Sometimes, there may be patients from different backgrounds, who may not understand English. Therefore, the surgery has a professional translator available should there be such a client. This is important in order for the patient to be able to communicate their ideas successfully to their doctor.
Emotional Needs
Emotional needs of a client can be very specific and sometimes be difficult for a doctor to provide. Clients may suffer depression or emotional distress. Often clients will need to share personal problems with their doctor, in order to be able to explain the problems they are having. A doctor will provide as much advice and help as they can but sometimes, if it is felt that a client has deep emotional troubles, they may be referred to a counsellor or in very serious conditions, a psychiatrist. A client requires their doctor to be open minded and understanding about anything they choose to share. Client confidentiality is another very important aspect in the client-carer relationship, as the client needs to know they can trust their doctor with any information they may wish to share. In addition, the doctor should approach problems in a professional manner, by offering advice or perhaps medical provision. The final decision should be left up to the client. Sometimes, clients will just require someone they can talk to and a doctor must be understanding and helpful in any way he or she can. If a patient is referred to a psychiatrist, the doctor may still have consultations with the patient in order to ask about how they are coping or whether they are feeling any better.
Social Needs
The main social need of a client relating to this particular care setting, is a good relationship with their doctor. This social interaction is very important because a client needs to feel at ease with their doctor. Good social relationships also mean the doctor will be able to discuss their clients’ personal problems without any embarrassment or unease. This will mean the patient will feel they have someone to turn to, who will not only provide medical provision but also advice and help about in depth problems. In some cases, communication between the patient and doctor can be difficult, for example, if the patient is from a foreign background and does not understand English. For this purpose, the surgery has a translator as well as a language line for anyone who contacts the surgery but doesn’t understand English. Communication is vital, which is why the surgery strives to work past any barriers that may get in the way of successful communication between client and carer.
I created the following pie chart in order to show how much the four PIES are dealt with in this care setting. I chose the percentages based on how much I think each aspect of the PIES is dealt with. I drew these conclusions based on my questionnaire as well as additional information I obtained by speaking to one of the doctors who works at my care setting.
Client groups
The surgery provides services for people of all different age groups. Ranging from infants to the elderly, the surgery strives to provide a high quality service for all its patients.
Infancy (0-3 years)
At infancy, the child is the most prone to illnesses and disease, as their immune system has not yet developed. Therefore, the parents or carers of the child are likely to schedule regular consultations with their doctors. As well as medicinal provision, the doctor will provide emotional support for the new parents as well as advice on how to deal with certain aspects of care for the child.
Childhood (4-10 years)
Children are the client group that will also be prone to a lot of illness, in particular because they will mix a lot with other children, for example at school. Young children are also likely to have a lot of accidents; some involving superficial wounds but some can be more serious, for example breaking a leg. These children will go to the hospital right away, but may choose to visit their doctor at a later stage in order to inform him or her of any troubles they could be having, or to ask for medical information or drugs.
Adolescence (11-18 years)
At Adolescence, patients will mainly need emotional support, social interaction and advice. Teenagers are the most likely to be very emotional or have mood swings etc. and it is important that the doctor can take a professional approach to problems and offer practical solutions for the patients. Doctors will also have to make adolescents aware of things like the affects of smoking or even taking of drugs (other than ones used for medical treatment). In addition information about sex and contraception will be relevant to this age group.
Adulthood (19-65 years)
During adulthood, many changes take place and it can sometimes be difficult to cope. It is important that a client has medical attention as well as a good basis for advice as well as knowledge. Adulthood brings many new responsibilities as well as important decisions, therefore good medical and social care can be very beneficial at times of need. The care setting strives to meet individual client needs and treat all patients as individuals. By educating clients and providing crucial advice, the surgery maintains a good basis for the relationships between the client and carer to develop.
Later Adulthood (65+ years)
This life stage, much like infancy in fact, requires a lot of care and attention. Elderly people are very vulnerable to disease as well as accidents such as falling down the stairs. It is important for elderly patients to have good medical support. Most of the time this will involve home visits as elderly people may find it more difficult to gain access to their GP.
How the Care Value Base is applied
Care workers are guided in their day-to-day business by following the core principles of the NHS. These principles help to ensure that clients receive the highest standard of care possible. It is important that the provision of care within the NHS meets the needs of every individual, is free at the point of need and is based on the patient’s clinical need, not their ability to pay. Unlike private services, the surgery is a free primary health service and this means that no one is exempt from using the service, as it is open to people of all different ages and backgrounds.
These are the main Core Principles that the Surgery is run by:
- Providing a comprehensive range of services- access to a comprehensive range of services will be provided, throughout primary and community healthcare. Information services and support to individuals in relation to health promotion will also be provided as well as disease prevention, self-care, rehabilitation and after care.
- Shaping services around the needs and preferences of individual patients, their families and their carers- services must be responsive to the needs of different groups and individuals within society and challenge discrimination on the grounds of age, gender, ethnicity, religion, disability and sexuality.
- Working continuously to improve quality services and to minimise errors-
Ensuring that services are driven by a cycle of continuous quality improvement. Quality will not just be restricted to the clinical aspects of care but include quality of life and the entire patient experience.
- Supporting and valuing all staff- staff have the right to be treated with respect and dignity. They will receive continuous support, recognition, and reward, providing opportunities for individual staff to progress in their careers and encouraging education, training and personal development.
- Helping to keep people healthy and working to reduce health inequalities- focusing efforts on preventing, as well as treating ill health is very important. Recognising that good health also depends upon social, environmental and economic factors such as deprivation, housing, education and nutrition, the service will work with other public services to intervene not just after but before ill health occurs.
- Respecting the confidentiality of individual patients and providing open access to information about services, treatment and performance-
patient confidentiality will be respected throughout the process of care. Information about health and healthcare services will always be available. Developments in science will also offer important possibilities for disease prevention and treatment in the future.
The Surgery applies the care value base to individuals of all ages and does not discriminate on grounds of gender, age, ethnicity, religion or sexuality. All patients receive the same levels of health care and all patients are treated with the same respect and dignity.
