Care Home MANAGEMENT www.chmonline.co.uk
March/April 2020 • ISSUE 84
MIND THE GAP How dementia villages will join up care
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WELCOME EDITOR’S LETTER
WELCOME
W Care Home Management
March/April 2020 Issue 84 Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Podcast Presenters and Editors Steve Hemsley Alan Rustad Design/Production Emily Hammond emilyh@freelancedesignpro.com Published by S&A Publishing Ltd Hillside office, 9 St James Park, TUNBRIDGE WELLS TN1 2LG Tel: 01892 680670 Email: editorial@chmonline.co.uk sales@chmonline.co.uk Advertising Rebecca Randall Head of Sales Tel: 01892 538880 Email: rebecca@chmonline.co.uk Production Manager Millie Gibson admin@chmonline.co.uk www.chmonline.co.uk Copyright: Care Home Management Magazine 2020 The Publisher holds all copyright and any items within may not be reproduced in any way, for any purpose, without the written permission of the Publisher. While every care has been taken to ensure accuracy, the information contained within this publication is based on submissions to the Publishers who cannot be held responsible for errors and omissions. The publisher does not necessarily agree with the views expressed by contributors and cannot except responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.
March/April 2020
to the March/April issue of Care Home Management magazine
ho decides what my care and support looks like? That’s a question that was posed recently following an inaugural meeting of the All-Party Pharmacy Group on Adult Social Care, which has reformed following the General Election.You can read about its work online at https://adultsocialcareappg.com/ With a new health and care minister appointed last month (February), politically-aware readers might answer this question by saying: “Helen Whately”, or “The Department of Health and Social Care” (or equivalent counterparts and administrations in Scotland and Wales).Taking up the post, Whately expressed support for fixing the system “so everyone can get the care they need - without being forced to sell their homes”. You may well be forgiven for thinking you’ve heard those words a few times before. For those of you with more of an eye on financial affairs, the Spring Budget may be your go-to resource. Due to be announced on Wednesday 11 March, the Budget has already prompted the pundits into action. Among those to give predictions about the new Chancellor’s debut is tax and management consultant Deloitte; its Rebecca George (UK public sector lead) says that in this first post-Brexit and postelection budget, public expectations for more Government funding are high. And, if predictions of an end to austerity budgeting are correct, this could mean more money for social care. If you’re interested in hearing more Deloitte experts’ predictions for the Budget with a focus on Brexit and tax, you can access these online at https:// www.ukbudget.com/budget-2020/reactions.aspx Equally, though, for those who lean towards the philosophy that ‘man (or in this case, ‘care’) is simply a product of its environment, you may feel that the greatest influence on residential care is its infrastructure: the people, the buildings and the regulation that make up the rules of play. Looking at the issue of ‘people’, recent postBrexit immigration controls suggest there are
editorial@chmonline.co.uk
some challenges ahead. A policy designed to reduce Britain’s reliance on cheap labour and encourage efficiency and effectiveness through automation is all well and good in principle. But the delivery of such a major cultural shift will not happen overnight – and care is not an activity that immediately lends itself to automation. I have no doubt that the care home world will survive this huge infrastructural change, but equally, I do not believe it will emerge unscathed. My prediction is for a bumpy road ahead. In terms of the buildings that will shape care, it’s clear that green is the colour of choice. In the course of researching the ‘Design & Build’ feature in this issue, I read a really interesting article by law firm Osborne Clark that raises the notion of “well buildings” – buildings that offer an experience that enhances people’s quality of life. For residents, that means being able to take advantage of amenities and services, such as swimming pools, fitness centres or communal gardens, and environmental features such as electric car charging points. For the communities that accommodate such buildings, it means reaping the benefits of a developer’s commitment to social responsibility and corporate citizenship. It’s an interesting concept, and one that I think new-build care properties are also beginning to adopt.You can read the full article online at https://tinyurl.com/rezqgds We’ve also published an exclusive online feature on care homes that are going green (available via the link: https://tinyurl.com/u25dkbt) which gives you great insight into how principles of sustainable care can be applied in practice. And, as for regulation... well there’s a defining factor in care if ever there was one. Restraint review, and the changing attitude of the CQC towards providers, are all discussed in this issue, and it’s an agenda that is high on the list for discussion at the forthcoming Dementia, Care and Nursing Home Expo at the NEC. We’ll be there, so why not book your place? Register via the link: https://tinyurl.com/vd5euuj
@Carehomemanage
Ailsa Colquhoun Publisher/Editor
Care Home MANAGEMENT 3
Care Home MANAGEMENT
Contents
www.chmonline.co.uk
7 Eleanore’s Words to the Wise
If it seems too good to be true
11 News
FEATURES
13 Research
A new study looks into the value of structured drinks rounds
14 Ask the Expert
How to get complaints handling right
11 Legal
Hear what our Podcast Special lawyers have to say about the CQC, employment law changes and local authority funding
18 Best Practice
The Ombudsman finds fault in a challenging personal care situation
20 Outstanding
See who’s made it into the Outstanding club
22 Profile
How Belvedere House steers a course balancing charitable objectives with high quality care
LEGAL
p20
Take a well-earned break with our new coffee time page
43 People and Events
Look out for the CQC’s restraint review report
RACT TP
42 Coffee Time
8 Market Barometer
A look at the market in care home sales
BES
ALTH HE
E IC
REGULARS
UITME CR
NT
ERSH AD
IP
LE
HR
RE
March/April 2020 • ISSUE 84
See who’s on the move and where to go during March/April
DEMENTIA, CARE AND NURSING HOME EXPO 2020
26 See our editor’s picks of the show on March 17-18
DESIGN & BUILD
28 Discover what goes into a successful dementia care village build
30 Money talks, but is the conversation flowing in new-build finance?
FOOD & NUTRITION
32 Understand how to embed best practice in clinically-assisted feeding
35 World of food. Understand how food
trends will influence our tastes in 2020
nutritious as possible
37 Blend with care to keep food as BATHING
38 How to design for resident comfort and staff wellbeing
40 How to enable unassisted bathing 38 Bariatric toileting.Weigh up all your
toilet options
p22
p37
p28 4 Care Home MANAGEMENT
www.chmonline.co.uk
NEWS ROUND-UP
CARE HOME AWARDS 2020 – see who’s made it into the finals! FIRMLY ESTABLISHED AS an annual celebration of innovation and excellence in the ownership, management and operation of care homes across the UK, and of key suppliers to the sector, the Care Home Awards continue to attract the interest of entrants and the attendance of finalists and sponsors. On Friday 15 May in the Palace Suite at the Royal Garden Hotel, London the Care Home Awards will announce the winners and high commendations for 2020. Some 330 senior representatives of care homes and care home groups will attend, together with sponsors’ representatives, and companies short-listed as finalists are already snapping up places. Helen Warrilow, commercial director of the Care Home Awards, is delighted with progress to date: “The take up of places for 2020 is very speedy. We are three months out from the lunch and ceremony and the Palace Suite is already half full. With more entries than ever this year I expect we will have a sell-out event very quickly.” The Care Home Awards receives support from Care Home Management as exclusive media partner and from Avery Healthcare, Bidfood, Florence, Residential and Home Care Show and Tanglewood Care Homes as category sponsors. For more information, visit: https://chmonline.co.uk/ care-home-awards-2020-whos-made-it-to-the-finals
THE LIST OF COMPANIES THAT HAVE MADE IT TO THE SHORT-LIST IS AS FOLLOWS: Adaptive IT Solutions Adept Care Homes Avery Healthcare Berkley Care Group Bidfood Canford Healthcare Care UK Caring Homes CHD Living Cornerstone HC Encore Care Homes Florence Halebourne Group Hamberley Care Homes Huntington & Langham Estate L&M Healthcare LifeCare Residences Loveday & Co (IAC)
Netli Orchard Care Homes Parklands Care Homes Pelham House Person Centred Software PLMR Priscilla Wakefield House and Magicare Rotherwood Healthcare Rowallan House Sanctuary Care Solihull MBC (Adult Care & Support Directorate) Springup PR Strong Life Care The Close Care Home Tunstall Healthcare Valerie Manor Wellbeing Care
Helen Whately replaces Dinenage as care minister HELEN WHATELY HAS been appointed Minister of State (Minister for Care) at the Department of Health and Social Care. Whately is a newcomer to health. She was previously Parliamentary Under Secretary of State at the Department for Digital, Culture, Media and Sport, and before that, she worked in Arts, Heritage and Tourism. In a straight departmental
March/April 2020
swap, Dinenage has been appointed Minister of State for Digital and Culture at the Department for Digital, Culture, Media and Sport. Whately is MP for Faversham & mid-Kent. Of her appointment, she writes: “Solving the crisis in social care, and achieving our commitment of 50,000 more nurses, are two of the most important things for making sure people get the care they need.” For more information, visit https:// chmonline.co.uk/helen-whatleyreplaces-dinenage-as-care-minister
Each week, the Care Home Management team sends out a weekly newsletter, with quick links to the best of the preceding week’s news. Sign up is free. Please email the editor with your email address and we’ll add you to the subscription list. Don’t miss out on this easy way to stay up to date. Email the editor now at Editorial@chmonline.co.uk Care Home MANAGEMENT 5
NEWS ROUND-UP
Half of councils have not planned for elderly living ALMOST HALF OF COUNCILS (45 per cent) haven’t sufficiently planned for where elderly people in their communities will live in 10 years’ time, a new report by law firm Irwin Mitchell has revealed. The report, Elderly Care Crisis: A Tipping Point, also predicts that by 2029, nursing and care home beds will run out, if capacity is not increased. In addition, Government must address the rising cost of nursing and residential care, which is expected to increase by 16.1 and 14.9 per cent, respectively, over the next few years. Kelly Greig, partner and head of later life at the firm, warns: “Government funding isn’t rising enough to meet the demand.” Noting that the funding gap in adult social care services will rise to £3.5 billion in 2024-25, the report makes a number of recommendations to social care ministers and councils. For more information, visit: https://chmonline.co.uk/halfof-councils-have-not-planned-for-elderly-living
DHSC publishes COVID-19 guidance for care homes
THE DEPARTMENT OF Health and Social Care has published guidance for care home staff on novel coronavirus, COVID-19. This includes information on: • how to help prevent spread of all respiratory infections including COVID-19 • what to do if someone suspected or confirmed to have COVID-19 has been in a health or social care setting • what advice to give to individuals who have travelled to specific areas • risk assessments for providing care in residential settings • actions to take if staff come into contact with someone who is self-isolating or is a possible or confirmed case of COVID-19 Read more information visit: https://chmonline.co.uk/ dhsc-publishes-covid-19-guidance-for-care-homes
Social care leaders condemn new immigration system SOCIAL CARE LEADERS have condemned the new pointsbased immigration system as “a devastating blow for social care”. The new system, which takes effect from 1 January 2021, will end free movement of workers from the EU. Instead, the system will introduce a minimum general salary of £25,600 and assign points for specific skills, qualifications, salaries or professions. Work visas will only be awarded to those who gain enough points. Key features of the new system are: • Minimum general salary threshold of £25,600 (base salary only, excluding allowances or pension contributions, and no regional differences) • Applicants can ‘trade’ characteristics such as their specific job offer, shortage occupation status and qualifications against a lower salary • Skills threshold reduced to Regulated Qualification Framework level 3 (equivalent to A level/level 3 NVQ in Health and Social Care and permitted number uncapped For more information visit: https://chmonline.co.uk/socialcare-leaders-condemn-new-immigration-system
6 Care Home MANAGEMENT www.chmonline.co.uk
NEWS ROUND-UP
Residents with dementia at risk of inappropriate polypharmacy, Scotland hears
HOW MANY PEOPLE with dementia are in a position to answer questions about what is going on [with their medicines] and to have those proper and full discussions, Adam Stachura from Age Scotland has asked the Scottish Parliament. Continuing the debate on the supply and demand of medicines, Stachura urges Scotland to take a “zero tolerance approach” to inappropriate polypharmacy. “The patient’s expectation is that those who treat them or help them should know about that and that they should look at every opportunity not to prescribe.” For more information, visit: https://chmonline.co.uk/ residents-with-dementia-at-risk-of-inappropriatepolypharmacy-scotland-hears
CQC calls for open culture for sex in care homes THE CARE QUALITY COMMISSION (CQC) is calling for care homes to create a culture of openness where people using services feel empowered and supported to be open about sexuality and relationships - while ensuring they are protected from sexual harm. A new report. Promoting Sexual Safety Through Empowerment, looks at what can be done to support people in adult social care to have safe sexual relationships. According to the CQC, almost 900 sexual incidents or incidents of alleged sexual abuse in adult social care services such as residential and nursing homes were reported in 2018 over a three-month period. Almost half of the incidents relate to allegations of sexual assault, followed by indecent exposure and nudity. Some 16 per cent of all notifications made allegations against employed staff or visiting workers and 5 per cent of reported instances were detailing cases of consensual sex. The report also highlights best practice in open conversation where people are supported to express sexuality. For more information, visit: https://chmonline.co.uk/ cqc-calls-for-open-culture-for-sex-in-care-homes/
ELEANORE’S WORDS TO THE WISE
If it seems too good to be true... By Eleanore Robinson, freelance social care journalist ATTEMPTS TO JOIN UP NHS and social care to provide seamless medical services for vulnerable adults in the past have been fraught with difficulty. At the sharp end of this is the relationship between care homes and their local GP. Services have traditionally been a postcode lottery, with some care homes enjoying a close relationship with their local surgery that is mutually beneficial, whereas others struggle. As a consequence, residents either don’t receive the medical services they need or end up in hospital, accounting for up to 185,000 emergency admissions a year, according to NHS England. In what seemed to be an ambitious plan to standardise medical services in care homes, NHS England announced plans, by 2020/21, to introduce weekly visits to a care home by a healthcare March/April 2020
professional, including fortnightly ward-rounds by GPs.The NHS England plan also included measures to deliver relevant vaccinations and conduct structured medication reviews in care homes. There were also pledges to support the professional development of care home staff by identifying opportunities for training and shared learning, and to work with the care home and “wider system partners” to address co-ordination challenges the home is facing. NHS England stated that CCGs would support the delivery of this service by holding a list of care homes in the area and agreeing responsibilities with each home’s GP-led Primary Care Network (PCN). This all sounded great but then, following a consultation, the plans were scaled back. No more fortnightly ward-rounds. Instead medical input will be at an “appropriate and consistent” level decided by the PCN. From 30 September 2020, PCN’s will have to deliver a
weekly “home round” for people living in the care home using GP practices in their area. However, this will involve only residents that have been prioritised by the multi-disciplinary team carrying out these visits and the care home. There will be “appropriate and consistent medical input” from a GP or geriatrician.The frequency and form of this, however, will of course be decided by the doctors. So much for an end to the postcode lottery. Care Home MANAGEMENT 7
THE PODIUM AWAITS!
