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Develop Procedures and Practice to respond to Concerns

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Outcome 1
Understand the regulatory requirements, codes of practice and relevant guidance for managing concerns and complaints

1.1 Identify the regulatory requirements, codes of practice and relevant guidance for managing concerns and complaints in own home We have to follow many guidelines within my home.
The main ones are as follows:
National minimum care standards for children’s homes.
OFSTED requirements.
Every child matters.
Step aside policies and procedures.
The complaints policy for Step aside Care outlines the following aims: To resolve concerns / complaints as quickly and effectively as possible, through an informal response by a frontline member of staff. If this is not possible then through a more formal investigation and conciliation in an open and non-defensive way to ensure that all concerns / complaints are dealt with in accordance with these procedures. To ensure that staff, young people and relatives/carers are aware of the policy and procedure. To improve quality of service by identifying lessons learned from complaints locally and nationally and by implementing improvements in service using the lessons learnt. To uphold even-handedness for both staff and complainant alike. To help all health professionals to feel they can be open in their communications with staff, young people relatives etc whenever mistakes are made and to not be reluctant to apologise.

Within our young peoples and staff complaint policy it states that what our expectations on how complaints will be dealt with. It states:Please be assured that any complaint you make will be taken seriously and handled sensitively and efficiently. An initial acknowledgement will be received within 3 working days and a full written response, following a thorough investigation, will be sent within 20 working days. If for any reason this cannot be achieved then you will receive written communication informing you of this. In the first instance we would encourage you to speak to the Home Manager to hopefully resolve the matter quickly. If this is not appropriate for any reason then please contact their line manager. The name and contact details of the director appropriate for this home is available in the complaints procedure along with stamped addressed envelopes. 1.2 Analyse how regulatory requirements, codes of practice and relevant guidance for managing concerns and complaints affect service provision within own area of work.

By ensuring we have a robust and efficient complaints procedure in the home we are giving young people and their families the confidence that we try and do everything right the first time, but that, should we not achieve this, then there are avenues in which relatives or visitors are able to complain about the function of home or an issue relating to company. The guidance that is in place is in line with more national guidelines regarding complaints. For example the complaints procedure that step a side Care have adopted is very similar to that in the NHS whereby time frame are set out and rights are protected for all parties. The fact that there are regulatory requirements also means that each complaint is dealt with in the same way and there are standards for the investigators of a complaint to abide by. A complainant can feel secure in the knowledge that, in line with guidance, they will not be unnecessarily discriminated against for the fact they have complained and they have clear rights which protect them from any stigma.

Having clear set guidelines also enable the investigators and those implicated in the complaint to understand their expectations of the process and feel more comfortable that things are being carried out in a procedural manner When I myself have had to respond to a complaint I am able to structure my work around the time frames given. So I may organise my diary in a way that incorporates time for meetings, gathering of data and time to write a letter of response or a holding letter. The outcome of a complaint or concern may directly benefit the service provision by leading to changes in policies or procedures or by changing the way care is provided for an individual or a group of people. It may also identify additional training needs for staff members which weren’t previously apparent.

Outcome 2
Be able to develop procedures to address concerns and complaints
2.1 Explain why individuals might be reluctant to raise concerns and make complaints In a care home setting a relative may feel like they are putting their loved one (service user) at risk of further maltreatment or prejudicial treatment if they complain. They might fear that they will be identified as being the one whom complained and then, as a result, that the young person might be the target of a rebellious staff members emotional response. Conversely, a lot of relatives see how hard the staff are working and feel that they don’t want to complain because they sympathise with the difficult job that the carers have to carry out, so they might feel like they are being ungrateful for the care their loved one receives. A relative might also not be aware that they can complain (although this is in the welcome back and checked by social services and that it has been given) or might not know what the expectation are for the care of their loved one.

They may assume that what has given them cause for concern is the norm and that in complaining they will be told ‘that is just the way it is’. A relative might not think their concern or complaint will be taken seriously or be dealt with professionally, they might have little faith in the management of a home or think that they will be alienated as a result of complaining. Staff who are the subject of complaints or concerns may experience anxiety and stress. Line Managers are expected to support their staff through traumatic and stressful situations; offering immediate support following a stressful event. Line managers need to provide a supportive style of management and be fully aware of the action to take if one of their staff members is experiencing difficulties. They need to be confident of seeking advice from senior managers and directors and to know that they can refer a member of staff to occupational health and confidential staff counselling service when greater levels of support are deemed necessary.

