Hankham Lodge - Safeguards

Introduction

The aim of this guide is for Hankham Lodge to promote good practice. One important element of good
practice is to guard against any kind of exploitation, neglect or abuse of residents. An environment
which is constantly seeking to improve the life and care of residents automatically tends to guard
against bad practice.
In spite of registration, inspection, internal monitoring, quality assurance systems and codes of
practice, regrettably abuse can occur. Sometimes this may be unwitting or unintentional perhaps
through ignorance or neglect. At other times, however, it may be deliberate, whether subtle or overtly
cruel. There is now greater recognition of the fact that abuse does occur and a fuller understanding of
how it arises.
The definition of abuse
'Elder abuse is a single or repeated act or lack of appropriate action occurring within any relationship
where there is an expectation of trust which causes harm or distress to an older person.'
Action on Elder Abuse
Abuse is the harming of another individual usually by someone who is in a position of power, trust or
authority over that individual. The harm may be physical, psychological or emotional or it may be
directed at exploiting the vulnerability of the victim in more subtle ways (for example, through denying
access to people who can come to the aid of the victim, or through misuse or misappropriation of his
or her financial resources). The threat or use of punishment is also a form of abuse. Abuse may
happen as a 'one-off' occurrence or it may become a regular feature of a relationship. Other people
may be unaware that it is happening and for this reason it may be difficult to detect. In many cases, it
is a criminal offence.
Physical abuse
Rough handling or unnecessary physical force, deliberate or unintentional, used in caring for a resident
is abuse. Injuries may not always be visible although often there may be bruises, broken skin, cuts,
burns or broken bones. During an episode of abuse, damage to property or clothing may also occur.
Restraining residents so that they cannot move, or by shutting them in a room, is abusive. However, it
may sometimes be difficult to draw the dividing line between justifiable and unjustifiable restraint.
Verbal abuse
Shouting and swearing at someone should be regarded as abusive behavior. In addition, speaking to a
resident in a quiet but threatening way so as to make the resident fearful or to make the resident an
object of ridicule is equally abusive.
Emotional abuse
Playing on someone's emotions to make him or her afraid, uneasy or unnecessarily dependent is
another form of abuse. Exploiting a resident through using personal information gained through the
caring relationship is an abuse of the trust vested in the carer.
Abuse through the misapplication of drugs
The use of drugs to control or restrain a resident is unacceptable unless medically required. The
over-use and misuse of sedatives and other medication, which too often happens in homes, should be
regarded as evidence of bad practice.
Financial abuse
Financial abuse includes the improper use or control of, or the withholding of, a person's money,
pension book, property, bank account or other valuables.
Racial abuse
Victimising people, verbally insulting them and physically attacking them because of their racial or
ethnic origin is abusive.
Sexual abuse
Forcing someone to take part in sexual activity against his or her will is abuse and a criminal offence.
The force does not have to be physical. Undue emotional pressure placed on an individual may lead
him or her to acquiesce in behaviour he or she finds unacceptable.
Neglect
The withholding of care and treatment when it is required is a form of abuse. Similarly, depriving
residents of the essentials of everyday life, such as food, clothes, warmth and personal cleanliness
should also be regarded as a form of abuse.
How and why abuse might occur
There are many reasons why abuse occurs in residential homes. They range from the individual to the
institutional:
· abuse may result from the actions of individual members of staff because they lack the training,
experience and management support to cope with the stresses of caring for people who require a high
level of assistance;
· occasionally it may occur because individual members of staff set out deliberately to harm residents;
· more often, abuse occurs because the home, its managers and staff slip, often without realising it,
into a set of attitudes which reflects low morale, defensiveness about their competence and a lack of
concern and respect for residents;
· over-work, lack of appreciation, low pay and low self-esteem may all contribute to the development
of an environment in which abuse becomes an accepted feature of daily life.
Hankham Lodge combats this by:
· careful staff selection procedures;
· training and management support for staff once in post;
· leadership from senior management;
· the development of a working environment which values staff, does not demand too much of them
and rewards them adequately.