The surgery empowers clients through patient education and discussion of care pathways. This means that the clients are always fully educated as to what their medical condition is and what can be done to improve it. Also, there may be many different ways in which a condition can be treated and all possible care pathways are discussed with clients to make sure that have a chance to make an educated decision. This is very important as it means clients can be kept up to date and feel they are involved in the decision making process. This will help to empower them, as they will feel they have the necessary tools they need to make the right decisions.
The surgery respects all clients as individuals and they beliefs and values are always taken into account when treating a patient. For example, orthodox Muslim women have female doctors; therefore feel more comfortable discussing personal issues.
Anti-discriminatory practice is always promoted in the surgery. Staff receives specific training and education about people of different cultures, which may have specific needs that must be met. Also, all patients are treated as individuals and the staff respects the individual needs of each client. Patients will feel their health service is significantly better because they are expressing their opinions in a free environment and there is no discrimination, so no clients will feel threatened by any of the staff. Confidentiality of client information is very important in the surgery. All clients feel confident in consultations with their doctors, as they know the information will be kept very confidential and not allowed to be handled by anyone other than the appropriate doctor. This means clients will not feel uneasy about sharing their problems and they can easily express concerns to the doctor, without worrying about whether the information will be kept private.
As well as rights for the patients, all staff within the surgery is respected for carrying out services required by the public, therefore also have their rights. There is a zero tolerance policy for verbal and physical aggression for example. This means that members of staff can feel safe in their working environment and not have to worry about being vulnerable when patients are present in the reception. Patients must treat all staff with the respect they deserve and staff do not tolerate any inappropriate behaviour or rudeness. This can result in a patient being taken off the patient list for the surgery. In more serious cases, a case could go to court, if there has been any legal violation.
Individualised care is also promoted within the surgery. Patients’ needs are clearly identified and this shows that the surgery as a whole works with their patients, to find achievable goals and targets. Doctors discuss health care goals with patients, which help them find a solution to their problems together. This is very important as it encourages interaction between the patient and the doctor, which is vital to ensure the smooth running of the relationship.
If the care value base were not applied within the surgery, there would be major problems for the clients. For example, a client needs to have a range of different option available to them. Without any choice the clients may not find the solution that is right for them and this would affect clients emotional well being as well as making them feel more stressed. They also need the professional advice to be able to make the right decisions about their own health. Without this help from a doctor, the patient is likely to make the wrong choices, which can ultimately damage the patient’s health.
No discrimination is also very important to a clients they need to feel they can express opinions in a free and not prejudiced environment. If there were discrimination within the service, this would have devastating effects on the clients who will lose self-esteem and be very reluctant to visit the care setting.
Empowering and respecting clients is also very important, as a strong emotional bond needs to from between client and care worker. Without this bond, the client would feel very demoralized and may also feel they are not getting the support they need for their individual needs. It is also vital that the clients receive respect as without it, they may lose self-esteem and this would affect their self-concept in a negative way.
Barriers that could prevent a client from using the service
A client uses the Surgery by self-referral. Self-referral is when the client themselves chooses to go to the service or use the service. In order to do this, the client must either visit the surgery or contact them by telephone in order to schedule an appointment or register, if they have already done so. After consultations with their doctors, some patients, who have more serious problems, perhaps specific to a particular area of medicine can be professionally referred to a hospital. Professional referral is when a client may be put into contact with a service by a care practitioner such as a doctor, nurse or social worker.
Physical Barriers
According to my questionnaire, this particular care setting has no physical barriers that could stop a client from using it. This means that the care setting has a ramp for wheelchair access. This is very useful for disabled patients as they must be able to enter and exit the building easily. There are also adapted toilets within the Surgery, allowing clients with all kinds of different physical needs to use the facilities. There are also lifts available for the disabled patients which mean they can easily go from one floor to the next, for example if their doctor is on the first floor of the surgery. There is also no risk of thefts or muggings in or around the Surgery. This may be due to the surgery being in a good neighbourhood or being in a well lit area that is not easily accessible to anyone. Also, there are wide doorways available for clients to use as well as adequate, clean waiting areas. In addition, there are professional communicators available all the time, should the patient be deaf etc. This means they will be able to communicate to the doctor and share problems via the communicator.
This means that friends or family of the client cannot be affected, as there are no physical barriers that can make it difficult for people to use the service.
Psychological Barriers
There are some psychological barriers that a client may face when using this service. A client may be embarrassed by their problems and not wish to share them with the doctor. For example, if someone has an STI, they may be reluctant to discuss this with their doctor. Also if a client has mental health problems, it may be difficult for them to communicate with the doctor especially is they have deep emotional problems that relate to their mental health problems. It is also difficult in this case for the clients to be at ease with their doctor, particularly if they have a problem specific to communicative trouble for example paranoid schizophrenia. However, clients do not feel they will be losing independence by using this service. This may be because they feel that the care workers at the surgery are helpful and will not pressure them, but instead will instead allow them to make decision based on their individual preferences.
If a client is embarrassed by their problems, they may refuse to go and see the doctor. In particular adolescents who may have problems they regard embarrassing will not agree to talk through these problems. This can be troubling for family, in particular parents, as they will want to get the problem sorted as soon as possible. It may also be worrying to close friends, who also have concerns about what could happen if the problem is not shared. The same may happen with adults who refuse to see a doctor because they do not wish to discuss their problems. This may be because of a lack of trust for their doctor, but could also be because they do not feel confident enough to discuss problems that they regard as embarrassing. Mental health problems can also have a large affect on the whole family of one individual. This is because this person will have to receive constant care and getting them to visit the doctor can be very difficult.
These barriers could be overcome in a number of different ways. If someone is feeling embarrassed about a problem they have, they can ask to see their favourite doctor or perhaps a doctor of the same gender, if they feel the problem is very personal. Family and friends can help by comforting the client and ensuring them that their problems will be handled in a professional and confidential manner. Also, clients may feel more at ease about talking to their doctor if the doctor takes the time to allow a closer emotional relationship to develop. In order to overcome the problem of mental health problems, it may help to give the client time to get to know their doctors. It would also be helpful if they had a counsellor or even psychiatrist they could speak to about problems they may be having. Family and friends can also offer love and support, which can be vital to the client.