Step a side Care states that it will ensure that such staff are supported and that they have access to appropriate advice and support. It is important to ensure that: Information regarding staff involvement in a complaint is only provided on a need to know basis. That staff mentioned in the complaint are advised of the content, progress and outcome of the complaint by their line managers within the correct protocols. There is a clear separation of the complaints procedure from the disciplinary procedure. Staff are supported by their line managers and colleagues. 2.2 Outline steps that can be taken to encourage individuals to raise concerns and complaints Providing easily accessible standards of care in the form of leaflets or within the welcome pack will help relatives and young people to identify the standards to be expected and then they can better identify whether they feel that these standards are not being met. An open door policy should be adopted by management.

I always ensure I am available at any time by either email, post phone call or face to face contact to relatives and visitors and that they can approach me with one off questions or arrange a more formal setting by means of an appointment. I encourage staff to actively seek feedback in the form of checking with young people and their relatives if everything is ok and is there anything additional that could be done to ensure that a young person of the home is comfortable and happy and well cared for. Furthermore, correctly handling complaints and showing that we respond to feedback by advertising our feedback and demonstrating the actions we took, this instils confidence in other young people and relatives. They may not have faith in the response they will get from a complaint but by making the feedback book a publicly accessible document then they can see hard examples of when a complaint or concern was received and exactly what was done about it. 2.3 Work with others in the development of procedures to address concerns and complaints It is easy to overlook certain areas of the home where things may be slipping below expected standards or perhaps staff have become complacent.

Through regular staff meeting and supervision I can ascertain staff opinions on what their observations are of the way the home is running and any areas that need extra care or attention. I also encourage the staff to come and see me with their concerns and complaints and my line manager adopts the same policy with myself. They may see a lot more of a certain area of the home and can bring things to my attention before I notice it myself. By going to senior management meetings and my own supervisions I am able to share and discuss the types of concerns that are being raised by other staff members and explore why these have come about.

It may be that I can take information back from these meetings to apply in my own area of work with the home, thus avoiding further complaints being put in at the home. I encourage feedback from other professionals and will actively seek feedback through a telephone call or in person. Particularly if a professional has visited whilst I have been absent, I may contact them to see how they found the staff in the home, were they able to access the information they required and is there anything they can recommend we put in place at our home based on their area of expertise?

2.4 Ensure information on how to raise concerns and make complaints is available in acceptable formats In my home I have made sure that all service users and visitors are made aware that they are welcome and encouraged to give feedback whenever they feel that it is necessary. They do not have to wait till a review of the young person’s care, until the young person’s key worker is on shift, or until I am in the home although social workers sometimes prefer to speak with the child’s key person. They can leave me a message, write me a letter/email or speak to my line manager or a director of the company team, in my absence. I have included a section in the ‘Welcome Pack’ specifically on complaints and how to go about making a formal complaint should the need arise. Once an individual makes a complaint they will be written to immediately, acknowledging receipt of the complaint and a time frame for certain feedback. There is a telephone number for my manager, the director responsible for the home, so that if the complaint is about me or they do not feel I can deal with it, then they can seek support from higher management line.

There is also a copy of expected standards of care which gives young people and relatives a reference for what they should be expecting to receive within the home. In my experience as senior most relatives choose to arrange a time to informally discuss their concerns. Also, many of my staff find that they can usually sort a small problem as it occurs meaning that there is no need for it to be taken further into a formal complaint. In staff meetings I encourage the staff to think of new ways we can encourage feedback and ask them all to make sure they regularly check everything is going well and always offer to do more (within reason). In staff supervision I check that each member of staff knows what the expectations are of them as staff members (dependent on grade) and what is expected of the home as a whole, I ask them for examples of what they are doing that is in line with these expectations. Staff training needs to be up to date and I monitor this frequently in line with my manger and head office.

If a complaint relates to a certain member of staff’s conduct and I find that they have made a mistake or behaved in a certain way because they have not been trained otherwise then I will be asking questions about why training was not up to date and ensure it is a developmental point that is immediately addressed. 2.5 Review the procedures that have been developed against regulatory requirements, codes of practice and relevant guidance. Below are the regulatory requirement and what has been implemented in line with these requirements in our setting. ‘If you are unhappy with care or treatment you have received you have the right to: make a complaint; have that complaint investigated; and be given a full and prompt reply.’