The Care Home Awards lunch and ceremony take place on May 15, 2020 at the Royal Garden Hotel, London W8 4PT. Book before March 9 and save £25 per person.
Great food. Great company. Great atmosphere.
To book, visit CareHomeAwards.com
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By Michael Hodges, Christies & Co managing director – healthcare consultancy
A
s we enter the final month of the first quarter of 2020 it seems like it has been a busy start to the new year: there has been a significant amount of activity in all segments of the market. There has also been an uplift in confidence as investors and operators react positively to the outcome of the December 2019 election, and the increased certainty that this brings. In terms of tangibles, it is difficult to predict which major deals will successfully transact this year, however, the current Priory sale process provides a useful marker.
We are seeing significant appetite in the UK healthcare sector from a wide variety of investors. The common denominator, though, is that these funds are looking to deploy a substantial amount of capital, which is clearly a major positive.
But what of the headwinds?
The Government announcement at the end of December that from Wednesday 1 April 2020 the National Living Wage will increase by the highest cash increase to date will once again place the issue of local authority funding in the spotlight. Operators will have to ask themselves whether their fee rate increases will sufficiently absorb this substantial extra cost. At the time of writing the answer is not clear and, as with previous years, operators will need to manage
cashflows carefully over the coming months. Our forthcoming Healthcare Market Review will include the results of our local authority and operator surveys for 2019, as well as providing some new insight on rental levels and the extent of development activity. There is real momentum gathering in the latter area, as several high quality homes enter the market, albeit primarily focussed on the private pay market. How the current positive market activity translates into deals later in the year is yet to be seen. Many observers will be watching the Priory process closely to assess the true market appetite for major M&A deals.
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March/April 2020
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NEWS RESTRAINT REVIEW
RESTRAINT REVIEW Lauren Wilson, solicitor at Markel Law, gives care home managers the inside track on the CQC review of restraint and segregation, and the report expected this month
F
or over a year, the Care Quality Commission (CQC) has been reviewing the use of restrictive interventions in the health and social care sector. This review was requested by the Secretary of State in November 2018; Phase 1 began in December 2018 and the final report is due out later this month. The aim of the review is to look at how different settings are using restrictive practices (including prolonged seclusion and segregation) to ensure any use is necessary, carried out in the correct way and that in doing so the setting protects the rights, welfare and safety of all service users. Restraint includes the use of a threat and/ or actual force to secure the doing of an act which a person resists or which restricts a person’s liberty. It can include physical, mechanical and/or chemical means. Seclusion or segregation includes staff preventing a person from leaving a designated space as management of a longer-term threat of violence.
Phase 1:
Phase 1 saw the CQC focus on child and adolescent mental health wards and wards for people of all ages with learning disabilities and/or autism. In May 2019, the CQC published the interim report which found inappropriate use of seclusion and restraint, poor ward environments and poor quality of care which had a damaging impact on patients and staff. The recommendations focused both on what could be done immediately, but also about changes to the system of care itself. These included: (1) An obligation for an independent and in-depth review in the next year, of the care provided to, and the discharge plan for, each person who is in segregation (2) An expert group to be convened to consider what the key features of a better system of care for this specific group of people would look like (3) U rgent consideration to be given to how the system of safeguards can be strengthened March/April 2020
(4) C onsideration to be given to the implications of the person’s human rights (5) The CQC should review and revise its approach to regulating and monitoring hospitals that use segregation.
Phase 2: adult social care
Phase 2 of the review considered restrictive practices in adult social care services, mental health rehabilitation and low secure hospitals, and some children’s residential services.The latter is in partnership with Ofsted. As can be seen from the above interim
recommendations, the final report should generate sector-wide changes throughout 2020 and beyond. It is clear that the CQC will focus on restrictive practices in future inspections; with a noticeable focus on considering and documenting the need for restrictive practices and how the welfare of service users is protected. However, the larger theme emerging is the overall consideration of whether the use of these restrictive practices are necessary and/ or whether they adversely impact on a person’s ability to reintegrate back into unsupported life. Initial conclusions reached by the CQC seem to indicate that use of restrictive practices has resulted in poor outcomes for the person. There is a concern that the people visited as part of this review have had contact with health, care and education services for many years but despite this, the treatment and care provided have not enabled them to live anything approaching a normal life.The CQC states: “Their world is narrowed to a highly-restricted existence in a single room, or small suite of rooms.Their interactions with other people are often characterised by distress and the use of force by staff to manage behaviours that put the person or others at risk.” Care Home MANAGEMENT 11
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RESEARCH STRUCTURED DRINK ROUNDS
HYDRATION
FOR HEALTH IN CARE HOMES
The role of structured drink rounds in reducing urinary tract infections in care homes has been investigated by colleagues at the Oxford Patient Safety Collaborative in a study: Reducing urinary tract infections in care homes by improving hydration Abstract
Dehydration may increase the risk of urinary tract infections (UTIs), which can lead to confusion, falls, acute kidney injury and hospital admission. This study aimed to reduce the number of UTIs in care home residents which require admission to hospital. The principal intervention was the introduction of seven structured drink rounds every day accompanied by staff training and raising awareness. UTIs requiring antibiotics reduced by 58 per cent and UTIs requiring hospital admissions reduced by 36 per cent, when averaged across the four care homes. Care home residents benefited from greater fluid intake, which in turn may have reduced infection. Structured drink rounds are a low-cost intervention for preventing UTIs and are implemented easily by care staff.
U
rinary tract infection (UTI) was the condition with the highest rate of emergency admissions to hospital in 2012/2013. Dehydration has been highlighted as a common cause of admission to hospital in nursing home residents, and there is evidence that many older residents living in care homes do not receive enough fluids. The SMART aim of this quality improvement project was to reduce the incidence of UTIs by improving hydration with the ultimate aim of reducing UTI admissions to hospital by 5 per cent from the previous year.
Study design
The study involved four care homes in East Berkshire CCG with the highest incidence of UTI admissions to hospital. Collectively, the homes care for 150 residents, of whom the majority are aged over 75 years old and more than half live with dementia. Staff were trained in the signs and symptoms of UTIs, using SIGN 88 guidance March/April 2020
to identify clinical signs and symptoms of a UTI rather than routine dipstick testing. Hydration champions were identified to cascade supporting information and posters. The principal intervention was the implementation of a structured drink round, during which residents were offered a wide selection of hot and cold drinks using colourful juices in colourful cups and mugs, with ice lollies and milkshakes offered as alternatives. Residents were consulted throughout the process and involved in selecting the drinks. The theme of the drinks trolley was changed regularly to stimulate residents and keep up with key events, for example, festivals or sporting events. Drinks were offered at least seven times a day, supporting the daily recommendation of between six to eight glasses of water a day. The full version of the research is available online via the link: https://tinyurl.com/v55x76o
The care homes decided what times they were going to undertake the drink rounds.
Lessons from the research
Key to the success of the project was the commitment of a team member from East Berkshire CCG who provided consistency, trusted guidance and encouragement, especially initially. It was imperative to involve staff in the design of the principle intervention to ensure that it was practical and sustainable. Staff competency with data within the care home environment varies widely. Having collected the baseline data, it proved invaluable for all the team to understand on average how many UTIs were occurring in their home. ‘Huddles’ at the beginning of each shift were introduced to reinforce the importance of hydration and to reinforce the contribution of staff to prevention. Regular review of the data with staff demonstrated improvement and provided encouragement to keep going with the intervention. Care Home MANAGEMENT 13
ASK THE EXPERT COMPLAINTS HANDLING
ASK THE EXPERT: IN THIS ISSUE: WHY COMPLAINTS ARE GREAT
By Alan Park, Local Government Association external training and relationship co-ordinator, explains how and why to establish a robust care home complaints handling process
HOW SAFE ARE YOUR FIRE DOORS?
