Procedures And Practice To Respond To Concerns And Complaints

1.1 Identify the regulatory requirements, codes of practice and relevant guidance for managing concerns and complaints in own home

The complaints policy for E-Spire Healthcare 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 the procedures.

To ensure that staff, patients and relatives/carers are aware of the policy and procedures.

To improve quality of service by identifying lessons learned from complaints and by implementing improvements in the service using the lessons learnt.

Since we opened the doors to E-Spire Healthcare in September 2013 I have been the Operations Manager, part of my job role is to ensure our Policies and Procedures reflect a safe environment for both the client and staff, to enable clients to have the person centred care that the rightly deserve and as a minimum expect, whilst ensuring that staff are given the information, training and skills, to support the client in a positive manner, and to ensure they understand the client’s needs. I designed the Service User Guide in this pack I have devised a section which includes a piece about expectations on how complaints will be dealt with. This reads as the following: Please be assured that any complaint you make will be taken seriously and handled sensitively and efficiently. An initial acknowledgement will be received within 5 working days and a full written response, following a thorough investigation, will be sent within 28 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 Manager to hopefully resolve the matter quickly. If this is not appropriate for any reason then please contact the Director. The name and contact details of the Director is available in this booklet. 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 we are giving clients 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 can complain about an issue. The guidance that is in place is in line with more national guidelines regarding complaints. For example the complaints procedure that E-Spire Healthcare 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 investigations 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. 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. 2.1 Explain why individuals might be reluctant to raise concerns and make complaints Although the client is receiving care within their own home a relative may feel like they are putting their loved one (the client) 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 client might be the target of a rebellious staff members emotional response. Conversely, a lot of relatives see how hard the care 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 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 domiciliary agency 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.

E-Spire Healthcare want their staff to know that it will ensure that such staff are supported and that they have access to appropriate advice.
It is important to ensure that:

Information regarding staff involvement in a complaint is only provided on a need to know basis.

That staff cited in the complaint are advised of the content, progress and outcome of the complaint by myself.

There is a clear separation of the complaints procedure from the disciplinary procedure.

Staff are supported by their 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 Service User Guide will help relatives and clients 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 on a drop-in basis to relatives 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 clients and their relatives if everything is ok and is there anything additional that could be done to ensure that a client of E-Spire Healthcare is comfortable and happy. 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 clients and relatives.

They may not have faith in the response they will get from a complaint but my 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 where things may be slipping below expected standards or perhaps staff have become complacent. Through regular staff meetings I can ascertain staffs opinions on what their observations are of the way the company 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. They may see a lot more of a certain area or aspect of the business than I do and can bring things to my attention before I notice it myself. By having regular management meetings I am able to share and discuss the types of concerns that are being raised and explore why these have come about.

It may be that I can take information back from these meetings to apply into different areas of the business, thus avoiding a complaint being put in. I encourage feedback from other professionals and will actively seek feedback through a telephone call, letter like a questionnaire 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, were they able to access the information they required and is there anything they can recommend we put in place based on their area of expertise? 2.4 Ensure information on how to raise concerns and make complaints is available in acceptable formats I have made sure that all clients and relatives 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 clients care, until they see a member of staff, or until I am in the office. They can leave me a message, write me a letter/email or speak to a senior member of the team, in my absence.

I have included a section in the ‘Service User Guide’ 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 and email address for my manager, the Director, 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. There is also a copy of expected standards of care which gives clients and relatives a reference for what they should be expecting to receive in their own home. In my experience as a manager most relatives choose to pop in to phone me and 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. 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 company 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. If a complaint pertains 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 in italics is what I have implemented at E-Spire Healthcare in line with these requirements.

If you are unhappy with the 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 ‘Service User Guide’ a quote from CQC about complaints is included, this demonstrates that not only do we care about complaints and feedback that clients 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 E-Spire Healthcare policy on Concerns and Complaints. A copy of this is sent out with a 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 ‘Service User Guide’ offered to clients and their relatives on their first initial assessment when I visit them in their own 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 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 a best practice to keep a record of what I said, who I 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 always state the 28 day time frame at the point of complaint, which will then be included in the initial letter. If I am unsure then I will consult with my Director or advise the complainant that it will be in their initial 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. .

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 another’s. We cannot expect everyone to adjust to an institutionalised way of living even if they are living in their own home, hence why person centred care is so important within our job role. It is important to me as manager that the agency adapts and is flexible in its approach to each service user, 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 same as they would for themselves. 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 persons 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 clients 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. For example, when I worked in a learning disability home I was once informed to the fact that a gentleman had been given orthopaedic cutlery similar to the other two clients who sit at his table. Whilst the other two residents did in fact require adapted cutlery in line with their needs, this gentleman did not. This led to him experiencing an undignified and uncomfortable dining experience and rightly so he chose to express his displeasure to his mother.

On exploration of who was on shift that day and speaking to that team of staff I was able to identify who had laid the table. Thus I was able to speak with that member of staff and highlight to them why it is important to consider individual needs and to set the table with a person centred approach. The member of staff was not aware that she had set three places with adapted cutlery rather than just the two, it had been an over sight on her part. Using her supervision session as a format to explore this, we considered how a simple over sight caused by not paying attention or being absent minded, had contributed to the discomfort of a client and put his family in an awkward position feeling the need to complain. It also caused upset to his mother because she felt saddened by the thought of her son being treated as though he had disabilities that he did not have.