Financial Barriers
There are some financial barriers that may prevent a client from using the service. One of them is charges and fees within the surgery. For example, a client may be charged if the doctor has to write a letter to give them sick leave from work. Also, sometimes clients will be charged for things like medication, for example nicotine patches for giving up smoking. Services to children up to the age of 16 are usually free and they remain free up to the age of 18, if the child in question is in full time education. Another important financial barrier is no entitlement to benefit. This can be a potentially very serious barrier as people may not be able to afford certain medication or treatment that is not free of charge. If an individual has no entitlement to benefits and very low income, it can mean they will not get the level of care they require. This means that there are some barriers that do not exist within this particular service. For example, there is no shortage of services and the clients can easily come in and use any service they wish to.
These financial barriers can affect the clients’ family and friends a significant amount. If a family is on very low income or even receive income support, they may find it difficult to afford the surgery’s fees and charges. This will put increasing pressure on families who cannot afford to have their family members treated in the appropriate way. Also the families that are not entitled to benefits will not be able to afford to spend money on services, which the Surgery charges for. This will also increase tension within family situations, which will not have a positive social or emotional effect on the family or the patient themselves.
In order to overcome these financial barriers, a client could speak to their Surgery and request some help or explain their situation in detail. Also, families may be able to claim benefits if they do have a particularly sick or disables relative in family.
Geographical Barriers
Only one geographical barrier has been highlighted within my questionnaire and that is that it may be expensive for patients to travel to and from the Surgery. For example, if a client does not own a car, they will have to rely on public transport to get them to and from their surgery appointments. As well as prices of public transport being constantly on the rise, public transport id often unreliable and timetables may not always be accurate. This can cause an inconvenience for many patients who might have to travel a long way to reach the Surgery. However, the Surgery is easy to find and there is public transport that can get a client there. The service is easily accessible and available to everyone so none of these things are barriers.
Cultural and Language Barriers
There is one barrier that could prevent a client from using the service regarding language. If a client’s first language is not English, they might find it difficult to communicate their ideas to their GP. A different language can also be difficult to work around if a client does not know any English at all. This is certainly a barrier because if the patient has no means of communication, then the professional care worker cannot provide the necessary help to the client. However, there are no religious barriers or barriers regarding different customs and cultures. The surgery provides for people of all different backgrounds and cultures. This means that this is not a barrier for the clients as they are all treated equally and there is no discrimination or prejudice in regard to an individual’s culture, race or religion.
In order to overcome this barrier, a client may choose to bring someone with them, perhaps even a member of their own family who can communicate with the doctor. A client may also request that a professional linguist helps them to try and communicate their worries to their GP.
Resource Barriers
There are no resource barriers within this care setting according to my questionnaire. This means that there is no lack of staff and there is always someone available to see and treat clients as required. There is also no lack of information which means clients can easily find the required information about their particular illness or worry. Patients are also educated in order to help them make the correct overall decision. There is no lack of funding which shows that the surgery is well funded by the government and can carry out all the necessary tasks they require. There is also not a large demand for service therefore the surgery is not overcrowded or overpopulated with patients. This means there is a good ratio of doctors to patients showing that the Surgery runs in an efficient manner as the doctors can provide the necessary attention to each individual patient. There is also no lack of resources, so the surgery and the patients receive all the resources and supplies (including medical supplies) they require. This ensures the continual smooth running of the Surgery.
This means that friends or family of the client cannot be affected, as there are no resource barriers that can make it difficult for people to use the service.
How powerful can the client be?
Although the doctor may give advice and medical provision, the client is really the person who has the power to make their own decision based on what they have been told. A doctor cannot make the patient’s final decision but can only try to convince the patient of what they think would be the correct step to take.
Patient confidentiality
Patient information is generally held under legal and ethical obligations of confidentiality. Information provided in confidence should not be used or disclosed in a form that might identify a patient without his or her consent.
A duty of confidence arises when one person discloses information to another (e.g. patient to clinician) in circumstances where it is reasonable to expect that the information will be held in confidence. It -
a) is a legal obligation that is derived from case law;
b) is a requirement established with professional codes of conduct; and
c) must be included within NHS employment contracts as a specific requirement linked to disciplinary procedures.
Patients entrust the NHS or allow it to gather sensitive information relating to their health and other matters as part of their seeking treatment. They do so in confidence and they have the legitimate expectation that staff will respect this trust, or may be unconscious, but this does not diminish the duty of confidence. It is essential, if the legal requirements are to be met and the trust of patients is to be retained, that the NHS provides, and is seen to provide, a confidential service.
Patient's Rights & Responsibilities
Rights
* To be treated with respect and courtesy. To have privacy, confidentiality and dignity respected.
* Receive clear understandable information about your treatment and care. Ask questions if you are unsure.
* Know the name of the person treating you and their professional capacity.
* To be kept informed on waiting times, delays and cancellations.
* If you desire you can be accompanied by a friend or relative during consultation or examination.
* You have the right to refuse treatment - the consequences of refusing treatment will be made clear to you.
* To be informed of hospital regulations.
* Provide feedback, which will help us improve the quality of care we offer in the future.
* To know what is being written about you at the time it is being written.
* To have access to your health records.
Responsibilities
* We appreciate reasonable behaviour from patients, relatives and friends.
* To provide full information about past or present illness and other health matters which will aid treatment.
* To confirm that you understand the treatment being provided and course of action.
* To follow treatment plans recommended. The patient is responsible for the consequences of refusing treatment or not following professional advice.
* Be considerate to other patients by assisting in the control of noise, smoking and by restricting the number of visitors.
* Notify the appropriate member of staff if you cannot make an appointment - alternative arrangements can be made, benefiting others.
* Consider participating in education, training and research
Organisation
Sandcastles Nursery is a non-statutory service. This means a service that complements, or adds value to, statutory provision. For example – there is a legal (statutory) requirement to provide assessment of client need, and to provide services to meet that need, for example rehabilitation. Non-statutory service may then provide much-needed, additional interventions – for example – socialisation skills. The nursery as a non-statutory organisation is privately owned and maintained. It does cost money to use and parents must pat this money twice annually.
The nursery is privately owned. This means that someone has brought it and is responsible for its care and organisation. This also means hiring and firing staff as well as making decision that may affect everyone working in the care service.
