt collection of waste reduce the risk of infection. White bags should
be placed in the residents’ rooms for household waste by a Care Assistant and removed daily for
disposal. Black bags from the kitchen and tearoom should be removed and disposed of in the skip
provided after every meal.
13. SHARP DISPOSAL POLICY.
A Sharps Box should be available for use at all times. The Managers of the Home sign contracts or
binding agreements for the removal of sharps.
• All sharps should be discarded with minimum handling.
• All sharps should be disposed of in the sharp boxes provided, never in general rubbish
bags.
• All sharp boxes should be sealed when full and stored in a safe place to await collection.
• Needles should not be re-sheathed but placed immediately into sharps boxes.
• If any drips are ever used, they should be reported and recorded using the correct
procedure.
Sharps is a term used to refer to items which may puncture the skin when contaminated with
blood i.e.:
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Needles
Blades
Stitch cutters
Syringes
Ampoules
IV administration sets, blood transfusion sets etc.
The Home are supplied with approved sharps disposal boxes and it will be the responsibility of
the Person-in-Charge to ensure that an adequate supply of boxes are available where required.
Any contract or binding agreement for the removal or supplying of sharps boxes will only be
signed and approved by the managers of the Home.
After use all sharps will be discarded with minimal handling.
Sharps will be put in the sharps boxes provided and not ever in general rubbish bags.
When full, sharps boxes will be sealed and stored in a safe place until collected by the suppliers
and taken for incineration.
Needles will not be re-sheathed, but placed immediately into sharps boxes.
Sharps will never be rammed into sharps boxes.
Should drip sets or the like ever be used they will be disposed of whole.
All accidents involving sharps will be reported to the Person-in-Charge and owners and the
procedure for needle-stick injury will be followed.
14. NEEDLE STICK INJURY.
In the event of a needle stick injury it must be reported immediately Person in Charge.
Needlestick Injury
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Report injury immediately to Person-in-Charge and/or Owner.
Accident Report will be completed.
Person-in-Charge will contact General Practitioner.
Staff member will attend surgery along with, if possible, the identified resident on
whom the needle was used. Blood samples will be taken and tested.
If injury occurs outside normal surgery hours, then staff member will attend the accident
centre of local hospital.
What are needlestick injuries?
Needlestick injuries are wounds caused by needles that accidentally puncture the skin.
Needlestick injuries are a hazard for people who work with hypodermic syringes and other needle
equipment. These injuries can occur at any time when people use, disassemble, or dispose of
needles. When not disposed of properly, needles can become concealed in linen or garbage and
injure other workers who encounter them unexpectedly.
Needlestick injuries transmit infectious diseases, especially blood-borne viruses. In recent years,
concern about AIDS (Acquired Immune Deficiency Syndrome), hepatitis B, and hepatitis C has
prompted research to find out why these injuries occur and to develop measures to prevent them.
Despite published guidelines and training programs, needlestick injuries remain an ongoing
problem.
What are the hazards of needlestick injuries?
Accidental punctures by contaminated needles can inject hazardous fluids into the body through
the skin. There is potential for injection of hazardous drugs, but injection of infectious fluids,
especially blood, is by far the greatest concern. Even small amounts of infectious fluid can spread
certain diseases effectively.
Accidental injection of blood-borne viruses is the major hazard of needlestick injuries, especially
the viruses that cause AIDS(the HIV virus), hepatitis B, and hepatitis C.
The risk of infection after exposure to infected blood varies by bloodborne pathogen. The risk of
transmission after exposure to HIV-infected blood is about 0.3%, whereas it is estimated to be up
to 100 times greater for hepatitis B virus (30%) and could be as high as 10% for hepatitis C virus.
HIV/AIDS
The risk of needlestick transmission of HIV, the virus that causes AIDS, is considerably less than
for hepatitis B virus. Several hundred health care workers have been accidentally exposed, mostly
through needlestick injuries, to blood from patients infected with the HIV virus. As of June 1999,
researchers report that needlestick injuries transmitted HIV to 49 of these health care workers in
the United States. Researchers estimate that needlestick injuries involving blood- contaminated
with HIV can spread the virus in 0.3 percent of cases. Stated another way, 99.7 percent of
needlestick/cut exposures do not lead to infection.
In Canada, the Division of HIV Epidemiology Research, Bureau of HIV/AIDS and STD, Public
Health Agency of Canada, Health Canada, has reported one case of occupational transmission of
HIV that can be clearly linked to a needlestick injury. There have been two other cases of HIV
infection in Canada that have been attributed to possible occupational transmission, both
involving laboratory workers.
A possible occupational transmission occurred to a 75 year old Ontario biochemist who had
worked in many laboratories with blood and blood products. There were no other risk factors
reported.
Another possible occupational transmission occurred to a Quebec laboratory technician in the
early 1990s. This case is still under investigation.
Hepatitis B
The risk of transmission of HBV is reduced by immunization against hepatitis B, which is 90% to
95% effective. The risk of transmission of HBV to susceptible HCWs via a needlestick injury varies
from 1% to 40%.
Because HBV may survive on environmental surfaces for more than a week, indirect exposure to
HBV can occur via contaminated inanimate objects and appears to have been a factor in HBV
outbreaks among patients and staff of hemodialysis units.
Hepatitis C
Needlestick injuries may also transmit hepatitis C. The risk factors for hepatitis C virus
transmission in occupational settings is 1.8% (range 0% to 7%).
Needlestick injuries have transmitted many other diseases involving viruses, bacteria, fungi, and
other microorganisms to health care workers, laboratory researchers, and veterinarian staff. The
diseases include :
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Blastomycosis
Brucellosis
Cryptococcosis
Diphtheria
Cutaneous gonorrhea
Herpes
Malaria
Mycobacteriosis
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Mycoplasma caviae
Rocky Mountain spotted fever
Sporotrichosis
Staphylococcus aureus
Streptococcus pyogenes
Syphilis
Toxoplasmosis
Tuberculosis
Many of these diseases were transmitted in rare, isolated events. They still demonstrate, however,
that needlestick injuries can have serious consequences.
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An accident report form should be completed.
The general practitioner must be informed.
The staff member involved will be sent to the surgery for a blood test.
If possible the client from whom the needle came should be identified.
If injury takes place outside office hours then the member of staff concerned will be sent to
the local accident centre.
15. HEALTH SPECIALIST CLINIC.
It is the Home’s policy to hold a weekly GP clinic at the Home. Clients who require treatment at
other times or any urgent matters are treated at the GP’s surgery.
The senior members of staff make the arrangements.
Residents’ names are to be written in the Home appointment diary on the appropriate day:
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If it is felt the client should be seen.
If the client is due to be seen for a review or annual check-up.
If a client requests to be seen the clinical examination couch, medical notes and any other
items should be available for use. A senior member of staff should remain in the clinic and
take notes and record outcomes on each resident’s medical form. Write the names for next
appointments in the diary where appropriate, and make relevant entries on the client
annual medical list. Any changes to medication should be entered on the medication
administration record and depot injection chart.
A checklist of the residents’ medical notes should be made every night and entries made on the
residents’ medical notes checklist where relevant. If any medical notes are removed from the
Home, the details should be entered in the record of residents’ medical notes book. This should
then be signed when the notes have been returned to the Home.
16. CHIROPODY
Any clients who require chiropody treatment are entered in the chiropody book. The GP should
be informed if any person requires any treatment, who will then complete the required
arrangement forms. Arrangements will then be made for the client to attend the chiropody clinic
for treatment.
Chiropody Clinic
It will be the responsibility of the Person-in-Charge to ensure that the names of residents requiring
chiropody treatment are entered in the Home's Appointment Diary on a G.P Clinic day.
The General Practitioner will complete the required paperwork and the Nurse-in-Charge will
make an appointment for the resident to visit the chiropodist. If required, the Person-in-Charge
will arrange for the chiropodist to visit the Home.
If required, the Nurse-in-Charge will be responsible for providing a warm comfortable room for
the Chiropodist to carry out the treatment and arranging that residents are available.
17. OPTICIAN
The optician contacts the Home every six months to make an appointment to visit and list the
clients who require eye tests. An entry should then be made in the Home appointment diary,
including any clients who have experienced eye problems or have requested eye tests. All clients
who have an appointment should be informed and members of staff should ensure that
individuals are available to be seen. A warm comfortable room should be made available for the
use of visiting opticians to hold the clinic.
18. CONTROL OF CLIENTS MEDICATION.
Client’s, where appropriate, are responsible for their own medication, and are protected by the
home’s policies and procedures for dealing with medicines.
The registered person ensures that there is a policy and staff adhere to procedures, for the receipt,
recording, storage, handling, administration and disposal of medicines, and client’s are able to
take responsibility for their own medication if they wish, within a risk management framework.
The client, following assessment as able to self-administer medication, has a lockable space in
which to store medication, to which suitably trained, designated care staff may have access with
the service user’s permission.
Records are kept of all medicines received, administered and leaving the home or disposed of to
ensure that there is no mishandling. A record is maintained of current medication for each client
(including those self-administering).
Medicines in the custody of the home are handled according to the requirements of the Medicines
Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of
Drugs Act 1971 and nursing staff abide by the UKCC Standards for the administration of
medicines.
Controlled Drugs administered by staff are stored in a metal cupboard, which complies with the
Misuse of Drugs (Safe Custody) Regulations 1973.
Medicines, including Controlled Drugs, for client’s receiving nursing care, are administered by a
medical practitioner or registered nurse.
In residential care homes, all medicines, including Controlled Drugs, (except those for selfadministration) are administered by designated and appropriately trained staff. The
administration of Controlled Drugs is witnessed by another designated, appropriately trained
member of staff.
The training for care staff must be accredited and must include:
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basic knowledge of how medicines are used and how to recognise and deal with problems
in use;
the principles behind all aspects of the home’s policy on medicines handling and records.
Receipt, administration and disposal of Controlled Drugs are recorded in a Controlled Drugs
register. The registered manager seeks information and advice from a pharmacist regarding
medicines policies within the home and medicines dispensed for individuals in the home.
Staff monitor the condition of the client on medication and call in the GP if staff are concerned
about any change in condition that may be a result of medication, and prompt the review of
medication on a regular basis.
When a client dies, medicines should be retained for a period of seven days in case there is a
coroner’s inquest.
All medication should be ordered one week prior to the end of each month. All medication stocks
should be checked prior to ordering. Any changes to a client’s medication during the month
should be entered on the client’s medication and medical administration records.
A dispensing chemist is responsible for collecting the medical administration records from the
home and delivering them to the GP surgery. He/she will also collect prescriptions for dispensing.
In the case of any medication that can only be prescribed by a consultant, a member of staff will
collect the medication from an authorised chemist.
19. DISPENSING CHEMIST, DELIVERY AND DISPOSAL OF MEDICATION.
The Boots dispensing chemist will deliver all medications to the Home in sealed bags. The bag
tags should then be halved, the appropriate part of the tag sent to the chemist and the remaining
part placed in the relevant file. All clients’ medication administration records should be arranged
in alphabetical order and placed in the relevant drugs’ files. Any medication that is unusual will
be collected at the end of each month for disposal by the dispensing chemist.
20. ADMINISTRATION OF CLIENT MEDICATION
Administration of a client’s medication is the responsibility of the Person in Charge. The Person in
Charge will be a registered or enrolled nurse and must hold a current up-to-date drugs certificate.
On the administration of medication the prescription issued by the GP must be used. A check
should be carried out before administration as follows:
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The resident’s name.
The correct drugs.
The correct route.
The correct dosage, i.e. tablet or liquid.
The medication and administration records must be signed when a client has taken the
medication. If medication has been refused for any reason, the correct entry must be recorded
using the appropriate codes, which are listed at the bottom of the sheet.
The member of staff administering the medication should always be aware of any possible sideeffects or hypersensitive reactions to medication that can occur and take the required action. After
all medication has been administered, it should be kept in the locked cupboard in the main office,
which is locked at all times when vacant.
The client must not be forced to take medication for legal reasons. This can constitute an assault on
the person, the exception being a section on the person (Mental Health Act) when the law states
that administration of medication can be given forcefully in extreme circumstances.
All completed administration records should be retained for a period of three years and filed in a
suitable location, as a quality record is a legal requirement.
21. ADMINISTRATION OF DEPOT / INTRA-MUSCULAR MEDICATION.
An intramuscular injection is a “shot” of medicine given into a muscle. A syringe with medicine in
it, is attached to a needle. The needle goes through the skin and into a muscle. The medicine is
pushed into the muscle by pressing on the syringe plunger. When the medicine has been pushed
into the muscle, the needle is removed.
This medication is prescribed for the client by the GP. It is ordered in the same way as all other
medication. Depot injections are administered at the prescribed frequency.
Before administration a check should be made:
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The correct client is identified.
The correct dosage should be drawn up.
The correct solution is used.
Medication should be administered at the prescribed times.
For correctness of medication a check should also be made of the resident’s medication
administration record, depot chart and Home diary. After administration of medication an entry
should be made on the appropriate documentation of details, medication dose and frequency,
name and injection given, and forwarded in the Home diary.
22. LAUNDRY.
All soiled laundry should be collected from each resident’s rooms every morning and taken to the
laundry room in the white bags provided in the Home by the Care Assistant on the. day shift.
Towels and face flannels should be collected by Care Assistant on the night duty shift, following
the same procedure.
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All soiled laundry should be laundered separately using the sluice option on the machine.
Kitchen and laundry areas will be washed separately at the end of each shift by domestic
staff
Laundry assistants are responsible for ironing.
Laundry assistants are responsible for distribution of laundry during the day, and placing
the correct laundry back in the residents’ rooms in drawers and wardrobes.
23. RECREATIONAL ACTIVITIES.
All clients should be encouraged by the Home members of staff to follow all their normal
activities, interests and religious beliefs providing they are not a risk to themselves or others, or a
nuisance to the other clients and Care Staff.
All members of staff should take appropriate actions to facilitate clients who follow identified
activities i.e. Day Centre, MIND, Y.M.C.A., Albemarle Centre etc. Care staff should acquaint
themselves with any activities within the home, giving assistance when needed and encouraging
all clients to participate if they so wish.
The programme of recreational activities should be displayed in a prominent place and Care Staff
should make a list of people who wish to participate.
All clients should be informed of the selection of board games that are available for use within the
Home.
24. BUILDINGS AND MAINTENANCE.
The Home’s managers inspect all the Home’s properties internally and externally, including
fixtures, fittings and furnishings, for signs of deterioration and wear. All Care Staff are instructed
to take note of any damage or deterioration of the Home’s contents during their normal duty
hours.
If a member of staff observes any maintenance fault then this should be reported in writing on the
Home’s maintenance forms and submitted to the site manager, who will take the appropriate
action to rectify the fault.
The site manager will collect the maintenance forms daily and return a form for filing when the
job has been completed.
The form will have written details about the fault and be signed and dated by the Site Manager.
All contractors are required to provide a written quotation for all work. When the work has been
completed the site manager and director will check that the work reaches the required standard.
The original quotation is checked with the final invoice and filed for future reference.
25. CARE OF THE DYING / DEATH.
Care of a dying client should be carried out with respect and dignity at all times. If the death of a
client was expected, the doctor who attended the deceased during their final illness would be
contacted by the Person in Charge. If the doctor is able to certify the cause of death he/she will
issue:
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A medical death certificate stating the cause of death, in a sealed envelope addressed to the
registrar.
A formal notice stating that the doctor has signed the death certificate, and an explanation
of what has to be done to register the death.
The death should be registered in the district in which it took place. In the event of an
unexpected death the following professionals and relatives must be informed immediately:
The resident’s G.P., the next of kin, the deceased person’s minister of religion, the police and the
social services /health authority inspector. (Within 24 hours of death).
The Person in Charge will have to complete written notes regarding the circumstances of death as
soon as possible after the death has occurred.
The Home Managers will only arrange the funeral if it is specifically required by the relatives of
the deceased, or if the deceased has no next of kin.
26. CLEANING THE HOME.
The overall responsibility – The Homes Managers
Task responsibility – Care Staff / Kitchen Staff / Domestic Staff / Laundry Staff
It is the senior care assistant’s responsibility to ensure that the Home is kept clean to the standard
required. It will be the duty of the all staff to ensure that all cleaning tasks set out on the daily
work sheet are carried out effectively by themselves and all other staff, and to report any nonconformances to the Person in Charge in the case of the task repeatedly not being carried out in
the appropriate manner.
27. TELEPHONE POLICY.
The telephone should be answered before the sixth ring. State politely and clearly who you are
and enquire who the caller is. If the caller wishes to speak to another member of staff or a client
ask if the caller will hold the line whilst you transfer the call or try to locate the person.
If that person is unavailable inform the caller of the situation and ask if they would like to leave a
message.
Ensure that the telephone message book is available in order to write down the message. If it is
not readily available ensure the caller knows this and politely ask the caller to hold while you
obtain the item.
28. MESSAGES.
Write down the caller’s name and telephone number. Establish whom the message is for, the
urgency of the call, and any time limit for reply/response.
Always repeat the message back to the caller to confirm the message and reduce any
misunderstandings.
Thank the caller and reassure them that the message will be passed on as soon as possible.
Make sure messages are written clearly and legibly.
Point the message out to the person concerned to ensure the message has been seen and noted.
All enquiries in relation to a client should be referred to the Person in Charge.
Any personal information in relation to staff or clients should not be discussed with the caller
without prior consent from the individual concerned.
29. REASONS FOR QUALITY SYSTEMS
Quality Assurance requires establishing a culture of quality, maintaining and changing
expectations and the needs of the market (client consumer etc…) A culture of quality will initiate
continuous improvement of the service, ensuring staff development in areas of skills and attitude
and an ethos of positive change management. Quality Assurance will only be achieved if there is
consistent management commitment to the process and give support to their staff. Quality
standards need to be identified and monitored in order to achieve the highest levels of service.
Three ways of showing how quality will affect client management are thus:
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Ensure good recruitment of quality staff
Client choice and needs are met
The physical environment is maintained to the highest standards
Quality control is the manner to which services are provided, maintained and monitored
consistently according to the Quality Standards set. This can be done by:
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Regular inspections of quality controls in the area of work identified
Ensuring standards and specifications that meet requirements
Monitoring and auditing to maintain compliance of the system
Providing statistical control to maintain services at the highest level
31. CONTROLLED AND UNCONTROLLED POLICY AND PROCEDURE MANUALS.
All copies of the quality manuals issued will be marked “controlled” on inside cover. The Nursing
Administrator maintains a list of all holders of controlled quality manuals, the date of issue and
the manual issue status.
Where the manual has been revised and parts of the complete manual have been reissued, the
Administrator records the changes so that all obsolete copies are taken out of circulation.
There are no uncontrolled copies at present. In the case of uncontrolled copies these would have to
be stamped “uncontrolled” and where the manual has been revised any person with an
uncontrolled copy would not be made aware of amended issues.
32. EXTERNAL QUALITY AUDITS – WHO IS INVOLVED AND HOW OFTEN.
The Care Quality Commission makes 2 Inspection visits per year
The Environmental Health Office visita annually
The Food Hygiene Officer visits annually
External audits take place every six months by S.G.Yardley Ltd. These are announced visits.
External audits are conducted by an outside professional who will come to the Home for the day
and check that all quality systems and procedures are being carried out in the appropriate
manner, e.g. documentation, medication etc.
33. UNDERSTANDING QUALITY STANDARDS, REASONS FOR IMPLEMENTATION
National Minimum Standards
There are National Minimum Standards for Care Homes for Older People, which form the basis
on which the Care Quality Commission will determine whether such care homes meet the needs,
and secure the welfare and social inclusion, of the people who live there.
These national minimum standards set out in this document are core standards which apply to all
care homes providing accommodation and nursing or personal care for older people. The
standards apply to homes for which registration as care homes is required.
While broad in scope, these standards acknowledge the unique and complex needs of individuals,
and the additional specific knowledge, skills and facilities needed in order for a care home to
deliver an individually tailored and comprehensive service.
ISO 9000
ISO 9000 is a family of standards for quality management systems. ISO 9000 is maintained by ISO,
the International Organization for Standardization and is administered by accreditation and
certification bodies. The rules are updated, as the requirements motivate changes over time.
Some of the requirements in ISO 9001:2008 (which is one of the standards in the ISO 9000 family)
include
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a set of procedures that cover all key processes in the business;
monitoring processes to ensure they are effective;
keeping adequate records;
checking output for defects, with appropriate and corrective action where necessary;
regularly reviewing individual processes and the quality system itself for effectiveness; and
facilitating continual improvement
Investor in People
Investors in People is the National Standard for the effective development of people to improve
organisational effectiveness. First developed in 1991, the Standard quickly established itself as the
UK’s most popular and effective model for people development. Such has been its success that, at
the time of writing this guide, almost 40’000 organisations of all sizes and across all sectors have
achieved accreditation (termed Recognition) against the Standard. Approximately 40% of the
UK’s workforce is now working for an organisation, which has achieved or is seeking Recognition
as an Investor in People.
However, the Standard has not stood still. Developed by employers for employers, it was first
produced in consultation with a number of successful organisations, and therefore based on those
key characteristics, which distinguish leading edge employers. It has continued to be developed
through research and consultation, at three yearly intervals. The Standard focuses more on the
outcomes of development processes, rather than the processes themselves, which reinforces its
demanding but non-prescriptive nature. It is a framework, which helps you to take a structured
approach to setting and communicating organisational goals and developing your people to meet
these goals - in the way that best suits the needs of your organisation.
The Standard is based on three principles
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Plan
Developing Strategies to Improve Performance
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Do
Taking action to Improve the Homes Performance
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Review
Evaluate the Impact of the Performance of the Home
Total Quality Management (TQM)
Total Quality Management (TQM) is a business management strategy aimed at embedding
awareness of quality in all organisational processes. TQM has been widely used in
manufacturing, education, hospitals, call centres, government, and service industries, as well as
NASA space and science programmes
Total Quality Management is the organisation-wide management of quality. Management
consists of planning, organizing, directing, control, and assurance. Total quality is called total
because it consists of two qualities: quality of return to satisfy the needs of the shareholders, or
quality of products.
As defined by the International Organization for Standardization (ISO):
"TQM is a management approach for an organization, centred on quality, based on the
participation of all its members and aiming at long-term success through customer satisfaction,
and benefits to all members of the organization and to society.".
MANAGEMENT UNIT 4.
QUALITY FORMS
1. REFERRALS FORMS
Senior members of staff complete this form when a referral for care is inquired for a prospective
client of the Home. All a prospective person’s details, such as GP, Social Worker are entered on
the form.
2. PRE-ADMISSION ASSESSMENT.
This form is completed when a senior member of staff has carried out an assessment prior to
admission, to establish whether the Home can offer suitable care needed to cater for the client’s
needs. Personal information regarding the individual is entered on the form. It will include the
present mental state of the individual concerned.
3. INITIAL ASSESSMENT FORM.
This form is completed by the Person in Charge prior to the end of a resident’s trial period at the
home. This form is then used to formulate a care plan for the individual concerned. It details
information regarding the client. – physical information (self care and hygiene needs), appearance
and physical health – to establish care needed.
4. ADMISSION / DISCHARGE.
These forms are completed when a client is admitted to the Home or discharged from the Home.
This form is used to record each individual resident’s D.O.A.: where they are admitted from,
admitted by whom, discharge address, and discharge by whom and at what date.
5. ADMISSION PROCEDURE CHECK LIST.
This form is used to ensure that the policy procedures for admission are carried out in the correct
manner. Whoever admitted the client must tick the list of procedures as proof that the task has
been carried out, sign and date the forms when completed and file the forms in the designated
place.
6. CLIENT PERSONAL PROFILE.
This form details each individual resident’s personal information e.g. marital status, religion, GP,
Social Worker, Next of Kin, addresses, telephone numbers, diet, types of medication. This is used
in the event of a missing person, discharge, and death. At a glance it summarises the past and
present history of the client.
EXAMPLE PERSONAL PROFILE
Client Name
Date Of Birth
Telephone No.
_____/_____/_____
Address1
Next of Kin Name
Preferred Form Of
Address
Main Carer Or Person
Closest To User
Registered Manager
Address2
Address1
Name
Care Plus1
Address3
Address2
Address1
Minehead Road
Post Code
Address3
Address2
Taunton
Date of Admission
Post Code
Address3
Somerset
Telephone
Post Code
TA2 6NS
Telephone
01823 270845
G.P.
Date of
____/_____/_____
Social Worker/ CPN Name
Address1
Section 117 Y [ ] N [ ]
Address2
Discharge/Transfer
Address3
Medication on
Address1
_____/_____/_____
Admission
Post Code
1
Address2
Transferred To:
Telephone No
2
Address3
Address1
3
Post Code
Address2
Admission Authorisation
4
Telephone
Address3
Name
5
Address2
Depot Injection
Address3
Post Code
Date of Next Review
Telephone
Transfer Authority
Post Code
Every
7. CLIENT CONTRACT.
This form is a statement by the Home underlining the intention to provide a comfortable and
happy home suited to each individual requirement. The form states what the Home provides.
That fees paid to the Home include food and drink, heat, light, laundry facilities, occupational
therapy and toiletries. It also informs the client of things that the fees do not cover i.e.,
newspapers, hairdressing, dry cleaning, dentist or opticians, clothing, etc. Any information the
client needs to know about the Home is found in the service specification contract, which is made
available to all new clients.
Each client has a written contract/statement of terms and conditions with the home.
Each client is provided with a statement of terms and conditions at the point of moving into the
home (or contract if purchasing their care privately).
The statement of terms and conditions includes:
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rooms to be occupied;
overall care and services (including food) covered by fee;
fees payable and by whom (client, local or health authority, relative or another);
additional services (including food and equipment) to be paid for over and above
those included in the fees;
rights and obligations of the client and registered provider and who is liable if there
is a breach of contract;
terms and conditions of occupancy, including period of notice (e.g. short/long term
intermediate care/respite).
8. CLIENT EVENT SHEET.
The client event sheet is used to record any untoward incidents or violent behaviour. If during
their period of duty Care Staff makes an entry on the event sheet it must be countersigned by the
Person in Charge as soon as possible. At the end of each week the Person in Charge will complete
the event sheet in each resident’s file, detailing the relevant occurrences, which have taken place
during the week.
9. CLIENT’S CARE PLAN
This form is used to record the resident’s plan of care. It includes problems that the client may
have and what actions need to be taken e.g. personal hygiene, unreasonable behaviour etc. All
staff must comply with any noted actions taken during the treatment of the individual.
The client’s health, personal and social care needs are set out in an individual plan of care.
A client plan of care generated from a comprehensive assessment is drawn up with each client and
provides the basis for the care to be delivered. The client’s plan sets out in detail the action which
needs to be taken by care staff to ensure that all aspects of the health, personal and social care
needs of the client are met.
The client’s plan meets relevant clinical guidelines produced by the relevant professional bodies
concerned with the care of older people, and includes a risk assessment, with particular attention
to prevention of falls. The client’s plan is reviewed by care staff in the home at least once a month,
updated to reflect changing needs and current objectives for health and personal care, and
actioned.
Where the client is on the Care Programme Approach or subject to requirements under the Mental
Health Act 1983, the client’s plan takes this fully into account. The plan is drawn up with the
involvement of the client, recorded in a style accessible to the client; agreed and signed by the
client whenever capable and/or representative (if any).
10. CLIENT’S EVALUATION SHEET.
This form is used to record any interview if a client was not in compliance with their plan of care
and the evaluation of any action taken, to determine whether intervention has had any effect on
the situation.
11. MISSING PERSON.
In the event of a missing person the Person in Charge must complete a missing persons form. All
details concerning the client must be entered on the form. A full description is given of the missing
person; the date and time they became missing; the time the police and relatives were informed;
any warning signs the client may have exhibited; and at what times, if necessary, any other
professional service involved in the ongoing care of the client was informed. If the client is found,
the place, date and time must be entered, and also who has been notified since the client was
found.
12. INJECTION CHART.
This form is used for individual clients who are prescribed injections. Once administered, the
details are recorded in writing stating the date, injection route and frequency. The person
administering the injection signs the chart so that other members of staff are aware of when the
last injection was given.
13. WEIGHT CHART.
This form is used to record each individual’s details – what their name is, how much the person
weighs, the date weighed and which Home the person resides in.
14. VITAL SIGN CHART.
This form is used to detail the vital signs of a client in the case of the illness. Checks of the person
are made at regular intervals: temperature, pulse and respirations, B.P., stools passed,
input/output and any tests that have been carried out.
15. CLIENTS FINANCIAL FORMS
The weekly cash audit sheet is used if a client has made a request for the Home to hold cash for
safekeeping on their behalf. The date, amount of cash held and amount returned are signed by
both staff and the client and the amount in balance after the transaction signed and confirmed by
the person giving out the cash and the night staff Person in Charge who will check the balance at
the end of the day.
Service users’ financial interests are safeguarded by:
The registered manager ensures that clients control their own money except where they state that
they do not wish to or they lack capacity and that safeguards are in place to protect the interests of
the client.
Written records of all transactions are maintained. Where the money of individual clients is
handled, the manager ensures that the personal allowances of these clients are not pooled and
appropriate records and receipts are kept. The registered manager may be appointed as agent for
a client only where no other individual is available. In this case, the manager ensures that:
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the registration authority is notified on inspection;
records are kept of all incoming and outgoing payments.
If the manager is to be an appointee for social security purposes, the DSS is given appropriate
notice. Secure facilities are provided for the safe-keeping of money and valuables on behalf of the
client. Records and receipts are kept of possessions handed over for safe keeping.
16. SERVICE USERS GUIDE
Prospective clients have the information they need to make an informed choice about where to
live.
Client’s and their representatives are given information in writing in a relevant language and
format about how to contact the local office of the Care Quality Commission and local social
services and health care authorities.
The registered person produces and makes available to clients an up-to-date statement of purpose
setting out the aims, objectives, philosophy of care, services and facilities, and terms and
conditions of the home; and provides a clients’ guide to the home for current and prospective
residents. The statement of purpose clearly sets out the physical environment standards, and a
summary of this information appears in the home’s client’s guide.
The client’s guide is written in plain English and made available in a language and/or format
suitable for intended residents and includes:
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a brief description of the services provided;
A description of the individual accommodation and communal space provided;
relevant qualifications and experience of the registered provider, manager and staff;
the number of places provided and any special needs or interests catered for;
a copy of the most recent inspection report;
a copy of the complaints procedure;
clients’ views of the home;
17. STATEMENT OF PURPOSE
The home has a statement of purpose setting out its aims and objectives, the range of facilities and
services it offers to residents and the terms and conditions on which it does so in its contract of
occupancy with residents. In this way prospective residents can make a fully informed choice
about whether or not the home is suitable and able to meet the individual’s particular needs.
Copies of the most recent inspection reports should also be made available. The statement of
purpose will enable inspectors to assess how far the home’s claims to be able to meet resident’s
requirements and expectations are being fulfilled. While it would be unreasonable and
unnecessary to expect every home to offer the same range of facilities and lifestyle, older people
do want a range of choice when they decide to move into a care home. By requiring proprietors to
‘set out their stall’, the problem of leaving choice to chance is overcome. There can be no room for
doubt either on the part of the prospective resident, the inspector or the proprietor. In this way
diversity and range of choice across the care home sector can be maintained. For example:
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If the home says it provides for the needs of people with dementia, it will have to make
clear in the prospectus how this is done – for example, small group living and structured
activities, with décor and signage helpful to people with dementia;
if a home says it can cater for the needs of Muslim elders whose first language is not
English, it must show that it can do so by, amongst other things, showing that it can
prepare and provide halal food, offer links with the local mosque and provide appropriate
washing facilities and demonstrate that it employs staff who speak appropriate languages;
a home will make clear in its information materials whether it aims to offer residents a
family-like environment at one end of the spectrum, or whether it offers hotel-style
accommodation where residents live more independently from one another at the other.
The key must be the choice and the opportunity to exercise choice. This can only be
achieved if full information is provided.
18. CLIENT SICK NOTE.
A sick notice is completed in the event of a client being seriously ill. These are sent to inform a
client’s relatives or minister of any urgency, advising the relative and minister to visit the client. In
serious cases i.e. urgent or seriously ill, an immediate visit, Type “B”, will be ticked. A Type “A”
visit advises relatives to visit as soon as possible and will be ticked in less urgent circumstances.
19. DIARY
The diary is an important book which indicates activities that may be planned on a particular date,
or forward plan activities. Appointments and meetings are also recorded here.
20. PERSON IN CHARGE HAND-OVER REPORT.
This is a list of all the people who are receiving care at the Home. Any changes regarding an
individual are entered on the report. This report is read out to members of staff resuming duty so
that they are aware of any incidents that have occurred relating to individuals during the shift.
21. SUPERVISION FORMS
The Manager/Owner who is the Person in Control has overall Responsibility for the actions and
Activities that happen within the Home.
Actions and Activities may be delegated the others where knowledge, experience and
appropriateness are applicable.
Each Individual is responsible for their actions and activities as defined within their Job
Description.
The Home operates a Key Worker System and staff will be allocated residents for Care input.
This means each member of staff will have specific responsibilities to certain residents but does
not mean to the determent of others, so where there is a need and a carer is available are
available, that clients needs are catered for.
At no time will any individual take on responsibilities beyond their role, experience or
knowledge level.
Any issues that are not understood by the individual are to be passed to the appropriate person
for guidance.
Managers will meet with staff on a regular basis and review their training, development needs
and their progress within the Home.
Managers will meet on a regular basis and report on actions and activities and address any
issues that need improving on.
Care staff will meet with Managers on a two monthly basis or more where appropriate to
address any issues brought to light, and conversely bring to the attention of the Care staff any
issues that may need discussion and improvement.
At any time, where issues are raised, individual one to one meetings will take place with the
view for improvement in performance or training needs to resolve situations.
Each member of staff should know who their immediate Manager is and if there are issues they
should be raised with that Manager. Where there are serious concerns that affect the welfare of a
client then it may be necessary to inform the most senior Manager immediately. This must not be
an excuse for not going through procedure.
An Organisational Chart is available to show the Management Structure of the Home and this is
found in the office.
Where issues fail to be resolved, a Staff Improvement Advice Form will be used for corrective
actions. Where the issues are deeper and more fundamental, Disciplinary Action may be taken to
seek improvement. This may range from a Verbal Warning, to a Written Warning to Instant
Dismissal in extreme cases. Min
The aim of supervision is to provide a regular opportunity for staff members with their manager
to meet and discuss issues relevant to work activities
22. CARE STAFF WORKSHEET.
This form should be completed daily at the end of each shift and signed by Care Staff Any tasks
that have been carried out during the day should be ticked to confirm that they have been carried
out.
23. CARE STAFF DAILY REPORT.
This form is completed and signed at the end of each shift. It is used to make any comments or
remarks and any concerns staff may have about individual clients during their span of duty.
24. ACCIDENT REPORT.
A member of staff completes this form if an accident has occurred. All the details of the incident
are recorded on the form which is dated and signed by the individuals involved, i.e. witnesses, the
person who had the accident, details of the accident and any actions taken.
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The Person-in-Charge will be notified immediately when an accident occurs.
When accidents of a minor nature occur the injury can be dealt with at the Home using the
First Aid Kit.
When accidents/injuries occur of a more serious nature, the injured party will be escorted to
the nearest Hospital Casualty Department.
In situations requiring ambulance assistance, the Nurse-in-Charge will dial 999 and give all
information required, clearly and calmly. A member of staff will escort the injured party
with the ambulance crew.
In all cases, the Person-in-Charge will complete an Accident Report Record, enter the details
in the Accident Book and place copies in relevant files.
Where appropriate, the Person-in-Charge will inform the Administrator and/ or owners.
Next of kin will also be informed if accident/injury is of a serious nature.
25. COMPLAINTS FORM.
These forms are used in the event of both members of staff or clients who wish to make a
complaint; with the date and time the complaint was made. A description of any actions taken to
resolve the complaint should be entered on the form, in the event of a complaint being of a serious
nature. Details of whom else have been informed of the complaint if necessary or specifically
requested by complainer should be noted, i.e. police, head of Home, family etc. The signature of
Person in Charge and any other member of staff who was in attendance when the complaint was
made and the date should be entered on the form.
Clients and their relatives and friends are confident that their complaints will be listened to, taken
seriously and acted upon.
The registered manager ensures that there is a simple, clear and accessible complaints procedure
which includes the stages and timescales for the process, and that complaints are dealt with
promptly and effectively.
The registered person ensures that the home has a complaints procedure which specifies how
complaints may be made and who will deal with them, with an assurance that they will be
responded to within a maximum of 28 days.
A record is kept of all complaints made and includes details of investigation and any action taken.
The registered person ensures that written information is provided to all clients for referring a
complaint to the Care Quality Commission at any stage, should the complainant wish to do so.
26. UNTOWARD / VIOLENT INCIDENT FORM.
These forms are completed in the case of untoward / violent incidents occurring within the Home.
The member of staff present at the time of the incident should report the matter to a more senior
member of staff immediately. All the details leading up to the incident; any precipitating factors;
action taken at the time; if assistance was required; and nature of injury, if any, should be recorded
on this form stating time and date of incident. Time and date must be noted if any outside agency
was informed.
27. MAINTENANCE FORM
Where repairs are needed, for maintaining standards, or for Health and Safety reasons the
relevant person fills out a maintenance form. There is a box for emergencies and one for routine
maintenance. All emergencies are dealt with immediately. The Site manager writes on the form
what he has done and the form is then filed in a Maintenance File.
28. RECREATIONAL PROGRAMME
There is a weekly Recreational Programme that clients can take part in, it is posted weekly and
Care Staff take part in the programme with clients. The form is filled in with what took place, at
what time, with whom and what staff were attending.
29. NEEDS ASSESSMENT FORMS
For clients who are self funding, the registered manager carries out a needs assessment covering:
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personal care and physical well-being;
diet and weight, including dietary preferences;
sight, hearing and communication;
oral health;
foot care;
mobility and dexterity;
history of falls;
continence;
medication usage;
mental state and cognition;
social interests, hobbies, religious and cultural needs;
personal safety and risk;
carer and family involvement and other social contacts/relationships.
30. SUPPLIER QUALITY QUESTIONNAIRE.
This form is sent to a prospective supplier of the Home. It will be necessary for the form to be
completed by the person in charge of the firm’s quality assurance in order to be placed on The
Home’s approved list of quality suppliers. The form lists a number of questions that need to be
answered to determine the reliability of the firm concerned. This helps to establish the type of
products and the quality of the products that the firm is offering to supply to the Home.
31. DOCUMENT CHANGE NOTE.
This form is completed if a member of staff wishes to propose a change to a document or data in
the Home’s quality systems manual. Their request should be made in writing. The document
name, details of change and reason for change should be entered on the form and submitted to the
Nurse Administrator for consideration.
32. SUPPLIER NON-CONFORMANCE LOG.
This form is used to report any faults with goods that have been supplied to the Home. A record
of the supplier, fault, who the fault was reported to, corrective action taken, who reviewed the
complaint and any further action that may be required is all entered on the form, which is signed
and dated by the persons concerned.
33. EQUIPMENT – LISTING FORM.
Any equipment that is being used by the Home is tested on a regular basis to ensure that the
equipment is safe to use. All equipment that has been tested is listed on the form. Various details
are entered on the form, i.e. equipment type, equipment number, date tested and whether the
equipment has passed or failed its inspection to conform with the health and safety regulations.
34. PREVENTIVE CORRECTIVE ACTION REPORT.
This form is used to record any non-conformance in the workplace. The agreed corrective action,
what date the corrective action was reviewed to establish whether the action taken corrected the
non-conformance, whether the matter was rectified, and any comments made are entered for
future reference, dated and signed.
35. AUDIT REPORT SHEET.
This form is to report any noted non-conformances and is completed by the designated person
who audited an area or procedure in relation to the quality system maintained by the Home. This
audit report sheet is submitted to the Nursing Administrator who will ensure that the nonconformance is rectified following the correct procedure.
36. SUMMARY OF AUDIT NON-CONFORMANCE.
This form is used to list any non-conformances that have been observed in relation to the running
of the quality system within the Home. Any noted non-conformances are entered on the form
against the element and criteria of the BS EN ISO 9002, the level of the non-conformance is entered
and any observations and comments that have been made are reported in writing for future
reference.
37. AUDIT SCHEDULE.
This form is used to record the audit schedule for the year, listing the procedures that are carried
out within the Home. At a glance it will provide detailed information relating to the auditing that
has taken place i.e. audit due, audit completed, whether a non-conformance was raised, which
month the audit took place and when it was completed.
38. AUDIT CHECKLIST.
This form is completed by a designated person and is to check that a procedure has been audited.
Entered on the checklist is the procedure to be audited, procedure number, location, name of
auditor, item number, requirement, level of conformance and any comments made by the auditor.
The Non Conformance audit report number is recorded.
39. INSPECTION VISITS RECORD.
This form is completed after an inspection of the Home has taken place by the outside authorities,
i.e. registration and inspection officer, health and social services department, fire brigade
department and environmental health officer / health and safety department. Inspection date and
any comments made by the individual concerned are recorded.
40. APPLICATION FOR EMPLOYMENT.
This form is provided to all prospective employees who are seeking employment and they are
required to complete the form prior to an interview. It is a personal questionnaire to record all the
prospective employee’s past and present personal details – employment, education, and home
address etc. This form will be used to establish whether the person applying for employment is
suitable for the post.
41. STANDARD INFORMATION LETTER.
This letter is sent to the prospective employee regarding the position that is being applied for at
the Home. It advises the person to return the application so that the Home is in a position to take
matters further regarding information to be obtained.
42. INTERVIEW QUESTIONNAIRE.
This is a questionnaire given to the prospective employee, which they will be expected to
complete during the interview, detailing a number of personal questions. The answers are used to
determine the suitability of the person for the position applied for.
43. REFERENCE FORMS.
This form is sent to the prospective employee’s previous employer to gain information regarding
the person concerned. It is a standard form asking the person concerned to supply a character
reference for the prospective employee, who has agreed to let the Home make enquiries about
himself / herself regarding employment, etc.
44. INTERVIEW CHECKLIST
This forms has headings to enable the Interviewer to ask relevant and pertinent questions in an
interview. At the bottom of the form they then tick whether the applicant was suitable or not. If
the applicant applies in the future, this form is referred to in case there is no need to re-interview.
45. STANDARD SUCCESSFUL LETTER.
This letter is sent to a prospective employee after an interview and will inform the person whether
they have been successful in their application for the position. If successful, the letter will inform
the employee of the expected start date and will welcome the person to the company. A reply will
be expected to confirm acceptance of the post.
46. STANDARD UNSUCCESSFUL LETTER.
This letter is sent to a prospective employee after an interview and will inform the person that
they have been unsuccessful in their application for the position. As an unsuccessful candidate
will be disappointed, a letter should contain a thank you for applying and wishing them well for
the future.
47. INDUCTION PROGRAMME.
On arrival the new employee will be given an induction day. The person will be introduced to
other staff members and clients. The induction programme includes information relevant to the
person’s position, e.g. training opportunities; job description; a statement of values, aims and
objectives of the Home; fire video etc. The new employee must sign the induction programme to
confirm that they understand the information given to them.
All members of staff receive induction training to Common Induction Standards specification
within 6 weeks of appointment to their posts, including training on the principles of care, safe
working practices, the organisation and worker role, the experiences and particular needs of the
client group, and the influences and particular requirements of the service setting.
48. IN-SERVICE TRAINING PROGRAMME
An In-Service Training Programme commences once they have completed the induction unit of
the In-Service Training course that all new staff are expected to undertake during the first 13
weeks of their employment. All the information that is needed to complete the Home’s Induction
Unit can be found in the Quality Systems Training Manual that is readily available for use by all
staff upon request.
49. PROVISIONAL / TEMPORARY CONTRACT
This is a 13-week contract during which In-Service training will be given to ascertain the
suitability of the new employee. If the person is deemed suitable and has reached a satisfactory
level of competence, then the provisional contract will form part of the full contract when
adequate levels of work are achieved.
50. PERMANENT CONTRACT
A permanent contract will only be given when an employee has achieved the standard required in
relation to work activities. This ensures that adequate levels of quality of work have been met after
the 13-week period has been completed.
51. ANNUAL LEAVE REQUEST FORM
This form is generally given out in November for the following year, and staff make decisions on
what weeks holidays they want. The dates are not guaranteed, as the staffing notice has to be met.
52. APPRAISAL FORM.
A senior member of staff who is monitoring the progress made by an individual employee
completes an appraisal form. These forms are completed at pre-arranged intervals to ascertain the
progress being made by an individual.
The strengths, development and any special achievements of the employee are recorded on the
form. A copy is given to the employee and the management, and then kept in the employee’s
personal record file.
53. IMPROVEMENT ADVICE NOTE.
This form documents any request for improvement or change in staff performance by the Person
in Charge or other senior members of staff, in order that the individual employees maintain the
standard of care required by the Home. This form is linked to staff appraisal and will be used in
an attempt to avoid disciplinary action. The employee is made aware of the improvement advice
note and notified of the content. After reading the note, the employee will sign and date the form
to say they have read the note.
54. DISCIPLINARY NOTICE.
A disciplinary note is sent to an employee who is deliberately ignoring the Home’s procedures
and policies or has acted in a manner that is classed as being unprofessional in work-related
duties. The level of discipline is noted on the form and the employee is made aware of the options
available to them.
55. SICKNESS/ LATENESS RECORD
Each month when individuals are sick or late, the fact is written down on a Sickness/Lateness
Record. This over a period of time may show a pattern that may not be noticed in the short term,
i.e. always sick or late on the last Friday of the month, coinciding with the individuals skittles
night the night before.
56. BANK DETAILS.
This form has to be filled in by all new employees, stating all their relevant bank details so that
arrangements can be made for their monthly salary to be paid into their own bank account on the
fifth of each month.
57. RECORD OF TRAINING.
This form is used to record the levels of training that each employee has completed and what
stage their training and development has reached i.e. which JET Training Unit they have
completed and the levels of competence reached. The various boxes are ticked according to the
levels reached.
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Blank indicates training needed.
Indicates Level 1. Demonstrated.
Indicates Level 2. Competent.
Indicates Level 3. Instructor.
58. FIRE INDUCTION RECORD.
A record of all fire lectures each employee has attended is recorded, with the date and time the
lecture took place. The lecturer’s name is noted, who must then sign to say they have given a
lecture. All staff that have attended the lecture should initial alongside their name under the date
the instruction took place.
59. FIRE EVACUATION CHECKLIST.
This form is used in the event of a fire when the building has been evacuated. It lists the names of
all clients and employees who, in turn, will have to answer when their name is called. This will
make sure that all the people in the building at the time of the fire are present, and have been
safely evacuated from the building.
If anyone is missing, the list will be handed over to the chief of the fire services so that they are
aware that a person may be trapped in the building and can carry out a rescue operation.
60. DISCIPLINARY REGULATIONS.
This form is given to all new employees and is usually given out during their staff induction
programme at the beginning of employment. It lists a number of regulations (8) that all staff are
expected to observe at all times.
All new employees are asked to read the list of regulations and must give assurance that they
have understood what they have read.
Failure to observe any of the listed regulations could lead to dismissal.
61. INSTANT DISMISSAL RULES.
A list of instant dismissal rules are given to all new employees on the commencement of duty, to
read, sign and date to say that they have understood the rules, which apply to their employment.
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Wilfully refuse to carry out instructions from the head of the Home.
Risk the health and safety of any client or other person in the Home.
Use gross or repeated verbal or physical abuse towards clients, visitors or staff in the
Home.
False entry – make deliberate false entries in written records of the Home.
Dishonesty towards the employer or client.
Abandon duty without authority.
Misuse drugs in the course of duty or otherwise, intoxicated by alcohol whilst on duty.
Fraudulently abuse the statutory sick pay scheme.
Prevent or interfere with residents’ rights of residency.
62. CLIENT SURVEY FORM
The client survey includes questions like:
FACILITIES
How do you assess:
 the quality of cleanliness in your own corridor?
 the cleanliness of the main lounge areas?
 the quality of decoration in your own bedroom?
 the quality of furnishings in your room and the Home?
 the cleanliness/hygiene of the bathrooms/WCs in the Home?
DAY CARE
How do you assess:
 the quality of the Daycare you receive?
 the activities you participate in?
 How would you assess:
 the variety of activities offered?]
 respond to more activities if offered?
OVERALL
How do you feel:
 about the care that is provided?
 about the facilities provided?
 about the food provided?
 about the Daycare provided?
CARE
How do you assess:
 the quality of support offered by the Qualified Staff?
 the quality of support offered by care Staff?
 your relationship with the staff in general?
Are you satisfied:
 about your access to a Social Worker if required?
 about your access to a C.P.N. if required?
Are your:
 O.P.D. and GP appointments adequately managed?
Does your:
 medication match your needs?
FOOD
How do you assess:
 your satisfaction with the range and quality of food you get?
 the quality of food you get?
the menu and variety of meals offered?
63. TRAINING MATRIX.
The training matrix is given to all employees who wish to undertake the JET In-Service Training
units to work towards an N.V.Q. qualification. It lists all the JET training units (1-16), and
indicates which elements of the N.V.Q criteria are covered by the units when cross-referenced.
Once a unit or element has been assessed or has been completed, it is recorded on the form by the
highlighting of the elements achieved. At a glance it will tell the trainer which areas need to be
covered next.
64. COMMUNICATION NETWORK.
Communicating within the organisation is essential for the smooth running of the Home and
cooperation with outside bodies involved in the care sector.
Communication takes many forms i.e. written, verbal, computer, fax, audio, visual, telephone,
staff meetings, staff/client meetings, fly sheets, memos, review meetings etc.
Communicating is very important to prevent problems within the establishment arising
unnecessarily.
MANAGEMENT UNIT 5.
INVESTMENT IN PEOPLE QUESTIONNAIRE.
The employee questionnaire is important to both management and the employees. It helps the
establishment to evaluate what we ourselves understand about In-Service training and will give
the management an insight on how to deal with issues raised in the questionnaire.
INVESTMENT IN PEOPLE.
1.1 The commitment from top management to the training and development of employees is
communicated effectively throughout the organisation. The organisation makes a commitment to
train and develop skills to all levels of employees so that they are competent to carry out work
tasks and duties relating to each individual’s job description to a high standard. This is achieved
by providing accurate and up to date information through verbal and non verbal communication,
giving all employees the opportunity to reach their full potential in developing skills and
knowledge, thus reaching a better understanding of what is required both legally and
professionally in the care setting.
The aim is to ensure that all employees are made aware of the positive advantages to them and the
management in the training programme. The organisation ensures that all new employees are
offered the opportunity to develop new skills through the In-Service Training programme. It is
then up to the individual to decide, after they have completed the induction programme, whether
they themselves wish to embark on further training.
The training offered by the management is ongoing. Information is readily available to people
who wish to take advantage of the opportunities offered by the organisation’s In-Service Training
Manual, etc.
The Home has a written commitment in the Home’s documentation, i.e. in the Aims and
Objectives of the Company, and there is the reference to development of employees in the
Aim/Vision/Mission statement. The Home is also a training centre with several staff members
qualified in training and assessing employees who wish to embark on further training at all levels.
1.2 Employees are made aware of the broad aims and vision of the organisation by
communication through staff meetings, memos, notices, the Mission/Vision statement, the
company’s Aims and Objectives statement, the Quality Assurance Charter, individual staff
appraisals and the In-Service Training programme.
1.4 Evidence is recorded in writing by the management when dealing with company
representatives through written documentation; recorded minutes of any meetings that have
taken place; through verbal communications; and by materials produced by and for local
representatives. This all contributes to the training and development of individual employees and
the aims, goals and targets set down by the organisation.
2.1 The training and development commitment can be achieved by drawing up a business plan to
identify the ways in which the company’s organisational policy could be improved to reach the
requirements of the Investment in People and the goals and targets that need to be reached in
order to obtain the Investment in People award.
2.2 A written plan identifies the organisation’s training and development needs and specifies what
action should be taken to meet these needs when implemented. It will ensure that the information
made available to employees is accurate and up to date and will enable employees to reach their
full potential and carry out tasks in a safe, efficient, and practical manner. It will give the
individual more confidence in their own ability to perform duties in the workplace.
2.3 A written plan, when implemented, identifies the need for progress reviews at specified
intervals during each individual’s training. These reviews enable the management to recognize
any difficulties individuals may be experiencing during different stages of the In-Service Training
programme, and which people may need external support for their pace and level of
understanding. Ongoing support can then be given by trainers, when any problems are identified,
without putting undue pressure on the individual.
2.4 It is important to monitor the training of all employees. Assessment of the training and
development of individuals in various roles relating to work duties identifies any weakness in the
system. They are essential in order to evaluate which efficient cost-effective training activities can
be implemented to realise the best cost-benefit.
2.5 All staff should be made aware of specific rules, regulations and legal requirements that are
involved in relation to their job descriptions, and any procedures are to be carried out in the
appropriate manner. All staff should be trained as “competent” before being allowed to carry out
duties in their job description. The management should recognize the need for training and
development within the care setting and ensure that all employees are aware of the
responsibilities involved when carrying out duties in their job description. These responsibilities
are shown in the Home’s organisational chart, which depicts the various levels of control and
authority between all employees.
2.6 Objectives are set for training and development, so that any actions taken when following
policy procedures meet the requirements set by outside authorities. In relation to work duties,
care of the client and health and safety, the Home’s own policy and procedure and organisation
chart set out these objectives to ensure that all employees are competent and have the appropriate
knowledge in work tasks.
2.7 All employees who have completed the induction programme and wish to embark on the InService Training units will be given full support by the management in their endeavours to
achieve and develop skills in relation to the care setting. When an employee has reached the stage
in the In-Service training, where they have acquired enough knowledge and developed skills,
which would enable them to be competent enough to be delegated duties in relation to their job
description, then where appropriate, a portfolio will be assembled. The progress made will be
linked to the N.V.Q. units and criteria to establish whether the individual has reached the required
standard to gain an N.V.Q. qualification.
Any prior achievements, appraisals and review reports are entered into the profile. These will all
be cross-referenced to link up with the external N.V.Q. units as evidence that the individual
concerned has reached the standard.
3.1 It is the policy of the management to ensure that all new employees in the organisation are
made aware that training will be given in relation to the job description. All new employees will
follow standard procedures by undertaking the In-Service training induction programme. In the
first week of employment all new employees will undergo an induction week of set hours 9-5
where all aspects of training will be explained to them before being put on shift hours. They will
be introduced to both staff and clients, shown the fire points, emergency exits, facilities etc. The
opportunities that will be available, once they have completed the induction programme, will be
explained to the new employees so that they are aware of the intentions of the management if they
decide to embark on further training matrix, lifting and fire training, health hygiene certificates
and health and safety courses.
3.2 Managers, through evidence of qualifications and certificates that they themselves have
achieved, are effective in carrying out responsibilities for training and developing employees: by
In-Service training; staff appraisal; management and employee meetings; staff reviews; and
making sure that all employees know who their own key and support trainers are whilst
undertaking training.
3.3 Managers are actively involved in supporting their staff training and development needs by
providing In-Service training. They make sure all employees are aware of their own job
descriptions, carry out staff appraisals, and provide accurate and up to date information to
employees enabling them to carry out work tasks and duties in the correct manner.
3.4 All employees are made aware of the training and development opportunities available to
them through In-Service training, job description, the notice boards, letters to staff, memos,
appraisals, training matrix and the Home’s own system which ensures that all employees are
aware of any training opportunities that are available. All employees are asked if they wish to take
part and an effort is made so that staff who are interested can undertake the training sessions that
are offered.
3.5 Employees are encouraged by the management to identify and meet their job-related training
and development needs, especially if individuals are having difficulty understanding different
aspects of training. This is achieved by the management making available to all employees
development materials in the Home, contribution to training fees, books, journals, In-Service
training, employee meetings, training meetings, job descriptions, training matrix and any other
training courses e.g. Health, Safety, Hygiene, Food Safety etc. All these may be available to
individuals who wish to take part in training and development.
3.6 Any action taken to meet individual training and development, needs teams and organisation.
The management keeps a record of progress in the employee’s personal file record – In-Service
training, certificates achieved, appraisals, project and assignments. This record of individual
progress on the training matrix this will tell at a glance the progress being made by the individual
concerned. Review meetings with the individual are recorded and filed to establish whether one
person needs more support than others do whilst training.
4.1 Evidence within the Home can be found by testing individuals on the knowledge they have
gained during training through the Home’s In-Service Training units and certificates. Written and
practical tests, oral questions, written questions and unit reviews with both trainee and
management provide evidence of progress on the training matrix.
4.2 Training and development is evaluated on the performance of staff through appraisal,
management meetings, the Home’s written business plan, In-Service training and employee
meetings. Individual performance is assessed on a regular basis. Any weaknesses found are made
known to all levels of staff at meetings, which are recorded for future reference.
4.3 The management evaluates the contribution of training and development to the performance
of staff to achieve the goals and targets written in the business plan, and the training plan of
employees. Evidence of this is found in the recording of management meetings, employee
meetings, the written business plan, In-Service training records and staff appraisals. The
management recognizes the importance of training to all employees in the Home, not just the care
staff. An assessment is made of all employees’ various roles and needs in order to evaluate what
efficient, cost-effective training activities can be undertaken within the costs of running the Home
to benefit both staff and clients in the Home whilst maintaining a high standard of care.
Corrective action is taken by the Home to control outcomes when weaknesses found are identified
to employees. Actions can be taken to ensure that the correct functioning of systems is maintained.
4.4 Top management understands the cost and benefits of training and developing employees.
The main benefit is that training protects managers from negligent employees who if not trained
could cause situations or untoward occurrences to occur within the Home. Training helps
employees to communicate in the appropriate manner with the Home’s clients. It also ensures that
all employees are aware of the legal implications that have to be met in following the individual’s
job descriptions. All staff should be aware of the Home’s procedures and quality systems to
ensure the smooth running of the Home. This benefits the Home’s reputation with local health
authorities and social services etc. who register the homes. It also ensures that other outside
bodies are made aware that the quality of care given by the Home is of a high standard.
4.5 Actions to be taken by the management to implement improvements to training and
development are identified as a result of evaluation through employee/management meetings,
appraisals and In-Service training letters to employees.
Evaluation of the training of the organisation’s employees takes place in order to assess the need
for any changes to be made, or to assess those that have already been made, to improve the
development and training of the workforce. The outcome may be happier employees high
morale, fewer untoward incidents, a more motivated workforce, fewer accidents in the Home, less
sickness and absence, and fewer complaints. The monthly records of evidence used for statistical
analysis would provide the means for evaluation.
4.6 All employees are made aware of management commitment to training and
MANAGEMENT UNIT 6.
HEALTH AND SAFETY
HEALTH AND SAFETY
1. HEALTH AND SAFETY POLICY.
The Managers recognise and accept responsibility as an employer for carrying out their business
in a manner which will not as far as reasonably practicable give rise to undue risk in the health
and safety of their employees or any other persons within the Home. All reasonable precautions
are taken to prevent any health and safety risks befalling themselves.
All care staff will be made aware of the procedures used within the Home and all senior staff will
fully understand and maintain the Home’s policy on health and safety within the Home when
carrying out work-related duties.
All health care staff are required to report any matter concerning health and safety in the course of
duty to the Managers and/or Person in Charge.
2. HEALTH AND SAFETY POLICY STATEMENT
Companies employing five or more people must, by law have a written Health & Safety policy
statement. This includes Care Homes.
The statement should be specific to the Home, setting out the general policy for protecting the
health and safety of its employees and others that may be affected by its undertakings. It should
also show the organisation and arrangements for putting that policy in to practice. The statement
is important because it is the Home’s basic action plan on health and safety, which all employees
should read, understand and follow.
Legalities aside, the Health & Safety Policy Statement is the proprietor’s declaration of
commitment to Health & Safety and recognition that it is an integral part of the business. Well
thought out and prepared, it can lead to reduced accidents to both employees and clients alike.
3. HEALTH AND SAFETY STATEMENT OF INTENT.
If an employer has five or more employees he is required by law to make a written statement
specific to the place of work. It is a general policy for the protection and the health and safety of its
employees. All new staff should be made aware of the statement of intent on commencement of
employment.
4. STATEMENT OF ORGANISATION.
The Home has an overall responsibility for health and safety they will obtain all the appropriate
information on health and safety regulations and codes and practices. They will then advise and
instruct all their employees, ensure a copy is shown to all employees, train staff until they fully
understand and maintain safe systems and procedures of work and comply with statutory
regulations and codes of practice.
INSURANCE
5. The Home is insured with ______________________ Insurance company. The cover includes
buildings and contents and public liability.
6. The Insurance certificate must be placed in an area that can be seen by people entering the
building and in a prominent place.
HAZARDS AT WORK
7. LIST OF HAZARDS.
Hazards at work are anything that can cause harm whether it is an activity or substance.
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Moving and handling.
Bleach.
Any machines
Gas.
Electricity.
Wet floors.
Poison
Ladders.
Splinters.
Broken glass,
Mirrors, china etc.
Ill-fitting objects/clothing
Loose fitting carpets.
Flammable substances.
Sharp objects i.e. knives, kitchen equipment etc.
Wet Floors
All hazardous substances should be kept in a safe place i.e. locked cupboards when not in use, for
legal reasons. This includes any other cleaning flammable substances to protect others from harm.
8. PREVENTATIVE ACTION.
Preventative action is taken by the management of the Home to ensure that all health care staff
have been adequately trained and instructed to carry out the tasks expected of them within the
Home.
All staff should be made aware of the hazards that may exist within the operation of those tasks.
All new staff will be given appropriate training in respect of any machine or equipment before
being authorized to operate such machines.
All areas of the compact will be maintained in a safe working condition and defective machines or
equipment should be reported immediately to a senior member of staff so that such equipment
can be repaired or replaced. All hazardous substances should be kept in a locked room when not
in use. All staff should be trained with regard to safe working practice.
ACCIDENTS
9. EMERGENCY PROCEDURE.
The Person -in-Charge must be notified immediately when an accident occurs. The procedure in
an emergency in the first instance is to call for help by dialling 999 and asking for an ambulance.
Give the nature of the accident explaining the injuries received, number of casualties, the exact
address and location of the emergency. Attempt basic first aid while waiting for help. Make a
report of all actions taken and give it to the ambulance driver who will pass any reports to the
hospital, or in case you are called to give evidence in the event of a fatality.
If the injury requires hospital treatment then arrangements should be in place to escort the injured
party to the Accident & Emergency Department of the local hospital.
10. FORMS AND THE ADMINISTRATION OF ACCIDENTS
In all cases, however minor the accident, the Nurse-in-Charge should:
1. Enter details in the Accident Book. This is the official Accident Book, available from HMSO
and it is a legal requirement to fill it out. It allows details to be recorded of the person
involved (name & address), the nature of the injury, the treatment given, the person giving
the treatment and a brief description of the accident.
2. Complete an Accident Report form. There is no set format for this document. It can be
designed to suit the Organisation. There is no legal requirement for this, but it is good
practice to have one. It’s purpose is to take the details from the Accident Book a stage
further and establish it’s cause and identify remedial action so that a recurrence can be
avoided.
SHARP OBJECTS
11. LIST OF POTENTIALLY DANGEROUS OBJECTS.
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Needles.
Scissors.
Kitchen knives.
Can openers.
Broken glass.
Broken china.
Scalpels.
Broken furniture.
Loose wiring on an appliance.
12. NEEDLESTICK INJURY AND PROCEDURE
Any injury involving sharps must be reported immediately to the Person-in-Charge and/or
Administrator. The Accident Book and Accident Report Form should be filled out.
The Person-in-Charge or Administrator must contact the General Practitioner attached to the
Home. The injured person must attend surgery along with, if possible, the identified client on
whom the needle was used. Blood samples will be taken and tested. If injury occurs outside
normal surgery hours, then the injured person must attend the Accident and Emergency
Department of the local hospital.
13. WOUNDS CAUSED BY GLASS, TIN, METAL, BARBED WIRE.
Deep cuts, superficial abrasions, infection, severed arteries and veins, scaring, organ puncturing
can all be caused by glass, tin, metal and barbed wire.
14. TREATMENTS OF 12 & 13 ABOVE
All these wounds are liable to cuts and infection, the nature of some of these wounds not only will
cause bleeding, possibly severe but also if barbed wire or tins have been around for some time,
then Tetanus may be a potential problem, and the action must be to take the individual to casualty
where either a Tetanus injection or booster may be given. If the event of wounds caused by the
above, cover wound immediately, do not put pressure onto wound in case of glass, tin, metal
residue left inside. Seek professional help and let them deal with it.
They will:
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Check the wound for residue, splinters etc.
Tetanus injection if applicable.
X-ray.
Suturing the wound.
Clean the wound.
Remove any object still in the wound.
AGGRESSION AND TENSION
15. GUIDELINES ON AGGRESSION AND VIOLENT INCIDENTS.
All acceptable preventative actions should be taken by all staff to limit violent incidents. Senior
members of staff will ensure that all staff fully understand the guidelines for dealing with violent
or potentially violent incidents. Where the client or others are at risk the Person in Charge will use
minimum force to control the situation. The resident’s GP will be contacted where necessary.
Where the situation is unmanageable and dangerous the Person in Charge should inform the
police and request assistance. A violent untoward incident form should be completed and placed
in the appropriate files.
SAFETY
16. STORAGE OF LADDERS.
Ladders should be one foot wide for every foot they rise. They should always be kept on firm level
base. The ladder should always be secured either at the top or the base when stored, to prevent
accidents from occurring. Never attempt to lean from a ladder and never suspend an unnecessary
weight from a ladder.
17. C.O.S.H.H. RULES.
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Be sure you can read the labels and follow the instructions for use.
Use protective clothing provided.
Don’t mix chemicals, mixing chemicals can kill.
Never put chemicals into unmarked containers.
Be sure to know what first aid treatment is required if you accidentally spill chemicals on
yourself or others.
Store all chemicals safely.
Report any damaged containers, spills, or faulty containers to supervisor.
Always follow safety rules and develop safe practices in the workplace.
Report anything wrong to your supervisor.
LAUNDRY SAFETY
18. CLINICAL WASTE
Relevant Legislation:
• The Health and Safety at Work etc. Act 1974
• The Control of Substances Hazardous to Health Regulations 1999
• The Management of Health and Safety at Work Regulations 1999
What is clinical waste?
• clinical waste is officially divided into five categories
• the particular category then determines necessary packaging and labelling requirements for
that type of waste.
• the type of waste likely to be experienced in the local authority enforced sector falls into
Category E, which includes items used to dispose of urine, faeces and other bodily
secretions or excretions (that do not fall into Category A which are human tissue and
blood).
For information other groups include:
Category B which are discarded syringe needles, broken glass and any other
contaminated disposable sharp instruments or items
Category C which are microbiological cultures and potentially infected waste from
pathology Departments or other clinical/research laboratories.
Category D which are drugs or other pharmaceutical products.
Micro-organisms are covered by the COSHH Regulations, and therefore if it possible
that any of the waste your staff may have to staff deal with may contain micro organisms e.g.
hepatitis B, you should conduct a COSHH assessment. If this assessment shows that sanitary
towels, tampons, incontinence pads and other similar wastes do present a risk of infection, then it
should be classified as clinical waste and handled accordingly.
What types of premises are likely to experience problems with clinical waste?
Staff in a variety of workplaces that are subject to health and safety enforcement by the local
authority can be exposed to potentially harmful clinical waste including:
• Care homes, where care staff are exposed to incontinence pads and body Fluids
What procedures do I need relating to clinical waste?
Employers should ensure that suitable procedures have been developed and are in
place relating to:
•
•
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•
the handling of all foreseeable types of clinical waste;
assessment of staff training and the provision of information;
personal hygiene;
personal protective equipment;
immunisation;
segregation;
handling;
packaging;
storage and disposal.
What should I include in staff training about clinical waste?
• the procedures for safely handling clinical waste, including the clearing up of
• spillages;
• emergency procedures including the use of spillage kits ( which should include disposable
aprons, latex free gloves, clinical waste bag and tag, paper towels, sodium hypochorite);
• use of the correct type of cleaning substances necessary to clear up spillages.
What are the storage requirements for clinical waste?
• clinical waste should be placed into the correct colour plastic bags (excluding sharps which
should be placed directly into a solid container). For Category E waste, bags which are
yellow with black stripes should be used to indicate that it is non infectious waste and is
therefore suitable for land fill or other means of disposal.
• the sacks should only be three quarters full and then sealed off by tying the neck.
• clinical waste should not be permitted to accumulate within the home, or places where they
are accessible to members of the public, residents, pests/vermin. the store should be
designated for clinical waste only, readily cleanable, should be enclosed and secure.
How should sharps be stored?
• sharps should be placed directly into a sharps container which meet the requirements of BS
7320:1990.
• sharps should never be placed in to bags prior to disposal.
• it should be ensured that sharps containers are not left where vulnerable people could gain
access to them
What steps should be taken to minimise the risk of contamination from infected blood/body
fluids?
Precautions include:
• ensuring that staff cover cuts/grazes with waterproof dressings before commencing work
• ensure staff maintain good personal hygiene standards i.e. thorough hand washing after
contact with blood and body fluids
• the maintenance of good environmental hygiene
• the wearing of latex-free gloves, disposable aprons etc. for high risk /messy activities
Should my staff be immunised against foreseeable diseases that can be transmitted by
handling clinical waste?
In workplaces where there is a high incidence of hepatitis B, as an employer you should offer your
staff appropriate immunisation and this should be free of charge. If this is the case then you
should establish an agreed arrangement with a GP for the immunisation of staff.
It is important to remember that once immunised, there will be a need for periodic checks to
ensure staff remain adequately protected by the vaccine.
19. LIST DANGERS OF WASHERS AND DRYERS
Gas Washers and Dryers
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Explosion
Gas Poisoning
Electrocution from electrical supply
Smoke inhalation
Injuries sustained from above
Electrical Washers and Dryers
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Electrocution from electrical supply
Smoke inhalation
Injuries sustained from above
20. VENTILATION OF WASHERS AND DRYERS.
All washer / dryers should be placed in a well-ventilated area, or have adequate ventilation hoses
leading from the appliance. This stops condensation building up (prevents damp). It also prevents
the appliance overheating, which can cause a fire.
21. FIRE SAFETY OF WASHER / DRYERS.
It is important after use to ensure that all filters are cleaned and any build-up of fluff is removed.
If fluff or paper is blocking the filter the machine may become overheated and this can cause a fire.
Heat could ignite fluff that has been allowed to build up in the filter. Plugs should be removed
from the socket and the switch turned to the off position. If left in the socket a fault in the
electricity system could cause a fire.
22. CHEMICALS USED IN WASHING
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Washing Powders
Fabric Softeners
Disinfectants
Bleaches
23. DANGERS OF CHEMICALS IN WASHING
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Skin Disorders
Allergic Reaction
Eye irritation
Children may eat or drink chemicals
Discolouration of clothing
Shrinkage of clothing
May cause fluff build up, and may cause machinery failure
24. FOUL LINEN AND WHAT TO DO WITH IT.
All foul linen should be removed from the area in a white bag as soon as possible and taken to the
laundry area. Foul linen should be washed separately using the sluice option on the machine.
25. WHAT KIND OF BAG IS USED FOR DISPOSAL
A yellow bag – should be used for waste that is destined for incineration i.e. body waste, which
cannot be disposed of in a sluice, pads, wipes, dressings and soiled tissues etc. This is a legal
requirement in the Environmental Protection Act 1990.
26. CONDEMING CLOTHES.
In the course of duty staff might notice that some clothing owned by a client needs to be
condemned, because it is thought the item is beyond repair. Then the staff should in the first
instance inform the client and ask permission to dispose of the item. In the second instance the
staff must inform the by putting a written request forward so that the item can be replaced. In the
case of the client who cannot afford the replacement, the Home will replace the garment by
making an application to bodies who are able to supply usually second hand clothing on behalf of
the client or to other outside agencies that will offer assistance i.e. Oxfam, Scope or the Red Cross.
In extreme cases the management will replace the item, as new, at no charge to the client.
27. CROSS INFECTION.
Health care staff should take every precaution to prevent infection spreading from one client to
another and ensure that a client does not suffer from potential sources of infection in their
surroundings.
Health care staff will wash their hands whenever their hands have become soiled or there is a
potential risk of passing on infection.
Health care staff must maintain a high level of personal cleanliness and must report to the Person
in Charge. any cold or flu symptoms, other infectious diseases and cover any open wounds.
28. USE OF SLUICE
All Person in Charge and other members of staff must use the sluice to empty bedpans after
removing them from residents’ rooms. The sluice is used to dispense of body waste i.e. faeces and
urine.
29. PROTECTIVE CLOTHING.
Protective clothing should be worn at all times where appropriate to work-related duties i.e.
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Whenever you may be exposed to blood or body fluids.
In the kitchen area for food safety and hygiene regulations.
30. WASTE DISPOSAL.
The correct procedure is to ensure that adequate arrangements are made for the disposal of waste.
Arrangements for the prompt collection of waste reduce the risk of infection. White bags for
household waste should be placed in residents’ rooms by the H.C.A. and removed daily for
disposal.
Black bags from the kitchen and tearoom, provided after every meal, should be removed and
disposed of in the skip. This will be collected on designated days by waste management.
31. MACHINE FILTERS, WHEN TO CHECK / REMOVE FLUFF AND / OR OTHER
CONTENTS.
Machine filters should be checked at the end of each shift to remove fluff or any other content that
may have gotten into the cycle.
They should be maintained and serviced at least once a year by recommended repair specialists.
32. WHO TO CONTACT IF MACHINES ARE FAULTY.
Repairs to machines are contracted to Pearce lifting services. The electrical service repair company
telephone number can be found in the contracts folder in the main office.
MANAGEMENT UNIT 7
FIRE
FIRE PRECAUTIONS AND REGULATIONS
1. LEGAL POSITION REGARDING RESPONSIBILITY IF A FIRE HAPPENS IN A HOME
The home Proprietors have ultimate responsibility if a fire happens, although each member of
staff will have to justify any actions that they take, ultimately to a court or coroner’s court.
2. FIRE INSTRUCTIONS
Fire Instructions are posted in prominent positions within the Home and gives written
instructions on what to do in the event of a fire.
3. FIRE PREVENTION.
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Make sure fire doors are kept closed at all times.
All fire doors and exits should be kept free from obstructions.
Wiring should be checked regularly.
Alarm systems should be checked regularly.
Check ashtrays before depositing in the bin.
Check fire extinguishers regularly and have them serviced.
Instruct all staff in preventative measures and fire regulations.
Switch off and remove plugs after use of an appliance.
4. PROCEDURE IN THE CASE OF FIRE.
In the event of fire, sound the alarm and call 999 and ask for the fire service. Remove all persons
from the area of fire, close all doors and windows if possible. Conduct a roll call, and if anybody is
left behind or missing inform the chief fire officer on arrival.
5. RECORD OF FIRE TRAINING
Each employee must in his or her file have evidence of fire training. The Fire Precautions
(Workplace) Regulations 1997 states: When did the last fire drill take place? Fire drills must be
carried out at least every six months. Staff should be regularly trained in fire procedures.
Therefore all staff must attend must attend Fire Lectures every year.
6. UNDERSTANDING THE FIRE ALARM SYSTEM AND HOW IT WORKS.
Smoke and heat fire detectors are connected to the main indicator panel in zone1. When an alarm
goes off the panel will tell members of staff exactly which area the alarm has been activated.
7. RAISING THE ALARM, LOCATION OF CALL POINTS AND ALARM INDICATOR
PANEL
Usually, when a fire is discovered, the Alarm system rings which is loud enough for everyone to
hear, those who have hearing problems may have a system of flashing lights to indicate a fire is in
the building. There may be designated areas where people are lead to in order to be away from
the risk. This is a call point. All available staff in the first instance should congregate at the Alarm
Indicator Panel and await instruction from the Person in Control.
8. ACTION ON DISCOVERING A FIRE.
In the first instance ring 999 emergency services and ask for the fire department. Operate the
nearest fire alarm call point. Extinguish the fire if possible without taking risks yourself or putting
others at risk.
9. ACTION IF THE ALARM BELL SOUNDS
On hearing the fire alarm go directly to the alarm indicator panel to see in which area the alarm
has been activated.
10. CORRECT METHOD OF CALLING THE FIRE BRIGADE.
The designated member of staff in charge will call the fire brigade using emergency services (999)
on hearing the fire alarm, whilst other members of staff prepare to evacuate the building.
11. KNOWLEDGE OF ESCAPE ROUTES.
There are 10 escape routes. 5 escape routes in the Home. There are 7 fire exits. Fire exits: 1 in zone
1, the front door in zone 2, 1 in zone 4, 1 adjacent to room 10, 1 in the Home, 1 outside room 9, 1 in
the dining area and 1 at the front door.
12. LOCATION OF ASSEMBLY POINTS
There are 3 fire assembly points in Greenway House: the patio outside the main office, the back
garden patio area and the front door patio area. There are 2 fire assembly points in the Home: the
back garden patio area and the front door garden.
13. LOCATION OF STAFF ON DUTY LIST
The staff on duty list is kept in the main nursing office in the Home. All staff that leave the
building must report to the Person in Charge.
14. LOCATION OF CLIENT LISTS
This list is kept in the main nursing office in Person in Charge. A record is kept of any client who
is absent so that their whereabouts is known at all times.
15. WHO IS YOUR FIRE TRAINER
The Homes Fire Trainer is___________________________________
16. THE IMPORTANCE OF FIRE DOORS, THE NEED TO CLOSE ALL DOORS AND
WINDOWS AT THE TIME OF THE FIRE AND HEARING THE ALARM
It is necessary to close all doors and windows on hearing the alarm at the time of a fire. On
discovery of a fire it is important to keep all main doors and windows closed to prevent the
spread of fire. Closing all doors can keep a fire at bay for at least 30 minutes.
17. FIRE FIGHTING EQUIPMENT AND USE
The most common type of fire-fighting equipment is of course the portable fire extinguisher.
Other equipment includes fire hose reels and fire blankets.
Fire extinguishers may be used to put out fires of limited size, as long as it is safe to do so. Such
fires are grouped into four classes, according to the type of material that is burning. Class A fires
include those in which ordinary combustibles such as wood, cloth, and paper are burning. Class B
fires are those in which flammable liquids, oils, and grease are burning. Class C fires are those
involving live electrical equipment. Class D fires involve combustible metals such as magnesium,
potassium, and sodium and so are not of real interest here. Each class of fire requires its own type
of fire extinguisher.
Class A fire extinguishers are usually water based. Water provides a heat-absorbing (cooling)
effect on the burning material to extinguish the fire. Stored-pressure extinguishers use air under
pressure to expel water.
Class B fires are put out by excluding air, by slowing down the release of flammable vapours, or
by interrupting the chain reaction of the combustion. Three types of extinguishing agents—carbon
dioxide gas, dry chemical, and foam—are used for fires involving flammable liquids, greases, and
oils.
The extinguishing agent in a Class C fire extinguisher must be electrically non-conductive. Both
carbon dioxide and dry chemicals can be used in electrical fires.
The following table illustrates the various fire “classes” and the types of extinguishers that should
be used in conjunction with them.
18. DETECTORS AND EMERGENCY LIGHTING
All smoke detectors and emergency lighting are connected to the main fire alarm system indicator
panel. In the event of a power cut, a back-up generator works the lighting.
19. EVACUATION PROCEDURES
Prepare the group of clients for whom you are responsible for possible evacuation. Leave by the
nearest fire exit, close all doors and windows. Ensure nobody is left behind. Check all toilet
facilities and any out-of-the-way places.
Go directly to a prearranged assembly point. The person in charge is then responsible for checking
that all persons are clear of the building using handover sheets and duty sheets. Report any
missing persons to the fire officer.
20. FIRE DRILLS.
Fire drills are carried out every six months to ensure all members of staff know what to do in the
event of a fire.
21. HOW TO PERSUADE THE MENTALLY ILL/CONFUSED/INFIRM TO LEAVE.
Keep the person calm without panicking them. This can be achieved by appearing calm yourself
and by talking gently to them. Explain that there is a fire, and use minimal force as a last resort if
unable to reassure the person concerned.
22. HELP FOR THOSE WHO REQUIRE ASSISTANCE.
Assistance must be given to people who are unable to walk by using the correct lifting procedures.
Enlist the help of another person without putting the other person at risk and endangering their
lives as well as your own.
23. ANNUAL FIRE LECTURE.
All staff must attend the annual fire lecture. Attendance is recorded, dated and signed by the
members of staff who attend and the Person in Charge
24. AFTER FIRE REVIEWS, PREVENTION AND CONTROL.
The Administrator, who will discuss prevention and fire control for future reference, holds post
fire reviews. All minutes of the meeting are recorded, dated and signed at the time of meeting.
25. FIRE BOOKS / WEEKLY CHECKS.
Fire alarms are checked weekly to ensure they are in working order. The site manager, who will
record the results in the fire book, makes the checks.
26. DRAW EACH CARE HOME
Include a diagram in your portfolio
27. SHOW FIRE DOORS AND EXITS IN 26 ABOVE
Include this in your portfolio
28. SHOW FIRE EQUIPMENT PLACEMENT IN 25 ABOVE
Include this in your portfolio
29. FIRE CEILING, LENGTH OF TIME PROTECTION
The protection time of fire ceilings is 1 hour
30. FIRE DOORS LENGTH OF TIME PROTECTION GIVEN.
Passive fire protection is an integral component of the three components of structural fire
protection and fire safety in a building. PFP attempts to contain fires or slow the spread, through
use of fire resistant walls, floors, and doors .... item within buildings to prevent the spread of fire
Fire is the oxidation of a combustion material releasing heat, light, and various Chemical reaction
products such as carbon dioxide and water.... or smoke
Smoke is the collection of airborne solid and liquid particulates and gases emitted when a
material undergoes combustion, together with the quantity of air that is entrainment or otherwise
mixed into the mass.... which may consist of dangerous chemicals. It is usually the only means of
allowing people to pass through a fire-resistance rated
A fire-resistance rating typically means the duration for which a passive fire protection system
can withstand a standard fire test. This can be quantified simply as a measure of time, or it may
entail a host of other criteria, involving other evidence of functionality or fitness for
purpose.... wall assembly.
An intumescent is a substance which swells as a result of heat exposure, thus increasing in
volume, and decreasing in density. Intumescents are typically used in passive fire protection and,
in America, require listing and approval use and compliance in their installed configurations in
order to comply with the law.... strip, which expands when exposed to heat
Regulations
All components are required to adhere to product certification
Product certification or product qualification is the process of certifying that a certain product
has passed performance and quality assurance tests or qualification requirements stipulated in
regulations such as a building code and nationally accredited test standards, or that it complies
with a set of regulations governing quality an... requirements that are acceptable to the local
authority Having Jurisdiction (AHJ) by meeting the requirements of the local building code
For example in the United Kingdom a fire resisting doorset should be sujected to either a British
Standard Fire Test BS 476 Part 22 1987, or a BS/EN 1634-1 2000 test. The results are recorded by the
test house or Institute and given in a report which will also detail such things as constructional
details, distortion data and pressure readings. These tests are applicable to the performance of the
specimen tested. It is the Building Regulations approved Document B or British Standards such as
the BS 5588 series which lays down the criteria for the fire performance such as 30 minutes FD30
or FD30(S) if cold smoke resistance is required.
31. REASONS FOR GLASS IN FIRE DOORS
Georgian glass is fire proof and used in fire doors such as kitchens as they allow sight of who or
what is on the other side. In the case of a kitchen, if there is hot food and an alarm goes off,
someone running in to the Kitchen may cause an accident by running into someone carrying hot
food.
MANAGEMENT UNIT 8
MANUAL HANDLING
MANUAL HANDLING
1. HEALTH AND SAFETY REGARDING MOVING AND HANDLING
Health and Safety Act 1974.
Sections 2 and 7 of this act impose specific duties on employers and employees relevant to
handling people. It is the duty of the employer to ensure the health and safety and welfare at work
of all their employees. An employer must do this by providing;
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A safe plan and system of work.
The safe handling, storage and transportation of articles and substances.
Necessary information, instructions, training and supervision.
A safe place of work including safe accesses and exits.
A safe working environment.
An employer with more than five employees has a duty to prepare, and then regularly revise, a
written health and safety policy.
The Manual Handling Operations Regulations 1992:
These regulations are based on an ergonomic approach to preventing manual handling injuries.
This involves fitting the job to the worker, taking into account anatomy, physiology and
psychology.
2. CAUSES OF BACK PAIN.
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Unaccustomed work – new working methods involving unaccustomed bending or move
and handling require time for adjustment and acquiring new skills.
Postural stress is a common source of back pain – long periods of stooping or
holding a heavy article in an awkward position for any length of time can bring it on.
Back injuries can cause acute attacks of back pain – working activities may be divided into
two recognized types. The true accident with immediate damage to spinal structure such as
a fall; or a series of incidents usually involving
exceptionally heavy work or prolonged postural stress.
An individual can be susceptible to sudden pain due to an underlying degenerative joint
disease or an earlier injury.
3. PURPOSE OF THE SPINE.
The main function of the spinal column is to facilitate and permit movement of the spine, to hold
the body erect, to be the strut against which the legs work, and to protect the spinal cord.
4. STRUCTURE OF THE SPINE.
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There are approximately 24 vertebrae between the skull and sacrum.
Fibrous pads or discs link vertebrae, and many muscles and ligaments support the spine.
The discs, which have no nerve supply, have a fibrous outer layer and a soft gelatinous
nucleus. When the disc is compressed, it tends to bulge as intradiscal pressure increases. If
the spine is then rotated or laterally flexed the pressure is further increased. This is a major
risk if the disc is degenerating. Degenerating and rotation injuries themselves are causes of
degeneration.
During walking the pelvis rotates as the legs work against it; at the same time there is an
opposite rotation of the shoulders. If a large or awkward object is carried, the mid thoracic
movement is effectively splinted and rotation is forced on the lumbar spine. This may result
in pain and disc damage because the lumbar vertebrae interlock at the facet or apophyseal
joints and are not designed for rotation.
Abdominal muscles help support the spine and abdominal contents. If these muscles are
poor the abdomen sags forward resulting in poor posture. This, together with excess
weight, high-heeled shoes and pushing movements with a bent or twisted back, lead to
poor positioning of the spine, resulting in the risk of degeneration.
5. ENVIRONMENT.
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Provide privacy for Moving and Handling
Prepare the environment for a safe move method.
Wear appropriate clothing and footwear that allow you to move and handle safely.
Position the person safely and comfortably.
Place the call signal, drinks and other necessary items within reach. Respect the resident’s
wishes whenever possible for move and handling or changing positions. Maximize respect
and dignity, and minimize any pain, discomfort or friction from moving. If you need to
change the environment for the move, get the person’s permission first. Then return the
environment to its original state.
The working environment needs to be ergonomically satisfactory and labour efficient, offering a
safe and satisfying place in which to work. Ergonomics is the study of the efficiency of workers in
their working environment.
7. PRINCIPLES OF HANDLING.
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Wear appropriate clothing and footwear.
Never move and handle manually unless there is no other option. Always ask “do I need to
move and handle?”
Assess the person to be move and handled before commencing a move.
Always select the appropriate move and handling equipment for the task.
Nominate a move leader prior to move and handling with other carers.
Explain the manoeuvre to the person about to be move and handled and to any assisting
move and handler.
Prepare the handling area.
Make a good base with your feet.
Keep the person to be move and handled as close to your body as possible (where
necessary, use protective personal equipment).
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Make sure of good handgrip.
Test your grip and the weight if necessary before attempting the move and handle.
Know your own move and handling capacity and do not exceed it.
The move and handle leader must give clear, precise instructions, e.g. ready, steady, go.
Use rhythm and timing move.
Raise head before commencing a move.
Bend knees when move.
Never move, handle and twist at the same time.
9. SHOULDER LIFT
This manoeuvre is now unacceptable and should not be used.
10. SLIDING TECHNIQUES
A sheet or special fabric can be used to manoeuvre a client in or out of bed
11. BED TO CHAIR.
A risk assessment must be done prior to any action. The manoeuvre combines one or more
persons in discussion with the client where appropriate. The amount of input from staff should be
at the minimum, helping the client to be self-managing as possible. The process may take many
small moves or some larger moves for the action to take place.
12. SIT UP IN CHAIR THROUGH ARM MOVE
A risk assessment must be done prior to any action. The manoeuvre combines one or more
persons in discussion with the client as appropriate. The amount of input from staff should be at
the minimum, helping the client to be self-managing as possible. The process may take many
small moves or some larger moves for the action to take place.
13. POSSIBLE INJURIES, WHICH A CLIENT CAN SUSTAIN DURING MOVE AND
HANDLING.
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Friction.
Bruising to limbs.
Banging somebody’s head.
Back injury due to incorrect move and handling.
Broken limbs.
14. FACTORS REDUCING THE RISK OF INJURY.
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Protect yourselves and others by using good move and handling techniques.
Position your body – back, hips and feet in a straight line this will prevent injury,
it is also less tiring.
Use only move and handling techniques learned in your training programme.
If unsure before move and handling or beginning any move, get help.
Never risk injury to your back.
15. CONDITION OF CLIENT WHEN MOVING AND HANDLING
Both Physical and Mental conditions must be taken into consideration for Risk Assessment: There
are quite a few issues that are looked into when a professional is assessing someone. In order to
obtain the relevant information in order to gain the correct assessment the areas below are
reviewed.
Identifying Information:
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Main Complaint or Problem
Medical History
Past History
Mental Status
Physical Examination
Age
Sex
Coping efficiency
Cognition (Knowing)
Orientation
Memory
Concentration
Attention
Judgement
Volition
Activity
Aggression
16. TREATMENTS FOR BACK PAIN
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Posture Change
Physiotherapy
Weight Loss
Painkillers
Rest
Acupuncture
Exercise
Yoga
Chiropractor
Osteopathy
Chinese Medicines
Massage
Reflexology
Stress Management/relief
Benzodiazepines
Surgery
17. HOW TO MOVE AND HANDLE WITH AN ASSISTANT, IMPORTANCE OF
COORDINATED MOVE AND HANDLING.
It is important to remember when you are move and handling with assistance that there are two
people move and handling. Make sure the move is suitable for the patient, check with your
partner that you are both clear about the move and handling method and using signals. Move and
handle together. This prevents back injury to either party during manoeuvre.
18. HOW TO MANOEUVRE IN / OUT OF BATH/SHOWER
A risk assessment must be done prior to any action. The manoeuvre combines one or more
persons in discussion with the client as appropriate. In all cases either self management or The
amount of input from staff should be at the minimum, helping the client to be self-managing as
possible. The process may take many small moves or some larger moves for the action to take
place.
19. MOVING CLIENTS UP AND DOWN STAIRS
A risk assessment must be done prior to any action. The manoeuvre combines one or more
persons in discussion with the client as appropriate. The amount of input from staff should be at
the minimum, helping the client to be self-managing as possible. The process may take many
small moves or some larger moves for the action to take place.
20. MANOEUVRE CLIENTS IN / OUT OF A CAR
A risk assessment must be done prior to any action. The manoeuvre combines one or more
persons in discussion with the client as appropriate. The amount of input from staff should be at
the minimum, helping the client to be self-managing as possible. The process may take many
small moves or some larger moves for the action to take place. As a car environment is usually
low, contained and more difficult area to move and balance, with curbs as an extra hazard, extra
care must be used when using risk assessments.
21. PHYSIOTHERAPIST / CHIROPRACTOR / OSTEOPATH - EXPLAIN ROLES
Physiotherapy is a health care profession which provides services to individuals and populations to
develop, maintain and restore maximum movement and functional ability throughout life. This includes
providing services in circumstances where movement and function are threatened by aging, injury, disease
or environmental factors.
The role of the physiotherapist is to be guided by a doctor or advise a doctor in the decision
making as to what treatment is best for a clients condition.
Treatment by a physiotherapist is usually given after accidents; if there are broken arms, legs, back
injuries etc. Depending on particular needs the following types of treatment are used by the
physiotherapist: different types of exercise; and other methods such as mobilising, stretching or
strengthening, hydrotherapy, electrotherapy, cold therapy, relaxation, acupuncture, walking,
training, general information and advice.
Chiropractic is a health care discipline and profession that emphasises diagnosis, treatment and
prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the
hypothesis that these disorders affect general health via the nervous system. It is generally
considered to be complementary and alternative medicine, a characterisation that many
chiropractors reject. The main treatment involves manual therapy including manipulation of the
spine, other joints, and soft tissue; treatment also includes exercises and health and lifestyle
counselling. Traditionally, chiropractic assumed that a vertebral subluxation or spinal joint
dysfunction interferes with the body's function and its innate intelligence, a notion that brought
ridicule from mainstream science and medicine.
Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in
health and disease. It is practised in the United Kingdom, the rest of the European Union, Israel,
Canada, New Zealand and Australia. Osteopathy is not to be confused with the historically
related but now distinct field, osteopathic medicine in the United States.
In most countries, osteopathy is a form of complementary medicine, emphasizing a holistic
approach and the skilled use of a range of manual and physical treatment interventions in the
prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal
problems such as back and neck pain. Osteopathic principles teach that treatment of the
musculoskeletal system (bones, muscles and joints) facilitates the recuperative powers of the body.
22. LEGAL IMPLICATIONS OF MOVING AND HANDLING
Employees have a duty under the legislation to take reasonable care of their own health and safety
and those who may be affected by their omissions.
It is their duty to cooperate with their employers regarding any training that is available.






