Care Home Management magazine Jan/Feb issue by chmonline

Care Home MANAGEMENT www.chmonline.co.uk

January/February 2019 • ISSUE 77

INFECTION CONTROL Are your policies and procedures up to scratch?

ASSISTIVE TECH

How the internet of things is changing care

TAKE A SEAT

But make sure you choose it carefully

DRESSED FOR SUCCESS

Corporate or cosy? What’s the best uniform for staff

WITHOUT QCS WE WOULDN’T HAVE BEEN RATED AS AN ‘OUTSTANDING SERVICE’ Rupert Stocks Registered Manager, Guyatt House

We are as committed to supporting outstanding care as our 4,000 care providers are to delivering it. We provide the leading bespoke policies, procedures and management toolkits for the Care Sector. Join over 53,000 satisfied users nationwide who already…

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WELCOME EDITOR’S LETTER

Care Home Management January/February 2019

Issue 77

Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Design/Production Emily Hammond emilyh@freelancedesignpro.com 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: davidh@spacemarketing.co.uk www.spacemarketing.co.uk www.chmonline.co.uk Copyright: Care Home Management Magazine 2019

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.

WELCOME to the January/February issue of Care Home Management magazine In September last year, Beiersdorf, the parent company of the skincare range NIVEA, successfully opposed a UK trademark application consisting of the word NIVEA with a circular swirl on a brand of cigarettes. In its defence Beiersdorf alleged that the trademark has a reputation and is so well known that any use of the word NIVEA, for any goods or services, would be misleading as consumers would believe it had a connection with Beiersdorf. In evidence, it submitted evidence of use dating back to 1922 in relation to skincare products as well as various sponsorship arrangements with others such as the English National Football Team and the TV show “The Voice”. However, very important in this case was the fact that Beiersdorf also provided evidence of a very public, and well-established working relationship with Cancer Research UK. As cigarettes and tobacco products are known to be cancer-causing, it was alleged that the association of the NIVEA brand for these products would be highly detrimental to the brand’s reputation. Having considered all the evidence, trade mark arbiter the UK Intellectual Property Office (IPO) agreed that Beiersdorf’s NIVEA trademark had a considerable reputation in the UK in skincare and concluded that registration of the cigarette mark would be detrimental to the reputation of Beiersdorf’s NIVEA brand as we all know it. WHY AM I TELLING YOU THIS? Because, it would be great to think that 2019 is the year that the name of your care home becomes synonymous with proactive, superior care and unrivalled best practice. Creating a world-famous brand takes more than a new sign and kitting out your staff in a customised uniform, although this helps. It’s about putting in place solid foundations of excellent practice, and getting the positive values of your name out there as widely as you can. For a care home this is going to mean meticulous compliance with all relevant guidance and regulations, relentless engagement with all your stakeholders – residents, families, other health and social care professionals, commissioners and other local providers – excellent leadership skills, continuous staff training and development – and a sprinkle of marketing magic in your dealings with the Care Quality Commission, the media and prospective clients. We know this isn’t easy - we’re doing the exact same thing with Care Home Management, which this issue unveils a new magazine design and some new features, to join our new weekly e-newsletter, our ground-breaking new regular podcast (see news for details of how to listen in), and last but not least, our new commercial promotional film service detailed on our website (and ideal for care homes!) This is just the start of a process that we believe will make us as well-known as NIVEA (well, in the care home world, at least). We look forward to seeing you do the same.

editorial@chmonline.co.uk

@Carehomemanage

January/February 2019

Ailsa Colquhoun Publisher/Editor Care Home MANAGEMENT 3

Care Home MANAGEMENT

Contents

www.chmonline.co.uk

January/February 2019 • ISSUE 77

REGULARS

FEATURES

Planning ahead in an ever-changing political and economic landscape

Test your knowledge of these infection essentials

7 Eleanore’s Words to the Wise 8 Hall of Fame

See who’s reaching for the stars in this issue

10 Care Home Awards 2019 Find out how to get involved in this unmissable awards event

13 Leadership

How to move from a manager into a leader

15 Training

Hear the truth – straight from the horse’s mouth

16 Wellness Whistle-stop

Ask the expert: Flu; How to manage scabies

18 Best Practice

Learn from the ombudsman and from outstanding homes

22 Care Home Profile

Cornerstone: cornering the specialist care market

42 People and Events

See who’s on the move and where you can go during Jan/Feb

p15

4 Care Home MANAGEMENT

INFECTION CONTROL 24 Quiz time! 25 Invasive Medical Devices: How to manage them safely

UNIFORMS 29 Protective clothing:

Keeping staff safe and infection at bay

31 Take two suppliers: Read our head-to-head on the role of workwear

p10

INTERIOR DESIGN 32 Colours and accessories: How to move away from magnolia

34 Inspiration:

See the look - pinch it for your own home!

35 Seating:

Why it should always be function over design

ASSISTIVE TECH/ WELLBEING 36 The Internet of Things: How tech is revolutionising care

38 Let the music do the talking:

The role of music therapy in safeguarding

41 Security:

p22

How it’s core to wellbeing

p38

www.chmonline.co.uk

NEWS ROUND-UP

Immigration rules will not help social care

LAWYERS ARE WARNING that the Government’s new immigration system fails to tackle the deepening staffing crisis in the health and social care sector. According to law firm Royds Withy King, the Immigration White Paper severely limits the ability of health and care providers to recruit so-called low-skilled care workers from the EU after Brexit. The new restriction is in addition to existing immigration controls on international workers. Under proposals, employers will have to sponsor workers from the EU and internationally to work in the UK in the future. EU workers won’t get priority for UK work visas, and employers will have to pay each worker at least £30,000 per annum, which is significantly more than the current annual salary for care workers. The UK Government intends to introduce a short-term scheme to enable low-skilled workers from specified countries to work in the UK for up to one year, however, individuals would not be able to extend their stay, or switch into other visa categories in the UK. The Government also wants to plug the vacancy

gap in certain sectors by extending the current Youth Mobility Scheme to EU countries, enabling individuals aged between 18 and 30 to work in the UK for up to two years.

• Proposals to change the requirements for overseas nurses and midwives taking the International English Language Test System (IELTS) have been given the go-ahead by the Nursing and

First CHM podcast

Midwifery Council (NMC). Following the change a level 6.5 in writing will be accepted alongside a level 7 in reading, listening and speaking. For more on these items, visit CHM Online at: https://chmonline.co.uk/ immigration-rules-do-not-help-social-carelawyers-warn/ https://chmonline.co.uk/english-writingtest-restrictions-eased-for-nurses/

The Care Home Awards

available to download now 2019 are open! THE FIRST CARE HOME MANAGEMENT magazine podcast, sponsored by myAko.com, is available to download now. We review the latest care home sector news, discuss the December issue and chat with editor Ailsa Colquhoun about the redesign of this issue. Also, you can hear an interview with Nadra Ahmed from the National Care Association on the departure of Andrea Sutcliffe from the CQC and why care home staff must be valued. We also look at the power of video to promote your care home with Five on a Bike’s York Smith, and chat to myAko.com managing director Kevin Ashley about his company’s new learning and employee engagement solution. The podcast joins the new CHM weekly e-newsletter as the latest innovation to be created specifically for care home managers. To receive the new, free e-newsletter or to receive a free copy of the print magazine, care home managers can email editor Ailsa Colquhoun at editorial@chmonline.co.uk Access the podcast [online] at: bit.ly/2QtM1p6 January/February 2019

THE 2019 CARE HOME AWARDS offer even more opportunities for care home managers to show off their best practice to their peers: Open now for entries are new categories: Best New Care Home; Best Care or Residential Home for Young People and Best Care or Residential Home for Special Needs. Interest in the Care Home Awards is higher than ever with entries already promised from care home organisations that have not entered before. To be part of this glittering event, entries must be received by January 31, 2019. Don’t miss out! Get your entry in today! For more information on the Care Home Awards 2019, please see p10

Care Home MANAGEMENT 5

N EW S ROUND-UP

ICO begins action against 25 care homes for failure to pay new data protection fee THE INFORMATION COMMISSIONER’S Office (ICO) has begun formal enforcement action against 25 care homes that have failed to pay the data protection fee. The data protection regulator has sent notices of its intent to fine the businesses unless they pay: those that don’t could face a maximum fine of £600. It says it is not naming the homes at this point. The ICO recently sent out the first fines to more than 100 organisations across a range of sectors for non-

payment of the fee. All organisations that process personal data, particularly sensitive personal information for health administration and patient care purposes, must pay a fee to the ICO and be listed on its register of data controllers. The care home sector is currently under-represented on this register.