Fire Door Surveying can inspect and report on the fire doors throughout your care home to ensure you are meeting your legal obligations under the Regulatory Reform Order 2005. The inspectors are FDIS Certified Inspectors and have a Diploma in Fire Doors and have been independently assessed by a UKAS certified body. Fire doors are one of the most important elements in giving occupants time to escape safely, but they are also one of the most neglected in terms of inspection and maintenance. Fire doors are generally in constant use and are therefore subject to more abuse, damage and wear and tear than most fire safety devices, such as extinguishers, and they are more prone to failure. Ensure you get your fire doors inspected. Contact us now. Telephone: 07950 575 695 Email: sansompk@gmail.com www.firedoorsurveying.co.uk We operate in London and the South East
14 Care Home MANAGEMENT
Care Home Management asks our panel of experts to answer your common care queries
M
istakes will always occur, but an effective complaints system allows an organisation to put things right and learn from them. Complainants often tell us they simply want to make sure mistakes do not happen again. So, when things go wrong it’s always best for you, as care providers, to put things right, and as soon as possible before they escalate to us. For any organisation, a mature, and effective complaint handling system is an important part of learning and development. It’s free feedback and so much value can be gained from taking a proactive approach to dealing with complaints. Unfortunately, all too often complaints descend into an adversarial situation, with entrenched positions on either side. But wouldn’t it be better for all if the organisation took the opportunity to try to understand if something has gone wrong, and what it could do to put things right? The recent case of Burlington Care (details online via the link: https:// tinyurl.com/s6tudln) which has resulted in an adverse findings notice and referral to the CQC, shows how a sad situation was made worse by not handling a complaint effectively. There is no one-size-fits-all approach to complaint handling. But some basic guidance on the tenets of a clear, accessible and flexible process can be found in our Principles of Good Administrative Practice, available [online] via the link: https://tinyurl.com/urjk3gr These are as follows: • Getting it right – your complaint process should be simple, clear, easy to access and comply with the law • Being customer-focused – always speak to the complainant to understand what they think has gone wrong, and whether there is
anything you can do to put it right immediately •B eing open and accountable – be clear on timescales, and when the complainant will hear from you again • Acting fairly and proportionately – consider whether the complainant needs support to make their complaint •P utting things right – when putting things right, focus on the impact of what happened as opposed to what went wrong. • S eeking continuous improvement – make sure you have a mechanism in place to learn from complaints you uphold. Many people who complain simply want an apology. A good apology is short and straightforward.You should show empathy, accept responsibility, acknowledge the impact on the person and explain how you will put it right. We offer several ways to help you improve your own complaint handling: •R esources for care providers such as template letters and procedures are available [online] at: www.lgo. org.uk •D ecisions are also published online and in weekly decision emails. A look at the kinds of decisions we make will help you to identify necessary changes within your organisations before something goes wrong •R ead our focus reports and guidance notes which pull together learning in specific areas.There is a recent report on the lessons from our investigations into independent care providers, and a guidance note into funded nursing care payments • Training in effective complaint handling. For more information visit www.lgo.org.uk/training
www.chmonline.co.uk
ADVERTORIAL
What exactly is the Court of Protection? T he Court of Protection (CoP) was created by the Mental Capacity Act 2005 and has a number of roles: • t o decide whether someone (“P”) has capacity to make a particular decision • t o make declarations (decisions) or orders on financial or welfare matters where P lacks capacity • t o appoint a deputy to make decisions for P • t o decide whether an LPA or EPA is valid • t o remove deputies or attorneys who fail to carry out their duties. Applications to the CoP are needed: • f or serious medical treatment cases •w here clinicians and P / their family disagree about treatment • f or direction where ongoing decisions need to be made about care / treatment / location of care
March/April 2020
• challenges to a Deprivation of Liberty (DoL) Standard Authorisation. Care Homes will most commonly see the latter – where one of their residents objects to their placement and wants to move. Home care providers will most commonly be involved in LA / CCG applications to the CoP to authorise a Deprivation of Liberty. In neither case should a provider be directly involved in the proceedings, but certainly care homes should engage with round table meetings and reviews around their resident. The purpose of a CoP challenge (often called a s21A challenge) is to ensure that P is receiving the right care, in the right setting, and with the least restrictions in place.You can support your residents by facilitating more community access and ensuring their needs are personalised. If you think someone is unhappy, speak to your social worker and
case manager and see what additional funding you might be eligible for or how you could support P differently – it may avoid the need for a CoP challenge and improve your resident’s life at the same time! You can hear Philippa Doyle speak on this subject in more detail at the Dementia, Care & Nursing Home Expo at the NEC on 17-18 March 2020.
Philippa Doyle, Partner, Hempsons E: p.doyle@hempsons.co.uk www.hempsons.co.uk
Care Home MANAGEMENT 15
LEGAL PODCAST SPECIAL
GETTING IT RIGHT COMMISSIONING AND Care home operators should not be afraid to challenge CQC if they feel they have been unfairly treated.They must also be aware of the latest employment law and should consider taking legal advice when working with local authorities to manage and set fees
T
hese were the three main areas discussed during Care Home Management’s Legal Advice Special podcast. This article is an abridged version of what was discussed by three leading law firms and the full podcast roundtable (plus our other podcasts) can be accessed here: https://chmonline.co.uk/podcast/ Our Legal Advice podcast roundtable panel comprised Philippa Doyle, partner in the health and social care advisory team at Hempsons Solicitors; Sybille Steiner, partner in the employment team of Irwin Mitchell Solicitors; and Mei-Ling Huang, partner in the social care team at Royds Withy King. The podcast was chaired by CHM’s publishing editor, Steve Hemsley.
WHO REGULATES THE REGULATOR?
Care Home Management (CHM): Care home providers will have noticed a much tougher approach by CQC in recent months. So, how can they challenge inspections and inspectors if they feel they have been treated unfairly? Philippa Doyle (PD): CQC is a big beast that nobody delivering social care services can ignore. In recent years it has been perceived as being quite soft and supportive with providers seeing the same inspector for years, 16 Care Home MANAGEMENT
but there has been a change. There seems to be much more of a black and white, regulatory-driven approach, with no room for grey areas. We are seeing Philippa Doyle a huge increase in the number of threatened prosecutions against providers, and we feel many inspectors are coming into homes with a fixed agenda. Homes are not getting an opportunity to really showcase what they do. Don’t get me wrong, it’s good to see a more focussed approach and new inspectors coming through, but they could look at things in a more holistic way. They can forget that these are people’s lives and that care is not a black and white service. When clients get upset, I often get asked ‘who regulates the regulator?’ All I can say to providers is that it is you, if you feel the CQC has been unprofessional or unfair. The CQC does have a separate complaints team and using a lawyer can help to get a quicker response. Earlier this year CQC had to retract a number of reports because duplicate material had appeared across different reports. Mei-Ling Huang (MLH): I noticed an increase in pressure on providers by CQC last Spring. Reading between the lines, the change can be traced back to the BBC TV Panorama story on Whorlton Hall hospital around the same time. If a whistle-blowing or safeguarding complaint comes on to CQC’s radar, it seems providers and managers have to prove that
what they’ve been told is wrong.This approach has put providers on the back foot. Legal advice can help them to explain the contents of the documents they are providing CQC with and respond to inaccuracies in a draft report. Sybille Steiner (SS): Care homes need to have a robust whistle-blowing policy and
SLEEP-IN PAY TACKLED BY THE SUPREME COURT A new policy published by the Government could reduce the fines faced by organisations if the Court of Appeal ruling is overruled. Last month, and just after this Podcast was aired, the Supreme Court heard the appeals for two cases sleep-in cases: Mencap v Tomlinson-Blake and Shannon v Rampersad. The judgements from these cases are not expected until around mid-May. The case relates to two care workers, Mr Shannon and Ms Tomlinson Blake, who were said to be only “available” to work during their sleep-in shifts (rather than actually working) and only had to be paid the National Minimum Wage (NMW) if they were asked to work during that time. The care sector is bracing itself for costly penalties if the Supreme Court overrules this decision – but it appears that a new policy published by the Government will limit the penalties that care organisations have to pay. More information on sleep-ins is available [online] at: https://chmonline.co.uk/newgovernment-policy-on-minimum-wage-couldoffer-relief-in-supreme-court-sleep-in-cases/
www.chmonline.co.uk
LEGAL PODCAST SPECIAL
IN REGULATION, EMPLOYMENT LAW update it regularly to ensure they comply with the latest legal requirements. When preparing for CQC inspections, it is important all employees know what they have to do. If an inspection does not go as well as hoped, employees must be able to deal with issues that have legitimately come up. If disciplinary issues are required, then the employer clearly needs to act.
CHANGES IN EMPLOYMENT LAW
CHM: It is important care homes are up-todate with the latest employment law. What are the key areas they need to be aware of in 2020 and how might this impact on CQC inspections? SS: Changes to employment contracts and Section 1 statements come into force in April. As the law currently stands, only employees are entitled to receive a written statement which has to contain certain basic information about terms and conditions of employment. Such a statement now has to be provided on the first day an employee starts work. Also, from April 6, the rules do not just apply to employees, they also apply to workers. This is a significant change. Providers must now provide additional information, including the days of the week someone is required to work and how the hours each day might vary. Benefits should also be set out in the employment statement, plus any training entitlement. We recommend providers have one contract template for employees and one for other workers because there are different legal implications. Existing staff can ask for an updated statement.
My advice would be to join a local care association to engage directly with commissioners in your area March/April 2020
PD: Paperwork is the most important evidence base you can produce to show an individual exactly what is expected of them and what their rights are. It also shows CQC you are a slick organisation that knows what it is doing, supports its staff and works within the regulations. MLH: The management of staff is one of the biggest headaches providers face. It’s complicated, but care homes need legal support to ensure their HR systems are robust, especially if there are a lot of staff. A home runs the risk of creating big liabilities.
LOCAL AUTHORITY FEES
CHM: What trends are we seeing in terms of the setting of fees by local authorities this year? MLH: Commissioners will continue to try and whittle down the fee rates at the front end.We have been seeing this since 2009. I also think commissioners will continue to try and impose more obligations in terms of what providers are expected to deliver under their contracts. If you are a council with a stretched budget, how do you get more for your money?
Mei-Ling Huang
For example, there has been a lot of talk about the Liberty Protection Safeguards (LPS) that come into force in October and replace the Deprivation of Sybille Steiner Liberty Safeguards (DoLS). Coordination of the LPS process could move from local authorities to care home managers. We could see more paperwork requirements put on providers. We are already seeing this from clinical commissioning groups (CCGs) around funding reviews. PD: There has always been tension between commissioners and providers but each party needs the other. There are pockets of the country where the only way that local authority-funded placements can become sustainable is where a provider can utilise a higher level of fees from private fee-paying residents, and that is not right. SS: Funding is a massive concern for our care home clients. The minimum wage has to be paid, and this goes up in April from £8.21 to £8.72 per hour for those over the age of 25 and it will continue to rise. If the local authority does not provide the funding then providers can look at a judicial review, although they may feel reluctant to do that. MLH: I think many local authorities anticipate this and try to ensure their decision making is judicial review-proof. The judicial review is simply a look at whether the decisions taken are within the law. Ultimately, we need to remember there is strength in numbers, so providers should work together to have a voice. My advice would be to join a local care association to engage directly with commissioners in your area, while the wider discussion must take place on a national level. Care Home MANAGEMENT 17
BEST PRACTICE FROM THE OMBUDSMAN
My care provider hasn't resolved my complaint. What can I do now?
LESSONS FROM THE
OMBUDSMAN The Local Government and Social Care Ombudsman decisions relating to complaints about local public services offer useful learnings for care home providers
THIS TIME IN CHM MAGAZINE
Countrywide Care Home Limited
SUMMARY: Mrs X complains about
the level of care the care home gave Mrs M, its failure to respond to the concerns she raised and its decision to evict her. The care provider is at fault for causing an injury to Mrs M with jewellery, not protecting Mrs M’s dignity, not ensuring it met Mrs M’s personal care needs and for not keeping her room clean. It was not at fault for how it reached it decision to evict her.