Hankham Lodge guards against
· inadequate staffing levels to cope with a high incidence of incontinence;
· lack of trained and experienced care staff;
· absence of staff supervision by trained and experienced managers;
· terms and conditions of employment which do not provide holidays or guarantee other basic
employment rights;
· a casual approach to resident privacy where staff walk into rooms unannounced, doors are left open
when residents use the toilet, staff talk about residents over their heads or divulge confidential
information.
Prevention
Staffing procedures
The quality of life in the home is underpinned by the qualities of leadership and competence shown by
Mr & Mrs Sims and Mrs Blake. Beyond that, much depends on the calibre of the staff team. It is
essential that basic good practice in staff recruitment, training and supervision is observed.
This involves:
· Hankham Lodge takes up references, character checks and an enhanced criminal records check
(CRB). We confirm written references by telephone calls;
· We provide regular supervision and appraisal sessions between manager and individual staff
members to provide support in coping with stressful situations and to encourage staff;
· encouraging an atmosphere where staff feel able to discuss and therefore prevent the development
of potentially abusive situations;
· assuring staff that their jobs will not be threatened if they 'brow the whistle' on abusive behaviour by
other staff;
· making clear in the terms and conditions of employment and in the disciplinary procedures that
abusive behaviour is a dismissible offence. Instances of serious abuse will be regarded as gross
misconduct and subject to instant dismissal and be reported to the adult protection unit. Lesser forms
of abuse will be subject to the formal disciplinary procedure and reported to the CQC, which if
repeated would lead to dismissal;
Action to be taken if abuse occurs
If the situation is urgent, the person witnessing the abuse should:
· immediately challenge the person who is abusing the resident, even though this may be difficult to
do, and try to persuade him or her to stop;
· report the incident to a senior manager straightaway.
If the immediate risk to the resident has passed a more considered approach might be helpful. The
person witnessing the abuse should:
· check which of the home's policies and guidelines have been broken, or check against this guid; write
down all the relevant facts;
· consider using the home's complaints procedure if appropriate;
or
· consider the most appropriate senior member of staff to approach and whether it would be helpful to
have another member of staff involved;
· ask for a confidential meeting with the most senior manager appropriate at which the abuse is raised;
· the manager should then decide what action to take (for example, invoke the disciplinary procedure,
take evidence, call in the police or the adult protection unit).
If the above action does not stop the abuse, or if the home's management is involved or is unwilling to
take the necessary corrective action, then the person witnessing the abuse should:
· speak to another trusted member of staff if not already involved;
or
· seek advice from a professional or expert organisation, i.e. registration authority; Adult protection
Unit
If at any time the situation involves something which is against the law, or the resident or witness is in
danger, the person concerned should:
· contact the police and ask for immediate help.
Other abuse
In some circumstances, staff themselves may be subject to abuse from residents or residents may
abuse each other. Sexual advances and verbal abuse are not uncommon. Racist behaviour from and
between residents can and does occur. Staff may find this difficult to talk about and handle. They may
react inappropriately. Hankham Lodge through its training and support systems attempt to managing
such behaviour.

Ensuring standards: registration, inspection and quality assurance
Introduction
The procedures for ensuring standards in continuing care are both mandatory (registration and
inspection) and voluntary (quality assurance). The way in which Hankham Lodge deals with them are
as follows.
Registration
The CQC (Care Quality Commission) registered and is responsible for the continuing registration of
Hankham Lodge. The CQC ensures that the purposes and aims of the home are clearly set out and
that the standards of care we offer match these aims and objectives. They have a duty to ensure that
the best quality of life for residents is achieved.
Registration process
Throughout this process, registration staff were consulted and monitored progress and preparations for
the opening of the home. Advice was given to us about the initial selection of residents, selection of
staff, preparation of a home brochure, and on how to ensure that the registration requirements agreed
initially would be implemented.
Our suitability for registration
The Social Services (until mid 90s) The Inspection Unit (until 2000) N.C.S.C (until 2003) and now CQC
ensured that we posses the relevant qualifications and have extensive experience of employment
within residential care. They are also confident in our in our understanding of financial projections and
budgeting. They recognise our business-like approach that will ensure that Hankham Lodge will be
managed on a secure financial basis and will not put the future welfare of residents at risk.
Change of owner or manager of a home
Peter and Svetlana Sims hope to continue to provide unrivalled quality care at this site for many years
to come. This is our commitment to you.