For more on this item, visit CHM Online at: https://chmonline. co.uk/ico-begins-action-against-25-care-homes-for-failure-to-paynew-data-protection-fee/

Council shenanigans highlighted in ombudsman report UNLAWFUL DECISIONS INVOLVING care homes are coming to light as local authorities face budget and resource pressures, concludes a new report on the activities of local authorities. The report from the Local Government and Social Care Ombudsman, Under Pressure, says councils must not “throw out the rule book” when redesigning services. From nearly 40 case studies the Ombudsman identifies systemic problems stemming from councils changing the way they provided services. Among the examples of unlawful decisions involving care homes is one council which thought it could avoid the cost associated with free entitlement to intermediate care and reablement for six weeks, by using a subtly different approach and describing the service as ‘enablement’. But, the ombudsman says: “Just referring to intermediate care by another name does not allow the council to charge for it.” For more on this item, visit CHM Online at: https://chmonline.co.uk/council-shenanigans-highlightedin-ombudsman-report/

6 Care Home MANAGEMENT www.chmonline.co.uk

NEWS ROUND-UP

One in five providers receiving 2015 rates

High-rise fire safety consultation to launch in Spring THE GOVERNMENT HAS unveiled plans for a Spring consultation into fire safety in high-rise buildings, including care homes, as part of its postGrenfell tragedy action plan. Detailed as part of the Building a safer future initiative, the consultation is expected to affect buildings over 18 metres (approx. five- to six-storey buildings). Legislation will ensure that developers are explicit about

how safety is incorporated in buildings; owners of existing buildings are managing safety effectively and that regulators have greater powers to intervene and pursue those who do not follow the requirements. For more on this item, visit CHM Online at: https://chmonline.co.uk/highrise-fire-safety-consultation-tolaunch-in-spring/

OVER ONE IN FIVE (22 per cent) providers are working for 2015 rates, having not had a fee increase for three years, the National Care Association has said in a new briefing paper. Launched at its annual social care reception held at the House of Commons on Wednesday 5 December, the briefing paper also reveals new National Care Association research, which shows: • 87 per cent of members do not receive adequate fees to sustain their business • 68 per cent of members have recruitment issues • 63 per cent of members receive less than £700 in fees. The Association says the Government must bring forward a sustainable plan for social care and for local authorities to ensure service users are funded based on their assessed care needs. For more on this item, visit CHM Online at: https:// chmonline.co.uk/one-in-five-providers-receiving-2015rates/

ELEANORE’S WORDS TO THE WISE Where do we go from here? By Eleanore Robinson, former editor at LaingBuisson and freelance healthcare journalist

With the recent political turmoil climaxing with Prime Minister Theresa May almost being ousted from her job during December, it is not going too far to call 2018 a year of instability. The uncertainty around the Brexit negotiations has affected almost every industry in the UK: social care, with its dependence on a European workforce, also has not been immune. On top of this, the much-promised Green Paper, potentially offering a long-term funding solution for this cash-strapped sector has not materialised. If, and when, it does, it is expected to offer only a short-term solution. This is, of course, presuming the present Government lasts that long. So how can care homes plan for the year ahead in this ever-changing political and January/February 2019

economic landscape? Those relying on local authority funding have had a harder time than most and this looks set to continue. One suggestion I recently heard in order to ensure that public-facing operators are paid a fairer price for care is to change the dynamic of the conversation: rather than ask commissioners what services they want for the price they are offering, instead providers will suggest what bits of care can be taken away from existing services for the price commissioners are willing to pay. Another suggestion is to give social equal standing to the NHS, which has got a five-year plan. There is no reason why social care can’t have its own long-term strategy, but this does mean operators working together, a lot of banging on the Department of Health and Social Care’s door and more work convincing voters that this sector urgently needs investment.

And, what if providers could capitalise on the political instability, as the prospect of a General Election in the near future becomes more likely by the day? This could be the opportunity to send out a clear message to Government and the electorate that social care needs a long-term plan now rather than leaving it in the hands of politicians who may not last the year. Care Home MANAGEMENT 7

CONGRATULATIONS TO…

PROUD TO

PRESENT... The Care Home Management care home Hall of Fame

ASHTON MANOR IS A GOLD INVESTOR IN PEOPLE Ashton Manor nursing home in Farnham (Surrey) has been awarded a Gold Investors in People standard, the highest accreditation a company can receive on a first assessment. Home manager Carla Dixon-Peart says: “This shows that, as an employer, we really look after our staff. [This] is helping make us an employer of choice as it shows how much we care about our staff as well as our residents.” For more information on the Investors in People standard, visit: https://www.investorsinpeople.com/ Carla DixonPeart, manager of Ashton Manor Nursing Home, (front, right) pictured with staff, and home owner Kumar Gnanakumar (front, left)

WELL DONE, THE WHITE HOUSE The White House nursing home has won the SME Excellence Award and the Business of the Year 2018. The Kingston home is also accredited with the GSF Award for End of Life Care. For more information on the awards, visit: https://kingstonawards.co.uk/

(l-r) Meallmore managing director Gerry Hennessey with staff

LEARNING COMMENDATION FOR RMBI RMBI Care Co has been commended in the 2018 Learning at Work Week Impact Awards. The Learning at Work Week Impact Awards are competitive awards that are presented to companies and organisations for running excellent Learning at Work Week campaigns. The awards are run by The Campaign for Learning. For more information on the RMBI Learning at Work Week campaigns, visit: https://www.campaign-forlearning.org.uk/rmbi-care-company For more information on the Learning at Work Week awards, visit: https://tinyurl.com/y99fsatn

MEALLMORE TRAINING AND DEVELOPMENT PRAISED Inverness-based Meallmore has scooped a Scottish Care training and staff development award for its ‘Good to Great Upskills Academy’ senior care worker programme. Unique to Meallmore, the programme is open to those in senior care and management positions and provides personalised development plans and one-on-one mentoring, enabling participants to learn new skills and enhance self-awareness. For more information on the Scottish Care awards, visit: http://www.scottishcare.org/

WINDSOR CARE HOME MANAGER WINS DEMENTIA PRIZE Shahnaaz Mohamad, manager of Sandown Park care home in Windsor, has been named the UK’s best dementia care manager in the National Dementia Care Awards. These awards recognise exceptional work and person-centred dementia care. For more information on the awards, visit: http://www.careinfo.org/dementiacareawards/

8 Care Home MANAGEMENT

ABOVE: (l-r) Claire Dodd, RMBI Care Co assistant director of learning and development, Claire Barratt, RMBI home Devonshire Court trainer holding learning and development team mascot Cyril the squirrel and Devonshire Court home manager Juliet O’Connor

www.chmonline.co.uk

ADVERTORIAL

Avoiding a war on two fronts We are seeing an increasing number of cases in which providers are at the centre of a ‘tug of war’ between their regulator and another body to which they may be accountable. By Helen Claridge, Partner at Hempsons

n such cases, it is key to avoid a war on two fronts. If the CQC identifies concerns then it will be necessary to reassure your commissioners in parallel with the CQC. If placing authorities have identified concerns, then early discussions and prompt resolution may prevent escalation to the level of regulation. You must assume that regulators and commissioners will discuss issues between themselves. It will not assist to assume or demand a strict detachment between the various bodies. However, it may be necessary to remind each of the remit of their roles and the extent of their powers in relation to specific findings. The involvement of a number of bodies following a concern may look and feel both overwhelming and unjust. We suggest the

following top tips to avoid or successfully navigate a war on multiple fronts:

• Do not bury your head in the sand –

acknowledge concerns early on and carry out your own assessment of merit • Assume that the regulator and the commissioners will talk and pre-empt this if possible to avoid the appearance of concealment • Correct misunderstandings, mistakes or a lack of evidence at the earliest opportunity • Establish the remit of each interested body and any timeframes for complaint and/or challenge • If independent expert advice is required, seek it early

Helen works across a wide range of health and social care issues in different jurisdictions including the Court of Protection, Coroner’s Court, the Family Division and the First Tier Tribunal (health and social care). Helen regularly advises organisations and provides training in relation to inspections, complaints, the Mental Capacity Act 2005, safeguarding and funding. Contact: h.claridge@hempsons.co.uk

AWARDS CARE HOME AWARDS 2019

BE A PART OF THE

CARE HOME AWARDS 2019

he 2019 Care Home Awards sees a further revision of categories to include a greater spread of categories for suppliers to the sector to enter and the addition of Best New Care Home, Best Care or Residential Home for Young People and Best Care or Residential Home for Special Needs. Interest in the Care Home Awards is higher than ever with entries already promised from care home organisations that have not entered before. Worth making a note in the diary that the closing date for entries is January 31, 2019. Judging will take place during February and the short-list of Finalists will be published in March. The celebration of the winners will take place at a lunch and ceremony on June 27 in the Platinum Suite at ExCel London. The full list of categories for 2019 is as follows: CARE HOME CATEGORIES • Best for Architecture, Interior Design or Communal Spaces • Best for Garden or Outdoor Spaces • Best for Communication (with residents, families, friends & carers) • Best Facilities Management or Maintenance Team • Best for Non-clinical Facilities (including January/February 2019

wellbeing and alternative therapies)

• Best for Sporting, Social or Leisure Activities • Best for Nutrition, Food & the Dining Experience

• Best Care Home Marketing, Advertising or PR Campaign or Initiative

• Best Training Initiative • Best Nursing Care • Best Specialist Care (including respite, dementia, stroke, etc)

• Best for Young People • Best for Special Needs • Best New Care Home (opened between January 1, 2017 and December 31, 2018) SUPPLIER CATEGORIES

• Best Clinical Equipment, Product or Product Service Supplier (including paramedical or therapeutic service, activity or product, such as eye care, chiropody, hygiene, and therapies, etc) •Best Equipment, Product or Product Service Supplier (including furniture, appliances, heating and air conditioning, art, music, drama, etc, food or catering supplier, maintenance supplies & soft facilities or outdoor supplier, aids for memory or disability, etc) • B est Professional Service Provider (legal, financial, planning, property management, insurance, compliance, etc) • B est Business or Creative Service Provider

