Care Home MANAGEMENT www.chmonline.co.uk
November/December 2019 • ISSUE 82
HEALTH & SAFETY Medical oxygen, gas and fire – know the risks
INSURANCE
Limit your liability – get it down on paper
MANAGEMENT TECH Helping you along the road to Outstanding
MEDICINES The trouble with people
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WELCOME EDITOR’S LETTER
WELCOME
A Care Home Management
November/December 2019
Issue 82
Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Podcast Presenters and Editors Steve Hemsley Alan Rustad Design/Production Emily Hammond emilyh@freelancedesignpro.com Published by S&A Publishing Ltd Hillside office, 9 St James Park, TUNBRIDGE WELLS TN1 2LG Tel: 01892 680670 Email: editorial@chmonline.co.uk sales@chmonline.co.uk Advertising Rebecca Randall Head of Sales Tel: 01892 538880 Email: sales@chmonline.co.uk www.chmonline.co.uk Copyright:
to the November/December issue of Care Home Management magazine
h, technology, that holy grail of health and social care in the 21st century. But, do your customers really see the benefits that a robo-carer can bring to their daily wellbeing? Or are we still at an earlier adoption stage when people see the value of technology but only in a complementary role to human interaction? Perhaps, the most important question of all is what will tomorrow’s customers expect from technology in their experience of care? Some insight into the role of AI technology in the delivery of health and wellness comes each year from the USA-based IEEE, which describes itself as “the world's largest technical professional organisation dedicated to advancing technology for the benefit of humanity”. For the past three years IEEE has published an annual global study, looking at the confidence of millennial parents in the UK, when using AI and emerging technologies in the health and wellness of their children. In its 2019 report1, IEEE finds that Generation Alpha (or children born between 2010-2025, who are said to be the most tech-infused demographic) are growing up with AI. When asked for their views, Gen Alpha’s parents (who will be care home residents long before their kids hit your sofas in 2090 and beyond) said they, too, supported the use of technology in the following situations: • 3D-printed heart implants: 60 per cent of UK parents said they would be very comfortable allowing a properly tested/fully functional 3D printed heart to be implanted in their child • Virtual Reality pain management: 82 per cent of millennial parents said they would prefer the use of VR distraction therapy to medication in pain management
• S mart furniture: 66 per cent of parents said they would use a smart chair in their home that could automatically conduct health tests. But when it came to care, whether in a formal institution or as part of the daily routine, parents’ views about the role of technology changed: • Are millennial parents happy to let an AI-powered virtual nurse care for their children? Not really, according to the majority of UK parents (57 per cent). • What about self-driving vehicles? No, thank you, said 51 per cent of UK parents – despite the efforts of the UK government to implement driverless cars within a few decades.2 Of course, technology has a useful role in situations where it is impossible or impractical to do it ‘the old-fashioned way’. A care home telemedicine pilot in Liverpool has just been rolled out to 55 care homes.3 Providing care home residents with 24-hour access to a clinical care team, the pilot aims to reduce pressures on frontline healthcare staff and local resource costs. But before your care team consider that their jobs are at risk from a virtual carer or a health professional ‘bot’, I’d like to share with you a news item about the Simonsfield Care Home in Runcorn. Here, staff put on pyjamas during the night shift to help dementia patients get off to sleep. I’m tempted to say that I am sure the effectiveness of this technique depends on the type of pyjamas the care staff were wearing… either way, it’s hard to imagine that a robot wearing pyjamas would have the same effect. People will always want to interact with people. The proper role of technology is to enable that interaction to take place at a pace and time that suits the individuals involved.
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.