18 Care Home MANAGEMENT
ANALYSIS
Mrs M moved into the care home in July 2015. By September 2017 she needed nursing care and was confined to bed. She needed support for all her care needs. Mrs X has power of attorney for Mrs M and she raised concerns about the level of care with the care home manager and subsequently with the area manager and the council’s safeguarding team. Mrs X’s diary shows she was concerned about: • the standard of personal care provided • unexplained bruises that she thought were due to rough handling by carers • a small tear on Mrs M’s arm caused by the ring a carer wore when giving personal care in early October 2017
• dressings not changed regularly and allowed to get dirty
• Mrs M lying in wet bedding after the care home had left her unsupervised with a cup of tea, which had spilt • Mrs M again lying in wet bedding two days after reporting the previous incident, due to being left unattended with a milkshake. Care home records show: • Mrs M was aggressive towards staff when they tried to give personal care • Mrs M’s distress with showers was discussed with Mrs X and it was agreed showers would only be given by staff members that Mrs M was comfortable with. The area manager wrote to Mrs X to confirm that a number of actions would www.chmonline.co.uk
be taken. The care home then appointed a new manager (manager 3). Still feeling dissatisfied with Mrs M’s care Mrs X then also contacted the council’s safeguarding team who recommended actions for the care home, and tried to mediate with the family. However, the family continued to raise concerns with the care home and did so in an aggressive manner. The care home considered its relationship with the family had broken down and served Mrs M with a notice to leave, in line with its termination policy.
CONCLUSION:
Care home staff were not recording the specific care provided nor when care was refused, and what action was taken following refusal. This is fault. However, the care home could document how it implemented improvements following recommendations from the council.
The care home took appropriate steps to encourage Mrs M to accept personal care. It consulted the family and the GP about what action to take. It agreed that showers would only be given by staff Mrs M was comfortable with to minimise her distress. The carer apologised for the ring accident and the care home took appropriate action. However, the injury did cause some distress to Mrs M and Mrs X. Care home records show it accepted failings when Mrs M was twice found in wet bedding due to spilt drinks. It agreed not to leave Mrs M alone with a drink in future and subsequently, there was only one further incident of a spilt drink. This is not sufficient to make a formal finding of fault. Mrs X accepts the care home responded to her concerns at this point and the level of care improved for a two-month period. Overall, records show Mrs M’s needs were generally met. However, the care home has
accepted failings in relation to personal care and cleanliness in Mrs M’s room and agreed an action plan with the council, which was monitored. No further procedural recommendations are required.
AGREED ACTIONS: • The care provider will apologise to Mrs X for the distress caused by its faults in causing an injury to Mrs M with jewellery, not protecting Mrs M’s dignity, not ensuring it met Mrs M’s personal care needs and for not keeping her room clean. • The care provider will pay Mrs M £500 for the distress caused to her as a result of these failings. It should also pay Mrs X £250 to acknowledge the distress the faults caused her and her time and trouble in pursuing the complaint. Read the whole decision [online] via the link: https://tinyurl.com/v5vhp9o
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Care Home MANAGEMENT 19
BEST PRACTICE OUTSTANDING HOMES
CONGRATULATIONS TO...
Care Home Management is delighted to be able to share with you these examples of outstanding care home practice
Shinfield View Care Home, Reading Safe:
Effective:
Caring:
Shinfield View Care Home is a care home without nursing providing personal care to up to 66 people aged 65 and over, some with physical disability, sensory impairment and dementia.
What Shinfield View did: Safe
Every week the service hosts an activity where local residents bring their babies and toddlers to the home.This was developed to encourage a resident prone to falling to walk with a pram, to aid stability. The home also introduced a ‘feeling safe’ survey, and has invested in electronic systems for recording and handling medicines.
What Shinfield View did: Effective Where people need extra help to eat, the service implements a buddy system, including to support people who prefer not to sit at the table. Residents are given a choice of food to eat, and where they can eat, including in their own rooms.The home has also invested in technology to reduce the risk of pressure ulcers, and at least twice a year carries out a dementia environmental assessment to
Responsive:
ensure premises and private facilities continue to offer a suitable environment for residents. Staff also receive additional training in specialist areas such as caring for people with diabetes, Parkinson’s and dementia.
What Shinfield View did: Caring
People are treated with tremendous care and kindness. In one example, one person was taken to visit their partner in hospital and on another, connected via video call.The service has developed the role of mental health firstaider to offer residents, their families and staff the mental health equivalent of physical first aid: early intervention is said to reduce distress, help to preserve life, and facilitate recovery from mental ill-health. People’s care plans focus on ability and maintaining and increasing independence.
What Shinfield View did: Responsive Arrangements for social activities are both innovative and highly person-centred.The home also runs a ‘namaste’ care programme based on an ethos which acknowledges the person first,
Read mthe full report online at: https://www.cqc.org.uk/location/1-2517056445
Well-led: not the disease. Changes relating to namaste include: a pull-out bed for relatives to stay in the room with the person at the end of their life; a private time sign for the room; warmer lighting; flowers in the room and soft relaxing music.There are also items to aid relaxation and wellbeing, including: hand and foot massage cream; body moisturiser; LED candles and lavender scented items. Staff also attended endof-life and bereavement training.
What Shinfield View did: Well-led
The service is highly proactive and very involved in the local community. Staff are considered generous in their support of community activities, including for schools and toddlers, and the elderly. Specific examples of charitable actions include organising the Carols Round, the Tree Christmas event, letting a local choir practice at the care home, and supplying pancakes for the community pancake race. Community professionals have applauded the management for being approachable and fair, and for always being open to new ideas and learning.
20 Care Home MANAGEMENT www.chmonline.co.uk www.chmonline.co.uk
BEST PRACTICE OUTSTANDING HOMES
Read the full report online at: https://www.cqc.org.uk/location/1-137466837
Coxwell Hall and Mews, Faringdon, Oxon Effective:
Caring:
Responsive:
Well-led:
Coxwell Hall and Mews is residential care home providing personal and nursing care for up to 66 people with a range of conditions, including mental health conditions and dementia.
International Dysphagia Diet Standardisation Initiative to manage food consistency.
What Coxwell Hall and Mews did: Effective
Staff never pass by people and take time to have meaningful conversations and on a personal level. One person at the home walks constantly, so staff walk alongside them chatting and laughing. People that want to can be involved in recording their care records. In one instance this involved completing an incident report about a fall. At meals, people are encouraged to sit at the table. However, people are able to stand up and move to different areas. Once settled, staff bring their meals to them, even if this means moving the meal several times.
Staff feel extremely well-supported to develop their skills and knowledge and can complete specialist training in areas such as conflict management, physical intervention and dementia care. Staff use a personalised approach to manage anxiety in residents, including using distraction techniques. Care plans are in place, and these reference current standards, including: oral health care plans, accessible information standard (AIS) and current best practice relating to dementia care. Continuous assessment and review ensure people’s needs continue to be met. When refurbishing the property, the manager used evidence-based colour therapy to create colours that helped to balance moods, and areas were changed if they were felt to be at increased risk of triggering distress.To improve physical comfort, the provider purchased twelve specialist chairs. To ensure adequate nutrition and hydration, people are supported to have snacks, and mealtimes are staggered to enable staff to have time to sit with people, creating a social atmosphere. Care plans ensure specific dietary requirements are met, including using the March/April 2020
What Coxwell Hall and Mews did: Caring
What Coxwell Hall and Mews did: Responsive
People’s personal needs are understood by staff, for example, they understood that a resident who tended to grab staff was holding them as they did not want to be left alone.The person was given the necessary reassurance. The service is also accredited as a ‘Butterfly Care Home’, as a result of regular quality audits. Other initiatives include working to improve community involvement through, for example, a new Coxwell Friends group to involve families, friends and the local community. In addition, there are emerging links with local public houses, the local choir and the local scouts
and nursery groups. In the home’s garden group residents work as gardeners (and one receives a weekly payslip) and people grow vegetables. As a result, people can feel valued and respected for their contribution. Additional ways to improve engagement include pet therapy and the new sensory room with an interactive floor. People are also able to go out with staff to local shops and to help with errands for the service.Where English is not the person’s first language, staff are supported with cards, with key words, signs and electronic devices.Where possible, staff are partnered with people that share the same first language.
What Coxwell Hall and Mews did: Well-led
The registered manager is extremely supportive of staff both professionally and in their personal lives, including devoting time outside work to help staff adapt to a new country and to support mental ill-health. To encourage staff to take on additional responsibilities the manager has created new lead roles, and encourages staff to share and listen to others’ ideas for improvement. A home refurbishment is just one of the ways in which the manager demonstrates commitment to improving people’s experience of the service. The registered manager keeps up to date with best practice and shares learning, including research from universities specialising in dementia care. Care Home MANAGEMENT 21
PROFILE BELVEDERE HOUSE vides Belvedere House pro ’ a ‘Home from the Sea for former sailors and maritime folk
PLOTTING A COURSE FOR FUTURE SUCCESS The Royal Alfred Seafarers’ Society home Belvedere House has its sights set on balancing charitable objectives with high quality nursing care
W
hen the first residents arrived at the Royal Hospital for Worn-Out and Disabled Merchant Seamen in 1865, they found an institution very different to the Belvedere House care home they can enjoy today. Men who entered the hospital – then located at Erith, in Kent – found themselves accommodated in a cold, stone-floored building and subject to an institutional regime involving an obligatory three-piece blue uniform including a hat, and prayers and a ‘Divine Service’ every Sunday. The menu – sometimes described as “monotonous” by its diners – often involved liberal helpings of boiled mutton and potatoes, salt fish and suet pudding. The Society moved to Banstead, Surrey, in 1978 and has remained in the area since, although premises have moved from the old Belvedere House on Holly Lane to today’s Belvedere House on the Weston Acres estate set in 14 glorious acres. Still run today by the Royal Alfred Seafarers’ Society, named
22 Care Home MANAGEMENT
after HRH Admiral the Prince Alfred, Queen Victoria’s second son, the home retains at its core an ethos of caring for former seafarers in their time of need. Today’s residents and their families and friends find themselves in a much more relaxed environment: Belvedere’s doors are now open to both men and women with a maritime connection, as well as, on occasion, non-seafaring folk. Rated Good by the CQC in its previous inspection, the current site in Banstead can easily be described as luxurious, comprising sheltered accommodation, as well as general and specialist care for up to 68 residents and 28 tenants, following the opening of a dementia annex in July 2011. Replacing the old regimented day to day routines of the old hospital is a daily programme of enjoyable and stimulating activities.
Among the 100 in-house staff there are three full-time activities coordinators, who are charged with organising fun activities, including boating days out, walks in the newly-landscaped garden, invitations to Buckingham Palace garden parties and visits from military charities such as Lest We Forget and Not Forgotten. There is also a very popular in-house bar where residents, tenants and their families can sit in comfort to share maritime ‘banter’ and stories. In its latest inspection report, the CQC applauded the home for its use of nautical paintings, items and imagery dotted around the home to stimulate and engage people. And, of course, gone is the old solid fuel tortoise stove that heated the old Erith hospital - in favour of solar heating and a sustainable pellet-fired biomass boiler. To the old seamen of Erith, today’s mealtimes would probably also www.chmonline.co.uk
PROFILE BELVEDERE HOUSE
be unrecognisable: twice-a-week mutton has been swapped for appetising options including salmon and broccoli quiche and whiskey & marmalade pudding with custard.
expected to become heavier.” Careful investments, as well as prudent control on costs, aim to ensure the home’s finances remain shipshape. Recruitment costs are kept to a minimum, thanks to a policy of employee engagement and wellbeing. The Society has been rewarded with high rates of staff retention. According to Goddard, over 50 per cent of people have worked for the charity for over five years and manager Anne Kasey has herself worked at the home for more than 35 years. The home is particularly proud to be accredited for the Living Wage and achieved 99 per cent satisfaction ratings in all areas of the staff survey. Staff also receive training in naval lifestyles to understand the true picture of life at sea, including the length of time that people can spend away from home and its impact on family life. As Kasey says: “If you invest in staff, they invest in you.”