(including architecture or interior design specialists, consultants, marketing, advertising, PR or digital specialist and training and development, etc) • B est IT or Communications Product or Service Provider (including monitoring, care management, nursing or emergency response, Broadband, internet, broadcast TV and radio) OVERALL ACHIEVEMENT CATEGORIES (Gold Awards) (To enter the Overall Achievement categories you must have entered at least one other category • B est Individual Care Home or Care Community • B est Single Care Home or Care Community in a Group • B est Smaller Care Home Group (up to 50 homes) • B est Larger Care Home Group (over 50 homes) Work has begun on assembling the judging panel for 2019, increasing its size and breadth of experience in the expectation of new types of entry to the new categories. Legal & General has taken up the reins of Headline Sponsor for the Awards and the Health + Care Show, the Care Show and Fred Theatre return as sponsors for 2019. Care Home MANAGEMENT 11

LEADERSHIP BOOSTING MORALE

WILL YOU PASS THE

L EADERSHIP TEST? It is widely acknowledged that morale is low in the sector, and many of us are struggling to recruit and then retain good staff. But, there is a lot within your control to rectify matters, says Chris Gage, managing director of Ladder to the Moon

ow you view your role, and how you work with your team can have a considerable impact on your team’s morale and performance. Role: You most likely have the word manager in your title, however, you’ll have noticed a strong message from the Care Quality Commission and other agencies that leadership is critical to outstanding care. Leadership and management are two distinctly different practices that are often lumped together. Management is concerned with delivering goals, being consistent, controlling situations, ensuring tasks get carried out. Leadership, on the other hand, is concerned primarily with people, and creating the conditions in which they can perform at their best. SO, ARE YOU A MANAGER, OR A LEADER? Of course you do both, but I suggest it is worth considering what your primary purpose is in your organisation. Is it to deliver on tasks (management) or is it to enable your team to do their best work (leadership)? Working with your team: Twenty years of research form Stanford University show a direct link between leadership behaviours and positive workforce outcomes such as: • Pride in the workplace • Strong motivation (willingness to work hard and long hours) January/February 2019

• Team spirit • Being productive • Trusting management • Clarity about responsibilities. And, the key leadership behaviours that produce these outcomes? • Modelling the way • Inspiring a shared vision • Challenging the process • Enabling others to act • Encouraging the heart. TIME FOR REFLECTION I’d encourage you to think about the best managers you’ve had, and how they behaved. id they behave in a way D that they wanted others to behave? id they inspire you by D talking to you about your values and what is important to you (not the latest corporate vision, or regulatory guidance)? ere they will to W challenge what was happening? id they find ways to D support their team to take control and act on their ideas? id they connect D with your passion and courage? My guess is that the best leaders you have worked with did most of those things. And when they did how motivated were you? Care Home MANAGEMENT 13

ADVERTORIAL

A new focus on inclusion across the Learning & Development industry

ith the social climate changing on a global scale and varying physical and mental needs being better accommodated throughout daily life, diversity and inclusion are becoming an ever-present and vital focus of training in the Learning & Development (L&D) sector. Businesses throughout the UK are becoming more aware of the value of training and viewing it as an investment, rather than a cost. The idea that training enables staff to perform better day-to-day, makes them feel more valued and keeps them engaged, has become more of a fact than an idea as we move into 2019. Based on a 2016 study by Shift, 7 out of 10 employees say that training

and development opportunities influence their decision to stay with a company and this is reflected in the market growth and uptake. Paterson Training, based in the South East, has noted the importance of ensuring training courses of all styles, targeted towards any industry, include room for on-the-spot adaptation to support distinct needs, â&#x20AC;&#x153;In the past, training has not always considered the differing needs of learnersâ&#x20AC;? says Paterson Trainingâ&#x20AC;&#x2122;s Lead Trainer Matthew Mitchell-Farmer. As businesses continue to see the advantage of employing a well-trained workforce, the demand for effective training is increasing.The national workforce is growing more diverse and the opportunities for people with physical or

mental health needs is increasing, which presents Trainers with the challenge of successfully meeting the requirements of a wider group: ensuring breaks are in line with prayer times for different faiths, altering practical sessions to accommodate people with varying levels of physical ability, or indeed modifying face-to-face sessions to better include a delegate with a learning difficulty, for example. Increasing awareness of adapting and delivering training to encompass equality and diversity is an extremely positive step forward for the training industry. This enhancement will no doubt aid in businesses willingness and ability to offer training to their employees, including those of varying faiths and abilities.

TRAINING EQUINE-FACILITATED LEARNING

PUTTING HORSE-POWER INTO

TRAINING

Are you looking at a gift horse in the mouth when it comes to choosing leadership and management training, asks Care Home Management editor Ailsa Colquhoun

ith their prey instinct and hypersensitive awareness, horses are innately able to size people up, says equine training provider Hornby and Birtwistle - which makes them the perfect tool for leadership and development training. Company co-director Catherine Howley says: “Horses do not role play. If you want a horse to co-operate and follow, you must demonstrate real leadership.” It’s easy to think of horses as animals to be controlled with a kick of the heels and by putting a metal bar in their mouths. However, as anyone who has worked with horses can tell you, it takes real skill to get a horse to do what you want. Equine-facilitated learning and coaching (EFLC) is a training and development tool that harnesses this challenge. It combines interaction with horses (on the ground - not riding) with non-directive coaching techniques such as Neurolinguistic Programming. The aim of ELFC is to use horses to challenge and assess a person’s level of emotional January/February 2019

intelligence, leadership, communication and influencing capabilities. Joining Howley in the ELFC team is co-director Catherine Birtwistle and equine companions Teddy, Rocky,Willow, Bertie Biscuit, Juno, Flicka and Gypsy. Birtwistle says that horses are adept at picking up and responding to human intention and non-verbal communication. Through their reactions to people, horses provide honest, immediate feedback to a participant, which can then be addressed by highly-targeted training. Among the many demonstrations of ‘horsepower’ the team has seen: the horse that shied away from an overly-aggressive participant, who was then able to receive training on aggression management. Conversely, a horse misbehaved for a participant, jumping around and pulling away its head. It turned out that this participant struggled generally to exert control over work colleagues, and was able to benefit from highly-targeted assertiveness training. Sessions can also highlight an individual’s management style, for example, the micromanager who cannot stop themselves from

turning back to check the horse is doing what he expects. Birch Green care home, in Skelmersdale, is among the care home clients to have accessed ELFC and general manager Vicky Sudworth agrees that horses have an exceptional role to play in leadership training. She says: “There are many different ways in which we are able to communicate with our staff. Horses need you to connect on their level. If you can lead a horse and control the horse, you can lead and motivate your staff.” Horses will naturally follow a human with good leadership skills

Care Home MANAGEMENT 15

WELLNESS WHISTLE-STOP

ASK THE EXPERT:

Care Home Management asks our panel of experts to answer your common care queries

IN THIS ISSUE: FLU

groups of people. High-risk groups for flu complications include: • People over the age of 65 • Diabetics • P eople with lung, heart, liver, kidney or neurological diseases • People with a weakened immune system.

By Paul Mayberry, pharmacist and director of Pilltime Q: One of my residents has caught the flu and is really poorly, but when should I call the doctor? A: Firstly, thank you for asking this question. Doctors are often very busy at this time of year, so it’s important to work out whether a GP visit is necessary at the first signs of flu. There are three questions you should ask yourself to help you make the right decision about medical intervention for your residents. 1. Is it definitely flu? Although flu is prevalent during the winter months, common colds are often mistaken for flu. In the first instance, you should assess your resident to confirm whether they have flu. Cold symptoms include headaches, blocked sinuses and coughs. If your resident has the flu, they will likely be showing additional symptoms, such as achy joints, extreme muscle tiredness and vomiting. If your resident is suffering with these additional symptoms, they may need further medical attention.

For these people, antiviral treatment is recommended within the first 48 hours of flu symptoms.You should call the doctor to assess your resident and prescribe medication as they see fit. 2. Is your resident otherwise healthy? Flu can have more severe effects on some people than others. If your resident is otherwise healthy, it’s likely that the symptoms will pass in a couple of days and they will start to feel well again. In this case, GP intervention may not be necessary. Flu symptoms can be managed by resting, drinking plenty of fluids and keeping warm. Paracetamol may also be used if the resident has a fever. 3. Is your patient at risk of flu complications? Flu can be more dangerous for certain

If you’re still unsure about whether to call a doctor and you’d like some more advice, you may wish to call NHS 111 Service to discuss your resident’s symptoms. Public Health England also offers advice for managing the following common infections in primary care: lower and recurrent UTIs; prostatitis; pyelonephritis; otitis media (acute); sinusitis (acute); sore throat (acute), available [online] via the link: https://tinyurl.com/zcbxozw

WELLNESS WHISTLE-STOP

Focus on scabies

In a new series, Care Home Management magazine looks at health conditions affecting care home residents and how care home staff can support rapid accurate diagnosis and treatment Q: Why do I need to know about scabies?

A: Scabies can have a profound impact on a personâ&#x20AC;&#x2122;s quality of life; infection causes severe and persistent itching that is characteristically worst at night. Frail elderly people may also be at increased risk of secondary bacterial infections resulting from scratching that damages the skin.

Q: How is scabies managed in the care home?

A: Scabies infections are caused by infection with a scabies mite. Treatment is with insecticidal cream or lotion.

Q: What are the signs of a scabies infection?

