Introduction to the Case
In this assignment I am going to use a nursing home for elderly residents, both male and female with both dementia and different medical conditions like diabetes, Parkinsons disease and hypertension. Some of the service users in this nursing home are bed bound while others are mobile or self dependant. It has two floors with 42 bed capacity.
What quality means to the following stakeholders
Service users
These are residents or clients in our Nursing home. Quality to our service users means any service that is offered to their satisfaction for example:
Respect: Most of our residents prefer to be addressed by the names while some prefer to be addressed as Mr. or Mrs. We respect their wishes and this makes them happy. Also when we are offering personal care like washing or bathing we ensure that doors are shut for privacy and dignity purposes we also respect their age as adults and treat them as adults according to their wishes.
Choice: Residents choices in our nursing home are usually observed as this makes them to have their freedom of choice in whatever they want to have for example we have different menu choices for foods and drinks and before we serve them we ask them what they prefer to have. The same applies to the way they prefer to dress and so we offer them a choice on their own clothes and activities that they would like to participate in and at the end of it all they are happy and the quality of service offered is satisfactory to them and everybody else.
Confidentiality: Anything concerning a resident in our Nursing home is private and confidential unless for medical reasons like consultation and to those who are concerned like family and relatives.
Friends and family: They usually appreciate when they are involved in care plans of their relatives and they are satisfied when what they have agreed on is followed through.
Safety:they are always appreciative and supportive when they know that their parents and friends (residents) are free from harm by the care they are provided with for example safe from falls, abuse and infections within the nursing home. They like their relatives to be treated equally like other residents without discrimination because of either their conditions, disabilities or ethnicity.
Carers
These are the major service providers in our nursing home and quality to them means:
Equity- all service providers should be treated equally regardless of their race, ethnicity, gender and knowledge and skills they have on their job when this is put into consideration they are motivated and tend to offer the best quality of care to residents which in turn leads to customer satisfaction.
Safety all service providers in our Nursing home ensure they are safe on the environment they work on for their sake, residents, relatives and friends and anyone concerned. We ensure proper procedures are followed such as moving and handling by using proper equipment on residents like hoists and slings to avoid accidents to ourselves and to residents. Carers are always happy when they are not abused either by residents, relatives and friends or their fellow carers.
We have four different models of quality
Total quality management (TQM): a way of managing people and business processes to ensure complete customer satisfaction at every stage internally and externally (Department of Trade and Industry, DTI 2010). Although different quality experts emphasize different experts of this methodology, its major components can be summarised as follows: processes, people, management systems and performance measurement. According to Ross and Perry (1999), in addition to creating delighted customers through empowered employees, total quality management processes also lead to higher revenue and lower cost. In our Nursing home, every department is involved in implementing quality management to offer the best quality of service; we always work as a team and ensure we have offered the best quality of care that our residents need.
Continuous quality improvement:
is a system that seeks to improve the provision of services with an emphasis on future results (Marshall, 2003). In our nursing home, the manager ensures that every service provider receives training, implements what they have learnt and they are supervised if there is need for retraining again we are retrained this ensures that we receive updated information to offer the best quality of service.
Quality standards:
The for England has produced a guidance to help providers of health and adult social care to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 (CQC, 2010b). This guide contains the regulations and the outcomes that the CQC expects people using a service will experience if the provider complies. This forms the basis for the quality standards in care homes. There are 16 core ones range from respecting people receiving the services to safety and suitability of premises and staffing levels just to mention a few. In my care setting, we get an annual inspection from UKAF over and above inspections from CQC and have been given a star rating of three. All activities this year are geared towards a rating of four.
Quality cycles:
According to QCC (2010b) quality cycles represent periods within which care homes should be reviewed to determine compliance in its service provision. This may be annually. However private organisations like the United Kingdom Accreditation service also offers a quality cycle inspection called the Residential and Domiciliary care Benchmarking (RDB). The RDB annual quality cycle supports strategic planning by providing comparative feedback on a homes care provision and enables the identification of performance gaps and cost/benefit assessments to be made (UKAF, 2010). In this model we have four major aspects to be looked into namely: planning, doing, checking and acting.
Quality and principles of care
Legislation
These are laws and rules set by the government on how the provision of care should be for example protection of vulnerable adults. In our nursing home, every service provider should be ready to protect all residents from any form of abuse we attend mandatory trainings such as safeguarding vulnerable adults according to regulations by the CQC (2010b).
Safety
In our nursing home we always do risk assessment on every service user and put measures in place like using bed rails to prevent falls by doing this we have protected residents from accidents and this ensures quality service to our residents.
Independence
Service users should be made in control of their lives by allowing them to do some of the things like arranging their wardrobes, making and tidying their rooms by themselves because some of the residents are very active and would like to do what they used to do before and we always encourage them to do while we supervise them and this makes them happy hence promoting the quality of service as they are satisfied.
