# Health and social care, Level 3: leading practice on a shift

*Positive risk taking, supervising colleagues and escalating without hesitating.*

## Production summary

- Modules to record: 2
- Total script: 965 words, about 6 minutes of finished audio
- Voices: Amara (host) and Nadia (practice educator)
- Level: Level 3, senior care workers and team leaders

## Accreditation wording that must appear in the description

- **The CPD Certification Service** (planned): Application scheduled.
- **Skills for Care knowledge sets and the Care Certificate standards** (aligned): Mapped by us to published Skills for Care material. This is our own mapping and implies no endorsement or assurance by Skills for Care.

> Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved.


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## Enabling risk, holding a standard and escalating in time

**Runtime** about 3 minutes. **Words** 451. **Starts at** 00:00 in the full course recording.

### Learning outcomes to state on camera

- Complete a risk assessment that enables rather than forbids
- Give specific, timely feedback on a colleague's practice
- Judge when to escalate and what information to carry
- Reflect in a way that changes what happens next

### Script


`[CUE 1]` *Risk assessment with a benefit column added beside the risk column.*

**AMARA**  [00:00]
I have written a risk assessment and the conclusion is that she should not go into the garden alone. Good assessment?

**NADIA**  [00:08]
Probably a failed one, and I say that gently. If the answer at the bottom is do not, the assessment has usually been used to find a reason to stop something rather than a way to allow it.

**AMARA**  [00:23]
But she has fallen in the garden.


`[CUE 2]` *Same garden scenario, forbidden versus enabled, with mitigations listed.*

**NADIA**  [00:26]
Then the question is what makes it safer, not what makes it stop. A different surface, a rail, a time of day when someone can see her from the window, shoes that grip. And the column everyone leaves out.

**AMARA**  [00:42]
Which is?

**NADIA**  [00:42]
The benefit. What she loses if the garden goes. Write that down beside the risk and the whole document changes character, because now a reader can see there were two things at stake and not one.


`[CUE 3]` *Feedback structure: what I saw, the effect, what happened?*

**AMARA**  [00:57]
A newly promoted senior has to raise a colleague's tone with a resident. Yesterday they were peers.

**NADIA**  [01:03]
Same day, privately, describing the behaviour rather than the person. Not you were rude. What was said, the effect it had, then a question: what happened?

**AMARA**  [01:14]
Why ask, when the senior witnessed it?


`[CUE 4]` *Escalation handover: observed, onset, change from normal, actions, ask.*

**NADIA**  [01:17]
Because they witnessed thirty seconds in a corridor. That colleague may be in the worst week of their life. Without the question you never learn it, and they conclude you are somebody who tells rather than asks. After that you stop hearing anything.

**AMARA**  [01:34]
And holding it for supervision next month?

**NADIA**  [01:37]
It stops being feedback and becomes an ambush. Nobody can act on something three months old, and they will spend the meeting wondering what else has been stored up.


`[CUE 5]` *Quiet deterioration signs preceding the obvious ones on a timeline.*

**AMARA**  [01:48]
Escalation. It is two in the morning, she is a bit off, not herself, nothing I can point at. I do not want to be the one who rings for nothing.

**NADIA**  [02:01]
Ring. Please. In fifteen years I have never seen anybody in trouble for escalating something that turned out to be nothing, and I have read a great many serious incident reports containing the words, I thought I would mention it in the morning.

**AMARA**  [02:18]
What do I actually say?

**NADIA**  [02:20]
What you saw, when it started, how it differs from her normal, what you have already done, and what you are asking for. That last part is the one people leave off, and it is what turns a worried call into a useful one.

**AMARA**  [02:37]
And not herself is enough to go on?

**NADIA**  [02:41]
From somebody who knows her, it is often the most valuable thing said all night. Deterioration in an older person is quiet before it is loud: new confusion, not eating, not wanting to get up. You are the instrument that detects that, and no observation chart replaces you.

