Level 3 - Self-assessment - JoTita Gonçalves

Level 3 - Self-assessment

As a Senior Support Worker and a Shift Leader, my role has big responsibilities that come implicitly with the terms “Senior / Leader”. In care, everyone is under the same legislation, laws, rules and there is always the duty of care that, when in doubt, commands every single action towards the people I support, by having their best interest at heart. When talking about duty of care, I could never forget to mention its best partner – the duty of candour – as both work side by side to promote the safety and wellbeing of the individuals receiving support. I might not know the 6 C’s in their right order, but I know what they mean on my day-to-day at work and I implement them without even thinking about it – they are part of my “uniform”.

On this self-assessment, I’ve chosen to talk about a few situations that had happened a couple of months ago and that made me realise many things, such as what to do in order to prevent similar situations from happening, be calm and ready to act promptly. There are always improvements that can be done, and I will never know it all.

Situation 1: At my Service (for people with Acquired Brain Injury that come to us for intensive therapy and rehabilitation), we’ve received a person that also had the Korsakoff Syndrome caused by many years of substance misuse, mostly alcohol. So, we were informed that she would ask for a lot of drinks, because she would not remember that she had had it, due to her poor memory and also as part of her condition. There were incident reports from the hospital because she would not be monitored properly ending up having seizures caused by Hyponatremia (low sodium levels in the blood). She would drink from the taps at any opportunity – she even would ask to go to the toilet on purpose for that, so we had to monitor her very closely 24/7. (There were allocated slots to rotate among the team members.)

We were sent her care plan to our work email during the weekend, in order to get familiarised with her story, what to expect and ways that have proven to work while dealing with it. So, this person arrived on Monday before lunchtime. She was very confused, shouting and with challenging behaviour. Her care plan mentioned that she was known as an aggressive person towards others. She was welcome, reassured, a cup of tea was offered as a distraction, and she had accepted to go and see the room where she was to stay in.

We had a form where we were supposed to write down every drink she would have, including how many millilitres it would be. It has been agreed that she would be allowed to have 1500ml per day.

OUTCOME: On Tuesday around 7pm 999 was contacted because she was having a seizure that looked like to be hyponatremia (getting blue/grey skin, difficulties in breathing; sweats, …) This was confirmed later by the paramedics.

So, what happened? There were a lot of things that led to that outcome.

➔ Not everyone would take her drinking limit serious, therefore, not everyone would write it down;

➔ On the second day, it was given the idea of giving her ½ cup of tea each time, so that way it would allow her to have “more drinks” during the day – because it was noticed that on the day before she had passed the limit;

➔ We were short staff, and she was supposed to have 1-to-1 all day and all night;

➔ There was a dilemma about going in with her to the toilet, as she was independent, and the dignity and privacy principles were not being respected;

➔ There were times that she would refuse to have someone with her in the bedroom and she would put the staff out and close the door – even though staff would monitor as close as possible (staying outside her bedroom’s door) due to the circumstances and she had the right to her privacy once again, sometimes when they would hear the tap running there was no way to measure what she must have drunk;

➔ There was some information printed out from the Internet about her condition, causes and symptoms, but not everyone had read it.

Lessons learnt:

1. There will be occasions that the best interest will interfere with gold principles, but it is in those situations that my duty of care needs to be strong and the right decision needs to be taken. Even though it might not be very nice to have someone with her in the toilet, it would be in her best interest to make sure she would not have the opportunity to drink water from the tap uncontrollably. We might struggle to do it, but we must see the big picture and all of what it’s involved;

2. There were staff that was not prepared to deal with the drinking situation, so this made the work harder. Some training should be given previously in order for everyone to have the same knowledge and skills to deal with the situation seriously and promptly;

3. We were supposed to have an extra member of staff, but not everyone was able to deal with her challenging behaviour, so the slot times were not always respected and most of the time it would need at least 2 people dealing with her – (more people when she was aggressive!);

4. The care plan was not too detailed and there was just a little information compared with the big picture that we had to face;

5. Some staff were not trained enough, others not trained at all, to deal with that type of behaviour;

6. There was not enough supervision and support as things were a bit chaotic;

7. Cases like this can be raised as serious safeguarding issues.

Situation 2: One of the People We Support (PWS) was released on his own from a Day Centre Gardening, even though he was under DOLS (Deprivation Of Liberty Safeguards).

The person was asked if it would be of interest to go and spend the day at the place, the person was very excited, the risk assessment was written, the documentation was all filled in and sent to the agency taking the lead on the activity, the person was accompanied to the place on the day and time agreed, he was dropped off safe, the time to be picked up was also reconfirmed, some important information was passed on and the person was left on the premises with the regular staff leading the activity.

So, when looking at what was done, it seems that all the main points were covered, right? The person was involved, and his wishes were taken into consideration; the documentation was done including the risk assessment; there was communication between the two companies; …

So, what could be missing?

