Care Home www.chmonline.co.uk
July/August 2018
Management
The elephant in the room Will social care get any more money? Excellence at the Close Close care home scoops top award
Flooring How to give your home the 'wow' factor
Lifting and hoists Why LOLER is no laughing matter
Issue 74
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Editor’s Letter
Welcome to the July/August edition of Care Home Management
Care Home Management July/August 2018
Issue 74
Annual Subscription £30.00 Where sold cover price of £4 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Design/Production Phil Cunningham www.creative-magazine-designer.co.uk Published by S&A Publishing Ltd Croham Lodge, Croham Road, Crowborough East Sussex TN6 2RH Tel: 01892 663350 Email: editorial@chmonline.co.uk sales@chmonline.co.uk Advertising Space Marketing Tel: 01892 677721 Email: naomil@spacemarketing.co.uk www.spacemarketing.co.uk www.chmonline.co.uk Copyright: Care Home Management Magazine 2018
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.
Care Home www.chmonline.co.uk
July/August 2018
Management
As this issue went to press the care home world is waiting with bated breath for some good news to come from the Department of Health and Social Care in the form of the green paper on adult social care. And good news will be timely indeed. With all the doom and gloom about “shock care home insolvencies” and the problems of financing care home excellence out of diminishing local authority budgets – not to mention the sword of Damocles of the HMRC sleep-in ruling – there are many who will feel that care homes are overdue their bit of good luck. In the past few months care minister Caroline Dinenage has been very visible at events such as the Dementia Care and Nursing Home expo and the Alzheimer’s Society annual conference speaking lots of warm words about the value of the sector, its importance to people’s quality of life and also of the ‘umbilical’ links between the NHS and social care. She has also pointed out that the green paper, which is expected to be launched in support of the NHS 70th anniversary in July, is the department’s chance to transform social care. Personally, I would caution against placing too much hope in the green paper. To me, it seems quite a big ask that one piece of policy will usher in a revolution in social care – do you remember the ‘so big you can see it from space’ reorganisation of the NHS in 2013? Some five years on from that, and in the era of GPs co-commissioning with CCGs, it is easy to find people who think we have merely navigated ourselves back to where we were at the start. And, let’s not forget that the cosmic reorganisation seen in the NHS over the past few years has not been accompanied by stellar amounts of additional funding. I am not sure why social care should feel its fate will be so very different. So, where does all this leave social care? On the fast-track to self-destruction? Of course not. For as long as people will continue to get old and need support as they live longer with chronic health conditions, there will be a need for social care. And, there is no doubt that those homes that deliver excellent care with pride and determination, will be the ones that, like the cream in your latte, float to the top of the cup. It is with great pleasure, then, that in this issue we can reveal the winners of the second Care Home Awards. Reading through the entries it is palpable how much care home staff care about their residents; how caring is far more than just a job or a business; how far more than money is invested in running a care home. And, if the green paper fails to deliver on its promises, take heart that the great and the good in caring will always find ways to survive.
editorial@chmonline.co.uk
The elephant in the room
@Carehomemanage
Will social care get any more money? Excellence at the Close Close care home scoops top award
Flooring How to give your home the 'wow' factor
Lifting and hoists Why LOLER is no laughing matter
Issue 74
Ailsa Colquhoun Publisher/Editor
July/August 2018 | Care Home Management 3
Contents
9
7 Care Home Awards 2018 The votes are in and the awards are out – find out who the winners are 9 Who’s been in the news since our last issue? Who’s been making the headlines on CHM Online?
18 Training Do you go for online training or faceto-face? Understand the pros and cons of each 21 Residents’ care Care advice from the people who receive it
12 Why the Close care home is a winner Discover what makes the Close care home so special
22 Flooring What the private market wants from your care home floor
15 The Care Home Management Hall of Fame Care home winners and success stories from around the country
23 Flooring Is your floor working as hard as it can to keep staff healthy and safe at work?
16 Outstanding practice Take a look at the learning points from two outstanding care homes
24 Flooring Common flooring myths debunked
12 4 Care Home Management | July/August 2018
15
25 Lifting equipment Why LOLER is no laughing matter for care homes 28 Chair-based exercises How to keep residents in motion – without leaving their chairs
25
33 Kitchens Hand hygiene and canny food preparation explored 35 Legal Why and how to implement a good whistle-blowing policy in your home 37 People and events Who’s new and what’s happening in the care home world
33
38 Product spotlights CHM’s preview of this issue’s new products
Eleanore’s words to the wise Sleep-in case appeal’s decision due soon By Eleanore Robinson, former editor at LaingBuisson and freelance healthcare journalist The care home sector is waiting with baited breath for the Court of Appeal’s decision on Mencap’s sleep-ins case. Expected as Care Home Management magazine went to press (mid-June), the ruling could literally be make or break for many care home operators. Ever since HM Revenue and Customs (HMRC) decided to stick to the letter of the law on making sure employees were paid the National Minimum Wage (NMW) even if they were working at night and expected to spend most of their shift asleep, providers have been fighting to save their business. It is not so much the demand to start paying employees what HMRC feels they are rightly owed, it is the right to historic back pay that could have devastating consequences for some operators, particularly those who are on tight margins. A survey of 190 providers earlier this year found that two-
thirds believed their organisation would come under threat if the ruling supported back dating pay for six years. If it was for two years, a third would be in danger. Compounding the problem further, less than half of local authorities have agreed to fund sleep-ins at NMW levels. As one of the major care home groups remarked to me “the tanks are at the gate now”, signalling that the past two years – the time this issue has been on the table for - really do seem to have become a war of attrition between operators and the taxman. The choice of joining the Government’s compliance scheme, which gives providers up to a year to identify what they owe to workers, and a further three months in which to pay workers - or to take your chances with HMRC’s inspectors, means you are damned if you do and very damned if you don’t. It seems the only real choice is to prepare for the worst, with redundancies, renegotiation of contracts with commissioners and handing services back all options on the table. But this could also be an opportunity, and some providers are already planning to use technology as an alternative to sleepins, redesign this type of service and join forces with other providers to share the burden. Whatever the outcome, the impact of this ruling could shape care services for years to come. July/August 2018 | Care Home Management 5
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Care Home Awards 2018 steal the
headlines at Health + Care 2018 The votes are in and the judges have made their decisions about the winners of the Care Home Awards 2018 A record number of entries of unprecedented quality made it a difficult job, but the panel of 13 judges drawn from residential care homes as well as their suppliers have made their decisions about the winners of the Care Home Awards 2018. The awards were presented at a glitzy celebration lunch, held at the Health + Care 2018 conference and exhibition, at London ExCeL on June 27-28. Together with the conference’s specialist content for residential and nursing care operators and staff (see box, below) the awards really made it a day to remember for the best of the best in residential and nursing care. In total, there were 32 finalists vying for 15 awards. For care homes, categories ranged from best specialist care to best facilities management or maintenance team. Three supplier awards were also on offer: two for best equipment, product or service provider and one for best professional or business services provider. Special congratulations go to the following gold award winners in the
following categories: ■ Best individual care home: The Close care home (profiled on page 12-13 of this issue) ■ Best single care home in a group: Care UK for Mildenhall Lodge ■ Best smaller care home group (up to 50 homes): Tanglewood care homes ■ Best larger care home group (over 50 homes): Avery Healthcare For more information on the awards, the judges and the winners, please see the Care Home Awards supplement included in this issue.
Residential and nursing care conference programme at Health + Care 2018 Here are just a few of the sessions held at Health + Care 2018 which were dedicated to residential and nursing care
There’s more great content for residential care operators planned for next year’s Health + Care. This takes place at London ExCeL on 26-27 June 2019. Register your interest at: www.healthpluscare.co.uk/
■ Learning from the Government’s New Care Models programme. Speaker: Emily Wighton, national care homes senior manager - New Care Models programme, Systems Transformation Group, NHS England ■ How to reduce your recruitment costs and grow your business by hiring great talent Speaker: Scott Sherriden, managing director - The Care Hub ■ Sources of finance for social care businesses - what’s fundable, and what’s available? Panel discussion ■ Tackling increasing dietary and nutritional needs in older people. Speaker: Jonathan Amies, head of specialist nutrition, Apetito July/August 2018 | Care Home Management 7
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News round-up
All the news you need to know Care Home Management brings you a concise round-up of the most important news articles from the past month
Green paper must address “elephant in room”
Alzheimer’s Society has called on government to address the ‘elephant in the room’ of social care funding, in response to calls to cut long stays in hospital. At the annual NHS Confederation conference on Wednesday, NHS England and NHS Improvement chief executives Simon Stevens and Ian Dalton committed to tackling the problem which sees up to a fifth of hospital beds occupied for three weeks or more. Responding, Sally Copley, director of policy and campaigns at Alzheimer’s Society, said: “It’s great to see the Government sitting up and taking this issue seriously. But the elephant in the room is social care funding, and this issue will never be fixed until that’s addressed.” Read more online at: https:// chmonline.co.uk/green-paper-mustaddress-elephant-in-the-room-ofsocial-care-funding/
Don’t forget Care Home Management’ s website, www.chmon line.co.uk brings you the news every day – as it ha ppens. Bookmark it n ow!
