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Lead and manage group living for Adults

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  • Pages: 31
  • Word count: 7657
  • Category: Nursing

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1.1 Review current theoretical approaches to group living provision for adults The approach to current group living provision has moved a long way forward since the days of the workhouse or asylums. The NHS and Community Care Act 1990 called for a more community based approach to care with the introduction of the person-cantered approach, by supporting the independence and autonomy of the service users. Some service users who require special consideration such as people with learning disabilities can still find the need to live in a group living environment, but these establishments tend to be much smaller than the old hospitals. OLPA for example only have homes that are four bedded which enables a truly person centred approach, and promotes the independence of the service users to enable them to achieve positive outcomes.

Wolf Wolfensberger’s formulation of the principle of Normalisation means “Making available to all people with disabilities patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways “of life or society” this is the basis of modern day thinking and legislation.

John O’Brien’s Five Accomplishment had a real impact on the way services for people with learning disabilities have been developed and delivered and indeed changed the thinking of many. Papers such as Valuing People ( “New Strategy for Learning Disability for the 21st Century”) and The Supporting People programme (2003) very much follow these accomplishments. The Disability Discrimination Act 1995 also had an impact by making all public buildings being made accessible to disabled people. The Equality Act 2010 and the United Nations (UN) Convention on disability rights help to enforce, protect and promote the rights of people with a disability.

My organisations ethos has always been that everyone should have the same rights and civil liberties, access to everyday living conditions and circumstances as everyone else, regardless of their disability.

These rights include:
Having a say in how they live their lives, and contribute to the decision making process. Being given opportunities to develop friendships
Being treated with dignity and respect
Living in a homely environment and having contact with family Be given the opportunity to be educated
Enable the service users to feel valued in society
Current approaches now ensure that service users can have control of their lives and the care that they receive. They are included in the decisions made about their care and are encouraged to communicate their wishes, preferences and needs.

Staff teams need to have good training and leadership to enable services to provide truly individualised care services and the service users must be supported to actively participate in the planning and provision of care that they provide.

As Manager of the care home I must ensure that we use appropriate methods to facilitate effective communication with the service users to ensure they are actively involved at all stages of how the home is managed.

1.2 Evaluate the impact of legal and regulatory requirements on the physical group living environment
National minimum standards were introduced with the Care Standards Act 2000 which gave clear guidelines of how care homes should be managed and what standard of care the service users should receive. The Care Quality Commission is the regulator of health and adult social care services and has powers of enforcement.

The CQC now inspect care homes against the five key questions of enquiry (KLOEs) which came into force in March 2015 and replaced the Essential
Standards. KLOEs put the service users at the centre of the inspection system and as the registered manager of a care service, I am carrying out a regulated activity which means I have to manage the care home in line with the five key questions of enquiry to comply with the law.

The Health and Social Care Act 2008 Regulations 2014 which came into force from April 2015 makes clear the duties that people providing and managing services have. Key lines of enquiry include:(1) Is it Safe :- S1 in residential care are people protected from bulling, harassment, avoidable harm and abuse that may breach their human rights.

S5 are people protected by the prevention and control of infection. (2)Is it Effective:- E1 how do people receive effective care, which is best practice, from staff who have the knowledge and skills they need to carry out their roles and responsibilities. E3 are people supported to eat and drink enough to maintain a balanced diet. E5 how are peoples individual needs met by the adaptation, design and decoration of the service (3) Is it caring :- C1 how are positive caring relationships developed with people using the service (4) Is it responsive:- R1 how do people receive personalised care that is responsive to their needs. (5) Is it well-led:- W1 how does the service promote a positive culture that is person- centred, open and empowering.

Other legal requirements which have impacted on the physical group living environment are:The Health and Safety at Work Act 1974 requires me to have a written health and safety policy that is reviewed and revised.

