Mellor
Nook.
Residential Care Home
For the Elderly
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Residential Care Home For the Elderly |
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Management,
administration and legal issues Introduction Sound
management and administration provide the foundation for running a home well and
for ensuring that the principles of high quality care and respect for residents
are put into practice. Fitness A
fit person Under
the supervision of the
C.S.C.I. (Commission for Social Care Inspectorate) a person
registered must be a fit and proper person to run a home. This means that the
management team have been seen to be capable of managing a home and have the
relevant business and professional experience. None of the management team has a
criminal record nor have they been barred from running a home by another
registration authority. Since 2002,
C.S.C.I. (Commission for Social Care Inspectorate)
hold an enhanced C.R.B. check on all care home managers. Fitness
of premises The
premises has bee judged suitable by the C.S.C.I. for use as a home in terms of
its situation, construction, state of repair, accommodation, staffing and
equipment. Fitness
of purpose The
C.S.C.I. are satisfied that the services and facilities offered meet the home's
stated aims and objectives. These relate to choice, privacy, the opportunity for
consultation, and general accommodation and services for residents. The role of the
manager The
tasks of the manager and deputies include the management of staff, the supervision
of care the efficient administration of the organisation (record-keeping,
domestic organisation, legal matters, financial affairs, upkeep of the buildings
and gardens), the management of supplies, support services such as laundry,
cleaning, catering and gardening. Perhaps most importantly, the manager of the
home is responsible for setting the tone and style of the home in terms of its
efficiency, its concern for residents and staff, and its
relationships with the outside world. The team at Mellor Nook has successfully
provided this since opening in 1988. Record-keeping in
relation to residents Records
Certain
records, detailed in the National Minimum Care Standards Act 2000 Act are open to
inspection by the C.S.C.I. on request. Personal details in these records are
kept in a secure place and access is limited to those with overall
responsibility for the day-to-day care of the residents. Anyone who has access
to records is instructed in the proper handling of confidential information.
Managers and staff have been adequately briefed on issues relating to
confidentiality and access to case files. As well
as those records required to be kept by law, such as personal details and next
of kin, the home also keeps other records:
Residents'
access to personal records The
staff share information with residents in the context of an open, professional
relationship. Residents who wish to have access to their health records have a
right in law to do so In some instances, counselling can be offered where
sensitive information is disclosed.
Management and
administrative records Mellor Nook has produced an 'aims and objectives' document underpinning the day-to-day work of the home which is regularly reviewed and updated. Mellor Nook s certificate of registration is displayed in the small lounge and can be seen on entering the home to assure prospective residents and their families and friends of the registered status of the home. There are records kept which set out details about the home and which are available for inspection by the C.S.C.I. . These include:
Following
guide lines Mellor Nook keeps records of residents for three years from the last
entry. Other
records that are kept will relate to safety:
Other
documentation include:
Financial
systems are also in place which record:
Fees Fee
levels Details
are clearly set out in agreements entered into at the time of moving into the
home. They specify in detail what is included in the fee and what services or
elements of care are costed and charged for separately. Increases
in fees There
is one month’s notice of the annual increase in fees this allows time for a
consultation process. This is important both for individuals funding themselves
and for residents who are funded by other sources. Local authorities are closely
involved in any changes in existing fee levels, particularly in relation to
their contractual arrangements and service specifications with the home. Residents' money Owner/Managers
Deputies or staff never under any circumstances control residents' money. To do
so may lay us open to suspicion of malpractice. Control of one's own finances is
an important way of being able to be in control of one's life. In line with
this, residents handle their own money as far as they are able. They need to
make their own arrangements for collecting their pensions. Residents are made
aware that they are responsible for the safekeeping of their own money,
documents such as pension books and other valuable possessions, by means of the
safe (strong Box) located in every room, unless they are unable to do so because
of mental or physical impairment. Legal issues Appointments of agents, appointees, attorneys and trustees by residents
Agents and appointees
A
resident may nominate a relative, friend or someone in the community over the
age of eighteen to act as his or her agent in drawing and making payments. There
is a well-established procedure for doing this for social security payments. If
the resident wants a third party to operate his or her bank account then he or
she can instruct a bank accordingly. When there is no relative or friend
available whom the resident trusts, the Department of Social Security (DSS) is
asked to recommend someone to act as agent. Mellor Nook, manager or staff
members DO NOT take on this role In some
circumstances, a relative, friend, or someone in the community such as an
advocate, may become an appointee, able to make claims for and receive and deal
with state benefits on behalf of the resident. In order to do so, an application
needs to be made to the local DSS office. Social security regulations state that
the claimant must be 'unable for the time being to act'. This usually means
that the person does not have the mental capacity to look after his or her
financial affairs, because of memory loss, disease, or some sort of disability.