November/December 2019
1https://transmitter.ieee.org/health-2019 2 https://www.ukri.org/innovation/industrial-strategychallenge-fund/self-driving-cars/ 3 https://www.digitalhealth.net/2019/10/liverpool-rolls-outcity-wide-telemedicine-service-to-care-homes/
editorial@chmonline.co.uk
Ailsa Colquhoun Publisher/Editor
@Carehomemanage Care Home MANAGEMENT 3
Care Home MANAGEMENT
Contents
www.chmonline.co.uk
7 Eleanore’s Words to the Wise
Safety first for care home success
8 Market Barometer
A new, behind-the-scenes look at your operating business environment
11 Outstanding
See who’s made it into the five-star Outstanding club
12 Best Practice
The Ombudsman critiques a home’s visitor policy
14 Training
Three providers go head-to-head in the first CHM podcast training special
16 Legal
Buying a care home and reporting to the HSE
19 Leadership
E xplore the road to outstanding in the well-led KLOE
21 HR
How to integrate temporary staff
22 Care Home Profile
ow Oakland Grange residents and staff H benefit from enhanced health in care homes
BES
ALTH HE
25 Ask the Expert
Get to grips with lasting power of attorney
RACT TP
LEGAL
E IC
REGULARS
UITME CR
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ERSH AD
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HR
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November/December 2019 • ISSUE 82
p22
42 People and Events
See who’s on the move and where to go during November and December
FEATURES
MEDICINES 26 Understand the human factors in medicine errors
28 Helping residents with dementia to get the best from their medicines
HEALTH & SAFETY 30-33 Medical oxygen, gas and fire – do you know the risks?
MANAGEMENT TECHNOLOGY 34-38 How technology helps in achieving compliance, improved ratings and future-proofing your business
INSURANCE 39-41 Liability and the importance of a paper trail
p25
p28
p11 4 Care Home MANAGEMENT
www.chmonline.co.uk
NEWS ROUND-UP
Be third time lucky! Care Home Management magazine is delighted to once again support the Care Home Awards as media partner. This is the third year of partnership, during which time the awards have developed and expanded, and gone from strength to strength. This year, there are 16 care home categories for care homes to enter, in a wide range of categories including architecture, interior design and communal spaces, marketing, PR and advertising, and specialist care, such as dementia, respite, young people, special needs and mental health. Supplier categories include: Best clinical and non-clinical equipment, professional service, business
or creative service and IT and communications. The awards take place at a special, glittering presentation event in London, on May 15, 2020. Entries made before December 15, 2019, attract an earlybird rate.
For more details, see the ad on page 10 or visit www.CareHomeAwards.com
Start planning for 2020 Look out for your free 2020 Year Planner included in this issue. This musthave office management tool contains key dates in the care home year, and is brought to you, free of charge, thanks to the support of the following suppliers: Acute Training Solutions Armitage Shanks Bishop Fleming British Healthcare Trade Association Calla Style Designs Care Home Recruitment Compass Associates Dechoker UK Discount Care Supplies Finders Genealogists Health Technical National Association of Care Catering Paterson Training November/December 2019
If your copy is missing, or you would like a second Year Planner (while stocks last), please contact the editor, Ailsa Colquhoun, on email: editorial@chmonline.co.uk Care Home MANAGEMENT 5
NEWS ROUND-UP
Four Seasons sale collapses after just two weeks
CHM ONLINE EXCLUSIVE!
Mind the Gap!
CARE PROVIDERS ARE increasingly looking at their pay scales as they mind the gender pay gap, says social care writer Eleanore Robinson in an exclusive CHM Online feature A gender pay gap exists in residential care. According to one report published earlier this year, male employees earn on average 11.8 per cent more than their female counterparts, compared to the national average gender pay gap of 17.9 per cent. Tim Kellett, director of Paydata, which carried out the research, said the difference in salaries could be attributed to the fact that men and women tend to do different jobs in residential care. Men are more likely to be on the service side, for example, in driving jobs, whereas the vast majority of care assistants were women. Kellett explained: “There are so many people being paid at the National Living Wage, so there is no inequality around the largest proportion of the workforce.” To find out how gender pay is being managed in the care sector, read the full online feature at https://chmonline.co.uk/portfolio/mind-the-gap/
Average cost of residential care rises 5.3 pc, authorities report AVERAGE COSTS OF elderly residential rose 5.3 per cent during 2018-19 - from £604 per week in 2017-18 to £636 per week in 2018/19, according to new official data. What’s more, according to NHS Digital’s Adult Social Care Activity and Finance Report, England - 2018-19, the average cost of nursing care for the same age band (65+ years) increased 6.3 per cent - from £638 per week in 2017/18 to £678 per week in 2018/19. In total, local authorities handled an extra 195 requests for support each day during 2018-19, adding 600,000 to the 1.3 million requests handled the year previously. However, during the year, the number of clients receiving long term care continued its three-year decline, to 841,850. The decline is mainly attributed to a decrease in clients aged 65 and over receiving long term care, down 39,060 to 548,435 since 2015-16. For more information, visit: www.chmonline.co.uk/averagecost-of-residential-care-rises-5-3-pc-authorities-report
THE SALE OF TROUBLED care provider Four Seasons remains in doubt following the collapse of a £350 million deal after just two weeks. The initial deal was announced on October 14 “subject to certain pre-steps and conditions”. However, just two weeks later, administrators announced that the sale to a fund management company had been terminated “due to certain conditions having not been met or waived”. The announcement added: “The joint administrators, the group and the majority creditor remain in constructive discussions with a view to implementing a consensual
restructuring of the group (including the ongoing leasehold estate restructuring) and maintaining continuity of care throughout such process.” Commenting on the collapse, UNISON assistant general secretary Christina McAnea said: “Complete [political] inertia has left the country’s second largest residential care provider in administration for months. Today’s failure to secure a buyer leaves residents and staff fearful for their futures. “Without ministerial action and substantial investment, care homes will continue to be prey to private equity firms and hedge funds, which excel at extracting profit from those in need.”