In the ‘Welcome pack’ a quote from national minimum care standards about how complaints in included, this demonstrates that not only do we care about complaints and feedback that service users and visitors to the home have, but we are required and regulated to respond to them in a certain way. By law, all health and social care services must have a procedure for dealing efficiently with complaints. A flow chart of exactly how a complaint should be dealt with is within our policy on Concerns and Complaints. A copy of this is sent out with a holding letter that is written and sent to the complainant immediately after we receive a complaint. Ask the service you want to complain about for a copy of their complaints procedure. This will tell you who to contact, how they will handle your complaint and how they will learn from your complaint. ’

A copy of our complaints procedure was available to be viewed upon asking the manager for a copy. I have included this document within the ‘Welcome pack’ offered to young people and their relatives on their first day in the home. This encourages people to be forthcoming with their concerns and not fear the stigma associated with asking for the policy. You can make a complaint by email, letter, in person, or by phone. If you make a complaint by phone or in person, the service should give you a written copy of your complaint. I always ensure someone is present to take minutes when I hold a formal meeting with a complainant so that there is a written record of what is said. Furthermore, this means that both the complainant and I have a reference from which I can see what needs to be addressed and they can see what they have raised and what to expect a response to. It is usually a good idea to keep a record of what you said, who you said it to and what they said.

The service you complain to should let you know how long they think it will take to investigate your complaint and respond to you. I am usually able to provide a reasonable time frame estimation at the point of complaint, which will then be included in the holding letter. If I am unsure then I will consult with my manager or advise the complainant that it will be in their holding letter and they can use this to refer to when awaiting correspondence in relation to the investigation. If staff members are absent or there are a lot of staff involved then it will take longer to investigate, as time needs to be allowed to interview staff and take statements and follow correct protocols. Complaining can be a difficult experience. There are many organisations, including charities that can give you free support and advice on how to make a complaint. It is important to me that young people and their relatives are not afraid to give me feedback or raise their concerns with me. I want young people to feel at home and comfortable and if we are not achieving this then we are not achieving our standards of care. Be able to lead the implementation of procedures and practice for addressing concerns and complaints

3.1 Promote a person-centred approach to addressing concerns and complaints As every individuals care needs are different, so should the delivery of that Care be. Furthermore, one person’s standards and opinions will be different from anothers. We cannot expect everyone to adjust to an institutionalised way of living. It is important to me as senior that the home adapts and is flexible in its approach to each young person, not vice-versa. As such it is to be expected that, whilst our standards of care are set at a certain level, some individuals will expect more and some will expect less. Therefore, we may receive complaints from people who are used to doing things a certain way that we are perhaps not used to doing at the home. This will rarely be raised in the form of a complaint, but perhaps more as a concern regarding adapting an element of care to suit that person’s needs.

When I receive a complaint with regards to an individual’s care my first area of interest will be that individual’s care needs and the care plan that was established (or reviewed most recently) as being an accurate representation of the type of care that person should be receiving. I will then analyse the complaint in light of the agreed expectations to see how far the complaint has merit. Also I will speak to the relatives and the service user about how the complaint has come about and take any dates, names, or details which will assist me in generating a picture of how that person’s needs have not been met. 3.2 Ensure that others are informed about the procedure for raising concerns and complaints Not only are young people and relatives aware of how to complain and encouraged to complain by promoting the complaints procedure and encouraging feedback, the staff are also made aware of how they can complain themselves, either about one another or about the organisation, or anything about which they have concern.

They have a copy of the whistle blowing procedure as well as general complaints procedure in their staff handbook and they are made aware of the disciplinary procedure that they will be subject to should a complaint be received which involves them and serious misconduct. There is a comments box and a feedback book in the main reception of head office. This provides relatives and guests with an opportunity to provide feedback anonymously if they wish to. The comments book also means that everyone can read the comments in there. Meaning a prospective service user and their relatives could read this for an idea on the sorts of feedback and comments that we receive, in the home, from existing visitors. 3.3 Use supervision to support workers to recognise and address concerns and complaints In staff supervision and staff meeting we are able to discuss and practice the ways in which we seek out feedback and what we do with the information we receive. For example I encourage staff members to openly discuss comments they have received, whilst on shift, in the forum of a general staff meeting.

They can discuss how they responded and seek opinions from other staff members about the issue. It may be that one staff member has not had all the necessary information in order to deal with a concern or complaint and discussing it with their team members may mean they become better informed and are thus able to better deal with it in the future. Furthermore junior members of staff or new starters can hear from more experienced staff how they dealt with a complaint and learn from one another. In individual supervision sessions I will firstly ensure that a staff members training is up to date. Having fully trained staff is key to ensuring that standards are being met in that staff feel competent and knowledgeable about the care they are providing. I can also explore any areas that a member of staff might feel they need to re address.