It is a legal requirement for me to display a certificate of employer’s liability insurance and the Health and Safety Law poster. I must ensure that my employees receive adequate and appropriate information, instruction and training to enable them to carry out their work safely. I must also ensure the health and safety of employees and other people on the premises and complete risk assessments.

Employee’s must comply with the legislation and ensure that their actions do not Adversely affect others. They must take reasonable care for their own safety and that of others and Co-operate with their employer on health and safety matters.

The Human Rights Act 1998 includes the following rights – The Right to life, The right to freedom from torture and inhuman or degrading punishment , The right to freedom from slavery, servitude and forced or compulsory labour, The right to respect for private and family life, home and correspondence, The right to freedom of thought, conscience and religion, The right to freedom of expression, The right to freedom of assembly and association, The right to marry and found a family, The prohibition of discrimination in the enjoyment of convention rights, The right to peaceful enjoyment of possessions and protection of property, The right to access to an education, The right to free elections.

In the past I am sure many of these rights were withheld from service users with learning disabilities such as the right to possessions. One of the service users I supported had a fixation with her wardrobe and clothing, which was probably due to the years when she lived in St Georges where I believe the acronym “First up best dressed” was common. In those days she only wore dungarees from the communal closet.

Control of Substances that are Hazardous to Health Regulations 2002 (COSHH) requires me to have a COSHH file.
The file we have lists all the hazardous substances used in home and contains Data sheets for every product, which contain advice on emergency treatment protocols. The storage of medication in the care home is also covered by COSHH The Safeguarding Vulnerable Groups Act 2006, which requires me to obtain a criminal record certificate before any prospective employee works with vulnerable adults. The Mental Capacity Act 2005 which came into force in 2007 which states that every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise.

This means that we cannot assume that our service users cannot make a decision for themselves just because they have a learning disability. We must support them to make their own decisions by giving the information in ways that may help them make their own decisions. If lack of capacity is established, it is still important that I involve the person as far as possible in making decisions. I must ensure that anything done for or on behalf of a person who lacks capacity is done in their best interests and I should consider whether it is possible to follow a less restrictive course of action. Where a person does have capacity they have the right to make decisions that others might regard as unwise.

The Health and social Care Act 2008 regulations 2014 replaced the previous regulations and came into force from April 2015. The regulations set out the statutory Fundamentals of care of which there are 11 regulations.

The CQC now send out a “Provider information Return” prior to an inspection which asks for information relating to the five key questions and this has to be completed and returned on line within a set time scale. They then inspect services using the Key lines of enquiry to determine the rating of the service. Regulation 20A requires providers to display their rating both at the premises and on their website. Providers could be fined for not displaying the rating legibly.

1.3 Review the balance between maintaining an environment that is safe and secure and promoting freedom and choice
As Manager I have a duty of care for the service users that I support and must ensure the health and safety of my employees and any other people on the premises. Risk assessment and risk management are a crucial part of adult social care and I have to balance the needs of the staff and the wishes of the service users, which can be quite difficult in some cases. For example one of my service users has to be hoisted for every transfer and cannot access the toilet independently. The main problem is that he is only being funded for five hours of two to one time a day and health & safety dictates that two staff must assist with hoisting. Because of funding we mostly lone work and I have had to enlist a domestic care agency to come in at 8am, 12pm, 4pm and 9pm to assist with the hoisting. This was the best compromise which enables him to use the toilet four hourly and at the same time protects my staff team from harm. I have to be mindful that the service users have the right to make choices and to take risks but I have to consider my duty of care towards them. For example one of my service users enjoys 3

watching films on the TV and he has said he would like to visit a cinema. He has no awareness of stranger danger or the dangers posed by passing traffic or crossing the roads and is risked assessed as not being able to access the community without support. To enable him to access the cinema a staff member will need to be on duty to support him and transport him. Both the service users have their own rooms that are decorated in the style of their choice and contain their own personal furniture and possessions.

The bedrooms are in line with the National minimum standards by having usable floor space sufficient to meet individual needs and lifestyles and staff are always mindful of the service users right to privacy.