STEERING CHOPPY WATERS At the helm of Belvedere House today are registered home manager Anne Kasey, and business manager Karen Goddard. Together, they are charged with balancing the Royal Charter obligations to house seafarers and their dependents irrespective of their financial situations, while achieving high occupancy rates based on quality care. In 2018 occupancy at the home in 2018 ran at 94 per cent, which the THE FUTURE home’s trustees describe as “highly creditable”. The home’s management team is acutely aware of the changing demographics of its customer But, with an increasingly complex care offer to base. Bed occupancy currently benefits from provide to its ageing resident population, financial the age of WW2 conscription, and a generation pressure on the charitable organisation is never far of ex-military seamen who now need care. off the management’s horizon. There is also a steady pipeline of customers In common with many other charities, grants from other maritime charities and investments are becoming more important to the Belvedere’s household’s finances doors are now as legacies left to the home become fewer open to both and further apart. As men and women Royal Alfred Seafarers’ with a maritime Society CEO and connection, as well former Royal Navy Commander Brian as, on occasion, Boxhall-Hunt OBE says: non-seafaring folk “Reliance on grants is March/April 2020
from the nearby sheltered accommodation who can move across into the home as their care needs increase. But as the wartime generation naturally passes on, and with changes to the nature of maritime activity, demand for services is being challenged. To ensure the flow of residents remains, the service now employs a specialist PR company. Its brief is to reach the next generation of seamen and women who today work in diverse trades such as dockers, watermen on the Thames, and in fishing fleet. A report into the demographics of UK seafarers concludes that demand for charitable help and support is set to continue for many years to come. Among the factors driving increased demand for charitable care is the low membership of occupational pension schemes among some groups as well as continuing pressure on public funding for social care. The Belvedere House team has every intention of being there for its residents and families. There is great pride, they say, in serving those who are finally ‘Home from the Sea’.
Care Home MANAGEMENT 23
ADVERTORIAL COMPLIANCE
How you can achieve an Outstanding rating in the Safe key question Achieving an Outstanding rating in the Safe category, is far from easy. In fact, the latest research conducted by the Care Quality Commission (CQC) suggests that it’s almost impossible.
E
d Watkinson, a Residential Care and Inspection specialist, who also consults for Quality Compliance Systems (QCS), the largest provider of compliance tools in the UK, reveals why person-centred care wedded to compliance is the key to excelling in the Safe category Q) Why are so few providers rated as Outstanding in this domain? EW): “Only 0.5 percent of providers actually achieve an Outstanding rating under the Safe question. I think, in the main, providers struggle on two fronts. Firstly, the assessment criteria calls upon inspectors to be much more absolute and binary in their decision-making than in other categories. For instance, a care home’s infection control policy either passes or fails. There’s no middle ground. As a result, many providers, particularly those who don’t use compliance management tools, treat the Safe category as a tick-box exercise, which it most definitely is not. In contrast providers that score highly in the Safe criteria - which to quote the CQC are those that suitably “protect” service users and staff “from abuse and avoidable harm” - tend to be care practices that deliver holistic and outstanding personcentred care across the board.”
QCS has developed a mock inspection toolkit, which enables Registered Managers to measure their service against real-world CQC criteria 24 Care Home MANAGEMENT
Q) What are the greatest challenges in achieving an Outstanding rating under the Safe category? EW) “I’ve spent 25 years in social care, and during my time as an inspector, there’s nothing that I haven’t seen. If there’s one recurrent theme that stands out, however, it’s working in partnership with the person using services, that really makes the difference. This, of course, can manifest itself in many different ways. In terms of medication, for example, providers that are rated as Outstanding closely involve clients in the medication process. They also tend be the ones that understand the importance of empowering and nurturing clients to live full lives, through a collaborative and coproductive lens.” Q) How can compliance management tools help? EW) “Even those who consistently provide compassionate care for their service users can struggle in the Safe category. However, compliance management systems, which shine a light on best practice, can be hugely effective and transformative. Part of the problem is a lack of role models. Often, for example, when I visit care homes, or speak at conferences, I’m asked, ‘what does Outstanding care look like in the Safe category?’ The easiest way for providers to truly understand what it is and what it’s not, is to see an Outstanding care home in action. But often they’re located hundreds of miles away and it can be challenging for Registered Managers to find the time to be away
from their service. But QCS, the company I consult for, has come up with a solution. It reviews Outstanding reports to understand what distinguishes a Good rating from an Outstanding one in an attempt to capture best practice. From there, a Registered Manager can work with staff and service users to identify areas for improvement and use the QCS management system to support the implementation of ideas; using audit tools, individualised policies and the App to ensure that all staff have full access to the most up-to-date information. When fully implemented, this approach ought to ensure better outcomes. However, for anyone concerned that they may not be meeting CQC standards, QCS has developed a mock inspection toolkit, which enables Registered Managers to measure their service against real-world CQC criteria.” www.chmonline.co.uk
WITHOUT QCS WE WOULDN’T HAVE BEEN RATED AS AN ‘OUTSTANDING SERVICE’ Rupert Stocks Registered Manager, Guyatt House
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March/April 2020
Care Home MANAGEMENT 25
SHOW PREVIEW DEMENTIA CARE & NURSING HOME EXPO
It’s not too late to book your free place ati The Dementia Care and Nursing Homei Expo 2020. Simply visit the event websitei via the link: https://tinyurl.com/vd5euuji
Come and meet the CHM editorial team on stand D474
WHO TO SEE AT THIS YEAR’S
Dementia Care & Nursing Home Expo The first of two Dementia Care & Nursing Home Expos in 2020 takes place at the NEC on March 17-18. There’s around 250 exhibitors to see, so to help you find your way around, we recommend the following must-see exhibitors: STAND NUMBER: D914
STAND NUMBER: D670
STAND NUMBER: D666
ATLAS eMAR LTD
Bosch Thermotechnology Ltd
Courtney Thorne
ATLAS is the only electronic medicines management system in the UK proven to increase resident safety and improve care home efficiency. Our mission is to improve patient outcomes, reduce NHS costs and enhance the way healthcare professionals deliver care. We aim to do this by developing well-designed, intuitive software solutions that put pharmacy at the heart of healthcare so it can play a more central role in medicine management.
26 Care Home MANAGEMENT
Benefit from lower energy bills with a Bosch system upgrade! Bosch Commercial and Industrial have helped over 200 care homes throughout the UK in the past three years. We have developed bespoke heating and hot water solutions with flexible payment options that are perfect for upgrading your system, improving efficiency and lowering energy bills. Visit our stand to book your free consultation, to find out how much we could help you save.
The innovative ALTRA RANGE combines SMART mobile technology with the best of wireless nurse call. It comes with a market leading three-year warranty together with tailor-made maintenance packages to suit all budgets. Smart wireless technology reduces both installation and operating costs. Live operational data available locally and remotely help decision-makers with monitoring and improve the safety of patients, residents and staff. Wireless installations are completed without disruption to staff, patients or residents.
www.chmonline.co.uk
SHOW PREVIEW DEMENTIA CARE & NURSING HOME EXPO
STAND NUMBER: D510
STAND NUMBER: C1390
STAND NUMBER: D732
Hempsons
PainChek UK Ltd
Person Centred Software Ltd
Hempsons, the leading UK health and social care law firm, is able to support and advise providers in relation to all aspects of their business activity, including CQC regulatory issues, GDPR, health and safety matters, employment law and Coroner`s Inquests. We also have a superb corporate commercial team. Care homes can also take advantage of up to 15 minutes free legal advice through the Care Home Management legal help line. See page 15 for more details.
STAND NUMBER: D960
Quality Compliance Systems Ltd (QCS)
Quality Compliance Systems (QCS) compliance management system provides over 50,000 care, dental and medical professionals with access to comprehensive customised policies, procedures and compliance toolkits, enabling users to stay compliant with current CQC policies. Instant updates are delivered digitally, 24/7, directly to our customers via the online management system and QCS App. Furthermore, our compliance tools reflect the CQC`s changes to their Key Lines of Enquiries (KLOEs). Visit the QCS stand to sign-up for a FREE no obligation trial.
STAND NUMBER: H1132
Smooth Digital
Smooth Digital is a care sector focused digital marketing agency. Services Include: paid search/pay per click advertising using Google Ads & Bing Ads, Facebook Ads & Instagram Ads and 24-hour outsourced live chat lead capture. Your personalised reporting suite will allow you to view all generated leads and listen back to calls. We understand which strategies work and more importantly, which don`t! We only manage care marketing campaigns and have designed a blueprint which works.
March/April 2020
PainChek is the world`s first pain assessment tool with regulatory clearance in Australia and Europe. Using AI and facial recognition technology, PainChek provides carers across multiple clinical areas with three important new clinical benefits: • T he ability to identify the presence of pain, when pain isn`t obvious • T o quantify the severity level of pain, when pain is obvious • T o monitor the impact of treatment to optimise overall care.
STAND NUMBER: D1050
Ridouts Professional Services PLC
Ridouts law firm only acts for care providers, providing legal, operational and strategic advice to providers when they are faced with matters that can negatively impact their businesses, such as poor CQC inspections, enforcement action, safeguarding and embargoes. On the stand are associate Laura Paton and director Caroline Barker to provide top tips on how to improve your CQC rating.
Mobile Care Monitoring from Person Centred Software is an intelligent mobile solution for evidencing care interactions, electronic care planning and reporting. The icon-driven app creates more than 1.3 million care notes every day, reducing paperwork and giving carers more time to care, improving care quality and the care cycle overall. Supporting CQC inspections, including the new technology KLOEs, we help providers to be recognised for innovative, transparent and personcentred care.
STAND NUMBER: D434
Skills for Care
Skills for Care provides practical tools and support to help you recruit, develop and lead your workforce. Our support ranges from entry level right through to senior leadership and management roles, helping you to create a well-led, skilled and valued adult social care workforce. Area teams can signpost you to relevant information and tools, as well as providing tailored support to your organisation. To get to know us and our work better, sign up to our fortnightly update at www.skillsforcare.org.uk/ enews.
STAND NUMBER: D422
SportsMed Products Ltd
SportsMed Products Ltd will exhibit two key products in keeping people moving: the AlterG antigravity treadmill and the HUR strength training equipment. AlterG is an unweighting antigravity treadmill that uses NASA-patented differential air pressure to build strength, and improve cardio conditioning in a comfortable, pain-free environment. Use the HUR air resistance exercise equipment to safely increase strength. Whether you are looking for strength training equipment, balance platforms or our SmartTouch reporting technology we have a bespoke solution for you.
Care Home MANAGEMENT 27
DESIGN & BUILD DEMENTIA VILLAGES
What will I learn from this feature? How dementia villages are revolutionising care
Village people
Holistic design that supports the provision of varied levels of care within a single site goes a long way to supporting people to live longer and happier. By Lauren Di Pietro, architect at DWA Architects
A
s a care concept, dementia villages have revolutionised ‘design and build’ projects in the healthcare environment. They replace the standard segregation of a typical three-storey care home, split into residential, nursing and dementia floors, and demolish what has become an institutionalized perception of old age. Instead, there is holistic understanding within the built environment of the need to create a ‘united kingdom’ that functions cohesively for occupants as it responds to their changing needs.
