The Importance of First Aid

Introduction

First aid refers to basic medical emergency care and treatment to assist in minimizing the consequences of more serious injury or illness until medical health assistance is available.

First aid training is a mandatory requirement of The Health and Safety (First-Aid) Regulations 1981. It is important that managers look at the first aid training course for staff to ensure that it meets with CQC Fundamental Standards of quality and safety.

Training

Managers must be on the ball as staff will need to attend first aid training every 3 years. You will also need suitable numbers of staff qualified in first aid in proportion to the significance of health and safety risks of your service.

It is the manager’s responsibility to arrange training that equips staff with the skills to deal with situations that might require first aid treatment. As part of the training, your staff should be equipped to give first aid to people with specific medical requirements also.

It’s good practice to have a first aid trainer if possible to support, deliver and assist in coordinating staff with their first aid training.

When staff are initially employed, first aid principals should be covered as part of their induction.
The service must keep a record of all staff that have received first aid training and a schedule of planned training for staff first aid. The CQC or Local Authority Contracts Visitor may ask to see training records to ensure you are meeting regulatory requirements.

Delivering First Aid

Staff should have read and understood the services first aid policy and:

When staff are giving care, a first aid box should be available so that staff can have access to use the right equipment in the treatment of injuries.

Both staff and service users can suffer injuries or be taken ill. Both must be given immediate attention. In serious cases, an ambulance must be called. Arrangements should be made to make sure this happens.

This can save lives and prevent a minor crisis becoming a major crisis or even save lives.

As part of the Accident Incident Near miss procedure, staff should understand their responsibilities in relation to the managing and reporting of an accident, an incident or a near miss.

The manager should examine the services first aid policy annually for its ongoing suitability.

Summary

Managers need to manage all aspects of first aid training which will equip staff with the
skills to give a rapid first response in the event of an accident, injury or illness.

Skilled staff who are first aiders are a valuable asset as they will be equipped to manage incidents that occur with service users and other staff members and ensure that beyond their first aid response, will request the assistance of other medical professionals to give further treatment and care in an emergency.

Stuart Cook
Company Director
Bettal Quality Consultancy

NICE guidelines managing medicines for adults receiving social care in the community

In this weeks blog I want to draw to providers of community care services, the NICE guidance on Managing medicines for adults receiving social care in the community. The guidance was published in March 2017.

This guideline covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing if people need help with managing their medicines, who should provide medicines support and how health and social care staff should work together.

Assessing and reviewing a person’s medicines support needs

Many people want to actively participate in their own care. Enabling and supporting people to manage their medicines is an essential part of this, with help from family members or carers if needed. The term ‘medicines support’ is defined as any support that enables a person to manage their medicines. This varies for different people depending on their specific needs.

When carrying out an assessment of a Service Users needs staff should:
• Assess a person’s medicines support needs as part of the overall assessment of their needs and preferences for care and treatment.
• Do not take responsibility for managing a person’s medicines unless the overall assessment indicates the need to do so, and this has been agreed as part of local governance arrangements.
• Ensure that people assessing a person’s medicines support needs (for example, social workers) have the necessary knowledge, skills and experience.
• Engage with the person (and their family members or carers if this has been agreed with the person) when assessing a person’s medicines support needs. Focus on how the person can be supported to manage their own medicines, taking into account:
• The person’s needs and preferences, including their social, cultural, emotional, religious and spiritual needs.
• The person’s expectations for confidentiality and advance care planning.
• The person’s understanding of why they are taking their medicines.
• What they are able to do and what support is needed, for example, reading medicine labels, using inhalers or applying creams.
• How they currently manage their medicines, for example, how they order, store and take their medicines.
• Whether they have any problems taking their medicines, particularly if they are taking multiple medicines.
• Whether they have nutritional and hydration needs, including the need for nutritional supplements or parenteral nutrition.
• Who to contact about their medicines (ideally the person themselves, if they choose to and are able to, or a family member, carer or care coordinator).
• The time and resources likely to be needed.

Keeping a record

Staff are required to record the discussions and decisions about the person’s medicines support needs. If the person needs medicines support include the following information in the provider’s care plan:
• The person’s needs and preferences.
• The person’s expectations for confidentiality and advance care planning.
• How consent for decisions about medicines will be sought.
• Details of who to contact about their medicines (the person or a named contact).
• What support is needed for each medicine.
• How the medicines support will be given.
• Who will be responsible for providing medicines support, particularly when it is agreed that more than one care provider is involved.
• When the medicines support will be reviewed, for example, after 6 weeks.