Occasionally, the problem might be temporary, for example because of a serious
accident. The
person to be appointed must demonstrate to the DSS that he or she would make the
most suitable appointee and show an active interest in the welfare of the
individual. Once accepted, an appointee has a duty to ensure that the resident
will get the full benefit of the payment made and that any changes in the
circumstances of the resident which may affect his or her benefits are promptly
reported. Appointment
under the social security regulations comes to an end: if it is revoked by the
DSS; if the appointee resigns after giving one month's notice; or if the DSS is
told that a receiver has been appointed by the Court of Protection for England
The DSS must also be notified if either the claimant or the appointee dies.
Power
of attorney A power
of attorney is an arrangement by which one individual (the donor) gives
authority to another or others to act on his or her behalf. The attorney is
required to act as if he or she were the donor. Appointing an attorney might be
a good idea if a resident has difficulty getting out to the bank or building
society, or has difficulty signing cheques or documents. However, power of
attorney (like agency) cannot be used where the person does not have the mental
capacity to give authorisation to the attorney. The
power can be used in specific or general areas of managing income and capital.
Copies can be shown to banks, building societies, pension funds or insurance and
pensions companies when required. At any time the donor can cancel the power of
attorney. The attorney must demonstrate that he or she is taking proper care of
the donor's affairs and may be sued for any loss due to insufficient care. It is
very important to realise that in England, Wales and Northern Ireland a power of
attorney is automatically cancelled by operation of law when the individual
loses mental capacity to manage his or her own affairs. An attorney who then
continues to act is doing so without authority and is liable to be sued.
Instead, the attorney should stop acting. The person's affairs may then have to
be handled by the Court of Protection in England and Wales or the High Court and
the Office of Care and Protection in Northern Ireland.
Enduring
power of attorney Unlike
an ordinary power of attorney, in England, Wales and Northern Ireland an
enduring power of attorney (EPA) can continue in force even if the individual
loses mental capacity. EPAs are often made by older people who are aware of
failing mental faculties, but still have capacity to understand what is involved
in creating an EPA. The EPA can give the attorney general power to act in
relation to the donor's property and affairs, or can relate to specific items.
An EPA must be made in a prescribed form laid down by law, and the person may
wish to consult a solicitor or legal advisor and may appoint a solicitor or
social services department to act as an attorney under an EPA. More often, the
attorney chosen will be a son or daughter, spouse or other close relative. An
attorney under an EPA must take proper care of the donor's affairs and also
takes on certain special duties. As soon as the attorney believes that the donor
is or is becoming mentally incapable then the attorney must stop acting until
the EPA has been registered by the Court of Protection in England and Wales or
by the High Court in Northern Ireland. Again, this must be done in the correct
prescribed form, with certain relatives of the donor (laid down by law) being
informed. Once the EPA is registered, the attorney can safely start acting
again. An EPA may, alternatively, stipulate that it should take effect only if
mental incapacity should occur, in which case it would first need to be
registered as above.
Court
of Protection In
England and Wales the Court of Protection exists to protect the interests of
people who are unable to manage their own financial affairs because of mental
disorder. The term 'mental disorder' is a legal label which includes dementia,
learning disabilities and mental health problems. The
Court usually delegates power over the income of the person to a 'receiver' who
can handle day-to-day matters. Capital is usually retained on deposit by the
Court. Anyone can apply to be a receiver, giving full details of their finances
and family situation (and paying a Court fee). Often a relative or solicitor
applies, but it would be appropriate for someone such as an advocate to do so. The
responsibilities of the receiver are detailed in a handbook issued by the Court.