3.2 Ensure that others are informed about the procedure for raising concerns and complaints Not only are clients 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 including serious misconduct. We conduct annual quality reviews for both our clients and our care staff. This provides our clients staff and relatives an opportunity to provide feedback anonymously if they wish to. We anyalyse all the reviews and report the findings of our reviews this way we can clearly see what we are doing well and what as a company we can improve on, we also keep all annual reports which anyone is able to see.

Meaning a prospective client and their relatives could read this for an idea on the sorts of feedback and comments that we receive, from existing clients and staff. 3.3 Use supervision to support workers to recognise and address concerns and complaints In staff supervisions and staff meetings 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. Mrs X’s daughter came to me concerning an incident which had happened over the weekend whilst I had not been on call. She was concerned that her mother had been taken to hospital and scanned to have it discovered she had a fractured pelvis. Mrs X’s daughter was concerned that she had managed to break her hip without anyone noticing. When Mrs X’s daughter came to me in my office I initially asked her if I could take notes. I read back these notes to her at the end to clarify that the information I had taken was representative of her concerns. I then advised her of the complaints procedure and gave her a detailed flow chart of the time frames she should refer to when expecting a response to her complaint. I then sent an initial letter to her identifying the complaint had been logged formally and was being investigated. I then devised a chart with several headings:

Incident of concern; details; expected outcome; response
This enabled me to structure my feedback and also itemise the different areas of the complaint. The expected outcome had details regarding the wishes of Mrs X’s daughter as to what she would like to be done about the issue. The response provided details of the outcome of my investigation and also exactly what had been done as a consequence of my findings. For example, some staff received disciplinary action, some were asked to re-do certain elements of their training. There was also a partnership working element which meant I needed to speak to the ambulance service and the ward staff at the hospital about miscommunication and concerns about the way the situation was handled. I asked the complainant if she would like to receive the response in this grided format or would she prefer it in the corporate format of a letter.

She stated she appreciated the format I had written the complaint in as it helped her to see exactly how each concern was investigated and dealt with. 4.1 Monitor the use of systems for addressing concerns and complaints A standing item on the staff 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 see whether or not we are learning from our mistakes and whether or not clients and their relatives feel as though the way we are dealing with their concerns is effective and appropriate. 4.2 Evaluate the effectiveness of systems for addressing concerns and complaints Based on my experience of handling complaints I have found that a structured step by step format has been both useful to me as an investigator for dealing with a complaint in a structured and thorough 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. Another point I highlighted at the managers meeting was that I felt 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. 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 is effective because it is client 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 meetings
Client reviews
Informal discussion on an ad hoc basis with relatives
Feedback form
Managers meeting to discuss the types of concerns being raised Reviewing trends in complaints and writing reports to send to higher management Writing and publishing lessons learned and such amending the service user guides Encouraging clients to give us feedback on the way we are dealing with their complaints, either ad hoc or in the client review forms. 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 manager over the past 2 years at E-Spire Healthcare I have only had to deal with two 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 ask for suggestions and opinions on how we can either continue to do what we are doing well or prevent negative situations from occurring. This involves everybody and demonstrates the need for staff to be constantly evaluating the effectiveness of the service we provide. I have also facilitated a model of supervision in which staff are encouraged to carry out their own analysis of their conduct and score themselves. I ask them to comment on what they have done well and areas in which they wish to improve or mistakes they have made and what they have learnt from them.

4.5 Demonstrate how recommendations from concerns and complaint investigations have been used to improve the quality of the service. When working in a residential home, we had the following complaint: ‘I would like to see more of a seasonal selection of food on the menu’ This comment was taken to the kitchen staff meeting, and also the residents meeting on the. The cook stated that he felt that he was limited in what he could buy as the budget he was given dictated how much he could spend, whilst he agreed with the comment he didn’t feel like there was enough flexibility within the budget to accommodate for more choice. The kitchen assistants shared the view of the cook, although they did not have any knowledge regarding budgets. I arranged a separate meeting between the cook and I, to look at budget management and the catalogue of food from which she could choose.

With it being winter we decided to ask the residents if they would like more casseroles, stew and dumplings and if they would like to see foreign dishes such as pasta dishes and curries. I also arranged some time in my diary to look at the budget as a whole and was able to see where we were consistently under spending on one area and could afford to increase the budget in the food department. I considered that this would have to be a permanent over spend as I did not want to provide the clients with an improved menu for a period of time and then revert back to the menu which had generated this complaint. At the residents meeting it was decided that they would like there to be more winter-themed items on the menu and that the idea of a foreign selection could be something offered once fortnightly. There was mixed opinion on curries and pasta dishes, so for those who were in favour we compromised by offering this once a fortnight.

By extending the budget available to the cook, we were able to create a fortnightly menu offering 14 different lunches and main meals. Before acting on the menu we took the ‘draft’ to the residents meeting and also displayed it in the visitor’s area for one week prior to its implementation, we received only positive comments. After one month, the menu was brought up at the residents meeting and there were a few members of staff who had received positive comments from clients and relatives who contributed to this meeting and over all the clients rated the new menu at 9/10. We asked if they would like to see it changed again and 61% agreed that it should be changed regularly, whilst 39% liked the menu and wanted it to stay as it gave them comfort knowing what to expect on certain days.