CQC shares tips from seven turned-around homes Seven care homes have shared their hints and tips to turn a CQC ‘inadequate’ rating into ‘good’, in a new CQC report. The report, Driving improvement: Case studies from nine adult social care services, finds that the recruitment and retention of capable, valued and supported staff are critical if a home wants to improve. According to the CQC, key lessons to arise from the case studies include understanding and accepting that problems exist; creating a clear vision to improve and putting that
into action; appointing strong leaders who can establish an open and transparent culture; and focusing on developing a workforce that is valued, well trained and supported to deliver safe, effective person-centred care. Read more online at: https:// chmonline.co.uk/cqc-shares-tips-fromseven-turned-around-homes/
Care England names and shames 10 CCGs for 0% fee uplift Care England has named 10 CCGs which have not increased their continuing healthcare (CHC) funding for 2018-19. Warning that these could represent the tip of the iceberg, Care England has named the following CCGs: • Camden • Haringey • Islington • Oxford • Waltham Forest • Stafford and Surrounds • Cannock Chase • East Staffordshire and Seisdon Peninsula • North Staffordshire • Stoke on Trent. Care England has also initiated a series of Freedom of Information requests across 152 councils to gather data on commissioning activity for 2018/19.
This data is being collected on the themes of fees paid by councils for residential, nursing home and supported living care, as well as use of resources and placement activity across older people and learning disability care. Once collated, Care England will triangulate responses with other data such as quality ratings, projections on bed numbers and staffing, and analysis of council’s spending plans to build up a comprehensive picture of each council’s response to the local care market. Read more online at: https://chmonline.co.uk/freedomof-information-act-scrutiny-overcommissioning-policy/ https://chmonline.co.uk/careengland-names-and-shames-10-ccgsfor-0-fee-uplifts/
July/August 2018 | Care Home Management 9
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Building a better future for care
News round-up
Adult social care employers contribute £46.2 billion to the UK economy, according to a new report
CMA weighs in with customer care advice The Competition and Markets Authority is consulting on new advice to help care homes meet their consumer law obligations. Proposals cover issues such as: ■ What upfront information homes need to provide to prospective residents and their representatives to help them make informed choices
The consultation closes on 12 July and will add to new advice on the charging of fees after a resident’s death. Read more online at: https:// chmonline.co.uk/cma-consults-ondraft-consumer-law-advice-for-carehomes/
■ How to ensure that contract terms and treatment of residents and their representatives are fair ■ Obligation to provide services to residents with reasonable care and skill ■ Fairness and transparency of complaint-handling policies and procedures.
The ‘fork in the road’ facing social care funding Adult social care employers contribute £46.2 billion to the UK economy, according to a new report. Commissioned by Skills for Care and Development. The Economic Value of the Adult Social Care Sector - UK report quantifies the economic impact of a growing sector offering services in 45,000 sites across the UK in 1.8 million job roles. Skills for Care & Development chair Dame Moira Gibb said: “This is the first time we have produced a UK wide report into the economic value of adult social care and we find our sector injects billions into the national economy. “This report highlights the importance of social care not only as provider of services to our fellow citizens when they need it, but our sector’s importance as a provider of jobs in local economies across the country where much of the money is spent.” Read more online at: https:// chmonline.co.uk/adult-social-careemployers-contribute-46-billion-to-theuk-economy/
“England is now at a clear ‘fork in the road’ between a better, but meanstested system, and one that is more like the NHS: free at the point of use for those who need it,” according to a new report by the Health Foundation and the King’s Fund. The organisations say that the current system, which sees fewer
people receiving publicly-funded care every year, will result in a £6 billion funding gap by 2030/31. If the system is improved, the costs go even higher. The report sets out several options for social care reform. Read more online at: https:// chmonline.co.uk/social-care-fundingis-at-a-fork-in-the-road/
Welsh care homes face extra inspections of medication use Welsh politicians have called for enhanced scrutiny of the way care homes manage challenging behaviour in residents with dementia. In a new report, they call for mandatory routine reviews and recording of antipsychotic medicine use in care homes. The report by the Welsh health and social care committee also makes a number of other recommendations including: ■ An allied health professional dementia consultant to work with
care homes assessment of care home staff skill and guidance on safe and appropriate staffing levels ■ Specific training for challenging behaviour in dementia ■ Health boards to collect and publish data on the use of antipsychotic medication in care homes. Read more online at: https:// chmonline.co.uk/welsh-carehomes-face-spectre-of-enhancedmedicines-policy-inspection/
July/August 2018 | Care Home Management 11
We just want to be the best
Best Individual Care Home
The Close Care home in Burcot, Oxford is this year’s best individual home in the Care Home Awards. CHM magazine editor Ailsa Colquhoun finds out why it won Cuddling Louis, the Jack Russell/ Chihuahua cross, or spending time in the garden, are not the only activities to help residents at the Close care home to feel like they are at home. Residents also enjoy a Friday night take-away, cooked in the home but served in real take-away containers, and they have their own mini-kitchen if they want to make themselves a small meal or a snack. And, just like in a normal home, residents also get a say in who gets to work for them. In a recent Care Quality Commission inspection, the home received an outstanding rating for its care: inspectors described residents as being “supported by an exceptionally caring service”. They noted that managers took opportunities to spend time with people in a social environment… and that they saw many kind and compassionate interactions and many examples of staff and
management going to exceptional lengths for people. Just one example is when staff arranged for a resident to Skype into a relative’s wedding, as they were too unwell to attend. In his entry to the 2018 Care Home Awards, director Sanjay Dhrona describes the home as having “been on a remarkable journey” over the past three years. During this time, the 90-bed home has moved from a rating of inadequate with a full red local authority report to an allgreen rated, multi-award-winning establishment with its eye squarely on achieving an overall outstanding rating from the CQC. The latest accolade for the home is to win the 2018 Care Home Award for best individual home, which will join the award won by the home last year for best nutrition, food and dining experience. Dhrona says the awards are a great way to recognise the
12 Care Home Management | July/August 2018
Sanjay Dhrona “collective hard work” of all the staff that has gone into transforming the home. Close partnerships Close care home prides itself on being a true part of the local village of Burcot, near to Oxford. The home played a key role in bringing high speed internet access to the village, and is often to be found hosting village events from its four-acre site. The home also describes itself as the “number one care home working with the John Radcliffe hospital”, which has selected the home as a test site for a new, non-contact heart and respiratory rate monitoring system. This aims to replace manual hourly nighttime observations. The trial should go live by the end of August, and if successful, will make the Close care home the only home in the UK to offer this technology to residents. A second piece of research involving the home, taking place in partnership with Oxford University and the Said Business School, centres on the development of a virtual reality product to support residents with dementia.