The home itself has none slip flooring in the bathrooms and kitchen, all of which are freely accessible to the service users, although there are risks assessments in place for when there is cooking taking place.

The service users are always consulted when new furnishings are going to be purchased or rooms decorated to ensure that things are how they want them, after all it is their home and only our work place.

The only restriction on the environment is a stair gate on the top landing which is there to prevent anyone accidentally falling down stairs during the night. The service user that has an upstairs bedroom can independently open this.

The front door lock is of a design whereby anyone can exit the property without the need to have it locked because once it shuts you cannot gain entry from outside. The back door has a turn knob instead of a key so that the mobile service user could leave if he wanted to.

1.4 Explain how the physical environment can promote wellbeing The physical environment needs to be warm, clean, comfortable and safe to ensure the service users wellbeing and to promote their independence and uphold their rights to human necessities and niceties.

By maintaining a high standard of environment the service users will have a sense of self worth and have a feeling of pride in their home, this will all have a positive effect on their health, happiness and emotional wellbeing. It can also promote their sense of identity, self-image and self-esteem and above all make them happy.

1.5 Justify proposals for providing and maintaining high quality decorations and furnishings for group living
The Essential Standards of Quality and Safety state that the premises must be suitable safe and promote wellbeing.
The new regulatory framework, aims to ensure quality services rather than service users having to live with second best. In applying the standards regulators will seek evidence of a commitment to continuous improvement, quality services, support, accommodation and facilities which assure a good quality of life for the service users.

As a manager I have to ensure that all equipment is safe and meets British Safety Standards to ensure that any hazards are kept to a minimum. I have to ensure that staff are properly trained in the use of equipment and that it is properly maintained and where possible we ensure equipment is as ‘homely’ as possible to prevent the home looking like a hospital

The furniture and fittings need to be of good functional quality and aesthetically pleasing to fit in with the “home” and to promote the emotional well being of the service users. Living and working in an environment that is decorated and furnished to a high quality promote pride and people will value the home and can get a feeling of self worth. Careful thought is given to details such as textures and colours and how fabric feels because one of our service users has autistic tendencies, and it is important for him to feel comfortable in his home. It is also important that all furnishings and decoration are of a high quality because if you buy cheap you get cheap and things wont last long before they need replacing that has a detrimental effect on the homes budget.

By providing and maintaining high quality decorations and furnishings for the care home we promote a sense of wellbeing where the service users feel safe, secure and valued as well as adhering to legislation and making sound financial sense.

1.6 Develop an inclusive approach to decision making about the Physical environment When making decisions about the physical environment of the home we always involve the service users as far as possible. Although it is very difficult to fully engage them in every decision because of there profound learning difficulties.

The service users are provided with as much information as possible about any proposed changes and they are given choices. For example we recently needed new flooring for the hallway down stairs. The service users were involved in choosing to have laminate flooring and they chose the actual boards that were put down.

When making decisions that the service users find difficult to be involved with I consider their past choices and desires, Staff input is also sought to endeavor to make the choices that will be what the service users want.

After all the care home is their home and they are the ones that are affected by any changes, be they large or small.
The staff team give thought to what the service user want every month on the paperwork we complete that gives consideration to the service users perceived want and needs. An example of when a service user showed signs that he wanted a different chair was when he stopped sitting in his arm chair in the conservatory and either sat on the floor next to it or sat on the sofa in the lounge. After some discussion we decided to try putting the sofa in the conservatory for him. It was very evident that he was pleased with this because he chose to spend most of his time sitting on it or laying out on it looking very happy and relaxed. (He always chose to sit in the conservatory by choice)

When it comes to the decoration of the home the service users are always given a choice of the colours they wish to have. The service users had full control over the colours of their rooms and using our knowledge of their likes they were offered a variety of tester colours. One service user always used to take great interest in a new building that had been erected along side one of the roads we regularly used. It was four shades of green starting with a light shade on the bottom and ending with a dark shade on the top, his room was decorated to resemble this building and he seemed very pleased with the end result.