Rights
Service users should continue to enjoy the same rights when in nursing homes like they used to when they were living independently. Every service user supported in nursing homes has the right to say NO, right to have a relationship and the right to have a say in their care plan. Service providers always tend to balance service users rights against their responsibilities whether both are at risk or not.
External agencies:
These are bodies that regulate quality of care including:
The Care Quality Commission an independent regulator for health and social care in England (CQC 2010a; 2010b). They regulate care provided by NHS, local authority, private company and voluntary organisations. Their aim is to make sure better care is provided for everyone. In our nursing home Care Quality Commission makes a minimum of three inspections annually (two announced and one unannounced) on such things as how we provide care in terms of cleanliness of the home and to service users.. It has a wide range of enforcement powers to take action on behalf of service usersif services are unacceptably low.
TheCQC makes sure that the voices of service users are heard by asking people to share their experiences of care services. It makes sure that users views are at the heart of its reports and reviews. The CQC takes action if providers do not meet essential quality standards, or if there is reason to think that peoples basic rights or safety are at risk (CQC, 2010) through a wide range of enforcement powers, such as fines and public warnings, and can be flexible about how and when to use them. It can apply specific conditions in response to serious risks. For example, it can demand that a hospital ward or service is closed until the provider meets safety requirements or is suspended.
The National Institute for Health and Clinical Excellence (NICE)- this is an independent organisation responsible for providing national guidance on promoting good health preventing and treating ill health (NICE, 2010). In our Nursing home, residents who have anxiety, panic attacks request for sedatives in order for them to sleep they are usually reassured and instead a government practitioner is consulted to review and advice them accordingly. Service providers take NICE guidelines trainings on different medical conditions for example diabetic foot (identification and care of the foot).
Quality Standards
Benchmarks: According to Philip B. Crosby (1999) benchmarks are indicators of best practice including access to care environment and the culture of a home. The Benchmarks is one of the most comprehensive sets of social and environmental criteria and business performance indicators available (Daniels et al 2000). Our nursing home is accessible publically, to wheel chairs, a spacious car park and a section for activities for residents and relatives. We also have a signing in visitors book stating whom they are visiting.
Code of practice for and employers for social care workers
This document is developed by General Social Council and it contains agreed codes of practice for social care workers and employers of social care workers describing the standards of conduct and practice within which they should work ( GSCC, 2002). Employers use this set of code of practice to make decisions about the conduct of staff and support social care workers to meet their code of practice. Service users and members of the public use the codes to help them understand the behaviour of social workers (how they should behave towards them) and also how employers should support social care workers to do their job well. It is the responsibility of social care workers to make sure that their conduct does not fall below the standards set in the code of practice and no action or omission harms service users (NCSC, 2010). Social care workers must protect the interests of service users, maintain confidence, respect rights, promote independence, be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills. The general social council expect social care workers to meet the codes and may take actions (deregistering) if registered workers fail.
Different approaches to implementing quality
Communication is a means of passing information from one person to another. In our nursing home we have different ways of communication like when doing care plans we always document what we have done for a resident so that whoever takes over knows what to do next to ensure continuity of care. Also when handing over is done during change of shifts information about residents is shared and everyone is aware of any changes in care plans in accordance to CQC guidelines (CQC, 2010). We also have staff meetings where certain information is passed on and in cases where staffs have a problem it is addressed and solutions are given out. For effective communication systems there should be a language that everyone understands.
Policies and procedures
These are guidelines set on how to do things often informed through regulations as outlined in various government documents (GSCC, 2002; NICE, 2010; CQC, 2010a. 2010b). In our Nursing home we have different policies and procedures for example in cases of accidents to residents we are required to fill a resident incident report and pass it on to the supervisor families, friends and relatives are informed about the accident then precautions are put into place walking frames, to avoid future occurrences of similar accidents.
Infection control policy helps to prevent spread of infections within our nursing home. We always use personal protective equipment when offering personal care to residents, handling of any infectious wastes. We also use the proper technique for hand washing. There are also hand gels in each residents room, in public toilets and at the entrance of the building for sanitation purposes and all wastes like clinical and kitchen wastes are usually put in the bins ready for collection. In cases of disease outbreaks like diarrhoea and vomiting residents are isolated and managed separately and proper hand washing techniques are used to prevent further spread of the infection.
Whistle blowing policy is designed to deal with issues that do not directly affect the employee and their employment but are a cause for concern in relation to the harm that may be done to other employees, residents or the wider community. Any employee who is concerned about their personal situation should raise their concern with their line supervisor or manager. This policy is for reporting issues like elderly abuse, misuse of drugs, faulty machinery that may cause accidents, illegal dumping of waste. The policy protects not only employees but the wide community.
Confidentiality- all residents or service users information is private and confidential. It is not a proper practice to discuss residents information in public like their conditions and behaviours by doing that is breaching the policy and legal action should be taken. In nursing homes all information is kept safely and only accessible to relevant persons. This promotes quality of service.
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