The person or people in the case of Sandcastles Nursery are called proprietors. They are Darren and Kate Taylor. They are married themselves with four children and have always wanted to have their own childcare service.
Proprietorship is having the legal title to something and owning and managing a business or other such establishment. The owner is responsible for all management decisions, takes all the profits and bears all the losses. His liability is unlimited, and not only his business assets, but the whole of his private belongings (with certain minor exceptions) can be taken from him to satisfy business debts. This means that the Taylors are fully responsible for the nursery and its staff.
Within Sandcastles Nursery, all the funds are received from parents of the children who go to the nursery. This early years service is quite expensive and a parent will pay on average £150 a week. This varies according to the age of the child and the particular sessions they wish to participate in. The funds from the nursery are used such that around 50% of the money goes towards staff salaries and paying workers. The remaining 50% goes towards a mortgage, general maintenance of the building as well as providing books and other resources for the children.
The rest of the nursery consists of staff. The staff are hired based on their experience and skills. At the very top of the chain is the officer in charge. She is in charge of making decisions as well as supervising the staff. In addition, she takes complaints etc. from parents. Her deputy helps her in this role and takes on important work that the officer in charge may not be able to do for any reason.
Senior nursery assistants and nursery assistants are the people who have the most direct contact with the children. They spend all their time looking after the children and making sure they are receiving the high quality of care the nursery promises. The nursery assistants teach the children new skills, help them to read and play together in order to gain the emotional, intellectual and social development they require.
Meeting the care needs of individuals
Care
Most importantly the nursery provides care for children while their parents are at work or otherwise engaged. The nursery provides for ages 0-4 and then children up to the age of 10 attend an after school club. The nursery has to care for each of these client groups in a different way as they all have specific care needs. Below is a summary for each age group within the nursery. I have chosen to highlight the particular areas relating to the PIES (physical, intellectual, emotional and social needs) in order to indicate where each age group requires the most work.
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Pebbles (Age group-birth to 2 years)
This section is designed to cater for babies from birth to 2 years. They are cared for by a dedicated team operating on a ratio of 1:3. The babies are able to enjoy and explore a wide variety of activities and resources. Daily records are kept, detailing the child’s routines for the day, which is shared with parents at collection time. The Nursery always appreciates any comments parents wish to make to help the nursery to provide continuity in the daily care of a child. Staff work hard as a team and feel it is important that parents can build up a good relationship with all staff members. Parents are encouraged to telephone the nursery as often as they may feel necessary.
Physical
There is a soft gym area and messy and creative play for the slightly older children. The gym areas help the children move around and exercise as well as gain mobility skills and learn to move more independently. The messy and creative play can involve games, music and songs which will keep the children moving as well as ensure they are intellectually stimulated.
There is also an area for meal times and snacks. The nursery provides freshly home cooked meals daily and prepares these for children as requested. Special dietary needs are also catered for e.g. Vegetarian, food allergies etc. The meals are balanced and it is ensured the children receive healthy snacks throughout the day.
The play and eating areas are kept separate for hygiene and safety reasons and the eating area is cleaned regularly and thoroughly. The play area is checked thoroughly for any hazards or problems before children are allowed to use it. This ensures the safety of the children at all times. The ratio of adults to children is always 3:1 and this ensures the children are receiving the care they require at this stage.
There is a sleeping area where the babies can rest under twinkling stars and a sensory area equipped with many resources to stimulate their senses. The babies sleep as and when they require. These times are all then noted for the parents to take away. This gives a parent an idea of how much sleep their child has had throughout the day.
Intellectual
A large floor to ceiling bay window provides the babies with an interactive view of the comings and goings of the nursery and a large safe pond with a waterfall and fish. This provides visual stimulation for the young children as well as developing their intellectual skills. The sleeping area is equipped with many resources to stimulate the children’s senses.
Social
Upstairs provides opportunities for quieter play. The babies are able to enjoy their own safe garden area and are provided with opportunities to interact with siblings and older children. It is very important the children learn to interact with each other as well as with other children as this ensures vital social interaction is taking place. Children can gain confidence as well as form friendships by playing with other children, whether they be babies or some of the slightly older children. As well as giving the children a chance to develop emotional relationships, they can have the chance to socialise with others.
Emotional
It is important that young children experience continuity between home and nursery and in order to achieve emotional comfort and well-being. The nursery relies heavily on building a bond with the whole family. During the child’s induction to the nursery the staff take time to get to know the child’s routine, likes and dislikes. In order for the staff to follow the baby’s home routine, parents are asked to supply the milk normally used at home. This helps the child to feel at ease within the nursery and therefore settle in quickly. Emotionally, the child will still feel secure as their old routine is not discarded but they are instead slowly weaned off it and onto a new and more efficient system, based on each individual child’s specific needs.
- Starfish (Age Group-15 months to 2 years old)
The Starfish Room welcomes children from approximately15 months to 2 years old. It involves a lot of learning activities mainly through play. This is done in order to encourage children to continue with intellectual and physical development as well as learning new skills and adapting to the nursery environment. The children are cared for by a qualified, caring and experienced team operating on a ratio of 1:3. There are no rigid routines or inflexible staff. The nursery encourages parents to telephone them as often as necessary.
Physical
The tiny toddlers have their own familiar and safe room which is equipped with toys and resources appropriate for their age and stages of development. The children enjoy a wealth of play opportunities allowing them to obtain physical activity throughout the day. The children also have a lot of chance to move around whether outside or in the nursery, providing them with a chance to practice mobility skills as well as interact with other children.
Weather permitting the children enjoy time in their own garden area and are taken out for walks. The nursery provides freshly home cooked meals daily and will prepare these for the child as requested. Special dietary needs are also catered for e.g. vegetarian, food allergies etc.
Intellectual
Through play, the children can develop their intellectual skills with things like puzzles and books for very young readers. The staff read to the children before mealtimes giving them the opportunity to listen and start learning how to pick up words etc. The children enjoy a wealth of play and learning opportunities designed to allow free expression and to satisfy natural curiosity. With guidance and support they enjoy activities such as water play, sticking and painting.