➔ In the documentation that was filled in, there was no mention that the PWS was under DOLS (there was no question about it and neither did I mention it!);

➔ On the day, before leaving him there, it was mentioned again a few things, including that the person was a high risk of choking so he would need to be monitored whilst eating and drinking (well, the answer was: “We don’t have enough staff for that!” – they didn’t take the matter seriously and he was left there even so. The result: even though he took his packed lunch with him, staff from the day centre gardening, left him to go out on his own to buy some food on a nearby shop – he ended up having food that was not recommended for him – but no choking incident was reported to us, fortunately;

➔ The picked-up time agreed with the regular staff member from the Day Centre gardening was between 3:30 and 4 pm, so our Support Worker has agreed to come and collect him up around 3:30pm. Around 2:45pm our Service received a phone call from the Day Centre informing us that the PWS had gotten bored and requested to go home around 2:15pm, therefore, there was no need for our staff to come and pick him up, as he had left the premises on his own.

So, here was when all the trouble started! I was informed 30 min after he left the premises; no one knew what route it had been taken – if he caught any bus (if so, which one, where to?), if he was safe walking around on his own in the very busy main street and the big roundabout; he had no mobile phone with him, so, therefore, there was no way I could try to contact him; and the list of worries just kept going on and on. So, I and another colleague decided that we would split the work into 2: while one would deal with the phone calls (police, managers, family, …), the other would make a plan to split the rest of the team in order to try finding him. So, I’ve chosen to lead the team. My first action was thinking about what were the places the person regularly used to go. All team members would mention places and then people were split into different directions. Each team member would have a picture of the person missing so, this would be the main tool used to try to know if anyone had seen him around the area. All team members had their personal mobile phones, to keep everyone informed of any updates. There were even some people from other Service, joining us on the search. The other colleague stayed at home making all the phone calls and dealing with the police. There were also 2 other staff members there to make sure all the other PWS were looked after. So, if the person missing would come back home, there were be someone to open the door and all team would be informed.

Outcome: A few hours later the person missing was found by one of our staff members, just 2 minutes away from home after being in town, going to a CD’s shop, going to his favourite coffee shop and finally his last stop was in the corner shop. He was very happy, seemed confident and he was completely safe.

Lessons learnt:

1. He was able to be more independent than he had credit for – he caught all the correct buses, went to different places with a plan and he always knew where to go, so his DOLS had to be revised;

2. When filling in documents, I must be sure ALL IMPORTANT information is put in there; also, if there is no specific space for some details (like if the PWS is under DOLS), to make sure I’ll still add the information and, before the documents are handed over, must be revised by one of the managers;

3. When the risk assessment was written, there were elements that were not pounder on, like what to do if this situation would happen, so, I must make sure all possible outcomes are thought out thoroughly in advance to prevent surprises and have already a detailed plan in case it needs to be used;

4. The PWS didn’t have any way of being contacted while in the community, so I must make sure he takes his mobile phone with him before going out, that it’s charged, that the person also knows how to use it and who to contact in case of feeling unsafe, unwell or in an emergency to call for help;

5. Because each person remained calm and followed instructions, the outcome was positive, and all work was done in an orderly way.

It may be good to emphasise that under the duty of candour it has been my role to ensure that relatives were informed of the 2 situations, ensured openness and transparency as a service. This was confirmed by CQC when discussing each situation.

Above I’ve described two exceptional situations that will always be in my memory as challenges and grown-up moments. Most of the time, when people talk about care, they don’t mention how hard it can be, how dangerous and draining it can become. But care is much more than those difficult moments. When I see someone’s smile after making a simple cup of tea by themselves, being able to do their shopping list, being able to say a difficult word correctly, being discharged to live in the community after months of intensive rehabilitation; … there is no price for that! In my role, it is my responsibility to give the staff a good example, support and oversee areas that might need improvement in order to make the teamwork in a unit. Being observant, having good communication skills and being approachable is the beginning of success. Also, making sure that my training is up to date is essential for my personal development but also for keeping the company’s high standards. I’ve been given the opportunity to supervise and be responsible for the weekly COSHH products check, file updates and stocks; to monitor the fire panel, do the weekly fire alarm test, participate in the drills; be the Medication Functional Role – this means be the person that deals with everything related with medication – weekly checks, reorders, check medication in/out, do the returns; be the one in charge of the new staff induction; being a key worker and I even had the opportunity of being seated in some job interviews (having the questions ready in front of me for the participants).

As we are aware, care has much more involved than just being with and helping people – there is a lot of work that needs to be done on the “backstage”. Before I was a senior, I was not aware of all this “hidden” workload, but now I really enjoy making sure that I have enough forms; the care plans are up-to-date (in order to do that – feedback, good records and thorough handovers are essential); book and attend appointments; spot changes, offer suggestions, take some risks; deal with challenging and conflicting situations between PWS and their families (privacy, confidentiality, safeguarding); speak up and make sure things are dealt with promptly and so on.

In conclusion, Care; Compassion; Competence; Communication; Courage and Commitment are qualities that I was not born with, but with effort, drive, and power I’ve made my way through. I’m willing to grow each day, improve and become the best version of myself, this will hopefully give others the chance to see how possible and achievable it is, allowing me to grow together with them. My goal is to be able to take my Level 5 soon.