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Contents

Index. Page 2Learning outcomes. Page 3Alignment to Qualifications and Credit Framework (QCF). Page 3Fundamental standards. Pages 3 - 4

Unit One. Pages 5 - 9Introduction, legislation, person centred values.Unit One Questions. Page 10

Unit Two. Pages 11 - 13Individuality.Unit Two Questions. Page 14

Unit Three. Pages 15 - 18Rights and choices.Unit Three Questions. Page 19

Unit Four. Pages 20 - 25Active participation.Unit Four Questions. Page 26

Unit Five . Pages 27 - 29Working towards person centred care.Unit Five Questions. Page 30

N.B: We are aware that official practice is to use the terms “service users” or “people using this service” to describe those receiving care. We prefer the term “client” and use it throughout our training package.

Key:

worksheet important

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Learning outcomes.

• Identify person centred values.• Understand person centred approaches for care and support.• Identify how to work in a person centred way.• Support an individuals right to make choices.• Understand how to promote active participation.

Alignment to Qualifications and Credit Framework (QCF).

Covers knowledge elements of unit HSC026.

Fundamental standards.

The fundamental standards are the standards by which CQC will inspect social care. The standards are based on the regulations from the Care Act 2014 and CQC have changed the focus for the purposes of inspection.

The fundamental standards are those standards that no care setting must fall below.

The standards are based on five areas as follows:Safe. People are protected from abuse and avoidable harm.

Effective. People’s care, treatment and support show quality of life and promote good outcomes, and providers should show evidence to prove it.

Caring. Care should be person centred involving dignity and respect, and compassion.

Responsive. Following correct working procedures as agreed by your workplace and as set out in the client’s care plan.

Well led. Management leadership and governance should ensure all of the above happens. Staff training should be recognised and openness and fairness be apparent.

These areas are known as key lines of enquiry or KLOES. Each KLOE has a set of criteria which CQC use to check whether the fundamental standards are being met.

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The fundamental standards are as follows:

Person centred care. Ensuring that those receiving the care are at the centre of all decisions.

Dignity and respect. Providing the client with dignity and respect in all aspects of their care.

Need for consent. Asking the client’s permission before carrying out tasks that affect them.

Safe care and treatment.

Following correct working procedures as agreed by your workplace and the client’s care plan.

Safeguarding service users from abuse.

Following agreed working and safeguarding procedures and being aware of signs and symptoms.

Meeting nutritional needs.

Being aware of dietary needs, working with the care plan, ensuring clients have the right equipment and conditions to eat.

Cleanliness, safety and suitability of premises and equipment.

Carrying out required checks of premises and equipment, implementing cleaning rotas and carrying out safety checks.

Receiving and acting on complaints.

Having a complaints policy and procedure in place that is accessible to all and act in accordance with the policy when dealing with complaints.

Good governance. Ensuring that all aspects of the workplace is overseen and policies and procedures are implemented and monitored regularly.

Staffing. Fit and proper persons employed.Fit and proper person requirement for Directors is followed.

Duty of candour. Relevant information must be volunteered to all persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made.

Our Redcrier manuals will provide your staff with training to support attainment of the fundamental standards.

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Unit Four

Active participation.

Active participation is the key to implementing person centred approaches; in this unit we are going to look at the three areas in which active participation is to be promoted:

• In person centred planning.• In decision making.• In the running of the home.

Person centred planning.

Person centred planning should be an ongoing process to support clients to receive the care they need in an appropriate way and to achieve their personal goals.

To support person centred planning you need to start thinking in a person centred way. Forget what you think your clients’ aims will be and start with an open mind. People do not define themselves by a diagnosis or disability, they define themselves by what they enjoy doing and through the relationships they have and this is likely to be reflected in the goals that they set.

Cleo had a stroke at the age of 51 which left her unable to walk. Her therapists and care team believe that her goal is to walk again. When asked what’s important to her Cleo talks about getting back to her family home, being able to walk might help her achieve this but it’s not her main concern and there might be other things that could be done to get her home.

Personal budgets were introduced to allow people needing health and social care services to prioritise their own needs and make decisions about what they would like to spend money on. The aim was to give increased flexibility and to enable people using services to access support as and when they need it. People are encouraged to make use of their informal care network of family and friends to compliment the support they pay for. It is believed that this will give people more freedom of choice and that services will, by necessity, become more person centred as the client and not the council now holds the purse strings.

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There are different tools which can help carers to focus on individual needs and identify priorities for care provision, examples include:

Relationship circles – draw a chart with the client at the centre surrounded by the people who matter to them.

Important to / important for – create a list of what’s important to the client and a list of what’s important for the client. Think about how we can achieve a balance between the two.

Important to X (the client). Important for X (the client).

friends. medical treatment.safety. happiness.health. reaching full potential.

A relationship circle where the length of the arrow indicates the “closeness” the client feels between themselves and their support.

