Health and Social Care Unit 7: Principles of Safe Practice in Health and

Social Care

Adult Case Studies

Merryvale Residence

The Merryvale Residence provides support for 10 older men and women who are
all over the age of 75. Three of the residents have a hearing impairment, two
have dementia and the remaining residents have varying degrees of reduced
mobility.

Two of the female residents are in a same-sex relationship and have experienced
discrimination from one member of staff, but do not want to cause problems and
have therefore not made a complaint. The couple feel that they must be entitled
to a double room but are not certain what their legal rights are on this issue.
One of the women has noticed that her partner, who requires support with
dressing and bathing, has developed bruises on her neck and arms. When
questioned by her partner, she states that she fell over.

The residence has a high turnover of staff and often operates with less than the
legal limit in terms of care workers. This can mean that residents who require
support with personal care have to either wait for long periods or manage by
themselves. Some residents have remained without a bath or shower for two or
three days, causing distress and, in some cases, worsening of a skin condition.

The residence has recently lost its full-time cleaner Mary Jones, following a
dispute between Mary and the deputy manager. This means that the care staff
are currently sharing the domestic duties between them. Spilled food and drinks
are often left on work surfaces and waste bins overflow, as staff cannot keep up
with all the cleaning in addition to caring for the residents.

Chilchester Drop-in Centre

The drop-in centre provides support for young adults with mental ill health. The
staff have recently become concerned about Zara, who is 19 years old and has
an anxiety disorder. She has been prescribed medication to deal with this. Zara’s
key worker has noticed that her symptoms have increased; she has panic
attacks, which appear to begin if she is approached by any of the male service
users or members of staff.

Although the weather is currently warm, Zara has begun to appear in long
sleeved sweaters, insisting that she is cold. Zara’s appearance has deteriorated
recently; her hair is often unkempt and her clothes dirty. Zara states that this is
her protection, but from what she refuses to say.
The staff are aware that Zara is unhappy about her mother’s new boyfriend. She
states that he is too `friendly’ but refuses to explain what she means by this.

Zara has a social worker, Elizabeth Green, who has also noticed the changes in
Zara’s physical appearance and increased anxiety, but has linked this to a
perceived jealousy regarding Zara’s mother’s new relationship. Elizabeth has
not recorded the changes in Zara’s case file, as she considers that Zara will soon
‘get over’ her jealousy and really needs to grow up.

Zara has asked Elizabeth to arrange alternative accommodation for her, but the
social worker has stated that Zara has no legal entitlement to this, as she is not
sufficiently vulnerable.

Walters NHS TrustHolly Ward

Holly Ward is a male surgical ward in the Walters NHS Trust. The ward provides
surgical care for 15 male service users. Martin Chambers is the ward manager,
and is supported by a team of registered nurses and healthcare assistants.

The service users come into the ward for surgical procedures, some of which are
planned and others are emergency procedures.

Robert Brown, who has learning disabilities, was recently admitted for surgery
on his left arm following an accident at home. Whilst in hospital, Robert
developed a bout of diarrhoea and vomiting, which was not related to his
surgery.

Prior to becoming ill, Robert had eaten a portion of cottage pie that he
described as tasting ‘funny’. He also said that he had eaten the pie because he
was hungry and didn’t get enough to eat at home. His parents want to make a
complaint against the hospital, accusing them of neglect, but the ward manager
has said that this is not possible. He stated that the complaints procedure is
being reviewed and therefore unavailable.

Martin said that the stomach upset was due to Robert overeating, accusing
Robert’s parents of starving him, resulting in him overeating when the
opportunity arose. Robert’s parents deny this, saying that Robert often makes
up stories to gain attention. However, the nurses who have cared for Robert
whilst on the ward have noticed that he is underweight for his height and
constantly complains of being hungry, saying that he is not allowed to eat at
home without permission. The nurse mentions her suspicions to the ward
manager, who dismisses her comments stating, ‘he probably doesn’t understand
about eating properly’.

One of the nurses suspects that there was a problem with the food in the
hospital as several service users have become ill. The nurse mentioned this to
her manager, but was told not to discuss this. The nurse would like to make a
complaint to the relevant body but is not sure who this is, and also whether she
would be protected under law if she did speak out.
Health and Social Care Unit 7: Principles of Safe Practice in Health and
Social Care

Child Case Studies

Zebra Ward

Zebra Ward is a paediatric medical ward at the Prince Oswald Children’s

Hospital, providing care for children from the age of six months to two years
with a variety of medical conditions.

Lucy Smith, aged six months, and Kevin Smith, aged four years, are brother and
sister and have recently been admitted to the ward from the Emergency
Department, following a car accident involving their father as driver and a stone
wall. Neither of the children were secured in their car seats and have both
sustained serious injuries. Both have broken bones and bruised faces.

When the duty doctor examines the children, she notices bruises at the base of
Kevin’s spine and round marks on Lucy’s neck that resemble burns. When the
children’s father is questioned, he states that the marks were inflicted by his
wife who died three months ago due to a long-term illness that had affected her
mental state. The doctor is unconvinced, as the marks appear to be more
recent. However, another emergency is admitted and the doctor forgets to
record her opinions.

A nurse is asked to give each child a sedative to help them sleep. He notices the
marks, but is in a hurry to complete the medicine round before going off duty
and fails to record his observations. The nurse also fails to complete the ward
records with regard to the sedatives given to both children.

The children’s father did not sustain any major injury and was allowed home
after examination. He comes the next day to visit his children and bring them
each a present. A visitor to Zebra Ward notices that Kevin and Lucy do not look
pleased to see him. Kevin hides under his bed, refusing to come out, and Lucy
cries when her father lifts her out of the cot. The nursing staff assume that the
children’s reaction is due to delayed shock from the car accident. However, the
visitor, a social worker, is not convinced and asks to speak to the ward manager,
who says that he cannot discuss such issues with a visitor.
Cherry Trees Children’s Centre

Lisa is a three-year-old girl who is on the autistic spectrum. She has attended
the centre twice a week with her mother, Joanna, since she was born. All of the
children who attend the centre have additional needs and require medication
whilst at the centre

Several of the staff have recently left the centre and the manager has agreed to
allow several local people to act as volunteers until new staff can be recruited.
As they are all known to the manager, she has not bothered to ask the
volunteers to complete a Disclosure and Barring Service (DBS) form, stating that
there will be nothing of note on the forms. She has allowed the volunteers to
lead unsupervised play sessions with the children who attend the centre, whilst
the parents have coffee in another room. Joanna, Lisa’s mother, has expressed
concern about this, but has been informed by the manager that this is only a
temporary measure.

None of the volunteers have first aid training and have not been informed of the
emergency evacuation procedures at the centre. Instructions for the evacuation
of the centre are clearly displayed on the noticeboard, as is a health and safety
notice in compliance with the relevant legislation. However, the fire doors are
often locked and no evacuation practice has taken place for at least two years.

One day, whilst playing in the outside area at the centre, Lisa fell off the
climbing equipment and hurt her leg. As Lisa’s mother was in the coffee room at
the time, she did not see the incident. The volunteer who was supervising the
session checked Lisa’s leg and declared that there was no damage and gave Lisa
a biscuit to calm her down.

Later in the afternoon, one of the other parents heard two of the volunteers
discussing the outdoor play equipment. Concern was expressed regarding the
climbing frame, as it had cracks in the metal tubes that formed the main
structure. In addition, one of the crossbars had broken away from the main
frame.

On arriving home, Joanna noticed that Lisa was limping and decided to take her
to the G.P. for a check-up. The G.P. suspects that Lisa may have cracked a bone
and gives Joanna a letter for the local NHS Trust to arrange a scan.

The scan has revealed the G.P.’s suspicions and Joanna decides that she will
make a formal complaint of neglect against the children’s centre, but does not
know to whom the complaint should be addressed, or which piece of legislation
should be applied.
Briars Avenue Children and Young People’s Residence

Briars Avenue Children and Young People’s Residence is a group home for 12
children and young people aged 12-16, who have been placed there by the local
authority. All of the children and young people have behavioural issues and all
have a key worker within the residence.

Shenise, who is 15 years old, has lived at the residence for two years, following
the death of both of her parents. She has had two failed fostering arrangements
and is currently being assessed for asthma by the local G.P.

Recently, the staff were surprised to hear Shenise refusing to go on a trip to

London where her favourite band is playing. Shenise said that she had no money
to pay for the trip. Shenise has a monthly allowance paid by a Trust that was
established by her parents in the event of their death.

The staff have also noticed that Shenise is becoming withdrawn, particularly in
the presence of Ruby, another resident. Ruby is 16 years old and will shortly be
moving into supported accommodation, to support her in becoming independent.

Ruby has no allowance but has informed the staff of her intention to take
Shenise’s place on the trip, stating that the mother of her best friend at college
has offered to pay for her. However, when Ruby’s key worker rang the woman,
she denied this, stating that she had taken on additional hours at work in order
to pay for her own daughter. When challenged, Ruby said that she had found the
money on the local waste ground.

The staff have also noticed that Ruby is wearing Shenise’s new watch. When
questioned by James Smith, the manager of the residence, both girls agree that
Shenise had given the watch to Ruby, although Shenise’s response is more
subdued than Ruby’s.