2.1 Evaluate the impact of legislation and regulation on daily living activities

Legislation starts with the NHS and Community Care Act 1990 which basically obliges local authorities to carry out an assessment of anyone that is unable to look after them selves. Daily living activities are the fundamental things that people should be able to do in their every day lives to enable them to maintain their independence.

Basic skills would include Eating, bathing, dressing, toileting, walking and maintaining their continence.
More complex skills include managing finances, using transportation such as driving or using public transport, shopping, preparing meals, using the telephone and other communication devices, doing housework, managing their medication.

When the “needs of Care assessment” is completed the local authority has the duty to provide services to meet the identified needs.
The Health and Social Care Act 2008 contains significant measures to ensure that service users are involved in every aspect of their care.
It states that Service users must be treated with dignity and respect and that all care should be Person-centred. The care and treatment of service users must be appropriate, meet their needs, and reflect their preferences. Service users must give their consent and where they are unable to give consent because they lack capacity to do so, the registered person must act in accordance with the mental capacity Act 2005. All treatments and care must be safe and service users must be protected from abuse or improper treatment. Premises and equipment must be fit for purpose and all nutritional and hydration needs must be met. The service must be well managed and should only employ fit and proper persons. All complaints must be handled appropriately and we have a duty of candour which states, we must act in an open and transparent way with relevant persons in relation to care and treatment provided to service users in carrying on a regulated activity.

The Care Standards Act 2000 and Essential standards for Quality and safety sets out what the service user can expect from their care provider and ensures providers ensure that they are given opportunities, encouragement and support to promote their independence. The Equality Act eliminates any unlawful discrimination, promotes equal opportunities and equality between protected groups.

The Mental Capacity Act 2005 sets out a framework for how decisions should be made in the best interests of someone who lacks mental capacity to make those decisions themselves. The service users living in my care home now have greater protection through legislation and consequently their rights to be involved fully in their daily living activities.

2.2 support others to plan and implement daily living activities that meet individual needs and preferences
As the Manager I support and guide the staff team to implement and plan our service users daily living activities. The plans are individual to meet the service users needs and are devised with as much involvement of the service user as possible, where this is not possible our knowledge of previous preferences are used.

Care plans and their implementation are discussed in team meeting and in supervisions to ensure that all of my staff team understand how to safely and effectively support our service users. When a member of staff needs extra training I ensure that this is provided. In the case of a service user being discharged from hospital and needing hoisting for every transfer I arranged for the staff team to receive hoisting training at the hospital prior to his discharge.

When a new member of staff is employed they always shadow for two weeks before they lone work. I ensure as far as possible that new staff shadow me for the first two weeks so that I can assess their performance and evaluate if the shadowing period needs to be extended. When we recently purchased a wheel chair accessibly vehicle the staff team received training and hands on experience provided by the training officer and myself. Guidelines were produced, using pictures of each stage and staff were given the opportunity to practice until they felt competent to safely assist the wheelchair user to enter and exit the vehicle. The service users are actively supported to have control over their daily living activities as far as possible. Because they have severe learning difficulties they tend to like familiarity and routine, but they can always deviate from routine if they wish.

For example one service user attends a day centre on a Monday afternoon, he is always asked if he want to attend and mostly he is very keen to go. On the rare occasion he does not wish to go his choice is respected.

2.3 Develop systems to ensure individuals are central to decisions about their daily living activities
It is very difficult for me to ascertain the views of my service users because of their severe learning difficulties. We always respond to signs
that they are unhappy with any aspect of their care, but these signs can be very hard to perceive. For example one service user is totally non-verbal and is unable to mobilise independently as he needs to be hoisted for every transfer. He is totally reliant on staff when it comes to where in the home he is positioned in his wheeled tilt and space armchair because he has great difficulty in communicating to us where he wishes to be. From passed experience we know that he prefers to sit in the conservatory looking out in the garden, and on nice days out in the garden. The only way we can ascertain if he would like to sit out in the garden is to open the doors and position the ramp, then by standing close to him he will either hold your arm and move it towards the garden or towards the lounge. This indicates if he wishes to go out side or remain inside.