Inspired care solution
There is no doubt that specialist facilities are sometimes required for people with dementia. However, it is worth remembering that a move into care can add to the confusion and disorientation being experienced. Relocation can also entail losing social relationships, changes in routines, leaving personal possessions and a loss of independence. On an economic scale, institutional care is often more expensive 28 Care Home MANAGEMENT
In the UK, to imply a ‘care village’, than care in the community and it adds terms such as assisted living, retirement pressure to what is already a fragile care housing, extra care facilities and sheltered workforce. accommodation are all used, and The rise of the dementia care this can confuse. For planners, village, comprising sheltered Planning the uncertainty relates to what and care home accommodation applications class of planning application to articulates an all-encompassing for care apply to a care village and to the solution to care – a housing villages may implications for liabilities such as provision intended to create a fall into the Community Infrastructure community where care is available either use Levy (CIL) and affordable housing if required. class C2 In the US, care villages are which covers liabilities. The word ‘village’ has a literal and conceptual meaning; in known as Continuing Care “residential Retirement Communities (CCRC) institutions” planning definition and legislation, a village is defined as a group of to communicate a sense of or C3 which houses and associated buildings ongoing living but with all the care is “dwelling larger than a hamlet, but smaller and facilities available on site as houses” than a town. This can often be the required. This concept provides a source of conflict when designing a care key precedent when designing care villages village as planners are uneasy that a C2 in the UK and the mixture of housing typologies, from one- and two-bed bungalows classification could be being misused as a device to avoid planning policies applicable to apartments and separate nursing facilities, to C3. In the context of a care village, allows residents to choose their living however, the term ‘village’ refers to the arrangements according to their particular sense of community consciousness and a care requirement.
DESIGN & BUILD DEMENTIA VILLAGES
£25,938
design, social structure and social this, we all seek out qualities such per resident needs of all abilities in a common as safety, security, and a space that per annum location. satisfies our physical, psychological in care home and comfort needs. Research tells staff costs in Understanding the us that we are all affected by our environment - that we can all be barriers controlled, enabled or disabled by Money is the biggest barrier to it - regardless of ability. good design: as the budget reduces It is often argued that people with so does quality and design; value is Source: Knight dementia lack the cognitive skills often engineered out of a project Frank UK necessary to pursue happiness and to the detriment of the service certainly, they can lack the ability and the completeness of the care to manipulate their environment themselves pathway. However, It isn’t always about the size to satisfy their intrinsic humanistic desires. of what we have or how it looks on paper: it’s However, this is not to say that people about the way that we work with what we with dementia do not possess the skills to have, and how well it creates a sense of place. passively experience good design and the Given the costs of caring for a population positive emotions it can bring. with dementia, it is no surprise that Sadly, all too often the physical and social stakeholders are keen to find solutions that environment is designed only for the mobile; maintain high standards of quality care while for people who are functionally independent. also providing a viable financial model for Design for disabilities commonly focuses operators. Grants, tax incentives and reliefs solely on physical disability rather than are among the ways in which this could be environmental or social barriers when it achieved on a national political level. Until is more than possible to create ‘liveable then, it falls to design to find a solution to this communities’ which connect the physical seemingly intractable conundrum.
2019 (+10%)
neighbourhood locality, which provides a level of care required to meet the C2 use classification.
Achieving good design
Certainly, designing different house types and homes for residents with a vast range of care needs is a challenge; but it is one that the right design team can meet. Of course, ‘good’ design is deeply subjective, but fundamentally it’s about good flow of space and creating a sense of wellbeing and quality of life. Quality of life is also a subjective value, but common to all definitions is the fact that it is never low. What’s more, as humans, we have an innate awareness of our environment and within
Yo r k | M a n c h e s t e r | B e i j i n g | L o n d o n
DWA Architects (London) Ltd Cyclops House, Link Business Park York, YO10 3JB Telephone: +44 (0)1904 544400 york@dwa-architects.co.uk
March/April 2020
Care Home MANAGEMENT 29
DESIGN & BUILD FINANCE
Money talks... Stuart Blair, Q: What’s the best way to finance for a new build? debt finance secure A: A priority for any financial institution is to know director at who the developer is and what experience they have OakNorth Bank, in developing similar projects on time and to budget. In addition, an investor will want to know what the discusses the demand dynamics are, including geographic location: climate for new where the care home is situated will have a large build finance impact on metrics such as supply of beds versus
demand in the region. Next, it’s important to clarify what levels of cash equity are being offered in the deal. All banks will want to balance their risk, whatever their loan to cost appetite. Finally, your investor will want to know what the exit looks like for the finance provided. Will the care home be pre-sold to a Real Estate Investment Trust (REIT) or operator? (The latter often makes it more straightforward to obtain development finance.) Or will the developer retain the home and either operate it directly or via a third-party company? Post-completion, if a developer also becomes an operator, the lender will need to be comfortable that the operator is experienced and has other homes in their portfolio that are well-run and perform successfully. A lender will also need to ensure that if a development loan is converted to a trading or investment loan, then the levels of debt can be comfortably serviced as the home fills up and moves to mature cashflows.
30 Care Home MANAGEMENT
Q: What are the pros and cons of each?
A: Development finance is a higher risk investment in that the project has to be built and delivered and as such it is more expensive. Currently, there are relatively fewer lenders operating in this space. The borrower/developer will also need to provide a reasonable level of cash equity to start the project. Most funders will also require a supplementary guarantee to cover a portion of the loan, plus any interest and cost over-runs. Going over budget is the main risk to a new-build project and can often occur very early if something unexpected is uncovered during the ground works. A borrower should therefore ensure that a suitable level of contingency is built into the project as the
DESIGN & BUILD FINANCE
TOP TWELVE COUNTIES FOR CARE HOME DEVELOPMENT 1. South Glamorgan 2. Greater London 3. Buckinghamshire 4. Wiltshire 5. Berkshire 6. Bedfordshire 7. Cambridgeshire 8. West Yorkshire 9. Essex 10. Avon & Somerset 11. Cornwall 12. Leicestershire.
per cent of people living in the UK will be aged 65 early costs of the build will need to be covered via or older by 2042. Generally, there is still a shortage borrower funding before the bank’s development of modern purpose-built homes, so it follows that finance can be accessed. there will be demand for more new-build projects, Investment finance is a cheaper and longer-term and the financing to make projects happen. solution and is much more widely available However, positive demand dynamics should to fund care homes that have stabilised and be balanced with the challenges in this are cashflow positive. Individual lenders’ market. These include the availability of credit appetite will vary, but generally, they billion in care sector professionals, the increasing will fund at up to 65 per cent loan-tohealthcare wage-linked costs and regulation, and as value (LTV) and up to 6x earnings before property appropriate, the mix of private- and local interest, tax, depreciation and amortization transactions authority-funded residents. (EBITDA) leverage. The obvious key risk in with this type of finance is if the financial performance of the care home declines Q: What kind of homes and cashflows can’t service the loan. As are most in favour Source: Knight such, borrowers and lenders need to be currently among lenders? Frank UK cautious when agreeing the loan amount at A: Lenders are naturally cautious, the outset. favouring operators with proven experience and projects that produce a modern, larger operation that is future-proofed to provide Q: What is the climate nursing care. Currently, there is also appetite to fund like for care home smaller specialist care units that focus on specific related finance? mental health conditions or acute conditions, due A: The market is generally positive for care to the higher average weekly fees that specialist home related finance. Office for National care commands. Statistics (ONS) project that more than 24
£1.76
2019
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Care Home MANAGEMENT 31
FOOD & NUTRITION CANH
What will I learn from this feature? How to manage nutrition at the end of life
GETTING
CANH right
Food and drink is so intrinsic a part of our lives – providing sustenance and comfort – that great anxiety is caused by decisions whether to start or continue clinically-assisted nutrition and hydration (CANH).Yet it is a core component of end-of-life care that care homes must get right. By Compassion in Dying policy officer Upeka de Silva
T
here are five steps to best practice in clinically-assisted nutrition and hydration (CANH).
1
Support and respect Advance Decisions and Lasting Powers of Attorney The Mental Capacity Act 2005 allows people to plan ahead to ensure that they receive the treatment and care that is right for them if they cannot make decisions. If someone does not want their life to be prolonged when they lack capacity and can no longer eat or drink, they can refuse CANH by completing an Advance Decision to Refuse Treatment and/or by appointing a Lasting Power of Attorney for Health and Welfare to make that decision on their behalf. Advance Decisions are usually legally 32 Care Home MANAGEMENT
binding in England and Wales and can be completed without a solicitor.
2
Have a clear process for best interests meetings, decisions and documentation A healthcare professional can make a best interests decision about giving or withholding/ withdrawing CANH in the following circumstances: If an individual has: • lost capacity to make that decision themselves, and does not have an Advance Decision covering CANH, or • not made a Lasting Power of Attorney for Health and Welfare giving the attorney the power to make decisions about lifesustaining treatment. Best interests decisions about CANH need to put the patient’s own values and wishes
centre stage. The decision-maker, usually the healthcare professional in charge of the person’s care, should aim to make the decision that the patient themselves would have made in this situation. To do so, a best interests meeting should be held, giving all those involved in caring for the individual and their families the opportunity to have a clear and honest discussion about the risks and benefits of continuing or withdrawing CANH as well as considering the individual’s wishes and values. Guidance on organising and documenting best interests meetings can be found in the British Medical Association guidelines (see further reading right).
3
Review decisions regularly A decision to start or continue CANH for someone who lacks capacity to consent must be reviewed on a regular basis to make www.chmonline.co.uk
sure that it is still in their best interests. The decision to stop CANH should be accompanied by an end-of-life care plan which covers the management of any pain or distressing symptoms. Maintaining good communication between the care team and the family during this time is an important part of quality person-centred care.
4
Provide honest and clear information People are often worried about a loved one “dying of thirst.” Most people don’t know that nutrition and hydration requirements change towards the end of life, what the risks and benefits of inserting feeding tubes are, and how signs of dehydration can be managed. Providing clear, honest information to families is intrinsic to effective decisionmaking in CANH. See further reading below for some helpful resources.
A decision to start or continue CANH for someone who lacks capacity to consent must be reviewed on a regular basis to make sure that it is still in their best interests
5
Effectively manage disagreement or conscientious objection Second opinions and mediation services can be very helpful in the event of a disagreement between a person’s care team and family about whether CANH is in a person’s best interests. However, if a best interests agreement still cannot be reached then an application must be made to the Court of Protection by the body responsible for commissioning the person’s care. The Court’s permission to withdraw CANH is not required if there is agreement between the family and the care team. Managers should be aware of staff with personal beliefs or conscientious objections to CANH, which may inhibit a best interests decision. Referral processes should be in place. A helpful flowchart on making decisions about CANH is available online (see further reading below).
Compassion in Dying is a national charity that helps people to prepare for the end of life, in particular, when making Advance Decisions. Contact Compassion in Dying on 0800 999 2434
FURTHER READING
Compassion in Dying factsheet. Advance Decisions, Is my form legally binding? Available [online] via the link https://tinyurl.com/ujcj3vs British Medical Association and the Royal College of Physicians information leaflet for families and friends, 2018, available [online] via the link https://tinyurl.com/trr4jem British Medical Association and the Royal College of Physicians guidance, 2018: Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent, available [online] via the link https://tinyurl.com/yacktgme Royal College of Nursing resource: CANH [online] at: http://rcneolnutritionhydration.org.uk/ British Medical Association CANH decision-making flowchart, available [online] via the link: https://tinyurl.com/qp4e47u
March/April 2020
Care Home MANAGEMENT 33
Graduate Management programme in health and social care Could you host an ambitious graduate? Our one-year programme fast-tracks graduates towards leadership roles, and we’re looking for forward-thinking health and social care employers to invest and grow with them.