Attend training sessions.
Comply with move and handling policies and procedures within the Home.
Not use move and handles that are proved to be dangerous or unassisted.
Use the equipment provided.
Report any faults with the equipment promptly.
Remove dangerous equipment from use.
If the move and handling procedures were not complied with, in the event of injury there would
be no case to answer to.
23. SAFETY AND AWARENESS OF WEIGHT DISTRIBUTION AND RESTRICTIONS WHEN
MOVING AND HANDLING
Balance is necessary when moving and handling, any shift of weight can have an impact on safety.
Where either the client or staff have restrictive clothing, this can cause health and safety issues and
be a reason for a bad, difficult or dangerous manoeuvre.
24. WHEN NOT TO MOVE AND HANDLE ALONE. REASONS FOR TWO PEOPLE TO
MOVE AND HANDLE.
You should not attempt to move and handle a person by yourself if they are over 25kg in weight
or they are unable to assist with the move and handle themselves. The reason needed for two
people to carry out a move and handle is that, with assistance, two people can distribute the
weight evenly. Assisted move and handles prevent accidents and injury to yourselves and to the
person you are move and handling.
25. MOVING AND HANDLING A DIFFICULT CLIENT
A risk assessment must be done prior to any action. The manoeuvre combines one or more
persons in discussion with the client as appropriate. The amount of input from staff should be at
the minimum, helping the client to be self-managing as possible. The process may take many
small moves or some larger moves for the action to take place. Any client who has disabilities of a
physical and/or mental origin will have to assessed to ensure that negative effects are minimised
and injuries prevented.
26. PSYCHOLOGICAL SUPPORT WHILST MOVING AND HANDLING
Whether self-managing or in need of full moving and handling by machines or people, the client
is in others hands, and will need to feel secure in order to be confident about not getting hurt or
injured. Talking with the client, reassuring them and explaining actions will help to ensure a
confident move.
27. CHECKING FOR INJURY PRIOR TO MANUAL HANDLING, FOLLOWING A FALL
Prior to moving a client, in a risk assessment, a client must be asked how self managing they can
be, and appropriate support given. Questioning should include reference to their physical stability
and if they have had any recent injuries. If they have, these need to be noted in the risk assessment
and acted on if there is a need to medical attention. The injury should be physically checked. If
there are gender issues, then appropriate persons may be called to check the injury.
Following a fall, a client may not injury themselves,. Have a superficial or mild injury, or may
have a fracture which will need medical attention. It may be that the client is helped back into
their chair, given a sterile dressing or that they need an ambulance and 999 is called and the client
sent to hospital. Following any necessary intervention, an Accident Form is completed and
witness statements taken.
28. MECHANICAL AIDS TO MOVE AND HANDLE
Mechanical Aids include:

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
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
Hoists
Mechanical beds
Special Cushions/mattresses
Specialised car or Electric buggy
Wheelchair
Walking stick
Rails
Ramps
29. TYPES OF EXERCISE TO STRENGTHEN BACK
Depending on the injury or situation back exercises are:




Walking, strengthening both back and leg muscles to minimise pressure on the back
Arching of the back, tensing muscles in order to strengthen them
Abdominal exercises, pulling in and tightening those muscles which hold the stomach firm
and eases the pressure on the back
Swimming, which helps all muscle groups and can strengthen the back
30. WRITE ABOUT A CLIENT AT THE HOME WHO NEEDS HELP BY MOVE AND
HANDLING.
Client B.M., client of the Home, needs assistance in getting up in the morning. B.M. has an ailment
with his knees and cannot always support his own weight.B.M. is far too heavy for one person to
move and handle as he weighs over 50kg. He can also be uncooperative, and on other occasions he
will stand and be very helpful when staff are assisting him to dress.
The Home has purchased a sling hoist to aid Care Staff to move and handle B.M. out of bed. This
is used when B.M. is unwell and totally reliant on staff to get him washed and dressed. B.M. also
needs assistance to get in and out of the bath. Wheeling him to the bathroom, when he refuses to
walk, and placing him into the bath hoist achieves this. All Care Staff. must be trained to use
equipment before they are permitted to use the equipment.
31. CHECKING FOR PHYSICAL IMPEDIMENTS PRIOR TO MOVING AND HANDLING
Prior to any move, the area must be clear and unobstructed and safe for the manoeuvre to
commence.
32. KNOWLEDGE WHO YOUR MOVING AND HANDLING
TRAINER IS
Our Moving and Handling Trainer is _______________________________
MANAGEMENT UNIT 9.
FOOD HYGIENE
FOOD HYGIENE
1. WHAT IS THE LAW REGARDING FOOD AND FOOD HYGIENE
Food Safety Act 1990
Wide ranging legislation designed to ensure all food produced and offered for sale is safe to eat
and is not advertised or presented in a misleading manner. The 1990 Act provides the
enforcement authorities, i.e. the environmental health officers of the local authority, with powers
to order improvements or even closure in appropriate circumstances.
The Food Safety (General Food Hygiene) Regulations 1995
These regulations apply to all food retailers, caterers, processors, manufacturers and distributors.
The regulations place two general requirements on the owners of food businesses. To ensure that
all food handling operations are carried out hygienically and according to ‘Rules of Hygiene’ To
systematically identify and control all potential food safety hazards. There is an obligation on any
food handler who may suffer from a disease which could be transmitted through food to report
this to the employer, who may be obliged to prevent the person concerned from handling food.
The Food Safety (Temperature Regulations) 1995
These govern the temperature at which food can be kept safely and for how long. There are 2
important temperatures for food safety: 8 degrees centigrade and 63 degrees centigrade. Food
which degrade must be held at no more than 8 degrees centigrade and below to minimise microbiological multiplication, and food heated to 63 degrees centigrade and above which kill off
Micro-organisms. Exceptions to this rule is food on display that can be kept for four hours, low
risk food and preserved foods. There may be exceptions where there is scientific evidence
Food Safety Changes 2006
New food laws applied in the UK from 1 January 2006. They affect all food businesses, including
caterers, primary producers (such as farmers), manufacturers, distributors and retailerste.
How the legislation affects you will depend on the size and type of your business.
There are a number of new European regulations, which apply directly to food businesses in the
UK, and also national legislation in England, Scotland, Wales and Northern Ireland.
Do I need to register my business?
Most food businesses will need to register all of their premises with their local authority before
they open (or before starting to use new premises). At the moment this is required under the Food
Premises (Registration) Regulations 1991.
If you have registered your premises already and have not changed the type of work you do, you
don't need to register them again.
The premises for certain types of food business need to be approved, rather than registered,
including those producing the following foods:




Meat and meat products
Eggs
Milk and dairy products
Fish and fish products
The approval requirements do not apply to primary producers e.g. farmers. As food businesses
they have to be registered with the relevant authority. However, this will not be a new
requirement for most farmers as existing forms of registration may be used to meet the
requirement. Therefore, if farming businesses are already known to Agriculture Departments,
their agencies, such as the Rural Payments Agency or the State Veterinary Service or local
authorities, then this will satisfy the requirement.
If information is not already held on any of these databases, then it is the responsibility of the food
business operator to contact the relevant authority.
What training is needed for my staff?
Food handlers must receive appropriate supervision, and be instructed and/or trained in food
hygiene, to enable them to handle food safely. Those responsible for developing and maintaining
the business's food safety procedures, based on HACCP principles, must have received adequate
training. Adequate training can be obtained by attending a formal training course, self study, on
the job training or relevant prior experience. The operator of the food business is responsible for
ensuring this happens.
What is HACCP?
HACCP stands for 'Hazard Analysis Critical Control Point'. It is an internationally recognised and
recommended system of food safety management. It focuses on identifying the 'critical points' in a
process where food safety problems (or 'hazards') could arise and putting steps in place to prevent
things going wrong. This is sometimes referred to as 'controlling hazards'. Keeping records is also
an important part of HACCP systems.
Where do I go if I have a specific question about how the new regulations apply to my
business?
You should contact the Food Safety Team by phoning (01789) 260832. If you have any specific
questions about how the new regulations apply to your business.
Why is EU food hygiene legislation being changed?
The legislation is being changed to set out more clearly the duty of food businesses to produce
food safely and to achieve consistency. The legislation includes most areas of farming for the first
time, so it covers the whole food chain from 'farm to fork'.
Will the new laws mean more Brussels red tape?
No, when the new EU legislation was being negotiated, the UK argued for flexible and pragmatic
legislation. The legislative framework will now be more explicitly focused on the need to protect
public health in a way that is effective, proportionate and based on risk.
2. SERVING FOOD - HOT AND COLD.
All food should be served in a cleanly environment, so any organism does not contaminate the
food leaving the kitchen. If it is going to be left for a period, then the food should be coved in a
hygienic cover, i.e. plastic film.
3. WHAT THE TEMPERATURE A REFRIGERATOR SHOULD BE KEPT AT
The temperature of a refrigerator should be preferably less than 5 degrees.
PREPARATION OF FOOD
4. WHAT DO YOU DO BEFORE PREPARING FOOD?
Proper protective clothing should be worn prior to preparing food. Hands must be washed prior
to food being prepared.
5. THE TEMPERATURE A FREEZER SHOULD BE KEPT AT
Zero degrees and lower
REHEATING OF FOOD
6. WHAT TEMPERATURE SHOULD IT BE?
Subject to certain exemptions, reheated food intended for immediate consumption / exposed for
sale, must be raised to a temperature of not less than 82 degrees centigrade.
7. COOLING OF FOOD.
If food is not to be served within a very short time it should be cooled to less than 10°C inside 90
minutes after the end of cooking. It should be refrigerated immediately cooling is completed.
Rapid cooling can be aided by:
•
•
Dividing the food into smaller portions.
Transferring the cooked food to a cold receptacle that is immersed in ice-cold water.
•
Placing the food in the coolest part of the workplace. (Providing this does not carry the risk
of cross-contamination.
8. RECEIPT OF FOODS / HIGH RISK FOODS
Food should be checked against the order form to ensure that what has been ordered has been
supplied. The sell by date should be checked and any food that should be refrigerated is in the
correct area. Food that has been already opened should be stored in an airtight container or bag,
clearly labelled with the time and date it was placed there.
9. NAME A HAZARD WHICH COULD OCCUR IN A KITCHEN
If a frying pan is left on heat without supervision it could cause a fire which may not just destroy a
kitchen, but could lead to an gas explosion affecting other parts of the building plus fire damage
to other, if not all parts of the building. This is turn, can leafd to death of clients, employees and
visitors.
10. AT WHAT TEMPERATURE DO BACTERIA GROW THAT CAUSE FOOD POISONING
Bacteria that cause food poisoning will grow at temperatures between 5°C. and 63°C. They grow
very rapidly at a temperature of about 37°C, which is the normal temperature of the human body.
For this reason the range of temperatures between 5°C and 63°C are classed as the temperature
danger zones. Even a small number of bacteria can grow rapidly in food that is allowed to remain
in the temperature zone.
11. TEMPERATURE CONTROL OF FOOD
See 10 above
12. WASHING OF FOOD
Where necessary, adequate provisions must be provided for washing food. Every sink or other
facility must:
•
•
Be kept clean
Be provided with an adequate supply of hot and/or cold wholesome water
13. PERSONAL HYGIENE.
Every person working in a food handling area shall:
Maintain a high degree of personal hygiene Wear suitable, clean and, where appropriate,
protective clothing Any person working in a food area who knows/suspects that he/she is
suffering or is a carrier of any illness or condition likely to result in food micro-organisms MUST
advise the proprietor of contamination by pathogenic organisms. No person, known or suspected
to be suffering from or to be a carrier of a disease likely to be transmitted through food (e.g.
infected wounds, skin there is a possibility of contaminating the infection, sores or diarrhoea) shall
be allowed to work in any food handling area if food
Washing and toilet facilities.

Adequate toilets and hand-washing facilities must be available.
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
Lavatories must not lead directly into food rooms.
Washbasins must have hot and cold or mixed running water.
Materials for cleaning and drying hands should be available for use.
Where necessary, separate facilities should be provided for washing food and for washing
hands.
14. FOOD WASTE AND REFUSE GENERALLY
Food waste and refuse generally:
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
Must NOT be allowed to accumulate in food rooms
Must be stored in suitable containers that are:
Fitted with suitable lids
Appropriately constructed to ensure ease of cleaning / disinfection
In sound condition
Waste must be regularly removed from the premises
Refuse stores must be designed and managed to ensure that they:



Are kept clean
Prevent access by pests
Do not contaminate food, drinking water, equipment etc.
15. EQUIPMENT REQUIREMENTS I.E ALL ITEMS THAT COME IN CONTACT WITH
FOOD
All items that come into contact with food, including packaging must:




Be kept clean
Be of such material and in such condition so as to minimise the risk of contamination
Be such that they can be thoroughly cleaned and where necessary disinfected (this does not
apply to non-returnable containers
Be installed so that the surrounding area can be adequately cleaned
16. WHAT IS A HAZARD IN ASSURED SAFE CATERING
Complacency, believing that safe practice is taking place when standards are deteriorating.
17. WHAT IS THE MOST IMPORTANT PRECAUTION BEFORE TOUCHING FOOD
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
Food handlers must wash their hands prior to any kitchen work, other issues include:
Avoid exposing food to the risk of contamination.
Report to the employer if suffering from upset stomachs, colds or coughs.
Make sure open wounds, i.e. cuts, are covered by a suitable waterproof dressing.
Not smoke or spit in the food area.
Ensure that, where appropriate, clean protective clothing is worn daily and that the food
handler keeps themselves and their own clothing clean.
18. KITCHEN SAFETY NOTES – SAFE KEEPING OF KNIVES
Always use the correct knife for the job being undertaken. Always carry knives point down. Never
leave knives in sinks, but clean them and put them away after use. Never attempt to catch a
dropped knife.
19. CONTROL OF STEAM
Always keep clear of steamer doors and always release pressure prior to opening a steamer.
20. DANGER OF FAT / OIL DANGER OF FIRE
In the event of spillage of fat / oil, turn off the gas or electricity supply immediately. Fat / oil is
highly inflammable when in contact with heat. Always clean up any spillages straight away. In the
event of a fire, never attempt to put out the fire with water as this can cause an explosion. If
available throw a fire blanket over the receptacle that is on fire. Never attempt to move receptacle
until you are sure that the fire is out.
22. GAS LEFT ON, CHECKING FOR LEAKS.
In the event of a gas appliance being left on, turn off the gas at the mains and open all windows to
allow the gas to escape. Never use other appliances i.e. electrical, as one spark could cause an
explosion.
In the event of a suspected gas leak, turn off the gas supply at the mains. Clear the area and call
the emergency gas specialist to check out apparatus.
23. DANGER OF WET / OILY FLOORS – PREVENTATIVE ACTION
All floors should be cleaned at the end of each meal, to prevent the build up of dirt, dust and oil.
Where relevant floors should be cleaned more often.
24. FIRE EQUIPMENT IN THE KITCHEN – TYPES AND USES.
Types of extinguishers that can be used in the kitchen area are:
Such fires are grouped into four classes, according to the type of material that is burning.

Class A fires include those in which ordinary combustibles such as wood, cloth, and paper
are burning.


Class B fires are those in which flammable liquids, oils, and grease are burning.
Fire blankets are used to smother fires in Kitchens
Use all of these as directed.
25. DANGER OF BREAKAGES GLASS / PLASTIC / OTHER
If glass, plastic or other materials are broken in a kitchen then the danger of slipping onto a
fragment causing abrasion or open wounds. All breakages must be cleared up as soon as they
happen to minimise risks of harm.
26. PLACEMENT OF COOKED FOODS / UNCOOKED FOODS.
Raw meat and poultry, shellfish, eggs, vegetables should be kept in the refrigerator and they
should be placed on separate shelves. Raw foods should be placed below cooked foods to stop
bacteria from dripping onto cooked foods. The need for this is that it prevents crosscontamination. Bacteria live in and on your own body and can enter food in the workplace, if you
do not maintain a high standard of personal hygiene. More than any other part of your body,
hands come into contact with food, work surfaces, trays, crockery and catering utensils.
When to wash hands:
•
•
•
•
Before entering the food area and before touching food.
After handling raw meats, poultry, shellfish, eggs or vegetables.
After using the lavatory.
Coughing into your hands or after using a handkerchief.
27. WHO IS NOT ALLOWED IN THE KITCHEN
Any person working in a food area who knows/suspects that he/she is suffering or is a carrier of
any illness or condition likely to result in food micro-organisms MUST advise the proprietor of
contamination by pathogenic organisms.
No person, known or suspected to be suffering from or to be a carrier of a disease likely to be
transmitted through food (e.g. infected wounds, skin there is a possibility of contaminating the
infection, sores or diarrhoea) shall be allowed to work in any food handling area if food
28. WHY WASHING OF HANDS, HAIR TIED BACK IS IMPORTANT
Washing of hands prevents bacteria build up and prevents passage onto others. Hair tied back
prevents any possible grease or dirt passing onto food.
29. E COLI
Escherichia coli (e coli)
Escherichia coli (commonly E. coli; p, and named for its discoverer), is a Gram negative bacterium
that is commonly found in the lower intestine of warm-blooded organisms (endotherms). Most E.
coli strains are harmless, but some, such as serotype O157:H7, can cause serious food poisoning in
humans, and are occasionally responsible for costly product recalls. The harmless strains are part
of the normal flora of the gut, and can benefit their hosts by producing vitamin K or by preventing
the establishment of pathogenic bacteria within the intestine.
E. coli are not always confined to the intestine, and their ability to survive for brief periods outside
the body makes them an ideal indicator organism to test environmental samples for faecal
contamination. The bacteria can also be grown easily and its genetics are comparatively simple
and easily-manipulated or duplicated through a process of metagenics, making it one of the beststudied prokaryotic model organisms, and an important species in biotechnology and
microbiology.
E. coli was discovered by German pediatrician and bacteriologist Theodor Escherich in 1885 and is
now classified as part of the Enterobacteriaceae family of gamma-proteobacteria.[
30 VENTILATION, REASON FOR WINDOW GRILL
• Adequate ventilation must be provided
• Never ventilate air from a contaminated area to a clean area
• All parts of the ventilation system, including filters, must be accessible for cleaning and
maintenance
• Adequate natural or mechanical ventilation of Toilet facilities shall be provided
31. FRIDGE TEMERATURES, FREEZER TEMPERATURES, FOOD TEMERATURES
• Fridge Below 8 degrees centigrade
• Freezer Minus 18 - 20 degrees centigrade
• Food Above 63 degrees centigrade to kill off micro-organisms
32. WHY NO FOODS SHOULD BE LEFT OPEN TO THE ELEMENTS
Kitchens by their nature, have a variety of food stuffs within them, whether cooked, uncooked,
dried or frozen. Where there is food, there will be the potential for insects and/or animals to seek it
out. Food open to the elements will be targeted by flies, mice, birds and other creatures who see or
smell the food. Food left in the open can also be tampered with by passing staff, clients or visitors
who may have time to nibble, but no time to wash their hands following a visit to the toilet! If they
infiltrate the food, then the food will become contaminate, which could give rise to anything from
an upset stomach, to much more serious disorders such as E. coli, which can in some cases can be
fatal.
E. coli bacteria are everywhere in the environment. Since they are such a common occupant of all
animals, anytime we eat, drink or touch something that has either been a part of or near where
animals are, there is always the potential to ingest these bacteria.
33. WHY ALL COOKED FOODS IN REFRIGERATOR AND FREEZER ARE LABELLED AND
DATE STAMPED
PREVENTION OF CONTAMINATION BY FOOD HANDLERS.
FOOD PREMISES.
Requirements in general are that no food business should be carried out in insanitary premises.
Food premises must be:
•
•
•
•
•
•
•
Registered with the local authority.
Kept clean from the accumulation of waste and refuse, and maintained to quality
standards.
Provided with an adequate supply of clean water.
Well lit and well ventilated in work areas.
Provided with adequate washing facilities, i.e. hot / cold water sinks or other means for
washing utensils, equipment and food.
By Law, equipped with first aid materials
Provided with toilets with wash hand basins for the use of staff and, where necessary,
adequate changing facilities must be provided.
EQUIPMENT.
All food equipment must be kept clean and in good working order. Any faults should be reported
to the appropriate person for repair or replacement immediately or as soon as possible
34. RISK ASSESSMENT
Under the legislation proprietors of food businesses are responsible for carrying out an assessment
that identifies steps in the activities of their businesses that are critical in ensuring food safety and
ensuring that adequate safety procedures are identified, implemented, maintained and reviewed.
The main steps involved in a hazard analysis system are:

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


Identify potential hazards
Identify where they may occur
Decide which of the hazards are critical to food safety
Identify and implement effective controls and monitoring procedures
Review hazards and controls and monitor regularly
1. Looking at every step in the operation where food is handled from delivery/purchase to
preparation, through to service
2. Identify the hazards associated with each step. A hazard is anything that can cause harm. The
hazard could be:



Microbiological e.g. germs, bacteria etc
Physical e.g. plastic, glass etc
Chemical e.g. cleaning chemical etc
3. Decide which of the steps are important to ensure food is safe to eat. These are called 'critical
points'. Example - germs are the hazard - thorough cooking is the critical control point.
4. Put in place 'controls' which will prevent these hazards occurring at the 'critical points' that have
been identified. These would include checks and methods such as:


Buying from reputable suppliers
Checking temperature of food
5. Regularly monitor/check the controls to ensure they are working. They should be reviewed on
a regular basis to ensure new hazards are included and the analysis is kept up-to-date.
The system does not have to be written down, but the proprietor has to show they are aware of
the hazards and have taken adequate steps to control and monitor them. It is recommended that
it is written down to enable effective monitoring and to make it easier for members of staff to
become aware and understand it.
MANAGEMENT UNIT 10.
BASIC FIRST AID AND RESCUSITATION
Whilst care is taken in the production of this UNIT, you should seek confirmation from other
suitably qualified sources and people before taking, or failing to take, any specific course of
action. We cannot accept responsibility for action taken, or not taken, based on the contents to
our documentation alone. First Aid and First Aid procedures change over time with new
techniques and technology
BASIC FIRST AID AND RESCUSITATION
1. Knowledge of Who is the Key First Aid Supervisor and Instructor
Our key first aid supervisor and instructor is: ..................................................................
2. Knowledge of Who is the Key Resuscitation Supervisor and Instructor
Our key resuscitation supervisor and instructor is: ..................................................................
3. Resuscitation




If an adult is not breathing normally, you must call an ambulance then start
cardiopulmonary resuscitation (CPR), which is a combination of chest compressions
and rescue breaths.
Place your hands on the centre of their chest and, with the heel of your hand, press
down (4-5cm). After every 30 chest compressions give 2 breaths.
Pinch the person’s nose. Place your mouth over their mouth and – by blowing
steadily – attempt 2 rescue breaths each over one second.
Continue with cycles of 30 chest compressions and 2 rescue breaths until emergency
help arrives.
When you see the person’s chest rise up remove your mouth then let his chest fall. If the chest
does not rise check that the head is tilted back. Continue at the rate of ten times per minute until
the person can breathe alone. Place person in the recovery position. When breathing on their own
if cardiac function is normal
Circulation - The heart is responsible for pumping blood around the body and circulation is also
essential for life. To check that the heart is circulating blood it is necessary to find a pulse. The
pulse is a wave of pressure which passes through the arteries. (Arteries are blood vessels that take
blood away from the heart. Veins are blood vessels that take blood towards the heart) If the
person has a pulse but is not breathing start mouth-to-mouth resuscitation immediately.
For the prevention of cross infection, one way mouth coverage’s are available for use during
mouth-to-mouth resuscitation. These prevent transmission of viruses and other micro organisms.
Be aware of these and where they are stored for use in emergencies.
Allow the most appropriate person to take over as soon as possible. Where someone has more
experience to deal with the situation arrives, the carer should allow them to take over and then
assist the more experienced person with the ongoing care.
Once the situation is stabilised, support and reassurance should be given to those involved.
Records of incidents are accurate, legible and complete.
5. Simple Dressings and Bandages
Minor injuries, i.e. those that can be dealt with independently. Wash hands and apply sterilised
dressing from first aid box, encourage person to be as independent as possible. Extend dressings
beyond wound and apply further dressings over bleed through. When bandaging, either for
support or to cover dressing, do not bandage so tightly that circulation is impeded. Wear gloves to
prevent cross infection. Dispose of waste by yellow bag system.
6. Wounds and Bleeding
Actions in a Emergency
In all cases of journey by ambulance it is The Home’s policy that a member of the care staff
accompanies the client in the ambulance whenever possible. All information relating to the
incident is recorded accurately in the client’s own file and recorded in handover sheets and
reported at handover meetings. An Accident / Violent Incident Form is completed by the
Personin-Charge. Next of kin and all relevant and interested parties are informed. Reassurance,
care and on-going support is offered.
Confidentiality applies, the privacy of client and next of kin is respected and afforded at all times.