We are unable to hold service user meetings because they are unable to actively participate or communicate their views to us. To enable us to ensure that the service users are central to decisions made about their daily lives we look back over the daily diaries to see if there are any indications that they are not happy with anything or have shown signs that they might like some thing new. This is recorded monthly on the “perceived service users views” which is completed monthly. By looking back and completing the “perceived service users views” we thought that one of the service users may like to attend a cinema to watch a film, we have obtained a cinema card for him which enables a member of staff to accompany him free of charge.

We have Person Centred Planning documentation in place for each service user, which gives consideration to many aspects of their lives, this documentation is used to device action plans and set any goals that we feel the service users might like to achieve. The PCP documents are completed and reviewed quarterly by the Key worker and involve the service user as much as possible, once yearly the PCP documents are reviewed at a team meeting. The August team meeting this year has been extended by two hours to give us time to accommodate this Individual support plans focus on improving the quality of daily life experienced for the service users and include giving the opportunity for the service users to do as much as possible for them selves, to ensure that we provide the right level of support while still giving them a degree of independence.

2.4 Oversee the review of daily living activities
As the manager of the care home I regularly review the daily diaries and other records that a completed to ensure that all of the service users daily living activities are fulfilled. This enables me to review the type of activity that they wish participating in and also whether it meets their needs and expectations and if they are working towards or meeting their goals. Implementing and overseeing regular monitoring and review of the systems and procedures which support group living and daily activities is part of my role as manager as is having effective mechanisms to manage disagreements, conflicts and complaints. Performance can be measured against agreed standards to reveal when and where improvement is needed.

3.1 Evaluate how group living can promote positive outcomes for individuals The main positive outcomes are the homes ability to maintain or prevent deterioration in the health of the service users and by us meeting their basic physical needs The service users can be assisted or advised on personal hygiene and how to look presentable in appearance that promotes well-being and a feeling of pride and self worth. We ensure that nutritional needs are met by providing varied nutritional food and drink. The home is always clean, tidy and comfortable and provides a safe and secure environment for the service users and they benefit from having social contact and company. Service users have control over their daily routines and staff are on hand to offer help and support when required.

The service users are listened to and have a say and some control over the services that they receive which promotes the feeling of being valued and respected. Service users can benefit by being able to developing relationships with each other and the staff team which prevents them from feeling isolated and alone. I feel that because the service users in my home have know each other for over 20 years, they have a close bond with each other even though they do not interact with each other.

The home also encourages regular contact with family by facilitating telephone calls and visits. 3.2 Review the ways in which group activities may be used to promote the achievement of individual positive outcomes

The benefits to individuals engaging in a range of activities promote mental stimulation and are important to health and well-being. Activities can stimulate the mind, build confidence and help form social bonds which could enable the service users to make new friends. Opportunities for meaningful activity can promote self-esteem, a feeling of wellbeing and mental health. It is important that individuals are able to freely choose whether they attend leisure and social activities, and the activities should contribute to the individual’s personal goals, lead to positive outcomes and ensure that the service users lead fulfilling life. Physical activity has several benefits for the service users and can help improve sleep, maintain a healthy weight, build muscles, boost the immunity system and releases feel good endorphins. Mental activities such as word games or even friendly conversations give a positive boost to mental health, and encourage social interaction.

Group games suck as Bingo can improve the ability to scan for information and can help short-term memory. Socialisation through human contact is vital to well being and interactions with others are very meaningful and are integral to being happy and content with our lives. Social interaction is important to emotional well being and group activities such as doing a jigsaw puzzle can promote physical dexterity and creative thinking skills.