As a single home business, Close has the agility and scope to be able to try new things, believes Dhrona. “We don’t have a great, corporate process to go through, so if I hear something on the radio that I think is worth trying, it can be part of an SOP before I’ve even stopped talking.” Providing everything goes to plan, from September 2019, the Burcot team will be able to share their ideas with a second Close care home. The company plans to build a new, 75-bed site in nearby Didcot which, according to Dhrona, will have a “bold colour aesthetic that communicates the glamour and sex of the 1950s and 60s”. A key aim, he says, will be to appeal to LGBT residents, who can feel “forced back into the closet” because of the way care is currently organised. He says: “The new home will be an opportunity to foster inclusivity and diversity.” Residents’ input Inspiration for care innovation at Close comes from a wide range of sources, including, of course, the views of residents, the local health and social care team, and staff. The home prides itself on its ‘no-door’ policy, which means senior managers are always accessible to staff, residents and their relatives. With three managers in post, every day there is a minimum of one manager on site - and every month managers do a shift of front-line care. “It’s good to keep up clinical skills and it also gives residents the reassurance
that the top brass knows what is actually going on,” Dhrona says. Also making their mark on the design and quality of care is Dhrona’s previous experience in experiential marketing for a City law firm, as well as the ‘time-out’ he takes in his favourite London haunt, the Groucho Club. Multisensory celebrity chef Heston Blumenthal has also left an impression. Dhrona explains: “When Heston creates a dish, for example, his
famous ‘Sound of the Sea’ offering, the experience includes sight, smell and sound. We’ve tried to do the same for residents with poor appetites. For example, our sea box tray includes the smells of the seaside, and the feel
Sea box tray
of real sand. It’s enough to make you want to head straight for the fish and chips.” A Close sense of pride Over the past three years the Close care home residents and staff have benefited from a significant programme of investment taking in décor, technology and staff training. And, with half of all beds funded by the local authority, it is clear this does not have to be an investment-limiting factor. Dhrona admits, of course, that even in the more prosperous home counties the climate for local authority funding is challenging, and that the home has had to fight plenty of battles in the past. He says: “Our position is that we have to have the right money for the right level of care. People are here for a reason – and that is that they need the care we can offer. For me, it is about setting a principle that you don’t just walk past and start to accept a certain behaviour.” Dhrona describes the past three years at the home like being on “a juggernaut at full speed, that needs to stop, to do a three-point turn and to start travelling in the opposite direction”. He feels that the Close is now pointing in the right direction, and that there is every reason to celebrate more than just the 2018 Care Home Awards win. He says: “We are doing everything we can to get outstanding [ratings] across the board. We just want to be the best independent nursing/care home in the UK.”
July/August 2018 | Care Home Management 13
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Audit Trail
CHM Hall of Fame
Proud to present…
…The Care Home Management magazine care home hall of fame good knowledge of policy and procedure with colleagues having to complete the care certificate within a period of 12 weeks. Pictured receiving the gold award from gold medal Olympic athlete Colin Jackson (right) are CHG’s Carol Corstin and Qube Learning CEO Joe Crossley For more information on the Qube Learning award, visit http://www.qube-learning.co.uk/qube-awards/
Nine awards have been given by the Healthcare Homes Group, in its inaugural company Star Awards. These recognise staff who go ‘above and beyond’ the call of duty, as nominated by managers. These included Kay Emsley (pictured above middle), newly-appointed home manager, at Shipdham Manor care home, near Thetford, Norfolk, who won the front line leader award. For more information on the Star Awards, visit: www.healthcarehomes.co.uk
Mrs Joy Adams, volunteer at Edenholme care home, Stonehaven, Aberdeenshire, has been awarded the medal of the Order of the British Empire (BEM) in the Queen’s birthday honours. Mrs Adams has been visiting residents in the home every day for the past 30 years. She says: “It costs nothing to go and have fun and some of the people I see have no-one to visit them. They make me feel so welcome.” Mrs Adams says she will be putting her OBE on display in the glass display cabinet in her living-room.
Care UK has picked up a gold and a silver award for its work on supporting employee recruitment and retention at the 2018 Employer Brand Management Awards. The awards were won for best innovation in employer brand and for using digital communication. For more information on the Employer Brand Management awards, visit www.employerbrandmanagementawards.com
The Caring Homes Group has been recognised as the large employer of the year by training provider Qube Learning for its investment in apprenticeships. CHG apprentices attend an external training academy, complete shadowing to provide a mentoring service and ensure July/August 2018 | Care Home Management 15
What does it take to be outstanding?
✔ Safe: Outstanding ✔ Effective: Outstanding ✔ Caring: Outstanding ✔ Responsive: Outstanding ✔ Well-led: Outstanding
Mansard House in Fullwood, Preston
Here, Care Home Management shares important tips from CQC reports of outstanding homes
Mansard House Safe “Every opportunity was explored to enable people to manage their own medicines” “There was a genuinely open and transparent culture.” What the inspectors saw: A ‘staying safe’ notice board… provided people with good information about how to keep themselves and others safe. Staffing levels were flexible and calculated in accordance with the dependency levels and needs of residents. Staff briefings were an opportunity for staff to discuss challenging situations and behaviours and how best to manage these safely.
What the inspectors saw: Signage was clearly displayed in the form of ‘eat well plates’ and there were practical workshops entitled, ‘hidden sugars’ and ‘mood foods’ to encourage healthy eating.
Caring “The service had introduced creative ways of helping people to express their views, so staff understood things from their points of view” “Everyone felt they ‘belonged’ to Mansard House and people were supported to achieve an ‘exciting lifestyle’” What the inspectors saw: A service-user led empowerment group. Group feedback to the management team had resulted in positive changes. People involved in the operation of the organisation.
Effective
Responsive
“People were involved in providing training modules by sharing firsthand experiences with others” “People take part in the recruitment of staff” “People were involved in preparing their individual menu choices”
“The ‘Recovery Star’ was used in the most effective way. People were empowered to plan for their recovery, with the support of the staff team” People who lived at Mansard House were at the centre of all practices adopted by the home”
16 Care Home Management | July/August 2018
What the inspectors saw: Good examples of people learning new skills, such as cooking, laundry, budgeting and computer skills. Social inclusion was seen as an important part of people’s lives. People were encouraged to take part in local community events. Plans of care included people’s personal history, important relationships and wellbeing and were written with the full involvement of those who used the service
Well-led “The visions and values were built in a creative way around those who lived at the home” “A genuinely compassionate leader, who continued to develop her own skills, whilst supporting the staff team to embark on new learning experiences” What the inspectors saw: Records that demonstrated periodic unannounced night checks. Robust and regular internal auditing system, with staff involvement. Staff were signed up to a challenge charter, which encourages bad practice to be challenged. Electronic legislation or good practice update systems. Read the full CQC report at: http://www.cqc.org.uk/ location/1-132341263
Responsive
Belong Crewe Care Village, Crew
“The service [found] creative ways to enable people to live as full a life as possible” “Their individual needs, likes and personal histories were known by those supporting them”
✔ Effective: Outstanding ✔ Caring: Outstanding ✔ Responsive: Outstanding ✔ Well-led: Outstanding
What the inspectors saw: People engaged in a wide range of stimulating, enjoyable and educational activities. Staff sharing experiences with residents.
Effective “The provider supported staff champions who actively supported people to ensure … good healthcare outcomes in dementia” “People were actively encouraged to make decisions… and were provided with information in a way they understood” What the inspectors saw: People received appropriate care and support in a location that suited their needs. Healthcare professionals have noticed a marked improvement in unnecessary 999 call outs or hospital admissions.
Caring
Well-led
“Staff had an excellent understanding of people’s social and cultural diversity, values and beliefs” “People received emotional support and took strength from those around them”
“Management … displayed core values and engaged community partners” “People were involved in the running of where they lived”
What the inspectors saw: People were matched to one of the six households within the home. Staff members talked sensitively with people and encouraged feelings to be expressed.
What the inspectors saw: An approachable and engaging management team. Strong links with the local community. Read the full CQC report at: https://www.cqc.org.uk/ location/1-153793415
Infection Prevention in Care and at Home One Day Conference Sunday 30th September 2018 • Scottish Event Campus, Glasgow The Infection Prevention Society is delighted to offer an Infection Prevention in Care and at Home One Day Conference. This one-day conference is tailored for those who work providing services for people in care and those receiving care at home. The programme will focus on achieving excellence in infection prevention practice to reduce the risk of infections for this vulnerable population. Infection prevention is high on the agenda for every healthcare organisation and finding expert affordable training for you and your team can be problematic. However, the Infection Prevention Society is offering this one-day conference which will address some of the most important current challenges we face in care homes and care at home by presenting the latest evidence and applications for practice. This day is relevant for all staff and in particular those senior staff with the accountability for infection prevention within the organisation. The cost to attend is £95 and this includes access to the UK’s largest infection prevention and control exhibition.
Online registration is available at
www.ips.uk.net/conference
@IPS_Infection | #IP2018 #Carehome Infection Prevention Society July/August 2018 | Care Home Management 17
Training
Facing up to new models of training
Face-to-face training offers many advantages but it can be problematic and expensive to arrange
Effective training in care homes, both mandatory and optional, is vital to ensure the best possible care. But has the pendulum swung too far towards online learning, asks CHM magazine’s publishing editor Steve Hemsley?