External Bleeding - Which can be seen on the outside of the body.
Identification / look out for :


Bleeding wound.
Shock
Types of bleeding :



Capillary bleed - Oozing, bright red.
Venous bleed - Darker red, steady and copious.
Arterial bleed - Bright red, spurting as a jet and in wave pattern, rising and falling with
arterial pulse.
Most dangerous is arterial bleeding, as the high arterial pressure can cause rapid emptying of
blood from the vascular system, resulting in rapid deterioration of patient's condition and early
onset of shock. Death can result within only a few minutes, depending on location.
What to do :
1. Apply direct pressure with a gloved hand at wound site, making sure there are no embedded
objects.
2. Apply a sterile dressing / pad to the wound with pressure.
3. Raise and support the injured limb.
4. Apply tight bandage over the original dressing.
5. Shock may follow and should be managed accordingly.
If embedded object in wound :
1. Do not apply direct pressure on the object.
2. Do not use a Tourniquet.
3. Do press firmly on either side of object and secure a bandage.
Internal Bleeding - Causes are injury, disease and illness. Heavy internal bleeding may occur in
the abdominal cavity, chest cavity, digestive tract, or tissues surrounding broken large bones, such
as the thigh bone (femur) and pelvis.
Initially, internal bleeding itself causes no symptoms, although an injured organ that is bleeding is
often painful. However, the person may be distracted from this pain by other injuries or may be
unable to express pain because of confusion, drowsiness, or unconsciousness. Eventually, internal
bleeding usually becomes apparent. For example, blood in the digestive tract may be vomited or
passed from the rectum. Extensive blood loss causes low blood pressure, making the person feel
weak and dizzy. The person may faint when standing or even sitting and, if blood pressure is very
low, lose consciousness.
First-Aid Treatment
A lay person cannot stop internal bleeding. If extensive bleeding causes light-headedness or
symptoms of shock (see Shock), the person should be laid down and the legs elevated. Medical
assistance should be summoned as quickly as possible. When dealing with blood or blood
products protect yourself from infection.
7. Nose Bleeds
If following a head injury, and especially if thin and watery, treat as serious. Usually, though, it is
as a result of trauma or infection. Sit person with head tilted well forward to avoid choking on
blood and keep airway clear. Encourage person to pinch fleshy part of nose just below the bridge,
reduce pressure after about ten minutes, clean up and advise rest. Do not blow nose so as not to
disturb clot. Uncontrolled bleeding - refer to casualty, put client in recovery position.
8. Bleeding Gums
Overview
• Progressive disease affecting oral cavity
• Characterized by chronic bleeding of gums
• May lead to tooth loss
Causes
•
•
•
•
•
•
•
•
•
Poor oral hygiene
Inadequate plaque removal
Oral trauma, like toothbrush abrasion
Inflammation caused by infection
Vitamin C / K deficiency
Hot food
Chemical irritants
Leukaemia
pregnancy
•
•
•
•
•
•
•
•
Apply pressure using ice-pack
Mouth rinse: Pinch of salt in lukewarm water
Rinse twice a day to reduce swelling
Consult a dentist if bleeding continues
Avoid aspirin intake
Massage gums regularly
Reline poorly fitted dentures
Take vitamin supplements if necessary
Treatment
Prevention
 Avoid Tobacco
 Avoid snacking between meals
 Reduce Carbohydrate- rich food
 Remove plaque every 6 months
 Brush teeth using soft-bristled brush
 Floss teeth regularly
9. Bleeding Of Varicose Veins
This factsheet is for people who have varicose veins, or who would like information about them.
Varicose veins are swollen superficial veins (veins that lie under the skin) that look lumpy and
dark blue or purple through the skin.
They usually affect the legs, particularly the calf and sometimes the thigh. Varicose veins don't
always need treatment as not everyone will get symptoms.
About varicose veins
Blood is pumped from your heart to your legs through arteries. Once it has supplied oxygen and
nutrients to your legs, blood returns to your heart through your veins. To do this, the blood in
your veins must flow upwards, against gravity. The muscles in your legs help this upward blood
flow. Each time your calf and thigh muscles contract when you're walking, veins deep inside your
leg are squeezed. One-way valves help prevent blood from flowing back down your veins.
Blood from the outer layers of your legs flows into superficial veins, which are connected to
deeper veins inside your leg by perforator veins. When blood doesn't flow properly from your
superficial veins to your deep veins, pressure can build up in your superficial veins. This results in
blood collecting (pooling) in your veins, and these are called varicose veins.
Varicose veins are very common and affect up to three in 10 people at some time in their lives.
They are slightly more common in women. For most people they are a problem mainly because of
the way they look.
10. Scalds and Burns
Do not remove clothing sticking to burns or scalds or burst blisters. If scalds and burns are small
flush with clean cold water and apply sterilised dressing. If large or deep apply dry sterile
dressing and send to hospital. Chemical burns: avoid self-contamination, remove clothing not
stuck to skin, flush with plenty of cold water, apply sterilised dressing and send to hospital.
Chemical in eyes: follow same procedure flushing with water, send to hospital with eye covered
with eye pad.
11. The Pulse/Blood Pressure/Temperature/Respiration
The Pulse
Pulses will be found in many areas of the body. The pulses we are most commonly concerned
with are: wrist (radium), neck (carotid), groin (femoral). In emergency situations the neck pulse is
the obvious one to locate (beside the centre of the throat and just above). Check breathing first.
Place index and middle finger on pulse point and count beats (Need to know number per minute
72 for average adult.) A normal pulse should be felt as regular and even, but neither weak nor
pounding. When measuring the pulse, as normally directed to do so, measure it when person is at
rest. Increased pulse rates causes: include exercise, fever, emotion and pain. The wrist site is
usually used and causes less alarm to the person. Record pulse counts and reports any major
changes from previous readings to a Person-in-Charge.
Blood Pressure
(Term used for high blood pressure - hypertension). Blood pressure measurement covers the
pressure of blood in the blood vessels whether High, Medium or Low. Hypertension is usually
discovered in routine examination, as the condition rarely displays symptoms. It occurs in
approximately 10 percent of persons over the age of 35 and can persist indefinitely. Causes are
thought to be genetic and environmental. A diet low in salt and regular exercise reduces the risk.
Overweight, heavy alcohol intake, smoking and the contraceptive pill are related causes.
Complications of hypertension include degeneration of the walls of the arteries, stroke, angina,
coronary thrombosis and heart failure. If a person develops hypertension, damage to the heart,
lungs, eyes and kidneys can be assessed by blood tests and x-rays. Hypertension can be controlled
by a change in lifestyle; the associated risks will be lessened.
Temperature
WHY MEASURE BODY TEMPERATURE?
Body temperature is a vital indicator of one's health. A number of diseases are accompanied by
characteristic changes in body temperature. Likewise, the course of certain diseases can be
monitored by measuring body temperature. The efficiency of many treatments can be evaluated
by monitoring body temperature and changes therein. Fever is a reaction to disease-specific
stimuli, where the setpoint of the temperature control center is varied to promote the body's
defenses against the disease process. Fever is the most common form of pathological
(diseaserelated) elevation of body temperature.
Rectal Measurement:
The most reliable core temperature is obtained by inserting a thermometer into the rectum. This
measurement is accurate and has low scattering in the results. The normal range is: 97.16 degrees
Fahrenheit (32.6 degrees Celsius) to 99.86 degrees Fahrenheit (37.7 degrees Celsius).
Oral Measurement:
Oral measurements should be performed under the tongue (sublingually). This measurement
underestimates the rectal temperature by approximately 1 degree Fahrenheit (.5 degrees Celsius).
Under-arm (Axillar) Measurement:
The only types of body surface temperature measurement used in clinically settings are underarm
and groin measurements. There is a difference between these measurements and rectal
measurements of 1 degree fahrenheit (.5 degrees Celsius).
12. Shock
A sudden loss of blood pressure, or blood loss that if not controlled can be life threatening.
Electric Shock: Do not touch casualty until current has been turned off. If this is not possible stand
on dry insulated material. Use wooden or plastic instrument to free casualty from electric current.
If breathing has stopped prepare for resuscitation and dial 999.
13. Fainting
Brief loss of consciousness due to temporary reduction of blood flow to the brain, slow pulse and
pallor. Lay person down, raise and support legs to improve blood flow to the brain. Ensure fresh
air as person recovers. If person feels faint again tell them to place their head between their knees
and to breathe deeply. After fainting, if person fails to regain consciousness, check breathing and
pulse. Prepare for resuscitation, put them in the recovery position and dial 999.
14. Law Regarding First Aid Box and Contents
The Health and Safety Regulation Act 1981 places a general duty on employers to make First Aid
provisions for employees in case of injury or illness at work. Regular occupational First Aiders as
per government guidelines set out in 1990 should be familiar with the notes defined.
Minimum standards for First Aid provisions and contents:
•
•
•
•
•
•
•
•
•
•
1 box of assorted waterproof plasters
Cotton wool (sterile)
1 antiseptic cream
1 plastic finger stall
1 first aid scissors
2 alcohol wipes
1 plastic eye bath
1 box of safety pins
1 eye pad with bandage
1 first aid leaflet
All First Aid boxes in The Home are coloured green with a white cross. Any items used from the
First Aid box should be replaced as soon as is possible. An entry of each case dealt with is made in
the Accident Book.
15. Cardiac Arrest
Also known as Myocardial Infarction or to the layman, “Heart Attack” the individual may
complain of pain down their right arm, or feel a crushing effect on their chest “Like an elephant
standing on my chest” one individual said. Sometimes it is sudden and final with death occurring
even though resuscitation was done. Getting someone to the Accident and Emergency
Department, or getting urgent medical attention increases the chance of survival. Where someone
is able to give cardiac massage whilst someone summons help, there is hope. Sometimes following
a Cardiac Arrest, the sudden fall to the floor may re-stimulate the heart.
16. Angina
Unlike heart attacks, pain will ease with rest. Ease strain on the heart by encouraging the person to
sit and rest. Reassure and make comfortable. Assist if person has medication to help ease the pain
of the attack. Response should be within a few minutes. If pain persists or returns call emergency
services. Check breathing and pulse and prepare for resuscitation if necessary.
17. Stroke
Signs - sudden severe headaches, confusion and unconsciousness, paralysis / weakness and
casualty one-sidedweakness, strong pulse, speech difficulties, loss of control of bodily functions,
dribbling, possible seizures. Lay casualty down, raise head and shoulders and support. Loosen
tight clothing. If casualty becomes unconscious prepare for resuscitation and dial 999.
Afterwards an eye test will be necessary. The limbs of stroke victims may be affected and the
ability to write may be lost. Assistance should be offered. Writing is an important part of
communication for some and enables persons in care settings to maintain contact with family and
friends.
18. Choking
Choking occurs when air cannot reach the lungs due to a blockage in the windpipe, e.g. a piece of
food. The natural reaction is to cough up the obstruction. Coughing will usually be the first sign
that a person is choking and this should be encouraged. A drink may sometimes help the food
down. If the windpipe remains blocked, the person may show signs of clutching at their throat
and will not be able to speak or breathe properly and may start to turn blue. Immediate action
must be taken as if the choking is allowed to continue this will lead to unconsciousness and
eventual death. Lean person forward and use sharp slaps on the back (up to 5) between the
shoulder blades, with the palm of your hand. If this is successful the person will probably be
anxious and frightened by the experience. Offer reassurance and give the person time to calm
down. Keep a check for normal breathing pattern. If the methods above prove unsuccessful
immediate action must be taken. The next step is called the abdominal thrust, which ideally
should only be carried out by someone trained. Under no circumstances should you use this on
children under the age of one-year-old.
If the person loses consciousness this may cause muscle spasms. Check in the person’s mouth to
ensure there are no obstructions. If not, lay the person down on their side and give 4/5 blows on
their back between the shoulder blades. If this fails commence with CPR. If their breathing starts
put them in the recovery position and call the emergency services. Check and record breathing
every 10 minutes. If the person still does not start breathing prepare to start resuscitation.
19. Unconscious Casualty
Unconscious means that a person is breathing and the heart is beating but the person will not
wake up. If circulation and breathing are not present then mouth-to-mouth resuscitation and CPR
will be necessary. Causes of unconsciousness: asphyxia due to insufficient oxygen to the brain,
injury, epilepsy, diabetic coma, alcohol, drug overdose. The cause may be unknown.
The main concern is to keep the person alive and prevent the condition worsening until the
emergency services arrive. Procedure in the event of unconsciousness – Establish breathing is
present, check for pulse and constantly monitor. Place the person in the recovery position this will
keep their airway open and clear.
Unconscious Client
Communication and awareness are important methods of passing on information to others and
also aid in the prevention of future reoccurrence, .g. drug overdose.
Diabetes Mellitus
Deficiency in insulin. Either too little is made in the pancreas or the blood cells are unable to use
insulin properly and therefore, need more amounts than are made. Lack of insulin equals an
increase in glucose concentration in the blood. The kidneys cannot reabsorb all the glucose and
therefore, some appears in the urine. Diabetes is kept under control by a regular diet - low in
carbohydrates and low in sugar, and/or regular insulin via injection. If the diabetic person does
not receive insulin or stick to a carefully planned diet this can result in unconsciousness. All
diabetics on insulin experience symptoms of unsteadiness, faintness, sweating and disturbed
behaviour at some point.
The person usually recognises the signs of low blood sugar (or hyperglycaemia due to too much
insulin) and prevents a full attack by taking sugar. If action is not taken then there is a risk of that
person becoming unconscious, when immediate medical help will be needed. Give the known
reason for the unconsciousness as complications of diabetes can effect the eyes, legs, nerves, heart
and kidneys.
20. Head Injuries
Scalp wounds: Replace any skin flaps. - Use clean pad and press down firmly and evenly (do not
touch the wound with your fingers) until bleeding is controlled. Use a bandage over the pad and
secure away from the wound. Check for sensible response, impaired consciousness over three
minutes - dial 999. Record breathing, pulse and response every 10 minutes. Lay person down and
raise their head and shoulders. Support, transfer to hospital in this position. Unconscious person place in recovery position and dial 999.
21. Fractures
Bone structure supports the body and protects vital organs. There are two main types of fracture:
Closed fracture when the bone is broken, but does not pierce the skin, and open fracture, when the
bone pierces the skin. Signs – may not be present, hearing bone snap?, pain and injury, tenderness
and swelling, lack of movement, abnormal shape. Shock may be present and unconsciousness
may follow.
Treatment / Action
Stay calm and offer reassurance. Assess injury, condition and response. Be prepared for
resuscitation in event of shock and unconsciousness. Don’t move person (unless exposed to real
and immediate danger) in the event of suspected injury to neck or spine, lower limbs and pelvic
regions. Nil by mouth in case of anaesthetic to reset bones.
Use assessment and judgement, offer comfort and reassurance, e.g. suspected closed arm fracture,
escort casualty to hospital. Multiple fractures of hips, neck, spine. severe bleeding,
unconsciousness prepare for resuscitation, dial 999. Keep person warm, check vital signs until
help arrives. All suspected fractures require medical attention. Ensure comfort and prevent
further injury.
Osteoporosis (brittle bone disease)
Most common in women past the menopausal stage, due to oestrogen deficiency, causing the
bones to become weakened and more susceptible to fractures. Regular exercise aids i n prevention
and as physiotherapy; rest and painkillers are used to treat symptoms. There is no cure, but the
disease can be halted and prevented with hormone replacement therapy in menopausal women
and those who have had ovaries removed by surgery. Osteoporosis is also found present in
persons exposed to prolonged steroid drugs.
22. Vasal-Vagal Attacks
Fainting causes include warm airless atmosphere, hunger, shock, fear, possibly heart disease,
anaemia, abnormal movements, moving a person from one place to another. Older persons are
more prone to fainting attacks on suddenly standing or sudden neck movements.
23. Respiratory Difficulties / Arrest
For example in Asthma. Signs of attack: breathing difficulties, rapid shallow and noisy coughing /
wheezing, tightness of chest, distress, difficulty speaking, blue lips and skin in severe cases. Sit
casualty down leaning them forward and supporting them with appropriate puffs of their puffer
(for known sufferers) - later if no improvement, give further puffs. Absence of medication will
prolong the attack – call ambulance. First attack – advise casualty to see the doctor.
24. Renal Failure
Kidneys are responsible for filtering waste products. Treatment for failure – Dialysis / transplant
(uncommon).
25. RASHES.
Most rashes represent the body’s reaction to physical or allergic reaction. Because rashes vary
greatly with each stage, identification depends less on appearance of the rash than on the area of
the body it affects, and other symptoms such as fever or cough which might be present.
There are three main rashes:
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Those that affect the whole body and are associated with general symptoms such as colds
or coughs.
Rashes that affect the whole body without associated general symptoms and are frequently
due to allergic reaction.
Rashes that affect one part of the body, the part of the body usually indicating likely causes,
e.g. impetigo, cold sores or roach affecting the face.
26. ANAPHYLACTIC SHOCK
This is a severe reaction to a wasp or bee sting through antigen being injected into the
bloodstream. The symptoms activate very quickly with a minute or two.
Wheals develop all over the skin and the soft tissue of the body swells up easily. On the face, the
area around the eyes may become so puffy that within five minutes the eyes may close up
completely. The lips swell up and the throat feels thick due to swelling of the tongue and mouth.
The swelling of the body causes a drop in blood pressure and a rapid heartbeat. Some people may
actually feel faint.
Anaphylactic shock can be brought about by using foreign bodies, such as a tampon for sanitary
protection.
27. HYPERTENSION AND HYPOTENSION.
Hypertension is high blood pressure. Some of the causes are:
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Hereditary
Smoking
Drinking
Stress
Sedentary Lifestyle
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Drug use Legal and illicit
Acute Pain
Acute Distress
Fear
Anxiety
Steroid use
Steroid related illnesses
Thyrotoxicosis
Hypotension is low blood pressure.
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Myxoedema
Tranquilizers
Major Tranquilizers
Good Health
Meditation
Blood or Fluid Loss
28. THE PULSE / B.P. / RESPIRATION / TEMPERATURE.
Each heartbeat sends an impulse into the arteries and some of these can be felt as the pulse.


The pulse rate and strength gives a good indication of how fast a person’s heart is beating.
It is best to test a person’s pulse by pressing where an artery lies close under the skin and
also just over a bone. There are three arteries, which allow us to do this; at the wrist, by the
ear and at the side of the neck. It is best to feel with fingers and not thumbs because the
thumbs are less sensitive. By not pressing too hard you can test the rate by counting the
pulses for 15 seconds then multiplying by four.
BLOOD PRESSURE / RESPIRATION / TEMPERATURE.
• The normal reading for blood pressure in a young adult is 120/80 although this
can vary. The higher pressure measured is systolic and the lower pressure is
diastolic. A consistent diastolic pressure is over 100mm. A systolic pressure over
140mm. is considered abnormal.
• By using a sphygmomanometer both these pressures can be measured or by use
of a pressure cuff. These are measured in MM.
29. PULSE ABNORMALITIES
REGULAR

A normal pulse is regular and said to be 72 beats a minute.
IRREGULAR

May have Atrial Fibrillation
TACCYCARDIA

Over 100 beats a minute
BRADYCARDIA
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Under 60 beats a minute
MISSED BEAT

Occassionally found in normal people. If having a heart disease, could be an indication of
further deterioration.
30. EFFECTS OF ANOXIA.
Anoxia is an insufficient supply of oxygen to the tissues of the body.
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In Anaemic Anoxia the reduction in the supply of oxygen to the tissues is caused by
deficiencies in the constituents of blood. There may be a shortage of blood cells (red) or a
fault in the chemical make-up of haemoglobin.
Stagnant anoxia is the result of general or localized slowing of circulating blood, and can be
caused by heart failure, shock or thrombosis.
Deficiencies in the respiratory system may also cause anoxia. It may also be caused by
asthma attacks.
MANAGEMENT UNIT 11
GENERAL HEALTH
1. ALZHEIMERS DISEASE/DEMENTIA
Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first
described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century
since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s:

Is a progressive and fatal brain disease. As many as 5.3 million Americans are living with
Alzheimer’s disease. Alzheimer's destroys brain cells, causing problems with memory,
thinking and behavior severe enough to affect work, lifelong hobbies or social
life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause
of death in the United States. For more information, see Warning Signs and Stages of
Alzheimer’s Disease.

Is the most common form of dementia, a general term for the loss of memory and other
intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease
accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular
dementia, mixed dementia, dementia with Lewy bodies and fronto-temporal dementia. For
more information about other causes of dementia, please see Related Dementias.

Has no current cure. But treatments for symptoms, combined with the right services and
support, can make life better for the millions of Americans living with Alzheimer’s. There is
an accelerating worldwide effort under way to find better ways to treat the disease, delay
its onset, or prevent it from developing. Learn more about recent progress in Alzheimer
research funded by the Alzheimer’s Association in the Research section.
Alzheimer's and the brain
Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed
thinking and occasional problems remembering certain things. However, serious memory loss,
confusion and other major changes in the way our minds work are not a normal part of aging.
They may be a sign that brain cells are failing.
The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to
form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and
remembering. Others help us see, hear and smell. Still others tell our muscles when to move. In
Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate
and die.
Dementia (meaning "deprived of mind") is a serious cognitive disorder. It may be static, the result
of a unique global brain injury or progressive, resulting in long-term decline in cognitive function
due to damage or disease in the body beyond what might be expected from normal aging.
Although dementia is far more common in the geriatric population, it may occur in any stage of
adulthood. This age cut off is defining, as similar sets of symptoms due to organic brain syndrome
or dysfunction, are given different names in populations younger than adult. Up to the end of the
nineteenth century, dementia was a much broader clinical concept.
Dementia is a non-specific illness syndrome (set of signs and symptoms) in which affected areas of
cognition may be memory, attention, language, and problem solving. It is normally required to be
present for at least 6 months to be diagnosed, cognitive dysfunction which has been seen only
over shorter times, particularly less than weeks, must be termed delirium. In all types of general
cognitive dysfunction, higher mental functions are affected first in the process. Especially in the
later stages of the condition, affected persons may be disoriented in time (not knowing what day
of the week, day of the month, or even what year it is), in place (not knowing where they are), and
in person (not knowing who they are or others around them). Dementia, though often treatable to
some degree, is usually due to causes which are progressive and incurable.
Symptoms of dementia can be classified as either reversible or irreversible, depending upon the
etiology of the disease. Less than 10 percent of cases of dementia are due to causes which may
presently be reversed with treatment. Causes include many different specific disease processes, in
the same way that symptoms of organ dysfunction such as shortness of breath, jaundice, or pain
are attributable to many etiologies. Without careful assessment of history, the short-term
syndrome of delirium (often lasting days to weeks) can easily be confused with dementia, because
they have all symptoms in common, save duration, and the fact that delirium is often associated
with over-activity of the sympathetic nervous system. Some mental illnesses, including depression
and psychosis, may also produce symptoms which must be differentiated from both delirium and
dementia.
2. PARKINSONS DISEASE
Also called: Paralysis Agitans, Shaking palsy
Parkinson's disease is a disorder that affects nerve cells, or neurons, in a part of the brain that
controls muscle movement. In Parkinson's, neurons that make a chemical called dopamine die or
do not work properly. Dopamine normally sends signals that help coordinate your movements.
No one knows what damages these cells. Symptoms of Parkinson's disease may include

Trembling of hands, arms, legs, jaw and face



Stiffness of the arms, legs and trunk
Slowness of movement
Poor balance and coordination
As symptoms get worse, people with the disease may have trouble walking, talking or doing
simple tasks. They may also have problems such as depression, sleep problems or trouble
chewing, swallowing or speaking.
Parkinson's usually begins around age 60, but it can start earlier. It is more common in men than
in women. There is no cure for Parkinson's disease. A variety of medicines sometimes help
symptoms dramatically.
3. ARTHRITIS
Arthritis is a term used to describe a number of painful conditions of the joints and bones. Two of
the main types of arthritis are osteoarthritis and rheumatoid arthritis.
Osteoarthritis
Osteoarthritis is the most common form of arthritis. Cartilage (connective tissue) between the
bones gradually wastes away (degenerates), and this can lead to painful rubbing of bone on bone
in the joints. It may also cause joints to fall out of their natural positions (misalignment). The most
frequently affected joints are in the hands, spine, knees and hips.
Rheumatoid arthritis
Also known as inflammatory arthritis, rheumatoid arthritis is a more severe, but less common
condition. The body's immune system attacks and destroys the joint, causing pain and swelling. It
can lead to reduction of movement, and the breakdown of bone and cartilage.
There are over 200 forms of arthritis. More common forms include:
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




Ankylosing spondylitis.
Cervical spondylitis.
Fibromyalgia.
Systemic lupus erythematosis (lupus).
Gout.
Psoriatic arthritis.
Reiter's syndrome.
Arthritis is often associated with older people, but it can also affect children. About one in 1,000
children develop arthritis. Arthritis in children is often called juvenile idiopathic arthritis (JIA).
The three main types of JIA are:


Oligo-articular JIA is the most common form of JIA. It affects four or fewer joints in the
body, most commonly the knees, ankles and wrists. This type has good recovery rates and
the effects are rarely long term. However, there is a risk of developing eye problems, so
children should have regular checks with an eye specialist (ophthalmologist).
Polyarticular JIA (or polyarthritis) affects five or more joints, and the symptoms are very
similar to adult rheumatoid arthritis. It can quickly spread from one joint to another and
can develop at any age. It is often accompanied by a rash or fever.

Systemic onset JIA begins with symptoms such as fever, rashes, lethargy and enlarged
glands, and later develops into swollen and inflamed joints. It can also affect children of
any age.
4. CORONARY ARTERY DISEASE
Coronary artery disease (CAD), also called coronary heart disease, is a condition in which plaque
builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich
blood.
Plaque is made up of fat, cholesterol calcium, and other substances found in the blood. When
plaque builds up in the arteries, the condition is called atherosclerosis.
Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more
likely that blood clots will form in your arteries. Blood clots can partially or completely block
blood flow.
Overview
When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart
muscle. This can cause angina or a heart attack.
Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is flowing to
an area of your heart muscle. Angina may feel like pressure or squeezing in your chest. The pain
also may occur in your shoulders, arms, neck, jaw, or back.
A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. This
prevents oxygen-rich blood from reaching that area of heart muscle and causes it to die. Without
quick treatment, a heart attack can lead to serious problems and even death.
Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart
failure is a condition in which your heart can't pump enough blood throughout your body.
Arrhythmias are problems with the speed or rhythm of your heartbeat.
Outlook
CAD is the most common type of heart disease. It's the leading cause of death in the United States
for both men and women. Lifestyle changes, medicines, and/or medical procedures can effectively
prevent or treat CAD in most people.
5. HEAD INJURY
Head injury refers to trauma to the head. This may or may not include injury to the brain.
However, the terms traumatic brain injury and head injury are often used interchangeably in the
medical literature.
Mild concussions are associated with sequelae. However, a slightly greater injury is associated
with both anterograde and retrograde amnesia (inability to remember events before or after the
injury). The amount of time that the amnesia is present correlates with the severity of the injury. In
all cases the patients develop post concussion syndrome, which includes memory problems,
dizziness, tiredness, sickness and depression. Cerebral concussion is the most common head
injury seen in children
6. STROKE
A stroke, or cerebro-vascular accident (CVA), occurs when blood supply to part of the brain is
disrupted, causing brain cells to die. When blood flow to the brain is impaired, oxygen and
glucose cannot be delivered to the brain. Blood flow can be compromised by a variety of
mechanisms.
Blockage of an artery

Narrowing of the small arteries within the brain can cause a so-called lacunar stroke,
(lacune=empty space). Blockage of a single arteriole can affect a tiny area of brain causing
that tissue to die (infarct).

Hardening of the arteries (atherosclerosis) leading to the brain. There are four major
blood vessels that supply the brain with blood. The anterior circulation of the brain that
controls most motor, activity, sensation, thought, speech, and emotion is supplied by the
carotid arteries. The posterior circulation, which supplies the brainstem and the
cerebellum, controlling the automatic parts of brain function and coordination, is supplied
by the vertebrobasilar arteries.
If these arteries become narrow as a result of atherosclerosis, plaque or cholesterol, debris can
break off and float downstream, clogging the blood supply to a part of the brain. As opposed to
lacunar strokes, larger parts of the brain can lose blood supply, and this may produce more
symptoms than a lacunar stroke.

Embolism to the brain from the heart. In situations in which blood clots form within the
heart, the potential exists for small clots to break off and travel (embolize) to the arteries in
the brain and cause a stroke.
Rupture of an artery (hemorrhage)

Cerebral hemorrhage (bleeding within the brain substance). The most common reason to
have bleeding within the brain is uncontrolled high blood pressure. Other situations
include aneurysms that leak or rupture or arteriovenous malformations (AVM) in which
there is an abnormal collection of blood vessels that are fragile and can bleed.
What causes a stroke?
Blockage of an artery
The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke.
The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and
oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die.
Typically, a clot forms in a small blood vessel within the brain that has been previously narrowed
due to a variety of risk factors including:

high blood pressure (hypertension),

high cholesterol,

diabetes, and

smoking.
Embolic stroke
Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque
(cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose,
travels through open arteries, and lodges in an artery of the brain. When this happens, the flow of
oxygen-rich blood to the brain is blocked and a stroke occurs. This type of stroke is referred to as
an embolic stroke. For example, a blood clot might originally form in the heart chamber as a result
of an irregular heart rhythm, such as occurs in atrial fibrillation. Usually, these clots remain
attached to the inner lining of the heart, but occasionally they can break off, travel through the
blood stream, form a plug (embolism) in a brain artery, and cause a stroke. An embolism can also
originate in a large artery (for example, the carotid artery, a major artery in the neck that supplies
blood to the brain) and then travel downstream to clog a small artery within the brain.
Cerebral haemorrhage
A cerebral haemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the
surrounding brain tissue. A cerebral haemorrhage (bleeding in the brain) can cause a stroke by
depriving blood and oxygen to parts of the brain. Blood is also very irritating to the brain and can
cause swelling of brain tissue (cerebral Oedema). Oedema and the accumulation of blood from a
cerebral haemorrhage increases pressure within the skull and causes further damage by squeezing
the brain against the bony skull.
Subarachnoid haemorrhage
In a subarachnoid haemorrhage, blood accumulates in the space beneath the arachnoid membrane
that lines the brain. The blood originates from an abnormal blood vessel that leaks or ruptures.
Often this is from an aneurysm (an abnormal ballooning out of the wall of the vessel).
Subarachnoid haemorrhages usually cause a sudden, severe headache and stiff neck. If not
recognised and treated, major neurological consequences, such as coma, and brain death will
occur.
Vasculitis
Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed.
Migraine headache
There appears to be a very slight increased occurrence of stroke in people with migraine headache.
The mechanism for migraine or vascular headaches includes narrowing of the brain blood vessels.
Some migraine headache episodes can even mimic stroke with loss of function of one side of the
body or vision or speech problems. Usually, the symptoms resolve as the headache resolves.
7. CONFUSIONAL STATES
Confusional states are among the most common mental disorders encountered in patients with
medical illness, particularly among those who are older. They are associated with many complex
underlying medical conditions and can be hard to recognize. Systematic studies and clinical trials
are difficult to perform in patients with cognitive impairment. Recommendations for evaluating
and treating delirium are based primarily upon clinical observation and expert opinion.
Knowledge of the clinical epidemiology of delirium and confusional states in various settings has
substantially increased as a result of applying standardised diagnostic methods. These prospective
observational studies provide a basis for understanding and managing the disorder.
The epidemiology, pathogenesis, clinical features, and diagnosis of delirium and confusional
states will be reviewed here. The prevention and treatment of these disorders are discussed
separately.
DEFINITION AND TERMINOLOGY — The American Psychiatric Association's Diagnostic and
Statistical Manual, 4th edition (DSM-IV) lists four key features that characterize delirium:
• Disturbance of consciousness with reduced ability to focus, sustain, or shift
attention.
• A change in cognition or the development of a perceptual disturbance that is
not better accounted for by a pre-existing, established, or evolving dementia.
• The disturbance develops over a short period of time (usually hours to days)
and tends to fluctuate during the course of the day.
• There is evidence from the history, physical examination, or laboratory
findings that the disturbance is caused by a medical condition, substance
intoxication, or medication side effect.
Additional features that may accompany delirium and confusion include the following:
• Psychomotor behavioural disturbances such as hypo-activity, hyperactivity
with increased sympathetic activity, and impairment in sleep duration and
architecture.
• Variable emotional disturbances, including fear, depression, euphoria, or
perplexity.
8. DIABETES
Over 2 million people in England are living with diabetes. Many more have the condition but
don’t know it. Type 1 and type 2 are the most common forms. The causes of both types are
different, but both result in too much glucose (sugar) in the blood.
Type 1 diabetes is caused by the body's failure to produce insulin. Insulin is a hormone released
by the pancreas to help control levels of sugar in the blood. It's sometimes called juvenile diabetes
or early-onset diabetes because it usually appears before the age of 40.
Type 2 diabetes is caused by the body not producing enough insulin or not using what it
produces effectively. It's the most common form and accounts for around 90% of all diabetes.
Diabetes can increase the risk of developing other conditions, such as heart disease. It can be
managed effectively and many people with diabetes lead a healthy, active life.
Diabetes can also occur in pregnancy. This is known as gestational diabetes. Some pregnant
women have high levels of glucose in their blood because their bodies do not produce enough
insulin to meet the extra demands of pregnancy. It affects less than one in 20 pregnant women and
usually disappears after birth. Although women with gestational diabetes are more at risk of
developing type 2 diabetes later in life.
9. EPILEPSY
DISORDERS
Epilepsy is currently defined as a tendency to have recurrent seizures (sometimes called fits). A
seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary
disruption in the normal message passing between brain cells. This disruption results in the
brain’s messages becoming halted or mixed up.
The brain is responsible for all the functions of your body, so what you experience during a
seizure will depend on where in your brain the epileptic activity begins and how widely and
rapidly it spreads. For this reason, there are many different types of seizure and each person will
experience epilepsy in a way that is unique to them.
Sometimes the reason epilepsy develops is clear. It could be because of brain damage caused by a
difficult birth; a severe blow to the head; a stroke which starves the brain of oxygen; or an
infection of the brain such as meningitis. Very occasionally the cause is a brain tumour. Epilepsy
with a known cause is called ‘symptomatic’ epilepsy. For most people - six out of ten, in fact there is no known cause and this is called ‘idiopathic’ epilepsy.
How is epilepsy diagnosed?
There is no conclusive test for epilepsy, although tests such as the ectroencephalogram (EEG) –
which records brainwave patterns - can give doctors useful information. Epilepsy should be
diagnosed by a doctor with specialist training in epilepsy. An epilepsy specialist will use their
own expert knowledge, along with test results and the patient’s or witness’s accounts of the
seizures, to make the diagnosis.
Because epilepsy is currently defined as the tendency to have recurrent seizures, it is unusual to be
diagnosed with epilepsy after only one seizure. In the UK around one in 20 people will have a
single seizure at some point in their life, whereas one in 131 people have epilepsy.
Treatment of epilepsy
At the moment there is no cure for epilepsy. However, with the right type and dosage of antiepileptic medication, about 70 per cent of people with epilepsy could have their seizures
completely controlled.
10. BLOOD
Also called: Hematologic diseases
Blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of
water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains
red blood cells, white blood cells and platelets.
Red blood cells deliver oxygen from your lungs to your tissues and organs. White blood cells fight
infection and are part of your body's defence system. Platelets help blood to clot. Bone marrow,
the spongy material inside your bones, makes new blood cells. Blood cells constantly die and your
body makes new ones. Red blood cells live about 120 days, platelets 6 days and white cells less
than a day.
There are many types of blood disorders, including: bleeding disorders, platelet disorders,
haemophilia and anaemia. If you lose blood, you may need a transfusion.
11. SKIN
Skin Disorders Include
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Abscess
Acne
Acute Urticaria
Alopecia Areata
Athlete's Foot (Tinea Pedis)
Baldness - Male Pattern
Boils,
Cancer of the Skin
Candidal Skin Infection
Cellulitis
Chickenpox
Chilblains
Chronic Urticaria
Cold Sores
Contact Dermatitis
Corns and Calluses
Dermatitis
Eczema
Excessive Sweating
Fungal Nail Infection
Ganglion
Head Lice
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Impetigo
Ingrowing Toenails
Insect Stings and Bites
Itch
Lymph Glands Swollen
Malignant Skin Ulcers
Nappy Rash
Port-wine Stain
Psoriasis
Pubic Lice
Ringworm
Scabies
Seborrhoeic
Shingles
Skin and Scalp Concerns of Healthy
Babies
Venous Leg Ulcers
Viral Rash (Non-specific)
Vitamin D Analogues for Psoriasis
Vitiligo
Warts and Verrucas
12. KIDNEY
What is the urinary system?
The urinary system cleanses the blood and rids the body of excess water and waste in the form of
urine. It consists of two kidneys, two ureters (one from each kidney), tubes that drain urine from
the kidneys into the bladder (a storage sac), and the urethra (the tube that transports the urine out
of the body). Muscles help control the release of urine from the bladder.
The kidneys, a pair of bean-shaped organs, are located at the bottom of the ribcage in the right and
left sides of the back. Although the body is equipped with two kidneys, you can function with one
reasonably healthy kidney if the other is damaged or removed. The kidneys receive blood from
the aorta, filter it, and send it back to the heart with the right balance of chemicals and fluid for
use throughout the body. The urine created by the kidneys is moved out of the body via the
urinary tract.
The kidneys control the quantity and quality of fluids within the body. They also produce
hormones and vitamins that direct cell activities in many organs; the hormone renin, for example,
helps control blood pressure. When the kidneys are not working properly, waste products and
fluid can build up to dangerous levels, creating a life-threatening situation. Among the important
substances the kidneys help to control are sodium, potassium, chloride, bicarbonate, pH, calcium,
phosphate, and magnesium.
Diseases and conditions affecting the kidney
Any diseases that affect the blood vessels, including diabetes, high blood pressure, and
atherosclerosis (hardening of the arteries), can impair the kidneys’ ability to filter blood and
regulate fluids in the body. Disease and infection in other parts of the body can also trigger a
kidney disorder. Because kidney impairment can be life-threatening, disorders and diseases that
may affect the kidney deserve prompt attention. Kidney disease often causes no symptoms until
late in its course and can lead to end-stage kidney failure, which is fatal unless a dialysis machine
is used or a kidney transplant is performed. There are more than 100 disorders, diseases, and
conditions that can lead to progressive destruction of the kidneys. Some of the more common
problems are described here. Warning signs that should not be ignored are also listed below.
Obstruction ―The urinary tract can become partially obstructed (for example, by a kidney stone,
tumour, expanding uterus during pregnancy, or enlarged prostate gland). The build-up of
pressure can lead to infection and injury of the kidney. With a kidney stone, often the blockage is
painful. Other obstructions may produce no symptoms and be detected only when a blood or
urine test is abnormal or an imaging procedure, such as an x-ray or ultrasound, detects it.
Infection ―Urinary tract infections, such as cystitis (an infection of the bladder), can lead to more
serious infections further up the urinary tract. Symptoms include fever, frequent urination,
sudden and urgent need to urinate, and pain or a burning feeling during urination. There is often
pressure or pain in the lower abdomen or back. Sometimes the urine has a strong or foul odour or
is bloody. Pyelonephritis is an infection of kidney tissue; most often, it is the result of cystitis that
has spread to the kidney. An obstruction in the urinary tract can make a kidney infection more
likely. Infections elsewhere in the body, including, for example, streptococcal infections, the skin
infection impetigo, or a bacterial infection in the heart can also be carried through the bloodstream
to the kidney and cause a problem there.
Glomerular diseases ―Glomerular diseases are those that attack the blood filtering units of the
kidneys. Diabetes and high blood pressure can lead to glomerular disease. Diseases of this type
cause more cases of chronic kidney failure than any other cause. The blood is continually filtered
through microscopic clusters of looping blood vessels, called glomeruli. Attached to each
glomerulus is a tiny tube (tubule) that collects the waste that has been filtered out. The filtering
unit (glomerulus and tubule) is called a nephron.
Often, a glomerular disease is triggered by an abnormal reaction of the immune system. In this
case, the body’s own infection fighters mistakenly attack the kidney tissues. Sometimes, an
autoimmune disorder such as systemic lupus erythematosus or Goodpasture syndrome is the
cause. The attack on the glomerulus may also be the result of an inherited condition. An attack on
the glomerulus may also occur after a bacterial infection in another part of the body, such as a
strep infection of the throat or skin, the skin infection impetigo, or an infection inside the heart.
Viruses, such as the HIV virus that leads to AIDS, can also trigger glomerular disease.
In diseases and conditions classified as glomerulonephritis (also called nephritis), the glomeruli
become inflamed. As blood filtering becomes impaired, urine output decreases, water and waste
products accumulate in the blood, and blood appears in the urine. Because the blood cells break
down, urine often becomes brown instead of red. Certain body tissues swell with the excess water
(a condition called oedema). Outcomes can vary: the condition may go away in a few weeks,
permanently reduce kidney function, or progress to end-stage kidney failure.
In nephrotic syndrome, the blood loses protein to the urine because of damage to the membrane
between the glomeruli and tubules. As the amount of albumin (a major protein) decreases in the
blood, parts of the body swell with fluid (often around the eyes or in the belly or legs). Other
diseases and illnesses may lead to this syndrome, and complications such as blood clots and high
cholesterol may develop. Childhood nephrotic syndrome usually responds well to treatment and
does not usually result in permanent kidney damage.
Other factors ―Any situation in which there is severe blood loss or reduced blood flow may
prevent the kidneys from working correctly. Severe dehydration, some aortic and heart surgeries,
a severe infection in the blood or heart, and severe heart failure are examples of events that can
lead to sudden kidney problems. The damage is usually reversible; although with shock or severe
infection, the damage may be permanent. Some medications and diagnostic agents can have toxic
effects. In some cases, non-steroidal anti-inflammatory drugs (NSAIDS, such as over-the-counter
ibuprofen and various prescription drugs), x-ray dye, ACE inhibitors, and certain antibiotics can
damage the kidneys. Acute (sudden) kidney failure may result, a condition that requires
emergency medical treatment to prevent death.
Cancers involving the urinary system are not as common as those in other parts of the body.
Kidney cancers are of two main types. One called Wilm's tumour occurs in young children and is
often detected as a firm swelling in the belly. Renal cell carcinoma, which occurs in middle-aged
to older adults, can cause blood in the urine but is often not detected until it has spread to other
parts of the body. Bladder cancers are more common, and often present with painless, bloody
urine. In many cases, the blood is only detected when a urinalysis is performed. Because bladder
cancers can be controlled when detected early, any urine bleeding in adults (except during a
woman’s menstrual period) should be checked by your doctor.
13. LIVER
There are many disorders of the liver that require clinical care by a physician or other healthcare
professional. Listed below are some.
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Alcohol-Induced Liver Disease
Chronic Liver Disease / Cirrhosis
Congenital Defects
Hepatitis
Liver Tumours
Hepatitis
Hepatitis is the Latin word for liver inflammation. It is characterised by the destruction of a
number of liver cells and the presence of inflammatory cells in the liver tissue.
Hepatitis can be caused by diseases that primarily attack the liver cells. It can also arise as a result
of a disease such as mononucleosis. Hepatitis can be divided into two subgroups according to its
duration:
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acute hepatitis - lasting less than six months
chronic hepatitis - lasting longer than six months.
What can cause acute hepatitis?
Acute hepatitis has a number of possible causes.
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Infectious viral hepatitis such as hepatitis A, hepatitis B, hepatitis C, hepatitis D and
hepatitis E.
Other viral diseases such as: mononucleosis and cytomegalovirus.
Severe bacterial infections.
Amoebic infections.
Medicines, eg paracetamol poisoning and halothane (an anaesthetic).
Toxins: alcohol and fungal toxins, eg toadstool poisoning.
What can cause chronic hepatitis?
Chronic hepatitis also has a number of different causes.
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Contagious viral hepatitis such as hepatitis B, hepatitis C and hepatitis D.
Medicines.
Toxins such as alcohol.
Autoimmune hepatitis. This is a disease in which a number of liver cells are destroyed by
the patient's own immune system. Autoimmune hepatitis can also sometimes occur as
acute hepatitis. The cause is unknown.
Inborn metabolic disorders, such as Wilson's disease (disorder of the body's copper
metabolism) and haemochromatosis (disorder of the body's iron metabolism).
How do you get hepatitis?
A person can develop hepatitis if they contract one of the viruses that can cause liver
inflammation, or as a result of exposure to substances that can cause hepatitis - alcohol, fungal
toxins and certain medicines.
There are two ways in which medicines can lead to hepatitis: it can either occur as a result of
medicine poisoning through overdoses of a medicine (eg paracetamol), or it can occur as a result
of an abnormal reaction of the liver to a normal dose (eg halothane, the anaesthetic). Fortunately,
the latter type of hepatitis is rare.
What are the symptoms of hepatitis?
Acute hepatitis
The symptoms of acute hepatitis vary considerably from person to person. Some patients have no
symptoms at all, and in most cases, children only show mild symptoms.
In the early stages:
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tiredness, general malaise, slight fever
nausea, poor appetite, changes in taste perception
pressure or pain below the right ribs caused by an enlarged liver
aching muscles and joints, headache, skin rash.
The jaundice phase:
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yellowing of sclerae (the white portions of the eyes), skin and mucous membranes
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dark urine
light-coloured stools
around this time, the other symptoms subside.
The recovery phase:
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tiredness that can last for weeks.
Chronic hepatitis
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Many patients have no symptoms.
Tiredness, an increased need for sleep, aching muscles and joints.
Periodic light pressure or pain below the right ribs - enlarged liver.
Jaundice is a very late symptom of chronic hepatitis. It is a sign that the disease has become
serious.
Who is at risk of hepatitis?
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Patients with jaundice or other symptoms of hepatitis.
People who are very likely to have contracted the hepatitis B or the hepatitis C virus.
People who are at increased risk due to a hereditary type of hepatitis in their families.
How can hepatitis be prevented?
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By avoiding exposure to the infectious hepatitis viruses.
By being vaccinated against hepatitis A and hepatitis B, if you run a high risk of being
infected.
By refraining from drinking large amounts of alcohol.
14. EATING
Eating disorders affect seven girls in every 1,000, and one boy in every 1,000. It usually begins to
be a problem in teenage years, but can happen at any time.
It’s not known for certain what causes then, but many factors could play a part:
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Social pressure, particularly caused by the media idealising being thin.
Losing weight can make us feel good and in control.
Puberty - anorexia reverses some of the physical changes of becoming an adult.
Family problems - saying “no” to food may be the only way you can express your feelings.
Depression and low self-esteem - binges may start off as a way of coping with unhappiness.
Genes - it can run in families.
Symptoms
Anorexia nervosa:
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Becoming extremely stressed about losing weight
Being unable to stop losing weight, regardless of your size
Smoking and chewing gum to keep your weight down
Losing interest in sex
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In women, periods become irregular or stop, in men and boys, erections and wet dreams
stop and testicles shrink
Bulimia nervosa:
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Becoming extremely stressed about losing weight
Binge eating
Making yourself vomit
Using laxatives
In women, periods become irregular
Feeling extremely guilty about your eating pattern, but staying a normal weight
Binge Eating Disorder has recently been recognised as a condition. It involves dieting and binge
eating, but not vomiting. Although distressing, it’s less harmful than bulimia. People with the
condition are more likely to become overweight.
Treatment
Self help
Try to stick to regular mealtimes – breakfast, lunch and dinner. If your weight is very low, have
extra snacks. Keep a diary of what you eat and your thoughts and feelings, you can use this to see
if there are links between how you feel, think and eat. Contact b-eat or join a self-help group.
Professional help
Your GP can refer you to a specialist counsellor, psychiatrist or psychologist. Your eating disorder
may have caused physical problems or you may have an unrecognised medical condition.
A specialist will want to find out when the problem started and how it developed. You will be
weighed and, depending on how much weight you've lost, may need a physical examination and
blood tests. A dietician may talk to you about healthy eating. You may need vitamin supplements.
With your permission, the specialist might want to talk with your family or a friend to see what
light they can shed on the problem.
Psychotherapy or counselling involves talking to a therapist about your thoughts and feelings. It
helps you understand how the problem started and how you can change some of the ways you
think and feel about things. Although it can be upsetting, a good therapist will help you talk about
things in a way that helps you cope with your situation, and builds your self-esteem
Hospital admission is only an option if you are dangerously underweight or just not getting
better. It involves controlling your eating, completing physical checks and talking about problems.
Compulsory treatment (sometimes called sectioning) only happens if someone is so unwell that
their life or health is in danger, or they cannot make proper decisions for themselves and need to
be protected.
Cognitive Behavioural Therapy (CBT) helps you to look at the links between your thoughts,
feelings and actions. It can be done with a therapist, with a self-help book, in group sessions, or a
computer program.
Interpersonal therapy is usually done with an individual therapist, focusing on your relationships
with other people.
Dietary advice helps you get back to regular eating, without starving or vomiting.
Antidepressants can reduce the urge to binge eat. Unfortunately, without the other forms of help,
the benefits wear off after a while.
About half of patients make a recovery, although it can take place slowly over a few months or
years.
15. SLEEPING
A sleep disorder (somnipathy) is a medical disorder of the sleep patterns of a person or animal.
Some sleep disorders are serious enough to interfere with normal physical, mental and emotional
functioning.
Broad classifications of sleep disorders
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Dyssomnias - A broad category of sleep disorders characterized by either
hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e.,
arising from within the body), extrinsic (secondary to environmental conditions or
various pathologic conditions), and disturbances of circadian rhythm.
Insomnia
Narcolepsy
Obstructive sleep apnoea
Restless leg syndrome
Periodic limb movement disorder
Hypersomnia
Circadian rhythm sleep disorders
.Medical or Psychiatric Conditions that may produce sleep disorders
Psychoses (such as Schizophrenia)
• Mood disorders
 Depression
 Anxiety
• Panic
• Alcoholism
Sleeping sickness - a parasitic disease which can be transmitted by the Tsetse fly
Snoring - Not a disorder in and of itself, but it can be a symptom of deeper problems.
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Common causes of sleep disorders
Changes in life style, such as shift work change (SWC), can contribute to sleep disorders.
Other problems that can affect sleep:
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Anxiety
Back pain
Chronic pain
Sciatica
Neck pain
Environmental noise
Incontinence
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Various drugs - Many drugs can affect the ratio of the various stages of sleep, thus affecting
the overall quality of sleep. Poor sleep can lead to accumulation of Sleep debt.
Withdrawal - Drug Withdrawal during the cold turkey actual withdrawal stage can lead to
loss of ability to get to sleep and can last for several days through to several weeks. It is
particularly a pervasive symptom for withdrawal from Opiods and in particular Heroin,
see Heroin Withdrawal.
Endocrine imbalance mainly due to Cortisol but not limited to this hormone. Hormone
changes due to impending menstruation or during the menopause transition years.
Chronobiological disorders, mainly Circadian rhythm disorders
Any time back pain or another form of chronic pain is present, both the pain and the sleep
problems should be treated simultaneously, as pain can lead to sleep problems and vice versa.
General principles of treatment
Treatments for sleep disorders generally can be grouped into four categories:
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behavioural/ psychotherapeutic treatments
rehabilitation/management
medications
other somatic treatments
None of these general approaches is sufficient for all patients with sleep disorders. Rather, the
choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history,
and preferences, as well as the expertise of the treating clinician. Often, behavioural /
psychotherapeutic and pharmacological approaches are not incompatible and can effectively be
combined to maximize therapeutic benefits. Management of sleep disturbances that are secondary
to mental, medical, or substance abuse disorders should focus on the underlying conditions.
Medications and somatic treatments may provide the most rapid symptomatic relief from some
sleep disturbances. Some disorders, such as narcolepsy, are best treated pharmacologically.
Others, such as chronic and primary insomnia, may be more amenable to behavioural
interventions, with more durable results.
Chronic sleep disorders in childhood, which affect some 70% of children with developmental or
psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also
common among adolescents, whose school schedules are often incompatible with their natural
circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and
perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical
treatment is often warranted.
Special equipment may be required for treatment of several disorders such as obstructive apnoea,
the circadian rhythm disorders and bruxism. In these cases, when severe, an acceptance of living
with the disorder, however well managed, is often necessary.
Sleep medicine
Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of
REM sleep and sleep apnea, the medical importance of sleep was recognized. The medical
community began paying more attention than previously to primary sleep disorders, such as sleep
apnoea, as well as the role and quality of sleep in other conditions. By the 1970s in the USA, clinics
and laboratories devoted to the study of sleep and sleep disorders had been founded, and a need
for standards arose.
16. EYE
Typically, common eye disorders can be broken down into common eye symptoms, making it
easier to sort them out and come up with specific guidelines. Major categories include:
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Redness
Itching
Swelling
Burning
Trauma
Pain
Blur (decrease in vision)
Spots, flashes and floaters
Blurred vision needs to be defined exactly what it means - there may be different understandings
of what blurred vision is. History and examination should reveal most causes but it may be
necessary to refer to an ophthalmologist for confirmation or management of the problem.
History
What is the patient complaining of?
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Blurred vision - a single image that is seen indistinctly. Is this at distance, near or both?
Decrease in peripheral vision - the patient may describe bumping into things or frequent
scrapes when parking the car.
Alteration of a clear image e.g. micropsia/macropsia (image appears smaller or bigger) or
metamorphopsia (distorted image).
Interference with a clear image (e.g. floaters, flashes of light - photopsia).
Diplopia - monocular (the double vision remains when the uninvolved eye is occluded),
binocular (vision returns to normal on covering one eye), horizontal, vertical, oblique.
Other disturbances of vision e.g. iridescent vision (halos, rainbows), dark adaptation
problems or night blindness (nyctalopia), colour vision abnormalities.
History of the presenting complaint
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Is it unilateral or bilateral?
Was it sudden or gradual in onset? If sudden, what was the patient doing at the time, what
have they done recently that may have affected the eyes (e.g. DIY, trauma). If gradual over
what period of time?
Has this happened before? When, what happened, has it been diagnosed?
Are there any associated factors? Examples include any of the other visual phenomena
described above, pain (distinguish between ocular pain and pain in the head), associated
ocular complaints (e.g. red eye, discharge, abnormal appearances) or systemic complaints
(e.g. headache, other neurological problems, generalised malaise).
Other important factors in the history