By taking part in group activities improvements in the service users physical, mental and emotional functioning can all be enabled and their self confidence and feelings of self worth can be promoted. 3.3 Ensure that individuals are supported to maintain and develop relationships It is very important to ensure that the service users maintain and develop relationships to prevent them from feeling or becoming isolated from family and friends. It is especially important for the staff team at my care home to actively assist the service users in this area because the service users have severe learning and communication difficulties.

When I first started working at this care home one of the service users had hardly any contact with his sister at all. I initially started to contact her via the telephone every two months and gradually build up a good relationship with her, then I contacted her monthly and started to invite her to visit the home, which she initially was reluctant to do. Eventually she accepted my invite and visited her brother. She now visits regularly and up until he had a stroke we used to assist him to visit her at her home. Sadly it is not possible to visit her home anymore because he is now wheelchair bound and her home is not accessible to him.

He is unable to speak with his sister on the telephone but I keep him in touch with her on a regular basis and always put the telephone on load speaker so that he can at least hear her voice. She still visits him and I feel they have build up a good relationship. We are now in the process of organising a lunch out for him at a local eatery with his sister. The other gentleman that we support has an elderly sister who now lives in a care home in Gloucester which is a sixty mile journey. I enable him to visit her every six weeks by arranging visits and ensuring that a staff member is on duty to take him and support with the visit. He is also assisted to speak to his sister every two weeks by telephone which forms part of his Person Centred Plan.

The service users are also enabled to visit another care home within our service to visit the service users there that they have known for many years. OLPA have two social events at the head office where our service users can meet up with all the other service users supported by OLPA. One service user is actively enabled to attend a weekly day centre session where he has several friends, and when possible he is assisted to attend the social events that are put on by the centre. Another service user has not attended his day centre since he had a stroke, now that he have recovered enough I will be attempting to get his session reinstated to enable him to renew his relationship with the other service users that attend.

3.4 Demonstrate effective approaches to resolving any conflicts and tensions in group living OLPA have policies and procedures in place for dealing with tensions and disputes and to enable positive outcomes and promote good relationships within the workplace I need to over see and implement these systems.

By encouraging an atmosphere of mutual respect within the care home conflicts are few and far between, but when there is conflict It is my role to deal with it whether they are between staff or the service users.

I arbitrate between the party’s involved and keep the lines of communication open and I listen to everyone viewpoints. I must be objective and impartial and be willing to negotiate and make compromises. I find that by keeping every one calm and listening to their viewpoint most conflicts can be dealt with in an amicable fashion. If the situation cannot be dealt with by myself the OPLA personnel officer, who is a trained councillor is asked to step in. The service users should be aware of how to make a complaint and that they will be supported to do so. Although this is very difficult to achieve in the care home that I manage.

We have a leaflet in an easy read format to enable the service users to access the complaints procedure and I actively promoting the service users choice’s and rights. 4.1 Evaluate the effects of the working schedules and patterns on a group living environment Continuity of care is not only important for the service user’s but also for the staff team. It can be both rewarding and create job satisfaction to have long term relationships with individuals and their families. It can be emotionally rewarding and also makes more sense in understanding the service users especially when they have complex needs. I believe by having a dedicated team appropriate and effective care can be given. A stable and experienced staff team are more confident in how to support the service users and the service users seem to be more at ease when receiving care. To effectively cover the shifts that are needed to support the service users I have a Rota that is compiled monthly.

My care home provides twenty four hour care for two service users at the moment, although we are registered as four bedded. The Rota has to provide for one staff to two service users when at home and one to one support for any appointments, outings, shopping, day centres, visits to relatives and hoisting.