The benefits of hosting a graduate Financial and practical value. Fresh thinking and insight. Injection of new ideas. Complement your professional network.
Their questioning of what we do and why we do it was helpful in identifying many areas for improvement. Cheshire East Council Applications close Monday 6 April 2020.
Find out more www.skillsforcare.org.uk/ hostagraduate | #HostAGrad
FOOD & NUTRITION TRENDS
STYLE ON A
PLATE
1
Feed the Senses
2
Simply Global
Niche cuisines and ingredients are coming to a plate near you. Flavours from countries and regions such as Lebanon, the Pacific Islands and Australasia all look set to make an appearance on menus in 2020. The Simply Global trend is making global cuisine more accessible using authentic ingredients to create fusion dishes that incorporate more than one cuisine, developing food without borders. Chilli will feature heavily in many dishes – from the fiery fragrance used in many Asian dishes, through to smoky heat from South America. Products to look out for: Gochujang Paste and Bang Bang Chicken Ingredients to try: Tahini, miso, chai, yuzu and chimichurri
3
Creatively Sustainable
Communal dining will continue to grow in popularity as shared meals that encourage interaction pique interest. Tabletop cooking with colourful dishes and sharing plates filled with sticks, skewers and dips – will bring interactive meals out of market halls and street food spaces, and onto restaurant tables. Products to look out for: Coconut Skewered Prawns, Rainbow Layer Cakes and Caramelised Onion Bloomer Ingredients to try: Beetroot and hibiscus
4
Skilful Flavour
The skills of chefs, mixologists and baristas will be tested in 2020, as unusual cooking and preparation techniques make their way from haute cuisine into the mainstream. Expect to see a rise in raw, pickled and cured gut-friendly dish elements, as well as blackened and burnt food from hightemperature cooking over a fire. Products to look out for: Blackened Peppered Beef, Biotiful Kefir and Street Food Pastes
86%
want a hot meal to be served at dinner – not lunchtime
6%
of people choose their care home for its food and drink offer
65%
of people look for menu variety
Ingredients to try: Harissa and sauerkraut
5
Beyond the Basics
Eco-anxiety will fuel demand for vegan, vegetarian and flexitarian diets, as well as creative ‘root-to-stem’ recipes that reduce waste to as near to zero as possible. Expect to see unusual cuts of meat make an appearance on menus along with an increased interest in offal.
Food and drink that evokes feelings of nostalgia will be popular, with basic wellknown dishes such as toast, eggs, salads and sandwiches being given gourmet makeovers using the very best in quality ingredients. Try your hand with over-filled and brightly coloured croissants, all-day breakfasts and supersalads
Products to look out for: BBQ Pulled Jackfruit, Kombucha and Smoked Tofu
Products to look out for: Orange Spiced French Toast and Nordic Bread
Ingredients to try: Banana blossom, nut butters and kimchi
Ingredients to try: Spirulina powder and coloured croissant doughs
March/April 2020
STATISTICS
67%
expect to drink alcohol
71%
expect catering facilities that can be visited outside of meal time Care Home MANAGEMENT 35
Source: Caterplus
An explosion of flavour is set to hit the UK food scene in 2020. Find out how to keep your menu on trend. By Bidfood
The 2020s are all about ‘experiential dining’ full of immersive experiences using theatre and music, light, smell and sound to heighten diners’ enjoyment.
Food made
for sharing
We are proud to bring people and food together, we cater for specific requirements and nutritional needs without compromising on the delight of a delicious meal that can be enjoyed and shared together. apetito.co.uk
FOOD & NUTRITION PREPARATION
Blending with care
The need for a modified diet does not preclude an enjoyable mealtime experience. By Robotcoupe managing director Ed Cotterell
I
n a care setting mealtimes play a vital role. As well as providing vital nutrition, mealtimes are a social occasion that ensures that residents engage with others and avoid isolation. People require a modified diet for many reasons (see box below) and there can be a tendency for chefs simply to blend dinners up and serve them in a bowl – forgetting about the important role of nutrients, flavour, colour and variety - and expect residents to eat them and be happy. But if we eat with our eyes, it’s time to drop the scoop and start piping the food on the dish to make it look more attractive.
The downside of blending
When blending involves adding liquid to food, nutrients are diluted and residents will have to eat a larger quantity to food to achieve the same nutrient load. For older people with small appetites, or those who cannot see the appeal of their blended food mass, this is often a challenge. Solutions such as blended ready meals can put pressure on catering budgets, whereas often training plus the right equipment are all that are needed to give the pleasure back to people requiring a modified texture meal.
A vegetable boiled... apetito dietitian Emily Stuart looks at the pitfalls in fresh food preparation
Chefs face several challenges as they try to maximise the nutritional content of their food. From the cooking method, to the sourcing of the ingredients, these variances can lead to inconsistent nutritional values and meal quality. Different cooking methods impact the nutritional value of an ingredient. For example, when boiling vegetables the water-soluble vitamins (vitamin C and various B vitamins), can become diminished unless the boiling water is used throughout the creation of the dish. Storage also has an impact: the longer fresh ingredients such as fruit and vegetables are kept before consumption, the less likely they are to retain their maximum nutrient profile. Flash-freezing fresh ingredients can lock in nutrients, maximising nutritional values. Care homes are encouraged to seek support and training for catering staff where necessary, or take advice from catering suppliers with dietetic insight.
Why people need modified texture meals •
peech and Language Therapist (SALT) Prescribed diet – Dysphagia, S choking and swallowing problems diagnosed as part of a SALT assessment
• Muscle weakness: particularly, those responsible for mastication and swallowing, leading to an increased risk of aspiration People with dementia: dislike of lumpy foods Oral health problems Poor fitting dentures due to weight loss, gum disease. Teeth problems such as missing teeth • Personal choice Residents wanting soft foods because of fatigue, ill health or end of life care.
• •
March/April 2020
Care Home MANAGEMENT 37
BATHROOMS DESIGN
DESIGNING THE
What will I learn from this feature? How to improve your bathroom experience
perfect bathroom Reducing risk of slips or falls and infection, while supporting best practice in moving and handling and providing residents with a relaxing therapeutic experience, are just some of the challenges facing your bathroom design. Malcolm Farmiloe, group director, Gainsborough Healthcare Group, discusses some of the options for making an impossible mission, possible 38 Care Home MANAGEMENT
FLOORING AND WALLS
Flooring should offer a durable, slip resistant surface that allows thorough cleaning right to the edge of the room. Ideally there should be no thresholds when moving between rooms or different surfaces so that assistive devices can be wheeled without interruption. Walls can be clad with contemporary paint, tiles or boarding, however, welded seams or an antimicrobial finish may add to easy cleaning and infection control. Wall colours and finishes are a matter of taste, albeit there are aesthetic considerations that may encourage use of matt paint or surfaces, with light hues and minimal patterns: • white gloss walls may look clinical and are easy to clean, however, they do not communicate a warm, relaxed atmosphere • reflections can be disorientating for some service users especially if visually impaired • darker colours can be perceived as threatening.
SANITARY WARE
Bathroom design should locate the bath and other sanitary ware in places with easy access for wheelchairs and hoists, whether transfers take a parallel or end-on approach. Three-side access to the bath also reduces the need for carers to reach, protecting them from back injury. Height adjustable baths with bather transfer seats reduce the risk of falls for bathers, improve dignity in transfer and reduce the risk of staff injury. Pleasure and therapeutic experience can be enhanced through optional features such as hydrotherapy, chromotherapy and sound. Careful thought, with the individual user’s requirements in mind, also needs to be given to the placement of grab rails, shower heads and controls: wheelchair users transferring to a shower chair or bench will require grab rails and their shower head and controls to be lower than those for a standing bather. Users with limited sight may benefit from colour-contrast fixtures and fittings. www.chmonline.co.uk
BATHROOMS DESIGN
SHOWERS
To protect against scalding bathroom planning should consider options such as temperaturecontrolled mixer or electric units and cool bar technology to counter exposed shower components. Temperature-controlled water is imperative to protect against injury, especially as care facilities store water at a temperature of over 60OC to kill Legionella bacteria. Other considerations include: • Hose: Longer hoses give users the option to sit or stand in the shower. • Heads: Overhead, rain or rose heads can be distressing and disorientating. • Seats: options include fixed, adjustable or folding options, and those with a greater weight limit for bariatric users. Users with balance issues may prefer seats with folddown arm rests for greater reassurance and stability. Contrasting colours can also help with orientation. Grab rail options include: straight, angled, ribbed or fluted designs. • Screens: Options depend on access requirements and the available space and layout. Choices include: uni-, bi- or corner-folding doors or ‘barn style’ shower screens that allow carers to remain dry.
TOILETS
There are many designs and wall mountings to choose from, and the priority is to achieve simplicity of use and ease of cleaning. Options for consideration include: • Raised units that facilitate sit-to-stand transfers. Remember to ensure your chosen product is compatible with commode chairs. • Stabilising lugs under a seat will eliminate lateral movement when making a side transfer from a wheelchair. • Soft-close seats and rounded corners increase safety. • Seats with signalling high visibility colours can help users locate and engage more accurately. • Cisterns should provide straightforward access for repairs and for the sake of hygiene should allow pipework to be concealed. For information on bariatric toileting, please see page 41.
WASH BASINS
Basin options include: semipedestal, height/lateral adjustable, swing-away, wide ‘flared’ with grab slots, countersunk or recessed, depending on
the available space and access considerations. Swing-away basins, if mounted near a toilet, allow users to wash hands whilst sat down – reducing a transfer process. The choice of pillar or monobloc taps, and plugs needs to reflect the intended usage. Homes should be aware that monobloc taps with their choice of rotational, pivot or push/pull controls can be confusing, especially for those with dementia. Conversely, they can be helpful for people with restricted mobility, perhaps, following a stroke. Rounded corners increase safety for bathers and carers.
VENTILATION AND DRAINAGE
Highly effective ventilation and drainage are commonly overlooked but reducing high levels of humidity is a key part of wet room management and durability.
LIGHTING
A centralised source of lighting is far less disorientating for residents. Lights activated by motion sensors reduce utility costs and provide the advantage of autonomous use.
Is your bathroom disabled or disabling? The Person, Environment, Occupation (PEO) model of occupational therapy deals with the relationship between a person, their environment and the impact on occupational engagement. It highlights that individuals should not be labelled as disabled, more that environments are disabling. PEO sees the person as more than just a medical condition but rather what motivates them, interests, their degree of autonomy, physical and cognitive level relative to their relationship to the environment. The environment does not just refer to the physical location but also to relatives, carers, friends, professionals and it is the relationship between these two domains that affects the person’s occupational performance and their ability to self-care, and enjoy productivity and leisure. Source: Closomat
BATHING ENABLEMENT
SHOWER POWER
Why unassisted bathing is the gold standard of care. By Hannah Berry of Horne Engineering
R
Laundry in a muddle? ...You need
egular, unassisted showering for as long as possible is the gold standard of care. Aside from improving health and cleanliness, autonomous bathing promotes independence, feelings of accomplishment, self-esteem and contentment. In short, it’s enabling. On top of this, you can add in the positive impact on health and wellbeing. Many people find bathing a therapeutic experience, enjoying the feeling of warm water on their skin. Physically, good personal hygiene reduces the undesirable effects of neglect: infections of the skin and of the urinary tract and other irritations. When these occur, these create a vicious cycle of declining health and self-esteem, which detrimentally affects mood and behaviour, and, potentially, the resident’s willingness to engage with shared activities and fellow residents – increasing the risk of isolation.
