CQC We and I Statements
Theme 3 – How the local authority ensures safety in the system: Safe systems, pathways and transitions
We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between services.
When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.
I feel safe and supported to understand and manage any risks.
Moving and handling people, property and equipment is a common feature of daily working practices for many members of staff. Poor moving and handling practice can result in:
- back pain and musculoskeletal disorders;
- moving and handling accidents – which can injure both the person being moved and the employee;
- discomfort, injury and lack of dignity for the adult being moved.
Employers must reduce the risk of injury to staff and adults using care services by:
- avoiding manual handling tasks that could result in injury, where practicable;
- assessing the risks from moving and handling that cannot be avoided;
- putting measures in place to reduce the risk, where reasonably practicable
- follow appropriate procedures and use the equipment provided
- inform line managers of any problems
- take reasonable care to ensure that their actions when involved in moving and handling tasks do not put themselves or others at risk.
2. Moving and Handling Risk Assessments
The Manual Handling Operations Regulations 1992 (MHOR) state that staff must avoid manual handling if possible, and if not possible, they must assess risks and having identified the risks they must reduce them to an acceptable level, as far as is reasonably practicable. It also says that they must document and review risk assessments when appropriate
Moving and handling risk assessments help identify hazards and risks where injuries and problems could potentially occur and how to prevent them. The person carrying out the assessments must be trained and competent to identify and address the risks from moving and handling activities.
A moving and handling risk assessment should include:
- consideration of the person’s needs and ability, task, load and environment;
- identify what is needed to reduce the risk for all the hazards identified as far as reasonably practicable;
- record the assessment and provide a safe system of work in the adult’s individual care and support plan;
- arrangements to periodically review, as well as whenever circumstances change to ensure they remain current;
- ensuring competence of staff, relevant training, appropriate equipment provision and management arrangements;
The assessment should be person centred and involve the adult, their advocate or their family in decisions about how their needs are to be met, utilising a balanced approach to decision making.
2.1 Identifying Risk
Activities that may increase risk may include assisting with:
- person transfers;
- daily activities (such as bathing) with adults with specific needs.
Stresses and strains arising from adopting awkward or static postures when caring for and treating people should be addressed during the risk assessment.
Risk assessment should be part of a wider needs assessment process to achieve the best outcome. Health and safety issues will then be identified and built into the complete care package.
2.2 Individual risk assessments
The assessment should be person-centred and involve the service user where possible, or their family, in decisions about how their needs are to be met. This can reassure the adult about the safety and comfort of any equipment to be provided, and how it will help to ensure their safety and that of the staff who work with them.
The outcomes of the risk assessment and the inclusion of the findings in the adult’s care and support plan (see Care and Support Plans) should be documented in their case records (see Case Recording chapter).
The risk assessment should include information about the adult’s moving and handling needs detailing whether the requirements are during the day, at night, or both specifying:
- what the adult is able/unable to do independently;
- the extent of their ability to support their own weight;
- other relevant factors, for example pain, disability, fatigue, tissue viability or tendency to fall;
- the extent to which they can participate in/co-operate with transfers, whether specialist equipment is required and the number of staff needed to perform a transfer;
- whether they need assistance to reposition themselves / sit up when in bed/chair, and if not how this will be achieved;
- specific equipment that is required and the type;
- arrangements for reducing the risk and dealing with falls where the adult is assessed as at risk.
Some adults may become upset or agitated when being moved, particularly if they do not feel safe or reassured. Others, though willing to assist at the start, may become frightened during the manoeuvre and are unable to continue. These are situations where injury to the adult, staff or both parties may be more likely to arise. Training may prevent injury occurring in such circumstances.
3. Monitoring and Review
Risk assessments should be reviewed periodically and whenever circumstances change to ensure they remain current. This should also form part of the adult’s care and support plan review (see Review of Care and Support Plans chapter).
There should also be arrangements in place to ensure that moving and handling activities are monitored to ensure that correct procedures, techniques and equipment are being used.