The staff team is made up of two full time staff and 3 part time, I also have two regular relief staff that pick up the shifts that the team cannot cover. The main Rota has to cover all of the sleep-in shifts that are from nine thirty in the morning until ten in the morning the following day. Once the main Rota is completed any of the four daily hoisting sessions that are not covered have to be booked with the agency. Although the Rota is compiled in advance the staff team and relief staff are very accommodating when changes or amendments are required, such as unexpected hospital or doctor appointments. The main disadvantage for the service users of having a set schedule is that they cannot spontaneously decide to go out to the cinema or visit a relative for example. 4

.2 Recommend changes to working schedules and patterns as a result of evaluation After evaluating the Rota and staff time allocated for one two one time with the service users I found that we are not giving the best service to our service users. Because one of the service users had a stroke he has not attended his day centre sessions for many months, but now he has recuperated enough I feel he would be able restart the session. To facilitate this I will need to rota on an extra staff to take and accompany him. At the moment we do not have enough staff hours on the rota without us all doing extra and this session will add even more pressure on an already stretched staff team. I have put in a referral for both service users to have a funding review with the Wiltshire council because in my opinion neither of the service users have enough one to one hours funded. Because one of the service users has not had a funding review for many years I am sure funding will increase and I will be able to employ another part time member of staff.

4.3 Develop a workforce development plan for the group living environment As manager my aim is to develop a confident, capable and well- trained workforce which can empower the service users to have as much independence and choice as possible. With the purpose of enabling them to stay healthy and active to promote their health and well-being. As a care home we must have a work force that is equipped with the right skills to deliver safe and high quality services which focus on supporting self direction, dignity, independence and choice,

Recruitment and retention of quality staff is crucial to ensure that people with the right potential are recruited and are retained to ensure continuity for the service users. In order to continue meeting the changing needs and preferences of the service users staff need to be encouraged and assisted to develop their knowledge and skills. OLPA offer a high standard of induction and training opportunities and has a commitment to supporting their staff teams with on going refresher training.

OLPA also endeavour to identify and develop staff that have the potential to progress within the organisation and eventually fill key leadership positions in the workplace. This was the case with my own development within OLPA, I started as a support worker and was given the opportunity to be a senior and gain NVQ 3. I then became a deputy manager and undertook NVQ4 in care and NVQ4 registered managers, which enabled me to become the registered manager of the care home. By nurturing and developing promising members of staff OLPA increases the availability of experienced and capable employees that are prepared to assume supervisory and managerial roles as they become available.

My training plan ensures that staff attend induction training when they first start employment and that all mandatory training is attended by all of the staff. To ensure that we have a well-trained team and to enable us to provide a better service, all staff are expected to attain a health and social care diploma Level 2. Those identified as showing promise are offered the opportunity to do level 3 as is the case with one of the staff team here at my care home.

As the registered manager I need to monitor the staff team and identify the skills mix required within the care home to ensure that we deliver and continue to deliver a high quality service, and comply with current legislation.

It is important that I keep up to date with proposed and current legislations and that I ensure that my staff team has the right mix of skills, competencies, qualifications, experience and knowledge to meet the service users needs.

4.4 Support staff to recognise professional boundaries whilst developing and maintaining positive relationships with individuals
For the home to be a caring home staff need to build a rapport with the service users, and they should ensure that they establish and maintain appropriate professional boundaries in the relationships between themselves and the service users. Boundaries define the limits of behaviour, which allow a professional carer and an individual to engage safely in a supportive caring relationship. These boundaries are based upon trust, respect and the appropriate use of power and must focus solely upon meeting the needs of the Service user. Should the focus move towards meeting the employee’s own needs this would be an unacceptable abuse of power and staff need to respect the boundary around their relationships with the service users.

They must not enter into relationships that exploit the service users, sexually, physically, emotionally, socially or in any other manner. They must not develop relationships which compromise their professional judgment and objectivity and/or give rise to advantageous or disadvantageous treatment of the service user. Staff must be not try to influence service users, other members of staff or other individuals living in the home by impressing their own beliefs and values on them. In some situations the fine line between good and bad practice may not always be obvious or clear. On occasions a member of staff may develop an attachment towards a particular service user, while this may be a natural progression of a professional relationship, the staff member should ensure it does not lead to a breach of the professional boundaries.

