“Escalating risk” of violence to social workers wasn’t acted on

A social care organisation failed to take adequate action to protect service staff from a potentially aggressive client with learning disabilities, despite staff being exposed to a number of violent incidents involving the individual over a 21-month period.

The HSE launched an investigation at Dimensions (UK) Ltd after the individual, who cannot be named for legal reasons, kicked a female support worker in the eye on 31 December 2010. She suffered blurred vision and was off work for 18 days, but has since made a full recovery. The location of the incident cannot be revealed.

The investigation found that between March 2009 and December 2010, Dimensions did not have adequate processes in place to control the risk of workers being exposed to the client acting in a violent or aggressive manner. HSE inspector Carol Forster revealed to SHP that social care staff were having to deal with “challenging behaviour” from the individual on a daily basis, and that there had been about 10 examples, over the period in question, in which the client had kicked workers in the head, or face.

Although staff reported the incidents, the organisation did not have a formal reporting system in place to adequately monitor and review incidents of this nature. Consequently, explained Inspector Forster, “Dimensions did not interrogate this information to get a clear picture of this challenging behaviour.”

She added: “The expectation is that all previous incidents would have been reported correctly and, from that, Dimensions would have been able to identify the triggers likely for the client to exhibit violence and aggression.”

Such triggers might include, for example, environmental factors, such as noise or where there are lots of people present, and activities that an individual with learning disabilities might not enjoy doing. The inspector did not wish to reveal what the exact triggers were in this case.

Asked what the organisation could have done to reduce the risks of a violent incident, the inspector listed several “simple measures”, such as giving staff a long-handled brush, or pick-up stick so that they didn’t need to bend down close to the client, and moving devices like the washing machine on to a bench, rather than leaving them on the floor.

Another key failure lay in staff training. According to the inspector, Dimensions’ service specification policy made clear when staff were deemed competent to work on a one-to-one basis with clients. Social care workers were required to undertake mandatory training in managing violence and aggression and carry out a number of shifts while shadowing more experienced staff. The injured worker had not been trained in accordance with the policy, and therefore was not competent to work one to one with the client, said the inspector.

Dimensions (UK) Ltd, which has its headquarters in Reading, pleaded guilty on 17 January to breaching s2(1) and s3(1) of the HSWA 1974. Newcastle Magistrates’ Court fined the company £14,000, and ordered it to pay £30,000 in costs.

Inspector Forster commented: “Social care organisations have a duty to ensure that proper management systems are in place to control the risk of violence and aggression to the lowest level possible.”

She continued: “In this case, Dimensions should have identified the triggers that would lead to this client displaying aggressive behaviour, and measures should have been put in place to avoid them. They should also have ensured that staff understood the activities and environments appropriate for this client, to reduce the risk of violent behaviour being triggered. Finally, they should have acted on incidents and near misses, which indicated an escalating risk.”

Dimensions’ operations director for Tyneside, Nick Ball, said the organisation sincerely regrets the incident, but stressed that no member of staff suffered serious injury during the period covered by the investigation.

He added: “The problems encountered during a period of staffing difficulties have been comprehensively rectified. Dimensions remains committed to constantly improving the service it provides and the environment in which its staff and agency employees engage with the individuals and families it supports. We were pleased to note that the magistrate found that our actions were not deliberate, or reckless.”