For more information, visit: www.chmonline.co.uk/fourseasons-sale-collapses-after-just-two-weeks
£34m Government investment for robocarers
THE UK MOVES ONE step closer to developing robot carers, thanks to £34 million government investment announced at the weekend. The research programme is said to be the UK’s biggest entirely dedicated to autonomous system safety. To be safe, robocarers have to keep data secure and have a clear set of rules in order for them make effective decisions. The research will look into robots’ cyber security, as well as principles like respect, fairness and equality, in line with latest information and guidelines around this technology. The aim is for robots to work in tandem with professionals to help relieve pressures. For more information, visit: www.chmonline.co.uk/34mgovernment-investment-for-robocarers
6 Care Home MANAGEMENT www.chmonline.co.uk
NEWS ROUND-UP
Employers to be obligated to provide a basic reference
New CPD programmes launched for managers and future leaders in social care
SKILLS FOR CARE has launched three continuing professional development (CPD) modules to develop the skills and knowledge of managers and future leaders in care services. The modules cover the fundamental building blocks managers need to lead and develop busy, high-quality services focusing on the importance of self-management, developing a positive workplace culture and performance management. For more information, visit: www.chmonline.co.uk/ new-cpd-programmes-launched-for-managers-and-futureleaders-in-social-care
EMPLOYERS COULD BE stopped from withholding references to any employee under new proposals announced by Business Secretary Andrea Leadsom. This would mean that employers could, for the first time, be required to provide at least a basic reference for any former employee. These proposals form part of the government’s response to an inquiry on non-disclosure agreements conducted by the Women and Equalities Select Committee (WESC). Many of the recommendations made by the Committee were addressed in a raft of proposals announced in July to crack down on misuse of non-disclosure agreements, including legislation ensuring that confidentiality clauses cannot prevent individuals disclosing to the police, regulated health and care professionals or legal professionals. Read more information, visit: www.chmonline.co.uk/ employers-to-be-obligated-to-provide-a-basic-reference
ELEANORE’S WORDS TO THE WISE
Safety first for care home success By Eleanore Robinson, freelance social care journalist WE ALL NEED TO BE SAFE and, crucially, feel safe when at work.This is especially important while working in a care home environment. A recent survey found that three quarters of care home workers believe that more could be done to prevent or manage a fire in their workplace. Over half said that unsatisfactory action was taken as a result of reporting their concerns. This terrifying finding illustrates that care homes should not just be aiming to meet fire or any other type of regulation, but to also ensure both residents and staff feel safe and reassured that every possible precaution has been taken in the event of an emergency. As every care home operator worth their salt will know, it is providing this impression, underwritten by solid safety procedures, that will November/December 2019
attract residents and increase the likelihood of them staying there. After all, who would want to live in a place where there is uncertainty over whether the building is safe? And who would want to work there too? It is just as important that staff members feel reassured. In a sector where retention rates are spiralling downwards, training staff in health and safety procedures can have a real effect.The State of the Adult Social Care Sector and Workforce report published last month (October) by Skills for Care found that the average turnover rate was almost 5 per cent lower among care workers who had received some form of training on subjects including health and safety, than those who had not (33 per cent). With fierce competition for care home workers, having the health and safety training box ticked with workers can make a real difference, as can carrying out risk assessments, fire drills, publishing
a health and safety policy and appointing health and safety representatives. Word of good practice will spread among the sector and it can be both a source of pride and comfort to staff when an employer takes safety in the workplace seriously.Those who don’t will quickly, and quite rightly, see employees leave. Working in social care is challenging enough without staff members having to worry about whether they are safe or not while carrying out their duties. Care Home MANAGEMENT 7
MARKET BAROMETER
What could a new Government bring to adult social care?