A: Usually, a red lumpy rash between the fingers, on wrists and elbows, which is persistently very itchy, and usually at night. However, the tell-tale scabies rash can also appear on the back and on the trunk â&#x20AC;&#x201C; areas that are usually covered with clothes - which can make it hard to find. Research from the Brighton and Sussex Medical School suggests that infections can go undiagnosed for as long as five months.

Q: What can I do to help?

A: Be aware that scabies does not just affect hands and other visible areas. Be on the look out for itchy skin conditions that do not improve with moisturising treatments for eczema and dry skin. January/February 2019

If a resident appears more agitated than usual, do not exclude the possibility of a scabies infection. Residents with dementia may be unable to communicate their itchiness.

Q: Why is quick treatment important in the care home?

A: Scabies is easily transmitted in places where there is close personal contact. Mass treatment is a substantial undertaking, that can take several months to work, and care home staff can find the process stressful and timeconsuming to manage. Treatment can involve multiple GPs and a struggle to acquire sufficient treatment. There may be extra administrative costs due to the need to employ extra staff, and increased costs of cleaning and laundry. Residents can find it hard to understand the need for mass treatment, particularly in intimate body areas, and may struggle with the need to limit personal contact with friends, families and carers, ultimately affecting cooperation.

Q: Where can I go for more information?

NHS Choices: Scabies information [online] at: https:// www.nhs.uk/conditions/scabies/ Brighton and Sussex Medical School, Various research resources, available from: Professor Jackie Cassell, head of department, primary care and public health. Email: J.Cassell@bsms.ac.uk 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 Shaw Healthcare (Group) Ltd

THE COMPLAINT: The complaint

SUMMARY: The complainant says

• look after or safeguard a client

DECISION UPHELD: The care

• make proper arrangements for

the care provider did not properly involve the family in a client’s welfare and failed to follow best interest practices.

provider failed to consider consulting the client’s daughters and to record its reasons for not doing so. It also failed to adequately manage disposal of out of date food kept in Mr Y’s room.

18 Care Home MANAGEMENT

is that the care provider failed to:

by allowing him to have out of date food in his room or checking the suitability of food received from visitors communicating with the client who has speech difficulties

• properly decide capacity and involve interested people in line with best interest practice thus denying the client’s daughters an involvement in his care and future care planning.

ANALYSIS

Section four of the Mental Capacity Act 2005 provides a checklist of steps that decisionmakers must follow to determine what is in a person’s best interests, the person’s past and present wishes and feelings, beliefs and values and other factors he would be likely to consider if he were able to do so. The decision-maker must consider if there is a less restrictive choice available that can achieve the same outcome. The checklist includes the decision-maker considering, if it is practicable and appropriate to consult, the views of: • Anyone named by the person as someone to be consulted on the matter in question or on matters of that kind www.chmonline.co.uk

BEST PRACTICE FROM THE OMBUDSMAN

• Anyone engaged in caring

for the person or interested in his welfare • Anyone with a lasting power of attorney granted by the person • Any deputy appointed for the person by the court. The decision-maker must also record their reasons for consulting or not consulting more widely. In this case, Mr Y is the client. His relatives include: Mrs Y, his wife, and Miss X, his daughter. THE HEART OF THE CONCERNS The heart of Miss X’s concerns is the exclusion of her and her sister from decisions made about Mr Y’s care and support. In their view staff consulted only Mrs Y whose daily presence and status as wife was presumed by staff to mean she was the only family member able to contribute. Miss X and her sister believe they can and should contribute to decisions especially when Mr Y may lack capacity. Miss X says she found out of date food in Mr Y’s room in September 2017 including items which had ‘use by’ dates of January, March, May and June 2017. Miss X says staff

January/February 2019

should be checking out of date food and food brought in to the care centre to ensure it meets Mr Y’s dietary needs. AGREED ACTION The care provider says staff now ensure they destroy food as soon as it goes past its use by date, and regularly check the room and fridge for food. The care provider also states that it gives “equal weight to the information we need to discuss with family to both [Mr Y’s daughters] and Mrs Y.” Standard practice is to always tell at least one family member about any changes in Mr Y’s condition as it is usual to expect the information to be cascaded to other family members. However, the care provider says as an exception to that usual rule it tells both Mrs Y and Miss X about any changes in Mr Y’s condition. Staff now have a process in place for involving Miss X in best interest decisions even though this may delay the decision. In addition, in light of the ombudsman’s decision, the care provider agrees to: • Apologise to Miss X and her sister for not properly considering consulting them and recording the reasons for not doing so

• Record an alert on Mr Y’s records

to remind staff to consider consulting Miss X and her sister when making best interest decisions. The alert should remind staff to note their reasons for consulting or not consulting Miss X and her sister, showing why it is not practicable or appropriate • Continue updating Miss X and her sister on recent decisions made about Mr Y’s care and support • Commits in writing to considering when making best interest decisions whether it is practicable and appropriate to consult with Miss X and her sister • Continue to share with staff the need to properly record for all clients how they decide on whom to consult and any reasons why such consultation is not practicable or appropriate. Read the whole decision [online] at https://www.lgo.org. uk/decisions/adult-care-services/ residential-care/17-008-490

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

Links Lodge, Blackpool Effective:

Caring:

What Links Lodge did: Effective

Staff continued to use the ‘Pool Activity Level’ (PALS) and ‘Living Well With’ tools to assess the most effective way to provide the most appropriate activities for each person. The home employs a full-time occupational therapist, supporting people with posture and positioning. For one resident, this resulted in an early discharge from hospital. Staff used picture menus and food DVDs, food sounds and smells to encourage people to eat and drink well. The service continued to promote the use of champions, among others for dementia, and infection control. Role play and experiential learning were used regularly to give staff interactive experiences, such as being lifted in a hoist, being fed by

Responsive:

Read the full report [online] at: https://www.cqc.org.uk/location/1-110425603

Well-led:

someone else, having a thickened drink or experiencing what it was like to have sensory difficulties.

What Links Lodge did: Caring

Happiness and well-being initiative ‘hygge’ was used separately, and in combination with sensory therapy to reduce sstress and anxiety.

What Links Lodge did: Responsive

One of the management team built a custommade electronic care system personalised to the people they supported, including using photographs and videos of each person’s moving and handling. Staff developed a “Night Owl Club” for people who cannot sleep, offering relaxing activities, a chat, drinks and snacks.

Staff supported one person who became seriously ill and was admitted to hospital with a poor prognosis by staying with them 24 hours a day.

What Links Lodge did: Well-led The home worked with therapists and learning disability teams to deliver the right support. Audits were frequent and thorough and included care, medicines, records and the environment. Links Lodge had started auditing the service against ‘Supporting People with Profound and Multiple Learning Disabilities – Core and Essential Service Standards’, a document supported by NHS England and the Royal College of Occupational Therapists.

20 Care Home MANAGEMENT www.chmonline.co.uk www.chmonline.co.uk

BEST PRACTICE OUTSTANDING HOMES

Formations Care Home, Shipley, West Yorkshire Effective:

Caring:

What Formations did: Effective

Health and social care professionals, described as “service advisors” provided training and support. The service contributed to the development of best practice guidance, sharing outputs with other homes. One example included a discreet chart to monitor and promote fluid intake of people and a heatwave management plan. Formations used visual or kinaesthetic (learn by doing) training and purchased ‘germ dust’ to simulate a contamination alert. Managers also purchased a life-size dummy to support training. Champions were in place for 12 areas including equality and diversity, infection control, medicines and behaviours that challenge. Comprehensive information followed people into hospital, including information on what people would like to take with them to hospital. The home then planned in detail, including the need for extra batteries for people’s headphones and religious artefacts to keep people as comfortable and distress-free as possible. Residents were involved in decorating communal areas of the home; sensory stimulants were located throughout the home, eg information, pictures and music from a band, which could be activated by residents to stimulate memories by pressing a large button. January/February 2019

Responsive:

Read the full report [online] at: https://www.cqc.org.uk/location/1-3740401619

Well-led:

What Formations did: Caring

Staff used a good mixture of verbal techniques, body language and communication aids to help reduce distress. There was a strong focus on promoting people’s independence. In one example, a person was brought their toast and plate of butter separately so they could spread the butter on their own toast. There were information and tools, including talking tiles for the visually-impaired, and a recorded complaints procedure.

What Formations did: Responsive

Formations purchased greenhouses and an allotment where residents could enjoy one-to-one time with staff.This is part of a personalised care strategy called ‘Time 4 care.This also included taking a resident to Scotland on an overnight visit. People and relatives were involved in all aspects of the service, from the comprehensive

pre-assessment conducted outside the premises to providing service feedback on the service at the annual quality event.

What Formations did: Well-led

Staff felt valued and diverse needs were catered for, including space and time off for staff to observe religious commitments, and dietary requirements observed. Quarterly reassessment using an outcome target scale of a person’s risk level and dependency in key areas such as weight, skin integrity, behaviours that challenge, mobility and social isolation: analysis showed that all people had seen improvements in at least one key area and 80 per cent in two more. Performance was audited against best practice guidelines including National institute for Care and Health Excellence (NICE) guidance and CQC Key Lines of Enquiry and using corroborate information from sources, including people and relatives, and health professionals.