Other ocular history - could this be a worsening of a pre-existing condition (e.g. cataracts
that have now become symptomatic) or new condition arising from a recent problem (e.g.
infection after cataract surgery)?
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Medical history - many systemic conditions affect the eye and may result in acute or
chronic blurring of the vision - see our dedicated article.
Medication - some drugs may be toxic to the eye or precipitate acute angle closure
glaucoma.
Family history - it is helpful to know about atopy, diabetes, thyroid disease, certain
malignancies and any hereditary syndromes.
Social history - important in many ways, e.g. a metal worker with arc eye, an elderly person
whose cataracts are making it difficult for them to cope alone, an HGV driver who needs to
contact the DVLA.
A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens
works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also
adjusts the eye's focus, letting us see things clearly both up close and far away.
The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps
the lens clear and lets light pass through it.
But as we age, some of the protein may clump together and start to cloud a small area of the lens.
This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder
to see.
Glaucoma Symptoms
Glaucoma is often called the "silent thief of sight," because most types typically cause no pain and
produce no symptoms.
For this reason, glaucoma often progresses undetected until the optic nerve already has been
irreversibly damaged, with varying degrees of permanent vision loss.
But with acute angle-closure glaucoma, symptoms that occur suddenly can include blurry vision,
halos around lights, intense eye pain, nausea and vomiting. If you have these symptoms, make
sure you see an eye care practitioner or visit the emergency room immediately so steps can be
taken to prevent permanent vision loss.
17. EAR / NOSE / THROAT
An ear infection means that the middle ear is infected. The middle ear is the eardrum and the
small space behind the eardrum. An ear infection is sometimes called 'acute otitis media'.
Tinnitus from the Latin word tinnītus meaning "ringing"[ is the perception of sound within the
human ear in the absence of corresponding external sound.
Tinnitus is not a disease but a symptom resulting from a range of underlying causes that can
include ear infections, foreign objects or wax in the ear, nose allergies that prevent (or induce)
fluid drain and cause wax build-up, and injury from loud noises. Tinnitus can also be caused by
hearing impairment and as a side-effect of some medications.
Nose Bleeds are relatively common occurrence of haemorrhage from the nose, usually noticed
when the blood drains out through the nostrils. There are two types: anterior (the most common),
and posterior (less common, more likely to require medical attention). Sometimes in more severe
cases, the blood can come up the naso-lacrimal duct and out from the eye. Fresh blood and clotted
blood can also flow down into the stomach and cause nausea and vomiting
Snoring in deep sleep the muscles of the tongue, throat and roof of mouth relax and allow the
tongue and soft palate and uvula to fall backward. The heavier the person is, the more
overweight, the more this backward fall can close the breathing passage. In a recent study it was
shown that by correcting the nasal condition and shrinking the tonsils, even sleep apnea can be
corrected.
Throat Infections are also called Pharyngitis, which is an inflammation of the throat or pharynx. In most
cases it is painful, and thus is often referred to as a sore throat.
Like many types of inflammation, pharyngitis can be acute – characterised by a rapid onset and
typically a relatively short course – or chronic. The remainder of this article is about the acute
form.
Acute pharyngitis can result in very large tonsils which cause trouble swallowing and breathing.
Some cases are accompanied by a cough or fever.
Most acute cases are caused by viral infections (40%–60%), with the remainder caused by bacterial
infections, fungal infections, or irritants such as pollutants or chemical substances.[2]
Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be
amenable to antibiotics and anti-fungals respectively.
18. ALIMENTARY
Alimentary disorders range from the occasional upset stomach, heartburn and nausea to the more
serious and life-threatening colorectal cancer. These disorders encompass the gastrointestinal tract
as well as the liver, gallbladder and pancreas. Most digestive disorders and diseases are complex,
with subtle symptoms, and the causes of many remain unknown. Some may be genetic or develop
from multiple factors such as stress, fatigue, diet or smoking. Alcohol abuse also poses a risk for
digestive disorders.
The human digestive system is a complex series of organs and glands that processes food. In order
to use the food we eat, our body has to break the food down into smaller molecules that it can
process; it also has to excrete waste. Most of the digestive organs (like the stomach and intestines)
are tube-like and contain the food as it makes its way through the body. The digestive system is
essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs
(like the liver and pancreas) that produce or store digestive chemicals.
The digestive system includes the digestive tract and its accessory organs, which process food into
molecules that can be absorbed and utilized by the cells of the body. Food is broken down, bit by
bit, until the molecules are small enough to be absorbed and the waste products are eliminated.
Digestion begins in the mouth when food is chewed and starch is broken down by ptyalin, an
enzyme secreted in saliva. Food then enters the stomach, where it is reduced to tiny particles and
further transformed by gastric juices. The solid portion remains in the stomach for one to six
hours until it liquefies completely; liquid passes into the duodenum (small intestine), where
numerous enzymes produced by the pancreas, along with bile from the liver, break it down
further for absorption. When it finally arrives in the large intestine, all nutritional value has been
spent, and the only remaining process is the removal of water before final elimination.
There are many disorders and diseases of the digestive system. Some, like gastroesophageal reflux
disease, ulcers, and hiatal hernias can cause heartburn. Others may not heartburn as a symptoms,
but because some people who have one of the above mentioned conditions also have other
disorders of the digestive system, such as irritable bowel syndrome (IBS), information is provided
for these also. Digestive disorders causes include toxic chemicals from pesticides and other
contaminates in food, blockage or damage in the intestinal track or an obstruction in the bile duct
which interfere with the passage of bile salts or prevents the pancreas to produce the enzymes for
digestion and absorption. Digestive disorders can also be caused from antibiotics, drug
medications, synthetic chemicals and processed food.
Digestive disorders cause autoimmune disorders like allergic reactions, arthritis, bacterial, parasite
and viral infection, diabetes, tumors and other health related conditions. Symptoms of digestive
disorders and malnutrition are abdominal pain, anemia, bad vision, constipation, depression,
diarrhea, dry skin, fatigue, gas, hair loss, heartburn, loss of concentration, low energy, muscle
cramps, physical problems, premenstrual syndrome, rectal bleeding, weakness, weight loss or
obesity in some. Every vitamin and mineral along with all the other essential nutrients will have
different effects from each deficiency.
People suffering from digestive disorders or malnutrition are less likely to detoxify and eliminate
the various toxins in the intestines and the rest without proper nutrition. Many toxins the liver
deals with originate in the gastrointestinal tract. Our ability to remove these toxins is dependent
upon proper function of the liver and enzymes for excreting the toxins. The detoxification and
healing process improves by taking the right balance of nutrients.
20. SPINE
Back pain can affect anyone at any age, but it's most common in people between the ages of 35
and 55.
'Acute' and 'chronic' are terms used to describe how long the symptoms last, not how severe they
are.
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Acute back pain - less than six weeks.
Sub-acute back pain - six weeks to three months.
Chronic back pain - longer than three months.
Causes of back pain
There isn't usually an underlying condition causing back pain - nothing shows up in tests and
nothing is permanently damaged. This is called simple or non-specific back pain. Nine out of 10
people with simple back pain recover completely within six weeks.
You're more likely to develop simple back pain if you:
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stand, sit or bend down for long periods
lift, carry, push or pull loads that are too heavy, or if you go about these tasks in the wrong
way
have a trip or a fall
are stressed or anxious
are overweight
Occasionally, there may be a more serious underlying cause of your back pain, but this is rare.
These causes include osteoporosis, a prolapsed (slipped) disc, spinal stenosis, malformation of the
spine, infection or collapse of the vertebrae, tuberculosis or cancer.
Symptoms of back pain
Simple back pain is often in your lower back (lumbar region), and may also spread to your
buttocks and thighs. It's often described as a dull pain and can come and go at different times,
depending on your level of activity. The pain can begin suddenly or come on gradually if you
strain your back over time.
Simple back pain usually only lasts a few days and gets better on its own.
However, you should see your GP as soon as possible if, as well as back pain, you have:

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fever (high temperature)
redness or swelling on your back
pain down your legs and below your knees
numbness or weakness in one or both legs or around your buttocks
loss of bladder or bowel control (incontinence)
Some symptoms are called "red flags" and may indicate that you require treatment for an
underlying condition. You should see your GP if:
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your pain is the result of an injury
you're under 20 or over 55 and the pain lasts for more than a few days
you have had or currently have cancer in any part of your body
you have HIV/AIDS
you have been taking steroid medicines for more than a few months
Diagnosis of back pain
Your GP will ask you about your symptoms and examine you. He or she may also ask you about
your medical history.
If your pain lasts longer than six weeks, or if your GP suspects there is some underlying cause of
your pain, he or she may recommend more tests such as:

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
X-rays
CT scans - a CT scan uses X-rays to make a three-dimensional image of the body/or part of
the body
MRI - an MRI scan uses magnets and radiowaves to produce images of the inside of your
body
blood tests
Treatment of back pain
Self-help
There are many things you can do to help yourself.


Stay active - return to your usual level of physical activity as soon as possible. This may
hurt more at first, but it will help you get better and reduce your risk of getting simple back
pain again.
Bed rest - if the pain is so bad that you can't get moving, keep the time you stay in bed as
short as possible. Lying in bed can do more harm than good.
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Stay positive and set yourself goals - this will help you get back to your usual levels of
physical activity.
Heat therapy - apply a hot water bottle or heat pack directly to the affected area, or take a
hot bath.
Ice therapy - apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel.
Don't apply ice directly to your skin because you could damage it.
Pace yourself - be careful not to overdo it when your pain improves.
Medicines
Taking a painkiller (such as aspirin or paracetamol) or anti-inflammatory medicine (such as
ibuprofen) is often enough to relieve simple back pain and can help you keep active. You can also
use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients that can be
applied directly onto the painful area.
If your pain continues, your GP may prescribe stronger medicines such as diazepam, morphine or
tramadol. However, these aren't suitable for everyone because they can be addictive and cause
side-effects.
Your GP or pharmacist will advise you which treatment is the most appropriate for you. Always
read the patient information leaflet that comes with your medicine and if you have any questions,
ask your GP or pharmacist for advice.
Transcutaneous electrical nerve stimulation (TENS)
TENS relieves back pain by delivering mild electric pulses to the painful area through electrodes
on your skin. These stimulate your nerve fibres and block the pain signals to your brain. TENS
isn't suitable for everybody and isn't always effective. You should check with your GP before you
use TENS and make sure you know how to use it properly.
Physiotherapy
Physiotherapists can assess and treat your back pain, and teach you exercises to do at home that
will increase your mobility and help you manage your pain. You should only see a
physiotherapist registered with the Chartered Society of Physiotherapy.
Manipulation
Osteopathy and chiropractic are treatments involving manipulation of the body, mainly focusing
on the spine. They are most useful if you have had back pain for less than three months and can
provide short-term (most often) or long-term pain relief. These treatments aren't suitable for
everybody and aren't always effective, so it's important to speak to your GP first. You should only
see an osteopath registered with the General Osteopathic Council or a chiropractor registered with
the General Chiropractic Council.
Pain clinics
If your pain continues, your GP may refer you to a pain clinic. Pain clinics offer a range of
treatments that are known to be effective and can also help you deal with your pain by changing
the way you think about it. Treatments at pain clinics are often combined and tailored to suit your
needs.
Injections
Painkillers and anti-inflammatory medicines (usually steroids) can be injected directly into the
epidural space (the space around your spinal cord) or around the joints of your spine to ease pain
and decrease inflammation. These injections are only given by specialist doctors in hospitals.
Epidural injections are usually only done if other treatments don't work.
Surgery
Surgery is considered as a last resort in the treatment of back pain. The type of surgery you're
offered will depend on the cause of your pain and each type has different risks and success rates.
Your surgeon will discuss the different options with you in more detail.
Complementary therapies
The following complementary therapies may help with back pain in some people. You should talk
to your GP before trying them as he or she may be able to refer you to a specialist practitioner
experienced in treating back pain.
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Acupuncture.
Counselling.
The Alexander Technique - becoming more aware of your body's balance, posture, and
movement.
Herbal remedies.
Massage.
Prevention of back pain
Good back care can greatly reduce your risk of back pain. To look after your back, make sure you:
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take regular exercise - walking and swimming are particularly recommended
try to reduce your stress levels - use relaxation techniques
bend from your knees and hips - not your back
maintain good posture - keep your shoulders back and don't slouch
21. FRAILTY
Frailty syndrome is a collection of symptoms or markers that place (mostly) older adults at
increased risk of adverse events such as death, disability, and institutionalisation. The term
"frailty" has been used quite often in the gertontological literature without a firm definition of the
state.
Frailty is determined based on cut offs in 5 components - Muscle weakness, weight loss, low
physical activity, exhaustion, and slow walking speed. Subjects below certain cutoffs on 3 or more
components are deemed frail, those with 1-2 components below cut offs are deemed
intermediately or moderately frail, and those scoring higher than cut points on all 5 measures are
deemed non-frail or robust.
22. INFIRMITY
Infirmity is an ailment; a disease; a imperfection in body or character; esp., an unsound,
unhealthy, or debilitated state; a disease; a malady; as, infirmity of body or mind. feebleness and
frailty, especially due to old age.
23. ANTACIDS
Antacids are an over-the-counter (OTC) medication used to treat the symptoms of heartburn.
They are usually available in tablet or liquid form.
What is heartburn?
Despite the name, heartburn has nothing to do with the heart. Heartburn is caused when stomach
acid passes out of the stomach and up into the oesophagus (the tube that carries food from the
mouth to the stomach).
The acid can irritate the surface of the oesophagus, leading to the burning sensation associated
with heartburn. Health professionals prefer to use the term gastro-oesophageal reflux disease, or
GORD, to describe this condition because it's a more accurate term than heartburn. See the Useful
links section for more information about GORD.
How do antacids work?
Antacids can work in two ways:
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they can coat the surface of the oesophagus to protect it from stomach acids, or
they can produce a gel in your stomach, which helps prevent acid leaking up into your
oesophagus.
Are antacids effective?
There is evidence that antacids are effective in providing short-term relief for the symptoms of
GORD. However, long-term use is not recommended because there are more effective prescription
medications for the treatment of recurring GORD, such as proton-pump inhibitors.
Lifestyle changes, particularly changes in diet, can reduce the symptoms of GORD. Your GP will
be able to provide more advice about diet.
You should see your GP if the symptoms of GORD persist for more than a week, or they quickly
return once the effects of the antacids wear off.
Who should not take antacids?
The long-term use of antacids in young children is not recommended. This is because they can
interfere with the body’s ability to absorb calcium, which is required for the development of
healthy bones.
There have been a number of cases where children have developed rickets (a developmental
disorder) due to taking high-dose antacids over the course of five to six weeks.
Antacids are generally considered to be safe to take during pregnancy, but they can interfere with
the absorption of iron. Therefore, if you need to take iron supplements during pregnancy, take
them at least two hours before, or after, taking antacids.
Similarly, antacids may interfere with your body’s ability to absorb other types of medication,
particularly if you take them at the same time. Your GP or pharmacist can advise you about the
best way to take both types of medication.
Some antacids contain high levels of magnesium and aluminium, which may be harmful for
people who have a history of kidney disease. Also, some antacids contain high levels of salt,
which may be harmful for those with high blood pressure (hypertension).
Ask your pharmacist or your GP for advice about which antacids are suitable for you if you have
high blood pressure or a history of kidney disease.
Side effects
A study that looked at how antacids affect people found that 12% of those who took antacids
experienced side effects. The side effects included:
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
diarrhoea,
nausea,
vomiting,
blood in the stools,
flatulence (wind), and
constipation.
However, any side effects that you experience should pass once you stop taking antacids.
24. ANTI-INFLAMMATORY
Anti-inflammatory painkillers are used to treat arthritis, sprains, painful periods, and other
painful conditions. Most people have no trouble taking these tablets. However, some people
develop side-effects which can sometimes be serious
What are anti-inflammatory painkillers?
Anti-inflammatory painkillers are sometimes called non-steroidal anti-inflammatory drugs
(NSAIDs), or just 'anti-inflammatories'. There are over 20 types. They include: aceclofenac,
acemetacin, aspirin (see also below), celecoxib, dexibuprofen, dexketoprofen, diclofenac,
diflunisal, etodolac, etoricoxib, fenbrufen, fenoprofen, flurbiprofen, ibuprofen, indomethacin,
lumiracoxib, ketoprofen, mefanamic acid, meloxicam, nabumetone, naproxen, piroxicam,
sulindac, tenoxicam, and tiaprofenic acid. Each of these also come as different brand names.
Anti-inflammatories are used to ease pain in various conditions including: arthritis (various
types), muscle and ligament pains (strains and sprains), period pain, pains after operations,
headaches, migraines, and some other types of pain. You need a prescription to get antiinflammatories, apart from ibuprofen and aspirin which you can also buy from pharmacies.
Ibuprofen and aspirin are also used to bring down a high temperature. Low dose aspirin is also
used to help prevent blood clots that can cause a heart attack or stroke. (See separate leaflet called
'Aspirin to Prevent Blood Clots'.)
How do anti-inflammatory painkillers work?
They work mainly by reducing the amount of prostaglandins that are made. Prostaglandins are
chemicals that are released by cells at sites of injury. Prostaglandins are involved in causing
inflammation and swelling. They also sensitise nerve endings which can cause pain. Antiinflammatories stop certain enzymes (chemicals) from working that are needed to make
prostaglandins. Therefore, as you make less prostaglandins, you have less inflammation and pain.
How effective are anti-inflammatory painkillers?
After a single dose, they work at least as well as paracetamol to ease pain, and they may even be
better. With repeated doses, they also reduce inflammation. This may further reduce pain and
stiffness that occurs with inflammatory conditions such as arthritis and muscle sprains. So, you
might not notice the maximum effect for up to 1-3 weeks after starting a course of tablets.
Some general points about taking anti-inflammatory painkillers
It is often worth trying paracetamol before taking an anti-inflammatory. Paracetamol is a good
painkiller, and is less likely to cause side-effects. Although paracetamol does not reduce
inflammation, it is often the preferred painkiller for muscle and joint conditions that cause pain
but have little inflammation. For example, osteoarthritis.
Anti-inflammatories do not alter the course of painful conditions such as arthritis. They just ease
symptoms of pain and stiffness. However, this may provide further benefit because, if pain is
eased, you may then be able to move around more easily or use a painful joint more easily. The
inflammation and pain of various types of arthritis often 'comes and goes'. During good spells,
when symptoms are not too bad, you may not need to take anti-inflammatories.
The different types of anti-inflammatories have pros and cons which is why different people take
different ones. For example:


Some are less likely to cause side-effects, but may not be as strong as others.
Some need to be taken more often each day than others.
Some people find that one preparation works better than another for them. If one preparation
does not work very well at first, then a different one may work better. It is not unusual to try two
or more preparations before finding one that suits you best. Your doctor can advise.
What are the possible side-effects and risks?
Most people who take anti-inflammatories have no side-effects, or only minor ones. Read the
leaflet that comes with the tablets for a full list of cautions and possible side-effects. One important
caution is that, ideally, you should not take anti-inflammatories if you are pregnant. The following
highlight some of the more important side-effects to be aware of.
Bleeding into the stomach and gut
Anti-inflammatories sometimes cause the lining of the stomach to bleed. Sometimes a stomach
ulcer develops. Sometimes bleeding is severe, and even life-threatening. Elderly people are more
prone to this problem, but it can occur in anybody. Therefore, if you are taking an antiinflammatory and you develop upper abdominal pains, pass blood or black stools, or vomit blood,
then stop taking the tablets and see a doctor as soon as possible, or go to a casualty department.
The risk of bleeding into the stomach is increased if you are taking an anti-inflammatory plus
warfarin, steroids, or low-dose aspirin (used by many people to help prevent a heart attack or
stroke). These combinations of drugs should only be used if absolutely necessary.
Some people need an anti-inflammatory to ease pain, and yet are at increased risk of stomach
bleeding. For example, people over 65, or those with a past history of a stomach or duodenal ulcer.
In such cases another drug may also be prescribed to protect the lining of the stomach from the
effects of the anti-inflammatory. This usually prevents bleeding and ulcers from developing if you
take an anti-inflammatory. Another option sometimes considered is to take an anti-inflammatory
that some studies suggest may possibly have a lower risk of causing stomach bleeding. These type
of anti-inflammatories are called selective cox-2 inhibitors and include celecoxib, etoricoxib, and
lumiracoxib. However, you should not take a selective cox-2 inhibitor if you have ischaemic heart
disease (angina, heart attack, heart failure, etc) or cerebrovascular disease (stroke).
If you have asthma, high blood pressure, heart failure or kidney failure
In some people with asthma, symptoms such as wheeze or breathlessness are made worse by antiinflammatories. Seek medical help if your asthma suddenly becomes worse after taking an antiinflammatory. Also, anti-inflammatories can sometimes make high blood pressure, heart failure,
or kidney failure worse. If you have any of these conditions, you may be more closely monitored if
you are prescribed an anti-inflammatory.
Some other side-effects that sometimes occur include:
Nausea (feeling sick), diarrhoea, rashes, headache, dizziness, nervousness, depression,
drowsiness, insomnia (poor sleep), vertigo (dizziness), and tinnitus (noises in the ear). If one or
more of these occur they will usually ease off if you stop taking the tablets. There are also a
number of other uncommon side-effects - see the leaflet in the tablet packet for details.
25. ANTI-HISTAMINES
Antihistamines are most commonly used to treat allergies such as hay fever. They are also
ingredients in other types of medicines, including cough and cold remedies, travel sickness
treatments and sleep aids.
You might take an antihistamine if you have symptoms of allergies, such as:



hay fever
allergic rashes
itchy skin
Certain antihistamines block the histamine receptors in the brain. These can be useful as a
treatment for travel sickness or vertigo and to relieve tickly coughs.
Some antihistamines cause sleepiness, and there are some types you can take to help you sleep (eg
over-the-counter sleep aids, such as Nytol, which contain the antihistamine diphenydramine that
causes drowsiness).
How do antihistamines work?
When a germ gets inside your body, your immune system recognises it as a foreign substance and
triggers various defences to protect you. The body's defences are called an immune response, and
include making chemicals that kill off germs.
When the cells that make up your body's tissues are damaged, they release a chemical called
histamine. Histamine acts like a messenger to nearby cells, telling them to start up their own
defences. This makes the site where the germ entered the body (the site of infection) red, swollen
and sore.
If you are allergic, your body mistakenly mounts an immune response to something that's not
really harmful. For example, with hay fever your body mistakes pollen for a harmful substance
and releases histamine. You then get symptoms such as sneezing and red, itchy eyes.
Antihistamines work by blocking the action of histamine on other cells, and so easing the
symptoms of allergic reactions.
How to take antihistamines
Many products based on antihistamines are available without prescription from a pharmacy.
Examples include chlorphenamine (eg Piriton) and desloratidine (eg Neoclarityn). These are
usually only for short-term use. Higher doses can only be prescribed by your doctor.
Antihistamines come as tablets, capsules and syrups (oral preparations), eye drops, nasal sprays
and drops, creams and lotions, and injections.
The nasal sprays can be helpful for hay fever and it's best to start using these before your
symptoms appear. You should not take non-prescription nasal steroids for hay fever for more than
three months. If your symptoms continue, see your GP.
The eye drops are useful if only your eyes are affected by hay fever or if, even after taking tablets,
your eyes still itch.
The creams and lotions can be helpful but can cause allergic-type reactions themselves. The risks
might outweigh the benefits, so ask your pharmacist for advice.
Antihistamine injections are only available on prescription and are only used for severe allergic
reactions and anaphylactic shock (a potentially life-threatening allergic reaction).
Antihistamines and children
Some antihistamines may be unsuitable for children under 12. Check the label or ask your
pharmacist for advice. Always read the patient information leaflet that comes with your medicine.
Special care
Talk to your doctor or pharmacist before taking an antihistamine if you have a medical condition
or are taking any other medicines.
You should also tell your doctor if you are pregnant or breastfeeding before taking an
antihistamine.
Side-effects
There are two types of antihistamines. The older (sedating) ones such as chlorphenamine are more
likely to make you feel sleepy. The newer (non-sedating) ones such as loratadine rarely cause
drowsiness.
Drowsiness caused by antihistamines can make it unsafe to drive or operate machinery.
Other, less common side-effects, mainly from the sedating group of antihistamines, are:





headaches
difficulty in passing urine
dry mouth
blurred vision
feeling sick or vomiting


constipation or diarrhoea
irritation (from creams, lotions and eye drops)
Rarely, some antihistamines can also cause:











palpitations and abnormal heart rhythms (arrhthymia)
high blood pressure
allergic reactions (such as swelling, rash and breathing difficulties)
dizziness
confusion
depression
disturbed sleep
tremor
convulsions (fits)
blood and liver disorders
over-excitement in children
Children, and adults over 65, are more likely to get side-effects.
Interactions with other medicines
Check with your doctor or pharmacist before you take any other medicines or herbal remedies at
the same time as an antihistamine.
The antihistamines terfenadine and mizolastine can interact with some other medicines and with
grapefruit juice to cause a serious abnormal heart rhythm. These antihistamines are only available
on prescription from your doctor, who will give you advice.
26. ANTI-HYPERTENSIVES
The antihypertensives are a class of drugs that are used to treat hypertension (high blood
pressure). Evidence suggests that reduction of the blood pressure by 5–6 mmHg can decrease the
risk of stroke by 40%, of coronary heart disease by 15–20%, and reduce the likelihood of dementia,
heart failure, and mortality from cardiovascular disease. There are many classes of
antihypertensives, which lower blood pressure by different means; among the most important and
most widely used are the thiazide diuretics, the ACE inhibitors, the calcium channel blockers, the
beta blockers, and the angiotensin II receptor antagonists or ARBs.
Which type of medication to use initially for hypertension has been the subject of several large
studies and resulting national guidelines. The fundamental goal of treatment should be the
prevention of the important endpoints of hypertension, such as heart attack, stroke and heart
failure. The several classes of antihypertensives differ in side effect profiles, ability to prevent
endpoints, and cost. The choice of more expensive agents, where cheaper ones would be equally
effective, may have negative impacts on national healthcare budgets. As of 2009, the best available
evidence favuors the thiazide diuretics as the first-line treatment of choice for high blood pressure
when drugs are necessary.
27. ANTI-DEPRESSANTS
What are antidepressants?
Antidepressants are drugs that relieve the symptoms of depression. They were first developed in
the 1950s and have been used regularly since then. There are almost thirty different kinds of
antidepressants available today and there are four main types:





Tricyclics
MAOIs (Monoamine oxidase inhibitors)
SSRIs (Selective Serotonin Reuptake Inhibitors)
SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants)
How do they work?
We don't know for certain, but we think that antidepressants work by increasing the activity of
certain chemicals work in our brains called neurotransmitters. They pass signals from one brain
cell to another. The chemicals most involved in depression are thought to be Serotonin and
Noradrenaline.
What are antidepressants used for?






Moderate to severe depressive illness (Not mild depression).
Severe anxiety and panic attacks
Obsessive compulsive disorders
Chronic pain
Eating disorders
Post-traumatic stress disorder.
If you are not clear about why an antidepressant has been suggested for you, ask your doctor.
How well do they work?
After 3 months of treatment, the proportions of people with depression who will be much
improved are:
50% and 65% if given an antidepressant compared with25 - 30% if given an inactive "dummy" pill,
or placebo
It may seem surprising that people given placebo tablets improve, but this happens with all
tablets that affect how we feel - the effect is similar with painkillers. Antidepressants are helpful
but, like many other medicines, some of the benefit is due to the placebo effect.
Are the newer ones better than the older ones?
Yes and no. The older tablets (Tricyclics) are just as effective as the newer ones (SSRIs) but, on the
whole, the newer ones seem to have fewer side-effects. A major advantage for the newer tablets is
that they are not so dangerous if someone takes an overdose.
What kind of antidepressant have I been recommended?
At the end of the leaflet you can find a list of antidepressants, their trade names, and their type.
Do antidepressants have side effects?
Yes - your doctor will be able to advise you here. You should always remind him or her of any
medical conditions you have or have had in the past. Listed below are the side effects you might
experience with the different types of antidepressant:
Tricyclics
These commonly cause a dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and
weight gain. Particularly in older people, they may cause confusion, slowness in starting and
stopping when passing water, faintness through low blood pressure, and falls. If you have heart
trouble, it may be best not to take one of this group of antidepressants. Men may experience
difficulty in getting or keeping an erection, or delayed ejaculation. Tricyclic antidepressants are
dangerous in overdose.
SSRIs
During the first couple of weeks of taking them, you may feel sick and more anxious. Some of
these tablets can produce nasty indigestion, but you can usually stop this by taking them with
food. More seriously, they may interfere with your sexual function. There have been reports of
episodes of aggression, although these are rare.
The list of side effects looks worrying - there is even more information about these on the leaflets
that come with the medication. However, most people get a small number of mild side-effects (if
any). The side effects usually wear off over a couple of weeks as your body gets used to the
medication. It is important to have this whole list, though, so you can recognise side effects if they
happen. You can then talk them over with your doctor. The more serious ones - problems with
urinating, difficulty in remembering, falls, confusion - are uncommon in healthy, younger or
middle-aged people. It is common, if you are depressed, to think of harming or killing yourself.
Tell your doctor - suicidal thoughts will pass once the depression starts to lift.
SNRIs
The side effects are very similar to the SSRIs, although Venlafaxine should not be used if you have
a serious heart problem. It can also increase blood pressure, so this may need to be monitored.
MAOIs
This type of antidepressant is rarely prescribed these days. MAOIs can give you a dangerously
high blood pressure if you eat foods containing a substance called Tyramine. If you agree to take
an MAOI antidepressant your doctor will give you a list of foods to avoid.
What about driving or operating machinery?
Some antidepressants make you sleepy and slow down your reactions - the older ones are more
likely to do this. Some can be taken if you are driving. Remember, depression itself will interfere
with your concentration and make it more likely that you will have an accident. If in doubt, check
with your doctor.
Are antidepressants addictive?
Antidepressant drugs don't cause the addictions that you get with tranquillisers, alcohol or
nicotine, in the sense that:


You don't need to keep increasing the dose to get the same effect
You won't find yourself craving them if you stop taking them
However, there is a debate about this. In spite of not having the symptoms of addiction described
above, up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms.
These include:






Stomach upsets
Flu like symptoms
Anxiety
Dizziness
Vivid dreams at night
Sensations in the body that feel like electric shocks (see references)
In most people these withdrawal effects are mild, but for a small number of people they can be
quite severe. They seem to be most likely to happen with Paroxetine (Seroxat) and Venlafaxine
(Efexor). It is generally best to taper off the dose of an antidepressant rather than stop it suddenly.
Some people have reported that, after taking an SSRI for several months, they have had difficulty
managing once the drug has been stopped and so feel they are addicted to it. Most doctors would
say that it is more likely that the original condition has returned.
The Committee of Safety of Medicines in the UK reviewed the evidence in 2004 and concluded
'There is no clear evidence that the SSRIs and related antidepressants have a significant
dependence liability or show development of a dependence syndrome according to
internationally accepted criteria.'
SSRI antidepressants, suicidal feelings and young people
There is some evidence of increased suicidal thoughts (although not actual suicidal acts) and other
side effects in young people taking antidepressants. So, SSRI antidepressants are not licensed for
use in people under 18. However, the National Institute for Clinical excellence has stated that
Fluoxetine, an SSRI antidepressant, can be used in the under-18s.
There is no clear evidence of an increased risk of self-harm and suicidal thoughts in adults of 18
years or over. But, individuals mature at different rates. Young adults are more likely to commit
suicide than older adults, so a young adult should be particularly closely monitored if he or she
takes an SSRI antidepressant.
What about pregnancy?
It is always best to take as little as possible in the way of medication during pregnancy, especially
during the first 3 months. There is evidence that babies of mothers who took antidepressants
during this time are more likely to have malformations. However, some mothers do have to take
antidepressants during pregnancy and the risks need to be balanced.




The older tricyclic antidepressants, such as amitriptyline, imipramine and nortriptyline, are
least likely to cause problems in pregnancy but they have more side effects and are more
dangerous in overdose than the SSRIs.
If you need to take an SSRI, Fluoxetine seems to be the safest. But there is evidence that all
SSRIs can increase the risk of a rare but serious condition (persistent pulmonary
hypertension) in the newborn baby if they are taken after the 20th week of pregnancy.
They also increase the risk of raised blood pressure in the mother, particularly if they are
continued beyond the frist three months of pregnancy.
There is some evidence that babies of mothers taking antidepressants can get withdrawal
symptoms soon after birth. Just as with adults, this seems to happen more often with
Paroxetine.
What about breastfeeding?
Women commonly become depressed after giving birth - this is called post-natal depression. It
usually gets better with counselling and practical support. However, if you get it badly, it can
exhaust you, stop you from breast-feeding, upset your relationship with your baby and even hold
back your baby's development. In this case, antidepressants can be helpful.
What about the baby?
A baby will get only a small amount of antidepressant from mother's milk. Babies older than a few
weeks have very effective kidneys and livers. They are able to break down and get rid of
medicines just as adults do, so the risk to the baby is very small.
Some antidepressants, like imipramine, nortriptyline and sertraline only get into the breast milk in
very small amounts –it is worth talking this over with your doctor or pharmacist. On balance,
bearing in mind all the advantages of breast-feeding, it seems best to carry on with it while taking
antidepressants.
How should antidepressants be taken?


Keep in touch with your doctor in the first few weeks. With some of the older Tricyclic
drugs it's best to start on a lower dose and work upwards over the next couple of weeks. If
you don't go back to the doctor and have the dose increased, you could end up taking too
little. You usually don't have to do this with the SSRI tablets. The dose you start with is
usually the dose you carry on with. It doesn’t help to increase the dose above the
recommended levels.
Try not to be put off if you get some side effects. Many of them wear off in a few days.
Don't stop the tablets unless the side effects really are unpleasant. If they are, get an urgent
appointment to see your doctor. If you feel worse it is important to tell your doctor so that
he can decide if the medicines are right for you. Your doctor will also want to know if you
get increased feelings of restlessness or agitation.
Take them every day - if you don't, they won't work.
Wait for them to work. They don't work straight away. Most people find that they take 1-2 weeks
to start working and maybe up to 6 weeks to give their full effect.

Persevere - stopping too early is the commonest reason for people not getting better and for
the depression to return.




Try not to drink alcohol. Alcohol on its own can make your depression worse, but it can
also make you slow and drowsy if you are taking antidepressants. This can lead to
problems with driving - or with anything you need to concentrate on.
Keep them out of the reach of children.
Tempted to take an overdose? Tell your doctor as soon as possible and give your tablets to
someone else to keep for you.
Tell your doctor about any major changes in how you feel when the dose of antidepressant
is changed.
How long will I have to take them for?
Antidepressants don't necessarily treat the cause of the depression or take it away completely.
Without any treatment, most depressions will get better after about 8 months.
If you stop the medication before 8 or 9 months is up, the symptoms of depression are more likely
to come back. The current recommendation is that it is best to take antidepressants for at least six
months after you start to feel better. It is worthwhile thinking about what might have made you
vulnerable, or might have helped to trigger off your depression. There may be ways of making
this less likely to happen again.
If you have had two or more attacks of depression then treatment should be continued for at least
two years.
What if the depression comes back?
Some people have severe depressions over and over again. Even when they have got better, they
may need to take antidepressants for several years to stop their depression coming back. This is
particularly important in older people, who are more likely to have several periods of depression.
For some people, other drugs such as Lithium may be recommended. Psychotherapy may be
helpful in addition to the tablets.
So what impact would these tablets have on my life?
Depression is unpleasant. It can seriously affect your ability to work and enjoy life.
Antidepressants can help you get better quicker. They can be prescribed by your GP and, apart
from the side effects listed overleaf, should have very little impact on your life. People on these
tablets, particularly the newer ones, should be able to socialise, carry on at work, and enjoy their
normal leisure activities.
If you have been depressed for a long time, others who know you well (for example your partner)
may have got used to you being like this. Some people in this situation have reported that, as they
get better and developed a more positive outlook, their partners had difficulty in adjusting to the
change. This can cause friction and is something that people need to be aware of and discuss
openly if it happens.
What will happen if I don't take them?
It's difficult to say - so much depends on why they have been prescribed, on how bad your
depression is and how long you've had it for. It's generally accepted that most depressions resolve
themselves naturally within about 8 months. If your depression is mild it is best to try some of the
other treatments mentioned later in this leaflet. If you can’t decide, talk it over with your doctor.
What other treatments of depression are available?
It is not enough just to take the pills. It is important to find ways of making yourself feel better, so
you are less likely to become depressed again. These can include finding someone you can talk to,
taking regular exercise, drinking less alcohol, eating well, using self-help techniques to help you
relax and finding ways to solve the problems that have brought the depression on. For some tips
on self-help, see our leaflet on depression.
Talking treatments
There are a number of effective talking treatments for depression. Counselling is useful in mild
depression. Problem solving techniques can help where the depression has been caused by
difficulties in life. Cognitive Behavioural Therapy was developed to treat depression and helps
you to look at the way you think about yourself, the world and other people. For information
about these and other forms of psychotherapy, see our leaflets on Psychotherapy and Cognitive
Behavioural Therapy.
Herbal remedies
There is also a herbal remedy for depression called Hypericum. This is made from a herb, St Johns
Wort, and is available without prescription.
Light
You may find that you get depressed every winter but cheer up when the days become sunnier.
This is called seasonal affective disorder (SAD). If so, you may find a light box helpful - this is a
source of bright light which you have on for a certain time each day and which can make up for
the lack of light in the winter.
How do antidepressants compare with these other treatments?
Recent studies have suggested that over a period of a year, many of these psychotherapies are as
effective as antidepressants. It is generally accepted that antidepressants work faster (see
references). Some studies suggest that it is best to combine antidepressants and psychotherapy.
Unfortunately some of these therapies are not readily available within the NHS in some parts of
the country.
Hypericum, or St John's Wort, is widely used as an antidepressant in Germany. It seems to be as
effective as antidepressants in milder depression, although there is little published evidence for its
effectiveness in moderate to severe depressions.
Exercise and self-help books based on Cognitive Behavioural Therapy can be effective treatments
for depression. If you have any further questions about antidepressants which haven't been
covered in this leaflet, take a look at the further reading section and have a word with your doctor
or psychiatrist. It's also good to talk things over with your family or friends.
28. ANTIBIOTICS
Antibiotics Introduction
Antibiotics are among the most frequently prescribed medications in modern medicine.
Antibiotics cure disease by killing or injuring bacteria. The first antibiotic was penicillin,
discovered accidentally from a mold culture. Today, over 100 different antibiotics are available to
doctors to cure minor discomforts as well as life-threatening infections.
Although antibiotics are useful in a wide variety of infections, it is important to realize that
antibiotics only treat bacterial infections. Antibiotics are useless against viral infections (for
example, the common cold) and fungal infections (such as ringworm). Your doctor can best
determine if an antibiotic is right for your condition
Types of Antibiotics
Although there are well over 100 antibiotics, the majority come from only a few types of drugs.
These are the main classes of antibiotics.

Penicillins such as penicillin and amoxicillin

Cephalosporins such as cephalexin (Keflex)

Macrolides such as erythromycin (E-Mycin), clarithromycin (Biaxin), and azithromycin
(Zithromax)

Fluoroquinolones such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin
(Floxin)

Sulfonamides such as co-trimoxazole (Bactrim) and trimethoprim (Proloprim)

Tetracyclines such as tetracycline (Sumycin, Panmycin) and doxycycline (Vibramycin)

Aminoglycosides such as gentamicin (Garamycin) and tobramycin (Tobrex)
Most antibiotics have 2 names, the trade or brand name, created by the drug company that
manufactures the drug, and a generic name, based on the antibiotic's chemical structure or
chemical class. Trade names such as Keflex and Zithromax are capitalized. Generics such as
cephalexin and azithromycin are not capitalized.
Each antibiotic is effective only for certain types of infections, and your doctor is best able to
compare your needs with the available medicines. Also, a person may have allergies that eliminate
a class of antibiotic from consideration, such as a penicillin allergy preventing your doctor from
prescribing amoxicillin.
In most cases of antibiotic use, a doctor must choose an antibiotic based on the most likely cause of
the infection. For example, if you have an earache, the doctor knows what kinds of bacteria cause
most ear infections. He or she will choose the antibiotic that best combats those kinds of bacteria.
In another example, a few bacteria cause about 90% of pneumonias in previously healthy people.
If you are diagnosed with pneumonia, the doctor will choose an antibiotic that will kill these
bacteria.
Other factors may be considered when choosing an antibiotic. Medication cost, dosing schedule,
and common side effects are often taken into account. Patterns of infection in your community
may be considered also.
In some cases, laboratories may help a doctor make an antibiotic choice. Special techniques such as
Gram stains may help narrow down which species of bacteria is causing your infection. Certain
bacterial species will take a stain, and others will not. Cultures may also be obtained. In this
technique, a bacterial sample from your infection is allowed to grow in a laboratory. The way
bacteria grow or what they look like when they grow can help to identify the bacterial species.
Cultures may also be tested to determine antibiotic sensitivities. A sensitivity list is the roster of
antibiotics that kill a particular bacterial type. This list can be used to double check that you are
taking the right antibiotic.
Only your doctor can choose the best class and the best antibiotic from that class for your
individual needs.
29. ANTI-EMETICS
An antiemetic is a drug that is effective against vomiting and nausea. Anti-emetics are typically
used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics and
chemotherapy directed against cancer.
Antiemetics are used to treat nausea and vomiting which are common complications of multiple
conditions. They give symptomatic relief but should only be used when the cause of these
symptoms is known as they can cause delay in diagnosis and treatment of underlying cause, for
example, diabetic ketoacidosis, digoxin toxicity.
Nausea and vomiting are mediated by three different pathways (key neurotransmitters in brackets):

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By visceral stimulation (dopamine and serotonin)
By CNS vestibular stimulation (histamine, acetylcholine)
By activation of the chemoreceptor trigger zone in the floor of the 4th ventricle(dopamine,
serotonin).
The pathways converge in the medulla which directly mediates nausea and vomiting.
The choice of antiemetic should depend on the cause and rational prescribing, based on an
understanding of the pathophysiology, should optimise treatment efficacy.
Side-effects can also be predicted based on the drug's mode of action.
30. ANTI-CONVULSANTS
Anticonvulsants Used For Partial Seizures
Partial seizures originate in a focal region of the cortex and can be subdivided into those that do
not impair consciousness (simple partial) and those that do (complex partial). Both types of partial
seizure can spread rapidly to other cortical areas, resulting in secondary generalised tonic-clonic
seizures.
See relevant articles on Managing Epilepsy in Primary Care, Epilepsy in Children and Young
Adults, Epilepsy in Adults and Epilepsy in Elderly People.

Simple partial seizures:
Presentation depends on the site of origin of the discharge, e.g. those arising from
the motor cortex cause rhythmic movements of the contralateral face, arm or leg
(Jacksonian seizures).
o Seizures arising from sensory regions or areas responsible for emotions and memory
may produce olfactory, visual or auditory hallucinations, feelings of deja vu or
jamais vu, fear, panic or euphoria.
Complex partial seizures:
o Previously called temporal lobe or psychomotor seizures. They are the most
common seizure type in adults and the most difficult to control with treatment.
There may be a warning aura immediately preceding loss or reduction of awareness.
o Complex partial seizures typically last less than 3 minutes. During that time, patients
may appear awake but lose contact with their environment and do not respond
normally to instructions or questions.
o Patients usually stare and either remain motionless or engage in repetitive semipurposeful behaviour called automatisms, including facial grimacing, gesturing,
chewing, lip smacking, snapping fingers, repeating words or phrases, walking,
running or even undressing. Patients cannot remember behaving in this manner. If
restrained they may become hostile or aggressive. In some cases it can be difficult for
an inexperienced observer to recognise that a fit is occurring at all.
o After a seizure, patients are often sleepy and confused and complain of a headache.
This post-ictal state can vary from minutes to hours.
o

Antiepileptic drugs (AEDs)

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Carbamazepine, lamotrigine, sodium valproate and phenytoin can be used in monotherapy
for secondarily generalised tonic-clonic seizures and for partial (focal) seizures;
alternatively, oxcarbazepine monotherapy can be used. Phenobarbital (phenobarbitone)
and primidone are also effective but they are more sedating and are not used as first-line
drugs.
Where a single drug has failed to control the seizures, combination therapy can be tried
with the above drugs or with additional drugs, e.g. gabapentin, tiagabine, topiramate or
vigabatrin; further alternatives include acetazolamide, clobazam and clonazepam.
Other antiepileptic drugs:
o For people with drug resistant partial epilepsy, adding gabapentin, levetiracetam,
lamotrigine, oxcarbazepine, tiagabine, topiramate, vigabatrin, or zonisamide to usual
treatment can improve seizure control but increases the frequency of adverse effects.
Interactions


Interactions between antiepileptics are complex and may enhance toxicity without a
corresponding increase in antiepileptic effect.
These interactions are very variable and unpredictable. Plasma monitoring is often
advisable with combination therapy.
Prescribing in children

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
Lamotrigine, controlled-release carbamazepine, topiramate or sodium valproate are options
for partial seizures.
The currently recommended first-line drugs in treating the majority of childhood epilepsies
are sodium valproate and carbamazepine.
Syndromes associated with partial seizures are less common than generalised seizures in
children. Carbamazepine is the usual preferred treatment for partial seizures.
Drug monitoring
Indications for drug monitoring include:
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When drug therapy is initiated and after dosage adjustments (sampling at trough level at
steady-state).
Suspected therapeutic failure; identify inappropriate dosage, non-compliance, altered
absorption, altered clearance (sampling at trough level at steady-state).
Therapeutic confirmation after optimum seizure control so that a drug level can serve as a
reference point in the event that seizure control is lost or side effects occur (sampling at
trough level at steady-state).
Signs of clinical intoxication (sampling at peak level or when symptoms are present).
Suspected drug interaction (sampling at trough level).
Monitoring of pharmacologically active metabolites.
Special risk groups where drug pharmacokinetics is altered: neonates, elderly patients,
pregnant women, patients with compromised elimination e.g. renal, hepatic disease
(sampling at trough level).
Suspected drug overdose.
Stopping antiepileptic drug treatment

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
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At 9 years after diagnosis of epilepsy about 70% of people will have been seizure-free for
the preceding 3 years and only about 30% will still be on medication.1
Because of the possible long-term side effects of the drugs, it is common clinical practice to
consider drug withdrawal after a patient has been in seizure free for three or more years.
The probability of relapse is greatest within the first year of treatment reduction or
withdrawal.
The more severe and long lasting the patient's epilepsy before remission the greater the risk
of relapse.
Juvenile myoclonic epilepsy or the presence of a structural lesion underlying the epilepsy
also increase the risk of relapse.
Social complications of failed drug withdrawal increase with adulthood and trials of drug
withdrawal should ideally take place before school-leaving age. After this a number of
factors may influence the decision, e.g. employment, driving, leisure activities,
contraception and pregnancy.
The final decision to come off drug treatment should be taken by the patients and their
families following advice from the physician. If a decision to withdraw medication is made,
discontinuation of treatment should be undertaken slowly, over a period of 2-3 months, to
minimise the risks of relapse.1
Anticonvulsants used for Generalised Seizures
Other relevant articles include:




Managing epilepsy in primary care
Epilepsy in adults
Epilepsy in children and young people
Epilepsy in elderly people
Generalised seizures are characterised by widespread involvement of bilateral cortical regions at
the outset and are usually accompanied by impairment of consciousness:1,2

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The familiar tonic-clonic seizure (grand mal) is often preceded by a cry. The patient
suddenly falls to the ground and exhibits typical convulsive movements, sometimes with
tongue or mouth biting and urinary incontinence. Other subtypes of Generalised seizures
include absence, myoclonic, clonic, tonic and atonic seizures.
Absence seizures (petit mal) mainly affect children. Typical absence seizures usually last 510 seconds and commonly occur in clusters. They manifest as sudden onset of staring and
impaired consciousness with or without eye blinking and lip smacking. The EEG typically
shows a 3Hz spike and wave pattern. There is a strong genetic component for the seizures
as well as for the EEG abnormality. While absences will remit during adolescence in around
40% of patients, related tonic-clonic seizures may continue into adulthood.
Atypical absence seizures usually begin before 5 years of age in conjunction with other
Generalised seizure types and mental retardation. They last longer than typical absence
seizures and are often associated with changes in muscle tone.
Myoclonic seizures consist of sudden, brief muscle contractions, either singly or in clusters,
that can affect any muscle group.
Clonic seizures are characterised by rhythmic or semi-rhythmic muscle contractions,
typically involving the upper extremities, neck and face.
Tonic seizures cause sudden stiffening of extensor muscles, often associated with impaired
consciousness and falling to the ground.
Atonic seizures (drop attacks) produce sudden loss of muscle tone with instantaneous
collapse, often resulting in facial or other injuries.
Antiepileptic drugs (AEDs) for adults
Systematic reviews have found insufficient evidence on which to base a choice among drugs in
terms of seizure control.1,2
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Tonic-clonic (grand mal) seizures:
o The drugs of choice for tonic-clonic seizures are carbamazepine, lamotrigine, sodium
valproate and topiramate.
o Second-line drugs include clobazam, levetiracetam and oxcarbazepine.
o For those patients who have tonic-clonic seizures and absence seizures, sodium
valproate is the drug of choice.
o For those patients who have tonic-clonic seizures and myoclonic seizures, sodium
valproate and levetiracetam are effective.
o Phenobarbital and primidone are also effective but may be more sedating.
Absence seizures:
o Ethosuximide and sodium valproate are the drugs of choice in simple absence
seizures.
o Sodium valproate is also very effective in treating the tonic-clonic seizures which
may co-exist with absence seizures in primary generalised epilepsy.
o Lamotrigine and clonazepam may also be effective.
Myoclonic seizures (myoclonic jerks):
o Response to treatment varies considerably.
o Sodium valproate is the drug of choice; clonazepam, levetiracetam and topiramate
can also be effective.
Atypical absence, atonic and tonic seizures:
o These seizure types are usually seen in childhood, either in specific epileptic
syndromes or associated with cerebral damage or mental retardation.
o Response to treatment is often poor but sodium valproate, lamotrigine, clobazam,
clonazepam, levetiracetam and topiramate may be effective.1
Combination therapy
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Therapy with two or more antiepileptic drugs concurrently may be necessary. It should
preferably only be used when monotherapy with several alternative drugs has proved
ineffective.
Combination therapy enhances toxicity and may lead to drug interactions between the
antiepileptic drugs.
Antiepileptic drugs (AEDs) for children3
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The currently recommended first-line drugs in treating the majority of childhood epilepsies
are sodium valproate and carbamazepine.
Most paediatric epilepsies and epilepsy syndromes are associated with generalised
seizures, and for these the current drug of choice is sodium valproate.
For generalised seizures, lamotrigine and topiramate should be used if the older AEDs are
unsuitable (e.g. contraindication, potential interaction, poorly tolerated or patient is female
and likely to need treatment in childbearing years) or for those who have not benefitted
from older AEDs.
West syndrome (infantile spasms) is characterised by infantile spasms. In the UK, ACTH or
prednisolone is the preferred treatment, whereas in many European countries vigabatrin or
sodium valproate are the drugs of first choice and ACTH is rarely, if ever, prescribed.
Interactions
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

Interactions between antiepileptics are complex and may enhance toxicity without a
corresponding increase in antiepileptic effect.
Interactions are usually caused by hepatic enzyme induction or hepatic enzyme inhibition;
displacement from protein binding sites is not usually a problem.
These interactions are very variable and unpredictable. Plasma monitoring is therefore
often advisable with combination therapy.
Drug monitoring
Indications for drug monitoring include:
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When drug therapy is initiated and after dosage adjustments (sampling at trough level at
steady-state).
Suspected therapeutic failure: identify inappropriate dosage, non-compliance, altered
absorption, altered clearance (sampling at trough level at steady-state).
Therapeutic confirmation (i.e. after optimum seizure control so that a drug level can serve
as a reference point in the event that seizure control is lost or side effect occur) (sampling at
trough level at steady-state).
Signs of clinical intoxication (sampling at peak level or when symptoms are present).
Suspected drug interaction (sampling at trough level).
Monitoring of pharmacologically active metabolites.
Special risk groups where drug pharmacokinetics is altered: neonates, elderly patients,
pregnant women, patients with compromised elimination e.g. renal, hepatic disease
(sampling at trough level).
Suspected drug overdose.
Stopping antiepileptic drug treatment
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As many as 70-80% of patients on antiepileptic drug treatment will eventually become
seizure free.
Because of the possible long-term side effects of the drugs, it is common clinical practice to
consider drug withdrawal after a patient has been in seizure free for three or more years.
The probability of relapse after stopping treatment has varied between 11-41% in different
studies. The risk is less for children than for adults. Most relapses occur within the first year
of treatment reduction or withdrawal.
The more severe and long lasting the patient's epilepsy before remission the greater the risk
of relapse.
Juvenile myoclonic epilepsy or the presence of a structural lesion underlying the epilepsy
also enhance the risk of relapse.
Whether EEG is helpful is controversial. Only those EEGs taken after a period of remission
are likely to be of value. In children there seems little doubt that the presence of persisting
EEG abnormalities has an adverse prognostic influence but whether this is true in adults
remains uncertain.
Social complications of failed drug withdrawal increase with adulthood and trials of drug
withdrawal should ideally take place before school-leaving age. After this a number of
factors may influence the decision, e.g. employment, driving, leisure activities,
contraception and pregnancy.
The final decision to come off drug treatment should be taken by the patients and their
families following advice from the physician. If a decision to withdraw medication is made,
discontinuation of treatment should be undertaken slowly, possibly over a period of
months, to minimise the risks of relapse.
31. ANTI-PSYCHOTICS / SPASMOLITICS
What are antipsychotics?
Medicines used to treat psychotic symptoms such as positive and negative symptoms (see below)
are termed “antipsychotics”. The old names for this type of medication are neuroleptic and major
tranquilliser. The older antipsychotics are called “typical antipsychotics” and the newer
antipsychotics are called “atypical antipsychotics”. Antipsychotics come in different forms
including tablets, dispersible tablets, liquids, short acting and long-acting injections.
Why have I been prescribed an antipsychotic?
Antipsychotics are medicines used to help treat schizophrenia and other similar conditions
including psychosis and mania. When people have schizophrenia or psychosis they may hear
voices, see things that are not present, may become suspicious or paranoid and feel that people
can control or read their thoughts. These symptoms are termed “positive symptoms”.
Antipsychotics can help relieve these symptoms. Many patients with schizophrenia also
experience “negative symptoms” such as feeling tired, lacking energy and becoming withdrawn.
Antipsychotics may help relieve these symptoms as well. Mania is when you are excessively
happy, irritable, have increased energy, talk very quickly and are full of ideas
and plans and are unable to sleep. Antipsychotics can help your mood return to normal.
Antipsychotics are sometimes used for other conditions such as anxiety, feeling sick, and
problems with sleep.
Are antipsychotics safe to take?
Let your prescriber know if any of the following apply to you:

Epilepsy, diabetes, heart, liver or kidney trouble


If you take any other medication including medication bought over the counter and
alternative therapies
If you are pregnant or breast- feeding
Benefits of antipsychotics
Antipsychotics can help relieve or reduce the symptoms of the illness and also the impact it may
have on daily life. They can reduce the risk of suicide, reduce the need for admission to hospital or
shorten the length of stay and help you be able to work and live independently. Antipsychotics do
not work straight away. For example, it may take several days or even weeks for some of the
symptoms to improve. To begin with, most people find that these medications will help them feel
more relaxed and calm. It usually takes 2-4 weeks, and sometimes longer, for an antipsychotic to
produce its full benefits. Generally all
antipsychotics as are effective as each other, however, individuals do not respond the same to
each medication so if one does not help another one could. Clozapine is the only proven effective
medication for treatment-resistant schizophrenia.
About 80% of people who do not take their medication will become ill again. Antipsychotics are
generally required over a long period and you should discuss with your doctor if you intend to
stop them as they should be stopped slowly to prevent you becoming ill.
45
Risks of antipsychotics
Antipsychotics can cause side-effects although there are differences between the medications
available so if you have a side-effect with one medication it could be changed to a different one
which may not cause that side-effect. The dose can be important with respect to side-effects. The
side-effect may reduce or disappear if the dose of medication is lowered. There may also be other
ways to manage the side effect.
The typical antipsychotics are more likely to cause restlessness, abnormal movements, stiffness
and tremors. The atypical antipsychotics are less likely to cause these side-effects.
Antipsychotics can cause weight gain, which may have long-term health effects. Some like
clozapine, zotepine and olanzapine are more likely to cause this while aripiprazole, amisulpride,
haloperidol, and trifluoperazine are the least likely antipsychotics to cause this side-effect.
Antipsychotics can cause other side-effects such as drowsiness, lowering of blood pressure,
changes to the hearts rhythm, raised cholesterol and raised blood glucose. The long-term sideeffects of antipsychotics can include movement
disorders. There can also be effects on the
Alternatives
There are many antipsychotics available in the UK so please speak to a healthcare professional
about the most suitable medication for you. Leaflets are available on each individual antipsychotic
so please ask for one. Medication helps but may not be the whole solution. Relieving some
symptoms with medication can make it easier for other kinds of help to work. Cognitive
behavioural therapy can help you feel better about yourself and learn new ways of solving
problems or coping with symptoms Counselling, supportive psychotherapy and family work can
all help the individual and their family with the problems of daily life and solve some practical
problems caused by the symptoms of the illness.
32. TRANQUILISERS / SEDATIVES
Tranquillisers are divided into two groups: major tranquillizers and minor tranquillizers.
Major tranquillisers are drugs used to treat psychotic illness such as schizophrenia. These drugs
are referred to as neuroleptics and are most commonly prescribed as antipsychotics.
Minor tranquillisers are sedative drugs used to treat anxiety and emotional tension. These drugs
are very commonly prescribed as anti-anxiety drugs or anxiolytics. The most widely used
anxiolytics belong to the class of drugs called benzodiazepines.
Benzodiazepines are also used to treat persistent sleeplessness, which can be caused by
psychological problems including anxiety or depression, or by pain and discomfort arising from
physical disorder.
Minor tranquillizers are prescribed for short-term relief of severe anxiety and nervousness caused
by psychological problems. But these drugs cannot resolve the causes. Tranquillizers should never
be regarded as the only way to cope with life’s stressful events. Tackling the underlying problem
through counselling and perhaps psychotherapy offer the best hope of a long-term solution.
Anxiolytics or minor tranquillizers are also used in hospitals to calm and relax people who are
undergoing uncomfortable medical procedures.
Major tranquillizers or antipsychotic drugs (also called neuroleptics) are used to treat psychotic
illness. They do not cure the disorder but they do help to control symptoms, thus making possible
for the sufferers to live in the community. Antipsychotics may also be given to calm or sedate a
highly agitated or aggressive person, whatever the cause. These drugs may be given by mouth as
tablets, or syrup, or by injection.
Are tranquillizers safe to take?
Benzodiazepines (minor tranquillizers) have an important medical role for short-term use, for
example, in the treatment of anxiety. They are safe for most people.
The main risk is psychological and physical dependence, in particular, for regular users or when
the prescribed dose has been increased arbitrarily. For this reason, they are usually given for
courses of two weeks or less. If they have been used for a longer period, gradual withdrawal
should be done under medical supervision.
Antipsychotic drugs (major tranquillizers) control the acute symptoms of a person with a
psychotic illness, so that it is important to continue taking the prescribed dose even if all
symptoms have gone.
Antipsychotic drugs can have permanent as well as temporary side effects, so the minimum
necessary dose is used. When treatment needs to be stopped, withdrawal should be done by
gradually reducing the dose.
Side effects
Minor side effects associated with benzodiazepines include dizziness, tiredness and forgetfulness.
It is wise to avoid driving or operating dangerous machinery as reactions may be slowed.
Side effects associated with antipsychotics include restlessness, disorder of movement and
parkinsonism. The most serious long-term risk of antipsychotic treatment is a disorder called
tardive dyskinesia which may develop after one to five years. This condition consists of repeated
jerking movements of the mouth, tongue, and face, and sometimes of the hands and feet.
Risk of addiction
With antipsychotics, it is important to continue taking the prescribed dose even if all symptoms of
the psychotic illness have stopped.
Benzodiazepines are usually effective for only a few weeks at a time; the brain soon becomes
tolerant to and dependent on their effect. You may be addicted to the drug if you rely on increased
doses of minor tranquillizers to function normally. Benzodiazepines have been abused for their
sedative effect, so they are prescribed with caution for people with a history of substance abuse.
Sedatives are substances that induces sedation by reducing irritability or excitement.
At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow,
uncertain reflexes. Doses of sedatives such as benzodiazepines when used as a hypnotic to induce
sleep tend to be higher than those used to relieve anxiety where as only low doses are needed to
provide calming sedative effects.
Sedatives can be abused to produce an overly-calming effect (alcohol being the classic and most
common sedating drug). At high doses or when they are abused, many of these drugs can cause
unconsciousness and even death.
33. BETA BLOCKERS
Beta blockers are a class of drugs used for various indications, but particularly for the
management of cardiac arrhythmias, cardio protection after myocardial infarction (heart attack),
and hypertension. Propranolol was the first clinically useful beta adrenergic receptor antagonist.
Invented by Sir James W. Black, it revolutionised the medical management of angina pectoris and
is considered to be one of the most important contributions to clinical medicine and pharmacology
of the 20th century. Beta blockers may also be referred to as beta-adrenergic blocking agents, betaadrenergic antagonists, or beta antagonists.
Indications for beta blockers include:
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Hypertension
Angina
Mitral valve prolapse
Cardiac arrhythmia
Atrial fibrillation
Congestive heart failure
Myocardial infarction
Glaucoma
Migraine prophylaxis
Symptomatic control (tachycardia, tremor) in anxiety and hyperthyroidism
Essential tremor
Phaeochromocytoma, in conjunction with α-blocker
Beta blockers have also been used in the following conditions:


Hypertrophic obstructive cardiomyopathy
Acute dissecting aortic aneurysm
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Marfan syndrome (treatment with propranolol slows progression of aortic dilation and its
complications)
Prevention of variceal bleeding in portal hypertension
Possible mitigation of hyperhidrosis
Social anxiety disorder and other anxiety disorders
34. DIURETICS
Diuretics are medicines that remove water from the body by increasing the amount of urine the
kidneys produce. They are often known as 'water tablets' because they remove excess water.
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Why would I take diuretics?
What are the main types of diuretic?
How do diuretics work?
How to take diuretics
Side-effects of diuretics
Interactions of diuretics with other medicines
Names of common diuretics
Further information
Questions and answers
Related topics
Sources
Why would I take diuretics?
Your doctor may prescribe you with a diuretic if you have:


high blood pressure
too much fluid in the tissues of your body (this is known as oedema) as a result of heart
failure, which is when your heart loses its ability to pump blood efficiently throughout the
body
What are the main types of diuretic?
The three most common types of diuretic are:



thiazides (eg bendroflumethiazide)
loop diuretics (eg furosemide)
potassium-sparing diuretics (eg amiloride)
Thiazide diuretics
Thiazide diuretics are classed as 'moderately potent' diuretics. Your GP may have prescribed these
to treat high blood pressure, especially if you're over 60, or 55 if you're of African-Caribbean
origin.
A low dose of a thiazide diuretic (for example 2.5mg of bendroflumethiazide daily) is often the
first medicine your doctor will prescribe if you have a slightly high blood pressure. This can be
taken on its own or in combination with another blood-pressure medicine if you have very high
blood pressure. For example, your GP may also prescribe angiotensin-converting enzyme (ACE)
inhibitors, angiotensin-receptor blockers and calcium-channel blockers.
Higher doses of thiazide diuretics may also be used if you have oedema or heart failure. For
oedema, you may initially receive 5 to 10mg of bendroflumethiazide daily. Thiazides
recommended for heart failure include bendroflumethiazide, indapamide and metolazone.
Loop diuretics
These medicines are named after the loop of Henlé, one of the tubes inside your kidneys. Loop
diuretics are powerful diuretics that are usually used for treating heart failure or too much fluid
on your lungs (pulmonary oedema). You may also be given a loop diuretic in addition to your
other medicines if you have high blood pressure and other medicines haven't been effective.
The main effect of loop diuretics is to make your kidneys re-absorb less salt and water, and so
produce more urine. Removing excess water means that your heart has to pump less and this can
reduce symptoms of heart failure, such as breathlessness and ankle swelling.
Loop diuretics recommended for heart failure include bumetanide, furosemide and torasemide.
Potassium-sparing diuretics
These medicines allow water loss from your body but reduce the amount of potassium that is lost
at the same time. Potassium has many important roles in your body, including keeping your heart
healthy and controlling your blood pressure.
Potassium-sparing diuretics work on the salt balance (the balance of sodium and potassium)
within the kidneys. They do this by increasing the amount of sodium that is lost from the body in
the urine and reducing the amount of potassium lost in the urine. This helps to maintain the
potassium levels in the body.
Potassium-sparing diuretics recommended for heart failure include amiloride and triamterene.
Potassium-sparing diuretics are weak when used alone but are often given in combination with
thiazide or loop diuretics to prevent low potassium levels in the body, which is known as
hypokalaemia.
How do diuretics work?
Thiazides, loop diuretics and potassium-sparing diuretics all work on the kidneys.
Your kidneys have a network of tubes that make urine by filtering your blood in two stages. In the
first stage, water, salt and waste products such as urea are filtered out from your blood, leaving
behind red and white blood cells. A lot of nutrients and other essential substances also leave your
blood at this stage.
In the second stage, your kidneys re-absorb these nutrients and essential substances back into the
blood. This leaves waste products, plus some salt and water (urine) in your kidneys. The urine
travels down tubes to your bladder where it's stored until you go to the toilet.
Heart failure can make your kidneys re-absorb more water and salt into the blood, and so produce
less urine. This is your body's way of trying to compensate for the reduced pumping power of the
heart, but it can make matters worse. There is a greater volume of blood for your heart to pump,
and so more work for it to do. Also, excess water in the blood can leak out into your lungs,
making you feel breathless (pulmonary oedema) and into the legs causing your ankles and feet to
swell up (peripheral oedema).
Diuretics reduce the amount of water and salt that is re-absorbed by your kidneys. So, more water
and salt passes out with the waste products into your urine. This means that you make more urine
and so lose more water from your blood. The overall volume of blood is reduced, which gives
your heart less work to do and helps to reduce your blood pressure. This is why diuretics are used
to treat heart failure and high blood pressure.
35. LAXATIVES
Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to
loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline
laxatives are used to evacuate the colon for rectal and bowel examinations, and may be
supplemented by enemas in that circumstance. Sufficiently high doses of laxatives will cause
diarrhea. Laxatives work to hasten the elimination of undigested remains of food in the large
intestine and colon.
There are several types of laxatives, listed below. Some laxatives combine more than one type of
active ingredient to produce a combination of the effects mentioned. Laxatives may be oral or in
suppository form.
Constipation with no known organic cause, i.e. no medical explanation, exhibits gender
differences in prevalence: females are more often affected than males.[2] Not surprisingly, some
advertisers promote their brands as being more feminine and thereby tailor their message to the
market. The way laxatives function in males and females, however, does not exhibit significant
differences.
36. OPIATES
Opiate, according to Merriam Webster Medical Dictionary is "a preparation (as morphine, heroin,
and codeine) containing or derived from opium and tending to induce sleep and to alleviate pain."
Although they've been used for 6,000 years, the role of opiates in pain management is much
debated today.
The role of opioid therapy in the treatment of non cancer pain has been very controversial due to
the limited number of clinical trials validating this approach and the understandable concerns of
doctors who worry about causing more harm than good. Physicians also have to worry about
regulatory oversight by law enforcement officials. Many doctors and even patients fear that the
patient will become addicted to the medication. However physical dependence is not the same as
addiction. Addicts take drugs to achieve a "high." Those in severe pain many times take it just to
be able to function. Unlike an addict, the typical pain patient experiences little or no euphoria
from narcotics. Because the effectiveness of pain medication varies greatly from person to person,
a patient's need for a high dose is not necessarily a sign of addiction.
Luckily for us, things are slowly changing. More and more doctors are using opiates for chronic
musculoskeletal pain. Studies are being done and they are showing that the actual addiction rate
is very low in those with chronic pain. In one study, only four cases of addiction were found
among 11,882 hospitalised patients with no history of addiction receiving opiates. Only one of
those four cases was considered major. Another study done at Johns Hopkins Pain Treatment
Center showed that in noncancer patients experiencing chronic pain, treatment with long-acting
opioids significantly decreased pain intensity, anxiety, hostility, and sleep problems. They did not
experience any cognitive declines, in fact treated patients improved on one measure of sustained
attention and psychomotor speed.
The regulations are changing also. A number of state medical boards have developed guidelines
for the prescribing of controlled substances for pain. In most cases, the purpose of these guidelines
has been to clarify that the board accepts that opioids may be used to manage chronic non cancer
pain and to outline the board's basic expectations of the doctors who prescribe them.
What does all this mean for us? Hopefully better pain control is in our future. Combined with
other pain management therapies, opiates can be a valuable tool in allowing those with chronic
pain to have a better quality of life.
37. STEROIDS
1. What are steroid medicines used for?
Most steroid medicines (sometimes called ‘corticosteroids’) are important treatments for a variety
of illnesses that involve inflammation in the body. Examples include allergic conditions in the
lung that cause wheezing (asthma), other serious allergic reactions, inflammation in parts of the
body such as the joints (e.g. rheumatoid arthritis), the bowel (e.g. ‘Crohn’s disease’ and ‘ulcerative
colitis’), and various other types of inflammation that affects muscles, blood vessels, skin (e.g.
eczema) and the eyes. In addition, steroids are sometimes used to treat blood conditions
(including leukaemia) and swelling of the brain.
The information below refers to steroid medicines (corticosteroids). Sex hormones (such as those
included in the Oral Contraceptive Pill, and Hormone Replacement Therapy for women), are also
steroids, but they are quite different from corticosteroids. If you take sex hormones for
contraception, menopausal symptoms or other reasons, you can find out more about these
medicines by reading the Patient Information Leaflet, or speaking to your doctor or pharmacist.
2. What are the different types of steroid medicines?
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
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Steroids can be given in several different ways. Whenever possible, steroids are given
directly to the part of the body that needs treating (e.g. by inhalation into the lungs for
wheezing, as eye drops for eye inflammation, or as an injection directly into a joint). Some
steroids are taken by mouth (e.g. as tablets) or are given as injections into muscles or
(occasionally) veins. These medicines have beneficial effects around the body and are very
important treatments for potentially serious illnesses, but they can also cause side effects in
some people (see below).
The risk of side effects is very much lower when steroids are given directly to the part of
the body that needs treating (e.g. by inhalation - most people have not problems at all
with inhaled steroids). However, it is important to stick to the dose prescribed for you.
Taking very high doses of inhaled steroids increases the risk of side effects.
Steroids that are put on the skin are generally much safer and cause very few problems
when used correctly. Your doctor or nurse will tell you exactly where to apply the
medicine and how much to use. Only use steroid creams or ointments on these areas of
skin, and do not use the medicine for any longer than you have been advised.
Examples of steroid medicines are:
Tablets or injections: Dexamethasone, prednisolone, methylprednisolone, hydrocortisone
Inhalers (‘puffers’): Beclomethasone, budesonide, fluticasone, mometasone, ciclesonide
Creams and ointments for the skin: Hydrocortisone, mometasone, betamethasone, triamcinolone
Many of these medicines are also available for use in very small doses as eye or nose drops, or for
treatment of mouth conditions. Some steroids can also be given by a number of other routes such
as an ‘enema’ (to treat bowel conditions).
This is not a complete list of steroid medicines - check your Patient Information Leaflet (which
comes with the medicine), or with your doctor, nurse or pharmacist if you are unsure if your
medicine is a steroid.
3. Are there any important side effects that I should look out for when taking steroids? See also
question 5 for longer term side effects
Steroids are very effective (and sometimes life-saving) medicines. The benefit of your steroid
medicine is expected to be greater than the risk of unwanted effects. However, like other
medicines, steroids can cause problems. Your Patient Information Leaflet lists all the possible
side effects.
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
Remember: Most people don’t get serious side effects.
The side effects below relate mainly to steroids taken as tablets or by regular injection.
Here are some particular signs to look out for
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Mood changes, depression, suicidal thoughts, or feeling ‘high’ (sometimes causing unusual
behaviour) – these conditions affect children as well as adults, and can happen within days
of starting treatment Difficulty sleeping, confusion, agitation (nervousness)
Skin rashes or any signs of infection - see question 4
Stomach/intestine problems (nausea, diarrhoea, pain, rarely ulcers or bleeding)
Worsening of diabetes (i.e. higher blood sugar)
Worsening of epilepsy (i.e. more frequent fits)
Headaches
Changes in your menstrual periods
If you feel unwell in any way, or are concerned about any of these possible side effects, keep
taking your medicine but seek medical advice as soon as possible.
4. Why might I need to look out for infections?
Steroids can reduce your body’s ability to fight infections (by making your immune system less
active), so you may be more likely to catch an infection, and you may be more unwell than normal
if this happens. Chicken pox is a particular concern if you are taking steroid tablets: if you have
not had chicken pox, avoid close contact with anyone who has chicken pox or shingles.
5. What about longer term side effects?
As with most medicines, the risk of steroid side effects increases with higher doses and with
longer treatment. You will be prescribed long-term steroids (i.e. for months or years) only if your
doctor thinks it’s important for your health. Here are the more important long-term side effects,
which you should look out for. Not everyone gets these side effects.
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Eye problems: poor vision due to problems with the eye lens (cataract) or increased
pressure in the eye (glaucoma)
Muscle weakness
Thinning of the bones and increased risk of fractures
Reduced growth in children (your doctor and nurse will check carefully for this)
High blood pressure
Change in appearance, and skin changes: bruising, ‘stretch marks’, acne, sweating, weight
gain, developing a rounder face (which disappears after stopping treatment).
If you feel unwell in any way, or are concerned about any of these possible side effects, keep
taking your medicine but seek medical advice as soon as possible.
6. How do I report a suspected side effect?
As well as talking to your doctor, you can report suspected side effects using ‘Yellow Card forms’.
These are available from pharmacies and other outlets across the NHS or from the Yellow Card
hotline on freephone 0808 100 3352. Reports can also be completed on the web at
www.yellowcard.gov.uk. The Government carefully checks these reports to see if new
information or advice can be offered to healthcare professionals and patients.
7. Is it safe to take other medicines when taking steroids?
Some medicines should not be taken together, and sometimes doses may need to be changed if
they are given together. Before taking a new medicine it is very important to tell your doctor,
nurse or pharmacist about any other medicines that you are taking. Don’t forget to tell him/her
about herbal remedies or any non-prescription medicines you might have bought in a
pharmacy or supermarket (e.g. painkillers or cold remedies) because these may affect your
treatment.
Your Patient Information Leaflet that comes with your medicine lists the medicines that you need
to be particularly careful about when taking steroids.
If you take steroids that are taken regularly as tablets or by injection you may need to be
particularly careful of the following:
Some medicines can affect how much steroid gets into your body or how quickly your body
breaks down or eliminates steroids (meaning that the dose you take may need to be adjusted).
These include:
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Some antibiotics (e.g. rifampicin, erythromycin), antifungal treatments (e.g. itraconazole,
ketoconazole) and antivirals including HIV treatments (e.g. ritonavir, saquinavir, indinavir)
Some treatments for epilepsy (e.g. carbamazepine, phenytoin, phenobarbitone, primidone)
Ciclosporin (a treatment used after organ transplant, and sometimes for rheumatoid
arthritis or severe psoriasis)
Antacids for indigestion (especially if they contain magnesium trisilicate)
Cold remedies, treatments for a blocked nose (i.e. those that contain the active ingredient
ephedrine)
Some hormones (including sex hormones and the contraceptive pill)
Some medicines may increase the risk of some side effects, if given with steroids, including:
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Aspirin and anti-inflammatory medicines (e.g. ibuprofen, diclofenac, naproxen and ‘-coxib’
medicines) are often used in combination with steroids for pain and arthritis. Stomach or
intestinal problems may occur more frequently when these medicines are used together report any symptoms (e.g. stomach pains, indigestion, vomiting or change in bowel
motions) to your doctor.
Methotrexate (sometimes used to treat cancer and commonly to treat rheumatoid arthritis) your doctor will arrange for blood tests to check for side effects
Some vaccines should be avoided (check with your doctor or nurse before you have any
vaccination)
Some medicines may not work as well if taken at the same time as steroids - doses of these
medicines may need to be adjusted:
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Medicines used to treat diabetes
Some medicines used to treat high blood pressure, including water tablets (diuretics)
Medicines for myasthenia gravis (a condition that causes muscle weakness)
Growth hormone
Some muscle-relaxing treatments used during surgery (make sure your surgeon and
anaesthetist knows you are taking steroids)
Some treatments may need to be carefully monitored (e.g. by blood tests) while you take steroids:
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Medicines for thinning the blood (e.g. warfarin, phenindione)
Some medicines, including digoxin (for heart problems), acetazolomide (for glaucoma and
epilepsy), some treatments for wheezing/breathing problems (e.g. salmeterol, salbutamol,
terbutaline) and water tablets (diuretics) make may reduce the amount of potassium in
your body, especially when taken with steroids. This may cause thirst, weakness, dizziness,
confusion, or (if severe) collapse.
Check you Patient Information Leaflet for full details of any other medicines that may be
important for your particular steroid, and tell your doctor, nurse or pharmacist if you use, or
intend to use, any of these medicines
8. What do I need to know about stopping steroid tablets?
If you are taking steroids tablets (or high-dose inhaled steroids) for more than 3 weeks, your
doctor will advise you to reduce the dose gradually - it is very important that you follow this
advice. When steroids get into your body for more than 3 weeks (particularly if given regularly by
mouth as tablets), your body gradually stops making its own (natural) steroids needed to keep
you well. Stopping your medicine gradually (for example by taking fewer tablets over several
days or weeks) gives your body time to get back to normal. If you feel unwell in any way while
you are reducing your steroids you should see your doctor as soon as possible.
If you are taking steroids for a short period (i.e. less than 3 weeks) your doctor may advise you
that there is no need to reduce the dose gradually.
9. Why have I been given a steroid ‘blue card’?
You may have received a steroid ‘blue card’ because you are taking steroid tablets (or high doses
of inhaled steroids) for more than 3 weeks. Keep this card with you everywhere: it is an
important reminder for you and your health advisers - always show it to doctors, nurses,
dentists and pharmacists, especially if you are due to have any surgery or other procedure that
involves an anaesthetic, or if you are unwell in any way.
The blue card:
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Includes information on type and dose of steroids you are taking
Reminds you not to stop taking your steroid suddenly
Warns about the dangers of chicken pox (for those who have not had it before)
Advises you to see a doctor if you feel unwell
Refers you to the Patient Information Leaflet for further information
38. VITAMINS
If you're like most kids, you've probably heard at least one parent say, "Don't forget to take your
vitamin!" "Eat your salad — it's packed with vitamins!" But what exactly are vitamins?
Vitamins and minerals are substances that are found in foods we eat. Your body needs them to
work properly, so you grow and develop just like you should. When it comes to vitamins, each
one has a special role to play. For example:
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Vitamin D in milk helps your bones.
Vitamin A in carrots helps you see at night.
Vitamin C in oranges helps your body heal if you get a cut.
B vitamins in leafy green vegetables help your body make protein and energy.
Vitamins Hang Out in Water and Fat
There are two types of vitamins: fat soluble and water soluble.
When you eat foods that contain fat-soluble vitamins, the vitamins are stored in the fat tissues in
your body and in your liver. They wait around in your body fat until your body needs them.
Fat-soluble vitamins are happy to stay stored in your body for awhile — some stay for a few days,
some for up to 6 months! Then, when it's time for them to be used, special carriers in your body
take them to where they're needed. Vitamins A, D, E, and K are all fat-soluble vitamins.
Water-soluble vitamins are different. When you eat foods that have water-soluble vitamins, the
vitamins don't get stored as much in your body. Instead, they travel through your bloodstream.
Whatever your body doesn't use comes out when you urinate (pee).
So these kinds of vitamins need to be replaced often because they don't stick around! This crowd
of vitamins includes vitamin C and the big group of B vitamins — B1 (thiamin), B2 (riboflavin),
niacin, B6 (pyridoxine), folic acid, B12 (cobalamine), biotin, and pantothenic acid.
MANAGEMENT UNIT 12
LAW AND REGULATION
1. CARE STANDARDS ACT
Care Standards Act 2000 (CSA) is an act in the United Kingdom which provides for the
administration of a variety of care institutions, including children's homes, independent hospitals,
nursing home and residential care homes.
The CSA, which was enacted in April 2002, replaces the Registered Homes Act 1984 and parts of
the Children's Act 1989, which pertain to the care or the accommodation of children.
The aim of the legislation is to reform the law relating to the inspection and regulation of various
care institutions.
2. NATIONAL MINIMUM STANDARDS
National Minimum Standards for Care Homes for Older People
This document contains a statement of national minimum standards published by the Secretary of
State under section 23(1) of the Care Standards Act 2000. The statement is applicable to care homes
(as defined by section 3 of that Act) which provide accommodation, together with nursing or
personal care, for older people.
The statement is accompanied, for explanatory purposes only, by an introduction to the statement
as a whole, and a further introduction to each group of standards. Each individual standard is
numbered and consists of the numbered heading and numbered paragraphs. Each standard is, for
explanatory purposes only, preceded by a title and an indication of the intended outcome in
relation to that standard.
This document sets out National Minimum Standards for Care Homes for Older People, which
form the basis on which the Care Quality Commission will determine whether such care homes
meet the needs, and secure the welfare and social inclusion, of the people who live there. The
national minimum standards set out in this document are core standards which apply to all care
homes providing accommodation and nursing or personal care for older people. The standards
apply to homes for which registration as care homes is required.
While broad in scope, these standards acknowledge the unique and complex needs of individuals,
and the additional specific knowledge, skills and facilities needed in order for a care home to
deliver an individually tailored and comprehensive service. Certain of the standards do not apply
to pre-existing homes including local authority homes, “Royal Charter” homes and other homes
not previously required to register. The standards do not apply to independent hospitals,
hospices, clinics or
establishments registered to take patients detained under the Mental Health Act 1983.
These standards are published by the Secretary of State for Health in accordance with section 23 of
the Care Standards Act 2000 (CSA). They will apply from 1 June 2003, unless otherwise stated in
any standard. The Care Standards Act created the National Care Standards Commission (NCSC),
an independent non-governmental public body, which regulates social and health care services
previously regulated by local councils and health authorities. In addition, it extended the scope of
regulation significantly to other services not previously registered, including domiciliary care
agencies, fostering agencies and residential family centres.
The CSA sets out a broad range of regulation making powers covering, amongst other matters, the
management, staff, premises and conduct of social and independent healthcare establishments
and agencies.
Under the Care Standards Act the Secretary of State for Health has powers to publish statements
of National Minimum Standards. In assessing whether a care home conforms to the Care Homes
Regulations 2001, which are mandatory, the Care Quality Commission n must take the standards
into account.
However, the Commission may also take into account any other factors it considers reasonable or
relevant to do so. Compliance with national minimum standards is not itself enforceable, but
compliance with regulations is enforceable subject to national standards being taken
into account.
The Commission may conclude that a care home has been in breach of the regulations even
though the home largely meets the standards. The Commission also has discretion to conclude
that the regulations have been complied with by means other than those set out in the national
minimum standards.
TH AND SAFETY AT WORK ACT 1974;
3. MANAGEMENT OF HEALTH AND SAFETY AT WORK REGULATIONS 1999;
Management of Health and Safety at Work Regulations 1999
The Management of Health and Safety at Work Regulations 1999 places a duty on employers to assess
and manage risks to their employees and others arising from work activities.
Employers must also make arrangements to ensure the health and safety of the workplace,
including making arrangements for emergencies, adequate information and training for
employees, and for health surveillance where appropriate.
Employees must work safely in accordance with their training and instructions given to them.
Employees must also notify the employer or the person responsible for health and safety of any
serious or immediate danger to health and safety or any shortcoming in health and safety
arrangements.
The HSE has produced an Approved Code of Practice and Guidance booklet on these regulations.
It is a priced publication and can be ordered online from HSE Books:
(HEALTH, SAFETY AND WELFARE) REGULATIONS 1992;
These regulations are concerned with the working environment. They place a duty on employers
to make sure that the workplace is safe and suitable for the tasks being carried out there, and that
it does not present risks to employees and others.
The regulations cover all aspects of the working environment, including:
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maintenance of the workplace, equipment, devices and systems
ventilation
temperature in indoor workplaces
lighting
cleanliness and waste materials
room dimensions and space
work stations and seating
condition of floors and traffic routes
falls or falling objects
windows and transparent or translucent doors, gates and walls
windows, skylights and ventilators
ability to clean windows, etc. safely
organisation, etc. of traffic routes
doors and gates
escalators and moving walkways
sanitary conveniences
washing facilities
drinking water
accommodation for clothing
facilities for changing clothing
facilities for rest and to eat meals.
5. PROVISION AND USE OF WORK EQUIPMENT REGULATIONS 1992;
These regulations, if fully implemented by employers, would do much to reduce the injuries
suffered by workers daily. More than 100,000 UK workers who were injured in 1994 were using
defective or inappropriate work equipment.
Many employers do not know that PUWER exists and because of weak enforcement it will be up
to workers and their Safety Representatives to monitor how employers implement the regulations
and to report instances of non-compliance to the enforcement agencies, namely the local council's
Environmental Health Department or the regional office of the Health and Safety Executive.
Examples of dangerous work equipment
Badly designed hand tools such as screwdrivers, handsaws, drills and knives which strain
wrists and cause carpal tunnel syndrome, etc. Air powered machine tools that do not have
fail-safe cut outs. Unguarded power tools or machine tools. Items used to jury-rig a job.
Badly organised workstations. Assembly lines running at speeds they were not designed
for. Photocopiers that are not regularly maintained and emit ozone. Sewing machines with
elbow operated speed controls that cause RSI. Printing machines causing unnecessary
bending of the wrists to load the card/paper feed-hoppers.
Where PUWER Applies
Regulations 1 to 10 came into force for all work equipment in all workplaces on 1 January 1993.
If the equipment was owned or rented by the firm/organisation before 1 January 1993, employers
are exempted from implementing regulations 11 to 27 until 1 January 1997.
Where there is an overlap between the general standards set by PUWER and specific standards set
by other regulations (e.g. the Display Screen Equipment Regulations 1992) then compliance with
the specific regulations will mean that the standards set by PUWER are met.
The Regulations do not cover crew on sea-going ships under the control of a Master.
The nation's armed forces may be exempted by a specific exemption certificate signed by the
Secretary of State for Defence.
The Regulations do apply to offshore oil and gas installations, diving support vessels, heavy lift
barges and pipe-lay barges.
The Regulations
All employers, and the self-employed, have a duty to make sure that all work place equipment
complies with the Regulations (Reg 4).
Equipment must only be used for the tasks for which it was designed (Reg 5).
PUWER must be implemented alongside Reg 3. of the Management of Health and Safety at Work
Regulations 1992 (every employer must complete Risk Assessments of all work tasks involving the
use of equipment).
Maintenance
The equipment must be efficiently maintained (Reg 6).
Employers must ensure that maintenance of equipment is conducted safely and equipment must
be shut down where appropriate (Reg 22).
Information
Written information and instructions must be provided on the proper use of the equipment. It
must be in a form that is comprehensible to workers e.g. in the first language of workers or in a
form readily understandable by those who may be dyslexic or have impaired literacy skills (Reg
8).
Such information and instruction must be backed up by training in the safe use of work
equipment (Reg 9).
All markings required by legislation must be clearly visible and warnings or warning devices
incorporated into work equipment for reasons of operator safety should be unambiguous, easily
perceived and easily understood (Reg 23).
Guards and protection
Machinery must have fixed guards or, if that is not practicable because the technology does not
exist, then other forms of guard or protection devices e.g. push sticks on circular saw benches. If
none of this is practicable, information, instruction, training and supervision must be provided
(Reg 11).
Employers must take action so as not to expose workers to risks arising from (Reg 12):
articles or substances falling or being ejected from work equipment (e.g. dust from grinding
machines) the rupture or disintegration of the equipment (e.g. abrasive wheels) the
equipment catching fire or overheating the unintended or premature discharge of any
article, gas, dust, liquid, vapour or other substance which is used, produced or stored by
the equipment explosions of the equipment or any article or substance used, produced or
stored in the equipment
Workers should be protected against burns, scalds and cold sears likely to be caused by any part
of work equipment or articles or substances used, produced or stored by equipment (Reg 13).
All fixed and mobile equipment must be stabilised to prevent it from collapsing or overturning
(Reg 20) and there must be sufficient light, suitably provided, for workers to use machines safely
(Reg 21).
A permit to work system must be implemented where a specific risk to workers is identified by
risk assessment (Reg 7).
Controls
Equipment must have controls for starting and controlling the use of equipment where that is
appropriate (Reg 14). For example, a pair of manual scissors does not need a "start button" but
electrical shears would.
Equipment must have, where appropriate, control(s) to stop the equipment safely (Reg 15).
Equipment must have, where appropriate, emergency stop controls (Reg 16). All controls on or of
work equipment must be both clearly identifiable and visible (Reg 17).
All equipment control systems must be fail-safe. For example, if the control system fails it must be
able to be stopped by a "stop" or "emergency stop" device (Reg 18).
Powered equipment must be able to be isolated from its source of energy (the electricity, gas, air
or water that drives it) and the means of isolation must be clearly identifiable (Reg. 19).
Action
Formulate action plan Inspect all work equipment Report flaws to employers Report
negligent employers to enforcement agencies Refuse to work with unsafe equipment
6. ELECTRICITY AT WORK REGULATIONS 1989;
The Electricity at Work Regulations 1989 clearly define that responsibilities for safety fall
with the Employer or Self Employed Person who employs one or more individuals under a
Contract of Employment.
The Electricity at Work regulations require maintenance of fixed electrical installations and
portable appliances to be carried out and for regular inspections to be made to ensure their
safety.
Persons responsible for buildings or electrical installations and appliances should ensure
that electrical test certificates confirming the installations and appliances have been tested
are in place.
Other British Standards require the testing & maintenance of fire alarm & extinguishing
systems and emergency lighting installations.
The Electricity at Work Regulations 1989 also state that where an accident occurs and it is
found that the systems are not covered by a valid test certificate, the Health & Safety
Executive (HSE) takes a keen interest in prosecutions resulting from electrocution or death
within the workplace. Reducing the risk of such an accident is a legal requirement.
7. HEALTH AND SAFETY (FIRST AID) REGULATIONS 1981;
The Health and Safety (First-Aid) Regulations 1981 require employers to provide adequate and
appropriate equipment, facilities and personnel to enable first aid to be given to employees if they
are injured or become ill at work. These Regulations apply to all workplaces including those with
five or fewer employees and to the self-employed. Detailed information can be found in the
Approved Code of Practice and Guidance: First aid at work. The Health and Safety (First-Aid)
Regulations 1981 L74.
What is adequate will depend on the circumstances in the workplace. This includes whether
trained first aiders are needed, what should be included in a first aid box and if a first aid room is
needed. Employers should carry out an assessment of first aid needs to determine this.
The Regulations do not place a legal obligation on employers to make first aid provision for nonemployees such as the public or children in schools. However, HSE strongly recommends that
non-employees are included in a first aid needs assessment and that provision is made for them.
An update on this topic is available on the 'What's new' page.
Assessment of first aid needs
Employers are required to carry out an assessment of first aid needs. This involves consideration
of workplace hazards and risks, the size of the organisation and other relevant factors, to
determine what first aid equipment, facilities and personnel should be provided.
8. CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH REGULATIONS (COSHH) 1988;
COSHH stands for The Control of Substances Hazardous to Health Regulations 2002. The
Regulations aim to protect people who come into contact with hazardous substances as part of
their work. Under COSHH every employer must, by law, ensure that the exposure of employees
to substances hazardous to health is either prevented or, where this is not reasonably practicable,
adequately controlled.
COSHH is the law that requires employers to control substances that are hazardous to health. You
can prevent or reduce workers' exposure to hazardous substances by:
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finding out what the health hazards are;
deciding how to prevent harm to health (risk assessment);
providing control measures to reduce harm to health;
making sure they are used ;
keeping all control measures in good working order;
providing information, instruction and training for employees and others;
providing monitoring and health surveillance in appropriate cases;
planning for emergencies.
Most businesses use substances, or products that are mixtures of substances. Some processes
create substances. These could cause harm to employees, contractors and other people.
Sometimes substances are easily recognised as harmful. Common substances such as paint, bleach
or dust from natural materials may also be harmful.
9. MANUAL HANDLING OPERATIONS REGULATIONS 1992;
The Manual Handling Operations Regulations 1992 (as amended) set no specific requirements
such as weight limits.
The ergonomic approach shows clearly that such requirements are based on too simple a view of
the problem and may lead to incorrect conclusions. Instead, an ergonomic assessment based on a
range of relevant factors is used to determine the risk of injury and point the way to remedial
action.
The Regulations establish the following clear hierarchy of control measures:
1. Avoid hazardous manual handling operations so far as is reasonably practicable, for
example by redesigning the task to avoid moving the load or by automating or
mechanising the process.
2. Make a suitable and sufficient assessment of any hazardous manual handling operations
that cannot be avoided.
3. Reduce the risk of injury from those operations so far as is reasonably practicable. Where
possible, you should provide mechanical assistance, for example a sack trolley or hoist.
Where this is not reasonably practicable, look at ways of changing the task, the load and
working environment.
Modern medical and scientific opinion accepts the scale of the problem and stresses the
importance of an ergonomic approach to remove or reduce the risk of manual handling injury.
Ergonomics is sometimes described as 'fitting the job to the person, rather than the person to the
job'. The ergonomic approach looks at manual handling as a whole. It takes into account a range
of relevant factors, including the nature of the task, the load, the working environment and
individual capability and requires worker participation.
When a more detailed assessment is necessary it should follow the broad structure set out in
Schedule 1 to the Regulations. The Schedule lists a number of questions in five categories:
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2.
3.
4.
the task;
the load;
the working environment;
individual capability (this category is discussed in more detail under regulation 4(3) and its
guidance); and
5. other factors, for example use of protective clothing.
Each of these categories may influence the others and none of them can be considered on their
own. However, to carry out an assessment in a structured way it is often helpful to begin by
breaking the operations down into separate, more manageable items.
The free leaflets referenced above are available to view and print from the HSE
website: http://www.hse.gov.uk/pubns/manlinde.htm.
Is there a guide to help with manual handling assessments?
The steps to follow
The Manual Handling Operations Regulations 1992 (as amended) establish a clear hierarchy of
measures for dealing with risks from manual handling.
These are:
1. avoid hazardous manual handling operations so far as reasonably practicable;
2. assess any hazardous manual handling operations that cannot be avoided; and
3. reduce the risk of injury so far as reasonably practices
10. REPORTING OF INJURIES, DISEASES AND DANGEROUS OCCURRENCES
REGULATIONS (RIDDOR)1985.
Who should report an incident?
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR),
place a legal duty on:
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employers;
self-employed people;
people in control of premises;
to report work-related deaths, major injuries or over-three-day injuries, work related diseases, and
dangerous occurrences (near miss accidents). The easiest way to do this is by calling the Incident
Contact Centre (ICC) on 0845 300 99 23 (local rate). You will be sent a copy of the information
recorded and you will be able to correct any errors or omissions.
NB. Copies of submitted RIDDOR forms are sent to the employers / duty holders regardless of
who has submitted the report.
Why should I report?
Reporting accidents and ill health at work is a legal requirement. The information enables the
Health and Safety Executive (HSE) and local authorities, to identify where and how risks arise,
and to investigate serious accidents. We can then help you and provide advice on how to reduce
injury, and ill health in your workplace.
For most businesses, a reportable accident, dangerous occurrence, or case of disease is a
comparatively rare event. However, if it does happen, please let us know.
What is the Incident Contact Centre (ICC)?
The ICC is a ‘one-stop’ reporting service for work-related health and safety incidents in the UK. It
was established on 1 April 2001 and is a primarily a call centre, open from Monday to Friday
between 8:30am and 5:00pm. If you wish to speak to an ICC operator, just call 0845 300 99 23. All
information will remain confidential.
How does the ICC work?
The responsible person, usually the employer or person in control of the premises, must report all
incidents and keep appropriate records. The quickest and easiest way to do this is to call the
Incident Contact Centre on 0845 300 99 23 with no need to fill in a report form. The ICC
Consultant will ask a few questions and take down appropriate details, this is reporting. Your
report will be passed on to the relevant enforcing authority. You will be sent a copy of the
information recorded which you can file - this meets the RIDDOR requirement to keep records of
all reportable incidents. It’s as easy as that. When you receive a copy of the information recorded,
you will be able to correct any errors or omissions.
You can also report by completing an interactive form which automatically sends you a copy for
your records.
Reports are also accepted via email or post to the ICC.
How do I contact the ICC?
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By phone: 0845 300 99 23 (local rate)
Online: HSE RIDDOR - Report online
By email: [email protected]
By Post: Incident Contact Centre, Caerphilly Business Park, Caerphilly CF83 3GG.
What must I report?
As an employer, a person who is self-employed, or someone in control of work premises, you
have legal duties under RIDDOR that require you to report and record some work-related
accidents by the quickest means possible.
You must report:
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deaths;
major injuries;
over-3-day injuries – where an employee or self-employed person is away from work or
unable to perform their normal work duties for more than 3 consecutive days;
injuries to members of the public or people not at work where they are taken from the scene
of an accident to hospital;
some work-related diseases;
dangerous occurrences – where something happens that does not result in an injury, but
could have done;
Gas Safe registered gas fitters must also report dangerous gas fittings they find, and gas
conveyors/suppliers must report some flammable gas incidents.
RIDDOR applies to all work activities but not all incidents are reportable. If someone has had an
accident in a work situation where you are in charge, and you are unsure whether to report it just
call the Incident Contact Centre (ICC) on 0845 300 99 23. .
You can also find details of reportable incidents by looking at RIDDOR in more detail.
Information supplied to HSE in a RIDDOR report is not passed on to your insurance company. If
you think your insurer needs to know about a work related accident, injury, or case of ill health
please remember to contact them separately - insurers have told us that reporting injuries and
illnesses at work to them quickly could save you time and money.
When do I need to make a report?
Although the Regulations specify varying timescales for reporting different types of incidents, it is
advisable to ring and report the incident as soon as possible by calling the Incident Contact Centre
on 0845 300 99 23.
In cases of death, major injury, or dangerous occurrences, you must notify the enforcing authority
without delay, most easily by calling the Incident Contact Centre on 0845 300 99 23.
Cases of over-three day injuries must be notified within ten days of the incident occurring.
Cases of disease should be reported as soon as a doctor notifies you that your employee suffers
from a reportable work-related disease.
What records do I need to keep?
You must keep a record of any reportable injury, disease or dangerous occurrence. This must
include the date and method of reporting; the date, time and place of the event; personal details of
those involved; and a brief description of the nature of the event or disease.
You can keep the record in any form you wish. You could, for example, choose to
keep your records by:
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keeping copies of report forms in a file;
recording the details on a computer;
using your Accident Book entry;
maintaining a written log.
If you choose to report the incident by telephone or through this web site, the ICC will send you a
copy of the record held within the database. You will be able to request amendments to the record
if you feel the report is not fully accurate.
11.THE REGULATORY REFORM (FIRE SAFETY) ORDER 2005
If you own, manage or operate a business, you will need to comply with fire safety law. The main
law is the Regulatory Reform (Fire Safety) Order 2005 or "the Fire Safety Order" which applies
across England and Wales and came into force on 1 October 2006.
The Order applies to virtually all buildings, places and structures other than individual private
dwellings e.g. individual flats in a block or family homes, and it is your responsibility to make
sure your workplace reaches the required standard. Other places covered by the Order include
common parts of houses in multiple occupations (HMO’s).
The Fire Safety Order places the emphasis on risk reduction and fire prevention. Under the Order,
people responsible for commercial buildings i.e. the employer, owner, or any other person who
has control of any part of the premises, are required to carry out a mandatory detailed fire risk
assessment identifying the risks and hazards in the premises. The risk assessment must be a
written document if you have more than five employees. The responsible person for the premises
is also required to:
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Consider who may be especially at risk.
Eliminate or reduce the risk from fire as far as is reasonably practical and provide general
fire precautions to deal with any risk.
Take additional measures to ensure fire safety where flammable or explosive materials are
used or stored.
Create a plan to deal with any emergency and where necessary document any findings.
Maintain general fire precautions and facilities provided for use by fire-fighters.
Keep any findings of the risk assessment under review.
It’s important to know that fire certificates are no longer issued and existing certificates are no
longer valid. A fairly recent fire certificate however may be a good starting point for your fire risk
assessment.
12. INDEPENDANT SAFEGUARDING AUTHORITY
The Safeguarding Vulnerable Groups Act 2006 defines the scope of the Vetting and Barring
Scheme. It provides that certain activities in relation to children and vulnerable adults are
regulated. This is known as 'regulated activity'.
What is regulated activity?
Regulated activity is any activity which involves contact with children or vulnerable adults. This
could be paid or voluntary work.
Such activities include:
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Any activity of a specified nature which involves contact with children or vulnerable
adults frequently, intensively and/or overnight.
Any activity allowing contact with children or vulnerable adults that is in a specified place
frequently or intensively.
Fostering and childcare.
Any activity that involves people in certain defined positions of responsibility.
Employers’ duties and responsibilities
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It will be a criminal offence for an employer to allow a barred person, or a person who is
not yet registered with the ISA, to work for any length of time in any regulated activity.
It will be a criminal offence for an employer to take on a person in a regulated activity if
they fail to check that person’s status.
Employees’ duties and responsibilities
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A barred individual must not take part in any regulated activity.
An individual taking part in a regulated activity must be registered with the ISA.
It will be a criminal offence for a barred person to take part in a regulated activity for any
length of time.
Domestic employment
Domestic employers (eg parents and carers) do not have to check that their employees are ISAregistered but the new scheme will give them the opportunity to check the status of an individual
(with their consent) if they wish to do so.
It will be an offence for a barred person to take part in any regulated activity in a domestic
circumstance.
For more information about regulated activities, read the factsheet ‘Regulated and controlled
activities'.
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Regulated and controlled activities (pdf, 63KB, new window)
What is controlled activity?
Controlled activities include:
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Frequent or intensive support work in general health settings, the NHS and further
education settings.
People working for specified organisations with frequent access to sensitive records about
children and vulnerable adults.
Support work in adult social care settings.
Employers’ duties and responsibilities
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It will be an offence for an employer to take on an individual in a controlled activity if they
fail to check that person’s status.
An employer can permit a barred person to work in a controlled activity as long as
safeguards are put in place.
For more information about controlled activities, read the factsheet ‘Regulated and controlled
activities'.
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Regulated and controlled activities (pdf, 63KB, new window)
Making referrals
It is important for the success of the Vetting and Barring Scheme that information about
individuals is shared by different organisations.
The following organisations have a legal obligation to refer relevant information about an
individual to the ISA:
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adult/child protection teams in local authorities;
professional bodies and supervisory authorities named in the Act;
employers and service providers of regulated and controlled activity; and
personnel suppliers.
All other employers of those working with children and/or vulnerable adults may refer relevant
information to the ISA.
Parents and private employers should go to a statutory agency who can investigate and refer if
necessary.
The ISA will inform professional and regulatory bodies when it bars someone so that their
professional registration can also be reviewed.
13. GAS SAFE REGISTER
Gas Safe Register deals with all aspects of the downstream gas industry covered by the Gas Safety
(Installation and Use) Regulations 1998 and the Gas Safety (Installation and Use) Regulations 1994
as amended and applied by the Gas Safety (Application) Order 1996 in the Isle of Man. It covers
both piped natural gas and liquefied petroleum gas (LPG).
It is law that anyone carrying out gas work that is within the scope of the appropriate Regulations
is on the Gas Safe Register from 1 April 2009.
The register is there to protect consumers from unsafe gas work. Your status as a registered
engineer is evidence that you are working legally and you are competent and safe to work with
gas.
Gas Safe Register will:
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Raise public awareness of gas safety and the gas register,
Manage inspection and enforcement,
Provide technical support and standards updates to registered engineers, and
Provide facilities for the reporting of notifiable gas work.
BENEFITS OF BEING A GAS SAFE REGISTERED ENGINEER
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Lower cost of overall service; reduced registration fees with planned reductions over the
next 10 years
Increased demand for your services; better public awareness to create a higher demand for
Gas Safe registered engineers
Renewal of registration on anniversary of registration; Twelve-months service for 12
months fee (see costs and renewals for details)
Technical standards update and technical alerts services (see technical support for details),
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Registered Gas Engineer; your monthly magazine, big on technical content and industry
needs. Written by technical experts from across the industry. (see technical support for
more details)
Consultation on significant changes; we will consult with you on matters that impact the
register
Simple online application and renewal process; supported by printed versions where
relevant
Straightforward complaints and appeals procedures
THE GAS SAFE REGISTER BRAND
Gas Safe Register is the new official stamp for gas safety in Great Britain and the Isle of Man and it
carries with it a simple message; gas, safe, register – keep gas safe.
This powerful new symbol is about gas safety and the meaning is clear. A Gas Safe Register
engineer is safe to work with gas.
As well as being the identity for the register, Gas Safe Register will be used for a range of gas
safety campaigns, so you will start to see it more and more – it’s here to stay. Gas Safe Register
will be held in trust by the Health and Safety Executive and will remain the official stamp for gas
safety in Great Britain.There will always be a Gas Safe Register, and as long as you remain
registered, you will always be a Gas Safe registered engineer.
Helping you to promote your registrationAfter you register, you will get a Gas Safe Register
marketing toolkit with access to logos and templates so you can change your stationery and
advertising. We have negotiated discounts with printers and suppliers of vehicle stickers on your
behalf, this information is contained in your marketing toolkit.
THE REGISTER
Technical SupportTechnical support is available to all registered engineers for any gas related
issues. Our dedicated technical support specialists are available by calling 0800 408 5577 or 01256
650 005 and by email – [email protected] to provide front line technical support.
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Standards update and technical alerts
Standards updates are published quarterly so that it is always clear which standards are
current. You will receive technical alerts when an issue arises, and you can choose to
receive alerts by email, letter or in urgent cases by SMS text message. This is all part of the
core service with no additional charge.
Registered Gas Engineer
You will receive Registered Gas Engineer every month. It is a technical magazine written
by engineers for engineers. Editorial contributions come from Gas Safe Register technical
team, registered engineers, industry bodies and others with an interest in gas safety. You
can also view Registered Gas Engineer online.
Work reportingGas Safe Register provides a service that allows you to report gas work that is
notifiable under the Building Regulations.
For more information about work notifiable under the Building Regulations visit the Communities
and Local Government website for Great Britain; and the Department of Local Government and
Environment for the Isle of Man.
Inspection and enforcementWe assess the competence of individual engineers by inspecting the
gas work you have carried out. Inspections will be generated from a range of data sources. Each
piece of work you carry out is a potential candidate for inspection.
All registered engineers and businesses have a risk profile that is made up of a range of factors.
This will help us to target inspection resources where we anticipate finding work that might be
considered of higher risk.
Along with building a comprehensive risk model, we are securing gas installation information
from a range of sources. We will regularly feed the risk model with installation data and from a
combination of both generate the work to inspect.
Our dedicated enforcement team will identify and pursue businesses and individuals that
undertake gas work unregistered.
Complaints and appeals
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Complaints
All complaints will be assigned to a complaints officer who will see the complaint through
from start to finish. All communications and a record of activity will be stored for future
reference to help us continue to improve procedures and processes. The complaints
procedure will also be supported by an independent appeals service.
Appeals
We have established an independent appeals service to resolve any outstanding customer
complaints impartially and promptly.
14. DISCRIMINATION LAW
UK Law on Equality and Discrimination
The United Kingdom (UK) has specific legislation on equality that outlaws discrimination and
provides a mechanism for individuals to lodge complaints with the courts when they experience
unlawful discrimination. The UK now has legislation prohibiting discrimination on the grounds of
race, religion and belief, sex, sexual orientation and transgender status, disability and age.
Discrimination on any of these grounds is prohibited in the employment sphere. Discrimination
on some of these grounds is prohibited in other spheres, such as education, housing, the provision
of goods and services and by public authorities. The operation of these different pieces of
legislation is dealt with in detail below.
The Human Rights Act 1998 (HRA), which incorporates the rights contained in the European
Convention of Human Rights (the Convention) into UK law, is also relevant in challenging
discrimination. Unlike UK equality legislation, the HRA can only be enforced directly against
public bodies, such as the police or a local authority and private bodies exercising public
functions. However, courts and tribunals are themselves public bodies and must interpret and
apply legislation in a way that is compatible with the Convention, even when the parties to the
dispute are not public bodies. Moreover, it is possible to rely on the Convention in any court or
tribunal proceedings, including for example proceedings in an Employment Tribunal, as the court
must act compatibly with the Convention when making its decision.
Article 14 of the Convention prohibits discrimination on many grounds including sex, race,
religion, political opinion as well as ‘any other status’. ‘Other status’ has been interpreted broadly
to cover, for example, marital status, sexuality, financial or employment status, physical or mental
ability. Article 14 is not a free standing guarantee of equal treatment or a prohibition on
discrimination more generally. Rather, it prohibits discrimination in respect of access to other
Convention rights and is intended to guarantee equality before the law of the Convention.
Article 14 must be used in combination with one or more of the other Articles in the Convention.
The other right need not have been breached, but the facts complained of must at least come
within the ambit of the substantive right. By way of example, men who have been widowed have
used Article 14, together with Protocol 1, Article 1 (protection of property rights) to argue that
benefits which were paid to women when their husbands died should also be paid to men when
their wives died. They were able to use Article 1 Protocol 1 because benefits can sometimes count
as property for the purposes of this Article, so a difference of treatment in respect of benefits came
within the ambit of Article 1 Protocol 1.
It is only differences in treatment of people in analogous situations which fall within Article 14
and thus far the European Court of Human Rights (ECHR) has interpreted this condition quite
strictly. However, there is no requirement that the difference in treatment has caused a detriment
to the complainant.
The right not to be discriminated against is not absolute, and discrimination can be justified if this
is necessary to achieve a legitimate aim. Discrimination will only be ‘necessary’ if the importance
of the aim to be achieved is proportionate to the impact that the discrimination will have on the
individual who is being discriminated against. There are a number of areas where the ECHR has
recognised that it will take very weighty reasons to justify discriminatory measures. These areas
include sex and race, but not sexual orientation or disability as yet.
There have been several cases in British courts where people have used Article 14 to enforce their
right not to be discriminated against in the enjoyment of other Convention rights. One example is
a well-known case which held that housing legislation should be interpreted so as to give
homosexual couples the same rights with regard to succession to tenancies as married couples.
Although Protocol 12 of the Convention establishes a free-standing right to protection from
discrimination, the UK has not signed this Protocol.
Equality Bodies and the Commission for Equality and Human Rights
Under each of the discrimination Acts separate equality commissions were established:
* Commission for Racial Equality.
* Disability Rights Commission.
* Equal Opportunities Commission.
The Equality Act 2006 established a new body called the Commission for Equality and Human
Rights (CEHR), which brings together the work of the three Commissions.
The CEHR will took on all of the powers of the existing Commissions, as well as new powers
which it plans to use to enforce legislation more effectively and promote equality for all. The
CEHR is responsible for tackling all forms of discrimination and ensuring all equality laws are
enforced, including new laws dealing with discrimination on the grounds of age, religion and
belief, and sexual orientation. Promotion of human rights is also included within the CEHR’s
remit.
The CEHR covers England, Scotland and Wales. In Scotland and Wales there will be statutory
committees responsible for the work of the CEHR. Northern Ireland has its own equality body, the
Equality Commission for Northern Ireland.
The CEHR states that it hopes that being a single commission will have many benefits, including:
* bringing together equality experts and acting as a single source of information and advice instead of the current separate organisations;
* being a single point of contact for individuals, businesses and the voluntary and public sectors;
* helping businesses by promoting awareness of equality issues, which may prevent costly court
and tribunal cases;
* tackling discrimination on multiple levels because some people may face more than one type of
discrimination;
* giving older people a powerful national body to tackle age discrimination
15. HUMAN RIGHTS ACT
Human Rights Act
The Human Rights Act 1998 gives further legal effect in the UK to the fundamental rights and
freedoms contained in the European Convention on Human Rights. These rights not only impact
matters of life and death, they also affect the rights you have in your everyday life: what you can
say and do, your beliefs, your right to a fair trial and other similar basic entitlements.
Most rights have limits to ensure that they do not unfairly damage other people's rights. However,
certain rights – such as the right not to be tortured – can never be limited by a court or anybody
else.
You have the responsibility to respect other people's rights, and they must respect yours.
Your human rights are:
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the right to life
freedom from torture and degrading treatment
freedom from slavery and forced labour
the right to liberty
the right to a fair trial
the right not to be punished for something that wasn't a crime when you did it
the right to respect for private and family life
freedom of thought, conscience and religion, and freedom to express your beliefs
freedom of expression
freedom of assembly and association
the right to marry and to start a family
the right not to be discriminated against in respect of these rights and freedoms
the right to peaceful enjoyment of your property
the right to an education
the right to participate in free elections
the right not to be subjected to the death penalty
If any of these rights and freedoms are breached, you have a right to an effective solution in law,
even if the breach was by someone in authority, such as, for example, a police officer.
Exercising your human rights
...see if the problem can be resolved without going to court
If you are in a situation in which you believe that your human rights are being violated, it's
advisable to see if the problem can be resolved without going to court by using mediation or an
internal complaints body.
Where you believe your rights have not been respected and you cannot resolve the problem
outside court, you are entitled to bring a case before the appropriate court or tribunal in the UK.
The court or tribunal will then consider your case.
Seeking legal advice
Before you decide to take any legal action is important that you seek legal advice.
The Citizens Advice Bureau may be able to help you and Community Legal Advice can put you in
touch with advice providers in your area. There are also a number of Law Centres around the UK,
which can offer you advice and help on a range of issues.
HMCS (Her Majesty's Courts Service) provides a leaflet, 'The Human Rights Act 1998 –
Information for Court Users', which provides information on how to issue a claim for monies
owed or damages under the Human Rights Act. It also sets out some important things to consider
before making such an application.
16. DATA PROTECTION ACT
Data Protection Act 1998 - a summary
The purpose of this summary is to assist you in exercising your rights, by highlighting some of the
areas of the Act which are of particular relevance. Please note that although every effort is made to
ensure that the information provided is correct we not take responsibility for any inaccuracies.
The Act
The Data Protection Act 1998 came into force on 1 March 2000 and replaced the Data Protection
Act 1984. It gives individuals (‘data subjects’) a general right of access to ‘personal data’ (ie
personal information) about themselves held by ‘data controllers’ within the United Kingdom. It
also lays down principles for the way personal data must be managed.
A ‘data controller’ is a person who determines the purposes of the processing of personal data,
and the manner of the processing. The City of London is a data controller.
Until 1 January 2005, the Act applies to such data where it is held on computer and when it is held
in very structured filing systems which are not computerised.
After 1 January 2005, for public authorities it applies to such data however it is held, although
there are still some limitations with regard to filing systems which are not computerised.
Information Commissioner
The Information Commissioner is responsible for ensuring compliance by public authorities with
the Data Protection Act 1998 and the Freedom of Information Act 2000. This may involve
monitoring, issuing guidance or taking formal steps to enforce compliance with the acts. The
Information Commissioner is a Crown appointment, reporting directly to Parliament.
Information Tribunal
Where the Information Commissioner makes a formal decision about an alleged failure to comply
with the Data Protection Act 1998 or the Freedom of Information Act 2000, with which any of the
parties concerned is dissatisfied, appeal can be made to the Information Tribunal. The functions
and operation of the Information Tribunal are described in the acts. The chairman is appointed by
the Lord Chancellor.
Data Protection principles
The Data Protection Act 1998 establishes the following 8 principles in relation to the processing (ie
management) of personal data
1. Personal data should be processed fairly and lawfully.
2. Data should only be obtained for specified purposes and should not be further processed in
a manner incompatible with these purposes.
3. Personal data should be adequate relevant and not excessive in relation to the purposes for
which they were collected.
4. Personal data should be accurate and where necessary kept up to date.
5. Personal data should not be kept longer than is needed for its intended purpose.
6. Personal data should be processed in accordance with the rights of the individual which the
information concerns.
7. Appropriate measures should be taken against unauthorised or unlawful processing or
destruction of personal data.
8. Personal data should not be transferred outside the European Economic Area (the EU states
plus Liechtenstein, Iceland and Norway).
Lawful processing
In accordance with principle 1, any processing of personal data must be allowed by, or required
by, statute or common law. Fair processing code Also in accordance with principle 1, any
processing must be fair; that is, must be carried out without deception. The part of the Act which
deals with this is now called the ‘Fair Processing Code’. So far as practicable, and subject to
exemptions, data subjects should be provided with certain information at the time of collection or
as soon as practicable thereafter, so that they understand why and how their data are being
processed. This information is provided in a Fair Processing Notice.
Fair processing notice
The fair processing notice (also known by other names such as ‘data protection notice’) should
include the following information
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the identity of the data controller
the purposes for which the personal data are intended to be processed
to whom the personal data may be disclosed to, eg a government department or agency
and any further information regarding the processing, to enable processing in respect of the
data subject to be fair
Further conditions for fair processing
In addition, personal data must not be processed unless one of the conditions listed in Schedule 2
of the Act is met; and in addition, in the case of sensitive personal data, one of the conditions listed
in Schedule 3 is also met.
Schedule 2 - Conditions for processing personal data
One of the following conditions must be met for processing personal data
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consent has been given by the data subject
it is for entering or performing a contract with the data subject
the data controller is under a legal obligation, other than under contract
it is to protect the vital interests of the data subject
it is for the administration of justice, exercising functions under an enactment, exercising of
government functions, or the exercise of any other functions of a public nature in the public
interest
it is for the pursuit of the legitimate interests of the data controller
The Secretary of State may also make an Order concerning other particular circumstances.
Schedule 3 - Conditions for processing sensitive personal data
For processing of sensitive personal data, one of the conditions listed in Schedule 2 must be met,
and also one of the following conditions listed in Schedule 3 must be met
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explicit consent has been given by the data subject
it is for the exercise of rights or obligations in connection with employment
it is to protect the vital interests of the data subject or anyone else
it is part of the legitimate activity of a not for profit organisation
the personal data have already been made public by the data subject
it forms part of legal proceedings, including obtaining legal advice, and exercising or
defending legal rights
it is for the administration of justice, or exercising functions under an enactment, or
exercising of government functions
it is for medical purposes
it is for the purpose of monitoring equality of opportunity
The Secretary of State may also make an Order concerning other particular circumstances.
‘Sensitive personal data’ consist of data relating to one or more of the following
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Racial or ethnic origin
Political opinions
Religious beliefs or other beliefs of a similar nature
Trade Union membership
Physical or mental health
Sexual life
Offences committed or alleged to have been committed
Proceedings in relation to these, including the sentence of any court
Rights of data subjects and others
The Data Protection Act 1998 sets out a framework of general individual rights in relation to
personal data. These are described in Part II of the Act, which concerns ‘Rights of Data Subjects
and Others’. This is the section to which the 6th data protection principle largely relates.
The six general rights are
1. Right of access to personal data (section 7 of the Act).
There is a general right of access by a data subject to the personal data held about the data subject
by the data controller. The process by which this right is exercised is called a ‘Subject Access
Request’ (often abbreviated to SAR). The Act describes how the data controller must respond to
such requests when an exemption does not apply. A data controller has 40 calendar days in which
to provide the requested data, if no exemption applies.
Following a subject access request to a data controller by a data subject, and the data controller
having failed to comply, the data subject can apply to court, which may support the Request and
order the data controller to comply.
2. Right to prevent processing which causes substantial damage or distress (section 10 of the Act).
There is a right to require processing either to cease, or not to start, if it would cause the data
subject, or anyone else, substantial unwarranted damage or distress. A data subject can issue a
‘Data Subject Notice’ to a data controller to prevent processing which he thinks is causing or likely
to cause unwarranted damage or distress to the data subject or to another person, unless the data
controller has met one of the first four conditions for processing stated in Schedule 2 of the Act
(conditions for processing personal data). The data controller must respond within 21 days of
receiving the notice, either complying or stating reasons why he is not complying. The data
subject can apply to court, which may support the notice and order the data controller to comply.
3. Right to prevent direct marketing (section 11 of the Act).
A data subject can give a notice in writing to a data controller to cease or not begin processing for
the purpose of direct marketing (in any medium) to the data subject. If the data controller does not
comply, the data subject can apply to court, which may support the notice and order the data
controller to comply.
The Act defines direct marketing as
the communication (by whatever means) of any advertising or marketing material which is
directed to particular individuals (s 11)
The Information Commissioner, in Data Protection Act 1998: Legal Guidance, has placed a broad
interpretation on this definition. The Information Commissioner regards the term as
covering a wide range of activities which will apply not just to the offer for sale of goods or
services, also the promotion of … aims and ideals.
4. Right in relation to automated decision-taking (section 12 of the Act).
A data subject can give a notice in writing to a data controller to require the data controller to
ensure that no decision taken by or on behalf of the data controller which significantly affects that
data subject is based solely on processing by automatic means.
If the notice has no effect but a decision using automatic means is nevertheless taken, the data
controller must, as soon as reasonably practicable, inform the data subject of the processing. The
data subject then has 21 days in which to write to request reconsideration of the decision (a ‘data
subject notice’). The data controller then has 21 days to respond specifying the steps he will take to
comply. If he does not comply, the data subject can apply to court, which may support the notice
and order the data controller to comply.
5. Right to compensation for damage and distress (section 13 of the Act).
A data subject who has suffered damage as a result of any contravention of the act by a data
controller has a right to compensation. The right to compensation for distress exists if damage has
also occurred.
6. Right to have inaccurate personal data rectified, blocked, erased or destroyed (section 14 of the
Act).
If a court is satisfied that personal data being processed are inaccurate, it can order the data
controller to rectify, block, erase or destroy the data. The court may also order third parties in
receipt of the inaccurate data to be notified.
Subject access request
There is a general right of access to personal data. This is the right by a data subject to see the
personal data held about the data subject by the data controller. The process by which this right is
exercised is called a ‘subject access request’ (often abbreviated to SAR).
A data controller has 40 calendar days in which to provide the requested data, if no exemption
applies. The data controller is allowed to ask for proofs of identity, and to charge an
administration fee of £10. If proofs of identity are required and/or the fee is requested, the 40 days
begins when the proofs and/or the fee are received.
If the data controller fails to comply with a subject access request, the data subject can apply to
court, which may support the request and order the data controller to comply. There is no
obligation on the data subject to state why he/she is making a subject access request.
The right of access to personal data is the key provision for the exercise of other rights under the
Act. Unless data subjects can learn what data are held about them, their rights to correct or
challenge it may become valueless.
Notification
Data controllers have to ‘notify’ the Information Commissioner of the purposes for which they
process personal data by electronic means.
The notifications are stored as a register entry. The register is a Public Register of Data Controllers.
There are certain exemptions to notification (for example, the processing of personal data for
personal, family or household affairs, including for recreational purposes, does not have to be
notified).
It is a criminal offence to process personal data without notification, unless exempted from doing
so.
Exemptions
Part III of the Data Protection Act 1998 concerns exemptions from aspects of the Act, particularly
from certain basic aspects of the Act such as restrictions on providing personal data to third
parties, and the right of access by data subjects to their personal data. There are very few
exemptions from the entirety of the Act, although there are some exemptions from much of the
Act.
Exemptions under the Act can appear complex. There are some exemptions to prohibitions on
sharing personal data with third parties; and also some exemptions to disclosure to data subjects
of the personal data held about them.
Exemptions to prohibitions on data sharing with third parties are where
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the data subjects have given their consent
the sharing is for the prevention or detection of crime
the sharing is for the assessment of any tax or duty
the sharing is necessary to exercise a right or obligation conferred or imposed by law (other
than an obligation imposed by contract)
the sharing is for the purpose of, or in connection with, legal proceedings (including
prospective legal proceedings)
the sharing is for the purpose of obtaining legal advice
the sharing is for research, historical and statistical purposes (so long as this neither
supports decisions in relation to individuals, nor causes substantial damage or distress)
There may be an exemption to access to personal data by data subjects where the personal data
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are part of a confidential reference given by the data controller
are subject to a duty of confidentiality, eg confidential references provided to the data
controller
are subject to legal professional privilege
are being used to investigate crime or detect fraud
are being used for management forecasting or planning
are part of negotiations which would be prejudiced if disclosed
are, in the opinion of the data controller or of independent professional advice, likely to
cause serious harm to the physical or mental health of the data subject or another person
relate to health, education and social work, and are processed by a court and consists of
information supplied in a report or other evidence to the court by a local authority
are processed for the purposes of assessing suitability for the conferring by the Crown of an
honour
Complaint procedures
General right of complaint to the Information Commissioner
With regard to any data protection matter, complaint can be made by anyone to the Information
Commissioner.
Request to the information commissioner for an assessment
In addition, a data subject (or anyone acting on his or her behalf) can request the Information
Commissioner to assess if data processing is being carried out by a data controller in compliance
with the Data Protection Act 1998. The time period for responding to an assessment request is
determined by the Information Commissioner.
17. MENTAL HEALTH ACT
The legislation governing the compulsory treatment of certain people who have a mental disorder
is the Mental Health Act 1983 (the 1983 Act). The main purpose of the Mental Health Act 2007 (the
2007 Act) is to amend the 1983 Act. It also extends the rights of victims by amending the Domestic
Violence, Crime and Victims Act 2004. It will introduce "deprivation of liberty safeguards" by
amending the Mental Capacity Act 2005 (MCA) in April 2009.
The 1983 Act is largely concerned with the circumstances in which a person with a mental
disorder can be detained for treatment for that disorder without his or her consent. It also sets out
the processes that must be followed and the safeguards for patients, to ensure that they are not
inappropriately detained or treated without their consent. The main purpose of the legislation is
to ensure that people with serious mental disorders which threaten their health or safety or the
safety of the public can be treated irrespective of their consent where it is necessary to prevent
them from harming themselves or others.
The changes in relation to the MCA are in response to the 2004 European Court of Human Rights
judgment (HL v UK (Application No.45508/99)) (the “Bournewood judgment”) involving an
autistic man who was kept at Bournewood Hospital by doctors against the wishes of his carers.
The European Court of Human Rights found that admission to and retention in hospital of HL
under the common law of necessity amounted to a breach of Article 5(1) ECHR (deprivation of
liberty) and of Article 5(4) (right to have lawfulness of detention reviewed by a court).
Summary
The following are the main changes to the 1983 Act made by the 2007 Act:
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definition of mental disorder: it changes the way the 1983 Act defines mental disorder, so
that a single definition applies throughout the Act, and abolishes references to categories of
disorder.
criteria for detention: it introduces a new “appropriate medical treatment” test which will
apply to all the longer-term powers of detention. As a result, it will not be possible for
patients to be compulsorily detained or their detention continued unless medical treatment
which is appropriate to the patient’s mental disorder and all other circumstances of the case
is available to that patient. At the same time, the so-called “treatability test” will be
abolished.
professional roles: it is broadening the group of practitioners who can take on the
functions currently performed by the approved social worker (ASW) and responsible
medical officer (RMO).
nearest relative: it gives to patients the right to make an application to the county court to
displace their nearest relative and enables county courts to displace a nearest relative who
it thinks is not suitable to act as such.
nearest relative: the provisions for determining the nearest relative were amended to
include civil partners amongst the list of relatives from 1 December 2007.
supervised community treatment (SCT): it introduces SCT for patients following a period
of detention in hospital. It is expected that this will allow a small number of patients with a
mental disorder to be discharged from detention subject to the possibility of recall to
hospital if necessary. Currently some patients leave hospital and do not continue with their
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treatment, their health deteriorates and they require detention again – the socalled
“revolving door”.
electro-convulsive therapy: it introduces new safeguards for patients
Tribunal: it reduces the periods after which hospital managers must refer certain patients’
cases to the Tribunal if they do not apply themselves and introduces an order-making
power to make further reductions in due course. Separate changes to the Tribunal system
also come into effect on 3 November: see the Tribunals website at the link below.
advocacy: it will place a duty on the appropriate national authority to make arrangements
for help to be provided by independent mental health advocates. This is on course to be
implemented in April 2009.
age-appropriate services: it will require hospital managers to ensure that patients aged
under 18 admitted to hospital for mental disorder are accommodated in an environment
that is suitable for their age (subject to their needs). This is on course to be implemented in
April 2010.
18. ACCESS TO HEALTH RECORDS ACT
Summary
Providing access to medical records is essentially a confidentiality issue; therefore, the starting
point is whether or not the patient has consented to disclosure. If not, access should be denied,
unless there is some other clear justification for allowing access.
Patient access
Patients have a right of access to their records under the Data Protection Act. There are limited
exceptions to this right, such as the disclosure of third party information, and where information,
if disclosed, would be likely to cause serious harm to the physical or mental health or condition of
the data subject or any other person.
Disclosure with consent
Before allowing access to anyone other than the patient or colleagues involved in the patient’s
care, generally speaking, you will need to confirm that the person making the request has the
patient’s consent. You need to be clear about exactly what part of the record the consent applies to.
Disclosure without consent
Occasionally, there will be circumstances where you have to disclose a patient’s records without
their consent (and, rarely, in face of the patient’s clear objection to disclosure). There are three
possible justifications for this:
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Disclosure would be in the best interests of a minor or a mentally incapacitated adult.
Examples of this might be where you suspect that the patient is being abused and must
inform social services.
You believe that it is in the wider public interest, or that it is necessary to protect the patient
or someone else from the risk of death or serious harm. Examples of this might be to inform
the DVLA if someone may be unfit to drive, or to assist the police in preventing or solving a
serious crime, or informing the police if you have good reason to believe that a patient is a
threat to others.
Disclosure is required by law – for example, in accordance with a statutory obligation, or to
comply with a court order or a disclosure notice from the NHS counter-fraud service.
In any of these cases, you should only provide the minimum amount of information necessary to
serve the purpose, and you should carefully document your reasons for making the disclosure.
Access to a child or young person's medical records
If the child or young person is competent you will need his/her consent before disclosing his/her
records, even to someone with parental responsibility. If a child or young person is not competent
you should allow the parents access to the child’s medical records, provided that it is in the child’s
best interests.
Fathers with parental responsibility have a right to access a child’s medical records, but you may
consider that it would be in the child’s best interests to allow a father access to the notes, even if he
does not have parental responsibility. If the child’s parents are divorced or separated, parental
responsibility is not affected. You may, however, wish to inform the other parent of the
application for access to records, so that they can seek their own advice.
The fact that someone is a healthcare professional does not in itself entitle him/her to access any
patient’s medical records. Doctors, nurses, physiotherapists, midwives, etc, have a professional
ethical duty to respect a patient’s confidentiality and should only access records if they are
involved in the patient’s care.
Access to the medical records of an incapacitated patient
Healthcare professionals can disclose information from the records of an incapacitated patient,
either when it is in the patient’s best interests, or where there is some other lawful reason to do so.
Disclosure would usually be related to the ongoing care of the patient. Information should not be
disclosed if it is judged that doing so would cause serious mental or physical harm to the patient
or anyone else.
An attorney (who is a person nominated by the patient) for the patient, acting either under a valid
Lasting Power of Attorney (LPA) or Enduring Power of Attorney (EPA), can ask to see
information about the person they are representing, provided that it is relevant to the decisions
the attorney has a legal right to make. Before disclosing any information, the holder of the
information should make sure that the attorney has the official authority.
The NHS Code of Practice on Confidentiality sets out examples of when disclosure would be in
the public interest, including what to do in situations when it may not be in the patient’s best
interests. There is an increasing requirement for non-clinical staff to access patients’ records for
administrative purposes, and this raises serious concerns about preserving patient confidentiality.
It is essential that all such staff be given training on confidentiality and record-security issues and
that a confidentiality clause be included in their contracts. Their access to patient information
should, as far as is possible, be restricted only to what they need in order to carry out their specific
duties.
Access to a patient’s records after death
The duty of confidentiality remains after a patient has died. Under the Access to Health Records
Act 1990, the personal representative of the deceased and people who may have a claim arising
from the patient’s death are permitted access to the records. This applies to information provided
after November 1991 and disclosure should be limited to that which is relevant to the claim in
question.
The records should not be disclosed if it is thought that they may cause mental or physical harm to
anyone, if they identify a third party or if the deceased gave the information on the understanding
that it would remain private.
Sharing information with other health professionals
Doctors, nurses, physiotherapists, midwives, etc, have a professional ethical duty to respect a
patient’s confidentiality and should only access records if they are involved in the patient’s care.
It is assumed that patients consent to their personal information being shared among the clinical
team for the purposes of their care. They should be made aware that this is the case and told that
they have the right to withhold consent. Sometimes, patients may ask for certain – usually
extremely sensitive – information to be kept private and you should respect this.
However, in certain circumstances, this information may need to be released if failure to disclose
would place others at risk of death or serious harm. A patient’s HIV or similar status should not
be disclosed without the patient’s consent, as this does not normally fall within the ‘risk of death
or serious harm’ exception.
19. GENERAL SOCIAL CARE COUNCIL
The General Social Care Council (GSCC) is a non-departmental public body which has
responsibility for registering and regulating Social Workers and Social Care Workers in England.
Its responsibilities include setting and promoting high standards of social care, and ensuring that
all workers in the Social Care sector adhere to high professional standards.
It is an Arm's Length body sponsored by the UK Department of Health. It has three sister
organisations which have similar responsibilities in the other parts of the United Kingdom; these
are the Scottish Social Services Council (SSSC), the Care Council for Wales (in Welsh: Cyngor
Gofal Cymru) (CCW or CGC), and the Northern Ireland Social Care Council.
The GSCC was set up in 2001 further to the Care Standards Act 2000, which was enacted partly in
response to criticisms in the late 1990s of social services in Britain, in particular the high-profile
case of Victoria Climbié, a young girl who was abused and eventually killed by her relatives in
north London despite having been known to local social services. The GSCC inherited the mantle
of the Central Council for Education and Training in Social Work (CCETSW), a previous body
which had responsibility solely for managing and funding Social Work education. The GSCC was
given a broader remit to take a lead not only in education but in the strategic development and
promotion of the whole social care sector in Britain.
A major responsibility of the GSCC and other councils is the maintenance of a professional