By Dr Jennifer Dixon, chief executive of the Health Foundation Clearly Brexit will be centre stage in the election campaign. But what have the parties pledged so far on health and care? How do they stack up? The most obvious feature in all the offerings is spending – a lot of it. Where the funds will come from is murky, but austerity is clearly unfashionable. Expect an arms race of spending promises in the election campaign. Yet to date we have seen no defining reform agenda to improve care at the front line, other than investment. Labour promises to repeal the 2012 Health and Social Care Act, and the Liberal Democrats to move some commissioning of NHS care to local authorities. Both are radical but largely administrative changes. The Conservatives under Secretary of State Hancock put their faith in technology to transform care. There is a real lack of detail on funding social care properly – an issue which is currently crippling the NHS. Labour comes closest with the free personal care pledge. But as we know from Scotland, personal care isn’t free but merely subsidised. Funding an adequate offer in England would total somewhere in the region of £15bn by 2023/24. Then there’s the acute staff shortage, aggravated by Brexit. What is encouraging in what we have seen to date, mainly in proposals from Labour and the Lib Dems, is the emphasis on improving wellbeing and health for the whole population. Some estimate that only about 20 per cent of the impact on our health is down to health care, the rest down to wider factors such as family, education, employment and housing. The Conservatives have pledged to raise the living wage to £10.50 an hour to match two thirds of median earnings. On critical issues – a long-term solution for social care, a credible workforce plan, investment in population health (particularly in left-behind areas with stalling life expectancy) and how these will be funded – no party will provide all the answers. Change is needed. But given the distraction of Brexit, there is no guarantee it is coming. A longer version of this article first appeared in Prospect magazine [online] at: www.prospectmagazine.co.uk For more information visit the Health Foundation [online] via the link: https://tinyurl.com/y4wlcmtt
8 Care Home MANAGEMENT
MARKET
BAROMETER By Michael Hodges, Christies & Co managing director – healthcare consultancy
N
ew build developments, particularly targeting the private pay market, are proving an extremely busy area at present, and in locations across the UK. In parallel with this, we are also seeing an increasing number of operators who are now receptive to taking leases. Many operators still view leases with a high degree of suspicion and, perhaps, rightly so given historic issues associated with onerous terms and unsustainable rents. Positively, lessons from the past have been learnt and both landlords and tenants are very focused on ensuring that rents are struck at sensible levels relative to trading performance and that leases are sensitive to the nuances of the care home sector. By way of example, a corporate-style new build care home developed for the private pay market realistically will achieve an EBITDAR per bed at maturity of usually £17,000 or more. This is predicated by average fee levels typically at or in excess of £1,000 per week. Rental levels typically reflect EBITDAR coverage ratios of 1.7 – 2.0 (the range reflects various factors including the strength of
the opportunity and the nature of the tenant covenant). This level of performance also applies to new build developments which will have to be able to cover acquisition, build and development costs often combining to reach £150,000 per bed. Taking a lease on an existing asset on sensible rental terms provides operators with a good opportunity to achieve growth without the capital outlay associated with freehold acquisition. Indeed, in many cases, there is an opportunity for such tenants to take over an existing business with several of the specialist funds adopting a model of acquiring good quality operational care homes on a WholeCo basis, prior to putting in place a lease structure. www.chmonline.co.uk
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YOU DESERVE RECOGNITION
We, your residents appreciate all that you do to make your care homes better run, better designed, better equipped and better resourced and your staff better trained, so we have just one favour to ask: Enter the Care Home Awards 2020 and tell the judges what you have been doing brilliantly over the last 15 months. And to encourage you to do so early, anyone who enters before midnight on December 15, 2019 can do so at last year’s rates.