Emotional
It is important that strong links between home and nursery are built and maintained. Key aspects of the child’s day are shared with parents at the end of each day and the nursery always appreciate any comments parents wish to make to help the nursery to provide continuity in the daily care of children. Staff work hard as a team and feel it is important that parents can build up a good relationship with all staff members.
It is important for children to bond closely with the care workers as they will spend a lot of time with them during the day. Good relationships must be formed and this helps the child to feel more secure each day. Children are treated as individuals and the nursery understands that each child has different needs and therefore requires different care.
Social
Children get the chance to mix and interact throughout the day. They are taught basic skills such as sharing and it is important for them to develop these vital social skills which will be required later in their school life. In addition, children have all their meals together in a relaxed and friendly atmosphere and the staff strive to bring children closer together through encouraging communication and making sure each child has the chance to bond with others.
- Seahorses (Age Group- 2-3years)
The Seahorse room welcomes children from approximately 2 to 3 years of age. As in the rest of the nursery the room is staffed by a qualified, experienced and dedicated team on a ratio of 1:4. Full day or a minimum of 2 morning sessions are available. Parents are encouraged to read the daily information board which lists the day’s activities and to speak to any of the staff regarding their child’s day at nursery.
Physical
Children have daily opportunities to use facilities in the nursery such as the soft play room/gym, heuristic play area and the use of the extensive outdoor facilities including their own covered outdoor area. This ensures the children will practice their mobility and gain confidence in moving around. It is vital the children obtain exercise and the staff ensures this through games and activities which encourage children to take a positive role and move around. Many children at this age still need a daily sleep and the nursery has individual beds and cots for sleep times.
Intellectual
The children have their own room equipped with appropriate equipment and toys for their age and stages of development. As with all the rooms at Sandcastles all the activities are carefully planned to ensure a wide variety of experiences and inclusion for all. This ensures the children will have the opportunity to develop intellectually as well as begin to pick up new and important skills.
The older Seahorse children benefit from time spent in the ‘Seashell Group’. The purpose of this is to give them access to different activities and helps prepare them for the transition to Dolphins. This is important so the children feel they are gradually increasing their intellectual development. It helps the children gain confidence as well as provides an insight for what is to come.
Emotional
During this important time a child will develop in many ways i.e. talking, potty training, expressing needs, taking turns etc. The trained and qualified staff on hand are very aware of the child as an individual and aim to provide the necessary support, encouragement and praise that he/she needs. The Nursery strives to provide the same level of emotional support as the child would get at home. Children are very sensitive and require a lot of care at this age so they are given a lot of encouragement and rewards for doing things like completing activities and learning something new.
Social
Activities are carefully planned in the nursery to include all children. As well as giving the children an opportunity to contribute to activities and enjoy themselves, this allows interaction and helps the children become more at ease with their peers.
Breakfast, lunch and tea are sociable times which help the children to develop their social skills in a relaxed and friendly environment. Simultaneously, this is a key time when children learn to share and feel part of a group.
- Dolphins (Age Group- 3 til school age)
The Dolphin Room welcomes children from 3 years up to school age. Children in this room benefit from a large bright room which is well equipped with a wide range of play equipment and learning resources to cater for their needs. Parents are encouraged to read the daily information board, which lists the day’s activities and to speak to any of the staff regarding their child’s day at nursery.
Physical
The equipment and toys are set out in an inviting way and offer opportunities for the children to play with the following: puzzles and games, mathematical equipment (i.e. sorting, matching, pairs etc), drawing, construction and imaginative play. As well as providing vital exercise, some of these activities are vital for intellectual stimulation.
Swimming lessons are held at Runnymede pool with a professional swimming instructor. The children gain in confidence and ability in the water through songs, action rhymes and skills teaching.
Intellectual
There is also a quiet area where children are encouraged to look at and enjoy the vast selection of books. During the day the children have opportunities to use the art, craft and messy area, the computers, the soft gym, the garden (weather permitting) and to explore the wide range of activities that are carefully chosen for them daily.
A lot of the learning throughout the nursery is through topic work such as ‘ourselves’, ‘change’, and our ‘environment and surroundings’. The nursery encourage children to bring in related objects etc. from home for the interest table and use the wealth of resources at Sandcastles Nursery to make the child’s learning experiences as wide, varied and fun as possible.
Emotional
Children at this age are beginning to form close emotional relationships with peers as well as the staff on hand. The children are praised and rewarded where appropriate and encouraged by the staff to fulfil their potential. The child can develop successfully and pick up vital communication skills they will require in their early years at school.
Social
A time is set aside daily for the children to work in small groups. This time is for a more structured approach to learning in readiness for school.
The Speech and Drama sessions are held at Sandcastles and help to promote language skills and confidence – much needed attributes for school life.
As children of this age have more developed social skills, we feel that they are able to benefit the rest of the nursery children. We encourage them to interact with the younger children in the nursery. This increases their confidence and develops a sense of responsibility in helping care for others.
Barriers that could prevent a client from using the service
A client uses the nursery by self-referral or third party referral. Self-referral is when the client themselves chooses to go to the service or use the service. In order to do this, the client must either visit the nursery or contact them by telephone in order to schedule an appointment or register, if they have not already done so. Obviously the client in this case is a child so they would have to allow their parents to register them. The nursery does take primary school children after school as well so they can refer themselves by simply telling their parents they are interested in attending the nursery. Third-party referral would be the parents of the children deciding to send them to the nursery. This may be because the parents hear about the nursery’s good reputation or simply because they need their child to be cared for during the day. Therefore, the parent may decide to send their child to the nursery for these reasons.
Physical Barriers
According to my questionnaire, there is only one physical barrier that may sop someone from using the nursery and that is that there are no lifts. This may make it difficult to transport a disabled child to the upper floor of the nursery. However, this is not necessary very often anyway as all there is is a gym and the children do not use it if the weather is suitable outside. This means that the care setting has a ramp for wheelchair access. This is very useful for disabled patients as they must be able to enter and exit the building easily. There are also adapted toilets within the nursery, allowing clients with all kinds of different physical needs to use the facilities. There is also no risk of thefts or muggings in or around the nursery. This may be due to the nursery being in a good neighbourhood or being in a well-lit area that is not easily accessible to anyone. In fact, one requires s code to be able to open the front door, so the children’s’ safety is ensured at all time. Also, there are wide doorways available for clients to use as well as adequate, clean waiting areas. In addition, there are professional communicators available all the time, should the child be deaf etc. Also, the nursery assistants are trained to know sign language anyway as this is part of their course of training. This means children will be able to communicate to the care workers and share problems via the communicator, if needed.