Traditional face-to-face training allows learners to ask questions, network with others, physically participate in activities and receive live and appropriate feedback to build their skills around their own specific needs. Yet eLearning is growing in popularity and is ideal for more visual learners and where flexibility is needed around where and when training takes place. With margins tight, eLearning can be a cheaper option for conveying regulatory and compliance information around care processes and procedures and is perfect for employees with the discipline to self-study. However, there are certain skills that cannot be learnt appropriately online because practical work needs to be assessed. This includes cardiopulmonary resuscitation (CPR) and automated external defibrillator
(AED) training. It is also difficult to learn how to use hoists or other practical equipment via a computer. At Anchor Trust, national learning and development manager Sam Leonard-Rawlings says the current split is 70 per cent online learning and 30 per cent face-to-face. Anchor has around 120 care homes across England and online learning is increasingly being used in a blended way, for example, to boost someone’s initial level of knowledge prior to a face-to-face session on a topic such as dementia “You shouldn’t think of one method being better than the other,” says Leonard-Rawlings. “You need to consider what would be the best method and solution for each training need.” At Springhill Care Group, which has
18 Care Home Management | July/August 2018
properties in Lancashire and Bristol, the split is reversed. Head of learning and development Mike Lakins says 70 per cent of the training delivered to its staff is still face-to-face because people need to be supported through supervisions, observations and competency assessments to ensure high standards. Springhill Care Group, named one of the 1,000 companies to Inspire Britain in a report by the London Stock Exchange Group, uses eLearning to provide access to training for employees based in different locations, and to refresh people’s knowledge annually around subjects such as health and safety and infection prevention and control. Lakins says: “Managed well by an experienced learning and development professional eLearning can be a great tool.”
Training
Choosing what works At an awards ceremony run by training provider Qube Learning, Caring Homes Group won the Large Employer of the Year honour partly because of its positive work with hiring apprentices. Qube Learning’s CEO Joe Crossley says apprenticeships are a way to attract new talent or to retrain what is typically an ageing or under-skilled UK workforce. “Knowledge-based activities work best online, such as quizzes, presentations, written assignments, online lectures/classrooms and peer support within a forum environment,” says Crossley. “Face-to-face is best reserved for mentor support as well as evidence gathering around professional discussions or observations.” So what do other training providers think about the steady shift from faceto-face learning to online? Founder of Tidal Training Colin Frensham says constraints on time and budget have fuelled the trend. “Online training supports a business’s need to be flexible with time. However one key client we have worked with for five years refuses to train its staff through the online medium believing that true value is given through face-to-face engagement.” This can certainly be true when looking to improve soft skills which help to ensure that a care home’s
ethics, values, policies and procedures are understood and shared throughout the workplace. “People have different learning styles and it is the responsibility of the care home to judge appropriately as to the most effective route to learning for their staff. For more complex subjects and those that integrally require practical elements, faceto-face is, by its nature, an optimal route,” says Frensham. Gary Hook founded Edify Training in 2006 after attending different training sessions. He believes the key question to consider is whether you want staff to come away knowing lots of facts about care or to leave a training room inspired to care for their residents to the highest possible standard.
What Hook is explaining is sometimes the subtle difference between training and learning. This was discussed at the recent Alzheimer’s Society annual conference by Isabelle Latham, dementia researcher at the University of Worcester. She says care workers need to learn to care and this all comes down to the relationship between care giver and receiver. This means the training must be integrated with other forms of learning to achieve maximum benefit. “Managers need to consider the definition of a good result, the compromises on the ground that workers might be making and how interactions with colleagues - informal and formal contact - will impact on care,” she says. “This will depend on how varied staff roles are, whether people have communication and mentoring skills and their personal relationships. Do we know the effect of factors such as ‘water cooler chat’ on training?” She adds that residents can also influence and boost learning thanks to the different real-life situations they create. It is impossible to halt the rise of technology in training but care homes must use it wisely. Whether eLearning or face-to-face it is crucial decisions are made on the value received and not purely on the price paid.
Banging the training drum Registered charity Music as Therapy International is training care home staff to deliver innovative music projects to help residents with dementia. A professional music therapist will spend half a day each week over a six-week period at a care home running music sessions with staff who gradually take over running the project. At one care home five members of staff were trained and they reported how music has helped
residents who can struggle to communicate verbally and who get frustrated by memory loss and other difficulties.
July/August 2018 | Care Home Management 19
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The residents' perspective
What residents really want… caring for dementia Shelagh Robinson has lived with Alzheimer’s disease for eight years. Here, in a new series in Care Home Management magazine, Shelagh gives first-hand insight into how people with the condition like to receive care
“The most important thing to remember about people with Alzheimer’s disease is that diagnosis does not have to mean ‘life-over’. I’ve been living with the condition for eight years and I am still working as a counselling supervisor. Through Alzheimer’s Society I also see amazing people who really help me to stay positive about my condition. People don’t want to be wrapped in cotton wool just because they have a diagnosis. “Quite often people tell me they find it hard to see me as having Alzheimer’s disease. That’s the thing with this kind of dementia: its effect on a person can be different every day, so it’s important that carers keep an open mind about the care they provide. For me, the main difference in my health is that I can have problems with numbers. This affects the way I
use public transport, tell the time and order food online. This has led to some funny moments as I can never be quite sure what sizes of food are going to arrive in my order. I also need more rest than before; I’m definitely not as resilient.” Person-centred care Shelagh currently lives with her husband in an extra care setting in order to future-proof her care requirements. “I have thought a lot about the type of care I would like to receive in the event that I need it. The most important thing is that care is weighted towards what I, as an individual, want. For me, this even includes how I am addressed. For example, the term, ‘duckie’, is not to everyone’s taste. Appearance is important to an
Q: What will I learn from this feature? A: How to offer patient-centred care for people with dementia
individual and to their relatives, so it is important that staff know what clothing combinations a resident might like. When an individual is not dressed in the way that they like, it suggests that staff haven’t taken the trouble to find out what the resident actually wants. “When I am tired I like to be able to curl up with an audio book and, maybe, take a nap. There are days when I just want a ‘duvet day’: I don’t always want to be up and dressed, so it is important that care plans give weight to what the individual wants. “I take my medication via a skin patch and am able to take responsibility for that. But when I start to need help, it will be important that medicines administration or the medicines’ round is done as discreetly as possible. In a residential setting, little moments of privacy are very welcome. It’s also important that people are given the right information about their medicines, particularly side effects. It can be worrying if these are not explained carefully enough and you experience something that you didn’t know to expect.” For Shelagh, the most important thing is that staff get to know residents as individuals. “A little bit of insight can do wonders for a resident. For example, one man I know is a brilliant artist, and he was asked by carers if he would like to run a painting class. Running this class has really improved this man’s self-esteem and has made a big difference to the way he feels. “That’s staff treating residents like individuals and not just labelling them with a condition. That’s the way care should be.”
July/August 2018 | Care Home Management 21
Flooring
Don’t be floored by private fee payers
Today’s private funders want comfort, style and performance from their care home, so make sure you avoid any flooring banana-skins, says CHM editor Ailsa Colquhoun in interview with Danfloor UK marketing manager Catherine Helliker In 2017, the Financial Times reported that 44 per cent of care home residents were fully self-funded: this has increased standards of expectation when it comes to accommodation; residents and their families are now seeking a style and finish more in line with a high-end hotel. Many care homes now employ interior designers to ensure they achieve the “wow” factor look and feel for the fee-paying resident.
As a result, Danfloor UK has seen an increase in demand for “something different” when it comes to carpet design, says marketing manager Catherine Helliker. “Although there is still great demand for tonal carpet designs, many homes are moving towards patterned carpets and modern twists on traditional designs such
as plaids for reception areas and communal living spaces.” Special requirements A common challenge faced by interior designers when working in communal residential settings is addressing a ‘multi-client’ brief. On-trend interior design notwithstanding, many homes still need to accommodate residents with complex needs such as dementia, which bring their own design considerations. There is a growing body of evidence that suggests that well-designed interiors can greatly enhance the lives of residents with these conditions.
Guidelines such as British Standards (BS8300:2010) - Approved Document M – Entering a Building; The Equality Act 2010 (which replaced the 2004 Disability Discrimination Act) and
22 Care Home Management | July/August 2018
Q: What will I learn from this feature? A: How to give your floor the 'wow' factor, while achieving the right specification for your residents with special health needs from Stirling University (online at: http://dementia.stir.ac.uk/design/ good-practice-guidelines/colour-andcontrast) highlight the importance of colour and contrast, good lighting and a person-centred approached when it comes to designing interiors for those with visual-perceptual difficulties as a result of living with dementia. For more information on the role of colour in residents’ well-being, see the box, top right opposite page. Light reflectance values Light reflectance value (LRV) is a measure of the percentage of visible and usable light that is reflected from a surface when illuminated by a light source. LRVs are particularly important when designing interiors that are suitable for the disabled and for those who are visually impaired. Certain surfaces and features are required to contrast visually within their surroundings to aid navigation and by equating colour with an LRV makes this achievable. Current guidance and code of practice BS 8300:2009 state that a 30-point difference in LRV is necessary to achieve adequate visual contrast.