ALSO OUTSTANDING AND WORTH LOOKING UP Ashgrove House nursing home, Purton, Swindon. (Pictured) Read the full report [online] at: https://www.cqc.org.uk/ location/1-117360070 Parkwood House, Plymouth, Devon. Read the full report [online] at: https://www.cqc.org.uk/location/1-144214093

Care Home MANAGEMENT 21

PROFILE CORNERSTONE

MINDING THE Cornerstone’s new residential care acquisitions in Hampshire aim to bridge the care gap for older people with comorbid neurodegenerative diseases

ornerstone’s opening of two specialist care homes in September marked the beginning of a five-year plan to open 500 specialist beds in an area spanning from the South Coast to the Midlands, says group chief executive officer Johann van Zyl. Since taking ownership of the 94-bed Safari Lodge in Waterlooville and 63-bed Kitnocks House in Botley, near Southampton, and with the financial backing of equity investor Ignite Growth new owner company Cornerstone is busy refurbishing a business which has previously operated as residential care for adults with dementia, learning and physical disabilities, and mental health conditions. Specialising in the care of people with neurodegenerative diseases such as Parkinson’s, Huntingdon’s diseases and other conditions including dementia, mental and physical health problems, Cornerstone is targeting a market of around 16,000 people who are currently underserved in terms of accommodation by around three people to every one bed. Together van Zyl and chief operating officer Dara Ni Ghadhra have over 50 years’ experience in international business and specialist neurological care at companies including Milton Keynes-based PJ Care and Provenance Healthcare in Cambridge. Ni Ghadhra says: “We have seen this population come into being in the past 20 years, as medical advances allow people with complex health conditions to live into older age, and it fantastic that facilities now exist to allow people to live in a community setting. Because of their dementia and age these residents are just not suited to a mental health unit, which are just not equipped for an older person’s needs.” SPECIALISING EVERY ASPECT OF CARE Offering mixed and single sex accommodation, Cornerstone’s homes have a waiting list and attract residents from all over the country. Ni Ghadhra says this recognises the fact that meeting a resident’s care need can be more important to commissioners and families than location. But, she says: “It is not cost effective to 22 Care Home MANAGEMENT

Funding is in place to allow Cornerstone to open 500 beds in five years, says group chief executive officer Johann van Zyl

have a specialist home in every area.” Differentiating themselves from homes that may have a few beds allocated for complex, comorbid residential care, the Cornerstone homes offer a holistic specialist care option. Ni Ghadhra says: “People see the bigger fees and think ‘I can do that’ but a specialism commands higher fees for a reason. We can specialise the training of every aspect of our service, including among our catering and ancilliary workers, so that everybody can communicate effectively with these residents and deliver the values of our service.” For the team this means training in specialist skills such as de-escalation techniques and endof-life care, as well as in catering (producing food in-house for people with swallowing difficulties), access to an in-house occupational therapist and a focus on specialist research in this population group. Additionally, the homes are currently being refurbished to cater for their resident’s specialist wellbeing needs. One example of the changes being made are the new-look rest areas in hallways that feature wall murals that look like a garden complete with decorative fluorescent light covers with a cloud design. These aim to bring the outdoors inside for bed-bound residents. “Quality systems and a quality environment aim to make the business more robust and more attractive to employees, which helps reduce recruitment and retention challenges, says Ni Ghadhra.

STAFFING CONSIDERATIONS Following recent successful recruitment drives in Romania for nurses, Cornerstone’s homes are currently operating at full capacity for nurses but, like many homes, finding carers can be more challenging. “We practice value-based recruitment, as we see values as a more important intrinsic asset than technical skills, which can be taught.” says Ni Ghadhra. The home also operates super numerally, so that staff are able to shadow more experienced colleagues. The current Brexit position does not worry her unnecessarily, she says, as existing staff are settled. “It is March 2020 that will be the difficult time for recruitment,” she says, so our focus is on retention. We never feel that investment in staff is wasted; even if they move on, it’s a small world: we gain from other providers as many skills as we lose.” INTEGRATING COMMISSIONING Inappropriate care can have a hugely detrimental effect on a person’s wellbeing and, for commissioners the costs can be enormous if the only alternative care model is one-to-one provision. Cornerstone’s care model aims to “bridge that gap,” says Ni Ghadhra. But, that’s not to say that gaining funding from integrated commissioners isn’t problematic. Ni Ghadhra says: “It is still a Cinderella service and there is a lack of recognition for this group. People only think of care homes in terms of older people and those offering five-star care. But working in mental health services for 20 years I am used to working in a Cinderella service where physical health gets all the attention.” Despite ongoing problems with silo thinking and ‘territorial’ funding, Ni Ghadhra is encouraged by the fact that integrated commissioning is now backed by “real intention”. She adds: “And, when you can demonstrate that you can save money and can meet need, commissioners are more open to funding our model of care. They see me as their risk management: that I can take risky individuals that others can’t and maximise their quality of life.” She believes that commissioners are beginning to understand that a well-managed need is still www.chmonline.co.uk

PROFILE CORNERSTONE

GAP

a need, and that people cannot just be ‘moved on’ when an acute situation has been managed. Ni Ghadhra says: “We have had situations where a commissioner has opted for another provider but has come back to us because of a failure of care. I have also seen people sectioned with a mental health problem having to go to hospital, when I believe we could have managed those needs. “We have demonstrated that it is better to place people with us, than to bounce people back and forth until they find the appropriate setting - sometimes commissioners just have to pay the price for a specialist service.”

Cornerstone clinical specialities: Dementia

Korsakoff’s Dementia Functional mental illness Huntington’s Disease Behaviour – risk to self or others Mobility – multiple falls requiring supervision, specialist moving and handling equipment Nutrition – regular choking risk. Continence Breathing PRN medications Altered State of Consciousness Skin – complex dressing regime

January/February 2019

We practice valuebased recruitment, as we see values as a more important intrinsic asset than technical skills, which can be taught. says Ni Ghadhra Care Home MANAGEMENT 23

24 Care Home MANAGEMENT

www.chmonline.co.uk Infection essentials quiz answers

1. True. Everyone is at risk of Legionnaire’s disease and the risk increases with age.The most at risk include: people aged over 45; smokers and heavy drinkers; people suffering from chronic respiratory or kidney disease; diabetes; lung and heart disease; people with an impaired immune system. For more information on Legionnaires’ disease, visit the Health & Safety Executive [online] at: http://www.hse.gov.uk/pubns/books/l8.htm 2. False. Legionella can remain dormant at water temperatures below 20°C.The bacteria flourishes in temperatures of between 20–45°C, 3. c) Seven times. See the infection control feature on page 25 for more information 4. b) 44,000.To understand the signs of sepsis, visit: https://sepsistrust.org/ 5. a) Two or more. See DHSC social care guidance [online] at https://chmonline.co.uk/ be-ready-for-flu/ 6. c) The first 48 hours. Remind yourself of the advice from our pharmacy expert on p16 7. a) within 1-2 metres of the patient. See NHS Employers guidance: Protecting staff from infection [online] at: https://www.nhsemployers.org/~/media/Employers/Publications/ Protecting%20staff%20from%20infection.pdf 8. True. For more information, visit NHS Employers guidance [online] at: https://www. nhsemployers.org/campaigns/flu-fighter/nhs-flu-fighter/why-it-matters 9. a) One in three. See NHS Employers (above) 10. False. Alcohol hand gels don’t kill norovirus. Washing your hands frequently with soap and water is the best way to stop the bug from spreading. For more information, visit: https://www.nhs.uk/conditions/Norovirus/

Care homes should consider they have an outbreak of flu if how many residents or staff start to display symptoms at the same time? a) 2 or more b) 3 or more c) 4 or more

According to the Sepsis Trust, how many people die each year or sepsis? a) 33,000 b) 44,000 c) 55,000

True or false: alcohol hand gels can kill the norovirus?

How many flu deaths are in otherwise healthy people? a) One in three b) One in four c) One in five

True or false. You can spread flu even if you don’t have any symptoms?

Using an invasive medical device increases the risk of infection in a resident by how much? a) Five times b) Six times c) Seven times True or false: A water temperature of below 20°C will kill the Legionella bacteria causing Legionnaires’ disease?

Test your knowledge of these infection essentials. The answers are at the bottom of the page

True or false: Legionnaires’ disease is a potentially fatal form of pneumonia and everyone is susceptible to infection?

According to NHS Employers guidance, staff should wear a surgical mask within what distance of a resident with an airborne transmittable disease such as flu? a) within 1-2 metres of the patient b) when in the same room c) it’s not recommended at all In people over the age of 65 with flu, antiviral treatment works best within what maximum time period? a) the first 12 hours b) the first 24 hours c) the first 48 hours

HOW MUCH DO YOU KNOW?

INFECTION CONTROL: INFECTION CONTROL QUIZ

INFECTION CONTROL INVASIVE MEDICAL DEVICES

CLINICALLY

CLEAN Invasive medical devices add an extra dimension to the challenge of preventing and controlling infection, says Claire Bailey, clinical operations manager at care home operator Autumn Care

What will I learn from this feature? How to safely manage patients who use invasive medical devices

nfections have the capacity to spread rapidly within environments where many people are living and eating in close quarters. In an elderly population with multiple health conditions recovery from an infection can be very complicated indeed. Using invasive devices increases the risk of infection seven-fold: this is because any invasive device is introduced into the body mechanically, either through a break in the skin or another opening in the body. The device acts as a mode of transport for external bacteria to enter the body. Invasive devices include: • Catheters • Tracheostomies • Intravenous tubes for enteral feeding • Sharps for glucose monitoring • Sub cutaneous lines for fluids and or medication.

carrying out procedures using an aseptic technique • Associated items should never be shared among residents and items should be single use where possible, for example, single use saline sachets and gauze swabs.