Friends and family of the child may decide not to send them to the nursery as there is no lift. This may be because the family will feel their child will be isolated or left out f=if they cannot join in certain activities, even if these activities only occur on an irregular basis.
Psychological Barriers
There is only one psychological barrier that clients may face when using the service. This is a problem that parents of the children are likely to have-guilt. Parents may feel they are not being a good parent by leaving their child at the nursery. They may also feel worried about the quality of care their child will be receiving. It is only natural that a parent has these worried about their child, especially when first leaving them at the nursery. This does mean, however, that there are no other psychological barriers that may be faced. So clients are not embarrassed by problems, as the clients are mostly children, who will feel open to discussion if they come to trust and like the care worker. However, clients do not feel they will be losing independence by using this service. This may be because they feel that the care workers at the nursery help the children to feel welcome and are helpful and will not pressure them, but instead will allow them to make decision based on their individual preferences. Because the age group is children, they are very unlikely to feel too proud to use the service and if is also highly unlikely that they will not want to be looked after, as this is the main aim of the nursery and the expectation of the child.
If parents are worried about leaving their children in the nursery, they may choose not to use the service. This may be because they feel they can manage without it or simply because they do not want to seem a bad parent by leaving their child in the care of others. This can be troubling for family, in particular partners or married couples who are both working, as they will want to have somewhere their children could go during the day. It may put pressure on the family if one parent refuses to leave the child in the care of the nursery, as it can cause disagreements and even arguing.
This barrier can be overcome in a very simple way. Through discussion with the nursery and a specific outline of how children will be cared for, a parent will feel much more at ease. This is because they will know what their child is doing throughout the day. To help overcome this problem, the nursery also fills in a small sheet about each child at the end of the day. This is then given to parents and outlines what their child has done throughout the day. This included number of times they have had a nappy change (for younger children), the amount of food they have eaten and the activities they have taken part in such as singing, reading etc. If a good relationship is formed between parent and care workers, a parent will feel more at ease about discussing problems and outlining any special requirements their own child will have.
Financial Barriers
There are some financial barriers that may prevent a client from using the service. One of them is charges and fees within the nursery. For example, a client may be charged for trips and outings for their child. These trips may include things like trips to the zoo etc. Small charges are also required for celebration of birthdays within the nursery and although this is not compulsory, some parents will feel it would be better socially for their child if they had a chance to celebrate their birthday amongst friends. Another financial barrier is the expensive early years service. Using the nursery costs around £150 per week on average. This fee depends on the age of the child and the older the child, the less the service costs but it would then be very costly for younger children. This price does include all meals but does not include all trips and the nursery may charge for some trips. This can be very expensive for some families, in particular if they have more than one child attending the nursery. Many will not be able to afford it. This does mean, however, that there are some barriers that do not exist within this particular service. For example, there is no shortage of services and the clients can easily come in and use any service they wish to. This is very useful as the nursery is open to children and parents to come and look around at any time and this is very useful in ensuring both parents and children familiarise themselves with the nursery and its staff.
These financial barriers can affect the clients’ family and friends a significant amount. If a family is on very low income or even receive income support, they may find it difficult to afford the nursery’s fees and charges. This will put increasing pressure on families who cannot afford to have their children cared for in the appropriate way. Also the families that are not entitled to benefits will not be able to afford to spend money on services, which the nursery charges for. This will also increase tension within family situations, which will not have a positive social or emotional effect on the family or the child themselves.
In order to overcome these financial barriers, a client could speak to the staff at the nursery and request some help or advice and explain their situation in detail. Also, families may be able to claim benefits in some cases which may help with the expensive service.
Geographical Barriers
Only one geographical barrier has been highlighted within my questionnaire and that is that it may be expensive for clients to travel to and from the nursery. For example, if a client does not own a car, they will have to rely on public transport to get them and their children to and from the nursery in time. As well as prices of public transport being constantly on the rise, public transport is often unreliable and timetables may not always be accurate. This can cause an inconvenience for many patients who might have to travel a long way to reach the nursery. However, the nursery is easy to find and there is public transport that a client can use to get there. The service is easily accessible and available to everyone so none of these things are barriers.
Cultural and Language Barriers
There are a couple of barriers that could prevent a client from using the service regarding language. If a client’s first language is not English, they might find it difficult to communicate their ideas to a nursery assitant. A different language can also be difficult to work around if a child does not know any English at all. This is certainly a barrier because if the child has no means of communication, then the nursery assistants cannot provide the necessary care to the child. Jargon or dialect can also cause a bit of confusion. However, because the child is still young, they can easily be taught the language and will pick it up very quickly. There are also no religious barriers or barriers regarding different customs and cultures. The surgery provides for people of all different backgrounds and cultures. This means that this is not a barrier for the clients as they are all treated equally and there is no discrimination or prejudice in regard to an individual’s culture, race or religion.
In order to overcome this barrier, a parent may choose to discuss this problem with the nursery staff. A teacher can then be arranged to come in and teach the child English. It is far better for the child if this issue is addressed quickly, as they can then go to school prepared for their education in a different language.
Resource Barriers
There is only one resource barrier within this care setting according to my questionnaire and that is a large demand for the service. The nursery has to have a waiting list as it is very popular and often there are not enough spaces for all the children that want to use the service. This does mean, however, that there is no lack of staff and there is always someone available to care for the child at all times. There is also no lack of information which means clients can easily find the required information about any problems they might face. Problems can be openly discussed with care workers. The children are also educated in order to help them to develop intellectually. There is no lack of funding which shows that the nursery is doing well within its budget as it does cost quite a lot to use anyway. There is a good ratio of care workers to children showing that the nursery runs in an efficient manner as the care workers can provide the necessary attention to each individual child. There is also no lack of resources, so the nursery and the children receive all the resources and supplies (including educational supplies such as books etc.) they require. This ensures the continual smooth running of the nursery.