Flooring To achieve the feel of ‘no change’ – and a stress-free transition for residents moving between surfaces or rooms flooring and joining strips should have LRVs within eight points of each other. “Not working within these guidelines can cause stress and confusion for someone who is partially sighted and can lead to behavioural difficulties, stress and anxiety. Manufacturers who supply materials to the care sector should clearly provide product LRVs to assist with the design process.” continues Catherine. “Shiny floors should also be avoided when it comes to dementia care because they can appear wet or slippery to someone living with visual perceptual difficulties. A combination of these problems can make a person afraid of falling and lead to them slowing down their movements while they try to walk safely. It can also restrict their independence and increase a feeling of isolation if they are not able to move freely.” Colour my way Considered use of colour in a floor can significantly improve a visuallyimpaired person’s ability to get around. It can create pathways, identify obstacles and define volume and space. In addition, the right colour can reduce the visibility of soiling or
Colour: more than aesthetics While memory loss and disorientation are the best-known elements of dementia, the condition can also cause visuo-perceptual difficulties and image distortion. Combined with the natural deterioration of eyesight with age, an inconsistent floor pattern, such as a floral carpet, can make it difficult for patients to differentiate between this and obstructions or objects. Patterned flooring or dark tiles can also confuse residents in whom spatial awareness and perception of colour and contrast can also be affected by dementia: these colour choices can appear as ‘holes’. However, there are some instances when a pattern or change in colour can benefit those with dementia. If the floor of a property is multi-level, with a single step between the kitchen and living area, for example, installing two different colours of carpet, preferably in a block colour, can help people distinguish the step. Additionally, carpets that are contrasting in colour to furniture can help residents find, or avoid, objects within the room. A contrast between the wall and floor design can also reassure patients, making it clear where flooring boundaries are. Source: CFS wear and tear to a high-traffic area: medium-to-dark coloured carpets are more effective than plain, light shades. Flooring for rest and relaxation Day or night, care facilities can be busy places yet rest and relaxation are essential for a resident’s health and wellbeing. Acoustics are an important consideration in flooring and solutions such as linoleum and luxury vinyl tiles (LVT) can add to unwanted noise and echo around the building. These factors are as important as hygiene when fitting out a home: UK building
regulations state that floor coverings should have a weighted noise reduction of at least 17Db. There are many flooring options that fall well below this level, some achieving as little as 2 or 3Db. Did you know? Warm tones such as yellow and orange, as well as earthy tones, are thought to stimulate conversation, so these are a good choice in communal living areas Blue is linked to increased creativity so use in a more creative space Source: CFS
Floors that care for your staff
By Lisa Tomlin, CFS Standing or walking for extended periods of time can cause staff to feel tired and prone to a range of muscular aches and pains, including: backache; swollen and stiff joints; pain and discomfort in the feet. It can
also cause secondary issues such as headaches and loss of concentration, putting staff and the residents they care for at an increased risk of a slip, trip or fall. There are many different surfaces that can provide an anti-fatigue solution. Here are just a few: Luxury vinyl tile – A smart choice as it’s durable, made to withstand high traffic areas, and is simple to maintain. Although it’s often associated with a harder texture, vinyl is capable of taking on the texture of whatever you put beneath on, so why not go for anti-fatigue options such as foam padding or cork?
Rubber – Great for functionality, rubber is especially good for slip resistance. It’s also good for insulation and, in fact, owes a lot of its anti-fatigue status to the fact that it provides a warmer surface area. Carpet - Carpet is always going to prove a winner for comfort – it’s shock absorbing and cushioning by nature. Another bonus is that it keeps spaces warmer in cold weather as well.
Q: What will I learn from this feature? A: How to reduce the risk of fatigue in your staff
July/August 2018 | Care Home Management 23
Flooring
Bust those myths! How to look after your floor By Lisa Tomlin, chief executive officer of CFS MYTH: If a carpet gets stained beyond repair, I need to replace the whole floor covering FACT: If your carpet is a broadloom a singe piece of carpet covering a large area - then yes, the entire floor covering will need to be replaced. Thus, in high use and high-risk areas, it is well worth considering a flooring tile presentation, ie, carpet or luxury vinyl tiles (LVT), that can be replaced quickly and more cost effectively in isolated areas. MYTH: I can’t use high strength cleaning products on floor coverings FACT: In days gone by, using specialist cleaning products could damage the floor covering, however, modern carpets are colour fast. Commercial grade LVT will come with a PU coating wear layer, providing extra surface protection. MYTH: There is nothing I can do to prevent wear and tear FACT: Studies show that more than 70 per cent of dirt and moisture in buildings is tracked in by pedestrian and wheeled traffic, something that can be significantly reduced by using entrance matting. Entrance matting can help to reduce this problem significantly, making
MYTH: There is no way to clean hardwood floors FACT: Excess water on a hardwood can lead to warping. Cleaning is still possible, though: keep water use to a minimum and mop up regularly; sweep floors regularly and use a specialist hard wood floor cleaner for a deeper clean. If hard wood is stained, it can be sanded out. Cushioned pads on the legs of chairs and tables also prevent scratching.
Tiles can be replaced individually, saving on the costs of replacing a whole floor
it a cost-effective investment in terms of reducing your cleaning and repair bills. MYTH: You only need to clean your carpet when it’s dirty FACT: Even if your carpet looks clean, it’s worth investing in proper carpet cleaning on a regular basis. Dust, pollen and other allergens can settle within the carpet, aggravating allergies. Regular cleaning is also a good time to inspect for damage that might cause a slip, trip or fall, and keep your flooring in tip-top aesthetic condition.
The specifier’s guide to flooring
LVT does not have to be boring!
24 Care Home Management | July/August 2018
MYTH: Wet cleaning my carpet will cause mildew FACT: To avoid mildew or mould forming on your fabric materials use a specialist floor cleaning product. And, once clean, make sure you allow your carpet to dry. If you are buying or hiring in a carpet cleaning machine look out for one with a power brush element, which will clear the carpet of debris that cannot be seen with the eye, whilst washing and drying the carpet. MYTH: One floor cleaner will work across my whole property FACT: You wouldn’t use the same product to clean your cutlery and bed linen and floor coverings should be the same. Carpets, hard wood, LVT and tiles all require different specialist products to prolong the lifespan of the floor covering and maintain health and safety levels. The Specifier’s Guide to Flooring provides a specification tool for facilities managers, purchasers and specifiers on all aspects of flooring. The guide explores key materials, from carpet to luxury vinyl tile (LVT), ancillary products and accessories – and everything in-between – as well as providing designinspiration. Read the guide online at http://www. specifiersguide. co.uk
Hoists
Care homes face ‘ticking bomb’ effect over ‘invalid’ Q: What will I learn from lifting safety checks this feature? A: How to ensure your ‘thorough examination’ does not fall foul of LOLER
How to check your home is 100 per cent compliant with the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) Care homes are being warned about the potential ‘ticking bomb’ effect over invalid lifting equipment safety checks. The warning from leading safety inspections company, ITENuk Ltd, follows a study that revealed over half of UK care homes’ lifting safety reports may be invalid. Under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) care homes need to obtain a ‘report of thorough examination’ from a ‘competent person’ either every six months or 12 in the case of non-people lifting equipment. Oliver Romain, senior safety inspections Adviser at ITENuk, said: “Most care homes are aware of LOLER and arrange thorough examinations, however, we are concerned that many care home owners do not understand how to select a competent person or how to check if a safety report is compliant.