Check out the full list of categories online, and submit your entries before December 15, 2019 to take advantage of the lower rate. For more details visit CareHomeAwards.com
The Care Home Awards are sponsored by
Media partner
24 - 25 JUNE 2020 + ExCeL LONDON
BEST PRACTICE OUTSTANDING
CONGRATULATIONS TO...
Care Home Management is delighted to be able to share with you this example of outstanding care home practice
Jubilee Therapy Centre Effective:
Caring:
J
ubilee House Therapy Centre is a short-break facility providing personal and nursing care for people with injuries and life-limiting conditions. People who stayed here are beneficiaries of the Fire Fighters Charity, including current and former fire fighters and their relatives.
What Jubilee Therapy Centre did: Effective
Resources available to residents include a hydrotherapy pool, electrical stimulation equipment and an anti-gravity treadmill. In the bedrooms there are profiling beds and accessible en-suite shower rooms. Apps in exercise and nutrition are used to support therapy. The service also employs an assessment practitioner to advise people about their care application and services available from the home, including from the psychologist. Staff training and collaboration with other agencies enable the home to offer a tailor-made care programme, and support for residents when they returned home.
What Jubilee Therapy Centre did: Caring
People are fully involved in planning their care and are considered the absolute decision-makers.The November/December 2019
Responsive:
Read the full report [online] at: https://www.cqc.org.uk/location/1-116490439
Well-led:
service has developed a ‘daily log book’ in which people set their own daily goals and aspirations. Staffing rotas are flexed to adapt to meet individual’s lifestyle choices. People said they received “superb” guidance from the service to self-advocate when applying for support from other agencies.The provider also employed welfare case workers to advise people with aids and adaptations, debt management, and paperwork. Staff were seen to go out of their way to ensure equality and inclusivity.
What Jubilee Therapy Centre did: Responsive
Staff used extremely innovative ways to help people to be independent. For example, staff researched several different ways to help one person who wanted to tie their own shoelaces, making an enormous difference to the person’s sense of dignity and independence. The service also provided people with the tools to successfully replicate achievements made at the centre when they returned home. There was a range of therapeutic and social activities tailored to residents’ own preferences, including lectures for people on specific conditions and self-help sessions such as
improving sleep and mindfulness, walking football, chair-based exercises, crafts and gardening. If people needed information in different formats, this was provided. For example, one person who was registered blind was provided with electronic copies of information which their computer then dictated back to them.
What Jubilee Therapy Centre did: Well-led
Service leadership was exceptional and distinctive. Organisational values were fully displayed by staff and were person-centred. Managers and staff were clear about their roles, and understood quality performance, risks and regulatory requirements. Audits and checks were undertaken by the registered manager and heads of non-patient care activities, who were able to share new ideas and good practice from other business areas. The service was also introducing a virtual consultation system, Attend Anywhere, which is a web-based consultancy platform for assessments and triaging.This allows clinicians to design individual support programmes for people before they arrived.The service also helped people to link with other self-help groups, such as the Motor Neurone Disease association, and with benefits and bereavement support. Care Home MANAGEMENT 11
BEST PRACTICE FROM THE OMBUDSMAN
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 Anchor Care Homes SUMMARY: The Ombudsman found fault, particularly in the area of record keeping and the way it responded to ‘Mr C’s’ complaint. Mr C complained that the care home where his mother lived (West Hall Care Home), did not allow his mother to have any visitors for a week in 2017, during an outbreak of Norovirus. As such, he was prevented from visiting her in the home. Mr C says the care home falsely claimed that it was following guidance from Public Health England (PHE) and that PHE had approved its approach with regards to stopping visitor access. Mr C says the home also misled PHE, the Surrey Council Adult Safeguarding team and the CQC about its approach. Mr C was also unhappy about the way in which the care provider investigated his complaint. DECISION UPHELD: PHE Infection control guidance for suspected viral gastroenteritis in care homes states: • A care home has to inform visitors of the outbreak and consider limiting their visits especially the elderly and the young
• I f possible, visits should be limited to those considered essential. Standard advice to care homes with regards to visitor access, following an outbreak of ‘diarrhoea and vomiting’, is that: • they should close to admissions, discharges, transfers and “non-essential visitors”, which are defined as: newspaper vendors, hairdressers, mobile libraries etc • v isiting should not be restricted for those receiving end of life care. The care provider’s own infection outbreak management protocol says that: • the home or location manager should notify PHE (for advice and support) and family members, in the event of a suspected outbreak • t he home or location manager is responsible for compiling and cascading a briefing to notify all colleagues. The briefing should include control measures to be taken to limit the risk that the outbreak will escalate
• V isitors should not visit the care home if symptomatic until they have been symptom free for 48 hours.
