Safeguarding people with learning disabilities in residential care and supported living services. Is it abuse or ‘just’ poor practice?
Disclaimer: These guidelines are derived from independent research commissioned/funded by the NIHR School for Social Care Research. The views expressed in this document are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS www.sscr.nihr.ac.uk
These guidelines are based on the findings from a research study. The research started by speaking to adults with learning disabilities and their families. We asked what people liked or disliked about the support they received. We used what they told us as the basis for interviews with 56 front-line workers (frontline managers, senior care-workers, full-time and part-time care-workers) in residential care and supported living services. These included a range of different organisations across England. The research found that staff were keen to give the right support to people with learning disabilities. It also found that staff were often confused about the difference between good practice, poor practice and abuse. The research showed that staff found it difficult to discuss abuse and poor practice with the other people they worked with. And it found that staff can find it hard to speak up about abuse or poor practice.
These guidelines cannot tell you exactly what to do in every situation, but they can help you to think about:
- How you approach your work
- The impact your actions have upon people with learning disabilities
- How you can help your team to become better at talking about abuse and poor practice
Roles and Responsibilities
Preventing abuse and poor practice is everyone’s business. Everyone has a part to play in safeguarding the people you work with from abuse and poor practice.
Support workers/care-workers/personal assistants
These are the people who have the most contact with service users. Every support worker must take personal responsibility for making sure that their work is of the highest standard. They should be open to feedback from others about how their work could be improved. If they see examples of poor work practices among other staff they should speak out against this. Support workers should report any abuse or poor practice to their line manager.
They are also sometimes called ‘house managers’, ‘home managers’ or ‘first line managers’. They are the people who directly manage support workers. They set the standard for how support is provided. These staff members need to spend time working alongside support workers, modelling best practice, leading by example and mentoring staff in effective safeguarding practices. They should have an ‘open door’ policy for staff to raise concerns. They should also help the staff team to talk about how to prevent abuse and poor practice.
Senior organisational managers
They are likely to have less direct contact with service users, but they still have an important role. Senior managers must make sure that the right policies and procedures are in place. They must employ enough staff to ensure a good standard of service. Their role includes following up allegations of abuse or poor practice. It also includes making sure that staff work in line with the right policy and procedures. And it includes making sure that enough staff are employed to give service users the support they need. ??
Recognising Abuse and Poor Practice
What is abuse?
Abuse occurs when harm is caused to an individual or group – the harm may be caused by a single incident or by an ongoing situation. Harm may also be caused by the effect of organisational practices on the lives of service users.
Abuse may include physical harm; theft; financial abuse ; neglect; sexual abuse ; discrimination; emotional or psychological harm; or misuse of medicine. It has a negative impact on the health and well-being of those who are harmed. Why harm and not ‘abuse’ – e.g. never heard of financial harm
Staff told us that abuse is…
“…anything that you or I wouldn’t want happening to us is abuse…”
“I think it’s everything, anything that really upsets them to be honest or abuses your power over them”
“…something that directly affects that person and their right to live a normal life.”
What is poor practice?
Poor practice takes place whenever staff fail to provide a good standard of care and support. It occurs when staff ignore the rights of service users or deny them the chance to enjoy an ordinary life. Poor practice which is allowed to continue can cause harm and can become abuse.
Staff told us that poor practice is…
“Not listening to them, trying to make decisions for them when they’re more than capable….small things that can make a big difference in their life….it can happen really easily without you noticing.”
“Just getting stuck into a routine and just sort of doing something …because it’s always been done that way, and not questioning”
“Poor practice can be an indicator that something else might be happening…”
Is there a difference between poor practice and abuse?
Abuse and poor practice are closely linked, and poor practice may become abuse. One-off incidents of poor practice differ from abuse in that they may be unintentional, do not cause any lasting harm and most short-term harm can be quickly put right.
Staff told us that…
“If you don’t deal with malpractice then abuse is undoubtedly going to happen.”
“It’s just like a fine line though isn’t it, as to whether it’s really wrong or really, really wrong”
“…all abuse will come under bad practice, I don’t think all bad practice will come under abuse.”
When can abuse or poor practice occur?
Abuse may take place in any situation where one individual or group has power or control over another individual or group. There is always the potential for abuse and poor practice in services for people with learning disabilities because staff have the opportunity to have a high degree of control over the lives of service users.