Romain’s concerns have been confirmed in a study of the implications of LOLER in care homes, by Laura Smith, a senior environmental health officer at Oldham Council, who studied the issue at Salford University following concerns raised during safety audits of care homes. The study found high awareness of LOLER in care homes, with over 95 per cent of respondents understanding the need for thorough examination reports. However, only 45 per cent were able to produce a report that complied with the regulations. Many reports lacked essential information such as the name and address, and date of the last examination and a staggering onethird of the reports failed to state the equipment was safe to operate. Romain stressed the need for care homes to ensure they are compliant: “LOLER rules are there for good reason, if they are ignored, it is only
a matter of time before a whole series of minor omissions build up to render equipment dangerous and even deadly. It’s a ticking bomb waiting to explode. “Given the high number of lifting injuries and deaths in care homes, it is distressing to find that over half of care homes have not been issued with a compliant report and a third have not even been informed if the equipment is safe to use.” Whilst care homes may be being mis-sold safety checks, this is no defence under law, according to Romain. “Care homes are paying for a service and have every right to expect that examinations are conducted according to the law, however, it remains the duty holders’ responsibility to ensure that they select the right competent person and that reports are valid. “Unscrupulous or unskilled firms are selling inspections that do not comply,
July/August 2018 | Care Home Management 25
Flooring even at a basic level, with LOLER, they are putting care home residents and staff at risk. It is only a matter of time before a preventable death or serious injury is attributed to an equipment failure due to this practice.” Romain also raised concerns over the objectivity of the reports care homes receive: “Many care homes are being sold ‘LOLER inspections’ as an add on to servicing and maintenance without considering objectivity. This can mean maintenance staff are effectively marking their own work and could render the report invalid. “We recommend using an independent lifting safety specialist with the expertise to produce a valid LOLER thorough examination report and the independence to make objective recommendations.” The study also revealed that only 25 per cent of respondents were able to correctly identify common care home equipment thorough examination requirements, with many wrongly stating that slings used on patient hoists do not require inspection.
What the CQC looks at in hoists and lifting CQC inspection staff look to see the provider is compliant with the regulations and that they are following relevant manufacturers’ guidance. Where issues are found this will be reported to the provider under the ‘safe’ key question in the summary report, and under the ‘environment and equipment’ subheading within the safe key question in the evidence appendix. For guidance on LOLER CQC inspectors refer to the Health and Safety Executive guidance available online at: http://www.hse.gov.uk/ pubns/hsis4.htm CQC provider guidance (in particular, regs 12 and 15) can be found online: http://www.cqc.org. uk/guidance-providers/regulationsenforcement/regulations-serviceproviders-managers
ITENuk offers a free, confidential, health check of LOLER reports. Simply email a sample report to advice@itenuk.com. ITENuk also publishes free, quick reference equipment safety guides for care homes and duty holders [online] at: www.itenuk.com
Useful resources: Laura Smith’s paper, the implications of the lifting operations and lifting equipment regulations (LOLER) 1998 in care homes is available by sending an email to: o.romain@itenuk.com [subject line: LOLER CHM paper]. How the lifting operations and lifting equipment regulations apply to health and social care – Health and Safety Executive [online] at: http://www.hse. gov.uk/pubns/hsis4.pdf) The lifting operations and lifting equipment regulations 1998 [online] at: http://www.legislation.gov.uk/ uksi/1998/2307/contents/made
Making manual handling safe It takes balanced decision-making to achieve safe manual handling in a complex and imperfect world, says Carole Johnson, chartered physiotherapist and publications officer for the National Back Exchange
A great deal has changed in manual handling in the past 25 years. Gone are the days when care staff could and would lift anyone that needed it; equipment has moved on. However, accidents still happen; residents are still injured; and there are still staff whose working lives are cut short. There is more work to be done. Practitioners completing manual handling assessments and managers trying to develop safer manual handling strategies have to wade through more
legislation, compliance and audit. It can be even harder to balance manual handling legislation with the Care Act (2014) and the Mental Capacity Act (2005). Consideration of all the options simply adds to the fear factor and the workload of many staff. Picture this scenario A resident wants to use an easy access sling (sometimes called a toileting sling). These slings have less fabric in the seat area to allow easier access
26 Care Home Management | July/August 2018
to clothing after transfer (for example) from a wheelchair to a commode. This type of sling eliminates the need to transfer to a bed first to remove clothing, saving time and promoting dignity. However, the resident needs to have good upper body strength to be able to use the sling as intended. The Manual Handling Adviser (MHA) believes that there is a risk of slipping through the sling and therefore insists the handling plan must be changed.
Hoists The request adds to the time required for the transfer and the resident becomes distressed that they won’t reach the toilet in time. How each person looks at risk in this scene is different: the resident wants to get to the toilet before it is too late, the staff want to ensure the resident’s comfort and safety in a timely manner; the MHA wants all of those things too, but is aware of the risk of physical injuries. In the end, it all comes down to risk and how it is viewed. Dealing with conflict So, how does the MHA deal with the inherent conflicts in the resident’s situation? The most important thing is not to make sweeping statements or demands or develop unbending policies. The best approach is to step back, take a breath and apply some clinical reasoning, mixed with the legal requirements, evidence-based practice, dialogue and some common sense.
Here are some points to consider: ■ Has there been any history of the resident slipping? Is it a real or perceived risk? ■ Is there evidence linking access slings with falls, and are the factors relevant in this case? ■ Is there an alternative sling on the market that meets everyone’s wishes? ■ Does the resident or staff have any other suggestions? ■ Can you have a discussion on the options without an emotional overlay? ■ Are there any assessment tools to help with the decision-making process? Managing risk There is no doubt that a full manual handling assessment should be completed before using any equipment, sling or technique, and it is important to refer to the
manufacturers’ instructions and the advice of a MHA: considerations will include resident comfort, and staff effort and competency. Staff will need to be able to respond to any early warning that the technique is no longer adequate and this will demand ongoing monitoring and education: it is unlikely that any protocols arising out of the assessment will be static.
Useful resources The Health and Safety Executive guide: Getting to grips with hoisting. www. hse.gov.uk Backcare guide: The manual handling of people. www.backcare.org.uk National Back Exchange guidance: Moving and handling in the community and residential care; Handling the plus size person. www. nationalbackexchange.org
July/August 2018 | Care Home Management 27
Chair-based exercises - anyone can do All care home residents can gain the benefits of exercise, even if they are unable to stand or move about easily. Here, Repose Furniture occupational therapist Kate Sheehan offers some chair-based mobility exercises that all residents can enjoy It all starts with posture Having a good posture for exercise is instrumental in keeping yourself fit and it ensures you benefit from each exercise. Good posture also prevents unwanted strain such as backache or muscular pain during exercise. It also means that your body can work efficiently as your bones are in alignment which allows your muscles, ligaments, tendons and joints to work correctly. To start: in your seat: ■ Sit nice and tall ■ Head neutral, looking straight forward, ears over shoulders (not forward, back or to the side). Shoulders should be relaxed, back and down ■ Lower back flat against the back of the chair (your bottom should touch the backrest ■ Palms of hands flat on either thighs or arm rests of the chair ■ Knees should be slightly lower than the hips with a gap between the back of the knees and chair ■ Feet flat on floor at a right angle to your knees, toes facing forward and do not cross the legs or feet ■ Please be aware that one side may be stronger than the other when completing these exercises ■ Complete each exercise to a point that you feel comfortable, never push beyond this point.
Mobility exercises
Repetitions: Beginner
Intermediate
Advanced
20 alternate knee lifts (10 each side) or 2030 seconds
20 alternate knee lifts (10 each side) Or 30-45 seconds
30 alternate knee lifts, or 45 – 60 seconds
Notes: Lift knee to at least waist height
Notes: Use arms at low Notes: use full arm height swinging so marching
Notes: To avoid shifting your weight you should utilise your core strength and contract your bellybutton towards your spine to give extra stability.
Wrist mobility Exercise: Wrist raises Rest forearms on your thighs with a wide stance or arm rests of a chair with palms facing down Keeping the arm still and with fingers outstretched raise your fingers towards the ceiling from the wrist as far as possible and relax back down Add an arm curl by raising your hand towards you shoulder once you reach advanced. Exercise: Wrist raises reverse Rest forearms on your thighs with a wide stance or arm rests of a chair with palms facing upwards Keeping the arm still and with fingers outstretched raise your fingers towards the ceiling from the wrist as far as possible and relax back At the advanced stage add an arm curl by raising your hand towards your shoulder once. Repetitions:
Hip & leg mobility Exercise: Seated marching ■ Hands on thighs, raise knees to at least hip height and march ■ Sit up tall, keeping your hands on your thighs, raise each knee in turn to as high as you can comfortably go ■ Initially complete 10 on each side, as you become stronger increase your repetitions. 28 Care Home Management | July/August 2018
Beginner
Intermediate
Advanced
Five wrist raises and then five reverse wrist raises (repeat three times)
Eight wrist raises with arm curl and eight reverse wrist raises (repeat three times)
10 wrist raise and arm curl and 10 reverse with arm curl keeping elbows tucked in to the body (repeat three times) Add band for additional resistance
Notes: When comfortable you can add a resistance band to the wrist raise and arm curls
Exercise: Side bend Start with sliding your arm as low as you can down to one side of your body. Keeping your head and neck in-line with your spine Make sure you do not lean forwards or backwards. Repetitions
Waist and trunk mobility Exercise: Stretch and rotate Sit up tall, interlock your fingers and raise them to shoulder height in front of you, rotate as far right as you can go and then as far left as you can go, making sure you keep the head faces forward Always stop in the middle before going to the alternative side. Initially complete five on each side, as you become stronger increase your repetitions.
