Communicating risk within a care setting
Since April 2015, the Health and Social Care Act 2008 has conferred powers on the Care Quality Commission (CQC) to take enforcement action against registered providers and managers who fail to meet the minimum standard of care. These minimum standards include ensuring that fit and proper persons are appointed to manage care homes, that care is person-centred and delivered with dignity and that care and treatment is safe.
The CQC is gaining momentum with these relatively newly conferred powers with a rise in cases where action has been taken, from 781 in 2017/18, to 906 in 2018/19. In an already heavily-regulated industry, it is clearly more important now than ever that care providers are communicating the importance of exercising safe practices to their staff, in order to avoid enforcement action.
Safe care and treatment
Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is designed to prevent people from receiving unsafe care and treatment, and to prevent avoidable harm or the risk of harm.
Regulation 12 not only requires the premises and equipment within it to be safe but also requires an assessment of the risks to the health and safety of service users receiving the care or treatment. This is a sizeable task for care home providers who also have to consider and assess more routine health and safety considerations such as manual handling and slips and trips. Regulation 12 requires that consideration should be given to industry-specific risks such as the safe use of bed rails, legionella and choking risks. It is an agreed industry-practice that individual risk assessments for these industry-specific risks may be incorporated into an individual’s care plan.
The CQC has indicated that it has not sought to set an unachievable standard and it understands that there may be inherent risks in carrying out care and treatment. The CQC has said that it will not consider it to be unsafe if providers can demonstrate that they have taken all reasonable steps to ensure the health and safety of people using their services and to manage the risks that may arise during care and treatment, much like the standards set by the Health and Safety Executive across most other industries in terms of safety management requirements.
Communicating the risk
The CQC advises that risk assessments should be completed and reviewed regularly by people with the qualifications, skills, competence and experience to do so. These documents must identify the significant hazards, identify who might be at risk and evaluate the risk and suggest precautions that can be taken.
Once this suite of documentation is in place, the next challenge is to communicate the significant detail contained within it to staff and for the care provider to ensure that the safe ways of working which make up the precautions arising from the risk assessment process are practiced and adhered to.
Due to the complexities of the risks involved in the care setting, there may be many risk assessments that run to a number of pages and it may not be feasible or effective for all members of staff to read every document, alongside the provision of care.
Care providers may wish therefore to consider alternative methods to communicate the detail contained within the assessments to their staff, such as:-
- Handover meetings – daily meetings where individual risk assessments are highlighted and discussed to ensure that all staff are aware of the precautions required, such as pureed food or a floor pressure sensor mat;
- Handover sheets – a written document that is updated on a daily basis with significant information relating to each resident and which must be kept with the staff member throughout their shift. Areas of risk (such as risk of falls) are highlighted in another colour;
- Online access – all risk assessments to be available for access by all members of staff to refer to when required;
- Induction and training – care providers should ensure all new staff are given sufficient time to familiarise themselves with all risk assessments prior to commencing their role.
Failure to comply with Regulation 12 can result in a significant financial penalty as well as the refusal of the CQC to continue to register a provider who is unable to comply. By way of example, in 2017, the CQC prosecuted a care provider for failing to identify the risks around the use of bedrails and the care home owner was ordered to pay £163,185.15 in fines and costs at Leeds Magistrates’ court.
It is therefore imperative that care providers take steps to ensure that their risk assessments are effective and clearly communicated to all staff, including bank and agency staff, to avoid the risk of prosecution and potentially also any subsequent loss of business.