The receiver is required to handle all financial transactions for the benefit of
the person. All dealings are monitored by the Court which requires the
submission of annual accounts. An annual fee is usually payable to the Court.
Trusts Alternatively
a resident may decide to set up a trust to manage his or her affairs. This is
normally worth doing only if there are substantial assets but it has the great
advantage of continuing to be valid even if the resident should cease to be
mentally competent. Guardianship
Under
the Mental Health Act 1983 in England and Wales and the Mental Health (Scotland)
Act 1984, a person who has one of four specified forms of 'mental disorder' may
be received into guardianship if it is necessary for his or her own welfare or
the protection of others. The guardian will almost always be the local social
services/work authority as this form of 'guardianship' is a way of seeking
compulsory control over a person who needs help. The guardian has the power to
require the individual to live at a particular place, to attend particular
places for medical treatment, occupation or training, and to require access to
be given to doctors, social workers and others at any place where he or she
resides. Application for guardianship is made to the local authority and must be
supported by two doctors and an approved social worker or in Scotland a mental
health officer. Under
the Mental Health (Northern Ireland) Order 1987, a person who has one of two
specified forms of mental disorder may be received into guardianship if it is
necessary for his or her own welfare. The guardian is generally the local health
and social services board. The guardian has the same powers as in England and
Wales. Application for guardianship is made to the local health and social
services board, usually by an approved social worker, and must be accompanied by
two medical recommendations and a recommendation by an approved social worker
who is not the person making the application.
The
previous section is for information purposes only Mellor
Nook s managers' responsibilities
Mellor
Nook has no legal obligation to defend the interests of residents who are no
longer capable of looking after their financial affairs. However, we do have a
duty to safeguard and promote the welfare of our residents Under no
circumstances will anyone connected with the home take on a role of
financial responsibility As
noted, Mellor Nook has no obligation to see that the law is complied with where
residents' financial affairs are concerned However, if we feel that something
(not necessarily of a legal nature) is going wrong, and the resident is unable
to deal with it will draw their fears to the attention of relatives or the
C.S.C.I. , whichever is more appropriate. This
duty in no way contradicts the essential principle that all those connected with
Mellor Nook will not become involved in the handling and management of a
resident's financial affairs. Homeowners and managers are potentially vulnerable
to accusations of misconduct. Suggestions of impropriety may be hard to dispel
even if they are without foundation. Advance statements
about health care A
resident with a progressive illness which could lead to loss of decision-making
capacity in the future may wish to record his or her views about health care
options. This might cover issues concerning refusal of treatment, requests for
treatment and purposes of treatment. If the person then loses capacity and
cannot participate in health care decisions, those involved in treatment and
care are able to take the previously expressed views into account. These views
are written down then the document is put in their “Care plan” and called an
'advance directive' Improving
quality: procedures for making suggestions Mellor Nook welcomes suggestions for improving or adding to the life of the home. An open and friendly style of management encourages this and prevents residents and their families and friends from feeling inhibited about raising issues, making comments or putting forward suggestions. Clear information about how to make suggestions is provided. This is through the provision of a suggestions box. Staff are always ready to listen to ideas that residents express and pass them on to the managers. Also regular Quality Assurance programme gives the opportunity for input. Complaints
procedures Mellor
Nook has a clearly established complaints procedure which is described in the
following section and about which residents, their relatives and friends are
told when the resident first moves in. Managers and staff do not assume that an
absence of complaints means that everything is running smoothly. We are
particularly alert to the general hesitancy of residents and relatives to
complain for fear (however unjustified) of recrimination. It is understood that
residents and relatives may even be reluctant to make suggestions because they
fear this may be seen as implied criticism. Residents may feel fearful and
vulnerable and therefore unwilling to speak out because they are dependent on
staff and managers for their care and assistance. More generally, it is
remembered that many older people tend to 'go along with things' in response to
questions and that a comment to the effect that something is satisfactory could
in fact indicate that improvements could be made. Advocates have a useful role
in supporting residents in making a complaint and Mellor Nook welcomes their
involvement in the life of the home. The information given to residents and relatives stresses that ideas, suggestions and complaints are welcome and expected. Our complaints procedure has the
following features:
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