There is no obvious to overcome this resource barrier because the nursery cannot do anything about the large demand for service. However, parents are notified as soon as a placement becomes available and there is no discrimination involved in the process so it is done fairly.
Care Value base
Care workers are guided in their day-to-day business by following a set of core principles called the Early learning goals. These principles help to ensure that children receive the highest standard of care possible. It is important that the provision of care within the nursery meets the needs of every individual and that staff can be professional enough to adapt to children with more specific care needs. The nursery does cost money to use but no one is exempt from using the service, as it is open to people of all different cultures, religions and backgrounds.
“Young children learn through play”- This is basically the rule by which the entire nursery is run. Children are not taught by worksheets or classroom activities but are instead taught through playing games, interacting with each other and learning more about themselves and their surroundings through carefully planned and structures activities. It is important for young children to feel welcome at the nursery and every attempt is made to plan activities that exclude no one. Children are taught basic principles they will need to apply later in life such as learning to share as well as beginning to understand their responsibility, no only towards themselves but also towards other people.
The Early Learning Goals emphasise six key areas of learning:
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Personal, Social and Emotional Development - this area of development is vital for young children in all aspects of their lives. The nursery provides many opportunities for children to develop these areas. For example, by caring for each other, helping the younger children, by helping to look after small pets in the garden and tending the allotments, by promoting good table manners and trying new food and by appreciating that things, which are different, are acceptable. Children are also encouraged to become more independent by clearing away toys and equipment that have been used. High expectations for behaviour are set and children are helped to distinguish between good and bad behaviour. The nursery also aims to develop self- control and a sense of responsibility encouraging children to take turns and share fairly. Personal independence, such as dressing, health and hygiene are encouraged. Activities and discussions are planned to promote confidence and self-respect. It is all of these important factors together that ensure children can have the highest rate of care available. Children are never made to feel out of place and are taught basic values that will contribute very much to their social and emotional development.
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Language and Literacy – staff set up a rich and varied environment and is always on hand to support and listen to each child. They ask open questions to allow children to develop their language skills and thought processes. They encourage children to listen carefully. The nursery recognises the importance of reading as a source of enjoyment and for the acquisition of information. Stories, poetry, rhymes and non fiction books are enjoyed daily which also help to extend a child’s everyday language and understanding of the world. Children’s fine motor skills, an essential requirement for writing are developed through play such as drawing, cutting, sticking, painting, threading, clay, play dough and many small toys. They are given opportunities to help them to recognise their own names and letter sounds. Literacy development is important to every child and trained staff can help any children who seem to be struggling. Children are always praised and rewarded for their efforts and each child is treated with the same kindness and respect, despite their abilities or skills.
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Mathematics – the nursery aims to develop a positive attitude in numeric and other mathematical areas. The nursery strongly believes that young children appreciate mathematics best when they can learn through a variety of practical experiences that provide pleasure and enjoyment. A practical approach is used allowing children to count, sort and classify, measure and develop an awareness of pattern and numbers plus encourage work with shapes, spaces and measures. Children are encouraged to use mathematical language to describe shape, position, size and quantity. The nursery provides opportunities for children to select from a wide variety of suitable resources, which include number rhymes, songs, stories and games. It is important for a child to develop these intellectual skills as it will put them in good stead for their early education and may give them an advantage as they would have already had a chance to practise these techniques.
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Knowledge and Understanding of the World – through topics, stories and discussions, children are encouraged to talk about their families, past and present events in their lives, where they live and their environment. They explore features of living things, natural and man-made objects, and recognise similarities, differences, patterns and changes. They have opportunities to talk about and record their observations, including questioning why things happen and how things work. Children begin to learn about their own cultures and the beliefs of other people. Where appropriate, they use technology to support their learning. Interest, nature and science tables are used to develop the children’s curiosity. Through extensive, well-planned grounds the children are able to benefit from rich first hand experience. Children are taught how to accept each other’s beliefs and see the world from different perspectives.
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Physical Development – the children learn to move confidently and imaginatively, with increasing control, co-ordination and awareness of space and others. All nursery children have daily access to a purpose built gymnasium housing soft play equipment. Careful planning allows the children to practice a range of skills. Being fortunate enough to have such a large garden area, the children are able to enjoy a vast range of outside activities including many wheeled toys, slides, a ‘climbing mound’, building site and large sandpit. In all areas of the nursery, children are able to handle tools, objects, and hard and soft construction materials safely and with increasing control. The children are also able to gain exercise and teach themselves new skills thorough playing alone and together. The idea of rules is also enforced whilst playing games so the children begin to understand how their play is structured.
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Creative Development – the nursery provides opportunities that allow children to explore and develop imagination in movement, music, art, role play and free play. Children are encouraged and praised for their individual approaches. Children are also encouraged to explore a variety of different materials, e.g. paint, collage materials, food, junk modelling, play dough and sand and water. This gives the child a chance to understand more about these different materials as well as pick up skills such as creative arts and also more basic skills such as clearing up after they are finished and sharing with each other.
The nursery firmly believes in access to all and all children are treated equally. No child will be disadvantaged because of his/her race, culture, beliefs or physical needs. A child’s beliefs and values are always respected and anti-discriminatory practice is very important within the nursery as it helps children to mix and understand each other. Activities are always planned to include everyone and promote care and responsibility towards other people.
Children are empowered through constant praise and recognition for their hard work. Each child is respected as an individual and they are always taught to voice opinions and remain well mannered, both when dealing with the staff and with each other.
The children’s information is kept confidential at all times. Anyone entering or exiting the nursery requires a code. This helps ensure the parents that the child will always be kept safe in the nursery’s care. If a child has an accident, an accident report is filled out right away and the parents are notified as quickly as possible. Confidential information is only accessible to the manager and parents of the children can specify any special treatment their child has to receive.
Individualised care is always promoted through encouraging children to become more independent as well as helping them to gain confidence in them and learn how to respect others. The nursery will tailor to suit a child’s exact needs, as well as medication and dietary needs. Children with disabilities are also welcomed as the nursery has the qualified staff that can look after them. Disabled facilities are available and the nursery does not discriminate against disabled or unwell children. They become part of the group quickly and are encouraged to form relationships with other children in a safe and comfortable environment.
