PREPARING FOR INSPECTION OF RESIDENTIAL services for people with disabilities

The benefits of national standards and inspections of services. Joe Wolfe and Trevor Nesirky introduce the fourth and final article in the series about standards. It focuses on their view of the potential benefits of the standards and the inspection process for people with an intellectual disability. (Contact email: joe@thewolfegroup.ie)

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The Health Information and Quality Authority (HIQA) is the statutory authority with responsibility for setting standards for health and social care services and for ensuring that such standards are met. This responsibility extends to residential services / centres for people with disabilities. There have been repeated calls for the introduction of national standards in services for people with intellectual disabilities for many years and these standards are clearly long overdue. They are overdue and necessary for three fundamental reasons:

  • The person with an intellectual disability has a right to a minimum standard of service, regardless of where that service is or who provides it.
  • Good services need to be acknowledged and they need to be recognised and promoted.
  • Services that fall far short of the standards need to be identified and unacceptable practice and standards need to stop. Services that continue to fall far short of the standards, despite being given a reasonable time frame and opportunity to improve, should not remain open.
What should people expect?

The benefits of national standards, if implemented properly and if monitored fairly and effectively, are potentially considerable. Effective regulation has shown to improve standards in services nationally and internationally. It does improve quality. It does improve the degree of person centredness of the service. It does result in safer services for the people who use them. It does result in improved governance and management. It does improve the protection and promotion of people’s rights and it does improve people’s health and development.

Once standards are formally introduced, people with intellectual disabilities should expect the following:

With regard to rights

  • To be given a formal written service agreement / contract by the service provider, which clearly sets out what they will receive from the service and the conditions of their residency.
  • That services and staff will promote and respect their rights, including their basic human rights.
  • To be treated in a dignified and respectful manner by the service and by all staff working in the service.
  • To be given choices and control in relation to their life, in accordance with their preferences and abilities.
  • To be informed and involved in decision making, in line with their preferences and abilities.
  • To have access to an advocate and advocacy services.
  • To be consulted with regularly by the service and by staff.
  • To be supported to develop relationships and friendships and links with the community, in accordance with their preferences.
  • To have an assessment of their capacity to manage finances and to consent to medical treatment.

With regard to safety

  • To be protected from abuse and neglect.
  • To have their safety and welfare promoted.
  • To have ongoing assessment in relation to any major risks to them and to have a plan in place to reduce and minimise those risks.
  • To be provided with information and support to help them reduce the risks to themselves.
  • To live in houses and environments that are accessible, safe, comfortable and homely.
  • Not to have restrictions or restrictive practices applied unless they are absolutely necessary from a safety point of view and unless they are carried out in strict accordance with best practice and legislation.

With regard to personal planning and person centredness

  • To be treated as an individual and be supported to live a fulfilling life.
  • To be treated fairly and equally by the service and by staff.
  • To be valued, respected and treated with dignity by the service and by staff.
  • To be consulted in developing a comprehensive personal plan, which is based on their abilities and needs and which supports them to achieve a good quality of life

With regard to complaints

  • To have the staff in their service actively listen to them with regard to any concerns or complaints they have.
  • To have any raised concerns or complaints responded to properly and, where necessary, investigated properly and fairly.
  • To be informed of the outcome of the complaint and have any action necessary taken to redress the situation.
  • To have their complaints taken seriously and to be informed of the outcome of their complaint. Services will have to provide evidence that they do this properly and effectively.
  • That the service will keep proper records of all complaints and their management for scrutiny by the regulator.
  • That if the service makes mistakes, it corrects them and does all in its power to prevent them from happening again.

With regard to staff

  • For staff supporting them to have been properly screened and recruited.
  • For staff supporting them to be properly trained and developed in line with the person’s needs and abilities.
  • For staff supporting them to have regular supervision.
  • For staff supporting them to have their performance reviewed on an ongoing basis.
  • For staff supporting them, who breach acceptable standards of practice, to be subjected to appropriate disciplinary processes, and to be managed effectively.

With regard to information

  • To receive information in a manner they can understand and which is appropriate for their level of communication ability.
  • An increase in the use of accessible notices and signs.
  • An increase in the availability of accessible policies and other information, with services using new technology to make it easier for people to understand important information.
  • That information about them is maintained in a confidential manner.
    That the service uses information to plan and deliver safe and effective services.

With regard to health and development

  • To have timely, comprehensive assessments of their health.
  • To receive appropriate support to meet any health needs.
  • To have their health and development supported and improved.
  • To have opportunities in relation to education, training and employment appropriate to their needs and preferences.

With regard to the management of the service

  • That the service will be well governed and managed.
  • That the managers are competent to carry out their roles and responsibilities.
  • That the service has safeguards in place in relation to safety, risk and well-being.
  • That the service complies with legislation, regulations and national policies and standards.
  • That the service has documents setting out clearly its purpose and function and that it implements this effectively.
  • That the service plans and manages its resources effectively.
  • That the service regularly reviews and audits its quality and continually improves the quality of the service provided to the person using it.
  • That management consults regularly with the person around the quality and development of the service.
  • That effective management systems are in place to enable a person-centred and safe service to be provided.

While the final standards and regulations for residential services / centres for people with disabilities are not quite finalised; they are almost complete and the current plan is to commence inspection and registration from the summer of 2013. It is extremely positive that this is finally close to fruition and we should see immediate improvements in some areas as a result of the introduction of standards and registration. There will, no doubt be a ‘teething-period’, as there is with the introduction of regulation and standards in any sector of life. However, if standards and regulation are implemented fairly and effectively, we will see an improvement in the lives of people with intellectual disabilities living in residential services.

Having spent their careers working in, managing and developing human services, Joe, Trevor and their team have been supporting organisations across the health and social care arenas to prepare for registration and inspection over the last number of years. They support organisations through: Establishing quality structures and systems in preparing for registration and inspection — Conducting GAP analysis / reviews of organisations against national standards — Providing training on preparing for the fit person’s process and on auditing and self-assessment skills.

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