Equality of Opportunity is put into place to safeguard everyone. An important aspect of the Equal Opportunity Policy is that it protects vulnerable adults in care. The Equal Opportunity Policy specifies that all clients will be given equal and impartial treatment regardless of their gender, age, disability, ethnic origin and race. It is important that all employees working within the care field comply with the Equal Opportunities Policy so that all clients are free from prejudice and are protected (Care Quality Commission: 2011). When concerned with the care of vulnerable adults, key legislations are put in place. These include laws, policies and strategies. All social care services are governed by legislation and government guidance which must be followed accordingly (www.legislation.gov.uk). Some Acts which are relevant to the case study include the Disability Discrimination Act (1995), the Care Standards Act (2000), the Race Relations Act (2000), the Human Rights Act (1998) and the Community Care Act (2003). The purpose of these Acts is to ensure that there are high standards set which health authorities and local authorities can follow to regulate care (Nazarko: 2002).
The Afan Nedd care study explains that the residential home cares for vulnerable adults. When concerned with those most vulnerable it is important that each service user is treated fairly and equally with their human rights taken into consideration at all times. The Afan Nedd case study shows that these basic requirements are not always met. The article states that the care home is being run by trained nurses and unqualified care assistants. In April 2002, the legislation that all residential homes in the UK must meet in order to stay registered changed. The Registered Homes Act of 1984 was replaced by the Care Standards Act (CSA) (2000). The CSA regulates and inspects all local authorities, establishes a General Social Care Council in England and a Care Council in Wales and it makes provision for the registration, regulation and training of social care workers (Nazarko:2002). The CSA ensures that the regulation of care workers is monitored closely. The Act also states that social care workers must be registered with the English or Welsh Council where each Council is required to ensure high standards of practice and training are being used at all times. It is important that Registered Social Care Workers (RSCWS) must abide by a strict code of conduct; any employees who breach this code of conduct will be called in for a disciplinary hearing which could result in suspension or being removed from the care register. In Wales, the Care Council approve courses and make allowances and grants for training to ensure that care homes care run properly (Nazarko: 2002).
Afan Nedd care home is regulated by the Care and Social Services Inspectorate Wales (CSSIW), they encourage ‘the improvement of social care, early years and social services in Wales’ (www.wales.gov.uk). CSSIW works in conjunction with the Welsh Assembly Government; they inspect local authority social services and regulate and inspect social care environments (www.wales.gov.uk). The CSSIW regulations include registration, inspection, complaints and enforcement in order to protect vulnerable adults. It appears that Afan Nedd care home does not comply with the CSSIW policies as it does not have qualified care assistants. To resolve this issue, a possible solution is that the care home should provide training for all employees to ensure the safeguard of vulnerable adults and to provide the highest standard of practice to service users.
When caring for vulnerable adults it is extremely important that their care is main priority. All care homes are regulated by the Care Quality Commission (CQC) which is responsible for monitoring the standards of care services (www.direct.gov.uk). The CQC is in place to ensure good work practice for professionals and to improve the standard of living of the service user. All care homes must follow the ‘Care Value Base;’ in nursing theory this is an ethical code which sets out rules which carers must follow within their social care setting which ensures that the carer is not discriminating the service user and are not violating their rights (Moonie: 2005). These values also include the promotion of equality and diversity and to have the ability to challenge discrimination. In 2002, the General Social Care Council (GSCC) published a code of practice for both employees and employers which explains the promotion of these values along with confidentiality and other rights and responsibilities. (Moonie: 2005).
The case study explains how John Davies, a registered general nurse, has been verbally abusing some of the clients. This should be a major concern for Afan Nedd nursing home as the service user is not receiving the correct care. The case study also explains that John Davies appears to be experienced and is very popular with the matron. This can then cause problems within the care home as issues such as discrimination and prejudice may arise.
It can be said that any type of institutional abuse is completely illegal and unprofessional. Verbal abuse within the care home cannot be tolerated as those who are physically and mentally frail are most at risk (www.direct.gov.uk). The Equality Act 2010 is a key piece of legislation which must be followed within every social care environment. The Act provides a ‘modern and accessible framework of discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society’ (www.equalities.gov.uk). Every health care professional must know all key pieces of legislation before they undertake any social care and must implement the rules throughout their health care career. By law each service user has the right to be treated with respect and dignity. The Protection of Vulnerable Adults (POVA) scheme was launched by the Department of Health which provides a list of care workers who have harmed vulnerable adults in their care. It is now a statutory requirement for managers to use when appointing individuals to work with vulnerable adults (www.criminalrecordscheck.co.uk). This could mean that John Davies may have had a history of verbal abuse to service users and this may have not been checked prior to being employed as the case study explains he is an agency worker.