Inspection
Under the National Minimum Standards 2002, homes must be inspected by the The CQC (Care Quality
Commission) All registered homes (since 2002) must be inspected twice a year although the CQC may
choose to visit more often. At least one visit is unannounced. Inspections are carried out by persons
authorised to do so by the CQC. Inspections vary in content, focus and length of time depending on
any outstanding issues identified on previous inspections. Inspectors focus on quality of care and
quality of life issues as much as on the fabric of the building. Time is devoted to asking residents and
staff about standards of care provided. Care is taken to ensure that courtesy, diplomacy and tact are
used in inspecting individual residents' private rooms Hankham Lodge makes every effort to make it
possible for the inspection officer to spend some time in private with individual residents We find
inspection enormously constructive and recognition is given to innovative and good care practice. Time
is also given to discussing and reviewing, with the us, the objectives of the home and how the care of
the residents can be enhanced.
Hankham Lodge's inspection reports are available to the public and are available on the internet.
Complaints procedures
The complaints procedure is outlined on entering the home. The majority of complaints regarding the
management of a home are normally satisfactorily resolved by the Mr and Mrs Sims with no need for
the CQC to be involved.
When complaints cannot be resolved internally the CQC will be informed of the complaint. All
complaints must be made in writing to the CQC, giving details of any action already taken and with
whom the matter has been discussed. CQC will then take the necessary steps to investigate the
complaint and arrange to interview the owner/manager, resident and all other people relevant to the
specific complaint. Following the investigation/interview, a letter will be sent to the owner and
manager, resident and the complainant stating the outcome and specifying any action.
Consumer advice
The CQC have available for consultation a list of all private and voluntary homes currently registered
in its area. Many authorities have also found it helpful to publish a more detailed list of registered
homes describing their individual characteristics and specific services provided, General information
can also be given on how to obtain advice about financial assistance towards the cost of
accommodation, and on the difference between a private and voluntary home and between a
residential care home and a nursing home. We have tried to provide as much information as we ca on
our web site.
Quality assurance (QA)
Quality assurance is the process whereby we can check that acceptable standards of service are being
met. This is done through self-assessment and annual inspection by the CQC. In order for this process
to work, agreed standards been set out in the previous pages. Performance against those standards is
then be measured through the quality assurance process. The inspection report details the standards.
The benefits of QA
There are many benefits for Hankham Lodge in establishing quality assurance procedures. this process
identifies what constitutes acceptable standards of care and assists in setting up processes for
monitoring our progress towards achieving them. Drawing up and agreeing standards has involved all
those concerned, including residents. The day-to-day experience of those who live and work in the
home has provided the starting point for the process. Essential to the process of quality assurance is
the idea of self-audit or self-assessment whereby we systematically examine the service we provide,
assess our performance against standards which we have already agreed in conjunction with
residents, and then make adjustments to improve anything shown to be deficient. Quality assurance
involves all members of staff at every level. Through this, standards are raised and team-working is
developed.
Accreditation
Accreditation is given in the way of an annual CQC report that doesn't outline major requirements or
recommendations.

Terminal care
Introduction
As important to residents as the quality of their lives while they are living in the home will be the way
in which they are cared for during the process of dying. This means that their physical and emotional
needs are met, their comfort and well-being attended to and their wishes respected. Pain and distress
is controlled and the privacy and dignity of a resident who is dying is at all times be maintained.
The death of people living in Hankham Lodge
The fact that most residents die in the homes they are living in rather than returning to their own
homes or being moved into hospital does not mean that dying and death is routine and commonplace.
The impact of death on the community of residents is significant and continuing and we ensure that
opportunities are available for them to come to terms with issues of life and death in the way that each
individual finds best. This is done by ensuring that opportunities are provided for meditation and
reflection, for contact with local religious and spiritual leaders and that there is an openness and
willingness on the part of staff and others involved at Hankham Lodge to talk about dying and death,
and about those who have recently died.
Policies and procedures
The issues around dying and death are very sensitive. Hankham Lodge's operational policies which
deal with quality of life before death, planning in anticipation of death and the practical and legal
requirements following the death of a resident.
Considerations are:
· Physical and medical (especially with regard to comfort and pain relief);
· Spiritual and emotional aspects;
· Cultural and religious beliefs and practices;
· Legal issues and other formalities to do with death;
· Relatives' and friends' involvement;
· Support for staff.