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Often, distress triggers are involved. The most common include: falling, scalding and fear of flooding their environment.
T: 0344 5611994
Reducing falls: A well-thought out dementia-friendly bathroom design will encourage even the frailest or confused resident to retain their bathing confidence for longer. Useful features include signage to assist wayfinding, decluttered hallways and wellplaced and highly visible handrails.
Choice of colour is important for the ageing/impaired eye: colour perception fades over time, with purple, blue and green colours the first to be affected. For optimised inclusivity and visibility, contrast and beneficial effect on mood, vivid orange is recommended over red - which is commonly associated with danger - and yellow, which presents an unsuitable tonal contrast with pale background walls. Scalding and flooding: Bathroom fittings that deliver comfortably warm water (user-adjustable up to a 41°C maximum) and at an adequate – but not overwhelming - flow rate will lower stress and increase the pleasure associated with bathing. Easy to use lever controls with good grip and stability, fine adjustments, low-force release and easy carriage movement will all help to increase a resident’s confidence that they can bathe without fear of flood.
Keeping it down By Trudi Osborne, marketing manager at Airdri Don’t let excessive hand dryer noise spoil your residents’ bath time pleasure. Hand dryers are commonly positioned in an enclosed, tiled environment, and this amplifies the noise they make, putting pressure on the eardrums and causing significant discomfort. For some, particularly those wearing hearing aids or who have dementia, loud high-speed hand dryers can be alarming, leaving them feeling intimidated, and discouraging them from using the washroom facilities.
www.chmonline.co.uk
BATHROOMS BARIATRIC TOILETING
Behind closed doors One size does not fit all, particularly in bariatric toileting says Closomat marketing manager Robin Tuffley
E
veryone, regardless of size, goes to the toilet on average eight times a day. But, before an obese person can ‘go to the loo’ they need to be able to get on and off it. A person’s weight and size can all impinge on mobility and agility. Effective personal hygiene, that promotes optimum independence and dignity, is important throughout the care home, and nowhere more so than in ‘the smallest room’.
Toilet support systems
In a bariatric care environment, there should be a wider and higher toilet seat, located with a minimum turning radius of 1.8m/6ft to accommodate larger wheelchairs. There should be adequate distance between toilet and sink to allow the person to rise without using the sink for support. The following may be suitable for your bariatric bathroom: Toilet lift: If the person can stand and walk unaided, or with minimal help, a toilet lift fitted over the WC can provide appropriate support with standing and sitting. Hoist: Variants include wheeled frames and ceiling track. Choice is influenced by budget, and environment: • A single or multi-user environment March/April 2020
• F or use in one room or beyond
• The layout of the room
•
i.e. whether ceilings and walls are robust enough to bear the necessary load, and the positioning, and style/protuberance of fixtures and fittings Transfer requirement – transfer from similar height (wheelchair to toilet) or for more height adjustability (wheelchair to changing table).
5–6 June 2020 Olympia London
The toilet
There are two main influencing factors – weight loading and body mass. Weight loading: The toilet itself needs to withstand the weight load. Conventional WCs and most wash/dry toilets bear up to 127kg/20 stone. Most bariatric aids will withstand up to 346.5kg/55st. Body mass: A larger body can often cause the user to be sat too far forward, so their bottom does not cover the seat opening. The user can feel perched on the toilet, and unstable. The volume of flesh can also impact on their – or their carer’s – ability to reach and wipe clean. Solutions may include a wash/ dry toilet comprising toilet, bidet and drier in one unit.
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Full Virtual Dementia Tour Training
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The UK’s only exhibition and conference for Alzheimer’s and dementia is your opportunity to hear from leading experts, discover new ideas and information, experience the full Virtual Dementia Tour training and further your professional skills. To book tickets and for more information visit
www.alzheimersshow.co.uk In partnership with
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Care Home MANAGEMENT 41
COFFEE TIME TIME OUT
TIME A DAY IN MY LIFE...
Put your feet up with a cuppa while you enjoy these bits and pieces from the care home world
CARE HOME MANAGEMENT
MARCH CROSSWORD
WIN a bottle of fizz!
Aliyyah-Begum Nasser shares the ups and downs of her life as a director at rehabilitation and care community Askham Village Community March 8 was International Women’s Day 2020, a campaign that this year takes the theme #EachforEqual The key aims of the campaign are to challenge stereotypes, broaden perceptions, and celebrate achievements. In the working world we typically hear about the contribution of women in the workplace and the opportunity cost of failing to be inclusive. Well, amid this backdrop, it’s time to fly the flag of the health and social care sector. In the care sector women can and do lead large, complex organisations effectively and consistently. In finance, it’s celebrated when a senior team is over 50 per cent female. In care, it’s the norm. In law, flexible working at the highest levels is something working mums fight for. In care, it’s the norm. Recruitment and retention are the biggest challenges in social care: the work we expect staff to do each day is gruelling and often thankless.Yet care staff routinely juggle the daily challenges of work and home life with skill and compassion. Whether it’s flexible working around childcare or looking after unwell relatives, or being supported in study alongside daily work duties, the culture of care extends beyond residents to our staff. Dignity and respect are values that apply equally to staff as they do to residents; that staff are empowered to be their best selves irrespective of gender. Our environment is one where female staff can and should flourish.Women working in care display determination, ambition and compassion – and that is something to be celebrated all year round – not just in March! 42 Care Home MANAGEMENT
ACROSS 3 A home from the sea in Surrey 4 The best colour for eyes with suboptimal colour perception 6 Who’s encouraging bathroom independence 11 This is one of the most important elements in giving occupants time to escape safely in the event of a fire 12 The CQC review of restraint and __________ is due this month (March) 15 The location of the Dementia, Care and Nursing Home Expo on March 17-18 16 A group of residents with special toileting needs 18 Author company of our Market Barometer 19 Something care homes need to get good at handling 20 This is the smarter way to care Terms and conditions To enter the March Care Home Management crossword, simply photograph your completed crossword and email it to editorial@chmonline. co.uk by March 31, 2020.The winner will be the first correct entry drawn after the closing date. Postal entries to the address on page 3 will also be accepted.
DOWN 1 Solicitors that run Care Home Management’s legal helpline 2 LPA stands for Lasting Power of __________ 5 Skills for Care is looking for homes to host these 7 Coconut Skewered __________ are one way to feed the senses 8 We’ll see you there on June 8-9! 9 In the US, care villages are known as__________ Care Retirement Communities 10 Technology used in this sports equipment 13 Gainsborough Specialist __________. The new name for Gainsborough Specialist Bathing 14 Our research tells you how to improve this 17 This expert in heating can help you save money
HOW TO ENTER: To enter the March Care Home Management crossword, simply cut out or scan your completed crossword, and send by post or email to the editor at Care Home Management (editorial@chmonline.co.uk) by March 31, 2020. The winner will be the first correct entry drawn. Name: ……………………………………………………… Care Home name & address:…………………………… ………………………………………………………………… ………………………………………………………………… To receive the free CHM weekly newsletter, please provide your email address: …………………………………………………
www.chmonline.co.uk
PEOPLE EVENTS
People
Care home movers and shakers NHS England has created a new post to ensure the representation of care home nurses at the highest levels. Professor Deborah Sturdy OBE, who is an honorary nurse advisor for Care England, will take on the role of strategic advisor for care home nursing, liaising with chief nursing officer for England Ruth May.
Carolyn Ball has been appointed general manager of Belong Morris Feinmann, in Didsbury, Manchester. Ball brings with her six years’ of management expertise, including as front of house manager at the Didsbury care village. Ball is succeeded at the care village by Lorraine Johns. Rebecca Blackburn has been appointed to run Czajka Care Group’s Fairmount nursing home, in Shipley. Blackburn has had careers in finance and nursing. Charlotte Gilbert (left) has been promoted to manager at the Brendoncare Chandler’s Ford home. Previously, Gilbert held roles of acting general manager and deputy manager, having started her caring career at age 16. Also joining the Hampshire-based charity is Lisa Wallace, who takes up the post as manager at Brendoncare Meadway, in Winchester. Hampshire-based specialist care provider Cornerstone Healthcare has appointed Michelle Murchan as general manager of its South Africa Lodge home. Murchan is a registered general nurse with experience in healthcare management within the NHS, in private care homes and as a regional manager. Canford Healthcare has appointed Sandra Roche MSc DipSW as manager of its Hampton Care Home. Roche’s experience lies in field social work, home management and local authority provider services. Borough Care has promoted Nerys Carpenter to the position of area manager. Carpenter was previously manager of Borough Care’s Shepley House in Hazel Grove, starting her career in care, with Borough Care, as a care assistant. Taking up promotion to the role of experience coordinator at Belong Warrington is Carol Norman. Norman brings 25 years’ experience in dementia and end of life care and currently, she is working towards her NVQ level 5 leadership and management qualification. She moves up from the role of lead senior support worker.
March/April 2020
Events
MARCH
National Education Scotland Bereavement Charter Consultation events. Friday 13 March. 10am-12pm (Venue: NES Edinburgh); Monday 23 March. 10am-12pm (Venue: NES Edinburgh). To register your interest in attending please contact SupportAroundDeath@nes.scot.nhs.uk. Dementia Care & Nursing Home Expo 2020. TuesdayWednesday. March 17-18. NEC, Birmingham. For more information, see page 26 or visit the event website, via: link: https://tinyurl.com/vd5euuj Safeguarding Adolescents and Young Adults: Delivering a Strengths-Based Approach. Monday 16 March. De Vere West One Conference Centre, London. For more information, visit: https://tinyurl.com/qr9h6ts Appello event: Meeting expectations with digital telecare. Wednesday 18 March St James Park, Newcastle. For more information, visit: https://tinyurl.com/ratsx88 Scottish Care member employment law webinar. The Good Work Plan. Friday 20 March. 11-11:30 am Charity organisation Dundee Volunteer & Voluntary Action (DVVA). Dundee SmartCare Convention. Wednesday 25 March, Dundee University. For more information, visit: https://tinyurl.com/walg9rr Life Sciences Hub Wales conference. ‘Tomorrow’s Health 2020’, Wednesday & Thursday 25-26 March, Llandudno. To register for a free space, visit: www.tomorrowshealth.wales
APRIL Care England National Safeguarding Adults Conference. Liberty Protection Safeguards Implementation of the Mental Capacity (Amendment) Act 2019. Wednesday 22 April. Novotel Conference Centre,York. For more information, visit: https://tinyurl.com/qr9h6ts Appello event: Meeting expectations with digital telecare. Thursday 23 April. Cardiff City Stadium, Cardiff, Wales. For more information, visit: https://tinyurl.com/urkp62x Care England National Safeguarding Adults Conference. Adult Safeguarding 2020: Delivering a StrengthsBased Approach. Friday 24 Apr 2020. West One De Vere Conference Centre, London. For more information, visit: https:// tinyurl.com/wtw6c8n Scottish Care member webinar: Care Inspectorate. Friday 24 April. For more information, visit: https://scottishcare.org/ event/scottish-care-webinar-care-inspectorate/ Appello event: Meeting expectations with digital telecare. Thursday 30 April. Chester Racecourse, Chester. For more information, visit: https://tinyurl.com/rlngos3
FUTURE EVENTS The Alzheimer’s Show. Thursday-Friday 5-6 June. OIympia, London. For more information, visit: https://alzheimersshow.co.uk/ Care Forum conference and networking event. Monday & Tuesday 8-9 June. Whittlebury Park, Northampton. For more information, visit: https://thecareforum.co.uk/
Care Home MANAGEMENT 43
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