As mentioned earlier, John Davies appears to be popular with the matron which may cause problems if another social care worker wanted to report his verbal abuse to the service users. It could also mean that the service users do not feel confident enough to report the abuse to the matron as they feel that they may be discriminated against or they may not have the mental capacity to report this issue. Since 2006, the social services complaints procedure has changed in Wales. The CCSIW are legally obliged to have their own written complaints procedures. It is important to stress that all complaints must be kept confidential along with following the CCSIW complaints procedure (Department of Constitutional Affairs: 2007). Another issue that may arise from the fact that John Davies is popular with the matron is other employees of the nursing home may not want to be seen as a ‘whistle blower’ if they wanted to repot abuse within the care home. Knights and Willmott (2006) believe that ‘whistle blowers tend to be well respected and conscientious employees. They tend to believe that once they have informed the appropriate managerial authority of these illegal or unethical acts the organisation will take the appropriate measures to change its behaviour.’ However, it appears that many whistle-blowers feel that management do not see ‘whistle blowing’ as an act of good organisational citizenship, instead management see this as trouble making. In many cases, the whistle blower may be victimised or even disciplined, making other employees stay silent in reporting any further discrimination or abuse within the care home. The Older People’s Commissioner for Wales, created a policy where the commissioner is contacted by an employee from another organisation who is worried about unethical acts in their place of work and want to report it (www.powysweb3.ruralwales.net). The Public Interest Disclosure Act, (PIDA) protects employees who ‘blow the whistle’ about wrong doing within the nursing home, providing that they do so in the ways set out by PIDA. Any employee who is victimised by their employees for ‘blowing the whistle’ has the right to take their employer to a tribunal. The Commissioner ‘recognises that employees are often the first to realise that there may be something wrong within their organisation and therefore encourages all individuals to raise genuine concerns about wrongdoing at the earliest possible stage’ (www.powysweb3.ruralwales.net). This policy relates back to the Afan Nedd nursing home as the policy will protect them if they wanted to report the John Davies for abusing the service user. The Nursing Midwifery Council (NMC) believe that it is ‘important to establish a comprehensive vulnerable adult protection and safeguarding service to ensure good leadership and performance management, however, it appears that such arrangements are not consistently found across social services’ (www.nmc-uk.gov).
Albert and Gladys Griffiths have recently arrived at Afan Nedd nursing home, the case study states that Albert is mentally alert however his wife Gladys have early onset Alzheimer’s. The reader learns that Gladys becomes easily confused and disorientated but is usually calmed by Albert’s presence; however they do not have a double room in the nursing home. As the couple does not have a double room this can be seen as discrimination and a violation of their human rights. It can be said that to maximise Albert and Gladys’ quality of life, they have the right to a double room as they have never spent a night apart. Quality of life refers to the total living experience, which results in overall satisfaction with ones quality of life. ‘Quality of life is a multi-faceted concept that recognises at least five factors; lifestyle pursuits, living environment, clinical palliation, human factors and personal choices’ (Singh: 2009). It can be said that quality of life can be improved by bringing in these five factors into the delivery of care.
It appears that the Human Rights Act (1998) has been breached as Gladys and her husband are not able to share a room together. The Act states that ‘these rights not only impact matters of life and death, they also affect the rights you have in your everyday life: what you can say and do, your beliefs, your right to a fair trial and other similar basic entitlements.’ When working in a social care environment, it is the responsibility of the health care professional to respect the rights of the service user. Learning that Gladys has early onset Alzheimer’s, this could mean that she does not have the mental capacity to address her human rights within the nursing home. The Mental Capacity Act (2005), safeguards those with mental illness and it is also a stepping stone for those most vulnerable to receive treatment in a nursing home to improve their quality of life (Department of Health 2005). The Mental Capacity Act (2005) is designed for those who are unable to make decisions for themselves or lack the mental capacity to do so. It can be said that under the Mental Capacity Act, any person is ‘presumed to make their own decisions unless all practical steps to help him or her to make a decision have been taken without success,’ (www.nhs.uk). It is important to remember that a change of routine can affect behavioral problems with someone suffering with Alzheimer’s which can cause them to lash out of feel uneasy. It is said that Alzheimer’s do not do well to change as change causes anxiety and stress, therefore changing Gladys’ normal routine is not in her best interests when settling into a new environment (Gale: 2010). All service users of nursing homes have the right of privacy. The right of privacy is a fundamental basic right that must always be met. Each service user has the right to live in a friendly, homely and caring environment, where the care assistant always delivers the level of care that is appropriate to each individual. ‘Each person has the right to be treated as an individual, with respect and dignity, as well as having a right to privacy and to choice; it is the duty of the management and staff to safeguard these rights and to help the service user exercise them correctly’ (Ford: 2005).