register of Social Workers. From 1 April 2005 it became a criminal offence to claim to have the title
Social Worker without proper qualifications. Social Workers are required to renew their
registration every three years, and to undertake a certain amount of professional training and
learning during each three-year registration period. In this way the GSCC hopes to raise the
standards and reputation of the social care UK workforce.
20. NURSING AND MIDWIVES COUNCIL
The Nursing and Midwifery Council exists to safeguard the health and wellbeing of the public.
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They register all nurses and midwives and ensure that they are properly qualified and
competent to work in the UK.
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They set the standards of education, training and conduct that nurses and midwives need
to deliver high quality healthcare consistently throughout their careers.
They ensure that nurses and midwives keep their skills and knowledge up to date and
uphold the standards of their professional Code.
They ensure that midwives are safe to practise by setting rules for their practice and
supervision.
They have fair processes to investigate allegations made against nurses and midwives who
may not have followed the Code.
The remit is set out in the The Nursing and Midwifery Order 2001. The work of the NMC is
governed by this and other associated legislation.
Alongside the core functions, the NMC also offers the following services
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an online registration confirmation service for employers
a free and confidential advice service for nurses and midwives
free publications to keep practitioners, students and the general public informed about the
Council’s work
a range of events including exhibitions, seminars and conferences
NMC News, a quarterly news magazine, is mailed to all registrants in the UK and overseas
21. EMPLOYMENT LAW
Employment law is the body of laws, administrative rulings, and precedents which address the
legal rights of, and restrictions on, working people and their organisations. As such, it mediates
many aspects of the relationship between trade unions, employers and employees.
An employee has the right to know how much they will be paid and how often. They are also
entitled to receive an individual, detailed written pay statement from their employer, either when
they are paid or shortly before.
The employment contract may set out what sick pay you are entitled to. This will vary from job to
job. Company sick pay cannot offer you less than they are entitled to through Statutory Sick Pay.
A company may introduce a performance-related pay scheme to encourage you to work harder.
The better the individual - or your team - carry out your work, the more the employer pays you.
All employees have an employment contract with their employer, although it might not be in
writing. If an employee does nott have a written employment contract, the contract would have
automatically been created when you started to work for your employer.
Sometimes it's necessary to change the terms and conditions of an employment contract.
Both employers and employees can be in breach of a contract of employment - so it's important to
know what this is and what you should do if either you or your employer breaches your contract.
Contract terms can come from a number of different sources; for example they could be:
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verbally agreed
in a written contract, or similar document
in an employee handbook or on a company notice board
in an offer letter from the employer
required by law, for example, your employer must pay you at least the minimum wage
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in collective agreements (see below)
implied terms (see below)
If there's anything in the contract that the individual is unsure about, or which is confusing, they
must ask their employer to explain it to you.
It should be made clear what is a legally binding part of the contract and what is not. The legal
parts of a contract are known as 'terms'.
If either the individual or their employer breaks a term of the contract, the other is entitled to sue
for breach of contract.
22. NATIONAL MINIMUM WAGE
A minimum wage is the lowest hourly, daily or monthly wage that employers may legally pay to
employees or workers. Equivalently, it is the lowest wage at which workers may sell their labour.
Although minimum wage laws are in effect in a great many jurisdictions, there are differences of
opinion about the benefits and drawbacks of a minimum wage. Supporters of the minimum wage
say that it increases the standard of living of workers and reduces poverty. Opponents say that if
it is high enough to be effective, it increases unemployment, particularly among workers with
very low productivity due to inexperience or handicap, thereby harming lesser skilled workers to
the benefit of better skilled workers.
23. MAPPA
Protecting the public - Multi Agency Public Protection Arrangements (MAPPA)
West Mercia Probation Trust is one of the three agencies that make up the ‘Responsible Authority
for Multi Agency Public Protection Arrangements’ in the West Mercia area. This responsibility is
shared with West Mercia Police and the Prison Service.
Multi Agency Public Protection Arrangements (MAPPA) exist to deal with the risks that are
presented by some offenders who are thought likely to cause serious harm. They are few in
number. The formal arrangements ensure consistency in sharing information
Why have these arrangements?
From enquires about what went wrong following serious and notorious crimes, certain things
seem to arise regularly: agencies do not communicate with each other enough, or when they do it
is often not consistent or effective. There is a failure to use expertise and knowledge from other
agencies that could be crucial. At worst this amounts to a collective failure to take an overview
and a failure to protect victims.
What sorts of things can be done to safeguard victims?
There are a range of things that can be done to reduce the risks to the public as a whole or to
named victims or groups of victims, for example:
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Arrange licence conditions to meet offender and victim needs
Extra supervision imposing close monitoring and allowing quick interventions if warning
signs noted
Surveillance to gather more information
Obtain specialist help
Enable early breach and recall to prison, where necessary
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Plan applications under the Sex Offenders Act 2003 to prohibit certain activities that some
sex offenders use when preparing to offend
Ensure sharing of information across geographical boundaries
How do MAPPA work?
Violent and sexual offenders are supervised by police, probation, youth offending teams and
mental health services. These organisations can refer offenders for consideration by a multiagency meeting. The task of these meetings is to share information, assess the risk(s) the offender
represents, and plan safeguards to protect the public. Every case has built-in timescales for the
risk management plan, individual accountability and a mechanism for checking progress.
Three MAPPA levels
Level 1 – agencies assess and manage the risks that people they work with represent to the public.
Level 2 – cases where there is a high risk of reoffending and causing serious harm* that cannot
effectively be assessed and/or managed by one agency alone are brought to where all processes
and recording follow a formal pattern. Agencies organise and manage level two meetings when
they deem it to be necessary. The key contact can assist with this.
Level 3 – The Multi Agency Public Protection Panel (MAPPP) use the same formal processes but
deals with the most risk cases, and involves regular monthly meetings from all agencies involved.
(*Serious harm
That which is 'life threatening and/or traumatic and from which recovery, whether physical or
psychological, can be expected to be difficult or impossible' - Offender) Assessment System
(OASys) definition used by MAPPA Responsible Authorities.
24. MARAC
Multi-Agency Risk Assessment Conference (MARAC)
The MARAC process is part of a countywide strategic response to domestic abuse, that aims to
increase identification of victims at very high risk of serious harm from domestic abuse; and then
to produce a multi agency risk management plan to reduce the risks to victims, their children and
any other vulnerable person in the household. This work is part of the Specialist Domestic
Violence Court Programme, the components of which are:
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Multi-agency partnerships with protocols
Multi agency Risk Assessment Conferences (MARAC) and Multi agency Public Protection
Arrangements (MAPPA)
Identifcation of cases
Specialist domestic abuse support services
Trained and dedicated criminal justice staff
Court listing considerations
Equality and diversity issues
Data collection and monitoring
Court facilities children's services
Perpetrator Programmes.
25. TRAINING AND QUALIFICATION
A minimum ratio of 50% trained members of care staff (NVQ level 2 or equivalent) is achieved,
excluding the registered manager and/or care manager, and in care homes providing nursing,
excluding those members of the care staff who are registered nurses. Any agency staff working in
the home are included in the 50% ratio. Trainees (including all staff under 18) are registered on a
certified training programme.
The registered person ensures that there is a staff training and development programme which
meets Skills for Care workforce training targets and ensures staff fulfil the aims of the home and
meet the changing needs of service users.
All members of staff receive induction training to Skills for Care specification within 6 weeks of
appointment to their posts, including training on the principles of care, safe working practices, the
organisation and worker role, the experiences and particular needs of the service user group, and
the influences and particular requirements of the service setting.
All staff receive a minimum of three paid days training per year (including in house training), and
have an individual training and development assessment and profile.
The registered manager is qualified, competent and experienced to run the home and meet its
stated purpose, aims and objectives. The registered manager: has at least 2 years’ experience in a
senior management capacity in the managing of a relevant care setting within the past five years
and has a qualification, at level 4 NVQ, in management and care or equivalent or where nursing
care is provided by the home ( i.e. nursing home), is a first level registered nurse, and has a
relevant management qualification.
26. SUPERVISION AND APPRAISAL
Supervision
Overview
Supervision, whilst being a managerial tool and a key aspect of a line manager’s role, also benefits
the employee. The approach taken to supervision will reflect and reinforce the organisation’s
culture. The key purpose of supervision is to ensure that staff performance is up to standard,
organisational and unit targets are met and that staff are developed, valued and supported in their
role. The key task on which managers need to focus in order to improve performance is the way in
which people are managed. Clear standards and expectations, a specific work programme,
training and development, support and feedback are some of the important features of
supervision. Delivering quality services requires competent, motivated and committed staff. A
person’s contribution to the organisation and the extent to which they are meeting their tasks is
monitored and assessed through supervision. This chapter intends to outline key requirements of
line managers and staff when it comes to supervision and to offer guidance on the conduct of
supervisory relationships.
Key features of supervision are:
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to review and account for work
to plan and prioritise work
to be supported in the work
to receive feedback about the work and to give feedback
to periodically identify training and development needs in relation to work
Objectives of Supervision
Supervision should seek to meet the needs of the job and of the individual performing the duties
of the job. The former refers to whether or not staff are performing the duties to an acceptable
standard in order to achieve the aims and objectives of the organisation. This is the aspect of
supervision that is concerned with accounting for work and planning ahead. Meeting the needs of
the individual involves ensuring that training and development needs are met in order that staff
can perform well in their role. The organisation should be concerned with recognising the
importance of providing an environment where staff can develop in their work, explore concerns,
and get support and feedback when they are experiencing difficulties.
Features of Supervision
Frequency
It should be the line manager’s responsibility to arrange and ensure supervision happens on a
regular basis (normally every 6 - 8 weeks is acceptable). Dates should be set in advance by the line
manager and ideally sessions for throughout the year should be planned at the beginning of the
year so that the time is allocated in both the supervisor and supervisee’s diaries. Changing or
cancelling supervision can indicate a lack of
commitment and is not good practice.
Duration
Line managers should allocate a reasonable period for each supervision session and ensure that
each session begins and ends on time to allow for individual work schedules.
Confidentiality
A record of each supervision session should be retained on the individual personnel file. Usually
the manager and the member of staff should only see these notes, however in disciplinary and
capability situations, other managers may see supervision notes.
Appraisal
Overview
Conducting a staff appraisal is the process of ensuring that staff know what is expected of them in
their work and measuring how performance meets these expectations. It gives managers and staff
the opportunity to sit down together and take time to discuss performance, career progress and
career and development issues. It leads on naturally to setting future objectives/goals. An
appraisal should be used for disciplinary or grievance purposes and each organisation should
have other formal procedures for this purpose.
Key features of a staff appraisal scheme are:
to integrate organisational objectives with the assessment of staff
• to enhance communication between managers and staff
• to assist the organisation to determine general training needs
• to review job descriptions
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to provide a vehicle for managers and individual members of staff agree specific
training requirements.
Frequency
Organisations normally set key targets and objectives during January/February for the year
beginning 1 April. During the financial year, these objectives should be reviewed formally at least
once, although it is expected that key targets and objectives will be the basis of frequent
discussions through the formal supervision sessions as appropriate. The actual appraisal itself
should take place in the year or at the end of the financial year, when the staff member’s
performance against objectives has become obvious. At this
time, or shortly thereafter, key targets and associated objectives should be agreed for the coming
year and action plans can be added to the objectives. This process may require a series of meetings
rather than a single interview.
Roles and Responsibilities
All staff should share an ongoing responsibility to monitor and review their performance and all
line managers should, as a matter of course, observe and monitor the performance of their staff
and offer feedback whenever appropriate in terms of recognition, praise or constructive criticism.
This should be conducted through a formal supervision process referred to earlier in this chapter.
27. OTHER
Write here any legislation with regard to your care category
MANAGEMENT UNIT 13.
HAVE COPIES OF COMPLETED FORMSS /REPORTS IN YOUR PORTFOLIO
A: SERVICES AND OPERATIONS
1.1 How Does Investment In People Work To Improve
Quality Standards.
Investment in People works to improve quality by training individuals in relation to job
descriptions to the required standard that is needed for them to carry out work tasks and other
duties. One of the main benefits is that training protects managers from negligent employers who
if not trained could cause situations or untoward occurrences within the work place. Training
individuals within the work place helps employees to communicate with the management at all
levels and this helps them to be more involved in their duties. It also ensures that all employees
are aware of the legal implementations that have to be followed in regard to individual job
descriptions. Therefore Investment in People work by improving the performance of individuals
in the work place who maintain and produce higher standards thus the management can offer
quality in there services.
The right employee training, development and education, at the right time, provides big payoffs
for the employer in increased productivity, knowledge, loyalty, and contribution. Learn the
approaches that will guarantee your training brings a return on investment.
Licensing, certification, continuing education, and training to retain and grow skills are becoming
increasingly important.
Important Aspects of Training
How training needs are determined, how training is viewed by employees, and how training is
delivered become critically important issues. Training trends and methods for gaining knowledge,
other than traditional classroom training, such as coaching and mentoring, take centre stage.
New employee induction, , is a significant factor in helping new employees hit the ground
running. Training that helps each employee grow their skills and knowledge to better perform
their current job is appreciated as a benefit. Training also increases employee loyalty, and thus
retention, and helps you attract the best possible employees.
Transfer of training from the training provider, whether online or in a classroom, to the job, is also
increasingly reviewed as you invest more resources in training.
Learn the approaches that will guarantee a return on your investment and ensure employee
loyalty. Organisations are increasingly asking for monetary justification that the training provided
produces results - be prepared to demonstrate your results.
Options for Training and Education for Employees
Options for employee training and development are magnifying due to these factors:
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technological innovations,
employee retention strategies, and
the need for organisations to constantly develop their employees' ability to keep up with
the pace of change.
So, sending an employee off for training at a one-day seminar or a week-long workshop is only
one of many options that exist now.
The chance for ongoing development, is one of the top five factors employees want to experience
at work. In fact, the inability of an employee to see progress is an often cited reason for leaving an
employer.
As a retention strategy for preferred employees, training and development rates highly. Only their
perception of their salary and benefits as competitive, and reporting to a manager they like, rate
higher.
Options for Employee Training and Development
When thinking about education, training, and development, options exist externally, internally,
and online. Choices range from seminars to book clubs to mentoring programs. Here are the
existing alternatives to help employees continue to grow. For recruiting, retention, and managing
change and continuous improvement, adopt all of these practices within your organization.
External Education, Training, and Development
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Seminars, workshops, and classes come in every variety imaginable, both in-person and
online.
Take field trips to other companies and organizations.
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Colleges and universities, and occasionally, local adult education, community colleges or
technical schools provide classes. Universities are reaching out to adult learners with
evening and weekend MBA and business programmes.
Professional association seminars, meetings, and conferences offer training opportunities.
Internal Education, Training, and Development
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Onsite seminars and classes provide training customised to the organisation.
Coaching gives employees the opportunity to share knowledge.
Mentoring is increasingly important in employee development and training as are formal
mentoring programs.
What Organisation’s Can Do to Facilitate Continuous Learning and Regular Training
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Create a learning environment. Communicate the expectation for learning.
Offer work time support for learning. Make online learning and reading part of every
employee's day.
Provide a professional library.
Offer college tuition reimbursement.
Enable flexible schedules so employees can attend classes.
Pay for professional association memberships and conference attendance annually for
employees.
Training is crucial to the ongoing development of the people you employ and their retention and
success. Be creative to provide diverse opportunities for training.
1.2 How Does Quality Systems Work To Improve Standards
The reason for the implementation of Quality Systems is that all policy and procedures within the
work place are followed and maintained in the correct manner. This ensures that top quality
standards are upheld in conformance with British Safety standards and the stated requirements
are complied with in accordance within legislation and guidelines. The Quality Systems state how
the management can improve the quality of services offered by carrying out work related duties
and maintaining them at the level that is required in the Quality Systems standards.
The home is run in the best interests of client’s.
Effective quality assurance and quality monitoring systems, based on seeking the views of client’s,
are in place to measure success in meeting the aims, objectives and statement of purpose of the
home. There is an annual development plan for the home, based on a systematic cycle of planning
– action – review, reflecting aims and outcomes for client’s. There is continuous self-monitoring,
using an objective, consistently obtained and reviewed and verifiable method (preferably a
professionally recognised quality assurance system) and involving client’s; and an internal audit
takes place at least annually.
The results of client’s surveys are published and made available to current and prospective users,
their representatives and other interested parties, including the Registering Authority. The
registered manager and staff can demonstrate a commitment to lifelong learning and
development for each client’s, linked to implementation of his/her individual care plan. Feedback
is actively sought from client’s about services provided through e.g. anonymous user satisfaction
questionnaires and individual and group discussion, as well as evidence from records and life
plans; and this informs all planning and reviews.
The views of family and friends and of stakeholders in the community (e.g. GPs, chiropodist,
voluntary organisation staff ) are sought on how the home is achieving goals for client’s. Client’s
are told about planned Registering Authority inspections and are given access to inspectors and
the views of service users are made available to inspectors for inclusion in inspection reports.
Policies, procedures and practices are regularly reviewed in light of changing legislation and of
good practice advice from the Department of Health, local / health authorities, and specialist /
professional organisations. Action is progressed within agreed timescales to implement
requirements identified in inspection reports.
1.3 Quality Assurance
Quality assurance is a professional concept. It is sum of the processes of assessing and stimulating
the quality of medical practice by measuring outcome and comparing it with current criteria and
demands of medical care. Quality assurance should ensure that medical activities are systematic
and controlled. It should affect all levels of the medical community and every professional
working in health care. It can only succeed if the individual doctor accepts that his/her practice
should be open to assessment by the profession and to comparison with demands for medical care
and with established criteria.
Quality assurance is a moral and ethical obligation for the individual specialist, but
basically it should be a voluntary responsibility. A specialist who fails to meet this obligation
should receive counselling by the profession but should not undergo disciplinary action.
Quality assurance can be:
- internal, where a doctor or a group of doctors review their own results,
- external, where an external professional body reviews the data of the practice (peer review).
The Quality Assurance Process:
The quality assurance process is the method by which quality assurance is carried
out in practice. The normal sequence is:
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identifying and selecting a quality problem,
identifying indicators,
preparing criteria,
preparing tools for the registration of data,
registering of data,
analysing and assessing quality on the basis of the registered data,
comparing the results of the assessment with current criteria,
taking steps to improve quality on the basis of this assessment of the registered data
checking the result of the measures taken to improve quality, identifying a next quality
problem on the basis of the evaluation of the result of the previous measures.
Professional responsibility:
Quality assurance is a professional concept, initiated and controlled by the profession itself. In the
process of quality assurance, criteria should be employed that have been developed by the
profession itself. Professional and scientific organisations are required to develop these quality
criteria in their specialty.
Tools for implementation:
For the purpose of quality assurance, the specialists must generate in their practice the
instruments that are necessary to implement quality assurance projects. Good record keeping is an
indispensable aspect of the necessary conditions for quality assurance projects. Data about
examination, diagnosis, treatment and follow-up should be collected in a structured manner.
Accessibility for the profession of these data is an absolute condition and has to be implemented in
the daily care practice.
Training
Training in the basic requirements of quality assurance like collecting and assessing of data and in
the implementation of quality assurance projects should be part of the
daily practice of postgraduate training. Trainees have the same obligation as practising specialists
to assess their performance in medical practice on a continuous basis.
Continuous Development
Continuous development is a fundamental requirement for the maintenance of the quality of care
practice. A Quality Assurance Charter is a written assurance by the management the home will
uphold all rules and regulations set by the government, registering authorities and the
requirements clients and the authority.
The reason for the charter is that other outside professionals and prospective clients are made
aware of the quality and high standards that the home has to offer within the care sector and it
assures that the standard of care and requirements that the home has to offer will be maintained at
all times.
1.4 Quality Policy And Statement Of Authority And Values.
Our Quality Policy is to be committed to providing Quality Care services that consistently meet
client and relatives specified needs and expectations, providing a programme of health that
insures optimal quality of life.
Staff work to achieve Continuous Improvement in all aspects of work with the Home and are
committed to improving quality of service and care to directly benefit our Clients.
Our Commitment is to:
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Ensure a Philosophy of Care which enhances the values that all staff agree will be used in
the various workplaces
Provide high Quality care, service and leisure activities for clients
Be flexible in responding to the changing needs of clients and their families
Provide ongoing assessment of the quality of existing services and how we can improve
that quality
Apply quality assurance principles and practices to improve our service
Meet and exceed nominated outcomes and standards set by the Registering Authority
Develop teamwork and communication among all staff throughout the organisation
Maintain a safe, happy and enjoyable work environment
Provide quality training, staff development and motivation to each member of staff
Ensure that management and staff strive to achieve best practices in all aspects of work at
the Home
Promote initiatives and achievements
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Ensure ongoing assessment of ways through which we can improve efficiency and
effectiveness
Maximise staff involvement in all work practices and procedures through regular
consultation and client involvement in the decision making process and the formation of
new policies and procedures
Be compliant with all legislative Acts, Agreements, Codes of Practice and Regulations.
It is the responsibility of every person working at the Home to actively participate in all related
activities.
The organisation shall provide all resources necessary to achieve the above objectives.
Our commitment to quality care and quality carers ultimately delivers our clients a service that
they can rely and depend upon.
Plus we provide our clients with strategic and value added services, to help deliver the best
solutions for their individual needs.
The Home maintains a comprehensive Quality Management System, which underpins our people,
development, customer satisfaction and business philosophy.
The reason for this policy is that the home has made a statement to the registering authorities that
it will strive to maintain and continually improve the quality of the services provided in a manner
which will meet the stated and implied needs and requirements of the people in their care.
They recognise the quality service can only be achieved through the dedication and efforts of
management and staff. If it is statement by the home in which the efforts used to achieve this aim
are based on the requirements of Quality Systems.
It is the policy of the home to endeavour to maintain the quality. All employees at the Home are
required to contribute to the continuing improvement of the quality.
STATEMENT OF VALUES
The Home upholds the following values for its residents:
Choice
The opportunity to select independently from a range of Options as available.
Rights
The maintenance of all entitlements associated with Citizenship.
Fulfilment
The realisation of personal Aspirations and Abilities in all aspects of daily life.
Independence
The opportunity to Think and Act without reference to another person including a willingness to
incur a degree of a Calculated Risk, unless that risk involves others.
Privacy
The right to be alone or undisturbed and free from intrusion, or public attention in relation to
Individuals and their affairs.
The right to privacy includes the need to respect the confidential nature of information relating to
the Resident their family and friends.
Dignity
A recognition of the intrinsic value of people regardless of circumstances by respecting their
uniqueness and their personal needs.
The right to dignity includes the recognition of, and the catering for, individual, ethnic, cultural
and religious needs.
Freedom of Movement
The right of residents to move to an area or place of their preference.
1.5 Risk Policy.
The reason for this policy is that all decisions made in the ongoing care of the clients in the care
home involves a certain amount of risk. The policy is enforced in order to minimise the danger of
inappropriate actions or omissions. Any failure to act on any omission caused which affects the
Clients best interest may be regarded as negligent by the Home. This may involve outside health
professionals, registration authority tribunals or courts of law, etc.
If the risk policy is upheld and all aspects of risk have been covered which relate to the people in
our care and documents and further information given to appropriate agencies. Then the person
in charge has been discharged of their responsibilities.
RISK POLICY
1. Care Home work involves decision making that requires a certain amount of risk. In order to
minimise the danger of inappropriate actions or omissions, the following points should be noted:
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Where a resident is admitted he or she may decide to take actions regarding his/her
life which may be contrary with the care needs of that individual.
Where the resident has legal sanctions imposed on him/her as a care order, the staff
must take action to ensure those care order conditions are met. Appropriate
Authorities must be informed.
The Person-in-Charge has a ‘Duty of Care’ towards the resident in which he/she must
act in the best interests of that person. Any failure to act or any omission caused,
which affects the resident's best interest may be regarded as negligent by the Home,
Health Professionals, Registration Authorities, Tribunals or Courts of Law.
Any decision involving risk may put the good name of the Home in disrepute.
The express wishes of the Health Professionals, Registration Authorities, Family,
Home or other interested parties may well be of concern in the decision making.
The actions of the Person-in-Charge if inappropriate in advising the Resident, may in
exceptional circumstances affect the professional status of that individual.
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Where a resident requests activities or situations outside of the care needs, then the
Person-in-Charge must find out the rationale for such actions, and advise accordingly.
2. Where the resident fails to accept the advice of the Person-in-Charge and proceeds with his
actions, then the Person-in-Charge should:
• Advise the resident with regard to the dangers of their actions and/or of its consequences.
• Document in full the situation and the impact at the time, or as soon as possible.
• Inform all relevant authorities of what has happened, and the possible impact of the
actions.
• In serious cases bring it to the notice of the Directors, or their designated deputy.
Risk Policy Summary
Where all aspects of the risk have been covered which relate to the resident, have been
documented and further information given to appropriate agencies, the *Person-in-Charge has
then discharged their responsibilities.
Where decisions have been made of a sensitive nature and complications have arisen because of
the level of risk involved, a full discussion of the events should be conducted as soon after the
event as possible. This will determine if the decisions that were taken were correct and establish if
other actions would have been more effective.
If the situation has been assessed and it is found that the actions of the Resident were incompatible
with his/her care needs, then the individual placement may require review.
* The term ‘Person-in-Charge’ relates to whoever is responsible for that action / task within the
remit of their Job Description. This can relate to all levels of staff.
1.6 Statement of Purpose.
Each home must produce a statement of purpose and other information materials (client guide)
setting out its aims and objectives, the range of facilities and services it offers to client’s and the
terms and conditions on which it does so in its contract of occupancy with client’s. In this way
prospective residents can make a fully informed choice about whether or not the home is suitable
and able to meet the individual’s particular needs. Copies of the most recent inspection reports
should also be made available. The statement of purpose will enable inspectors to assess how far
the home’s claims to be able to meet client’s requirements and expectations are being fulfilled.
While it would be unreasonable and unnecessary to expect every home to offer the same range of
facilities and lifestyle, older people do want a range of choice when they decide to move into a
care home. By requiring proprietors to ‘set out their stall’, the problem of leaving choice to chance
is overcome.
The rationale for this is that all would be home users has a clear understanding of the principles,
aims and objectives of the homes and its services. To keep in line with Legal Requirements. The
home has prepared a document providing information. The principle aims and objectives
document will guide staff and set the vision for the community based service, i.e. the main aim of
the Home is to provide its Clients with an agreeable environment in which individuals can
improve their quality of life while retaining their dignity and identity and maximise their
physical, emotional and social capabilities.
1.7 Complaints Procedure And Forms
The following section addresses the matter of how client’s and/or their relatives and
representatives can make complaints about anything which goes on in the home, both in terms of
the treatment and care given by staff or the facilities which are provided. It deals with complaints
procedures within the home relating to matters between the client and the proprietor or manager
Complainants may also make their complaints directly to the Registering Authority.
Whilst it is recognised that having a robust and effective complaints procedure which client’s feel
able to use is essential, this should not mean that the opportunity to make constructive
suggestions (rather than complaints) is regarded as less important. Making suggestions about how
things might be improved may create co-operative relationships within the home and prevent
situations where complaints need to be made from developing. However, it is important to
remember that many older people do not like to complain – either because it is difficult for them
or because they are afraid of being victimised. If a home is truly committed to the principles
outlined in earlier sections of this document, an open culture within the home will develop which
enables residents, supporters and staff to feel confident in making suggestions and for making
complaints where it is appropriate without any fear of victimisation. The Registering Authority
will look to the quality assurance process and client survey for evidence of an open culture.
Client’s and their relatives and friends are confident that their complaints will be listened to, taken
seriously and acted upon.
The registered manager ensures that there is a simple, clear and accessible complaints procedure
which includes the stages and timescales for the process, and that complaints are dealt with
promptly and effectively. The registered manager ensures that the home has a complaints
procedure which specifies how complaints may be made and who will deal with them, with an
assurance that they will be responded to within a maximum of 28 days. A record is kept of all
complaints made and includes details of investigation and any action taken. The registered
manager ensures that written information is provided to all service users for referring a complaint
to the Registering Authority at any stage, should the complainant wish to do so.
Place of incident where Complaint originated (full address):
Time of Complaint: am / pm Date of Complaint:
The member of staff who was present at the time of the complaint should report to his / her Superior
immediately.
Complainants name: Mr / Mrs / Miss / Ms
Address:
Tel:
Description of complaint:
Describe actions taken by staff, clients or other persons to resolve situation:
Describe actions that are recommended to prevent the situation re-occurring:
I am happy that the problem has been adequately handled and resolved.
Signed:………………………………. Date:…………
I am not satisfied that the problem has been adequately handled and resolved. I wish for the matter to be
taken further and involve others mentioned below.
Signature of Staff in Attendance: ………………………… Date:…………
Signature of Person-in-Charge…………………………… Date:…………
If necessary or requested the Complaint should be reported to one or more of the agencies below.
Head of Home:…………………………….. Time:………… Date:……
G.P. informed:………………………… Time: :……… Date:……
Social Worker informed:…………………. Time:…………. Date:…….
C.P.N. informed:…………………………. Time:………….. Date:……..
Reg. Officer informed: …………………….…. Time …………… Date:……..
Police informed:…………………… Time:………… Date:……..
Family informed:……………………. Time:…………. Date:……..
Care Notes [ ] Handover Notes [ ] Accident File [ ] Personal File [ ]
Complaints Book [ ] Item No on Forms [ ]
1.8 Inspection visits Records Visits Record
Please enter names and dates of inspections from the following departments:
Registration and Inspection Officer - Health / Social Services Department
Name Date Comments
Fire Officer / Fire Brigade Department
Name Date Comments
Environment Health Officer / Health and Safety Department
Name Date Comments
1.9 Statistical Techniques
PURPOSE
To ensure that the Quality of service provided by the Home is maintained and improved where
appropriate and to identify and rectify any trends which may occur.
RESPONSIBILITY
Proprietor and Managers
PROCEDURE
Every month the Person Administrator will analyse the following records:
• Staff / Purchaser / Client / Relatives / Friends Complaints
• Record of Referrals
• Admission / Discharge Records (Including changes in Client Status, i.e. from Nursing to
Residential care)
• Violent Incident Records (Gives a good indicator into Client behavioural assessment)
• Accident Records
• Occupancy Levels
• Staff Sickness
The details from each record mentioned above will be documented in the form of graphs which
will be displayed in the Office and reviewed as part of the Management Meetings. Any trends that
occur will be highlighted and a Preventive Corrective Action Report raised as appropriate.
Should the results of the analysis indicate that changes are required to the operating procedures,
the Directors and Person Administrator will document and authorise the change. Any changes
which involve amendments to any part of the Quality System will be identified by the Quality
Management Representative and implemented as documented in Quality Procedure.
2.0 Quality System Audit Report and Audit Checklist Scope
Internal Quality Audits are carried out to verify that the Home’s Quality Activities comply with
the Quality Plans and also to determine the effectiveness of the Quality System.
Approach
The Home carries out periodical audits of the defined Quality Management System in accordance
with our documented audit schedule. The schedule is the responsibility of the Quality
Representative who has the authority to increase the frequency of audits as the circumstances
require.
Records of all audits and associated actions are maintained for assessment to ensure effective
implementation of required changes and to provide objective evidence of our continued efficiency.
These checks are designed to ensure the following:
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The Quality Documents (Manuals, Procedures, Forms) adequately meet the care
requirement as stated in the Policy and Procedure Manual
That the procedures are practical, understood and followed.
The training is adequate.
The audits are carried out by a responsible person independent of the activity being audited. The
results of all audits, both positive and negative, are recorded including any necessary corrective
actions, time agreed for corrective actions to be carried out, and the person responsible for doing
so. The planning of these audits is reviewed annually to ensure their relevance to Quality
Standards is maintained.
2.1 Write a short proposal, identifying and detailing a potential improvement to working
practices or documentation within your area of responsibility
ASSIGNMENT
My job is a Home manager with 20 clients and 20 staff. I would you like to improve the
communications between shifts and have more information and less hearsay and guess work.
The resources needed are:
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Time
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People
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Increased administration
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Small budget for stationary and worksheets etc.
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Work Routines
I estimate that costs would be:
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Stationary, Newsletter, telephone calls, stamps etc.: £50 per month
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Overtime for monthly meetings £ 120 per month so everyone can attend that meeting
Total cost per –annum £2040 per annum.
It would affect others by:
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Improved Communication
Less Backbiting
Higher staff morale
Lower sickness and absence
Lower staff turnover
Better care for clients
It should decrease the workload if the communications and guidance is clear, so that jobs are done
once not twice because the system would have work routines that are signed for when they are
done. There may be an increase in administration but this would be more than offset by the time
savings.
There may be some initial disruption whilst change is introduced, and new working arrangements
are put in place but once up and running should lead to better and more efficient care. Because
there are financial as well as structural changes, management would need to be involved and
agree cost and approve the changes to stamp authority on the project.
I believe it would take 3 months to agree new work arrangements and 3 months to implement and
adjust the routines in order to make them work. Some staff may be against change, but all new
staff would be employed knowing what is to be expected of them. There are no real alternatives,
as this process is being devised to improve care, and it needs everyone to be involved, the
downsides are on getting agreements in place so that everyone is singing from the same song
sheet. There will be some who will try to disrupt the change and attempt to destroy the new
procedures before they have chance to work. Those people will have to be monitored very
carefully.
2.2 Collect Evidence which clearly illustrates how you contribute to the maintenance of Quality
Standards:
Show evidence by submitting your own forms of:
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Meetings
Training
Authority to act
Surveillance of standards
Signed Forms
Witness Statements
Team and Individual Involvement
Policy Adherence
B. HEALTH & SAFETY
1.1 Statement Of Health And Safety At Work Policy.
The reason for this statement is that the directors of the home have made it their policy to
recognise and accept responsibility as an employer for carrying out their business in a manner
which will not as far as is reasonably practicable give rise to any undue risk to the health and
safety of their employees and other people within the home.
The Owners will take all reasonable precautions to prevent any health and safety risks, which may
befall themselves. As employers they will be required to make every effort to comply with their
obligations as laid down by the health and safety at work act 1974 and the management of health
and safety at work regulations 1992.
The employer should take into consideration all aspects of the health and safety of employees and
people within their care. The management should ensure the active prosecution of the policy
defines areas of responsibility for safety where appropriate. Collate a set of codes of practice i.e.
instructions manuals, list of procedures standards, advise etc., which areas they apply.
Ensure that others apart from employees who may be within the home are also covered with the
protection of the policy. A statement of organisation and arrangements for the insurance of staff
should be attached for carrying out this policy. The policy should be reviewed and amended as
necessary. This may be because amendments have been made to the health and safety legislation
or faults in the effective pursuance of this policy.
Any amendments should be made aware to all staff both verbally and in writing.
1.2 Procedures in Case of Fire
IF YOU HEAR THE ALARM
When you hear an: Intermittent siren means that your floor is receiving a fire alert. The alert
advises that there is a fire elsewhere in the building, on a different floor. Stand-by for the alarm
signal to either change to a continual siren (evacuate) or for the alarm to cease (emergency over)
Continuous siren means to evacuate immediately and without question.
DO NOT TAKE ANY PERSONAL RISKS
On hearing the alarm, the Person-in-Charge should make their way to the alarm control panel,
with the Clients Register and call the Fire Brigade. Staff should proceed to the alarm control panel
to take instructions from the Person-in-Charge. Instruction will be given to evacuate the Clients
from immediate danger. All staff must be aware of the relevant Muster Points. The main Muster
Point is the MAIN LOUNGE to which Clients should be evacuated.
Should this not be possible, Clients should muster in the CAR PARK AREA.
If it not possible to move a Client far or at all, they should be safely placed into one of the fire
safety zones (which can include their own bedroom), ensuring that the fire doors are closed. This
should be reported to the Person-in-Charge.
Clients - where practical, should proceed to the main muster point, which is the MAIN LOUNGE.
Should this not be possible, Clients should muster in the CAR PARK AREA. If they are unable to
proceed unassisted, they should wait for assistance, ensuring that all doors are closed.
When proceeding through the building, staff should ensure all fire doors are closed. Passenger
and Stair Manually Handles must NOT be used. The Register should be checked by the Person-inCharge to ensure that everyone has been assembled at the Muster Points. If anyone is missing, this
must be immediately reported to the first fire appliance that arrives.
1.3 Accident Report/Forms
Confidential - Client / Employee / Visitor
Report of Accident to a Client, Employee or Other Person on the premises
Name in full: (surname first)
Home Address:
Nature and extent of injury:
How caused:
Where occurrence took place: Time: Date:
If an Employee:
1. Nature of employment
2. Was he / she doing authorised work? [ YES ] [ NO ]
3. Was he / she on or off duty at the time? [ ON ] [ OFF ]
4. Normal Duty:
5. If on duty did he / she continue to work after the occurrence? [ YES][ NO ]
6. If he / she went off duty, time am / pm
Name and address of witnesses (witness statement should be attached)
Description of apparatus or equipment involved
Has it been retained for inspection? [ YES ] [ NO ] If YES give location
Action taken:(continue below if necessary)
Signature: Date: / /
Designation:
Statement and signature of witnesses can be attached or given below:
Action taken (continued from above)
Person-in-Charge Signature: Date: / /
Nursing Notes [ ] Handover Notes [ ] Accident File [ ] Personal File [ ]
Accident Books [ ] Item No on Forms [ ]
1.4 Untoward/Violent Incidents Forms
Place of Incident (full address):
Time of Incident: am / pm Date of Incident:
The member of staff who was present at the time of the incident should report to
his / her Superior immediately.
Resident’s Name: Mr / Mrs / Miss / Ms
Date of Birth: Home:
General Practitioner:
Description of incident:
Clients behaviour prior to incident:
Any precipitating factor:
Describe action taken at time of incident:
Name of staff or other person who gave assistance:
Describe injuries to client, self, other clients or any other persons (complete Accident Form as
necessary):
Describe damages to property - (personal, the Homes, other):
Signature of Staff in Attendance: Date:
Signature of Person-in-Charge: Date:
If necessary the incident should be reported to one or more of the services below.
Head of Home: Time: Date:
G.P. informed: Time: Date:
Social Worker informed: Time: Date:
C.P.N. informed: Time: Date:
Reg. Officer informed: Time: Date:
Police informed: Time: Date:
Family informed: Time: Date:
Nursing Notes [ ] Handover Notes [ ] Missing persons File [ ]
Personal File [ ] Missing Persons Books [ ] Item No on Forms [ ]
GUIDELINES FOR UNTOWARD/VIOLENT INCIDENTS
This statement below - is an outline of the elements exposed and needed in dealing with
Violent/Untoward Incidents.
TRAINING
Training can and does help reduce the threat of violence/ Untoward Incidents. Staff Training in
the Home, plus the Training Courses available should be maximised. All staff should be aware of
the following.
PREVENTION
Most incidents are preventable. Some incidents not preventable can be at least minimised by
observing the build up of volatile situations. Many incidents do not take place due to this activity,
so many violent incident situations do not take place.
SITUATIONS
Some incidents are slow to come to the surface, but can be seen if the signals are assessed and
acted on. Borrowing of cigarette, and not repaying debts are problems, as are the confused who
constantly trip over others feet. Some incidents are fulminating and decisive action is needed.
Removing combatants from one vicinity may be required.
ATTITUDES
Staff and Clients attitudes can play a major role in both contributing to violence. Not adequately
responding to requests for counselling, medical help or passing unhelpful remarks may cause a
threat. Medical and Paramedical causes, such as Doctors, Social Workers, C.P.N.’s failure to
respond adequately or quickly enough to care needs can rebound into violence.
COMMUNICATION
Full communication between staff, through ongoing observation, handover periods, staff meetings
are essential in evaluating the potential of any incident. Staff conversations with Clients, formal
and informal, Clients meeting can pick up on problems that can get out of hand. Communication
between the Home and the Mental Health Team is important if decisions are taken outside the
Home which affect the Client which may potentiate incidents. Effective written notes are essential
for ongoing continuity, especially where new, part time or bank staff are employed
THE INCIDENT
Staff should be calm, effective and positive. All attempts should be made to limit violence. In law
minimum force required to control situation must be used. The Person in Charge will have to
gauge that level. The incident should be dealt with in such a way that all involved should not be
put at an unacceptable risk. If danger exists call the police. Medical and professional help should
be sought if necessary. Remove any object that can be used as a weapon or could cause damage if
people fell against it. Draw the incident to a close within an appropriate timeframe. Where
medication is indicated, give prescribed medication and dose unless it is felt the incident has
stabilised, and it is important to allow medical practitioners see the psychological state of the
Client. Often when medicated, the Client does not exhibit symptoms that may need medical
supervision and hospital treatment.
POST INCIDENT
Continue observation, write up Violent Incident/Untoward Incident form, also Accident form and
Missing Persons form if required. Discuss incident with colleagues and others, pinpoint areas of
potential conflict and times relating to the incident that gives clues to what happened and assess
preventability, with a view to preventing future incidents. Assess damage, and whether damage is
repayable by Client, probation service or other agency, or whether it is to be written off.
STAFFING LEVELS
Consider whether in admitting a Client, that there known potential violence or there level of
difficulty can be managed on the Homes regime and Staffing Levels. If not, do not admit, or seek
appropriate fee structure in order to not put others at risk. Be aware of the Homes Aims and
Objectives.
PERIODIC REVIEWS
Client’s needs change, it is important to be aware of this, as a passive Client may change into a
more aggressive or intolerant person. Familiarity breeds contempt. Medication needs change.
Ongoing assessments are important, Periodic Reviews with the Client, the Multi Disciplinary
Team, with professionals individually and with relatives build a network of both care and
confidence of each others judgment and abilities that can improve the care of the Client and act as
a prevention of incidents, where there is division it can be
destructive.
COUNSELLING
Counselling of both staff and Clients on an ongoing basis is important in dealing with incidents.
REMEMBER
The more assured the individual is, the safer the Home is.
1.5 Missing Persons Forms
From: Person-in-Charge
Home’s Address of Missing Person
Date of Admission / / Missing From (Date) / /
(For Completion on Admission and Retention with Resident’s notes)
Name
Place and Date of Birth
Occupation (if appropriate)
Home Address
Height Build ( Stocky / Thin / Fat / Slim / Medium / Heavy )
Hair ( Dark / Fair / Auburn / Grey / White )
Length of Hair ( Short / Long / Bald / Wig )
For Males Only ( Unshaven / Clean Shaven / Moustache / Beard )
Colour of Eyes ( Blue / Brown / Hazel / Green / Other )
Complexion ( Dark / Coloured / Fair / Ruddy / Pale / Sallow )
Dentures YES / NO Spectacles YES / NO
Visible Marks / Scars
Peculiarities or Other Distinguishing Features
Other
The Police were notified at am / pm on 200__ that the client was missing and I have searched the
immediate area, and made suitable inquiries without finding the client.
Signed Person-in-Charge
Description of Clothing Worn
Known to be in possession of money? YES / NO Estimated £ :
Warning Signs ( Suicidal / Depressive / Confused / Alcohol / Violence )
If necessary this should be reported to one or more of the following services below:
Head of Home informed at
Registering Authority Informed at:
Social Worker informed at:
C.P.N. informed at:
G.P. informed at:
Relatives informed at:
Name:
Address:
Relationship: Telephone:
Client found at:
Date: Time:
All of the above who were notified of missing person to be notified when client is found.
All notified YES [ ] NO [ ]
If NO reason:
Nursing Notes [ ] Handover Notes [ ] Missing persons File [ ]
Personal File [ ] Missing Persons Books [ ] Item No on Forms [ ]
1.6 Missing Persons
TYPES OF MISSING PERSON.
Individuals who nave attended day care centre’s and have not returned at agreed times. Persons
who may wander from the building who is in a confused state. An individual who may break
their care plan agreement by leaving the premises without permission. An individual who may
have expressed suicidal thoughts.
A person who may be absent from a party of people on an outing or holiday who have failed to
return at a prearranged time and may have got lost. Particulars and any concerns for a client’s
personal safety should be noted, e.g. present mental state, and physical or a risk to other people.
A missing persons form should always be completed in the care of an individual whom it has
been decided is missing.
Client Going Missing
Definition
A client is classified as missing when their whereabouts cannot be accounted for, and a search of
the building and surrounding area has failed to locate them.
Action to be Taken
1. Notify the senior person in charge.
2. Ask other clients and staff if they know where the person is likely to have gone, or when they
were last seen.
3. Organise a search of the building, surrounding buildings, and grounds.
4. If the client cannot be located within a reasonable time, notify the police, and inform the client’s
doctor or the doctor on call (if appropriate).
5. Notify the client’s next of kin or carer, in case the client makes contact with them.
6. Discuss and evaluate the level and type of risk (to the client and to others) posed by the client’s
unsupervised absence.
7. Record within the client’s notes:
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the outcome of this discussion
the plan of action.
8. If there are any safeguarding adult issues, inform the relevant social services team.
9. If appropriate, inform the client’s GP in case the client presents at the surgery.
10. Inform any relevant community staff and request they undertake a home visit to see if the
client has returned home and is willing to return.
11. Complete Missing Person incident form.
12. Document all action taken in the client’s notes.
Location and Return of Missing Clients
If a client is located safely and staff are able, they should make every effort to persuade the client to
return to the Home.
If staff need to go out to collect the client and return them to the Home, they should only do it
themselves if it is safe and practical to do so.
As soon as the client returns, everyone who had been notified of their absence must be informed of
their return.
If necessary, conduct a risk assessment, examining the likely factors involved in the absence, with
recommendations to prevent a recurrence. Consideration should be given to whether it is
appropriate to use the Mental Health Act 1983 to detain them
If a person who lacks capacity to make serious decisions about treatment or where they live does
not have a responsible relative or next of kin to advise them, an independent mental capacity
advocate (IMCA) should be appointed to support and represent them
1.7 Prevention of Abuse/Dealing with Abuse
The procedure to follow when investigating or reporting an alleged incident or suspected abuse,
in the first instance:
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Report the incident or concern to the manager or shift leader.
Establish the facts.
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Decide if there are grounds for action.
Discuss with relevant agencies.
Carry out further investigations.
Call a case conference if appropriate.
Protect and review your plan.
Monitor the situation.
It should be included in the homes policy that staff report an allegation of abuse rather than keep
a confidence the concerns or fears of the victim should be passed. This also applies if client’s
family makes disclosure. All matters should be dealt with in strict confidence. I would deal with
abuse by reporting my concerns to an appropriate member of staff by discussing the situation and
then decide which actions to take in relation to allegations
1.8 Control and Restraint Policy
It is the policy of The home that restraint of a Client is used as a last resort and where any other
course of action would be likely to fail. Physical Restraint is only permissible where the safety of
the Client, others or serious damage to property is apparent. Wherever possible, strategies for
coping with a Client will be agreed in advance as part of their plan of care.
All staff are to be aware that Physical Restraint will only occur as an act of care and concern.
Where Physical restraint is deemed necessary, these guidelines are validated: The Person-inCharge will believe that restraint is necessary and have good grounds for applying it. Physical
Restraint will never be used where there is no immediate danger to the Client, others or property.
Before applying Physical Restraint the Person-in-Charge will verbally warn the Client that the
stated course of action will be taken unless behaviour ceases.
In cases where this is inappropriate i.e. there is apparent danger, the Person-in-Charge will taken
the appropriate course of action following this policy. The Person-in-Charge will make every
effort to ensure other staff are present to act as a witness to the Physical Restraint. Only minimum
force to control the situation and to prevent injury and damage will be used.
The degree of restraint used is important as any act of touching another person’s body may be
technically assault if there is no consent so, there must always be ‘good cause’ to use Physical
Restraint.
The Person-in-Charge will ensure that, during the intervention, every effort will be made to
verbally pacify and calm the Client. Physical Restraints will be released as soon as it is safe thus
allowing the Client to gain self-control. The Person-in-Charge will ensure that all potential
hazards are removed immediately. This will include Client’s property considered to be dangerous.
The Person-in-Charge will be aware of and inform the Client of their right to the return of their
property when circumstances prevail.
Immediately following the incident, the Person-in-Charge will check the Client/others for any
signs of injury and, where appropriate, will complete an Accident Form following The homes
written procedure for dealing with accidents. The Person-in-Charge will enter the circumstances
and justification for Physical Restrain in the Client’s personal file, the Handover Report and will
complete a Violent Incident Form.
The Managers and / or Employers will be informed at the earliest opportunity as will other
agencies as appropriate. Other agencies could be the Client’s consultant, G.P., Social Worker,
Community Psychiatric Person, and Police (where relevant).
1.9 Manual Handling/Risk Assessment
SAFE MANUAL HANDLING OF PERSONS OR HEAVY OBJECTS
HSE data shows that 34% of accidents resulting in injury are related to handling of people or
objects. Of these, 65% fall into the category of sprains and strains, mostly to the back. An object
does not have to be heavy to cause injury. In fact, you do not need to be Manually Handling
anything at all. Be aware at all times of how you move and use your body muscles.
TRY THIS SIMPLE EXERCISE…
Find an object about 1 to 11⁄2 kg (a bag of sugar or flour will do). Hold it with both hands at arms’
length in front of you for three minutes. Feel the strain on the muscles in your arms - your back,
even? Now repeat the exercise, this time with your elbows tucked into your sides. Much easier,
isn’t it? This is because you are using your own body’s centre of gravity to make the best use of
your muscles. If you need to Manually Handle a heavy object off of a table, pull it to the edge first.
Then, as with the bag of flour, hold the object close to your body, elbows tucked into your sides and move.
Which do you think are the strongest muscles in your body? You would be right if you said your
legs. Use them!
No employee will attempt to Manually Handle or use mechanical aids until trained by one of the
Home’s qualified Manual Handlers and found to be ‘competent’. Any breech will contravene
Health & Safety Regulations and will put yourself and the Clients at risk.
ASSESS the situation:
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Do I need to Manually Handle?
Do I need to use a mechanical aid?
What are the needs of the client and how much can they do for themselves?
Is the surrounding area safe? i.e. free from obstacles and safe floor covering.
PLAN the Manual Handling situation
Organise extra help whenever possible.
Plan the most suitable type of manoeuvre for the client
Ensure the environment allows for a safe activity.
Ensure that the manoeuvre does not put others at risk or contravene Health & Safety
Regulations.
• Ensure that the correct aids are in situ prior to manoeuvre.
• Ensure that the Client’s dignity and rights are maintained.
THE MANOEUVRE
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Explain to the Client what you are going to do.
Ask for the Clients help where appropriate.
If Manually Handling with another person, ensure that you are manoeuvring in ‘harmony’.
Ensure that the correct uses of mechanical aids are used.
Avoid a ‘long manoeuvre’ and ensure that you follow the correct techniques.
If in doubt:
DO NOT MOVE OR HANDLE, SEEK ADVICE.
Manually Handling, Moving and Handling / Risk Assessment Form
Risk Assessment Covered (tick) Candidate Tick & sign when shown Manual Handling Technique
Candidate Tick & sign when practised Manual Handling Technique
Assessor sign Date
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Health and Safety Act regarding Manually Handling
Cause of back Pain
Purpose of the spine
Structure of the spine
Equipment for safe Manual Handling
Environment
Principles of handling
Manually Handling techniques Grips and Grasps
Reason for Safe Handling
Sliding Techniques
Treatments for Back Pain
How to Manually Handle with Assistance, importance of co-ordinated Manual
Handling
How to Manually Handle in/out Bath and Shower
Moving Clients Up and Down Stairs
Manoeuvre Clients In/Out of a Car
Physiotherapist/Chiropractor, Osteopath explain roles
Legal implications of Moving and Handling
Safety and Awareness of Weight Distribution and Restrictions Whilst Manually Handling
When not to Manually Handle alone, Reasons for Two people to Manually Handle
Manually Handling a difficult Client
Psychological Support whilst Manually Handling
Checking for Injury prior to Manually Handling following a Fall
Mechanical Aids to aid Manually Handling
Types of Exercise to Strengthen Back
Write about a Client at the Home who needs help Manually Handling
Checking for Physical Impediments or Obstacles prior to Manually Handling
Knowledge of who your Manual Handling Trainer is
The spine is one of the main components of the skeleton; it provides central support, attachment
of muscles and ligaments, allows movement to occur and provides protection for the spinal cord.
The spine consists of 33 vertebrae.
The spinal unit consists of 3 principle components:
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The vertebrae
The inter-vertebral disc
Muscles and ligaments
The inter-vertibral disc has 4 functions
Absorbs shock
Acts as a spacer between vertebrae
Reduces friction during movement
Limits excess movement
The disc can be damaged by mechanical or chemical changes. The disc can rupture suddenly, or
cumulative injury over time. Effects of emotional stress can cause the muscles in the back and neck
to tighten, causing back problems. The most commonly injured areas of the spine are the cervical
and lumbar regions.
2.1 Equal Opportunities Policy.
The reason for this policy is that it works towards the elimination of discrimination and promotes
equality of opportunity, types of equal opportunity issues. There are several types of
discrimination: overt, covert, inappropriate appropriate.
Overt Discrimination.
This occurs if one person is deliberately treated less favourably than another, i.e. stating that a job
applicant must belong to a certain ethnic group.
Inappropriate Discrimination
This may take the form of an organisation only employing staff under a specific age group for
managerial posts.
Appropriate Discrimination
This may include a situation where a person has convictions for child abuse and the organisation
deals the care of children and would not consider a person with these convictions for the post.
There are provisions made legal where there is genuine occupational qualifications, i.e. where a
job holder provides people of a particular ethnic group with personal care or welfare services
although this fact can be argued that those services can be provided effectively by applicants from
the client ethnic group.
The equal opportunities commission 1988 outlined certain aspects that should be included in the
policy:
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A statement that the organisation has made a commitment to equal opportunities.
The name of the person who is responsible for enforcing the policy.
A complaints procedure that deals with discrimination.
Examples of unlawful practice.
Details of how the organisation revises and monitors procedures.
Details of the management’s commitment to the provision of training opportunities.
All organisations are obliged by law not to discriminate against workers by reason of their age,
gender (including transgender), marital status, disability, race, nationality or ethnic or national
origins.
As a minimum, organisations should ensure they comply with the following:
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Equal Pay Act 1970 Sex Discrimination Act 1975
Sex Discrimination Act 1975
Rehabilitation of Offenders Act 1974
Race Relations Act 1976
Disability Discrimination Act 1995
Asylum and Immigration Act 1996
Employment Equality (Sexual Orientation) Regulations 2002
Employment Equality (Religion or Belief) Regulations 2003
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Employment Equality (Age) Regulations (2006)
Civil Partnership Act 2004
Sex Discrimination (Burden of Proof) Regulations 2001
Equality Act 2006
Forthcoming changes
Please note that the government is proposing to implement a Single Equality Act, which would
bring together all the above equality ‘strands’ within the one Act. The intention is to make the law
simpler to understand and enforce.
Discrimination
Both direct and indirect discrimination are unlawful.
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Direct discrimination is said to have taken place where a worker has been treated less
favourably than another in similar relevant circumstances on grounds covered by
legislation, .e.g. not appointing one person over another or denying them training
opportunities on the basis of their gender, age, race etc.
Indirect discrimination occurs where the effect of certain requirements, conditions or
practices imposed by an employer or education provider has an adverse impact
disproportionately on one group or other. Indirect discrimination generally occurs when a
rule or condition, which is applied equally to everyone, can be met by a considerably
smaller proportion of people from a particular group, the rule is to their disadvantage, and
it cannot be justified on other grounds .
For example, indirect sexual discrimination could occur if an employer applied a redundancy
policy by selecting only part-time workers. This is because such action would discriminate
disproportionately against women, as over 80% of part-time workers in the United Kingdom are
women.
Note: Legislation now means that the burden of proof is on the employer to provide a nondiscriminatory explanation for their treatment of employees. If the employer can't do so, an
employment tribunal may find that discrimination has taken place.
Victimisation and harassment
Victimisation or harassment of another employee are illegal, on any of the grounds covered by
legislation, such as sex, race, disability, sexual orientation or religion.
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Victimisation would occur if you treated someone less favourably (for example, by
denying them promotion) because they made a complaint of discrimination under one of
the discrimination laws.
Harassment is where one individual engages in unwanted conduct that violates the dignity
of another person, or creates an intimidating, hostile, degrading, humiliating or offensive
environment for that person, on one of the grounds covered by legislation.
Exceptions to discrimination legislation
There are a small number of exceptions to discrimination legislation. These are outlined below.
Genuine occupational qualification/genuine occupational requirement
Discrimination may be lawful in limited circumstances, if being of a particular group is a
necessary (and not just desirable) genuine occupational qualification or requirement for a job.
If you are in doubt about whether it is appropriate to apply a genuine occupational
qualification/requirement in a particular circumstance, you are advised to seek advice.
Positive action
It is possible to take certain steps to redress the effects of previous inequality of opportunity. This
is called positive action and it is taken to encourage people from particular groups to take
advantage of opportunities for work and training. This can be done when under representation of
particular groups has been identified in the previous year.
You should note that there is a difference between ‘positive action’ and ‘positive discrimination’.
Positive discrimination could be, for example, selecting someone for employment specifically
because they are black, in order to address an imbalance in your organisation. Positive
discrimination is unlawful in the UK. Whilst positive action enables you to encourage people from
certain groups to apply, you should make clear that selection will be on merit without reference to
background.
Disability charities
Disability charities are allowed to favour, in recruitment, those individuals who have a disability
applicable to that charity. So, for example, a learning disability charity may specifically decide to
recruit people with a learning disability.
Positive duty to promote equality
There is a positive duty on public authorities to promote equality and demonstrate that they do
not discriminate on the grounds of race, disability or gender.
Ensuring compliance
In order to comply with such legislation organisations should ensure that they have a written
equal opportunities policy and written procedures covering equal opportunities in recruitment,
promotion, transfer, training, dismissal and redundancy.
Making a claim
In most cases of discrimination, a worker who wishes to make a claim to an Employment Tribunal
should do so within three months of the act they are complaining about. Care should be taken to
ensure that the three month point is not exceeded during any internal grievance/appeals process.
2.1 Visitors/Security Policy
The Home operates an ‘open door’ policy with regard to visitors but if staff are unsure or have
concerns as to a visitor’s identity or motives that person will be challenged. Identification of unrecognised visitors will be requested at all times. The Person-in-Charge is under no obligation to
admit anyone who has no authority or does not carry a document of authentication.
Staff will respect the Client’s wishes with regard to visitors. If a Client does not wish to see a
visitor this will be explained and the visitor will be asked to leave.
C ENERGY MANAGEMENT
ASSIGNMENT
Establish and energy efficiency plan including discussion of all energy sources.
• Gas
• Solid Fuels
• Renewable sources
Where can savings be made without compromising safety and security, legal and
organisational rules.
How can you measure its success?
Who would you need to involve?
How would you manage and monitor change?
What steps would you take to achieve a whole staff agreement?
How would you monitor compliance
MANAGEMENT UNIT 14.
D: RESOURCE PLANNING
1.1 Have copies of completed forms/reports in your portfolio.
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Supplier quality questionnaire.
Equipment listing form.
Financial plans.
Menu.
Care plans.
1.2 ASSIGNMENT:
Research and complete an assignment, which identifies potential savings in your area of
responsibility. Research and complete assignment where you believe expenditure should be
increased. Clear reasoning for your recommendations should be included. You should identify at
least five recommendations, which must include one from either of the following areas:
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Personnel.
Material/Equipment.
Energy.
Time.
Take into account budgetary constraints and potential benefits.
Example:
DISCUSS THE VALUES OF PERFORMANCE REVIEWS.
The values of performance reviews are that they identify any weaknesses within the
organisation‘s working policies and procedures and individual employee’s performance in the
workplace.
Performance reviews are used to evaluate overall performance / individual performance which
will enable the management to establish where improvements can be made.
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They are useful in monitoring employee’s in the early stages.
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They enable employers to put extra energy into those that are achieving.
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They can be a defence against law i.e. wrongful or constructive dismissal suits.
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They can bring about effective and better communications between the employer and
employees.
Encourages individual employees to achieve and reach their own goals with their training and
development. Assist the management to identify and establish which plan of action to take to
maintain required standards thus offering a good quality of service to its customers.
1.1
E: RESOURCE MANAGEMENT
1.2
COPIES OF PROCEDURES.
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Witness Testimony (of your ability to Manage Resources)
Nurse in charge handover report.
Inspection and testing.
Control of inspection, Measuring and testing equipment.
Inspection and testing status.
Inspection and testing status.
Inspection and testing of nursing care
Control and Inspection measure and test equipment
Inspection and test status
Control of Non-conforming
Corrective prevention action.
Handling storage, packaging, preservation and delivery
Purchasing
Product identification and delivery tractability
Process control
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RESOURCE MANAGEMENT
1.2
Auditing And Reporting. (My Role)
I would carry out an audit by using previously prepared checklists, the quality procedures and
current edition of quality standards. My role would be to check the compliance in my area of
responsibility by examining current activities, equipment, selected records and the knowledge of
staff that are working in that particular area.
Any non-conformance will be raised in the audit report, listing any corrective actions that have
been agreed during the audit. I would then arrange a meeting with the care staff to discuss any
recommended actions and agreed changes that have to be made to the system and ensure that all
staff are aware of the action that is implemented to ensure any non-conformances are corrected.
Once these have been carried out and completed records have been returned a follow up audit
will be arranged to assess the effectiveness of the actions taken.
This will take place within 3 months of the actions being implemented.
F: IDENTIFYING PERSONNEL REQUIREMENTS
1.1 COPIES OF JOB DESCRIPTIONS.
WITNESS TESTIMONY.
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Organisational Chart.
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Responsibility and Authority.
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Directors/Proprietors.
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Nurse Manager/Senior Manager.
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Registered Nurse/Person in Charge.
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Senior Nurse/Manager.
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Chef/Cook.
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Site Manager/Maintenance.
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Senior Health Care Assistant.
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Gardener.
THE HOMES ORGANSISATIONAL CHART
THE HOME
RESPONSIBILITY AND AUTHORITY.
PROPRIETORS.
ACCOUNTABLE TO:
The Home’s Health Authority/Social Services Dept.
PURPOSE OF POSITION:
To manage and control the finances of the Home.
To promote the Home as a desirable company to do business with.
RESPONSIBILITIES.
To show authority and control of all situations and events including public relations and to all
individual involved with the Home.
To forward plan and develop services as an envisaged need or requirement.
To ensure Quality System ISO 9002 is continuous.
To see that the Social Service ‘Service Specification’ is carried out and adhered to.
To ensure that all Health and Safety, Environmental Health, fire and other standards are being
met.
To support the administrative nurse with his/her responsibilities where appropriate.
To interview and employ staff or delegate this responsibility to a relevant staff member.
To promote staff to a relevant position based on merit.
To discipline or dismiss staff where applicable after due consideration of
the Disciplinary Rules.
To be informed where appropriate if any serious difficulty or situations take place.
To delegate responsibilities within legal and procedural boundaries.
To ensure staff has access to all policies and procedures relevant to the Home.
To attend staff meetings where appropriate.
To be aware of the clinical needs of the Home.
To be aware of the administrative needs of the Home.
To be aware of the training needs of the Home.
To undertake to support staff training requirements as necessary.
To be aware of the care planning of the Home.
To comply with the Registered Homes Act 1984.
To liase with the Registration Authorities regarding any matters of interest and resolution of
problems.
SENIOR NURSE
RESPONSIBLE TO: The Homes Proprietors
PURPOSE OF POSITION:
To provide an overview and support to the Home’s Satellite homes.
To maintain and monitor the health and welfare of the clients and manage the premises to prevent
untoward neglect of furnishings and fitments.
To promote professional, clinical, administrative, financial, training and care planning within the
Homes.
To support other trained staff and provide cover for sickness, annual leave etc.
To work a flexible shift pattern thus covering the needs of the Home. This includes weekends,
nights and bank holidays.
RESPONSIBILITIES.
PROFFESIONAL AND MANAGEMENT.
To conduct care and management in such a way as to not bring the Home or its clients into
disrepute.
To uphold the Home’s Quality Assurance Charter.
To maintain confidentiality regarding all aspects of care and management of the home.
To inform the Nurse Administrator if any serious difficulty or situation takes place.
To delegate responsibility within legal boundaries.
To conduct fire evacuation procedures at 6 monthly intervals in each satellite home.
To be knowledgeable regarding Health and Safety at work, including Environmental Health.
To attend and contribute to daily informal staff meetings and monthly management meetings.
Also to attend and contribute to 6 monthly staff meetings.
CLINICAL.
To give any medication as prescribed, with proper monitoring of drug, dose, time route and
person to whom it is given. To ensure the medication is properly taken and to monitor for any
normal, positive or negative effects of that drug.
For suitable qualified nurse to administer any prescribed depot injections to clients in their own
satellite homes.
To have knowledge of and the use of any equipment within the Home.
To check usability weekly.
To be knowledgeable regarding emergency procedures pertaining to our clients.
To respond to the spiritual, emotional and mental needs of the client.
To liase with staff, clients, general practitioners and other multi - disciplinary team members To
promote good care.
To monitor resident’s hygiene and self care promoting and encouraging independence.
To observe for any deterioration in a resident’s ability to cope in a satellite home.
To take prompt appropriate action to alleviate further deterioration.
To be responsible for transporting main meals to each satellite home in appropriate heated
containers.
TRAINING.
To keep up to date with recent developments, attend relevant courses and teach other staff in all
aspects of relevant care.
To develop training methods for improvement of resident’s rehabilitative processes, with hands
on involvement as required. (These methods will be shown in the Client Care Plan where
applicable).
To teach relevant information and knowledge to other staff.
To take part in NVQ training where relevant.
To participate in and to encourage care studies in order to give a wider understanding of
residents’ abilities and problems.
To teach clients about food preparation and hygiene.
FINANCIAL.
To control and manage any budget under the care of the Senior Nurse / Community Nurse.
To make sure all clients receive their weekly allowance and this is signed for.
To make sure they have what is legally theirs.
CARE PLANNING.
To influence and monitor care, utilising the nursing process.
To write reports on daily events, handing relevant information over to the Nurse - in - charge at
the Home’s main nursing home.
To involve those agencies who have input into a clients care planning.
CHEF.
RESPONSIBLE TO: Nurse Administrator.
PURPOSE OF POSITION:
To prepare nutritional, well-balanced menus.
To prepare and cook a balanced, nutritious diet within a controlled hygienic environment.
To control systems of food allocation to minimise wastage.
To operate in order that all purchases are controlled within a specified budget.
RESPONSIBILITIES.
To be aware of the clients needs and dietary preferences and respond to their comments and
requests in respect of the menu.
To prepare and cook in a hygienic manner.
To maintain a balanced diet and varied menus.
To control stocks and purchases, thereby allocating the quantities of materials.
To keep the purchase of materials within allocated budgets.
To be responsible for completing purchase orders for food, and checking food stuffs for nonconformance.
To ensure that all food is used within the prescribed period, with particular attention paid to
perishable goods.
To maintain the kitchen equipment, as specified by respective manufactures.
To ensure that the kitchen is cleaned after use and at the end of each shift, leaving the kitchen in a
clean and hygienic state.
To check the temperatures of fridges and freezers within the Home twice daily.
To dispose of waste in the correct manner.
To respond to any reasonable request made by the Nurse-in-charge.
To perform any other such reasonable duties as may be required.
To defrost freezers 3 monthly.
Prepare meals for clients outside normal hours.
To liase with the nurse- in-charge re. number of clients for meals.
To be up to date with current legislation regarding environmental health.
SENIOR HEALTH CARE ASSISTANT.
Responsible to: Nurse in Charge.
PURPOSE OF POSITION:
To provide or assist in managing housekeeping within the home.
To undertake domestic duties which can be performed during your shift period.
To take delegated responsibilities in the charge of the clients under your care,
to the appropriate level.
To mange Health Care Assistants, advise qualified staff of situations of concern.
To be flexible in working time and practices to ensure continuity of care.
PRINCIPLE RESPONSIBILITIES.
Carry out regular monitoring around the home at intervals determined by the need and with due
regards for clients and staff requirements under your responsibility.
Carry out regular checks on the building with special reference to fire protection.
Help in the promotion of mental and physical activity of clients through talking to them, taking
them out, sharing with them in activities such as holidays, reading, writing, hobbies and social
recreations.
Answer emergency bells, assess the situation, deal with the client or staff seeking help.
Inspect, launder and mend clients clothing.
Cook means, serve meals, assist clients at meal times if required, wash up utensils.
Answer emergency calls, the door and the telephone, greet visitors, read and write reports in case
notes, take part in staff and client meetings and also in training activities as required.
To assist in the giving of medication.
Overall keep control and monitor all Care Staff’ and be involved in the training
of all new Care Staff’s.
Any such relevant and reasonable duties not mentioned.
SITE MANAGER.
RESPONSIBLE TO: Administrator.
PUPOSE OF POSITION:
To help in the care of the residents’ physical environment and in the general day-to-day activities
of the home.
To maintain the upkeep of the home with regards to maintenance, repairs and improvements.
To control the maintenance and testing of fire equipment and lifts within the Home.
To ensure that all vehicles, owned by the Home are safe, clean and ready for use.
To operate and supervise subcontractors in order that all purchases are controlled within a
specified budget.
RESPONSIBILITIES.
To ensure that all of the Home’s homes are maintained to the highest standard.
To respond to maintenance requests made by staff.
To be knowledgeable in Health and Safety laws and requirements.
To maintain the upkeep of the Home, both inside and out, with regards to maintenance, repairs
mad improvements.
To be aware of one’s own limitations, using approved specialists where required.
To be responsible for the testing of the fire alarm systems in all Homes and arranging for
approved suppliers to test fire systems and equipment twice yearly.
To ensure that fire lectures are arranged twice yearly for all staff.
To ensure that lifts are functional and arrangements are made for twice-yearly services by
approved suppliers.
To keep the purchase of material within allocated budgets.
To be responsible for completing purchase orders and checking goods for
non-conformance.
To maintain any maintenance equipment, as specified by respective manufacturers.
To ensure that the Home’s vehicles are kept clean and roadworthy, are serviced regularly and
have adequate petrol.
To manage the Home’s account with reputable taxi company.
To perform any other such reasonable duties as may be requested.
To involve clients, as appropriate, in therapeutic work activities.
HEALTH CARE ASSISTANT.
RESPONSIBLE TO: Nurse in charge.
PURPOSE OF POSITION:
To share with other staff in meeting the personal care needs of clients in a way that respects the
dignity of the individual and promotes independence.
To help in the care of the clients physical environment and in the general day-to-day activities of
the home.
To take delegated responsibilities in the charge of the clients under your care, to the appropriate
level.
To be flexible in working time and practices to ensure continuity of care.
RESPONSIBILITIES.
Assist clients who need help with dressing, undressing, bathing and toilet.
Help clients with mobility problems and other physical disabilities such as incontinence. Help in
the use of aids and personal equipment.
Help in the promotion of mental and physical activity of clients though talking to them, taking
them out participating with them in activities such as reading, writing, hobbies and recreations.
Make and change beds, tidy rooms and do light cleaning.
Inspect, launder and mend clients clothing.
Cook meals, serve meals, and assist clients at meal times if required, wash up utensils.
Answer emergency calls, the door and telephone, greet visitors, read and write reports in case
notes.
Take part in staff and client meeting and also in training activities as required.
Assist in the giving of medication.
Take part in any training activity relevant to the role.
Any such relevant and reasonable duties not mentioned.
SENIOR HEALTH CARE ASSISTANT.
RESPONSIBLE TO: Nurse in charge.
PURPOSE OF POSITION:
To provide or assist in managing housekeeping.
To undertake domestic duties which can be performed during your shift period.
To take delegated responsibilities in the charge of the clients under your care, to
the appropriate level.
To manage Health Care Assistants and advise qualified staff of situations of concern.
To be flexible in working time and practices to ensure continuity of care.
RESPONSIBILITIES.
Carry out regular monitoring around the Home at intervals determined by the need and with due
regards for clients and staff requirements under your responsibility.
Carry out regular checks on the building with special reference to fire protection.