Beginner
Intermediate
Advanced
Five side bends (right & left)
Eight side bends (right & left)
10 side bends (right & left)
Notes: reach down as far as you can comfortably to feel the stretch
Notes: slide your fingers as close to the floor as possible
Notes: reach your right arm up in the air and then bend to your left reaching as far over the side as possible.
Notes: As flexibility improves, increase the number of repetitions and the range of motion.
Repetitions: Beginner
Intermediate
Advanced
Five back rotations (right to left)
Five back rotations (right to left)
10 back rotations (right to left)
Notes: Grasp hands in front at comfortable height. Rotate back so your clasped hands are over each knee
Notes: Grasp hands in front at comfortable height. Rotate back so your clasped hands pass over each knee to increase the rotation
Notes: Grasp hands in front at shoulder height. Push hands forward and extend your back to increase the back stretch. Rotate back so your clasped hands pass over each knee or to the armrest on chair to increase the rotation
Notes: Push your hands as far forward as you can without straining the back, keep your head neutral and looking forward.
Chest and back mobility Exercise: Push and pull Keep arms straight out shoulder height, palms down parallel to the floor Reach as far forward as comfortably possible, shrug shoulders forward slightly Lead with the elbows as the arms are pulled back, retract shoulder blades as arms are pulled back Keep neck in a neutral position and eyes looking forward. Repetitions:
Time for side bends? Read on for step-by-step help with this exercise
Beginner
Intermediate
Advanced
Eight push and pulls
12 – 15 push and pulls
20 push and pulls
Notes: keep arms in line with shoulders
Notes: increase range of motion all way forward and back
Notes: increase the range of motion and the speed of movement
Notes: Keep control through the movement as you increase the range of motion and the speed. July/August 2018 | Care Home Management 29
Ankle mobility Exercise: Toe raise Keeping the heel on the floor gently raise the toes upwards to a point that is comfortable. Lower the toes back to the floor. Exercise: Heel raise Keeping the toes on the floor gently raise the heels upwards to a point that is comfortable. Lower the heels back to the floor. Repetitions: Beginner
Intermediate
Advanced
10 toe raises each leg 10 toe to heel raises: 10 heel raises each leg One foot or both
15 - 20 toe to heel raises both feet
Notes: Hands on thighs Notes: Hands on thighs with good posture or armrests with good posture
Notes: Hands off with good posture
Notes: Start at the beginner level and work your way up if comfortable to advanced by completing each stage at least five times before advancing to the next level.
Stretching Exercise: Hamstring stretch Sit forward. If you need help with balance hold onto the chair Place one leg out in front of you on the heel as straight as possible Keep your back flat and bend from the hips You should feel the stretch down the back of the thigh. Hold stretch for 10 – 20 seconds Repeat five times each side initially and build up to 10, increasing your bend forwards as you become more confident Try to support weight by placing hands on the opposite thigh.
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What do all these people have in common?
They illegally wedged open a fire door and could be serving a custodial sentence or heavy fine for breaching fire safety regulations.
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Ref: CHM18 July/August 2018 | Care Home Management 31
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Kitchens
The 3 C’s of a care home kitchen after wash? How does it manage chemical dosing? How much energy is lost when heating up the water?
Save time, cost and increase the productivity of your kitchen by getting your warewash purchasing right first time round. Adam Lenton, marketing manager of Classeq, tells you the big questions to ask Capacity: Before making any buying decisions, mangers should consider how many residents they have, the number of mealtimes and refreshment requirements, what needs to be washed and the length of the washing cycles.
Keeping it clear: How much space do you have for storing returns process, eg, dirty crockery and glasses, and where will the dishes be scraped or rinsed before placing into the dishwasher? Stations within the kitchen should be clearly defined to increase process efficiency and define how much space to dedicate to the warewashing area.
Cost: Cost is not just about the upfront fee but the life-time running costs. Questions to consider include: how much water does it use per cycle? Will it provide reliable results wash
Useful resources: Visit Classeq [online] at http://www. classeq.co.uk/warewashing/ for help on choosing your warewash equipment
Four ways to keep five-finger hand and kitchen surface hygiene Did you know? The average person’s hands can carry more than 3,000 different types of bacteria and about 100,000 can live on each square centimetre of skin?
There can be few areas where hand and surface hygiene is more important than when preparing and serving food in the care environment: the World Health Organization (WHO) estimates there are over 200 diseases spread through food. Education – It is of the utmost importance that staff are aware of the required surface cleaning regimens, the importance of hand hygiene and
the dangers involved in not following procedure when working in care home kitchens. For instance, handwashing is the first line of defence against the spread of infection and should take a minimum of 20 seconds. Equipment – Touch-free technology – where dispensers automatically release the required amount of product – can boost hygiene standards significantly.
Formulations – Providing a wide range of hand washing and sanitising options, can help boost hand hygiene behaviours. Products used to clean food preparation surfaces should meet the ISO 4120:2007 food tainting standards. The extra step – For convenience, surface sanitisers and wipes come in bactericidal, fungicidal and virucidal no-rinse formats with effectiveness against the major foodborne contaminants: salmonella, campylobacter, listeria and yeast. Many formulations also offer reduced environmental impact. Information supplied by GOJO Industries-Europe Limited
July/August 2018 | Care Home Management 33
Legal issues
Lasting Powers of Attorney – Considerations for Providers a spouse, family member or friend. The LPA must include a certificate completed by an independent third party, confirming the donor’s capacity to appoint.
Rachael Hawkin What is an LPA? An LPA is a legal document registered with the Office of the Public Guardian, appointing an ‘attorney’ to make best interest decisions on their behalf. An attorney can be pre-emptively appointed. An attorney must be 18 or over with capacity and is most commonly
Powers of an attorney? This is dependent upon the type of LPA and any restrictions or conditions. Health and welfare LPA’s authorise attorneys to make decisions as to personal welfare, social activities, residence, assessments, contact and medical treatment where the donor lacks capacity. Advance decisions cannot be overruled, yet otherwise attorney’s have potentially extensive decision making powers. Property and financial affairs LPA’s relate to the management of bank accounts, tax affairs, funding entitlement, benefits and property. Providers must be aware of service users in their care with an attorney. The LPA should be reviewed to determine their decision making powers. For
34 Care Home Management | July/August 2018
example, if a medical treatment decision is required and the individual lacks capacity, you must establish whether a health and welfare attorney has been appointed, or whether the decision is a best interest’s analysis under the Mental Capacity Act. Is the attorney acting in your client’s best interests? Attorneys must act in the donor’s best interests, applying the best interests check list (Mental Capacity Act 2005 Code of Practice) and consulting those with an interest in the individual’s welfare. If there are concerns as to the above, an application can be made to the Court of Protection, who can determine not only the decision but the validity of an LPA and if required, remove an attorney. Contact: Rachael Hawkin T: 01423 724032 r.hawkin@hempsons.co.uk
Legal issues
What to do about whistle-blowing The concept of whistle-blowing in health and social care has a high profile that care homes should not ignore, says Debbie Nicholson, senior associate at Fieldfisher solicitors The term ‘whistle-blower’ is used to describe people who make a qualifying disclosure about a concern at work. Where a worker suffers a detriment or is dismissed as a result, then they may have certain employment protections under the Employment Rights Act 1996. In practice, this is likely to mean a claim for unfair dismissal at an employment tribunal.