The case study explains how Musad Mohammed is a Pakistani Muslim who is a resident at Afan Nedd nursing home. Musad Mohammed is finding life in the nursing home strange as he has no immediate family living in the UK; the food is an issue for him, having a female carer and the lack of privacy at prayer times. Being a Muslim man, resourcing halal food for Mr Mohammed should not be an issue as it is easily sourced in the UK (Q News: 1999). The Race Relations Act 1976 states that no person should be discriminated against on the grounds of race, colour, nationality, ethnic and national origin in the fields of employment, the provision of goods and services, education and public functions (www.legislation.gov.uk). From the information on the case study, it is clear to see that Mr Mohammed is being discriminated against as his needs are not being met. However, this type of discrimination tends to be indirect discrimination. It can be said that indirect discrimination is when a condition or rule within the workplace disadvantages one group of people more than another (www.direct.gov.uk). This applies to the case study as Mr Mohammed is being cared for by female care assistants which is against a Muslim mans beliefs. This is also a breach of his human rights which could affect Mr Mohammed’s quality of life. It is important to understand that each service user of the nursing home is entitled to privacy and an independent living. It is also important that the ‘right of every individual to select independently from a range of options, incorporating, choice of meal, bed times and taking part in activities/ entertainment’ (Rose and McCarthy: 2010). These basic needs are not being met for Mr Mohammed as he feels he has a lack of privacy at prayer times. For a Muslim man prayers play an important role in his faith and his care values are not being met. Every individual has the right to be treated as unique regardless of their beliefs and should be treated with respect at all times (Rose and McCarthy: 2010). It appears that the employees at Afan Nedd are not educated in a Muslims faith; a possible solution for this is that the staff could take part in discrimination training and multicultural awareness training.
Dilys Watkins enjoys staying up to watch the television at the nursing home, however the staff at the nursing home does not allow her to do this as it is said to interfere with the rota as everyone needs to be in bed before the night shift commences. This can be seen as a breach of her human rights and independence as Dilys says she is able to put herself to bed after her programmes have finished. It is important to avoid stereotyping an elderly person in care, mainly with regard to their own independence. This is because negative images of independence can become self fulfilling. This can cause an elderly person to have low expectations of their abilities and performance (Beaulieu: 2002). However, the case study does not state Mrs Watkins’ mental awareness, and the care assistants may feel that it is not in her best interest to stay up on her own and put herself to bed as she may fall and hurt herself. This is a possible reason as to why the Mental Capacity Act (2005) is put into place at nursing homes as the Act sets out a checklist of things to consider when deciding what is best for the service user. Another possible argument is the idea of empowerment in nursing homes. The idea of empowerment is that those who have little or no influence, such as Dilys Watkins are ‘able to acquire the capacity to have informed opinions, to take initiatives, make independent choices and influence change. It also means that those with influence actively change their attitudes and rules and change the way decisions are made through engaging with excluded people’ (www.equal.ecotec.co.uk). It can be said that the staff at Afan Nedd must show service users such as Dilys Watkins respect and dignity and must always follow the correct codes of practice; Processional Codes of Conduct are put into place to avoid discrimination and to improve the quality of life for residents at the Afan Nedd nursing home (www.npc-uk.org).
It is clear to see that Afan Nedd nursing home is beset by a number of problems where the relevant policies and legislations are not being followed correctly. The Care Council for Wales is the social care workforce regulator in Wales responsible for promoting and securing high standards within nursing homes to protect and safeguard vulnerable adults; these regulations are not being followed by Afan Nedd nursing home. There are many key issues identified in the case study such as discrimination, lack of staff training, verbal abuse, lack of privacy and poor professional practice. It is important to address these issues straight away to improve the quality of life to all service users. All social care workers are expected to meet the code of conduct set by the Care Council and serious failure to do so can result in the closure of the nursing home and suspension and the removal of employees from the Register. Nursing homes care for the highly dependent and vulnerable people. Many of them have many nursing needs that require a high level of professional knowledge and understanding. It is therefore important to ensure that all staff working at nursing homes takes part in any opportunities for improving and updating their skills along with organising educational and training days. Afan Nedd nursing home could promote and support research into the efficiency of diverse approaches to caring for the elder and those with mental disabilities.
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