Help in the promotion of mental and physical activity of clients through talking to them, taking
them out, participating with them in activities such as holidays, reading, writing, hobbies and
social recreations.
Answer emergency bells, assess the situation and deal with the clients or staff seeking help.
Inspect, launder and mend clients clothing.
Cook meals, serve meals, and assist clients at meal times if required, wash up utensils.
Answer emergency calls, the door and the telephone, greet visitors, read and write reports in case
notes, take part in staff and client meetings and also in training activities as required.
To assist in the giving of medication.
Overall to keep control and monitor all Care Staff’s and be involved in the training of all new Care
Staff’s.
Any such relevant and reasonable duties not mentioned.
ADMINISTRATOR.
RESPONSIBLE TO: Directors.
PURPOSE OF POSITION:
To promote and oversee professional, clinical, administrative, financial, training and care planning
within the Home.
To ensure that the health and welfare of the client group is maintained and monitored and mange
the prevention of untoward neglect of furnishings and fitments.
To act as deputy in the absence of the Directors.
To ensure that all standards are being met.
RESPONSIBILITIES.
PROFESSIONAL AND MANAGEMENT
To be the nominated Quality Management Representative with responsibility for directing and
maintaining the company quality System (BS EN ISO 9002: 1994).
To ensure that the care and management is conducted in such a way as to not bring the Home or
its clients into disrepute.
To uphold the Homes Quality Assurance Charter and ensure that all staff do likewise.
To maintain and ensure that staff members maintain confidentiality regarding all aspects of care
and management of the Home.
To inform the Directors where appropriate if any serious difficulty or situations take place.
To delegate responsibility within legal boundaries.
To ensure that the Home has adequate staff cover at all times as dictated by the Registration
Authority.
To provide flexible clinical cover (nights, days, weekends, bank holidays) in the absence of the
Nurse in charge.
To be knowledgeable in and ensure staff follow all policies and procedures relevant to the Home
including Environmental Health, Fire, Health and Safety at work.
To attend all staff meetings, and chair meetings in the absence of the Directors.
CLINICAL.
To ensure that clients; medication is properly administered, monitored and ordered.
To be Knowledgeable regarding the use of equipment in the Home and ensure that staffs are
likewise.
To be knowledgeable regarding emergency procedures pertaining to our client groups and
provide relevant training for staff.
To respond to the spiritual, emotional and mental needs of the client.
To liaise with staff, clients, general practitioners and other multi-disciplinary team members to
promote good care.
To ensure that residents’ hygiene and self care needs are being met.
ADMINISTRATIVE.
To prepare staff duty rosters each month ensuring that adequate cover is maintained at all times
as specified by the Registration Authority.
To prepare staff wages ready to go to the accountant.
To be involved in the hiring, training and disciplinary meetings regarding staff.
To ensure that staff records are kept up to date, including annual leave.
To calculate invoices regarding Social Services relating to clients placed in the Home after
01/04/93.
To investigate complaints ensuring that follow up procedures for resolution are met.
To maintain good working relationships.
To be aware of all procedures in the Home and ensure they are followed correctly.
To comply with the Registered Homes Act 1984.
To maintain and ensure that accurate records regarding the clients and home information are
maintained correctly.
To be knowledgeable regarding the whereabouts of all clients at all times.
To ensure that any repairs of fitments and fittings are dealt with appropriately.
To troubleshoot where a problem arises.
TRAINING.
To keep up to date with recent developments, attend relevant courses and teach other staff in all
aspects of relevant care.
To develop training methods for improvement of residents’ rehabilitative processes, with hands
on involvement as required. (These methods will be shown in the Client Care Plans where
applicable).
To teach relevant information and knowledge to other staff.
To take part in NVQ training where relevant.
To participate in and to encourage care studies in order to give a wider understanding of
residents’ abilities and problems.
CARE PLANNING.
To influence and monitor care, ensuring that the Nursing Process is utilised to its full.
To be involved in and ensure that reports are completed on daily events and that those agencies
that have input into a residents’ care regarding assessment meetings, general practitioners clinic,
CPN visits and OPA are involved.
To be aware of all relevant information handed over at the change of a shift.
REGISTERED NURSE-IN-CHARGE.
RESPONSIBLE TO: Proprietor
PURPOSE OF POSITION:
To promote professional, clinical, administrative, financial, training and care planning within the
Home.
To maintain and monitor the health and welfare of the client group and to manage the premises to
prevent untoward neglect of furnishings and fitments.
RESPONSIBILITIES.
PROFESSIONAL AND MANAGEMENT.
To conduct care and management in such a way as to not bring the Home or its clients into
disrepute.
To uphold the Home’s Quality Assurance Charter.
To maintain confidentiality regarding all aspects of care and management of the Home.
To inform the Nurse Administrator if any serious difficulty or situations take place.
To delegate responsibility within legal boundaries.
To check fire equipment weekly and conduct fire evacuation procedures 3 monthly.
To be knowledgeable regarding health and Safety at work, including Environmental Health.
To attend and contribute to staff meetings.
CLINICAL.
To give any medication as prescribed, with proper monitoring of drug, dose, time route and
person to whom it is given.
To ensure the medication is properly taken and to monitor for any normal, positive or negative
effects of that drug.
To have knowledge of and the use of any equipment within the Home.
To check usability weekly.
To be knowledgeable regarding emergency procedures pertaining to our client group.
To respond to the spiritual, emotional and mental needs of the client.
To liase with staff, clients, general practitioners and other multi-disciplinary team members to
promote good care.
To monitor residents’ hygiene and self care.
ADMINISTRATIVE.
To make sure all goods and equipment to be used within the span of duty and beyond is available.
To investigate complaints and follow procedures for resolution.
To foster good working relationships, take part in staff selection/staff meetings.
To be aware of all procedures of the Home.
To comply with the Registered Homes Act 1984.
To maintain proper and accurate records regarding the clients and other Home information.
To be knowledgeable regarding the whereabouts of all clients at all times.
To bring to attention of the management any repairs and renewals of fitments and fittings.
To troubleshoot where a problem arises.
To ensure clients are taken on minibus outings as per programme.
TRAINING.
To keep up to date with recent developments, attend relevant courses and teach other staff in all
aspects of relevant care.
To develop training methods for improvement of residents’ rehabilitative processes, with hands
on involvement as required. (These methods will be shown in the Client Care Plans where
applicable).
To teach relevant information and knowledge to other staff.
To take part in NVQ training where relevant.
To participate in and to encourage care studies in order to give a wider understanding of
residents’ abilities and problems.
To teach clients about food preparation and hygiene.
FINANCIAL.
To control and manage any budget under the Registered Nurse-in-Charge’s care.
To make sure all clients receive their weekly allowance and this is signed for.
To make sure they have what is legally theirs.
CARE PLANNING.
To influence and monitor care, utilising the Nursing Process.
To write reports on daily events.
To involve those agencies who have input into a resident’s care planning, i.e. Assessment
meetings, general practitioners clinic, CPN visits and OPA.
To make sure all relevant information is handed over at the change of a shift.
G. 1.1 IDENTIFYING PERSONNEL REQUIREMENTS
ASSIGNMENT
RECRUITMENT OF A STAFF MEMBER.
The Home provides twenty four hour care which is sub-divided into three shifts with minimum
staffing levels during weekdays.
MORNING - Registered Nurse (2).
Health Care Assistant (5).
AFTERNOON - Registered Nurse (2).
Health Care Assistant - (5).
EVENING - Registered Nurse (1).
Health Care Assistant (4).
NIGHTS - Registered Nurse (1).
Health Care Assistant (2).
These requirements are those which are set out and accepted within the Health Authority
guidelines.
In addition there is also employed a Chef and a Site Manager.
The Home provides day care for all the Satellite Homes, Staffing levels will relate to the needs of
the individual and the home at any particular time.
When a vacancy arises, it is the job of the Nurse Administrator or the Senior Nurse to employ a
new member of staff. The type, position available will be first discussed with the Proprietors of the
company. Hours and the rate of pay is then agreed on and the needs of the post ascertained.
Each home requires different skills. For instance, if the vacancy is needed in the Satellite Homes,
then someone with a current Driving License would be more beneficial to the Home. The reason
for this is that the person needs to be able to check hourly on these Homes and they are not within
walking distance.
Each vacancy that occurs is a requirement of the Health Authority Minimum Staffing Levels. Thus
filling the post is specific to the above criteria.
Changes in the staffing structure could happen in our Company, if for instance we expand. Thus
the staffing ratio would need to be higher. Registered Nurses are more expensive to employ,
therefore salary implications would be need to be budgeted. If this indeed did happen then some
staffing roles could change i.e. A cleaner may be employed then giving more quality Health Care
staff to Clients.
THE HOME NEEDS A NEW HEALTH CARE ASSISSTANT.
Due to staff shortage it was decided by the Proprietor, Administrator and the Senior Nurse to
employ a Health Care Assistant.
The job centre in Tawrton were informed and asked to proceed in advertising the position by
myself. Due to lack of response an advertisement was made in the Local Gazette.
The Home had an overwhelming response and subsequently many applicants were interviewed.
The successful applicant was chosen because of several factors. She was mature (to get the right
mix of staff, a more mature person would balance the age range), she was quiet, kind and showed
good overall skills. She had a Food Hygiene Certificate and experience with Mentally ill people. I
personally felt that this lady really wanted the job and all her attributes met the requirement
needed.
My thoughts on this particular employment process, is that I worked hard at being objective.
Although several people met the required standard needed a ‘Gut’ feeling makes one chose the
eventual successful applicant.
In discussion with Proprietor and Administrator, they agreed to the above employment with the
Senior Carer. Pay and conditions were also raised at the discussion. As this post was part of the
‘Staffing Notice’ there were no budgetary implications.
Copy of employment File of a person I interviewed and employed.
THE HOME
184 Greenborough Road,
Tawrton.
Somervon
TW2 6BX
Telephone 071893 - 7279569.
RECRUITMENT / VACANCY
HEALTH CARE ASSISTANT. (FULL TIME/PERMANENT)
• 35 hours per week.
• Alternate weekend work, rostered bank holidays.
• Pensionable Position (After qualifying period).
• Starting pay: £4.50 per hour until completion of induction process.
• On completion of induction process £5.50 per hour.
• 5 weeks annual leave.
• Full Training and Development
• Applicant must have an interest in Quality and Mental Health.
• The Home is an equal opportunities Employer.
• The Home operates Anti-Discriminatory practices.
• Subject to the Rehabilitation of Offenders Act 1974’
• Subject to adequate references obtained
• This post carries an appreciation of Mental Health and anyone not able to meet the at times
heavy demands of this client groups should not apply
ADVERT
‘The Home’ is a Mental Health organisation dedicated to
promoting the best care for its sufferers. We are both an
Investor in People and have been awarded the International Quality Standard BS/EN/ISO 9002
(known as ‘’Healthmark’’).
We employ staff who are dedicated to Quality Standards and
who’s standards of work will reach the required level. Those
unable to reach these standards need not apply.
If you would like further details, please write, or telephone Mrs.
Smith who will be happy to answer your questions and arrange
a visit and informal interview.
Skills and attributes needed include empathy and an ability to
listen and communicate.
Previous experience preferred but not essential.
COPY LETTER.
Miss.V. Jones
15 Victory Street
Tawrton
Somervon
T2W 9SG
Dear Miss V Jones,
Thank you for your CV and letter inquiring as to whether we had any vacancies for Health Care
Assistants.
We do not have any vacancies at this point in time, but if interested, I would be happy to offer you
an interview as we may well have posts coming up in the future.
If you would like to come in, and have an interview, and look around the home, please do not
hesitate in contacting me and we can arrange a mutually convenient date and time.
I look forward to hearing from you.
Yours Sincerely,
Mrs Smith
Manager
(PROOF THAT WE KEEP APPLICANTS FOR POST OF HEALTH CARE ASSISTANT WHOM
WERE NOT OFFERED A JOB FOR A PERIOD OF NOT LESS THAN 6 WEEKS. IN
ACCORDANCE WITH EQUAL OPPORTUNITIES.)
H .PERSONEL SELECTION
1.1
• Copies of Completed Forms and Checklists Questionnaires.
• Staff Selection and Recruitment.
• Employment Application.
• Interview Questionnaire.
• Reference Forms.
• Question Checklist for Staff interviews.
• Terms and Conditions of Employment.
• Testimony Of Others. (Witness Statements).
I have observed Candidate in association with the following activity:
The candidate has been present at 3 interviews in selection of staff, she has:
• Asked relevant questions of prospective staff.
• Answered questions asked of her.
• Identified areas of concern.
• Put prospective staff at ease.
I am satisfied that the candidate meets this satisfactorily.
1.2 ASSIGNMENT:
Write a short bullet point summary on aspects of the following:
• Employment Protection Act.
• Sexual Discrimination Act.
• Race Relations Act.
• Data Protection Act.
• Disablement Persons Act.
• Health and Safety Act.
EMPLOYMENT PROTECTION ACT
This act relates to statutory recognition of unions by employers
The question of whether to recognise a union is one that is entirely within the control of the
employer.
‘RECOGNITION’ means the employer recognising the right of the union to represent those
employees in the membership of the union.
Legally all employees have the right to be a member of an independent trade union irrespective of
whether the employer recognises that union.
SEXUAL DISCRIMINATION ACT
This act outlaws discrimination on the grounds of sex and on the grounds that a person is
married.
It states that no distinction be made between men and women in relation to employment.
Both men and women should be given equal opportunity and where job description is the same
equal pay.
RACE RELATIONS ACT
It is an offence for employers to discriminate against employees or job applicants on racial
grounds i.e. of colour, race, nationality, ethnic or natural origin.
‘Discrimination’ on these grounds treats a person less favourably on racial grounds than other
people are or would be treated.
DATA PROTECTION ACT
This Act imposes constraints on the way that computerised information is stored, processed and
disclosed.
It gives people whom computerised information is held the right to have access to that
information.
HEALTH AND SAFETY AT WORK ACT
There are common law duties on employers with regards to health and safety at work.
• They must select reasonably competent employees (or provide training up to a reasonable
standard of work, new recruits).
• They must provide adequate materials.
• They must provide a safe system of working with in the work place.
DISABLED PERSONS ACT
The managers of care and nursing homes should pay attention to the exemption that has been
conferred on property used for disabled people, the property must be wholly used for:
• The provision of training people who are disabled or who are suffering from illness.
• The provision of welfare services from illness.
• The provision of facilities under 15”.
• The provision of a workshop or other facilities under this act states a person as disabled, if he or
she is blind, deaf, dumb or suffering from mental illness of any description.
J TRAINING AND DEVELOPMENT,
INDIVIDUAL AND TEAM
1.1 Present ‘Live’ copies of forms deleting individuals names
from forms:
• Copies Of Procedures
• Completed Forms
• Witness Testimony
• Induction and In-service Training
• Records of training
• Investors in People Standard
• The Home In-service Training Programme
• The Home Management Programme
• Appraisal and Development Review
1.2 ASSIGNMENT
If one does not exist already, construct a training plan for your team, highlighting:
• Which parts of the In-Service Training Programme they are working on
• Any appropriate courses/seminars/workshops
• NVQs
• Individual strengths and weaknesses
My assignment was to develop a better Fire Training Programme. AS many aspects of this was
already covered, I chose to introduce Fire Video Training
FIRE VIDEO WORKSHOP
This included aspects of how a fire takes place and what it can cause, in a way that ordinary
lectures could not show. Following the Video, written questions were given for staff to answer to
show they understood what they had seen and confirmed competence. Questions such as:
1. What is the purpose of a fire drill?
• So you know what you have to do if there is a fire and you know where to go.
2. Why should you always use the back of your hand when testing for heat on a surface?
• If you should burn the back of your hand, you should still be able to use the front of your hand.
3. Which three areas are considered to be the most vulnerable to fire hazard, in your care home?
• Kitchens, bedrooms, boiler rooms, laundry rooms and smoking lounge.
4. Where are the assembly points in your care home?
• back garden and out of the front of the home.
5. Can you think of any obstacles in your care home?
• Objects in front and behind fire doors and frayed carpets.
6. Do you know your own strength and capabilities, should a fire situation arise?
• Yes I do.
6. How many people are in the building at this moment?
• 26.
8. Would you feel confident to ring the fire brigade in an emergency? What information do they
need?
• Yes I would, and I would give them the name and address and location of the fire.
9. When allocating a room for a client, what points should be considered, with reference to fire
safety?
• If they are smokers and how mobile they are.
10. What can you do to assist the fire brigade?
• Let them know if any clients are left in the building, where they are, if mobile, and where the fire
is.
Following the written questions, where answers were incorrect, the strengths and weaknesses of
an individual would be assessed and oral questions relating to the video and written questions
would be made, in some cases the video and questions would have to be revisited by the
individual.
This relates directly to Unit 7 of the Care In-Service Training Programme.
A certificate was then given to confirm competence and this went towards the candidates NVQ
Training, both in CU1 Care and A1 Management relating to Health and Safety. So this Training
initiative met the needs of all training in this area.
K INDIVIIDUAL AND TEAM.
1.1 EMPLOYMENT FILES.
Candidate has placed correctly all quality documentation in the Home. Employment files. She has
ensured that all paperwork relating to employment has been checked and signed by employees
with correct dates. She has checked that the Rehabilitation of Offenders Act has been dated and
signed by employees that both temporary and standard contracts are completed dated and signed.
1.1 INDUCTION PROGRAMME
TICK WHEN COMPLETED:
Induction Supervisor
q Introduction to staff and clients
q Tour of premises
q Staff procedure file
q Education and Training/Manual/NVQ
q Aims and objectives of the Home
q Accountability
q Advocacy/Clients rights
q the Home Quality Assurance Charter
q Fire Video and Questionnaire
q Fire Alarm System
q Fire Alarm drill and procedure in event of fire, Location of Fire Equipment
q Accident / Violent Incident and missing Persons Procedures
q Case note entries and their confidentiality
q Boots Medication System
q Safe keeping of clients money, articles and valuables
q Sickness procedures
q Nurse call system
q Diary
q Nursing process System
q Admission, Transfer and discharge procedure
q Weekly GP clinic
q Worksheet
q Using the telephone/Internal calls/Handing enquiries
q Relationship with Registering Authority
q Depot Injection and Recording
q Staff Client reviews and Staff/Client meetings
q Tea, Coffee and Meal Policy
q Social Services/Health Authority Services Specification
This induction should be seen as an introduction and further in-depth information of these
subjects should be followed up in the In Service Training part of this manual.
• Examples of training
• Delivered Evaluation Sheets
• Witness Testimony
• Induction Programme
• the Home In-Service Training Programme (delivering the Training)
• You will need to provide clear examples of the training sessions.
• Examples of training
• Delivered Evaluation Sheets
• Witness Testimony
• Induction Programme
• the Home In-Service Training Programme (delivering the Training)
• You will need to provide clear examples of the training sessions.
The venue for the Fire Training Video was in the Proprietors office, as he had both video and
Television in that room, this saved on any further expence, and also provided a quiet environment
for learning.
• Those who attended were:
Mrs Smith, Manager
Mr Jones Senior Care
Ms Dibly Care Assistant
Mr Mc Michael Care Assistant
Mr Webb Cook
Mr Grant Maintenance
CONTENT
The content was as follows:
• WHAT IS FIRE
• WHAT ARE THE MAIN CAUSES OF FIRE
• HOW DOES FIRE SPREAD
• FIRE FIGHTING EQUIPMENT
• FIRE PRECAUTIONS (WORKPLACE) REGULATIONS 1997
• RISK ASSESSMENT
• FIRE DETECTION AND WARNING
• MEANS OF ESCAPE IN CASE OF FIRE
• EXITS
• ESCAPE ROUTES - MUST BE FREE FROM OBSTRUCTION AND CLEARLY MARKED.
• TRAVEL DISTANCES –
• INTERNAL FIRE SPREAD
• EMERGENCY LIGHTING
• PLACES OF SPECIAL FIRE RISK.
• MECHANICAL VENTILATION SYSTEMS
• PROVISION OF FIRE-FIGHTING EQUIPMENT
• PLANNING FOR THE EMERGENCY AND TRAINING STAFF
• MAINTENANCE AND TESTING OF FIRE SAFETY EQUIPMENT.
• QUESTIONS AND DISCUSSION
After the training an evaluation form was given to everyone to read aand give feedback on the
training This was the form used.
Unit 15
MANAGEMENT UNIT 15
L: INDIVIDUAL AND TEAM TRAINING AND DEVELOPMENT ASSESSMENT
1.1
HAVE ‘LIVE’ COPIES OF COMPLETED FORMS / REPORTS IN YOUR PORTFOLIO.
• Appraisals
• Long Appraisal
• Short Appraisal
• Joint Appraisal
• Upward Appraisal
• Leaving Appraisal
• Staff Improvement Advice
• Disciplinary Forms
• Management Meetings
• Staff Meetings
• Review Form
1.2 ASSIGNMENT
Discuss the value of Performance Reviews. Is it necessary to have them. Suggest forms of
Performance Review other than Appraisal.
Discuss the Values of Performance Reviews
The values of performance reviews are that they identify any weaknesses within the organisations
working policies and procedures and individual employees performance within the workplace.
Performance reviews are used to evaluate overall performance/individual performance which will
enable the Management to establish where improvements can be made.
Individual Performance Reviews
Regular performance reviews will ensure the employer is aware of all employee’s strengths and
weaknesses. The value of performance review is that the employer can establish which individuals
need extra input for raining and development in order for them to maintain or improve their
performance. Advice and understanding can be given to individuals who have been identified as
having performance weaknesses’, performance review also gives an individual the chance to
discuss any problems they feel may be affecting their own performance.
• It will then enable the employer to establish a future plan based on the outcomes which can be
agreed to maintain or improve performance.
• They are useful in monitoring employees in the early stages.
• They enable employers to put extra energy into those that are achieving.
• They can be a defense against law ie. Wrongful and constructive dismissal suits.
• Bring about effective and better communication between the employer/employee.
• Encourage individual employees to achieve and reach their own goals with their training and
development. Assist the Management to identify and establish which plan of actions to take to
maintain required standards thus offering a good quality of service to its customers.
EXAMPLES OF APPRAISALS
LONG APPRAISAL
Employee Name: Mr P. Mallen
Department: The Home
Job Title: Health Care Assistance
Employment Commenced: 3. 6. 2000
READ INSTRUCTIONS CAREFULLY
• Use you’re own independent judgment.
• Disregard your general impression of the employee and focus on one factor at a time when
evaluating the employee.
• When rating an employee, call to mind instances that are typical of his/her work and way of
acting. Do not be influenced by unusual cases, which are not typical.
• Be sure your rating represents a fair and objective opinion. Do not allow personal feelings to
govern your rating.
• The Department Manager should review this appraisal and sign it before discussing it with the
employee, have the employee sign it and then return it to the Senior Manager.
QUALITY
Peter ensures that all written reports and paperwork that are completed by himself and are filled
in accurately and is competent when following correct procedures.
QUANTITY
Peter has developed good time management skills and ensures his work tasks are completed in
the given time.
INITIATIVE AND CREATIVENESS
Plans his work routine very well and has the ability to work on his own initiative.
EFFORT
Works hard is a very enthusiastic member of the team, has put tremendous effort in to his training
and is a well-motivated member of staff.
PERSONAL APPEARANCE
Always reports for work appropriately dressed.
ATTENDANCE
Attendance was lax at the beginning of the year but has greatly improved. No sickness or absence
in recent months.
TARDINESS
Peter is always prompt when reporting for work.
LOYALTY
Peter identifies and has good awareness to the goals and purposes of the company,
has good ability to promote the purposes of the company to new members of staff.
DEPENDABILITY
Peter is always dependable with his delegated duties and he ensures tasks are
completed when specifically asked to undertake a task.
COOPERATIVENESS
Has a willingness to work as part of a team in a friendly manner, and is always ready to
observe and conform to policies and procedures within the workplace.
PEOPLE INTERACTION
Peter has good interaction skills and is especially good with younger members of
staff and other team members.
JOB KNOWLEDGE
Has developed good skills and has in-depth knowledge of general policies and
procedures that maintain the quality standards within the home.
JUDGEMENT
Has the ability to make sound judgment within his responsibility, is not impulsive puts
a lot of thought into his actions.
CAPABILITY AND AMBITION
Has worked well with his In-Service Training (NVQ 3 Training) and with
encouragement will go further to achieve his own ambitions to gain promotion.
APPRAISAL REVIEW WITH EMPLOYEE
Peter was pleased with his appraisal and did not comment except that he was pleased with the
comments.
ACKNOWLEDGED BY:
Well thought out appraisal by L. Dannet, Appraisal is correct
SHORT APPRAISAL
GOOD AVERAGE POOR
Advocacy Yes
Basic Ability Yes
Common Sense Yes
Dependability Yes
Effective Worker Yes
Friendly Manner Yes
General Appearance Yes
Home Skills Yes
Interpersonal Skills Yes
Judgment Yes Yes
Kindness Yes
Learning Adaptability Yes
Motivation Yes
Noise Sensibility Yes
Observation Yes
GOOD AVERAGE POOR
Quickness Yes
Reliability Yes
Sickness Yes
Trustworthiness Yes
Understanding Yes
Volition Yes
Work Attitude Yes
Punctuality Yes
Extra Efforts Yes
Your Initiative Yes
Zest Yes
JOINT APPRAISAL
POSITION: STAFF NAME:
DATE OF JOINING: APPRAISAL DATE:
Staff member’s view of his/her performance listed below.
Assessor’s view of his/her staff member’s performance listed below.
ONE COPY SHOULD BE GIVEN TO BOTH THE STAFF MEMBER AND THE ASSESSOR, WHO
SHOULD COMPLETE THE FORM SEPARATELY AND DISCUSS COMMENTS IN FULL.
STRENGTHS
Employee: I believe that I carry out my duties quite well and to the best of my ability. I could put a
bit more effort into the cleaning side of my job. I think I am good with the clients and handle
certain situations well, ie: Arguments.
Manager:
DEVELOPMENT REVIEW
Employee: I have nearly finished my induction programme which is under the 13 weeks, but I feel
that I could have done it quicker if I had sat myself down more often and got my head around it.
Manager:
SPECIAL ACHIEVEMENTS
Employee: I think that my daily work schedule is carried out well.
Manager:
RELATIONSHIPS WITH PEERS
Employee: I feel that I have a good relationship with my peers.
Manager:
PUNCTUALITY
Employee: I feel that my punctuality is good.
Manager:
SICKNESS/ABSENCES
Employee: None. I would not take time off sick unless necessary.
Manager:
AREAS WHICH NEED EXTRA ATTENTION
Employee: I think I could pay more attention to my training.
Manager:
COMMENT
Employee: I am enjoying my job and the people I work with are friendly.
Manager: this shows that Hannah is aware of matters that need attention and I am
sure she will do well in developing her skills through her training.
DISCIPLINARY NOTICE
Despite the fact that you have attended a meeting with myself, the Person in Charge.
and S Bolt with regards to your attitude towards senior members of staff and your
performance within the workplace, and advice given to you at this meeting has been
ignored by yourself, and there ahs been no significant change in your attitude to your
responsibilities.
We have decided to issue this written warning to state that unless there is a noticeable
improvement within your attitude towards other staff members and your performance
whilst carrying out work tasks, then further action will be taken to try and resolve the
situation. Review Date 6.7.00
STAFF MEETINGS
SHIFT MEETING Date 6.6.00 11am
PRESENT:- M Tollard M Roseburn T Abbeyfield
E Swinsell P Mallen L Dannett
Minutes read from last meeting.
Discussion Points:
Staff Issues
M. Roseburn concerned about staff being taken off floor in the morning during duties to do
N.V.Q. work.
It was decide that NVQ would be more appropriate in the afternoons when it was quieter.
M Tollard request that rota could maybe be drawn up where staff can get some time each to do
N.V.Q. Training and In-service Training.
Mr Tollard was given the responsibility to devise a programme to meet the NVQ requirements.
Client Issues
P Mallen – clothes still being put in wrong rooms, other people’s clothes are even being found at
The Home.
Agreed that a memo should go out to all care staff and spot check would be done following the
memo
Toilet seat still coming off over at the Home in downstairs bathroom.
It was agreed to get a new seat and the maintenance department could fit the seat.
Meeting Closed 12 noon next meeting 7.9.00
M: SELF DEVELOPMENT
1.1
Email- [email protected]
John Eaton
Position Managing Director JET –Training.com
Senior Centre Co-ordinator JET Assessment Centre.
Centre No 63808
Experience 1987-2000 Nursing Home Owner
1997-Present JET NVQ Assessment Centre Co-ordinator
National Quality Standards Achieved
• 1996 ISO 9002
• 1996 Investor in People
• 1997 Assessment Centre
Personal Qualifications
• 1998 NVQ Management Level 5
• 1997 D34/ D36
• 1996 D32/33
• 1978 Registered Nurse (New York)
• 1976 State Registered Nurse
• 1974 Registered Mental Nurse
Training and Publication History
• 2001 Management Model Answers
• 2000 Care Model NVQ Answers
• 2000 Fastrack NVQ3 ‘Promoting Independence’
• 2000 Fastrack NVQ3 ‘Caring For Children and Young People’
• 2000Fastrack D34/36
• 1999 Fastrack Care Levels 2 and 3
• 1999 Fastrack D32/33
• 1998 Statutory Requirements Manuals
• 1996 Management In-Service Training
• 1995 Care In-Service Training
• 1992 Originating Author ‘Croners Records and Procedures’
Previous Experience
1981-1987 Charge Nurse Tone Vale Hospital
1979-1981 Charge Nurse Abu Dhabi Defence Hospital
1977-1979 Charge Nurse Harris Hospital Fort Worth Texas
1971-1976 RMN/SRN Training
Always remember to include:
• NVQs (your own
• Certificates (your own)
• In-Service Training Programme
• Any other development activity undertaken
• On the job Training
• Courses / Workshops / Seminars
• Qualifications
• Projects Assignments
• Any advice given
• Any written evidence that shows
• Your evidence of development
• Action Plans
• Evaluation of Training
1.2 What is the difference between training and development and Training and NVQs?
The Difference Between Training and Development
Training is an integral part of employment, where with the right amount of information, tuition
and practical application of skills, a Manager can enable employees to be able to fulfil their role in
a Safe, Efficient and Practical manner, whilst being confident in the knowledge that a task is
completed in a way that satisfies their own Competence, Performance and Ability.
Development is what happens next. Take the skills of a Nurse trained in the 1970s, as I was. The
requirements are very different from those expected now. Treatments and skills have changed,
there is more computerisation and new techniques and planning of care have taken place. As I
was Trained in the 1970s, and just retained those skills and had not developed further, the chances
are that I would be almost unemployable as a Nurse today. But as I have developed and
continued to Develop, keeping up with the current ideas and standards then they would
understand what is expected of them today. It does not stop there, as Development is a
continuous process, ongoing in order to gain skills for the future. For me it was continuously
developing and that is why I now run a successful training company training others. (see C.V.)
SENIOR MANAGEMENT
Managers must Manage - The first rule of any organisation. Not just Manage for it’s own sake, but
Managers must Plan, Anticipate, Lead, Participate and Develop. They also must have the tools to
be Managers, i.e. relevant Training, knowledge and experience. Managers may be NVQ Assessors,
or have someone in a post who fulfils that role. The Assessor should have the background and
authority to Train and deliver to the Trainee a successful outcome from the Training, i.e. an NVQ
qualification. The Training must be needs lead, so the most important issues are raised at the
beginning, and leaving weightier but less essential information for later. It is far more important to
know the temperature of bath water than the particles that water contains. Managers too have to
Train and Develop, as knowledge gained yesterday is out of date by tomorrow. The UKCC have
recognised this and now insist on Qualified Nurses having proof of on-going Training to keep
their registration through PREP.
MANAGERS
It may not be so important for all Managers to be Assessors, although the more Assessors there
are, the lighter the workload and better Training of all employees. If cost effects the number of
Assessors, a support role in Training and Development may be used for non Assessors, being able
to give ‘hands on’ practical advice based on work place practices. Other activities could include
Role Play, Health and Safety information, directing Trainees to the right ways of caring, finding
the correct knowledge from text books and other sources, and giving appropriate information
about the Home and the procedures within it.
CARE EMPLOYEES
A vast range of knowledge is now required for someone to be even a base line Carer today. Care
at the ‘Sharp End’ i.e. the direct contact with clients’ is the single largest consumer of NVQ2
qualifications in this Sector. A whole industry has grown from this Training which increases the
knowledge base that will allow a Care employee to reach a level 5 NVQ if desired and become a
Manager without having to go through the orthodox route of Professional Qualifications. If a
Home cannot afford the costs associated with NVQ, it may have an In-Service system that may be
appropriate. This would be especially realised in the Small Home, where resources can be limited
and time itself squeezed through Care needs alone. Training is now an expected part of any
Homes output and is increasingly part of the role of the employee. By measuring their potential
and allowing them to achieve what was achievable, the Home may unleash talents formerly
dormant or unknown. Some employees will be energetic, others good at their job, a few good at
absorbing knowledge. Managers should not stifle good intentions and hard work in Training, but
control output in an organised time set way so any Training in work time does not impede normal
Care activities. All those involved should know what is expected of them.
ANCILLARY EMPLOYEES
Often this is a forgotten group of people such as the Chef, Maintenance and Domestic staff. They
too need to be kept abreast with Training and Development, Chefs with the knowledge of rules
regarding Food Hygiene, Refrigerator and Freezer temperatures being reviewed, Maintenance
having to be aware of COSHH rules and Domestics aware of using chemicals that may cause
irritation to their or others skin, or solutions which may cause others to slip on a wet floor.
Training and Development of these employees must be relevant to their particular role.
Utilising In-House Resources
Because Assessor Courses and other external Training Courses can be expensive, Managers may
find the cost of having many Assessors prohibitive. Within the Home there maybe skills that can
be utilised for Training purposes, employees who can teach straight forward subjects such as
bathing and personal care whilst the more senior can teach more involved subjects such as
medications used in the Home. This is a saving on the costs of courses whilst still honouring the
Training Commitment. The Manager has a wealth of knowledge and experience that could fill a
Training programme if laid out, formalised and acted on.
WHO TEACHES WHAT
The Home may have Qualified Nurses to teach Care, Administrators who can teach the
administration of the Home, if the Home has a Cook, they will be able to teach about Kitchen
Safety and Food Hygiene, the Maintenance section will be able to teach Fire and Health and Safety
issues.
WHAT TRAINING IS REQUIRED TO BE TAUGHT
An Induction Programme is the first and most important focus in the Home. Aspects of the
Programme include a Tour of the Premises and meeting other employees and the clients,
answering the Telephone, Health and Safety Policies, Fire Procedures, Sickness Procedures, all the
basic administrative duties they will carry out and Professional Behaviour. Simple information
regarding Temperatures of Refrigerators, Bath Water, Lifting of a Client and Basic Care
Procedures. Other information could include Aims and Objectives, Admission and Discharge
Procedures, Complaints Procedures, some information about Investors in People and Quality
Systems, Missing Persons, Accident Procedures and Violent Incidents. Some information such as
Fire Procedures may be intense and need a considerable amount of work to show adequate
understanding.
AREAS OF TRAINING THAT HAVE LEGAL REQUIREMENTS
There are some procedures or rules that have to be satisfied by law and there is no choice in the
matter. If a Home is a Nursing Home it will have to have a employee who has a Nursing
Qualification on duty 24 hours a day. If involved in a kitchen and cooking, an employee must
have a Food Hygiene Certificate, there must be someone nominated as in charge of First Aid. All
these issues have to be dealt with regardless of whether they are affordable, as the liability in law
is the responsibility of the Manager with a consequence that the Home could be brought into
disrepute.
SHOW EVIDENCE HOW TRAINING HAS IMPROVED CARE
Training That Prevents Untoward Occurrences
It is a matter of good practice to be involved with and promoting Training activity. Potentially it
can save time in the first instance, and resources in the longer term. Training can protect Managers
from a negligent employee, who may, if not Trained, gain bad habits which could cause situations
or untoward occurrences to occur. Training in Communication can be helpful to prevent
misrepresentation, and being able to Communicate with an aggressive client can prevent injury or
accidents. Knowing where to find information or implements may save a life, e.g. by being able to
find the suction machine and bringing it in double quick time instead of having to ask where the
machine is.
Training That Specifically Affects the Home
As well as generic information there is information only valuable to an Individual Home, such as
its Philosophy, Aims and Objectives. The layout of each Individual Home is different, so its Fire
Extinguishers and Fire Alarm positions will be sited in an appropriate place. The Trainee must be
knowledgeable about where that equipment is sited, as it will be essential in the case of a Fire. The
Business Plan, which is specific to the Home, will need to be communicated to the employees, as
their understanding of the business is an essential component to the Care provided. The
relationship between professionals and agencies are also Individual to each Home. Training in
how to deal with each agency will make a difference when having to make an impression for
possible new clients to be referred from Families, Social Workers, Nurses or Doctors. Whilst it
would be ideal to know everything, reality is that where information is not known it should at
least be accessable easy to find that information when required. Some information must be
known, i.e. Fire Drill, Exits, where Extinguishers or Fire Blankets are. If these things are not
taught, the Manager may be seen as negligent, as if a Fire broke out, no-one should be searching
for is for a book or procedure of what to do in the Event of a Fire when flames are engulfing a
room! But, not knowing all the words of the Homes Aims and Objectives, is not as important as
knowing they exist, knowing the main thrust the words plus where to find them if needed.
Testing Competence is about reassuring Managers and colleagues that the Training that has been
given has been absorbed and understood, and if there are gaps in what knowledge should be
attained, then the Trainee should be able to indicate where that knowledge is and how to get it.
They must know what they must know, as in Fire Procedures and if they do not know they will
have to relearn the subject until they satisfy the competence requirement. In a sense it is testing the
Home and it’s own standards, so if a Home has low standards it may accept competencies at a low
standard and the opposite may true with high standards. Where there are high standards, the
employee may not seek the Assessor for confirmation of their competence until they are sure they
will be ready. It will be important for the Manager to set targets for completion otherwise the
Training cycle will go on and on without anything being achieved.
Training Trainers
It is possible that all employees can be Trainers. Once each employee has reached a competence on
a subject, they may be suitable to teach a new employee on a particular subject. If they teach it
often enough they may become an expert in that particular field. Having someone knowledgeable
on Fire Procedures is a distinct advantage, as they can add more depth to the subject and give a
more informative Training session. It can also give an employee a sense of responsibility. It would
not be wise to allow anyone to Train others in Speciality Areas which require expert knowledge,
i.e. Resuscitation Techniques, as this is specialised and involves a knowledge that should be
applicable to Trained personnel.
Available Courses
Most Homes are in the Training mode but at times no matter how much effort is put into InHouse Training, outside Training Centres either can do it better, or have the depth of knowledge
and are an accredited body to Train in specific areas, such as Food Hygiene Courses or First Aid.
Accredited Training Bodies who wish to have the Home utilising their Training programmes
usually send information by Direct Mail. Otherwise they will advertise in the local or national
papers.
Structuring an Induction, In-Service Training Programme
Managers will know what the Home’s specific Training needs are, although there will be some
base line legal or Registration requirements for all Homes, e.g. the Health and Safety Act 1974, or
Social Service or Health Authority Guidelines stating levels and or grades of employee, or Policies
and Procedures in the Home such as Admission and Discharge Policy. All the requirements must
be in some way measured in order that an across the board competence level is found. Once the
Home has a structured Induction Programme, this will become the seed of the In-Service Training
Programme, as topics picked up in Induction should be expanded for the In-Service Training and
given a greater depth for the employees knowledge base. An NVQ qualification may be
satisfactory as a starting point, but it has to go hand in hand with a knowledge base of the
individual Home, in order for the employee to understand what to do and how to do it, with each
Home carrying out similar activities in differing ways.
N: WORK ACTIVITY PLANNINNG / TACTICS / ACHIEVEMENT
1.1 It is suggested you keep copies of the following in your portfolio:
Healthcare Worksheets Diary
Work Routines Involvement in Care
Planning Clients Care Planning
Drs Meetings Witness Testimony
O.P appointment Menu
Management Meetings Bath File
Staff Meetings Chiropody Appointments
Handover Reports Dental Appointments
1.2 ASSIGNMENT
Write a list of factors which sometimes may prevent your team achieving it’s objectives, and
explain how much you endeavour to overcome them
MISINFORMATION
Incorrect and misleading information, given by one who has not heard clearly or quantified what
is to be done, or does not understand what has to be achieved, or is reckless as to the facts.
DISINFORMATION
False information intended to mislead. Deliberate falsification, usually to cause anxiety or fear in
employees, or offer false promises which are not deliverable in fact.
RUMOUR
Distorted, unrealistic ideas or fantasy masked as fact but usually believable. Often related to fact
or innuendo, such as an employee discussing future employment possibilities ends up as a ‘fact’
that they are leaving.
BLUFF
The ability of someone to prevent an action or deny responsibility by the use of words or actions
which then cloud an issue and where no result comes from any intervention. ‘I can use a type
writer but not a computer.’ (both are word processors but one is seen as simple and the other
technical though if someone can use one, they can use the other).
LIES
Deliberate attempt to verbally distort information for own gain, or to prevent a negative action
against or to deny guilt or neglect. Could be a Mental Mechanism or an excuse for not carrying out
prescribed responsible duties, such as an employee denying that a specific task had been
requested for them to carry out by a Manager, even though they knew the task had to be fulfilled
but did not wish to do it. Can be speculated without other evidence or proof.
GRAPEVINE
Hearsay, discussions between employees including off the cuff remarks and wishful thinking, or
trying to read the mind or the reasons behind a particular action. Transmission of unofficial
information or rumour.
UNQUALIFIED STATEMENT
Policy made on the hoof, a stated aim without a plan or organised implementation. Stated position
that cannot be adhered to because when the plan is formalised, most of the content is lost or
forgotten.
INAPPROPRIATE PLANNING
Policy not thought through, planned, properly researched or followed through to its conclusion.
Ends usually in disaster or at best reviewed in the light of circumstances and withdrawn. A
Tactical withdrawal may be required.
CHINESE WHISPERS
Reportedly, from the First World War when a message was sent out “Give me reinforcements l’m
going to advance.’ By the time it got to Army Headquarters and returned it became ‘Give me three
and fourpence I’m going to a dance. Once a message is given and passed around it changes
depending on the emphasis, quality of repetition or comprehension of the individual.
PREGNANT PAUSE
Untimely or unthoughtout stop in communication. Manager may not know what to say or how to
respond. May lead to loss of control of interview.
‘AH’, ‘UM’ AND ‘YOU KNOW’
It is better if none of these are used as it makes it apparent that the Manager may not be in control
of interview, or may not be properly prepared for discussion.
Ways of overcomming
communication difficulties
DIRECTIVE
Initiatives have to come from somewhere, usually from the Top Management to identify the
Policies and Procedures in general or a specific point, where that point has to be clearly
understood and is not for discussion as a decision has been made and MUST be carried out. An
example of this is a ‘No Smoking’ policy.
DISCUSSION
When the initiation of a policy needs clarification and or alteration. More than one person
discusses an issue and comes up with a solution that will be incorporated into the strategy of the
Home. An example of this is an implementation of a new Training Scheme.
CONSENSUS
When discussions cannot reach an agreed solution, a majority view is taken and all those who did
not agree must support the conclusion. Management must be seen to be effective and not seen as
inept or squabbling amongst themselves. Otherwise this undermines the efficiency of the decision
and in the end may not work as a result.
FEEDBACK
Once a decision has been taken and implemented, it is then reviewed at a defined later stage and
all those involved are able to comment on the value of the process. This may mean that the process
is correct and does not need changing, or that parts of it need alteration or at worst it needs
stopping. If the latter is true, it is probably the case that the idea was not well thought through in
the first place and should not have been introduced, and someone is going to look very silly in the
eyes of the employees.
VIDEO / AUDIO
This can be helpful in concentrating on issues that are either laborious or difficult to communicate.
Someone has found a way of packaging all the information that is needed to communicate with
your employees in 20 concentrated and interesting minutes that would take hours of Training to
give the same information, e.g. Fire Video.
LANGUAGE
Communicating with people should be done at a level they can understand. Technical wording
and Jargon are OK for those who are in the know but others may not understand. “ You heard
what l said but did you understand what I mean?” is a useful question to ask yourself when
communicating with others. “The client is in the social mileu” is acceptable for psychologists, but
Care employees may well want to hear “The patient on the ward.” Both mean the same but who
would understand the first statement? Keep it simple is the best way. There may also be cultural
differences which can affect Communication. Some cultures nod their heads when they mean no,
and this can give conflicting signals to the person who is attempting to communicate with them,
so knowing the ethnic and cultural make-up in the Home is very important.
SUPPORT
Ongoing input by Managers to employees to maintain morale, give advice and enhance care
standards. The level of support may vary, though it is important to give support to those who
seemingly do not need it, as most employees need to know how they are functioning. Some will
need extra support to help them through awkward moments or periods in their employment.
SINCERITY
Managers should ask employees to do something as if it is important for them that it is done as a
personal request and for no other reason, ‘I would be grateful if you could do this and I need you
to complete it today.’
VERBAL AND NON-VERBAL COMMUNICATIONS
Communication simply means sending and receiving messages. However, effective
Communications involve more than words. Both Verbal and Non-Verbal messages carry
meanings.
Verbal and Non-Verbal language must agree in order to send clear messages. The problem is that
most people are not aware of their non-verbal behaviour. Unless verbal and non-verbal languages
agree, the listener will get a mixed message. When messages get mixed, non-verbal messages have
more affect Consider Each Employee’s Needs and Levels Of Understanding
A variety of communication methods are necessary to support employees and to interact with
them. The methods are based on each employee’s needs and level of understanding. It may be
necessary to modify Communication to achieve this.
How Good Verbal Communications Are
Handled In The Home
SHIFT GROUP MEETINGS
These can be focused on twice weekly sessions, where administrative matters of concern, or needs
may be brought to the attention of all the employees, and could include work routines, attitudes to
Clients and others, reiteration of specific policies such as the sickness procedure or any other issue
that needs clarification. Following on from this should be Training matters where the shift leader
discusses the Training needs with the employees and allocates time to teaching either an
individual or a group, depending on the need, workload or other factors. This should be recorded
in a book and signed by all employees in attendance. This is then a useful book to prove that
issues occurring have been discussed and that Training has taken place. It also acts as a deterrent
to those who at a later stage state that they have not been taught or did not know about a specific
issue or a competence requirement. For example, both Administrative and Training needs would
ensure that the correct temperature of bath water is known to all employees to prevent scalding,
or they would know the correct temperatures of food in refrigerators and freezers, or the correct
temperatures of hot food.
EMPLOYEE MEETINGS
All employees may meet once or twice a year to discuss the needs of all, to communicate all
Training and administrative needs. To encourage all employees to attend, it may be useful to call
these meetings:
• When wishing to announce a pay increase
• Before the Employees’ Christmas party.
Both will be well attended!
MONTHLY MANAGEMENT MEETINGS
This meeting is where all aspects of Administration, Training and other issues are discussed and
documented. Specific Groups may be set up to look into specific projects, their need, viability and
value in the workplace.
TARGET GROUP MEETINGS
These take place when issues need to be resolved with a group of individuals, outside of any shift
pattern or grade. This could be to focus on a specific area of need or improvement in attitude,
behaviour, or of inadequate input into care, or poor writing up of notes, or work routines.
INDIVIDUAL MEETINGS
This one to one meeting may incorporate several issues such as a teaching session, an Appraisal
meeting, a pre disciplinary advice session, a question and answer situation, a clarification of the
Home’s policy or other issues discussed. It focuses on the employee, who is advised, coached,
trained or told about the issues at hand. It should enable the employee to respond and put their
views forward, even if those views are wrong. It will at least give a baseline for the Managers to
work from. At the end of the meeting, comments should be written down and signed by both
parties to state what was discussed and where to go from there. A formal Appraisal will have
specific headings to work to and a chance for the employee to comment, also the Appraisal should
be balanced to show both good points as well as bad.
ÃD HÕC MEETINGS
At times it may be needed to meet unexpectedly, and urgent attention be given to a specific item
or issue. Examples are a complaint against the Home or a new directive from the Social Services.
Communication must by its nature be both speedy and effective, and communicated to those who
are involved and need to know.
WRITTEN WORD
Policies and Procedures, Care Plans, Memorandums, Health and Safety, Fire, letters to employees
and other agencies all add up to good Communications.
How Good Non-Verbal Communications
Are Handled In The Home
LISTENING
Listening is an important Communication Skill. You can provide help and support by being an
understanding listener. Create a climate in which the employee needing support feels accepted
and confident enough to be able to talk freely about their thoughts and feelings without having to
be defensive. As a result of being able to talk freely, the employee may gain greater insight into
the situation and be able to cope better as a result. Be alert to ways that you can be supportive
when someone needs help. The idea is that the employee, not you does most of the talking.
SIGN LANGUAGE
A handshake, thumbs up or down, a smile or frown may signal the tone of any Communication.
BODY LANGUAGE
Legs or arms crossed, stern or sympathetic looks, eye to eye contact, may well indicate the
outcome of any Communication. Emotional Communication can be seen when a person is asked
about a subject, their eyes looking down to the ground showing feeling, or eyes looking upwards
showing they are trying to remember something relating to that Communication.
though beware when body language gives out conflicting signals.
MANNERISMS
Altered general attributes, like the Manager looking down their glasses as a sign of discontent or
disbelief, may affect the way that the Communication is directed.
ATMOSPHERE
Light, happy, tense or anxious, the feel of a room as a Manager or employee walks into it may well
shape the nature of any Communication.
CLOTHING
Business Suit, “Power Dressing,” Casual Clothes, Jumper and Trousers, A black cap in the case of
a ‘hanging judge’ in times past. All indicate the type of Communication that is to take place.
ENVIRONMENT
Changes in the workplace. A Manager may come in one day and find their car space has been
reallocated, or their office moved; a form of harassment Communication. Or they may wish to
Communicate change, by altering the office furniture to signal that changes are to take place.
PERTINENT PAUSE
When a Manager pauses in a controlled manner, taking into consideration the effects of the
communication for maximum value, or to give time for the employee to think hard or gain
composure.
SPEECH INTONATION AND DELIVERY
The way words are spoken, the speed, sound, clarity and effect of the delivery of words, sets the
mood of the communication and the end product of what will be the consequence of their use.
POSITIONAL
Managers sometimes sit on a chair which is higher than the employee in the Communication. It
enhances their Power and Authority and signals who is in charge.
Also note such other actions as:
• Gestures
• Gesticulation
• Posture
• Silence
• Touch
• Composure
Other Avenues of Communication In The Home
How to get understanding of a subject or situation through
alternate means of Communication
HUMOUR
Can help in memorising subjects. “I call my dog Benylin because elixir (he licks you).” This helps
the person associate the Cough Medicine (Benylin) and its main means of ingestion, i.e. as a liquid.
‘No mind is thoroughly well organized that is deficient in a sense of humour.’
Samuel Coleridge (1772-1834)
VERBOSITY
Ludicrously use of a long word or long words e.g. ‘The client in the Social mileu is intending to
articulate his situation to the senior member of the care team in order to gain a response regarding
a surgical procedure that will be incumbent in the morning’’. Really what is being said is ‘The
patient in the ward wants to talk to the Ward Sister about his operation tomorrow.’ When used in
specific situations can generate humour hence enabling an employee to remember a specific
incident or fact.
SPOONERISM
Unintentional or intentional transposition of sounds or letters in successive words use, with
amusing effect. e.g. Blushing crow for Crushing blow, Cursing nares for Nursing cares.
MNEMONICS, MEMORY AIDS
Making up sayings or using initials or using the first letter of each word to make a rhyme. The 2Ds
2Ts 3Rs. (Diet, Drugs, Tests Treatments, Rest, Reassurance, Rehabilitation), “Old Olympic
Towering Tops” The first 4 senses, Olfactory, Ocular, Troclear, Trigeminal, or initials made into a
well known word, such as SMART (see Business Plan) Specific, Measured, Attainable, Realistic
and Time Targeted.
ROTE LEARNING
Continuous memorising to ensure knowledge is learnt. Once used for its specific purpose it often
becomes embedded in our minds for life and can be used as ‘Party Pieces’ such as, “Modecate
Enanthate is an Esterfied Triflomethal Piparazine Derivative of Phenothiazine.”
RHYMING SLANG
‘Plates of meat’ is rhyming slang for feet. Concentrates thought on the meaning and therefore once
understood, re-enforces retention of memory.
MALAPROPISM
(Mal - prefix = ill or bad/ly)
The ability to make a statement using the wrong but similar sounding words, such as ‘Asparagus
Veins’ for Varicose Veins, or ‘Catholic Converter’ for Catalytic Converter.
Barriers To Communication
Minimise any Barriers to Communication. Try a variety of approaches if the message is unclear.
Barriers such as being:
• Bored or Impatient
• Threatening or Use of Harsh Language
• Negating or Devaluation of an Individual
• Jumping to Conclusions
• Judgmental Approach or Unwanted Advice Arguing
• Distractions
• Interruptions
• Closed Questions
• Monosyllabic Answers
• Multiple or Overloading Questioning
• Mumbling
• Unspoken Unresolved Issues
MANAGEMENT UNIT 16
R: MANAGEMENT OF INTERPERSONAL RELATIONSHIPS WITH JUNIOR COLLEAGES
HAVE COPIES OF COMPLETED FORMS / REPORTS IN YOUR PORTFOLIO.
Describe and produce evidence, which illustrates how you create and enhance working
relationships within your team.
Your evidence would include:
q Meetings Agendas / Minutes.
q Witness Testimony from Colleagues / Team Members. (should cover all performance criteria)
q Records of Conversations / Discussions with individual Team Members.
q Copies of Memos / Directives to your Team.
q Details of any personal problems you may have helped a Team Member overcome.
1.1 ASSIGNMENT:
q Meetings Agendas / Minutes.
In order to create and enhance working relationships, there must at first be a starting point. This
usually is a meeting of those involved. It should be a minuted meeting in order to have the ‘Terms
of References’ and delegation of authority. It would also consist of
Review of Resources:
q Time
q People
q Money
And the effect that this would have on the organisation.
q Witness Testimony from Colleagues / Team Members
WITNESS STATEMENT
On the 19th May 2000, Mrs Smith called a meeting of all the managers to find out if there was
anything more that could be done to improve the quality of care and working conditions.
Mrs Smith took the views of all the Managers in order to get a clear view of the issues.
Ideas like:
q More Training and development
q Time off to a�end course
q More manager support for training and development
As a result an action plan was devised and each member of staff were invited to discuss their
training needs and devised training plans for each individual. Each individual had a manager to
oversee the training and the managers were themselves trained in order to meet the training
requirements.
As a result there was a decrease in sickness and absence and moral improved. Occupancy
increased as we improved our performance and reputation.
q Records of Conversations / Discussions with individual Team Members.
All minutes are recorded and are available in the Managers Office
q Copies of Memos / Directives to your Team.
All memos /directives are recorded and are available in the Managers Office
q Details of any personal problems you may have helped a Team Member overcome.
REFLECTIVE ACCOUNT
Sally came to me on 5th November 2000 and stated she was having difficulties with other staff and
felt that she should resign. I listened to her and it appeared to me that she was being a li�le too
sensitive about the problems and was under confident.
I then wrote about this in her personal file.
I first gave her a chance to change her shi� and she declined. I felt then it was an important
moment to ask A Senior Care to work with Sally closely, yet not to encroach on her. The Senior
Care gave positive feedback to Sally, praising her when it was appropriate and showing her the
right way to complete a procedure when she was wrong. She was careful not to admonish her, but
improve her performance.
I met with Sally again on the 1st December 2000 and asked her how she was ge�ing on. The
change was total, instead of negativity; she was keen to put the decorations up for Christmas and
get involved in activities to make Christmas a success for the clients. She was positive about the
future and was now considering NVQ Training.
Although more positive and outgoing, I am continuing for a few more months to monitor Sally to
prevent any backward steps, though I am very hopeful this will not happen.
S: ENHANCING PRODUCTIVE WORKING RELATIONSHIPS WITH ONES INDIVIDUAL
IMMEDIATE MANAGER.
1.1
ASSIGNMENT:
Examples of ideas / proposals you have made to your manager and how you presented them. This
should include topics such as:
q Organisational plans.
q Quality Issues.
q Personal Issues.
q Personnel Issues.
q Trust.
q Team working.
q Appraisals.
q Meetings.
q Appropriate decision-making.
q Moral Issues.
T: INTERPERSONAL CONFLICT MANAGEMENT
•Quality Assurance Charter.
•Disciplinary Forms.
•Responsibility and Authority.
•Management meeting.
•Appraisals.
•Grievance Procedure / Complaints Form.
•Staff Contracts.
•Risk Policy.
•Care Staff Meetings.
•Care Plans.
CARE PLANNING FORMAT GUIDANCE
GENERAL GUIDANCE
Keep problems within resolving or understanding capacity. Try not to have too many problems
on any individual at one time.
Some multiple difficulties can be seen as one problem, i.e. Challenging Behaviour may be
aggressive or abnormal behaviour, it may manifest itself in many ways, but in essence, is one
problem. An example file is available for perusal
It is worth remembering that if you have 4 problems per client, then in The Homes that is over 200
problems to manage!
LONG AND SHORT TERM PROBLEMS
These should be documented on the PROBLEM - PLAN form. The Problem should be identified
by a number, commencing with one, two, three, four
LONG AND SHORT TERM PROBLEMS
Ongoing descriptions of incidents and observations should be recorded on the same
INTERVENTION - EVALUATION form. It is acceptable to have a PROBLEM and on the same
Intervention - Evaluation form.
DAILY INFORMATION.
Information of use, comments, visits by family or others can be recorded in the EVENTS SHEET
CARE ASSESSMENT PLANNING FLOWCHART.
Please refer to this chart for understanding of how the process of care should work.
PERIODIC ASSESSMENT FORMS
Can be used in conjunction with the Care Planning
CARE ASSESSMENT PLANNING FLOW CHART
COMPLAINTS PROCEDURE
Clients or their representatives are encouraged to ask any member of staff for further information
on matters which they genuinely do not understand.
Occassionally, the response may not be seen to be adequate: in, which case it, is important to seek
an answer from the proprietor at the earliest possible time. The proprietor will then investigate the
circumstances and attempt to resolve the problem/s.
In the event of the problem/s being not satisfactorily resolved, the issue may be serious enough to
involve the registering authority.The client or his/her representative or the proprietor may make
representations to the authority.
The registering officer is:
The registering authority is:
Tel no:
In the event that it is felt the registering authority, there has not adequately dealt with the problem
are other agencies who can help. One of the following may be of value. You may if you desire,
seek advise from any other source.
Name Name
Unit16
ASSESSMENT
UNREALISTIC
ASSESSMENT
REVIEW
INTERVENTION
INAPPROPRIATE GOALS
EVALUATION
PARTIAL SUCCESS
FAIL
SUCCESS
INAPPROPRIATE
ASSESSMENT
ALL THAT CAN BE ACHIEVED
NO MORE NEED
TO BE DONE 229
Address1
Address
POLICY FOR ADMINISTRATION OF:
COMPLAINTS FORMS:
• All parts of all forms MUST be completed fully and sections commented on.
• If a section is not applicable then this has to be stated.
• All forms must be dated and signed correctly by involved persons.
• If more than ONE person is involved then you must request statements
from them
• Where a statement requires information or action, write what is expected and not other
information.
• Write ITEM No____/______ in the appropriate book and on the copy of the form.
• One copy to Appropriate file (Staff or Client) One Copy to Central File. If incident affects other
persons create a file for this purpose.
A note must be made in Nursing Notes and Handover notes.
Remember, if this is not done properly, the paperwork WILL be returned to you until all is
finalised.
Proper administration depends on your cooperation, if we fail to be accredited, you will loose
your bonus as agreed, even if you are not the cause of the errors, so it is up to you to focus on
colleagues who do not fulfil their responsibilities.
COMPLAINTS FORM
Place of incident where complaint originated (full address)
Time of complaint am/pm Date of complaint
The member of staff who was present at the time of the complaint should report to his/her senior
immediately.
Complainants name Mr / Mrs / Miss / Ms
Address
Tel no
Descrition of complaint
Situation prior to complaint being made
Any precipitating factors
Describe action taken at time of complaint
Name of staff or other person who became involved
Describe actions taken by staff, clients or other reasons to resolve the situation
JET LIMITED
PROVISIONAL / TEMPORARY CONTRACT
1ST : 13 weeks, 2nd : 13 weeks, 3rd : 13 weeks, 4th : 13 weeks
Under this 13-week contract you will be bound by the Policies and procedures of JET.
This also forms part of the full contract once a satisfactory 13-week period has been achieved and
a full contract issued. UNLESS further periods of temporary Contracts are needed to ensure
adequate levels of work.
All staff are employed on a 13 week Trial Period
At any time during this period, JET may terminate the Employment by giving notice. This may
also be related to the Disciplinary Policy which forms part of this contract.
No Holiday Allowance will be calculated in the 1st 13 week contract, although once a Full
Contract has been issued, Holiday entitlement will commence from that day.
The Pay You Will Receive Will Be: £546:98 per month
Your Hours Are: 38 per week.
As this position is salaried you are paid equal amounts per month plus any enhancements /
overtime due.
Please note, no enhancements are paid for weekends or Bank Holidays during the first 13 week
contract.
Any absences are deducted at the accepted equivalent hourly rate.
Any extra work done will be paid at the accepted equivalent hourly rate.
Statutory Sick Pay Conditions Apply.
I have read the JET Quality Procedures and will abide by them.
Signed: Date:
Signed: Date:
T: INTERPERSONAL CONFLICT MANAGEMENT
ASSIGNMENT:
What standards do you expect from the members of your team. List them and describe why they
are important to you. They can include items from an Organisational ‘list’ of standards, and
should include a reference to:
· Racism.
· Sexism.
· Personal Habits.
· Compliance with Organisational Values / Policies.
· Working Practices.
· Disability.
· Religious Practices.
· Ethical Practices.
· Inconsistency in Approach.
· Sources of Abuse.
U: INTERPERSONAL CONFLICT MANAGEMENT cont……
1.1 ASSIGNMENT:
Provide an example of when you have intervened in an issue of Personal Conflict. How did you
tackle this and overcome it?
PROVIDE AN EXAMPLE OF WHEN YOU HAVE INTERVENED IN AN ISSUE OF PERSONAL
CONFLICT.
I was approached by one member of staff who was unhappy about her working relations with two
other members of staff who were working together on the same shi� as her.
The Care Staff felt that the other two members of staff were leaving her to shoulder most of the
a�ernoon’s tasks, while they were si�ing around cha�ing.
A�er a long discussion with the employee and a discussion with the employee and a discussion to
monitor the situation, to establish whether there was any evidence of the complaint being of a
valid nature.
A�er observing the situation it was decided that yes there was a problem, although slightly
exaggerated on behalf of the employee who made the complaint.
Taking into consideration that both the other employees where a lot younger and where relatively
new members of staff and they both mixed socially out of working hours. It was decided to
separate them to see whether their work performance improved, which was the case.
Both worked well when not in each others company.
A solution to the problem (action). Further to the employee who made the complaint and further
discussions with her, it was noted that she had several underlying problems herself, due to a
personal nature and apart from solving the initial problem her own personal morale was not intact
due to problems she herself was experimenting outside of the workplace. Results were reported to
the Person in Charge.
V: DISCIPLINARY AND GREIVANCE ACTIVITY
q Grievance Procedure
q Disciplinary Regulations
q Disciplinary Notice
q Staff Improvement Advice Form
q Instant Dismissal Regulations
q Complaints Form and Procedures
q Witness Testimony
SICKNESS AND INJURY: Statutory Sick Pay / You must make your own arrangements regarding
being unable to work.
PENSIONS AND PENSION SCHEME: Employers contribution at discretion of company a�er
satisfactory period of employment.
DISCIPLINARY RULES
A copy of the Disciplinary Rules relating to this employment is a�ached, and is posted for
inspection in the Procedure File.
If you are dissatisfied by any disciplinary decision you should raise the matter verbally or in
writing with :
GRIEVANCE PROCEDURE.
If you have any grievance relating to your employment you should raise the matter in writing
with Person in Charge, who will discuss the complaint or grievance with you and will then make
a decision in writing which will be delivered to you under a confidential cover.
If you are dissatisfied in any way with the decision of him / her upon your grievance you may
appeal in writing within 14 days to _____________ whose decision will be final and binding.
If you decide to appeal, a copy must also be delivered at the time to the person in charge who was
involved with the initial grievance.
I confirm that I have read and understood this document.
Signature:
Date:
I have received copies of the Disciplinary Rules and Acceptance of Gifts Form. A signed duplicate
of these will be held in your file. They are also available from the Procedures File In the Nursing
Office.
Signature:
1.2 ASSIGNMENT
Provide an example of a case where a member of your team has discussed a grievance with you:
· What did you do to Resolve the Situation?
· What Actions did you take?
· How did you manage to maintain a Non-Bias approach?
· How did you manage to determine the Truth?
· How did you maintain confidentiality?
· How did you manage the Emotions?
· How did you maintain Staff Morale?
· Did the Outcome match the Need, why?
COUNSELLING
Counselling is an integral part of any Home’s activities, which includes Appraisal. It plays an
important part of the day to day workings of a Home, and as such it is treated in this section as an
issue in its own right. Much Counselling is done on a day to day basis in the form of advice,
information or in conversation. Sometimes it is stated in mild tones of conversation and
sometimes it is demonstrated as being overt and has stark clarity. In many cases advice given may
be an indication of how the employee is viewed by their Managers and peers. In some
circumstances, Counselling is done on a more formal basis, either as a group or on a one to one
basis, such as in a disciplinary situation, Training session or information distribution.
In the Appraisal, once the overview of performance is reviewed and agreed by Managers, there is
an interview at an appropriate time and place in a generally formal setting. Rarely is an Appraisal
full of positive aspects or negative comment, usually it is a mix of both. There will be an element
of tension, anxiety and apprehension felt by the employee, who may know their Strengths and
Weaknesses prior to the Appraisal. The Assessor, who has to treat the Appraisal fairly, with
comments that may both enhance performance and diminish any Weaknesses of the employee
may be anxious that they have got the balance right. There may be a good working relationship
between the two of them, which may make the Assessor anxious about discussing the negative
aspects. So both parties may have apprehensions. The important point is that the Appraisal is an
accurate description and overview of the performance of the employee, which is accepted by both
parties as a fair and true account.
Always be Honest, Dependable and Reliable
Purpose of Counselling
Counselling is required to review the employee against their work requirement, performance in
the workplace and against their Job Description to see if they have attained a satisfactory level of
achievement in all the relevant departments, and then looking forward to future advancement and
improvement. The outcome should be an agreed statement of the employee’s contribution to the
Home and their future development. Both positive and negative features should be weighed
equally so that a fair, equitable and balanced view of their performance can be elicited.
Counselling should improve the overall performance of the employee by the skills used by the
Counsellor in the process.
FACTORS INFLUENCING COUNSELLING
TACTICS
Different situations may require a variety of strategies in order to achieve the required outcome.
Most situations may be really uncomplicated and relatively simple to carry out, the employee and
Counsellor have an agreed time, date and venue to meet and a Counselling session takes place. It
may be that the session is not too formal, with tea and biscuits as a sign of a relaxed interview. It
may be necessary to include a box of Kleenex if an issue raised causes an emotional reaction.
Occasionally, counselling is not that easy, and as such tension rises as the need to resolve a
situation becomes urgent. It may be necessary to take statements from other employees, clients,
other persons and / or the employee. This may take time due to the employee being off duty, on
holiday or sickness. The full weight of evidence must be in place before the Counselling session
commences. The date of interview may be decided and it may be made well in advance, in a
written letter, setting out the situation, the issues, the employee’s rights and any other relevant
information, together with the date to meet. There may be an air of tension and concern. Generally
it is be�er to resolve issues as soon as possible, and gain an agreed solution. A positive and
negative approach may be required in some situations (Carrot and Stick). The control of the
interview must remain with the Counsellor otherwise the authority of what is to be said and done
will be diminished, and the resolution of the issue may not take place.
HONESTY
It is always best to be honest as a Counsellor. If the Counsellor comes across as being less than
honest with the employee, they will loose confidence in their ability to trust what is said, however
there is no value in being brutally honest as this may be counter productive. To tell an employee
that they are totally unsuited to the job may be honest, but that in part may be due to the lack of or
poor Training, neglect of proper Induction and / or interest in the employee. It may be better to
accept the employee’s limitations honestly, then look at the reasons for failure and plan a better
future. Honesty should be balanced and thought through. Keep the process to the same standard.
Do not apply that standard selectively and appear to have favourites, as having favourite
employees will dent the Counsellor’s credibility of being the Honest Broker. Keep the
confidentiality of what is said within the defined range of people who ‘need to know’ about the
Counselling and its outcome and under no circumstances allow others outside this group to know
what the problem or issue is and do not discuss the outcome.
FAIRNESS
The employee must be allowed to have a fair hearing. Any feeling of bias against them will only
serve to make their ability improvement more difficult and may cause a lowering of morale. If the
Counselling is seen to be fair then the employee will be able to feel reassured that any weak points
can be worked on and improved. Fairness is also about balance, so a weakness can be balanced
with a Strength, e.g. an average employee may not be seen as a star, but their sickness record may
be very good and therefore the balance is that the good sickness record counters an average
performance; a high flier with great skills and flair may be told that whilst these features are
commendable, measured against their sickness record, the overall performance was average.
LISTENING
Whilst much of the Counselling can be in the form of advice, guidance and comment, there will be
periods of listening required, e.g. when justification by the employee of why a certain situation or
issue was dealt with and why the outcome caused benefit or concern. Interruption or ignoring the
points raised may cause genuine frustration and cause any required improvement to fail. Eye to
eye contact is important, with the recipient body language and reflection on issues discussed.
EMPATHY
Empathy has real value in difficult situations, where personal factors have influence on why an
employee has not fulfilled their work based requirements. It allows the Counsellor to understand
the employee’s difficulties and communicates that to them, but also takes an overall view of the
situation and looks to find agreed resolutions. It takes all relevant factors into consideration and
can be seen as being fair and unbiased. Other employees can then see the reasons for actions and
as long as the situation does not require an open ended commitment, will accept the Counsellor’s
extra help and guidance to an employee in difficult circumstances. If the commitment is open
ended, then the other employees will see any help as a bonus which they are not party to and this
eventually will cause bad feeling and reduce performance, job satisfaction and morale.
ISSUES RAISED
It is important for a Counsellor to keep to each issue and not be sidetracked. If there are problems
then those should be identified and acted on. If the employee tries to involve others or deflect
criticism by adding irrelevant facts or information then the Counsellor must bring the employee
back to the point of issue and stay with this issue until it is discussed and talked through, until it is
understood and resolved. Also Counsellors should not loose sight of the objectives of Counselling,
that is to gain improvement of Weaknesses by discussing areas of concern whilst promoting
development and praising good practice. Do not dwell on issues that are peripheral and
marginally relevant, whilst spending no time on and gliding over important issues. The input of
what is said should be relative to the need to say it. The issues raised may take more than one
session, if so; plan them where possible, deal with each issue and seek a resolution on each one,
seek targets for improvements and diary further sessions.
POOR COUNSELLING
The Counsellor who fails to apply their role adequately makes a rod for their own back as they do
not gain a better performance from their employee and may also lower morale at the same time.
Where a Counselling session has gone wrong then advice should be sought from a Senior
Manager, or the situation brought back to the Management Meeting for discussion, to find ways to
move the situation forward and prevent a repetition of any untoward situation happening again.
If the evidence for particular issues was inadequate and poorly thought through, or some
information was biased with conjecture rather than fact, further efforts to find accurate evidence
should be made, and at the same time a resolution of the problem should be sought. Did other
employees back up their verbal complaints, were they prepared to formally write and complain,
or were they just moaning or harbouring a grudge. A reassessment of the situation may be
required, a different approach may be needed with some practical advice included, e.g. there may
be a need for someone to seek medical advice, Citizens Advice Bureau or other specialists due to
personal reasons. The Counsellor may need a further Counselling course to update their skills.
SYMPATHY
Sympathy is unhelpful to a Counselling session. It clouds the real issues and pulls the Counsellor
from a work based review to a employee centred situation. This can cause dilemmas that will
ultimately fail to resolve issues because in order to achieve a resolution of any situation, there
must be fairness. The danger of sympathy in any situation is that decisions may be based on
emotional involvement and not a practical work centred resolution. The Counsellor may become
emotionally involved and try to help beyond their ability or responsibility to do so. In this
situation they leave themselves open to complaint, can be seen to be helpful for the wrong
reasons, or cloud their judgement eventually failing the person they are trying to help, failing
other employees whose time could have been used more effectively and failing the Home, its
Managers, clients and reputation. See Mental Mechanism on Transference below.
SUPPORT
This is important when the Counsellor wants to improve the performance of the employee and
makes positive actions or words that communicate that they are behind the employee and will
support them to achieve a better performance. Body Language such as leaning forward to appear
more attentive and interested, nodding of head, or facial expression may be signs of support.
Developmental
Helps employees confront and deal with specific developmental tasks in their employment.
Allows them to map out their vision of where they want to be within the Home’s structure.
Allows them to be able to show self awareness.
Problem Focused
Helps employees overcome problems, and learn to adapt their coping mechanisms to master their
specific problems.
Decision Making
Helps employees make specific decisions, which they need to make, though may not make
without input.
Crisis Interviews
Helps employees who feel overwhelmed and are having difficulty coping. They are often highly
emotional, and the Counsellor works on them getting over the worst of the crisis, so getting them
back on course to give the work effort.
Using Good Counselling Skills
The way MANAGERS treat people affects their behaviour.
The ability to Communicate well affects working relationships, builds morale, improves care and
makes work time more effective. Effective Counselling occurs through a variety of means and
methods. Always use language that is best suited to the employee. Speaking, listening, feedback
and actions affect everything the Manager does to improve performance. Here are some desired
effects:
• provide proper Input
• show concern
• show interest in what the employee does
• reduces conflict
• reports observations
• gives direction
• follows direction
• learns by listening and hearing
• sends accurate messages
• explains procedures
P: WORK ORGANISATION AND EVALUATION
1.1 Evidence provided in this unit and previous Units should be sufficient to cover this element
• Copies of completed Work Routines
• Witness Testimony
• Minutes of meetings
Where deficient use key forms to meet standards
1.2
ASSIGNMENT
Show how you can influence Work Practice, negotiating with senior and junior staff
How would you gauge its effectiveness
Work practice can be influenced by many factors:
• Training Communications And Counselling
• Shift Group Meetings
• Employee Meetings
• Monthly Management Meetings
• Target Group Meetings
• Individual Meetings
• Ãd-Hõc Meetings
• Written Word
All of these have been explained above.
Q: WORK PERFORMANCE FEEDBACK – INDIVIDUAL AND TEAM
Evidence previously supplied in this and previous units should be sufficient to cover this topic.
1.1
ASSIGNMENT
Detail all relevant forms and procedures and discuss their relevance and value.
State where you agree or disagree with their true value. Be Objective.
All relevant forms described above have been devised for a reason, mainly to achieve an outcome
that will make care safer and more efficient, whilst aiding managers to do their jobs properly.
Issues such as Health and safety, Fire, Manual Handling and Food Hygiene are relevant to a safe
home and also applicable to legislation, which means if the Home does not meet Regulations,
enforcement actions can be taken. Further in a more ligitimous society, the Home Owner is likely
to be sued by clients and staff if something untoward happens, further; there are Unfair Dismissal
Courts, effects on Insurance and Coroners Courts in the case of a death and also the Health and
Safety Executive may investigate any accident. Yes although increasing paperwork is a nuisance, it
can protect Home Owners and managers.
W: INFORMATION AND MANAGEMENT CONTROL
1.1
Record of Referrals
• Pre-Admission Assessment
• Initial Assessment Forms
• Client Admission / Discharge Procedure
• Admission / Discharge Checklist
• Client Personal Profile
• Clients Event Sheet
• Clients Care Plan
• Clients Evaluation Sheet
• Document and Data Control
• Clients Recreational programme
• Home Maintenance Form
• Management Meetings
• Care Staff Meetings
• Other Meetings
• Appraisals
1.2 ASSIGNMENT
Describe how the information on the documentation is collected, analysed and stored
RECEIVING, TRANSMITING, STORING AND RETRIEVING INFORMATION
RECEIVE AND TRANSMIT INFORMATION
All information received must be accurately recorded, and be current, relevant, legible and
complete.
Transmission of information can also mean verbal and / or non-verbal information. This can
include diagrams and pictures, coded messages, signals as well as written text.
The telephone should be answered within six rings; there is a telephone message book to record
messages for individuals who are not available, and a telephone system that can access other
workstations. There is a fax machine and e-mail address where messages may be sent. Any
message should be sent to the appropriate person as soon as possible. Urgent messages may mean
the need to telephone someone off duty and at home.
Information required should be firstly being checked to see if there is a confidentiality issue, either
for the client, employee, the Home or other party. Once that is checked, the information is either in
the public domain and can be posted, faxed, emailed or manually give to an outside party, or if
confidential, have ‘Private and Confidential’ written on the envelope and documents sent. Some
documentation may be taped with sellotape or masking tape, or have string around the outside to
prevent unauthorised access, or have a label ‘Fragile’ on it to ensure its safe passage. In specific
cases it can be sent by parcel post and / or by recorded delivery.
The speed of delivery for outside agencies and others will reflect the urgency of the documents
being moved. In most cases it is as soon as possible or practical, others it will be an agreed time
scale.
Confidential information should not be sent out or given out unless the person receiving the
information is authorised to have such information. An example would be for a GP to have access
to clients medication records stored in the Home, to enable them to prescribe new medication or
increase existing medication. The same access would be denied to a medical sales representative
who has no right to see client confidential information, but could see a blank medication record.
When a confidential document, letter or parcel does not arrive on time, a check should be done to
make sure it has not been placed in an obvious or not obvious place. It should be reported
immediately to the sender and to anyone else who may be involved. A time period may be agreed
for action, as there is always a possibility that
it may be delayed in the post. If a fax or e-mail, the document should carry a disclaimer that the
information is private and confidential and should be sent back to the sender. The sender may
wish to send a non confidential piece of paper to confirm fax address and then resend the
document. CD-ROM’s, other computer software, Video Tape and / or Cassette Tape may be
insured for loss or damage. Many documents have to be signed by an appropriate person, dated
to confirm that they have been received
All records, employee, client, suppliers, the Homes Policies and Procedures and other information
should be identified as to what they are, i.e. Care notes with the clients name and details on.
STORAGE AND RETRIEVING RECORDS
Care Plans that are taken to outpatient appointments with a client must be related to the client
having the Out Patient Appointment, and no one else.
The Care Plans and the client must get to the outpatient appointment at the notified time of
appointment. When the client, care and care notes return to the Home, the care notes should be
put into the appropriate place once they have been returned. The information on the records must
be legible and complete and accurate.
Any written comment in those records must reflect accurately the situation and at each stage of
inputting information and should be legible, signed and dated.
Some bloods and medications need monitoring by the local hospital, often bloods are taken and
have to be with the hospital by a specific time, otherwise the test done are inaccurate, it is very
important to send bloods to get to the hospital on time.
All documents are stored according to legal, organisational and ethical standards. Some
information, i.e. Menus, can be stored and displayed in a kitchen or dining area.
Any individual accidental or deliberate leaving of confidential information in an uncontrolled area
will be reported to the Person in Charge and may be subjected to the Homes Disciplinary Policy or
legal sanction. Documentation, such as care plans, medication sheets, employee files need to be
stored in locked cupboards in locked rooms to deny access to those who have no right to the
information.
X: INFORMATION AND ADVICE DISSEMINATION
Evidence found in this and other units. Where evidence is not found, use key forms to meet
criteria.