POLICIES FOR INFECTION CONTROL

Sepsis is a life-threatening illness caused by the body’s response to an infection and signs include: • Fever above 38°C or a temperature below 36°C • Heart rate of 90BPM or higher • Respiratory rate of 20 per minute or higher • Probable or confirmed infection.

Policies for the storage and use of these devices should be documented in the care home, and in the resident’s care plan. Examples of entries include the following: • Invasive devices such as urinary catheters should be prescribed for individual residents and be stored in their own room to ensure that they are used only for them • Ensure that any sterile equipment is in date and the packaging is sealed and not damaged • All relevant staff should be competent in January/February 2019

Staff should also be aware of the signs and symptoms of an infection in a resident. These include: • Fever • Overall malaise • Chills and sweats • Cough and coloured sputum • Shortness of breath • Stiff neck • Burning or pain with urination • Localised redness and swelling • Localised pain • Purulent discharge from a wound.

To reduce the impact of an infection outbreak: • Take extra measures such as deep cleaning with an appropriate solution, such as a chlorine-based disinfectant

solution, eg, Milton. Deep cleaning will cover areas that are usually cleaned less frequently such as curtains, doors and door handles, light switches, extractor fans and vents • Frequent cleaning of all common touch points • Isolate residents with infection (usually until they are 48 hours free of symptoms) • Review affected residents’ care: ensure they are given plenty of fluids and receive appropriate nutrition, such as light, bland meals after a vomiting bug • Postpone visitors, outside trips, new admissions and readmissions from hospital.

REMEMBER! The best way to limit the risk of infection from invasive devices is to ensure that they are used only when absolutely necessary, for example, when urinary incontinence is impeding wound healing or causing severe skin irritation, and where the benefit of catheterisation outweighs its risks Care Home MANAGEMENT 25

INFECTION CONTROL INVASIVE MEDICAL DEVICES

PREVENTION: BETTER THAN CURE

Preventing and controlling infections quickly are crucial to demonstrating quality of care in care homes. Current standards (see box, below) set out the risk assessments and processes to be followed for managing and communicating an infection outbreak. Good practice will include the following: • Routine cleaning of the environment, including reusable equipment and laundry

Should I cleanse or sanitise?

Hand cleansing using the correct technique with mild soap and water and then drying hands with paper towels is the best policy to help prevent the spread of germs, and for cleaning visible dirt from hands as well as many bacteria and viruses. Hand sanitising with an alcoholbased sanitiser (minimum of 60 per cent alcohol) is a good substitute for

washing hands provided hands are not actually dirty, contaminated or soiled, eg, with faeces and secretions, or during outbreaks of diarrhoeal illness (norovirus and C.diff). In these instances, washing hands with mild soap and water is necessary. To find out more about hygienic hand washing, get a copy of the ‘Get wise to hand hygiene’ guide from the British Healthcare Trades Association [online] at: http://bit.ly/2BL5fjm via the link https://tinyurl.com/ydawodvx

• Policies in place for deep cleaning and laundry management where infection is present

• Use aseptic techniques with clinical procedures

• Rigorous use of personal protective

equipment such as gloves and aprons

• Safe food preparation and storage • Effective pest control • Effective waste management and disposal

• Limit staff to discrete working areas (as far as care home layout allows) to avoid spreading the infection between areas

• Minimise use of staffing agencies,

and inform them of infection in your home. This will limit the spread of infections between care homes and hospitals.

Further Reading

Bupa and Centre for Policy on Ageing (2011) white paper. Changing role of care homes [online] at: http://www.cpa.org.uk/information/reviews/changingroleofcarehomes.pdf NHS Employers guidance: Protecting staff from infection [online] at: https://www. nhsemployers.org/~/media/Employers/Publications/Protecting%20staff%20from%20infection.pdf UNISON Health and safety guide. It’s not part of the job [online] at: http://www.unisonvob.co.uk/wp-content/uploads/2013/01/Violence-at-work.pdf Skills for Care report (2013). Violence against social care and support staff [online] via the link: https://tinyurl.com/ybjdb9q2 Nursing 2018 article: Reducing risks from combative patients. Perry Jane MA, et al; [online] at: https://journals.lww.com/nursing/Fulltext/2003/10000/Reducing_risks_from_ combative_patients.29.aspx

90 per cent of injuries to carers are to the arms

Lynne, carer: “I have worked with 90-yearold bedridden ladies, but who will fight like wildcats when being given personal care. They cannot help it: it is the illness”

BBC news article [online] at: https://www.bbc.co.uk/news/uk-england-45652459 The Sun news article [online] at: https://www.thesun.co.uk/news/7350927/monkeypox-outbreak-fears-uk-third-case/

30 Care Home MANAGEMENT www.chmonline.co.uk

UNIFORMS PROFESSIONAL DRESSING

TAKE TWO SUPPLIERS:

UNIFORMS

It is important to choose the right uniforms for staff. CHM asked two leading suppliers for their views: Grahame Gardner’s sales director Simon Ward and Meltemi’s head of marketing Sarah Herbert

CHM: How important are uniforms to how care workers and residents interact? Is it about looking professional? But this is a resident’s home so would a dress code be better? Grahame Gardner (GG): When you have a duty of care to those who are vulnerable, unwell or in need of professional assistance, looking professional helps to reassure and comfort residents and family members. Uniforms should represent the identity of your care home and the employee’s role, and make them feel proud to be a part of the team. Meltemi (M): We know how important it is from both a staff and resident’s perspective for care workers to wear uniforms that are appropriate to their role. Uniforms are also lightweight and fit for purpose, which is important in a warm environment. CHM: What makes a good uniform (comfort/washing/ repairing)? What about other factors such as colour? M: A good uniform is one that fits well and people can move in easily. A lightweight fabric helps from a comfort perspective and functional features such as action back pleats and side vents are important to allow for ease of movement. Waterproof lined pockets also help to keep the uniform looking good and to prevent damage. The fabric should be washable at 85°C for infection control and the tunic should retain its professional appearance for a minimum of two years’ normal wear. A good quality tunic, one that is manufactured using fabrics and fastenings that have been January/February 2019

tested to meet stringent industry standards, should not require any repairs during the lifetime of the garment, nor should the fabric fade, however dark the colour. GG: A good uniform combines comfort and practicality with style and choice: options can include vibrant scrubs, polo shirts and fleeces, through to traditional tunics and trousers. CHM: What advice would you give a care home when choosing a uniform supplier? M: Firstly, find a uniform supplier who has complete control over their quality standards. This generally means partnering with a supplier who owns their own manufacturing facilities. Ask to see case studies of other care home projects of a similar or larger scale that the supplier has successfully completed and follow up references with these organisations. Also, think about what type of business you want to work with and what is important to you and your business. Of course, quality, service and price are important factors when choosing a uniform supplier but what about other ethical factors, such as the supplier’s commitment to supporting the communities within their supply chain and environmental impact. GG: Choose a supplier with the experience and heritage to understand the needs of your business and employees. You might need customisation and branding through embroidery and monogramming, or made-to-order options, or next day or free delivery. Live web chat might help you manage your order. Care Home MANAGEMENT 31

DESIGN INTERIOR DESIGN TIPS

What will I learn from this feature? How to use colours, lighting and accessories to improve the look of your home

Painting a picture of health. Wordsworth House care team (L-R): David Hartley, Linda Menzies, Andrea Chadwick, Debbie Stevens, Maggie Albones, Collette Sharples, Laura Wolstencroft, and Aimee Green

MOVING AWAY FROM

MAGNOLIA

Stick to the golden rules of interior design and you will transform your home from a maze of magnolia into a care home resident’s dream, says Jacqui Smith, director of healthcare design company HomeSmiths FUNCTIONALITY A room has to serve the needs of the people who live in it, and be somewhere that feels warm and homely. Furniture and décor should aim to balance ‘aspirational’ with an environment your catchment area can relate to, and should encourage social interaction with clusters of different sizes of seat to meet each resident’s comfort needs (for more help with choosing a seat, see page 35). Corridor seating will also provide residents with resting places as they move from one part of the home to the other, encouraging them to be independent and sociable. 32 Care Home MANAGEMENT

www.chmonline.co.uk

DESIGN INTERIOR DESIGN TIPS

Painting a picture of health

Colour choice makes an enormous difference to a person’s experience of a room, affecting how they feel, behave and interact with others. The care team at Wordsworth House, Hapton, in Burnley, conducted research to identify the best colours to help residents living with dementia feel at ease; they selected shades of blue, purple, and yellow:

• Light blue for the dining room as it is soothing

“High colour contrast acts as useful navigation for older residents”

and serene, and it helps the residents to feel calm while they’re eating

• Lemon for the corridors because it can stimulate brain wave activity

• Royal blue for the handrails to add contrast for safety

• Lilac and purple for the lounge, for soothing and calming and to make the space seem bigger. Aimee Green, home manager at Wordsworth House, said: “The team at Wordsworth House have done a lot work to redecorate the dementia unit, from choosing the colours to picking up brushes and paint rollers. It looks fantastic, the residents love it, and they’ve done a brilliant job.” Wordsworth House forms part of Larchwood Care and is managed by Healthcare Management Solutions.The service provides residential care for up to 40 older people.

