Guidance around physical interventions lacking from a consumer’s individual support plan (ISP) - 20HDC00043

The Deputy Health and Disability Commissioner has found Brackenridge Services Limited (Brackenridge) in breach of the Code of Health and Disability Services Consumers’ Rights.

Rose Wall found the service breached Right 4(1) of the Code - the right to services provided with reasonable care and skill.

The decision concerns the care a community support worker provided to a young man residing in a Brackenridge residential facility. The young man has complex support needs due to intellectual disabilities and physical health problems. He is non-verbal and communicates via body and facial expressions.

In late 2019 a community support worker used physical intervention to remove the young man from harm. The incident highlights the importance of support workers treating consumers with respect and ensuring that challenging situations are managed appropriately, irrespective of circumstances.

On this occasion, no incident form was lodged to record the event, despite the incident reporting policy requiring one.

Ms Wall said the service failed to ensure that a consumer’s individual support plan (ISP) contained information about when physical restraint could be used.

"The disability service is responsible for the service delivered to this consumer. By failing to ensure that information regarding physical interventions was contained in his ISP, the disability service did not deliver services to the consumer with reasonable skill and care, and breached Right 4(1) of the Code," says Ms Wall.

Ms Wall noted the importance of providing support workers with adequate guidance and training on how best to respond to challenging behaviours. Guidance and training minimises the chance of interventions being used unnecessarily or inappropriately by support workers.

The man lived under a shared-care arrangement with Oranga Tamariki (Ministry for Children) operating as his guardian.The Deputy Commissioner also found the disability service in breach of Right 4(2) of the Code for failing to inform Oranga Tamariki in a timely manner of a complaint relating to the standard of care the young man received.

Ms Wall made a number of recommendations to Brackenridge Services Limited, including:

- Ensuring all residents’ ISPs contain clear guidelines outlining when and how support workers should respond to predictable types of challenging situations and risky behaviours.

- Ensuring managers are aware of the physical interventions that have been approved for each resident and that support workers have undertaken training in the management of actual, or potential, aggression.

- Undertaking an audit of all complaints received over the past six months to ensure Oranga Tamariki is informed of any complaints within the appropriate timeframe.

As a result of this incident, the disability service has undertaken several changes, including reminding service managers to ensure all ISPs are formally authorised by Oranga Tamariki.

The full report of this case can be viewed on HDC’s website - see HDC's ' Latest Decisions'.