Policies are clearly expressed and information made available to residents and their families and
friends when they first come into the home.
Expressed wishes of the resident
Some people will be clear about their preferences with regard to care when they are dying and the
formalities to be observed after their death. They may be very ready to discuss it with those closest to
them and with staff. In other cases, people may be more reluctant to broach the subject, or have it
broached with them. Staff are alert to occasions when individuals may reveal their thoughts and
preferences unexpectedly so that they can make use of this when the time arises.
However it is done, the process of talking to residents about their death is a delicate one which is done
sensitively and with compassion. It may be very time-consuming.
Planning ahead
Information about the resident
Where possible Hankham Lodge, perhaps in conjunction with relatives or friends, assembles
information about the following, to be made use of at the time of the death of a resident:
· details of next of kin;
· people to be informed in case of serious illness or death;
· the existence and location of a will and next of kin instructions (if kept at the home);
· funeral arrangements and any preferences;
· the person to be responsible for making arrangements and taking responsibility for the resident's
property;
· any religious or cultural practices;
· any other personal request.
Information of this sort, once gathered, is confirmed periodically and always observed at the
appropriate time.
Financial affairs, wills and next of kin instructions
These matters are handled by relatives, a solicitor, an appointee, an attorney or the Court of
Protection, Court of Session or the High Court. The resident may have completed a next of kin
instruction form or left other written instructions. Wherever possible, the resident's wishes are to be
respected and carried out. Hankham Lodge is never involved in any financial arrangements.
Dying
Some people may express thoughts about dying, in particular their hope for a peaceful, pain-free
death or their fear of death and their concerns for those left behind. Those who are in the position of
providing care and support do everything they can to calm these fears and attend to these concerns.
Staff adopt an approach which is honest and open about the facts of illness and death, should the
individual ask them.
At Hankham Lodge there are particular members of staff with experience and training in looking after
people who are dying and can advise other members of staff. All care staff receive some training
through NVQ in looking after people who are dying and are aware of their physical and emotional
needs. They only act within their competence and know when to call upon others.
Care and comfort
A dying person receives all the care and comfort that is required. Particular attention is paid to keeping
the person comfortable and responding to any requests. This may involve moving the person's position
regularly (sitting up or lying down), keeping the person clean and cool, paying special attention to the
person's mouth and giving regular drinks, and helping him or her to use the toilet. Additional staff are
brought in if required and night staff are fully involved to make sure that care is given constantly
throughout the night. A ripple mattress may be helpful,. Expert advice on pain control and
management is sought for all residents who need it. Medical practitioners, community nurses or
specialist nurses such as Macmillan or Marie Curie nurses can provide advice and assistance. Any
painkilling or respiratory drugs are given only under the supervision of a doctor.
At Hankham Lodge a person close to death is not usually left alone, although any wish to be alone is
respected. Relatives and friends may wish to be involved, but if there are none, staff have a special
role to play. Above all, at all times, the privacy and dignity of the dying person is preserved. Attending
to the physical needs of the person washing, bodily functions, feeding is done in private. Staff do not
assume that the person cannot hear what is being said so they never talk about the individual when
they are in his or her presence.
Place of dying
Residents are able to die in their own beds in their own rooms, surrounded by familiar people and
possessions. Wherever possible, residents do not have to move away from the home to die (unless it
is essential for them to go into hospital). Following death, the person's body isn't moved from his or
her own room to another part of the home before being taken away by the undertaker.
Shared rooms
Complications arise if the person who is dying is in a shared room (the position is different for couples
or close friends). There can be little doubt that it is easier to provide the care needed by the dying
resident with dignity and in privacy in a single room and without the presence of another resident. The
impact of a succession of deaths for someone living in a shared room would be intolerable. Residents
in a room with a dying fellow resident or where a death has occurred are if possible offered the option
of a move.
Hospices and hospitals
Hankham Lodge is aware of the care and services which local hospices have to offer. Many have
outreach services and are able to offer help in the home without the resident having to be admitted to
the hospice.