COLOUR CONTRAST

FINISH Hard flooring must be non-slip, particularly, in wet areas; it should also reduce glare so opt for matte and brushed finishes, rather than polished.

ACOUSTICS Acoustics should maximise sound but minimise noise. Think about your use of acoustic flooring, noise-absorbing window treatments and furniture such as room dividers, as well as where noisy areas such as the kitchen and lifts are sited in relation to resident areas.

ART AND ACCESSORIES

They add to the homely appeal and they can help residents remember where they are. There is a time and a place: Signage should be clear, incorporating light Visual contrast between critical surfaces text on a lighter background, which is easier will help a person with poor sight or impaired cognition to navigate their environment for an ageing eye to see than dark text on a light background. as easily as possible. Contrasting colours to the skirting boards and floor outline where the floors and walls begin and end. Architrave contrasting with the wall will define where the door is. Sufficient contrast is achieved when there is a 30-point difference in Light Reflectance Value (LRV), which is a measure of the amount of light reflected back into a room by a surface: the lighter the colour, the higher the index. The same logic applies to light switches and fixings like grab rails in bathrooms. Colour contrast in adjacent flooring surfaces is a real no-no for people with dementia. A dark threshold strip or a dark floor mat against a paler toned floor can appear like a step and can become a trip hazard. Dark door mats can look like a hole. Ideally, flooring throughout a care home should be the same colour. January/February 2019

LIGHTING Maximise natural light wherever possible. Window treatments should allow natural daylight in, but be able to filter strong light out when necessary to avoid glare. Wellthought out artificial lighting is a worthwhile investment: LED lights can change furniture or finishes with warm red tones into a less-thanuplifting muddy brown. Lights that give off a cool blue light can make residents feel restless, particularly at the end of the day (see box, below, for more information). Light fittings should avoid glare and there should be flexible task lighting to enable residents to adjust light levels to suit their individual needs.

Get into the rhythm of the light

Older people can have problems regulating their body clocks, and bad lighting can often be to blame. Different colours of light have varied wavelengths which trigger different responses in the human body: the cool, blue light of the morning kick-starts our body clock; the presence of sunlight stimulates the brain to secrete cortisol which promotes a state of alertness, preparing us for the day. As the light changes through the day and then fades to the warm yellow of dusk, we receive the cue to start thinking about winding down and ultimately falling asleep. The science behind this cue is the hormone melatonin which the brain releases towards the end of the day, which causes us to feel drowsy. White- and blue-based lights can inhibit the secretion of melatonin, which interrupts our body clock, upsetting our usual sleep pattern.

Care Home MANAGEMENT 33

DESIGN INSPIRATION ALASTREAN CARE HOME: In this ‘pamper’ room in the Alastrean care home, yellow is combined with soft tones of grey for a calming look. Milan fabric, used on the chairs, has waterproof characteristics making it practical as well

PRIVATE DINING: It’s nice for residents to have somewhere they can spend time and have a meal with their family on special occasions. Darker tones give the room a plush look and feel. The chandelier, velvet curtains and pelmets with a beaded border complete the look

FOLK HALL: Dementia care is supported here, in Folk Hall, using a mixture of soft tones and bright colours to prompt comfort, reminiscence and solace. In the image you can see the stark contrasts between areas to make it easier for dementia patients to see the different items of furniture

Creations

DESIGN

Get some inspiration from these design creations from Spearhead

WINDERMERE GRANGE: Agua Parody vinyl, used here on the chairs in Windermere Grange, looks just like a fabric, giving the room a cosier appearance while still being easy to clean. Fabric-look chairs remind residents of the comfort of their own home

RECEPTION: Chesterfield furniture and gold décor can give reception areas a traditional but classy appearance. The patterned carpet gives the area a unique feel

ALASTREAN CARE HOME, ABERDEENSHIRE: This home was set up for the caring needs and requirements of ex-service men and women. The brief demanded a traditional and salubrious look that captured a military theme, while remaining suitable for caring. This was achieved through the use of old RAF buttons inserted into the backs of the chairs pictured here, and the use of a dark navy colourway, which is still the colour of RAF Uniforms today

34 Care Home MANAGEMENT

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D E SI G N SEATING

TAKE YOUR

SEAT!

But, first, make sure it is the right one, says Kate Sheehan, occupational therapist at Repose Furniture When choosing seating for your residents, especially those with mobility problems, there are five key factors to keep in mind:

Seat depth – The human femur needs to be well-supported to allow for pressure to be spread across the whole of the thigh. If the chair is too deep, the resident will have to sit on the edge of the chair to place their feet on the floor and won’t have any back support. This will severely limit the amount of time a resident will be able to spend on their chosen activity. If the chair is too short, there will be excessive pressure on the mid-thigh causing discomfort and possible pressure sores. Seat height – Being able to put feet on the floor aids balance and enables residents to engage their core muscles to keep a straight upright position.

• Too high? The resident is liable to slump in

the chair to try and get their feet on the floor. This increases pressure on the bottom and requires the head to flex forward, reducing field of vision. • Too low? The knees will push upwards causing significant pressure on the sit bones (ischial tuberosity) making it uncomfortable to sit whilst carrying out activities. Seat width – If the seat is too wide the resident may slump to one side. Not only does this cause additional pressure to one hip – and the risk of a pressure sore - but it also locks in the arm on the slumped side reducing bilateral ability. Reduced transfers – Hoisting residents with dementia can be a very traumatic experience as it is an alien activity and it can cause agitation and challenging behaviour. Porter chairs can help reduce the need for this activity.

WHAT IS POSTURE? Posture is generally considered to mean a position of the body or the arrangements of the body’s parts relative to one another. Seating should aim to achieve the best possible posture, which acknowledges that some residents may not be able to achieve perfect or text book posture due to other physical barriers. January/February 2019

OCCUPATIONAL DEPRIVATION: is a term used to describe a ‘prolonged restriction from participation in either necessary or meaningful activities due to circumstances outside of the person’s control.’ When people lose control or have reduced choice, this can lead to frustration and challenging behaviour. Lack of activity can quickly lead to physical deconditioning and a loss of identity, as well as increased stress and agitation

What does Nice say?

The National Institute for Health and Care Excellence (2013) recognised the need for activity in its quality standards, which include the following statements: “Older people in care homes should be offered opportunities throughout their day to participate in meaningful activities that promote their health and mental wellbeing” “Older people in care homes are enabled to maintain and develop their personal identity” For more information, read: NICE guidance (2013): Mental Health & Wellbeing for Older People in Care Homes [online] at: https://www.nice. org.uk/guidance/qs50/chapter/Qualitystatement-2-Personal-identity

Care Home MANAGEMENT 35

ASSISTIVE TECH INTERNET OF THINGS

AGEING IN THE NEW AGE

The internet of things opens up a vast horizon of new care models, believes robotics expert and Institute of Electrical and Electronics Engineers senior member, Antonio Espingardeiro

ith a growing ageing population and more pressure on limited resources, innovative technological solutions can transform the face of care: creating more efficient solutions for those who provide care, and a better quality of life for those who receive it. We now have more ‘smart’ devices within our homes that are capable of improving our day-to-day lives – connected doorbells to see who is at the door, fridges able to let us know when we are low on key produce, smart speakers able to provide the world’s information almost instantly. In addition, the growing popularity of smartphones and tablets combined with the pervasive nature of the internet has opened new doors and opportunities. With all these devices, and more, able to talk to one another, this has culminated in what we now refer to as the Internet of Things (IoT), which represents a new form of aggregating sensors to gather vast amounts of data in real time. Harnessing 36 Care Home MANAGEMENT

this technology to the human body can reveal valuable information for medical diagnostics and revolutionise healthcare.

THE CATCH-UP CONUNDRUM

One of the biggest challenges in healthcare is that medical practitioners are often playing catch-up: reacting to symptoms only once they see a patient. Even then, the pathway from initial consultation to examination to diagnosis and treatment can often take weeks, sometimes even months or years. But technology can offer the solution to this conundrum by continually collating vital data while at home before medical intervention is needed. For instance, sensors such as motion tracking systems can analyse physical behaviour, such as

walking patterns. Studies have shown that we start to show signs of instability weeks before we actually fall for the first time, seemingly without warning. Other sensors can detect changes in levels of sweat (skin galvanic) giving us indications about potential sudden changes in temperature or blood pressure which may translate to specific clinical scenarios. Sensors measuring blood pressure, oxygenation, and blood glucose levels can pull critical information and upload it to the cloud to be analysed by a health professional. It is here that machine learning algorithms are crucial to identify patterns through supervised learning and deep learning techniques, alerting physicians and patients to potential medical emergencies. While it is local hardware that collects this data, it is the decentralised software in the cloud www.chmonline.co.uk

ASSISTIVE TECH INTERNET OF THINGS

that makes this data valuable. By analysing patterns (good or bad) catalogued in a huge volume of medical data amassed over many years, AI can look at a resident’s health data, map this against the information on file, and highlight any results of note. Consistently rapid processing speeds are vital for analysing data in real-time and responding when initial symptoms first appear.