Review

Service users medicines support should be reviewed to check whether it is meeting their needs and preferences. This should be carried out at the time specified in the provider’s care plan or sooner if there are changes in the person’s circumstances, such as:
• Changes to their medicines regime.
• A concern is raised.
• A hospital admission.
• A life event, such as a bereavement.

Joint working between health and social care

The guidance highlights the need for joint working that enables people to receive integrated, person-centred support. Health professionals working in primary and secondary care have an important role in advising and supporting care workers and other social care practitioners.
The guidance also covers:
• Sharing information about a person’s medicines.
• Ensuring that records are accurate and up to date.
• Managing concerns about medicines.
• Supporting people to take their medicines.
• Covert administration.
• Ordering and supplying medicines.
• Transporting, storing and disposing of medicines.
• Training and competency.

Summary

These are important guidelines that will need to be implemented by community care services. Managers will have to have policies and procedures in place that demonstrates that they are complying with this new guidance. The CQC will no doubt be looking for evidence of compliance in their inspections.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Prevention of Terrorism in care homes and domiciliary care services

Few of us cannot fail to be concerned about the terrorist attacks that have occurred in London and Manchester with loss of life and terrible family consequences. In the aftermath, the police and counter-terrorism organisations strive to understand the process of radicalisation that leads to people prepared to blow themselves up and inflict life changing circumstances on others.

In this blog it is my intention to bring to the attention of managers of care homes and domiciliary care services, the purpose of PREVENT in preventing radicalisation in the workplace.

What Is radicalisation? This is the act or process of making a person more radical or favouring of extreme or fundamental changes in political, economic or social conditions, institutions or habits of mind. Extremism is the holding of extreme political or religious views which may deny right to any group or individual. It can be expressed in vocal or active opposition to Core British values including:
• democracy
• the rule of law
• individual liberty
• respectful tolerance of different faiths or beliefs.

What is the Prevent strategy
The Counter Terrorism and Security Act 2015 and The Prevent strategy published by the Government in 2011 places responsibilities upon public services to address the potential for vulnerable people to become radicalised by others and as such they are at risk of being drawn into terrorism.

Prevent has 3 national objectives:
Objective 1: respond to the ideological challenge of terrorism and the threat we face from those who promote it.
Objective 2: prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support.
Objective 3: work with sectors and institutions where there are risks of
radicalisation may occur and needs to be addressed.

As a public service care home and domiciliary care managers are responsible for:
• Arranging for staff to attend the Prevent / Health WRAP training as required.
• Supporting staff with the processes to escalate a concern.
• Facilitating the appropriate escalation of PREVENT concerns.
• Liaising with Local Safeguarding Board if the concern raised is about a member of staff.

All Staff are responsible for:
• Attending the required PREVENT Training relevant to their role.
• Reporting all PREVENT related concerns to the Manager.
• Assisting the manager in appropriate escalation.

Radicalisation is a process not an event, and there is no single route or pathway to radicalisation. Evidence indicates that those targeted by radicalisers may have doubts about what they are doing. It is because of this doubt that frontline care home and domiciliary care staff need to have mechanisms and interventions in place to support an individual being exploited and to help them move away from terrorist activity.

The factors surrounding exploitation are many and they are unique for each person. The increasing body of information indicates that factors thought to relate to personal experiences of vulnerable individuals affect the way in which they relate to their external environment.

In this sense, vulnerable individuals may be exploited in many ways by radicalisers who target the vagaries of their vulnerability. Contact with radicalisers is also variable and can take a direct form, i.e. face to face, or can happen indirectly through the internet, social networking or other media. More commonly this will occur through a combination of the above.

Signs that may cause concern:
• Staff talking about exposure to extremist materials
• Changes in behaviour, e.g. becoming isolated
• Changes in attitude, e.g. intolerant of differences/ having a closed mind
• Asking questions about certain topics (e.g. connected to extremism)
• Offering opinions that appear to have come from extremist ideologies
• Attempts to impose own views/ beliefs on others
• Use of extremist vocabulary to exclude others or incite violence
• Accessing extremist material online or via social network sites
• Overt new religious practices
• Staff voicing concerns about anyone.