### Sources for the on screen credit

- Positive risk taking guidance, Social Care Institute for Excellence
- Mental Capacity Act 2005, legislation.gov.uk
- Safe staffing and escalation guidance, National Institute for Health and Care Excellence
- The Care Certificate standards, Skills for Care

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## Delegating safely, overseeing medicines and carrying a new starter

**Runtime** about 3 minutes. **Words** 514. **Starts at** 03:00 in the full course recording.

### Learning outcomes to state on camera

- Delegate a task lawfully and know what remains yours
- Oversee a medication round without taking it over
- Induct and mentor a new starter so they stay
- Handle a complaint on shift so it does not escalate

### Script


`[CUE 1]` *Delegation test as four gates, all four required.*

**AMARA**  [03:00]
I delegated a task and it went wrong. Am I liable, or is the person who did it?

**NADIA**  [03:07]
You are accountable for the decision to delegate. They are accountable for how they carried it out. Those are two separate things and both are real.

**AMARA**  [03:17]
So what makes my decision defensible?

**NADIA**  [03:20]
Four things. Were they trained and assessed for that specific task. Was it within their role and not merely within their ability. Was your instruction specific enough that they could repeat it back. And were you contactable while they did it.


`[CUE 2]` *Vague instruction versus specific instruction, side by side.*

**AMARA**  [03:36]
Give me an example of a bad delegation that sounds fine.

**NADIA**  [03:41]
Keep an eye on room four. It sounds responsible and it is meaningless. Nobody can be held to it, nobody knows what was meant, and when it goes wrong both people genuinely believe they did what was asked.

**AMARA**  [03:56]
Medicines. I am observing a round. What am I looking for?

**NADIA**  [04:00]
Not errors. The record shows you errors. You are there for the things the record cannot show: is she interrupted three times, does she give him time to actually swallow, does she code a refusal or leave the box blank because coding it means a conversation.


`[CUE 3]` *Medication round observation: interruptions, time given, refusal coding.*

**AMARA**  [04:19]
The round is slow. Can I not just take the trolley and help?

**NADIA**  [04:24]
Then you have learned nothing about whether it is safe without you, and you have told her she is not trusted in front of residents. Stand back. It is uncomfortable and it is the job.

**AMARA**  [04:38]
New starters. We lose a lot in the first few weeks.

**NADIA**  [04:42]
Almost everybody does, and it is almost never the work. Ask somebody who left at week three and you get the same three answers: nobody had time for me, I was in the numbers on day two, and I was scared to ask the same question twice.


`[CUE 4]` *First twelve weeks attrition, with the three stated reasons.*

**AMARA**  [05:01]
All three of those are mine to fix.

**NADIA**  [05:04]
All three. Name who they are with before the shift starts, so they are not standing in a corridor working out who to follow. Never count them in the numbers while they are shadowing. And say out loud, on day one, that asking twice is expected.

**AMARA**  [05:23]
Does saying it actually change anything?

**NADIA**  [05:25]
More than anything else you will do that week. People do not ask because they think asking exposes them. Say it explicitly and you have removed the reason. Then two minutes at the end of the shift, privately. That is the whole intervention.


`[CUE 5]` *Complaint at the door: listen, acknowledge, say what and by when, record, hand over.*

**AMARA**  [05:42]
Last one. A daughter is at the office door and she is furious about a late call.

**NADIA**  [05:49]
Listen the whole way through without correcting anything, even the parts that are wrong. Acknowledge it. Say what you will do and by when. Record it. Hand it over so it travels.

**AMARA**  [06:02]
Do I apologise if I do not know the facts yet?

**NADIA**  [06:06]
You apologise that she has had this experience, which is true and costs nothing. That is not an admission of fault. What turns a conversation into a formal complaint is defensiveness, a promise you cannot keep, or saying you will pass it on and then not doing it.

### Sources for the on screen credit

- Accountability and delegation, Royal College of Nursing
- Managing medicines in care homes, SC1, National Institute for Health and Care Excellence
- Recruitment and retention in adult social care, Skills for Care
- Complaints handling guidance, Local Government and Social Care Ombudsman

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