3.4 Implement systems and procedures which address concerns and complaints and fully inform the complainant of the outcome within the agreed time frames Any concern or complaint should be dealt with efficiently and be investigated properly and appropriately. Verbal concerns or complaints should be responded to immediately if at all possible and an apology offered at the time, if appropriate. Be able to review the procedures and practices for addressing concerns and complaints 4.1 Monitor the use of systems for addressing concerns and complaints A standing item on the staff meeting minutes and the residents meeting minutes is Concerns and Complaints this is not only an opportunity to openly discuss recent concerns, but also a way in which we can gauge whether or not we are learning from our mistakes and whether or not young people and their relatives feel as though the way we are dealing with their concerns is effective and appropriate.

Within the young people’s house meeting we recently had it brought to our attention that a concern had been raised about the menu getting a bit repetitive and boring so each young person including a respite child added their choices to menu list to be implemented over next few weeks. As a result of this concern the menu was reviewed and revamped to include a new variety of dishes with the young peoples wishes. Whilst the young people could see that this had been implemented, by the fact that their menu choices were changed, they said they would like to know about the process of the change and have some input in to reviewing the food again in future. As such I implemented a weekly menu change in which staff members and young people get to choose what is on the menu expressing what was well liked on the menu and what is most disliked. They also look through food magazines, review and discuss meals that they liked when they was at home and meals they are able to cook for themselves.

All staff team members cook so key points of the meeting must be shared and implement the necessary changes. 4.2 Evaluate the effectiveness of systems for addressing concerns and complaints Based on my experience of handling complaints I have found that a step by step format has been both useful to me as an investigator for dealing with a complaint in a structured and unprejudiced way, but also effective for giving feedback to the complainant. My method answers the points raised in chronological order keeps to the facts. Refers to any policies/procedures/guidelines in use encourages the investigator to be systematic in their investigations. I feel that complaints should be risk rated. Risk rating all complaints will help identify trends and help to promote responsive actions to ensure any underlying causes are dealt with immediately e.g. safeguarding issues where possible suspension of staff is needed.

I think the company should ensure that all complaints are reviewed at the highest level of the organisation to identify learning opportunities for those departments directly involved in the complaint and the organisation as a whole. The complaints procedure in place in all step a side homes is effective because it is young person focused, makes us open and accountable, it ensures we act fairly and proportionately, it ensures we put things right and are seen to do so and it means we are continuously seeking to improve upon the service we deliver. 4.3 Involve others in the review of procedures and practice for addressing concerns and complaints A number of meetings/forums are facilitated to encourage discussion and reflection of the procedures and practice for addressing complaints, these are: Individual staff supervision, General staff meeting, Service user reviews Informal discussion on a one to one basis with relatives Feedback. Seniors meeting to discuss the types of concerns being raised in other homes and how they’re being dealt with.

Reviewing trends in complaints and writing reports to send to higher management Writing and publishing lessons learned in young person’s guides encouraging young people to give us feedback on the way we are dealing with their complaints. Once a complaint has been dealt with and closed we can ask the complainant for their feedback on the process, for example is there anything they would have liked to have seen done differently. Are they satisfied with the way in which the complaint was dealt with, do they think we have learned from our mistakes going forward. 4.4 Show how own management has provided a culture where the organisation can learn from concerns and complaints. During my time as a senior I have not had to deal with any formal complaints. However, I have promoted and encouraged a culture where we learn from past mistakes and are constantly improving upon the service we deliver.

I take any comments or suggestions made to team meetings to discuss. This involves everybody and demonstrates the need for staff to be constantly evaluating the effectiveness of the service we provide. We also have a model of in which staff are encouraged to carry out their own analysis of their conduct and score themselves in their appraisal. I ask them to comment on what they have done well and areas in which they wish to improve or mistakes that they think they have made and what they have learnt from them. In the office we have our ethos board with our goals for the month this displays exactly what we have done, shows that we take our feedback seriously, it doesn’t just sit in a book unread.

4.5 Demonstrate how recommendations from concerns and complaint investigations have been used to improve the quality of the service. From complaints made in the house meeting regarding the menu we are now using different approaches to help widen the choice and still take young people’s views into account. From a recent complaint made about myself to one of the directors it became apparent that a young person became unhappy and was handed the complaints folder by a member of staff without checking what he wanted to complain about. It turned out that he was not in a happy mood and took something that was said by myself and misunderstood what had been said.

As the complaint was discussed it became clear he was confused and because the other member of staff just handed him the complaints folder that’s what he thought he had to do. This could have been dealt with much easier if the staff member had just been clear it was a complaint and not just a misunderstanding. This was discussed with relevant people including the young person and he agreed it was a complaint more a misunderstanding because he was in a bad mood. All parties are now aware of talking and judging people’s moods and body language before initiating the complaint process.

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