Where the person is in extreme pain or has other complications, it may be better for him or her to be
looked after in a hospice or a hospital. Such decisions are only made after consultation with the
person, any relatives and on medical advice. Any wishes of the resident, are respected if possible. The
resident should also be able to return to his or her own home if possible and if he or she so wishes.
Relatives' involvement
Relatives may wish to be with their dying relative and every encouragement and opportunity is made
for them to do so if this is known to be in accordance with the dying person's wishes. Space and a
quiet room is available for relatives to sit, collect their thoughts and grieve. Meals, refreshments and
other facilities are made available. This hospitality is extended to relatives whether they have been
regular visitors or not.
Some relatives may wish to be fully involved in the care of their resident while others may just wish to
be close by. Staff ask about relatives' wishes and facilitate them.
Other residents
The size and nature of Hankham Lodge to a certain extent dictates how the other residents are
involved. In general they are kept informed of someone's impending death and are encouraged to visit
him or her if they so wish. Cultural or religious practices may be appropriate such as prayers, vigils,
playing favourite music or welcoming relatives.
Staff involvement
All staff who have had any involvement with the dying resident and this includes managerial as much
as it does care staff are kept informed when someone is dying. Those who wish are given time to
spend with the dying resident. This is one way we ensure that there is always someone present.
Support is given to staff who have been closely involved with the resident and their emotional needs
are recognised and catered for, particularly in the case of staff who are witnessing death for the first
time.
Death
All the necessary procedures in terms of washing, dressing and laying out the body is undertaken
sensitively and with dignity by the Undertakers.
Inform next of kin
If the next of kin or those most closely involved were not present at the time of death, then the
manager or deputy will inform them as soon as possible that their relative has died.
Formal notifications and documentation
Depending on who is responsible for making the arrangements, the manager or deputy dose what is
necessary or give whatever help is required to support the relatives. Whatever the position Hankham
Lodge is likely to have a central role.
Things we do will include:
· obtaining the death certificate from the doctor;
· informing the coroner if the death was unexpected, if a death was unexpected then the police need to
attend (this is routine)
· contacting the undertaker.
The manager will also inform the registration authority and follow any other agreed organisational
procedures Re: Regulation 37.
Announcing a death
News of a resident's death will be announced in a dignified and gentle way. It may be best to announce
it quietly to individuals or staff to begin with but some more public announcement may also be
appropriate in due course. Some people may find this public recognition comforting. It is never
assumed that people with memory loss do not understand when someone has died. Some of the
following possibilities might be appropriate:
· a minute's silence at an appropriate time;
· a photograph or some other personal tribute in a suitable place;
· opportunity to visit the dead person and pay last respects;
· a memorial or thanksgiving service or some other religious or cultural ceremony;
· lighting a candle;
· playing a favourite piece of music or reading a poem;
· a plant, picture or piece of furniture in memory of the person.
Funeral
Residents and staff are able to attend the funeral or other ceremony if they wish. Transport can be
arranged and staff rotas when possible will be adjusted either to provide escorts for residents or so
that staff can attend in their own right. Hankham Lodge always tries to represent the home at funerals.
Bereavement
Staff are alert to the impact the death of individual residents may have on those remaining in the
home. They are trained to recognize symptoms of grieving and learn how to respond. Formal
bereavement counseling or contact with a specialist organization may be appropriate. In the case of
people with memory loss, changes in their behavior may indicate the impact the death of a fellow
resident has had on them and staff will be ready to offer comfort and support.
Within Hankham Lodge, the loss of one of a couple, or of a close friendship needs special and
sympathetic support. Particular sensitivity will be needed in some practical matters such as any change
of accommodation or disposal or handing over to relatives of clothes and other belongings. These are
never rushed.
Moving into Hankham Lodge following bereavement
Many people come into a home after their partner has died. Staff recognizes that new residents may
be going through a grieving process and they therefore are sensitive to their sense of loss and offer
support. The quality of support is enhanced by specific training.
Formal and business arrangements
The agreement of residence outlines the fees payable in the case of the death of a resident. The
former resident's accommodation will be available to his or her family for a reasonable period of time
in order for personal possessions to be removed and affairs completed. A balance should be struck
between this need and the time necessary to prepare the room for a new resident. A final account will
be rendered in accordance with the terms and conditions agreed at the outset and any valuables and
property held for safekeeping will be returned to the executor