Of prime importance to Sandcastles Nursery are the needs of the individual child. Activities, especially those relating to literacy, language and mathematics are tailored to suit the child’s skills. The aim is that the children enjoy their time at the nursery and leave to go to school as happy, confident and sociable children.
If the care value base was not applied to the children at the nursery, it is highly likely they would experience a number of problems. The children need to be empowered in order to ensure that they will do their best. Without this support and praise the children will lose self-esteem and this will hinder their development as well as making them develop less well socially.
Individualised care is very important to the children and without it the children would not be able to develop, as their individual needs are not met in the appropriate way. The children would also not be able to develop emotionally as they do not have the necessary skills. Individualised care will help them to develop and gain skills necessary for their early years life.
Roles of the people who work in the nursery
Sandcastles employs up to 35 staff at anyone time. The nursery professes an open doors policy, and welcomes parents and carers to meet the staff at any time. This helps parents feel more at ease about leaving their children with the care workers as well as promoting good relationships between parents and care workers.
The nursery firmly believe that a nursery is only as good as its staff and to this end all the staff are carefully selected by their qualifications and for their caring, warm approach and love of children. A continual training program is followed in order to ensure that all staff are up to date with current practices and policies relating to the care and development of the 0 – 5s. Since opening, sandcastles nursery has been awarded with two business awards for Essex and Southend. They have obtained a garden award and are recognized Investors in People.
The proprietors or owners of the nursery are directly involved in dealing with the children as well as running the business and financial side of the nursery. The couple are married with four children and this means they have first hand experience in dealing with children. Kate is a qualified primary teacher and holds the degree of Bachelor of Education (with Honours). She is also qualified to teach English as a foreign language. Her husband Darren is National Nursery Examination Board qualified (NNEB). He also has the degree of Bachelor of Education (with Honours) and has been a reception teacher in a local infant school. As well as being highly qualified, the proprietors are dedicated to working hard to make sure the children receive the highest levels of care possible.
The officer in charge, Hazel Goodwin is NNEB qualified and has worked in day nurseries since 1989. She is extremely versatile and has worked in many different roles within the childcare setting. Through her dedication and love of children she has built up an excellent reputation and is often found going way beyond the call of duty. In addition, Hazel is married and has two teenage boys. This means she knows how to deal with children and can apply her own experiences to her everyday life. The deputy, Kerry is NNEB qualified and has worked in day nurseries since 1998. She has been employed at Sandcastles since the very first day and is a fundamental part of the team offering excellent childcare and staff development opportunities.
However, the officer in charge and the deputy do not have as much direct contact with the children as the nursery assistants do. They are not entirely indirect carers as they do have some interaction with the children where possible for example, reading books to them and taking them on trips outside the nursery.
The main care workers in the nursery are the nursery assistants because they are the people who spend most of their time with the children. There are senior nursery assistants as well as junior assistants. The nursery also takes on trainees or work experience students. The care workers have to have many qualities in order to be able to work with children. Some of these qualities are listed below:
- Patience is vital for working with children as it is sometimes required that nursery assistants have to teach children new skills which they may have difficulty picking up. It is important that the staff can understand each child’s individual needs and help them develop intellectually.
- Nursery staff always has to remain cheerful and upbeat in order to ensure children are enthusiastic and do not get bored of being at the nursery.
- Dedication is another important quality and it is required that the staff are able to be very determined to give children the best possible care. Sometimes work can be difficult and the staff must be able to remain positive and work hard to meet challenging targets.
The nursery has three senior nursery assistants. These assistants are in charge of ensuring the staff are well organised and the senior staff take responsibility for organisation of trips and outings for the children. I have listen the three senior workers below and outlined some details about them:
Rebecca is NNEB qualified and has worked at Sandcastles since it opened in 2000. During this time she took a year's break to travel the world. Since the arrival of her son, she works part time within the various areas of the setting. She is very good with all the babies and young children in her care.
Sarah is BTEC qualified and has worked in childcare since 1996. Being a mother herself she fully understands the pressures of juggling work and home life.
Ruth is a qualified Nursery Nurse and has experience in home placements, Holiday Club as well as in various nurseries. Ruth runs the Seahorse Room which cares for children from approx. 2 to 3 years. Ruth is extremely proficient within her role and is held in high regard throughout the setting. She is a dedicated member of the team who provides parents/carers with peace of mind when leaving their children in her care. In addition she was the Employee of the Year in 2004.
Sara is a part time nursery assistant and has been employed at Sandcastles since January 2003. She is an active, enthusiastic member of the Seahorse team and is married with two young children of her own.
Most of the care workers in the nursery are direct care workers. They are the nursery assistants/nurses and they spend the most time with the children. A typical day is outlined below:
- A nursery nurse may start her morning by giving the children some breakfast. After the children have all had breakfast, they may be sent to play or they will all sit down to read a book.
- Once all the children are gathered, they play together and with objects such as Lego and puzzles which also have educational value. The children are also given the chance to read books and play on a computer.
- The children are then able to go outside and play in the gardens. In the winter, they use the indoor gym. A nursery nurse would make sure the children are dressed appropriately and are safe from nay obstacles that may get in the way.
- The nursery assistant would then sit the children down to have lunch. Sometimes she will eat with the children as this encourages social interaction as well as showing children that it is correct to finish meals etc.
- After lunch, the children split into groups and they each carry out a different task. A nursery sure will sit with one of these groups and help them to learn something, whether it is colours, shapes or objects in the world around them.
- The children will then be allowed to watch a short video and the nursery nurse would take this time to fill in sheets about the children’s daily activities for the parents to take away at the end of each day.
- Nursery assistants would then supervise the children whilst the play. They may also read books to them or help them with puzzles or similar activities.
- The assistants would then help to give the children their tea. By this time, the parents would be coming to the nursery to pick up their children.
A typical day goes from around 8am until around 6pm. The daily routine varies depending on which age group the nursery assistant is caring for but I have done the older children i.e. 3-4 years in the scenario above. Nursery assistants always work in groups and no nursery assistant would ever be left alone with a large number of children, as this is against the health and safety policy.