Staff told us that abuse or poor practice can happen…
“…when somebody is in a place of power and they’re abusing that power and trust.”
“…when the respect isn’t there for the individual, when staff take ownership of a part of somebody’s life”
“…if I said to you…you have to get up at this time of day because it fits in with what I need us to do today – well I’m actually here to support you, not dictate to you what we do”
Thinking About Your Work
It is everyone’s job to work in ways which respect service users. Talking with other staff about how you work can help everyone to do their job better. It can also help to prevent abuse or poor practice.
This will involve:
- Listening to what service users and their families have to say about the care and support they are given
- Learning from mistakes and one-off incidents of poor practice, so that they do not happen again
- Giving staff the chance to talk about their work and to learn from one another about how best to support individual service users
- Making sure that staff get the right training to do their job well
- Giving staff regular supervision and regular opportunities to think about and talk about their work
- Giving new staff time to get to know the care plans for each service user and to get to know the organisation’s policies and procedures
Recording the Right Information
“If it’s an everyday thing, then we don’t report it….if it’s out of the ordinary or we think there’s some concern we put it on [the computer]”
Record-keeping can play an important part in making sure that service users get high quality care and support. Good care plans mean that staff can understand the needs of each service user. Communication books help to make sure that staff working on different shifts are working as a team. Individual log books or end of shift reports help to give a picture of the service users’ day. Matters which need follow-up can be noted. For example, a night shift worker might make a note that someone said they were feeling unwell at bed time. The day staff can find out if the person is better in the morning and decide if a doctor’s appointment is needed.
It is important to make sure that you are recording the right kind of information. For example, it is more important to record whether someone is happy or sad than to write down what clothes they chose to wear or what they ate for lunch.
Accurate records can help to identify abuse and poor practice. For this to happen, it is important that records are reviewed. This means looking back over several weeks or months to see if a pattern of behaviour can be seen. For example, does a service user often seem unhappy or display challenging behaviours when a particular member of staff is on duty?
If an incident has taken place which you think could be abuse it is important that you record what happened. After any incident you should write down what you saw as soon as possible. What you write should describe what happened and not describe your feelings about what happened. It is important to be as clear as possible. Other people who saw what happened should also write down what they saw. Different people may have seen different things. Later on, it may help to talk to other staff about how the incident made you feel.
“I’d do it automatically. It’s instilled in me. I have no qualms. I’m not here to gain popularity. I’m here to do a job.”
Support workers must report any abuse or poor practice to their manager. If the abuse or poor practice carries on then support workers should report their concerns to a more senior manager. Support workers can report their concerns directly to the local authority Adult Safeguarding team. They can also report concerns directly to the Care Quality Commission.
Frontline managers must give staff clear guidance about how to do their job. This can help stop abuse from happening in the first place. If poor practice does take place, managers must tell staff what has to be done differently. If abuse takes place, frontline managers must report this to senior managers. Frontline managers can report their concerns directly to the local authority Adult Safeguarding team. They can also report concerns directly to the Care Quality Commission.
Senior organisational managers must take action when they are told that abuse may have taken place. They must report all alleged abuse to the local authority Adult Safeguarding team. They must help the Adult Safeguarding team with any investigation. If staff are found to have abused service users they will face disciplinary action. If a crime has been committed then staff may be suspended while the police investigate.
Local authority Adult Safeguarding teams have to investigate when it is thought that someone may have been abused. They can ask for staff to be suspended from work while they investigate the abuse. They can recommend changes to the way that support is provided. The local authority will report allegations of abuse to the police if they think that a crime has been committed.
CQC (Care Quality Commission) is the regulator for residential care homes in England. It sets standards which must be upheld by all care homes and home care services. The CQC has the power to shut down services which do not meet the required standards.
The following website has links to every local authority in the UK. Use it if you need to find information about your local authority Adult Safeguarding team.
Local Authority Safeguarding Team – A-Z list of local councils
The Care Quality Commission (CQC) is the independent regulator of all health and social care services in England
The CQC has written a guide called “Raising a concern with CQC”. It tells you how to get in touch with them if you are worried that someone is being abused.
Ann Craft Trust is a national charity that works to prevent the abuse of disabled children and vulnerable adults. They can provide advice, information and training.
Please direct any enquiries about this research to:
Dr Rachel Fyson
Tel: (0115) 951 5226
School of Sociology and Social Policy
The University of Nottingham
Nottingham, NG7 2RD