HUMAN RESOURCE SOLUTIONS

The combination of IoT and healthcare is not solely about pre-empting acute healthcare issues. An additional benefit is efficient use of scarce resources. Current resources – carers, beds, equipment – are

“One of the biggest challenges in healthcare is that medics are often playing catch-up” strained and struggling to keep up with the demand of the ageing population. Machines could extend our abilities to supervise people and predict any eventual health issues, while simultaneously easing the strain on resources, particularly carers. At a time where health and social care are in dire need of additional funds, technology could provide the answer.

Dr Alexa will see you now – but do you really want to see her? Healthcare artificial intelligence (AI) raises important ethical questions. Yes, studies have shown AI to be as good as human doctors at diagnosing certain conditions – for example breast cancer, where diagnosis can rely on the analysis of large data sets to identify patterns and derive predictions.

However, as healthtech becomes more sophisticated, ethical questions begin to surface. For example, Who will have the ultimate say? What scope is there for a doctor or their patient to deviate from the AI suggested approach. Who will be held accountable if the AI gets it wrong? The September issue of Care Home Management magazine (online at https://chmonline.co.uk/backissues-2-2/) centred on cybersecurity and the ‘bad actors’ who exploit health tech flaws for sinister purposes. According to digital strategy company Accenture, almost one in four healthcare workers knows of someone who has sold on confidential patient information. By Victoria Hine and Joe Cohen of legal firm Slaughter & May

January/February 2019

Care Home MANAGEMENT 37

WELLBEING MUSIC THERAPY

MUSIC SUCCEEDS WHERE WORDS FAIL What will I learn from this feature? How to use music therapy in care and staffing

Music therapy can benefit residents, empower staff and give managers important organisational feedback

usic therapist Meta Killick from Living with Harmony has seen music transform even the trickiest of care situations. In one home, a resident reacted quite aggressively every time they were asked to undress for an examination or to change their clothes, so the ‘stripper song’ was used to make light of the situation. With some (appropriate) improv participation from the carer, the resident was able to be undressed in a more relaxed environment and get the care they needed; for their part, the carer gained the confidence to deliver more effective care. As Meta says: “Music has the ability to encourage people to have open and honest conversations, on

“Service users, families and staff can think, speak, sing, dance, act or draw their responses to music” an equal footing, which enhances a feeling of happiness. Music helps [people] to come together in a positive way.” With no ‘standards’ or fixed way of delivering music therapy, there are no mistakes, which means everyone can get involved, says Meta, even if the resident has very limited capacity. “A favourite tune stays with a resident even with advanced dementia,” she says, and this can be used to reawaken memories or relax, which can then facilitate the conversation. Changes in music tempo, from down-beat to lively, can be used to manipulate a resident’s mood, too: as the music tempo increases, residents are encouraged to develop a new, more positive perspective on a situation, improving their state of emotional wellbeing. Residents who cannot communicate through words can smile, nod or rock affirmatively to communicate their response, which in turn encourages staff to listen more closely and to be more attentive to the resident’s emotional well-being. As the bond between 38 Care Home MANAGEMENT

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WELLBEING MUSIC THERAPY

Sounds of safety: what good looks like

1 2 3 4 5 6

Tambourines are a useful instrument to convey lightness and rhythm

Service users’ wellbeing - What is our home for? Staff skills - What makes me feel good in this home? (Question to residents)

Service planning - What is good about working in this home? (Question to staff) Management and leadership What’s good about our managers?

Quality of care and the environment - What’s good about how we are looked after? External agencies involvement Who comes to help us? Who do we go to see to help us?

carer and cared-for improves, residents feel more able to communicate their feelings, improving the effectiveness of safeguarding processes.

Residents with communication difficulties can replace words with the noise from an instrument

STAFF BENEFITS

Music therapy can also have a role in human resources, says Meta. Staff get to develop their creative potential, as well as emotional bonds with a resident and each other. Rather than make a spoken request, staff might use music to sing the request to a resident. Lively music can be used to waken a sleepy or sedentary resident, to gently encourage activity or social participation. There is also a role for managers in organisational development, Meta says. Through the custom-designed Sounds of Safety focus groups (see box out, below) music can be used to support a relaxed, non-combative but honest discussion of the home’s care model and quality. Service users, their families, the staff, managers and owners or trustees can think, speak, sing, dance, act or draw their responses to music designed to encourage thoughts on the ‘good’, ‘concerning’ or ‘ideal’ service offered by a home. “Where words fail, music succeeds,” says fellow therapist Alistair Clarkson. “People can find it very difficult to articulate what they are feeling or experiencing, and we know that staff stress is high in settings where abuse has been identified. Music can equalise the power dynamic and improve moral for those that live and work in care homes. Music has a way of helping us express ourselves in a safe way.” January/February 2019

The harp is used in music therapy to express generosity and resonance

Care Home MANAGEMENT 39

WELLBEING SECURITY

FACING UP TO

SECURITY

Technology can play a key part in ensuring the safety and wellbeing of residents, says Roy Ferris, director at Workforce Scheduling Solutions UK Ltd

acial recognition technology is increasingly being used by care homes to identify permanent and agency workers entering their premises. The latest systems combine face recognition tech with a staff PIN and can be managed using touch screen technology and web cams. The image identifies an individual and provides a security deterrent because the system builds a more accurate image of each employee over time. Facial recognition is particularly useful when it comes to monitoring agency staff because is not practicable to supply them with tokens or cards, or to record their fingerprints. For permanent staff, this technology reduces the cost of supplying tokens and the risk they will be lost or left at home. It also eliminates ‘buddy punching’ where employees can book colleagues on/off duty using someone’s tokens, swipe card or even fingerprint. The move to facial recognition is the latest example of how the care home sector is adopting

January/February 2019

technology. In this instance, paper sign-off sheets become obsolete and the need to check invoices against hours worked is removed. There will be further digitalisation of staff time sheets over the next year. An efficient cloud-based electronic booking on/off system, with or without facial recognition, can schedule, provide budgets and calculate the hours and overtime worked as well as monitor sickness and holiday absence. Rosters are produced in advance within budgeted hours and checks are made quickly, which eradicates staff time errors and wage queries. Technology is also helping care homes with their data security. For example, the arrival of GDPR last May means visitor books should not show the current visitor the names of the people who have visited previously. An electronic visitor book removes these risks by allowing visitors to record their arrival and departure without other visitor details being visible. Care Home MANAGEMENT 41

EVENTS APPOINTMENTS

EVENTS

Skills for Care: Prevention and wellbeing event. Tuesday 22 January, The Studio, Birmingham. 9.30am-2pm. More information [online] via the link: https://tinyurl.com/y7eogfno DHSC national recruitment campaign workshops. Various locations from Wednesday 30 January. Kegworth, Derbyshire. For more information visit: https://www.skillsforcare.org.uk/Gettinginvolved/Events/Events.aspx

FEBRUARY/MARCH

Local Government and Social Care Ombudsman Provider events all 10am-2pm at the following venues: • Thursday 7 February. Doubletree Hilton, Bristol • Wednesday 27 February.The Met Hotel, Leeds • Tuesday 5 March. Jury’s Inn, Birmingham • Wednesday 13 March. De Vere West One, London. To book visit: https://www.lgo.org.uk/care-provider-events

PEOPLE

Chief executive appointments…

Sara Livadeas has been appointed chief executive at care provider The Fremantle Trust. She will take up her position on 23rd January. Livadeas has extensive experience working across social care, health and housing and has held executive roles in a large local authority and a national charity. She is currently consulting. Care South has appointed Simon Bird as chief executive. Previously Care South’s deputy chief executive, Bird takes over from Susan Willoughby, who is retiring. Bird is a qualified chartered surveyor. At Canford Healthcare, Laird Mackay takes over as the chief operating officer. Mackay was previously the managing director for Caring Homes, and a trustee and board member of Care England.

Future of Care Conference 2019 To be chaired by BBC broadcaster and dementia charity founder Sally Magnusson. Tuesday 19 March. The King’s Fund, London For more information, www.futureofcare.co.uk

Promotions…

The Cleaning Show 2019. Thursday 21 March, ExCeL, London. For more information, visit: https://cleaningshow.co.uk/

Birch Green Care Home in Skelmersdale has promoted Vicky Sudworth (right) to the post of general manager, and Emma Kay becomes deputy manager.

Dementia Care and Nursing Home Expo 2019. Wednesday-Thursday 26-27 March, NEC, Birmingham. For more information, visit: http://www.carehomeexpo.co.uk/

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42 Care Home MANAGEMENT

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New Care has promoted Dawn Collett, a former registered nurse, to the role of commissioning director. Dawn, who has worked for the company for more six years, has also been appointed to the Board.

New joiners…

The neuro rehab Christchurch Group has strengthened its leadership team with two senior appointments: •D enise Masters, who will be responsible for the welfare of patients at Hunters Moor in Birmingham • Matt Street, who will oversee Park House in Bedford Denise qualified initially as a radiographer and later as a registered mental health nurse. She has also worked as a manager in mental health secure services and community residential care. Matt is a qualified physiotherapist working within brain injury rehabilitation.

Suppliers and business partners

Richard Muncaster has succeeded Alex Ramamurthy as chief executive officer of the Care Workers Charity (CWC). Muncaster was previously a freelance voluntary sector and arts management consultant. Ramamurthy now joins the board as trustee in a fixed-term part-time consultancy role. He will also be developing a start-up venture. Brookes Care home builder Wynbrook has appointed two site managers: Darren Tonks (right), as assistant site manager, and Joshua Brookes as trainee assistant site manager.

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