Disrespectful Behaviour and Abuse of Staff, Including Aggression and Violence and Appropriate Response in Care Homes (Wales) Policy

Policy Statement

This policy shows how this care service exercises its duty to care under the Health and Safety at Work Act 1974 to keep its staff safe from the abusive behaviour and risks of being harmed by people using the service and “third parties” in the course of their work. “Third parties” include relatives and friends of people using the service, visiting professionals, suppliers, tradespeople and contractors.

The policy is in line with requirements on care providers under health and safety and employment laws to maintain safe working environments, which do not put employees at unnecessary risk of harm and injury. It is also in line with the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, particularly Regulations 36: Supporting and Developing Staff and 57 Health and Safety.

There are separate policies and procedures for addressing abuse to and from colleagues in the workplace, which is usually treated as misconduct and addressed through the service’s disciplinary procedures.

Related policies include:

Challenging Behaviour, Violence and Aggression
Bullying
Harassment
Dignity at Work
Racial Harassment
Lone Working in Care
Equality, Diversion and Inclusion
Visiting and Visitors
Antisocial Behaviour.

The service’s default position is that its staff should always be treated courteously and with respect for the work they are doing. They should not be subject to abusive behaviour in any form, which includes:

rude, disrespectful and offensive behaviour, including derogatory remarks and disruptive acts amounting to verbal and emotional abuse
sexually inappropriate comments and behaviour
racist and discriminatory abuse
threats of physical violence
aggressive and violent behaviour.

This service considers that staff should be safe at work and should not be exposed to undue or unreasonable risk. It believes that staff must work safely, free from the threat of injury or distress from the abusive behaviour of others. It will not tolerate abuse in any shape or form and will investigate all reported or observed incidents of staff being subject to disrespectful behaviour or abuse.

Physical attacks on staff at work are, fortunately, very rare and the service does all it can to minimise this risk to ensure that staff are as safe as possible. Verbal abuse is more common and can cause considerable emotional distress. The service recognises that its staff could be subject to some form of abuse at any time and recognises its duty to ensure that staff are properly trained and supported to deal with any incident.

The Service Approach to Keeping its Staff Safe

This policy applies to all staff in contact with the people who use our service and “third parties” as defined above. It is written in line with health and safety requirements and guidance such as found in the Health and Safety Executive’s Health and Safety in Care Homes (HSG220), Skills for Care guidance, (2013) Work Smart, Work Safe: Combating Violence Against Care Staff — A Guide for Employers, and safeguarding regulations and requirements.

The service expects everyone in contact with its staff to treat them politely and respectfully and not to subject them to any form of abuse. It has a zero-tolerance approach to any form of abuse, which applies to its staff as to the people using its services.
In line with health and safety requirements, the service has in place systems to assess, record, audit and control all risks to its staff from any form of behaviour that breaches acceptable standards of conduct amounting to abuse by people using the service and third parties. This means that all risks of workplace abuse are comprehensively assessed and any identified risks are systematically managed.
Staff should report to management any incident in which they or colleagues have been subject to disrespectful or abusive behaviour from people using the service or third parties. They should also record the incident with full factual information in terms of what was said or done and with as much supporting evidence as possible from witnesses, including photographic/video evidence if that has been obtained.
Managers will discuss the harm caused by and risks of further harm to those subject to such behaviour and decide the actions to be taken, which will depend on the form and seriousness of the disrespectful or abusive behaviour. They will then act proportionately to and in line with their assessment.
With people using the service, persistent abuse of staff could amount to a breach of contract. With third parties, {{org_field_name}} might enter into constructive discussions to avoid recurrence, issue verbal or written warnings, or take action to prevent the person from being in a position of being able to continue their abusive behaviour. Any action will be recorded and a full explanation always give to the perpetrator.
Care home visitors who act in an abusive manner towards staff may be asked to leave and told that they could be prevented from visiting the home if their behaviour and attitude does not alter.
Where indicated from the available information risks of abuse from people using the service or other involved in their care and treatment, particularly concerning potential aggression and violence should be included in the initial needs assessment so that they can be appropriately managed, with, if necessary, contingency protocols put in place to control the risks. Care plans will continue to be reviewed and revised with continuing risks and incidents of abuse.
As part of their assessments managers should seek information from other agencies about prospective users of {{org_field_name}} and their families about any risks to their staff from abusive and violent behaviour, including racial abuse, etc.
Managers will avoid the need for lone working whenever there are identified threats to care workers’ personal safety from the abusive behaviour of people using the service or third parties. Care plans should identify any person whose care and support needs should not be met by a lone care worker or where support is not immediately available.
Staff will always work to minimise the risk of and prevent abusive, aggressive and violent behaviour. They are encouraged to adopt a confident, calm, professional, dignified approach in response to any disrespectful, impolite or overtly abusive behaviour.
They are expected to avoid retaliating to others’ abusive behaviour in kind other than to protect their own safety, for example, where being physically attacked. This is important to allow for constructive solutions to be found, to avoid escalation and counter charges, which could make them subject to disciplinary procedures.
Managers will ensure that supervisors of care workers always have details of their work schedules, which highlight any risks to personal safety and be available to help if needed.

Procedures

Responding to Verbal Abuse and Disrespectful Behaviour

The issues concerning people using the service who are persistently disrespectful to care staff, including racist abuse, will be addressed through their care and support plans and contracts. Though the service accepts that any abuse should not be tolerated it also recognises that there are often underlying factors behind individual’s behaviour and will always seek constructive solutions.
Staff who are subject to abuse from third parties should refrain from being abusive in retaliation but are entitled to say how they feel about being the recipient of abuse such as “I am hurt by what you are saying or your manner”, “I do not think you should talk to me like that”, “ I find what you are calling or saying to me offensive”.
When staff feel they are subject to such abuse they should state they will report it and indicate that the matter will be followed up. They might also direct the person to address any concerns about a person’s care that might have triggered an abusive outburst to the management or file a complaint.
A care manager will consider any report and decide on the appropriate actions to be taken, which might involve:
a. discussions with the perpetrator to ask for more respect to from them
b. directing any concerns through the complaints procedure
c. a verbal followed by written warning for persistent abusive conduct
d. a written agreement to stop being abusive
e. a proportionate and appropriate sanction expressed put down in writing that provides suitable safeguards for staff but which do not penalise unfairly any resident with whom the perpetrator might be involved.
All actions will be fully recorded and subject to regular review.

Responding to Violent Situations

In the event of a violent or aggressive incident, staff should adhere to the following procedure.

The priority of staff must be for their own safety and for the safety of other staff and people using the service.
Staff should immediately try to summon help, preferably from their manager or person on call; in most cases, by using a mobile phone, call bell or alarm.
Staff should try to calm the situation wherever possible, talking to the potential aggressor calmly, trying to find out what is wrong and pointing out how their behaviour is affecting people — staff should try not to get angry and should never shout back.
Where the level of threat continues to increase and staff feel that they are in imminent danger then they should try to escape (with other people who also could be in danger) and get help.
Staff who are being assaulted may defend themselves, but they must use only the “minimum reasonable force” to do this.
In the event of an actual physical assault, or if the incident involves an intruder to the home, then the police should be called as soon as possible.

Physical Intervention

Staff must always deal with behaviour that challenges them calmly and professionally. Physical and verbal aggression by an individual should be understood by staff and dealt with appropriately.

In the event of an aggressive incident staff should summon help or call the police immediately. They should try to de-escalate incidents, wherever possible, and their priority should be for their own safety and the safety of other people present. Physical interventions should be used only as a last resort by trained staff, and in line with best practice guidance to protect the rights and best interests of the person using services, and which are the minimum consistent with safety of all concerned.

If a member of staff is attacked they are permitted to use “minimum reasonable force” to defend themselves. Care should therefore be taken to ensure that minimum force is indeed used and that people using the service who are acting in an aggressive or threatening manner are not subject to undue restraint.

The law gives protection to people from being abused or attacked and, if a member of staff is attacked, they can use “minimum reasonable force” to defend themselves. However, staff should remember that if they restrain a violent person and injure them because of the force they use, they could be charged for assault. Because of this risk, staff should always follow the established procedure.

Reporting and Support

Any verbally abusive or violent behaviour towards staff (or volunteers), no matter how minor, must be reported at once to the manager who should make a record in the incident book.
Staff involved should complete and submit an incident form.
Appropriate support will be offered by the management to employees who are subject to abuse and who are emotionally distressed as a result and to any staff member involved in violent or aggressive incidents.
Violent or aggressive incidents, even if they just amount to being shouted at, can be very upsetting for a member of staff and, in extreme cases, can lead to them suffering psychological trauma or illness — staff should therefore be given the opportunity to discuss their experiences.
In extreme cases, the service understands that there may be a need for ongoing support and referral to occupational health services or professional counselling.
Where absence from work arises from a violent or aggressive incident, any such absence will be treated as special leave rather than sickness absence.
The service might need to notify the Health and Safety Executive under RIDDOR reporting procedures if the injuries meet their criteria.
If people using the service have been harmed, the service should refer the matter to the local adults safeguarding authority and the Care Inspectorate Wales under its notification procedures.

The service’s management will always seek the approval and consent of the member of staff attacked before making any decision about reporting the incident to the police or other authorities. However, it will report the matter without the victim’s consent where it deems this to be the correct action to take in the public interest or to protect other people from possible abuse.

Monitoring

The appropriate manager will review all reports of aggression and violence or potential aggression and violence and look for any trends or patterns or lessons to be learned. This is done with reference to the service’s security policy and might require a review of security procedures and precautions.

Managers will carefully monitor all incident reports relating to violence or the use of restraint to ensure that both staff and people using the service are being appropriately protected. Any suspicion of abuse by staff or by others, or any whistleblowing by other staff, will be investigated and acted upon in accordance with the service’s safeguarding policies.

This policy, and policies on restraint and abuse are regularly reviewed. If all policies and procedures are working adequately and are being properly applied, the service would expect abusive behaviour and violent incidents to be rare and the appropriate use of restraint to be a last resort used only in exceptional circumstances. The service always requires the regular and proactive review of care and support plans to ensure that the most appropriate level of care is being provided and the use of restraint avoided.

Training

The service ensures that all staff are trained to show respect for others and to expect the same respect from others as described in this policy.

How to respond appropriately to verbal abuse, aggressive or potentially violent behaviour is included in the induction training for all new staff.

All staff are trained to recognise the early warning signs of potential aggression and how and where to seek support if needed, including in high risk situations the use of panic alarms.

In-house training sessions are conducted at least annually and all relevant staff will attend.

Care staff training includes guidance in the use of physical interventions and restraint in the care of people using the service. Where required, staff are trained in a range of intervention strategies that have developed in respect of socially inappropriate behaviour. This training includes:

de-escalation techniques
the concept and use of “minimum force”
approved and acceptable breakaway techniques
inappropriate or unacceptable techniques.

Managers are trained in the management of abusive behaviour, violent or emergency situations and in appropriate post-incident follow-up.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

WCH80. Disrespectful Behaviour and Abuse of Staff, Including Aggression and Violence and Appropriate Response in Care Homes