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Communication records - identify and record the different ways in which the individual communicates; this is particularly important if their main communication is non verbal.

How we communicate with X (the client).

People / tools which support

communication.

Ways in which X (the client) communicates.

What we think X (the client) is communicating.

What’s working / what’s not – discuss and record what aspects of care clients are happy with and what they think could do with improvement.

Reviewing X’s (the client’s) medical care.

What X thinks is working: What X thinks is not working:

What care team think is working: What care team think is not working:

What doctor thinks is working: What the doctor thinks is not working:

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Regular person centred reviews should be carried out using these tools to assess how successful we have been in meeting the individual’s needs and how we are going to adapt plans for the future. To fully involve the client we might look at different ways of encouraging them to take part. Having considered their capacity to make decisions, preferred communication and factors such as age and gender we might try some of the following techniques:

• Asking the client to draw pictures or create diagrams showing what’s important to them.

• Using advocates to improve understanding.• Carrying out the review in an informal manner in an environment where the client feels

comfortable.• Asking the client and their friends and family to suggest creative ideas to overcome problems.

Putting clients at the centre of the planning process should help us to focus on positive aspects of their lives, rather than looking at what they can’t do we should be identifying what they want to achieve. Clients should feel much more in control of their lives and will hopefully feel that they can be honest about what matters to them.

Decision making.

As we saw in unit three the Mental Capacity Act was introduced to protect people’s rights to make decisions for themselves without others making assumptions about their ability to do so. Whenever a client can make a decision, or take an action, for themselves they must be allowed to. However, if clients are assessed as unable to make their own decisions for whatever reason, they must still be supported to actively participate in the decision making process.

Chris has inherited a large sum of money. His mother is in control of his finances and she employs an accountant to make sure that it is invested in a way which protects his best interests in the future. The accountant bases his recommendations on ensuring there are funds available to pay for Chris’s future care needs.

This is, of course, important for Chris but we also need to identify what is important to him.

Chris’s carers spend time talking to him about his dreams for the future, they ask him what he would buy if he had lots of money and he draws them a picture of a big house with smiling faces at the windows and a plane and car parked outside. Chris tells them that the smiling faces belong to himself and his parents and that the plane and car are there for when he wants to go on holiday.

Working together Chris, his parents, care team and accountant identify ways in which the money could be used to enable him to spend more time with his parents, have holidays and to receive appropriate care for life.

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Mina’s doctor has offered to refer her for surgery to reduce scarring on her face that she has had since she was a child.

Mina does not communicate verbally and is unlikely to understand the risks involved in the procedure. Mina has never indicated that she is unhappy with her appearance so it is not clear whether she would choose to have the operation.

One of her carers has the idea of giving her a smiley face and a sad face and then showing her pictures of herself taken with and without makeup and from different angles so that sometimes her scars are less visible. Mina is asked to use the faces to show whether or not she likes the pictures. Her responses do not seem to be affected by whether or not her scars can be seen; she responds most positively to photos she looks happy in. It is, therefore, decided that Mina’s wellbeing would not be improved by reducing her scars.

Running of the home.

The Care Quality Commission are going to be looking for evidence that your managers are identifying the needs of clients and responding to them appropriately. It’s important that you develop ways of getting client feedback, recording it and showing what action is taken in response.

Not all clients will participate in the same way so you must have different methods for getting their opinions on the way their care is delivered and the home is run. You could try the following:

• Regular group meetings involving as many clients and staff as possible - minutes should be kept to show what was discussed and there should be records of actions taken in response.

• One-to-ones - care managers should spend time with individual clients asking for their opinions on the care provided and the environment they live in.

• Formal complaints procedures - these should be viewed as a legitimate way for clients to voice concerns and an effort should be made to ensure that all clients know how to raise their concerns.

• Questionnaires - decide which area of care provision you want to focus on and ask clients and their families to give satisfaction ratings.

No one method of feedback will be suitable for all clients, it’s important to use different formats to ensure everyone can make their feelings known. Some people enjoy speaking at meetings and taking part in committees but others will prefer to be able to give their opinion anonymously.

It is not always going to be easy to support the active participation of all clients. There are many barriers to participation which you may have to overcome; the table below gives some examples, suggest ways in which you might deal with them.

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Barrier to active participation.

The client:

Way in which we can overcome it.

Cannot communicate verbally.

Lacks the capacity to understand and retain information.

Has become accustomed to having decisions made for them.

Does not believe that their participation will result in action.

Has no family / friends to support them.

Feels excluded from the process.

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Unit Four Questions

Look at the scenario on page 20. Suggest ways in which Cleo could be supported to achieve her goal.

2.

Describe a way in which you could involve clients in deciding how improvements might be made to the way the home is decorated.4.

In what three key areas should we be promoting active participation?1.

1.

2.

3.

Why is it important to identify, and overcome, barriers to active participation?5.

From the information given about Chris on page 23 identify one thing which is important for him and one thing which is important to him.

3.

Important for him

Important to him