RRN Closed Cultures

Thanks for thinking about taking part in this very important survey!

This survey has been co-produced by the Restraint Reduction Network. We are doing this survey to help the Care Quality Commission (CQC) make their inspection process better. They want to find out and stop ‘closed cultures’. These are places that do not respect people and their human rights. Closed cultures can be in mental health care, social care support, in a hospital or in community-based homes.  
If you have experienced a closed culture we want to hear from you!  

The survey should take around 20 minutes to finish.

The information you provide us is confidential and we won’t know anything that could identify you - it is an anonymous survey.

Anyone can fill out the survey. You might have been in a closed culture, a parent of someone that has experienced a closed culture. You may be an advocate or member of staff that has worked in a closed culture.

Thank you.
 
The data collected will be securely stored by the Bild Group. The CQC have asked us to collect demographic data so we can ensure we are gathering a representative range of views, but this data will not allow us to identify you - the survey is anonymous. 

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* 1. People should have a say in their own care, not just staff and professionals.

  I agree I am not sure I disagree
People receiving care should attend all meetings about them.
Staff and professionals must use clear language, not jargon, so that people receiving care can understand what they are talking about.  
Staff and professional must be able to tell inspectors how people receiving care prefer to be communicated with.
People receiving care in hospitals must have a clear and sensible plan for discharge.
People receiving care in hospitals and their staff should be able to explain what is in the discharge plan.
Staff should be able to tell inspectors if people receiving care have ‘consented’ to the treatment they are receiving.
People receiving care should be able to have a family member or other person they trust in meetings about them and their care, to help and advise them.

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* 2. What do people receiving care do all day?

  I agree I am not sure I disagree
Inspectors should ask people receiving care what they do during the day.
Inspectors should ask people receiving care whether what they do during the day is what they want to do.
Staff should be seen to ask people receiving care what they would like to do and try to support this.
People receiving care should not be told to do the same things as other people they live with.
People receiving care should have a personal time table that they can change.
Inspectors should watch to see if staff control what people receiving care do during the day.

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* 3. About restrictive practices

Staff sometimes feel they have to stop people receiving care from doing things e.g. by restraining them, sedating them or locking them in a seclusion room. Inspectors need to find out if these restrictions could have been prevented and are carried out correctly and respectfully.

  I agree I am not sure I disagree
Inspectors should ask both staff and people receiving care about an incident where restraint, medication or seclusion was used; Inspectors should compare  the views of staff and the people who experienced the restraint.
Inspectors should ask two or more staff how they try to prevent using restrictive practices with a particular person receiving care, and compare this with any restraint reduction plans.
Inspectors should look for blanket rules. This means when there is a rule for one person that everyone has to follow.
After an incident where people receiving care have been restrained, medicated or secluded, they should have the opportunity to talk about what happened and why and to give their view on whether staff were right to act as they did and if staff had any alternatives to using a restriction.

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* 4. Culture of a service

Good ways for inspectors to understand what the culture of a service is, should be to:

  I agree I am not sure I disagree
Spend time with people receiving care. Ask them about their care and their relationships with staff and professionals.
Observe interactions between staff and people receiving care are open, positive and friendly.
Speak to the family members of people receiving care.
Record their ‘gut feeling’ of a service. (This is likely to be kept confidential within CQC).  
Speak to ancillary staff and agency staff, cleaners and kitchen staff as they  often have good relationships with people receiving care and ‘see’ them in a non-professional light which can be very informative.
Inspectors should check if written care plans for people receiving care ‘match’ what happens on a day to day basis e.g. ask staff what a person’s care or their communication plans say, and check that people receiving care report the same thing.
Ask people receiving care who their favourite member of staff is, and why.
Ask staff about people they work well with and why.
If staff say they work well with ‘all of them’ this can be a sign of institutional attitudes i.e. ‘I treat them all the same’. 

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* 5. Family, friends and paid advocates

Family, friends and advocates play a central role in helping someone develop and connect with their community and wider life. People receiving care need to be able to communicate with family, friends and advocates easily.

  I agree I am not sure I disagree
Inspectors should check if family, friends and advocates are invited or given enough notice to attend meetings.
Inspectors should check if families and friends feel heard and their opinions valued.
Inspectors should check that efforts have been made to encourage positive relationships between people receiving care and family, friends and advocates where these have been under strain or broken down.
Inspectors should check if phone calls  are restricted or monitored (e.g. no privacy given during phone calls).
Inspectors should check if the Internet is not allowed or heavily restricted.
Inspectors should check if mobile phones are not allowed or heavily restricted.
Inspectors should check if visiting times are restricted and/or not facilitated.
Inspectors should check if leave ( section 17 ) is restricted/cancelled.
Inspectors should check if visits to family and friends are difficult to arrange or not carried out e.g. through staffing shortages.
Inspectors should check if family are not able to visit the person where they are being cared for. 

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* 6. Valuing people

Inspectors should try to find out if staff and professionals really know, or work to get to know and value the people receiving their care. 

  I agree I am not sure I disagree
Inspectors should check the written and spoken language is focussed upon diagnoses and what they think is associated with these e.g. ‘he’s autistic so doesn’t like communicating with people’. This is not ok. 
Inspectors should check if things written and said about the person focus mainly on their problem behaviour and how they can be ‘managed’and little  attention is paid to peoples interests, skills and desires. This is not ok.
Inspectors should check if medical language is used most of the time  and medical diagnoses are used to label people  - for example   ‘she is a PD '. This is not ok. 
Inspectors should check positive therapeutic relationships i.e. good rapport between staff and people receiving care are central to development and progress. This should be observed and recorded by inspectors. Staff sometimes interact differently for inspectors. 
Inspectors should check whether the hierarchy in the service is obvious i.e. the manager stays in the office, staff and people receiving care knock and wait to gain entry. They may be asked to wait if a professional in in the office or other ‘more important’ issues arises.

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* 7. Complaints, comments and contributing to ‘running’ their service

  I agree I am not sure I disagree
Complaints and other contributions are an important and healthy part of any service with an open culture. Hearing from people receiving care should be supported and welcomed whether making a complaint or contributing ideas for a better service.  
Inspectors should check if people know how to make a complaint and whether the process is understandable to all people and their families e.g. on notice boards and in a format all people and their families can understand.
Inspectors should check if a service has ways in which people receiving care can contribute their ideas and views on how ‘their’ service is run. This might be through surveys or through meetings between staff and people receiving care.
Inspectors should check how complaints or comments have been made and handled in line with policy.
That people receiving care and their families are given help to make a complaint or comment, if they need it.
Inspectors should check how staff and professionals accept and manage ‘difficult’ issues that arise e.g. complaints about restraints or seclusion.
Inspectors should check if complaints made have been resolved to everyone’s satisfaction.
Inspectors should inquire further where services appear unreflective and present a perfect front. Good services constantly seek improvement from family and people that use their care. They will accept they don’t get everything right.

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* 8. Anything else you want to tell us – please write in the box below.

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* 9. What is your gender?

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* 10. What is your ethnicity Choose one option that best describes your ethnic goup or background

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* 11. What is your sexual orientation?

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* 12. What is your age?

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* 13. Do you have a disability?

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* 14. If you have a disability could you say what that is?

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* 15. Have you been a patient in a mental health or learning disability hospital or are you a parent /carer of someone who has used these services?

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* 16. Do you currently live in the community supported by staff?

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* 17. Are you a:

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* 18. Did you have support to complete this survey?

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* 19. If yes, was this a family member friend or staff

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