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Original poster

Anyone here work in community care for those with LD

33 replies

wonderstuff123 · 09/05/2021 15:25

Have just started out in this role and trying to figure out if what I'm seeing and hearing from staff about behaviour of clients is normal.
One particular client I visited on Thurs seems to have constant notes on his records about pushing,pulling, spitting at staff,throwing items in the house. He's pulled a gas cooker out of the wall. To the extent that the staff get to a point where they have to lock him in a room to keep themself safe when he calms down....Jesus just writing this doesn't sound normal!

He clearly should be at least 2:1 staffing but only has that for 9 hours in the day.

Just wanted to check I'm not going crazy when I think that's not a safe/normal working environment?!

OP posts:
Onesnowynight · 09/05/2021 15:27

What does his care and support plan say? Risk assessment? Behaviour management has plan?

baldafrique · 09/05/2021 15:33

If hes meant to have 2 to 1 care, why isnt he?

Original poster
wonderstuff123 · 09/05/2021 15:35

So risk assessment says tends to destroy property,has a tendency to attack staff,staff need to leave back and front door open in case they need to escape quickly,introduced locking the lounge door to ensure staff are safe. That was done end of Feb 2021.

Positive behaviour of management chart mentions identified behaviour and triggers but the staff I met on Thurs who had worked with him years told me there weren't any identifiable triggers recently,they couldn't tell when he was becoming agitated and that he'd just hit out.

What kind of things should I be looking for as red flags? To me,if staff who have worked with him years are being assaulted,that's not a good sign

OP posts:
Original poster
wonderstuff123 · 09/05/2021 15:36

They said he's only funded for 2:1 care for 9 hours a day. So when I arrived at 8.30,it had just been a lone worker with him from 7 then another worker turned up at 10.

OP posts:
baldafrique · 09/05/2021 15:38

Ah I see. That's pretty poor tbh. Surely someone either needs 2 to 1 care or they dont. Not for an allotted time period.

AIMD · 09/05/2021 15:39

Doesn’t locking someone up count as deprivation on liberty? Has that been sorted for him.

Sounds really difficult and clearly like he needs higher staff ratios for more of the time.

What would happen if someone working one to one with him got injured, how would they get help?

AIMD · 09/05/2021 15:40

If you don’t feel safe I would refuse to worm with him or if you feel his care is not safe for him ans it’s not addressed report a safeguarding concerns.

Original poster
wonderstuff123 · 09/05/2021 15:40

Yeah I don't really get it as I'm new to the industry and no one's actually sat me down and explained things. I've had 1 meeting in 3 weeks with my mentor and that lasted 30 mins. I've said I'll give it another week then will ask for a meeting.

OP posts:
Original poster
wonderstuff123 · 09/05/2021 15:42

@AIMD

Doesn’t locking someone up count as deprivation on liberty? Has that been sorted for him.

Sounds really difficult and clearly like he needs higher staff ratios for more of the time.

What would happen if someone working one to one with him got injured, how would they get help?

Yes he has a DOLS in place.

From what I can tell,in the past when he's hit out at staff in the community,they've been on their own and just had to take it. I can't tell if I'm being overly sensitive and just not used to hearing and seeing what I'm being told. Or if the staff are just used to it and this is the way this sector is.

I mean,in my gut,something feels off.

OP posts:
Miarara · 09/05/2021 15:54

Do you have PMVA/MVA training? Why his is 2:1 only for 9 hours a day? I think you need to raise your concerns with your manager and make sure they are documented.

tinytoucan · 09/05/2021 15:55

Is there a positive behaviour support team in the service or in the local CLDT? I’d be talking to them as even if he has a behaviour plan it sounds like it either isn’t being followed or is no longer working well. In my experience you should always listen to your gut if something feels off.

You may also want to find out when he last had a social care review- the assessment for the ratio of support staff may be out of date and no longer meet his needs.

tinytoucan · 09/05/2021 15:57

They really need to be getting to the route of why his behaviour has changed, so that might involve checking he’s physically well (GP) and having a behaviour assessment (or getting it re-done if he’s had one before)

tinytoucan · 09/05/2021 16:00

Just to add, it is certainly not ‘just how this sector is’ or at least it shouldn’t be. You are doing the right thing in questioning this as it does not sound right at all

Original poster
wonderstuff123 · 09/05/2021 16:07

@Miarara

Do you have PMVA/MVA training? Why his is 2:1 only for 9 hours a day? I think you need to raise your concerns with your manager and make sure they are documented.
Hi,I don't have that training. I did raise it with the HR lady who covers training and she said they use PROACT but can't do f2f training until July. But I've just looked at this and it's about avoiding actions before they get violent. She also said some delivery of positive behaviour support training is being set up.