Understanding risk of extremism
• Staff, who already have extremist views. Or, whilst attending work may be influenced by a range of factors: global events, peer pressure, media, family views, extremist materials (hardcopy or online), inspirational speakers, friends or relatives being harmed, social networks, and more
• People who are vulnerable are more likely to be influenced
• Their vulnerability could stem from a range of causes, including: loss of identity or sense of belonging, isolation, exclusion, mental health problems, sense of injustice, personal crisis, victim of hate crime or discrimination, and bereavement.

Summary
Recent terrorist events have shown how important it is for all of us to recognise the signs of radicalisation in the workplace. The PREVENT strategy places responsibilities upon public services to address the potential for vulnerable people to become radicalised by others. Bettal Quality Consultancy have produced a policy on the prevention of radicalisation which is designed to enable managers of care homes and domiciliary care services to gain an understanding of radicalization, and carry out their responsibilities under the PREVENT strategy.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Identifying the attributes of a good quality care home

Registered managers of care homes are continually faced with the challenge of demonstrating to the Care Quality Commission that they are running a good quality care home. This represents no easy task in a world where according to CQC so many providers are still failing to achieve this grade. 

Andrea Sutcliffe Head of the Care Quality Commission discussing quality of care, is quoted as saying: “It’s about people’s whole lives, so we do need to be making it human, making it personal.”

Service users who live in care homes cannot rely on regulators alone to ensure they receive the high-quality service they deserve; it is ultimately the responsibility of those charged with the responsibility providing the care.

Regulators have a single focus; care home compliance with regulations and standards. They search for evidence, their role is not to provide advice on how the manager runs the service. The manager on the other hand must demonstrate service quality to regulators, but to current users of the service and potential service users, if they are to stay in business.

In many ways, however the registered manager and the regulator are both striving for the same goal, a quality service for those who use the service of the care home.

Researching into the attributes of a good quality care home reveals that there are no surprises, and I believe they are all known to registered managers. As a former principal inspector, I would expect to find the following attributes:

Culture and Values
The culture of the care home is crucial. It must be promoted at all times by the manager and senior staff. It must reflect the fundamentals of integrity, honesty, mutual respect and humanity in relation to service users and staff. Promoted through induction, staff training, supervision, policies and procedures.

Qualities of the manager
The success of the care home flows from the skills, knowledge and understanding of care by the registered manager. Managers need to be:
• confident, empathetic, energetic, capable and kind
• lead and be respected by staff
• have a clear understanding of own accountability and their staff’s
• know where and when to ask for help, and be fully supported practically and emotionally.

Kind caring staff
Staff in a good care home are its heart and carry out their role in line with its values. They must be respected, supported, well trained, treated well and valued. Their emotional as well as employment needs should be recognised and understood.

Service users speak highly of their kindness and the way the service is delivered in a professional manner within a homely atmosphere.

Clarity of purpose
Good care homes have a single clarity of purpose, that is to deliver quality of care that is underpinned by a quality management system (Policies and Procedures) that enables staff to have a clear understanding of what is expected of them, and how to achieve it.

Person centred approach
Staff of good care homes should provide care in a person centered way recognising the individuality of the person. Person centred care planning involves the person, their families where appropriate and not only takes account of their needs, but their preferences and choices. Health and wellbeing goals are set and reviewed to ascertain achievement and progress.

Engagement
Good care homes are engaged with their community. The local community takes responsibility to and encourages, cherishes and supports. Good care homes are welcoming places to visit.

A range of activities
A good care home can be characterised by the range of activities that are provided. People are supported to attend activities of their choosing. They are enthusiastic about the activities and the opportunities made available to them and feel they have plenty to do. The care home should have links with the local community and people are encouraged to be citizens in their own community.

Working with the health community
Good care homes have good relationships with the local health community – GPs, district nurses, hospital consultants. They have respect for each other and work together to find solutions with the person at the centre.

Working with relatives
Relatives are confident in the values of the care home. They feel they can challenge when needed and to thank management and staff. They know they can let the staff do their job with confidence. They are prepared to give feedback on the quality of the care home and suggestions for improvement.

Summary
All registered managers will have as a central goal the grading of a good care home or even an outstanding care home, by the Care Quality Commission. Research has shown that the adoption and commitment to the attributes covered in this blog will go some way to achievement of their goal.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy