The CARE CERTIFICATE

Duty of Care

What you need to know

Standard
THE CARE CERTIFICATE WORKBOOK
 Duty of care

You have a duty of care

to all those receiving care and
support in your workplace. This
means promoting wellbeing and
making sure that people are kept
safe from harm, abuse and injury.
Duty of care is a legal requirement; you cannot choose whether to accept it. It applies
as soon as someone has care or treatment. Breaking this duty, for example through
negligence, could result in legal action.

Wellbeing Code of conduct

Wellbeing could be defined as the The code of conduct tells you how
positive way in which a person feels you are expected to behave as a care
and thinks of themselves. worker.

Your duty of care is also to other workers, for example, in a hospital, to doctors, nurses
and healthcare support workers but also to caterers, cleaners and maintenance workers. If
you are a home care worker you will probably work alone in a variety of homes, but there
may well be other people in the premises, as well as whoever you are there to support.
Your duty of care is to each individual and to the other workers you come into contact with
in the community.

The duty of care is part of the code of conduct for healthcare support workers and adult
social care workers in England and will most likely also be in your job description. It is
important that you have the knowledge and skills to act on your duty of care in your role
but that you don’t work beyond it.

As part of your duty of care you should pass on any concerns you have about wellbeing.
Every employer has agreed ways of working to respond to possible harmful situations
which will include how to report any concerns. Concerns could be about anything from
poor working conditions or equipment to untrained workers, as well as suspected abuse.
In any situation, if you do not know what you should do, ask your manager. Providing
guidance about how to deal with abuse and violence or substance misuse or how to
handle toxic substances or carry out risk assessments are all part of making sure that
the duty of care is carried out. Fire drills, agreed ways of handling medication as well as
cooking and food storage procedures are some of the routine ways for making sure that
everyone knows how to fulfil their duty of care. The agreed ways of working vary from one
workplace to another, so you need to check them if you move to a new job in social care
or health. Agreed ways of working should be documented, but even if you are told about
them only in conversation, you must still work to them.
THE CARE CERTIFICATE WORKBOOK STANDARD 3
1
Supporting independence

The code of conduct says that you must work in ways that respect and protect the
individual’s rights, including their right to live as independently as possible, to make their
own choices and to take risks.

There may be times when they make choices that you think are unwise, unsafe or that you
disagree with. For example when someone with a disability wants to try a new physical
activity or when someone chooses not to eat less fatty foods. You should make sure that
they have as much information as possible about their choices and what could happen. If
they still choose to make a risky choice a risk assessment may identify ways in which risks
can be reduced and the individual can be supported to make those decisions. But the right
to make decisions that they are legally capable of making must not be taken away from
them by the social care or health workers.

Your employer will give you guidance on risk assessments, risk enablement and health
and safety. Whatever you come across you have to consider the individual’s wellbeing as
your main priority. If you are unsure about any situation, ask your manager. Other sources
of support might be the individual’s friends or family, a befriender or an advocate, their
GP, or another care worker.

Advocate
An advocate is a trusted, independent person who can speak and act for the individual.
They can advise on matters such as welfare benefits and can ensure that the
individual’s point of view is heard in care planning meetings, to make sure that
decisions are made in the interests of the individual. The importance of advocates and
advocacy services is emphasised by the Care Act 2014.

Individuals make decisions all the time and should be supported to do so. Sometimes an
individual may not be able to understand and retain the information they need to make a
decision or communicate their choice. If this is the case they may lack the mental capacity
to make the decision. They may be able to make day-to-day decisions, for example what
to wear and what they want to eat, but not able to make decisions about money or medical
issues. In situations where you are not entirely sure about an individual’s capacity, please
seek additional advice or guidance. You will look at issues about people’s capability
(‘capacity’) to make decisions for themselves, with varying levels of support, especially if
they have mental ill-health, dementia, or learning disabilities, in more detail in standard 9.

Comments and complaints

You have a duty to make sure that each individual knows that they have a right to complain
or comment about their care or support. It is important that this is able to happen quickly
and in a positive way. They should be taken seriously and explored so that any learning
can be used to keep doing the right things or to make improvements. Positive comments
can be encouraging and used to show how good ways of working are making a positive
difference. Ask your employer to tell you about what to do when someone wants to
complain or comment.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

2
The Local Authority Social Services and NHS Complaints (England) Regulations 2009
are the legislation for complaints in health and social care. The Department of Health
also published the NHS Constitution in 2011, which tells you about guiding principles and
patients’ rights. There should be a recorded process to follow which may differ depending
on the type of workplace and have a time limit in which the complaint has to be made after
the situation happened. If someone wants to make a comment or complaint you should
deal with it in line with your organisations agreed ways of working.
Depending where you work, that could include:

 arranging to talk in private

 making sure the individual knows that you may need to
pass on information if there is a risk to the safety
of themselves or others
 listening calmly and actively, assuring them that you are
taking them seriously
 not judging or becoming emotional
 offering your support but not trying to answer the issue
before the agreed way of working has taken place
 explaining what will happen next, who the complaint will
be passed to and when the person will get some feedback.

Thank them, tell your manager what has been said, and make a record as soon as
possible.

Often an organisation has one named person who deals with complaints. Depending on
the size of the organisation there may be a complaints section such as the NHS’s Patient
Advice and Liaison Service (PALS). You should ask who is the ‘responsible person’ or
‘accountable officer’ for your workplace. Smaller workplaces might not have anything in
writing but will still have agreed ways of working for when complaints are made.

Incidents, errors and near misses

Sadly, having the best ways of working, the code of conduct and the duty of care, doesn’t
always protect vulnerable adults from harm. All health and social care workplaces involve
workers collaborating towards the wellbeing of those needing care or support. Mistakes
happen through things like lack of knowledge, poor communication or not sharing
information, stress, negligence or being distracted. Mistakes are seen as being one of the
following:
Adverse events: Errors: Near misses:
action or lack of not doing something situations where an
action that leads as it should have been action could have harmed
to unexpected, done, for example the individual but, either
unintended and through bad planning by chance or purpose,
preventable harm. or being forgetful. was prevented.

Incidents:
specific negative events. In health and social care serious incidents are described as
events which need investigation as they caused severe harm or damage to either the
person receiving care or the organisation.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

3
The first thing to do after something has gone wrong is to do what you can to improve the
wellbeing and meet the immediate needs of the individuals involved.

Your workplace will have a form which you should complete to record incidents, accidents
and near misses. You should record the date, time and facts. This is used to make your
manager aware straightaway. Do not blame other workers or suggest to those involved
why the incident might have happened, even if you have an idea why it was. If your
thoughts turned out to be wrong you could lose the individual’s and family’s trust and
respect.

Legislation

For health and social care work a variety of legislation sets standards on how to handle
issues to improve services and positive outcomes.

Care and compassion

Think clearly and carefully about the potential reasons for someone’s distress. Use
your person-centred approach and knowledge of them as an individual, as you may
be able to de-escalate a challenging situation by recognising their unmet needs and
responding to these with supportive care and/or additional services.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

4
The Health and Safety at Work etc. Act 1974
This is the main piece of legislation covering occupational health and safety in the UK. It
places a duty on employers and employees for the health, safety and welfare of persons in
the workplace.
www.hse.gov.uk/legislation/hswa.htm

The Management of Health and Safety Regulations 1999

Workplaces should have a procedure in place for recording, reporting and evaluating all
serious incidents. They should take measures to avoid them happening again.
www.legislation.gov.uk/uksi/1999/3242/contents/made

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013

(RIDDOR)
This places duties on responsible persons working on the premises to report specific
workplace accidents, occupational diseases and specific dangerous occurrences or near
misses to their local Health and Safety Executive (HSE).
www.hse.gov.uk/riddor/

The Control of Substances Hazardous to Health Regulations 2002 (COSHH)

This requires employers to assess the risks of potentially harmful substances and
take precautions to minimise these. They include, for example, cleaning materials and
medication.
www.hse.gov.uk/coshh/

The Provisions and Use of Work Equipment Regulations 1998 (PUWER)

Anyone responsible for work equipment should ensure that it is suitable for the job, well
maintained, inspected regularly and only operated by well-informed and trained staff.
A breach of any of these regulations is a crime in the UK and therefore needs to be
reported immediately. If any person suffers harm as a result, the offender may be taken to
court.
www.hse.gov.uk/work-equipment-machinery/puwer.htm

THE CARE CERTIFICATE WORKBOOK STANDARD 3

5
Managing conflict and difficult situations

There are many things that can cause conflict with and between people. Conflict or
‘behaviour that is challenging’ often happens as a result of distress or because needs are
not being met. It could be caused by a number of factors including:
 biological, for example because an individual is in pain or suffering the side effects of
medication or substance misuse
 social, for example because of being bored, wanting social contact, having a need to
be in control, not being able to communicate or understand what is being said
 environmental, for example because of loud noise or bad lighting or barriers
to mobility
 psychological, for example because of feeling left out or lonely.

Your workplace might have a policy on responding to behaviour that challenges. There will
usually be a form to report what happened, who has been involved and where and when
the incident took place. You should include whether anyone has been injured and needed
medical assistance or whether the police have been called, and sign and date the form.
This will then be used to determine any action that is needed to support the individual
better.

An open discussion with any individual, where they are treated with respect and dignity,
can often find a solution. If possible and safe, when working with a person whose
behaviour is challenging:
 take them to a quiet place
 ask questions and listen carefully to what they say
 take their feelings of being upset or angry seriously
 try to find a way forward that they understand and can agree to.

It is important that you get to know the individuals you are working with as far as possible,
so you can recognise what triggers their distress. It is also important that you don’t get
emotionally involved but keep a clear head and look out for body language and reactions.
If you feel that a one-to-one situation between yourself and an individual has the potential
to become confrontational you should try to leave the scene to give them time to calm
down.

When you recognise frustration and aggression in a person’s behaviour you will learn, as
you develop in your role, how to use your communication skills and other ways of working
to manage a situation before it becomes violent or aggressive. Your manager will provide
guidance, explain ways of working and support you to develop your knowledge and skills
as you progress in your work.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

6
The CARE CERTIFICATE

Duty of Care

What do you know now?

Standard
THE CARE CERTIFICATE WORKBOOK
 Activity 3.1a

As a social care or health Duty of care

worker, you have a duty
of care to all people you
support. Use the following Define - provide a definition in your
words to define what is own words to demonstrate your
meant by duty of care. understanding.

Responsibility Safety Obligation Wellbeing

Duty of care is an important rule of law. It requires a person to take reasonable

precautions to protect another, such as providing emergency services or keeping the
property clean. In other words, people should do what they can to avoid any
foreseeable losses or injuries.

The duty of care is to be measured in a reasonable way. It has to be foreseeable and

reasonable so that it would satisfy the law. A person cannot be expected to take care
of a situation that is not foreseeable. The law doesnt consider whether the person
who caused harm intended for the harm or not. Instead, the duty of care is measured
by what was reasonably foreseeable at that time and by what was reasonably feasible.

Your responsibility is to take into account the needs and concerns of all people you
support, regardless of their age, sex, or race. It is your job to seek out information
about each person you work with and make sure that they are getting the care and
attention they need. You have a responsibility to help them feel connected to others,
without which their well-being may be at risk.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

8
 Activity 3.1b

Thinking about your

own work role, complete
the sentences below to
describe how the duty of
care affects you in practice. Describe - to describe means to create a
The first example has been picture with words but not simply writing
completed for you. a list of bullet points.

My job description states that...

I have certain responsibilities to the individuals I provide care and

support to and to my colleagues; this includes working safely and with
the interests and wishes of the individual at heart.

The code of conduct means that...

The code of conduct defines how I should act in the workplace on a daily basis. The code
of conduct ensures that I meet the requirements needed to complete my job and any
areas needed to be improved upon continuing my professional developement.

The organisational policies and procedures are there to...

Organisational policies and pocedures are there to ensure that I and the company I work
for adhere to all legal obligations

I must report unsafe or abusive practices because...

I have a moral and legal obligation to report all unsfafe or abusive practices. This will
ensure that the safety and wellbeing of the individuals I support is upheld

THE CARE CERTIFICATE WORKBOOK STANDARD 3

9
 Activity 3.2a

There will be times when your duty to safeguard

the wellbeing of the individual is in conflict with
your duty to promote the individual’s right to take
risks. It is your duty to ensure an individual is kept
safe and does not experience harm but these
situations may cause you a dilemma and you may
not know the right thing to do to keep them safe at Describe - to
the same time as enabling them to make their own describe means
choices. to create a picture
with words but not
Think of two dilemmas that might arise in your simply writing a list
work and describe these in the space below. of bullet points.

Dilemma 1:
A family member may have abused the service user I am supporting. The service
user refuses to tell anyone.

Dilemma 2:

The service user has refused to take their prescribed medication

THE CARE CERTIFICATE WORKBOOK STANDARD 3

10
 Activity 3.2b & c

For the two dilemmas that you

have described in 3.2a, complete
the table below to explain what
you must and must not do within
your role for each dilemma and Explain - to explain something you
where you would get additional will need to provide a clear account
support and advice to help you of your understanding, including
resolve the dilemma. details like why and how.

Where would you get

What you must do within What you must not do additional support and
your role within your role advice to resolve the
dilemma and why
Inform my line manager Confront the family I could get further advice
about the concerns that about the alleged abuse from my line
I have for the manager.My line
serviceuser. Document manager will know the
anything that the best course of action to
service user says in take and the appropriate
Dilemma 1
their own words steps necessary to
protect the service user
from harm

I would need to Force/bully the service I can get additional

document the user to have their support from work
medication refusal. I medication. The service colleagues that may
would speak to the user has the right to know the service user
service user and ask refuse their medication. better
why they are refusing
Dilemma 2
their
medication.Sometimes
getting a fellow work
colleague to support the
service user with their
medication can help

THE CARE CERTIFICATE WORKBOOK STANDARD 3

11
 Activity 3.3b

For each of the three

examples below, describe
who you would ask for
advice and support in Describe - to describe means to create a
handling comments, picture with words but not simply writing
concerns and compliments. a list of bullet points.

I would speak to my team leader and/or my line

manager.They will be able to investigate the allegations
that have been made by the individuals. I would also
A number of individuals document the complaints
you are supporting
believe that someone
has been tampering with
their medical records

My team leader will be able to explain the complaints

procedure if I don't fully understand it. If they cannot
explain the particular section that I don't understand then
You have read the they will know who to ask for advice
complaints procedure
but you would like to
ask for further guidance
on one section

I would document their complaints in their own words. I

would then take the documented complaint to my team
leader so as they can act on it accodingly.
An individual you
support has told you
that they wish to make
a complaint about the
food served at meal
times

THE CARE CERTIFICATE WORKBOOK STANDARD 3

12
 Activity 3.3c

It is essential to learn from

comments and complaints when
providing care services. Explain
the importance of learning Explain - to explain something
from comments, concerns and you will need to provide a clear
compliments in order to improve the account of your understanding,
quality of service that you provide. including details like why and how.

Comments and complaints are a vital source of information about the support we
provide. These comments and complaints can identify underlying problems and
potential improvements that can be made. It is important that these comments and
complaints are taken seriously and acted upon if necessary

THE CARE CERTIFICATE WORKBOOK STANDARD 3

13
 Activity 3.4a & b

You have a duty of care to respond to

Describe - to describe means to
events and incidents in an appropriate create a picture with words but not
and agreed way. To show your simply writing a list of bullet points.
understanding, complete the table below
to describe how you would recognise
adverse events, incidents, errors and Explain - to explain something
near misses (scenarios) and explain you will need to provide a clear
account of your understanding,
what you must not do in relation to each. including details like why and how.

Decide whether this Describe how you

Explain what you must
is an example of recognise this as an
do and must not do
an adverse event, example of an adverse
in relation to each
incident, error or event, incident, error or
example
near miss near miss
An investigation is Adverse Incident An adverse event is Must do:
started after a number event when actions or All relevant authorities
of patients died Adversee would need to
immisions cause
unexpectedly in care.
vent unintended imformed. ie,
preventable harm cqc,police, safe
toan individual guarding

Error Near miss Must not do:

I must not jump to
conclusions, lay
blame or attempt to
investigate the
situation myself

You arrive at an Adverse Incident Must do:

individual’s home to event The error would need
support them with their to be reported to my
shopping to find that a team leader or ine
colleague has already
arrived to undertake manager
this task.

Error Near miss An error is when a Must not do:

Error task has been It would be
performed incorrectly unprofessional to
or not completed have an argument
when it should have about the error
been

THE CARE CERTIFICATE WORKBOOK STANDARD 3

14
 Activity 3.4a & b
continued

Decide whether this Describe how you

Explain what you must
is an example of recognise this as an
do and must not do
an adverse event, example of an adverse
in relation to each
incident, error or event, incident, error or
example
near miss near miss
When serving lunch, Adverse Incident A near miss is when Must do:
an individual who event
something that could All near misses need
has a nut allergy was
have caused harm or to be reported to my
given a peanut butter
sandwich by mistake. injury was prevented line manager or team
You notice this just
leader
in time to change the
sandwich.
Error Near miss Must not do:
Near I must not confront
miss the individual that
made the sandwich. I
also must not ignore
the incident

An individual in the Adverse Incident Incidents are Must do:

bathroom area slips event Incident eventsthat cause harm My team leader and
on the wet floor. When manager need to be
investigating you imformed of the
notice that a wet floor
sign has not been incident immediately
used. to prevent further
incidents
Error Near miss Must not do:
I must not ignore the
situation or blame
anyone for the incident

THE CARE CERTIFICATE WORKBOOK STANDARD 3

15
 Activity 3.4c

Thinking about the four

scenarios in 3.4a & b, list
the legislation and agreed
ways of working that need
to be taken into account
when reporting adverse List - this term means to identify the
events, incidents, errors main points which can be written as
and near misses. bullet points.

1.
The health and safety at work act 1974.

2.
RIDDOR reporting of injuries, diseases and dangerous ocurences regulations 2013.

3.
Policies and procedures

4.
Management of Health and safety regulations

THE CARE CERTIFICATE WORKBOOK STANDARD 3

16
 Activity 3.5a

Fill in the spider diagram

below to list the factors and
difficult situations that may
cause confrontation. One List - this term means to identify the
example has been provided main points which can be written as
for you. bullet points.

An individual with
dementia may feel
misunderstood,
frustrated and
confused.

Unable Poor
tocommunicate due communication can
to disability. By not lead to
being able to Factors and misunderstanding.co
communicate may nverstaions maybe
difficult situations
lead to someone misunderstood.
feeling less valued
that may cause
than those that confrontation
cancommunicate include...

Isolation due to lack of mobility. By Pain and suffering may cause

not being able to move around someone to lash out.
freely could cause frustration and
lead to conflict.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

17
 Activity 3.5b,
c&e

Thinking about the factors

and difficult situations that
may cause confrontation,
select one that relates to
your own role and answer
the questions below.

1. What is the factor or difficult situation that may cause confrontation?

Poor communication.

2. H
 ow could communication be used to solve problems and reduce the likelihood or impact of
confrontation?
By finding a different way to communicate with the individual may help to improve
the situation. If the individual knows that they are being listened to then they wil lfeel
empowered and valued as an individual

3. How would you assess and reduce the risks in this situation?
Documentation helps to paint a picture of the situation. Care plans can be updated
to reflect these changes. This will reduce the risks that the situation may have
caused. Risk assessments are regularly updated which will lessen any risks posed.

4. What is the agreed way of working for reporting confrontation in your service?
Confrontation in the workplace are documented on the daily notes and incident
forms. These are reviewed by the line manager and appropriate action would be
taken to reduce confrontation in the workplace

THE CARE CERTIFICATE WORKBOOK STANDARD 3

18