Both of those sound great but surely there should be some training for incidences like the above?!

OP posts:
Original poster
wonderstuff123 · 09/05/2021 16:09

@tinytoucan

Is there a positive behaviour support team in the service or in the local CLDT? I’d be talking to them as even if he has a behaviour plan it sounds like it either isn’t being followed or is no longer working well. In my experience you should always listen to your gut if something feels off.

You may also want to find out when he last had a social care review- the assessment for the ratio of support staff may be out of date and no longer meet his needs.

No positive behaviour support team that I'm aware of. I'd agree his plan isn't working as the two staff who have worked with him years were both adamant there was no trigger.

The social care review - pardon my ignorance but would that be done by his social worker?

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Original poster
wonderstuff123 · 09/05/2021 16:11

@tinytoucan

They really need to be getting to the route of why his behaviour has changed, so that might involve checking he’s physically well (GP) and having a behaviour assessment (or getting it re-done if he’s had one before)
Yes there's suspicion of another mental health diagnosis triggering this but I couldn't get to the bottom of whether he's been diagnosed with it or on medication for it. If he is,the medication isn't working as they said this has been going on for months,since last year.

Who would be in charge of his behaviour assessment?

OP posts:
Original poster
wonderstuff123 · 09/05/2021 16:12

Thanks for all your replies everyone. This has thrown me completely as I am a healthcare student but only previous experience has been in the NHS so this private care company is a whole other kettle of fish.

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something2say · 09/05/2021 16:14

It IS how it is. Sometimes behaviour deteriorates over time, funding is late to the table and staff just have to suck it up. Lone working is common especially after a certain time of night.

Do write things down tho; written evidence will eventually secure funding.

Use his support plan so you know what he might do. Adhere to safety plans. Know who to phone. It's sad but normal in this line of work. Stability and routine help, but some people do exhibit violent behaviours.

tinytoucan · 09/05/2021 16:17

Yes it would be a social worker doing the social care review. If he has a named one already it might be quicker but I’m afraid often there are long waits.

With regards to the behaviour assessment it would be the responsibility of whoever wrote the behaviour support plan to review it regularly and initiate a reassessment as necessary. Unfortunately in some areas they write behaviour support plans without a behaviour assessment and this is very poor practice. In our area there is a PBS (positive behaviour support) team within the CLDT who accept referrals from the community.

something2say · 09/05/2021 16:17

Work out what risk level you'd be happy with. Me I will do a low secure hospital, but would think twice about a medium secure. I also do not want to be assaulted at work. I hear about broken legs, kidney injuries from kicks, blood running down neck etc and it's not for me. I realized that I needed to be careful about where I was prepared to work if there was risk involved. The imperfections of the sector are a fact, but they will have minimal impact on me and I'll keep it like that.

Keep studying. You'll get a well paid job that way.

tinytoucan · 09/05/2021 16:19

@something2say as I said, it shouldn’t be like this. You’re right, sometimes a person’s behaviour will deteriorate but you should never just accept that’s how it is without understanding the reasons why. It sounds like this poor man’s behaviour has changed so this is not the norm for him- surely you agree it would be irresponsible not to investigate further?

tinytoucan · 09/05/2021 16:21

@something2say I do agree with you that the sector is far from perfect, and sometimes care staff have to do a lot of chasing to get the support they need which is not right or fair.

franklyshankly2 · 09/05/2021 16:21

How would having two members to staff make you safer?

Original poster
wonderstuff123 · 09/05/2021 16:22

@something2say

It IS how it is. Sometimes behaviour deteriorates over time, funding is late to the table and staff just have to suck it up. Lone working is common especially after a certain time of night.

Do write things down tho; written evidence will eventually secure funding.

Use his support plan so you know what he might do. Adhere to safety plans. Know who to phone. It's sad but normal in this line of work. Stability and routine help, but some people do exhibit violent behaviours.

So it is how it is because people have different thresholds of what they'd accept at work? Aka km happy to read a behaviour plan,risk assessment,know what I'm getting into when I visit this client. Would I be happy with lone working with them? Defo not. Would I be happy that this behaviour has persisted against staff for months and that everyone seems to accept it? That doesn't seem good either.

I used to work in schools so know behaviour isn't black or white. But I always drew the line at,if I'm not safe or the kids aren't safe,something needs to be said. Shouldn't it be the same here?

OP posts:
something2say · 09/05/2021 17:32

So where do those people go? Hospital. And does it change?