I encourage my staff team to talk about the service users during supervision and I offer advice and support if they are unsure about the nature of a developing professional relationship with a service user.

Staff are encouraged to discuss any difficulties with me during their supervision and I discuss boundary issues within team or facilitated discussions when it is appropriate.

I conduct regular monitoring and review to ensure my company’s policies, procedures and guidelines, regarding boundaries are being upheld. Any significant and or repeated breaches of the policy are discussed with my line manager and could lead to disciplinary action which could ultimately include dismissal.

4.5 Use appropriate methods to raise staff awareness of the group dynamics in a group living environment
Group dynamics refers to a system of behaviours and psychological processes occurring within or between social groups. A group is two or more people who are interacting with one another to achieve a common goal or purpose which is striving to achieve a shared outcome. The group should provide each member with a level of acceptance, listen to their views and provide a forum for the membership to express their opinions. Each members opinion may of course be consistent or inconsistent with the group’s aims or goals. Because every individual has their own personality and views, the aim should be to mould the group into a cohesive team which is working for a common goal. Disagreement and dissention among group members is only to be expected and is a normal path that all groups traverse. For an effective and dynamic group to evolve, members need to recognise the interdependence model exhibited by its members and find ways to deal with them for the overall good. The group need to be open and honest and share information because communication is the key to successful interaction.

Providing a positive group living environment starts with good management of the home and by maintaining the environment to a high standard. It is also promoted by ensuring and training staff to give choice and respect the preferences of the service users, and by encouraging the service users to remain as independent as possible and by ensuring adequate monitoring of staff through regular supervisions and appraisals to ensure staff are aware of good practices and that they adhere to them. A good method of assuring the effectiveness of the group is for the members to show common courtesies to each other by giving support and encouragement to each other. I try to promote an environment that encourages openness and idea sharing among the group where everyone has a valid point of view.

My leadership skills are developed and honed with each experience I have in my day-to-day activities, when dealing with the two groups that live and work at the care home and I need to be aware of the various interactions and events as they transpire. Because the homes group is made up of staff and service users with different dynamics it is important that staff receive education and training in order for them to be aware of the important role they play and the “power” that they have within the groups dynamics.

Good training can improve my staff teams communication skills, both verbal and non-verbal and can aid them with working within the group

The service users participate in group activities in different ways and at different levels because of several factors which include their individual capabilities, the physical environment, the psychological atmosphere, their own personality and how they feel about taking part and interacting with others.

4.6 Review the effectiveness of approaches to resource management in maintaining a positive group living environment
It is very important to manage the care homes resources to ensure that we remain within budget and continue to be commercially viable.
I have to manage the budget to ensure that staffing levels are within the requirements of regulations and that they meet the service users individual needs, and at the same time stay within my budget.

I do this by compiling the monthly duty rota, primarily to meet the needs of the service users and endeavour to cover all shifts by the staff team. When this is not possible due to sickness or holidays for example I call on OLPA relief staff, agency staff are only used in extreme cases when there is no other alternative.

All of the homes resources are used for the benefit of the service users and are used to improve their life styles.
It is crucial that I consider staff levels, equipment, supplies and other expenditures when allocating the homes budget to ensure that I do not overspend.

The homes weekly budget is used to give the service users their weekly personal allowance, purchase the weekly groceries, fuel for the house car, office incidentals, eating out expenses, day centre charges, day to day expenses, and small equipment / appliance replacement. Large appliance replacements are purchased via accessing the homes renewal budget from head office.

I audit the homes budget on a weekly basis and ensure that it is not exceeded and at the moment we have in excess of ÂŁ1000 in the Lloyds bank savings account. Reviewing my budget is an important step in ensuring that the home is meeting its goals and objectives and that it is running as efficiently as possible. If the home does not remain within its budget there could be repercussions for both staff and service users and it could result in the homes closure.

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