The whistle-blowing NHS review, ‘Freedom to Speak Up’ made recommendations for building an open and honest reporting culture in the NHS. Subsequent recent changes to regulations prohibit discrimination against whistle-blowers seeking jobs or posts with certain NHS employers. While these regulations do not directly apply to the care home sector,
10-step action plan 1. M ake sure you have a whistle-blowing disclosure policy. Clear policies demonstrate a willingness to improve. For some policy content suggestions, see below right. 2. P rovide staff with training and support: workers must feel they can easily approach a range of people in the organisation. 3. C onsider appointing a whistle-blowing champion to emphasise the organisation’s commitment to whistle-blowing and to protecting whistleblowers. 4. T ake any concerns seriously whoever raises them. Research has suggested that one in three care staff feel their whistle-blowing concerns [often a safeguarding or patient safety issue] were ignored. 5. I f other agencies are involved in any disclosure, make sure it is clearly defined who will lead on the investigation. If the home is not the lead agency, it is important to cooperate with the investigator and provide support to members of staff involved in the investigation.
7. R elevant evidence in an investigation will include speaking to members of staff or asking them to write down what they observed, and documentation such as rotas, floor plans and care records. Information should be gathered promptly to maintain the integrity of the information. 8. A ny investigation should be considered an objective fact-finding exercise.
10. A t the conclusion of an investigation [and potentially during], assess whether any disclosures should be made to other agencies such as the police, social services and the CQC.
their spirit should not be ignored, particularly as social care and the NHS are both regulated by the Care Quality Commission (CQC). Social care staff must feel as empowered to speak out as their NHS colleagues; registered managers are expected to deal equally robustly with whistleblowing disclosures. Whistle-blowing reports should be viewed as welcome: they are an early warning system of potential risk or poor practice, which could cause significant distress, complex legal issues and loss of income further down the line. Whistle-blowing policy ideas Any policy should be specific to the organisation, and should be reviewed annually. The key areas to include are:
6. T he scope of any investigation should be carefully monitored. A serious allegation that raises systemic cultural concerns is likely to lead to immediate regulatory action; legal advice should be sought in these circumstances.
9. T he Public Interest Disclosure Act 1998 protects workers from victimisation if they raise concerns about poor practice in good faith, even if there is no substance to the disclosure.
Q: What will I learn from this feature? A: Why, and how to implement a whistle-blowing policy
■ A statement encouraging staff to speak up, including reassurance that all investigations will be evidence-based and independent, with a focus on learning ■ Reassurance that steps will be taken to protect a whistle-blower’s identity, and that the organisation is committed to anti-victimisation ■ The escalation process, including external sources of help ■ The name of the organisation’s whistle-blowing champion ■ The provision for disclosing the investigation outcome.
July/August 2018 | Care Home Management 35
Facing enforcement action from CQC? Need to challenge a draft report? Meet the LA Care Team – we’re here to help We can support you with: • Advice on compliance with the regulations and Fundamental Standards • Defending CQC enforcement action • Challenging inspection reports and ratings • Safeguarding investigations • Coroner’s inquests
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Events and Appointments
Events line-up
Appointments New Tanglewood care homes MD
July Tuesday 3 July Care Roadshow Birmingham. For more information, visit: www.careroadshows.co.uk September Sunday 30 September Infection prevention in care and at home one day conference. For more information, visit http:// ips.uk.net/conference/ October Wednesday-Thursday 17-18 October Care Show For more information, visit: www.careshow.co.uk
Care home operator Tanglewood care homes has appointed Julie Wright as managing director. Julie has 38 years’ experience in the social care sector, most recently in her own company, Wright Care Solutions.
New manager for New Care Care home operator New Care has appointed Kad Daffe as centre manager for the new Ruddington Manor care home in Nottingham. Kad has worked for New Care for 18 months and was previously part of the team at The Grand in West Bridgford. Ruddington Manor is the company’s second care home in Nottingham.
Tuesday 23 October Care Roadshow Cardiff. For more information, visit: www.careroadshows.co.uk Wednesday, 24 October Public Health conference: the unusual suspects For more information, visit: https://tinyurl.com/y7trlf8o November Tuesday 13 November Care Roadshow London. For more information, visit: www.careroadshows.co.uk Wednesday 14 November Care England 2018 technology conference & exhibition, ‘Logging On’. For more information, email: conference@careengland.org.uk
Hafod makes two senior appointments Welsh care provider Hafod has
appointed two senior executives: Karen Rosser (pictured right) as executive director of people and change, and Kath Palmer to the new role of executive director of place, policy and stakeholder engagement. Karen was previously HR director at Compass PLC, and Kath, deputy director for housing and regeneration for the Welsh Government. Hafod operates across 10 local authority areas in South Wales, providing care to 16,000 people.
New staff roles at Springhill Care Home Springhill Care Home, in Accrington, has created three new staff roles in key areas of care. Pictured (l-r) are Anne Wareing, who is now responsible for medication and infection control, Susan Balazs, palliative care lead and Deborah Bennett safeguarding lead (‘react to red’ and wound care).
CQC appoints a new chief executive
Come and see Care Home Management on stand A16
Ian Trenholm has been appointed as CQC’s new chief executive and will take over the role from Sir David Behan when he leaves in July. Ian has held the post of chief executive of NHS Blood and Transplant since 2014. July/August 2018 | Care Home Management 37
Product spotlight
The Specifier’s Guide to Flooring launches at CDW 2018 The Specifier’s Guide to Flooring has launched in the UK. Officially unveiled at Shaw Contract’s showroom during Clerkenwell Design Week, the ‘definitive guide’ will provide a specification tool for architects, designers, facilities managers and specifiers on all aspects of flooring. Exploring key materials, it will provide a rich resource for industry, in hard-copy format and online at http://www.specifiersguide.co.uk The flooring-focused Guide includes commentary from prominent names in industry, as well as technical analysis and inspirational imagery. Its launch at CDW included an address from Fiona Bowman MBA CBIFM, FCMI Senior Facilities Management Consultant. Fiona praised the resource for its “compelling, substantive, clear and concise content; an invaluable guide for the complex specification process,” - whilst Simon Jackson, Design Consultant and sjjdc founder described it as an “expert at your elbow”. “The Guide to Flooring is the must-have publication for every architect, designer, FM and specifier from Land’s End to John ‘o Groats. Never before has there been such a comprehensive guide to all aspects of an installation,” added David Strydom, editor of CFJ. Echoing these sentiments, John Heath, Kick-Start Publishing’s CEO added, “The Guide will light the way for those seeking inspiration for their flooring requirements.”
Hold your doors
Hold your fire doors open legally with an Agrippa acoustic fire door holder. This fire door holder is ideal for care homes, it is hygienically fitted to the top of a fire door and offers a wireless solution to maintaining fire safety in your setting, whilst ensuring ease of movement for staff and residents. On hearing the sound of your fire alarm, the Agrippa acoustic fire door holder will release the magnetic connection between door plate and keeper, allowing the fire door to swing shut, preventing the spread of fire. For more information on the Agrippa acoustic fire door holder please contact us on 0800 978 8726 www.safelincs.co.uk
NURSE CALL ALARMS
Radio Nurse Call Leads the Way!
The Therapeutic Benefits of Carpet Carpet offers many therapeutic benefits to a healthcare environment, they are naturally sound absorbent and can reduce the conduction of sound impact by 29 dB, which helps to create an acoustically sound environment. Carpets also improve indoor air quality by trapping airborne particles, which can cause respiratory distress, in the carpet fibre prior to them being remove via vacuuming. By choosing a carpet from danfloor’s healthcare collection, which includes an anti-microbial coating, any harmful bacteria which comes into the carpet fibre is killed with a 4 log reduction rate of 99.99%, thus helping with infection control.
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With today’s technology, it is possible to upgrade an old Nurse call system in under a week. Gone are the days of engineers installing cables and being on site for weeks, as with the new Radio Nurse Call a call point can be fitted in a resident’s room in minutes. Flexibility is another benefit as units can easily be repositioned when necessary, and multiple displays can be positioned around the care home to ensure staff never miss a call. Southern Care Maintenance Ltd, SCM, was established in 1987 and are a specialist independent company for the Service and Maintenance of Nurse call, Fire and Nursing equipment. They have many years’ experience in both fitting and servicing Nurse Call systems covering Kent, Sussex, Surrey, Essex and South London. This month they are launching mySCM, a new online customer portal, free of charge to all service contract customers, so that they can access service records, certificates and invoices securely 24/7. For more information see southerncare.co.uk and follow the link to the Nurse Call Page. You can also download a case study of a customer using Radio Nurse call or ring 01580 890089
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Tel: 0800 849 5123 | Email: info@medicaresystems.co.uk | www.medicaresystems.co.uk July/August 2018 | Care Home Management 39
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