• i t is the home or location manager’s responsibility to decide what are the appropriate measures to take based upon: a risk assessment and recommendations made by external bodies for, example PHE, visitors may be restricted or visits postponed
The PHE document, Norovirus - Information for staff, says: • The resident should remain in their room for at least 48 hours after their symptoms have resolved
• a central file should be created that stores all information relating to the suspected outbreak. This may include the action taken by whom and when.
12 Care Home MANAGEMENT
www.chmonline.co.uk
BEST PRACTICE FROM THE OMBUDSMAN
My care provider hasn't resolved my complaint. What can I do now?
ANALYSIS
The decision to restrict visits An infection outbreak occurred in one of the buildings of the care home (“building X”) where Mr C’s mother lived. It officially started on 22 November 2017. During the outbreak, Mr C’s mother did not become infected. Mr C says the care home: • told him in person, and subsequently on several occasions by email, that no visitors would be allowed access to the home • did not tell him that it would make an exception for those residents who were receiving end of life care. • told the residents they would not be allowed to have any visits for the duration of the outbreak. The home did not, as was implied by the home, have “a discussion” with each resident to explain the situation and “ask” if they would agree to temporarily stop their visits As a result of the care home’s actions, Mr C was unable to visit his mother in the care home for several days. Records show the care home notified PHE of the outbreak on 23 November 2017. It also notified CQC. The CQC notification form said building X is “closed for all visitors”. The care provider says the manager of building X sent an email to all family members November/December 2019
on 22 November to inform them of the outbreak. However, the care provider was unable to provide a copy of this due to a change of staff. Correspondence with other family members and residents, including Mr C’s mother, attest that they were informed of the outbreak, and that they agreed with the policy of restricting visitors. It is not clear if residents were ‘asked’ or ‘told’ about the proposed restrictions. There is a lack of clarity about what was discussed and / or agreed by PHE. It is possible that PHE did not clearly communicate its advice to the care home, which could have been misinterpreted. There is also a lack of record keeping of the discussions with Mr C’s mother (and other residents) and a lack of compliance with the home’s own infection outbreak management protocols. Some information provided by the care home provided to the Council and CQC was inaccurate. The complaints process Mr C says two responses to his complaints did not properly address his specific comments and evidence. The investigator did not identify any faults and appeared to make the decision based on what the home manager said rather than any recorded evidence (including emails provided).
AGREED ACTIONS: The home should: • provide an apology to Mr C for the faults identified • improve record keeping, particularly of what it explains to residents about the measures the home will put in place, the reasons why, and if each resident agrees with this, and of telephone conversations with outside bodies, such as the Council and PHE, when there is an outbreak. There should be a central file to store all information relating to the outbreak, which should be accessible to all staff • immediately inform relatives / family members when there is a virus outbreak (by email), and what the visit arrangements will be during the outbreak • review its infection control policy and procedure in light of the most recent PHE guidance (September 2018) called “Infection Prevention and Control: An Outbreak Information Pack for Care Homes”. This says that: “Visitors should not be stopped from visiting if they wish, as long as they are aware they may become ill themselves” • share the lessons learned with its other care homes and the staff members who dealt with Mr C’s complaint. Read the whole decision [online] via the link: https://tinyurl.com/y67rlkf5
Care Home MANAGEMENT 13
TRAINING PODCAST SPECIAL
CARE HOME
HOW TO KEEP STAFF Care Home Management’s first special training podcast put a spotlight on the role of training in staff retention
Care home training should be standardised, while managers need to consider the role of technology and how delivering excellent training can tackle staff attrition. These were the main topics discussed by three leading care training experts on the Care Home Management training special podcast. You can listen to the full debate online at https://chmonline.co.uk/podcast/ We were joined by Steven Embleton, chief cloud at My Learning Cloud, Peter Hewitson, customer service manager at Edify Training and Faye Oughton, head of employability and skills at Pin Point Training.
Steven Embleton
Peter Hewitson
Faye Oughton
CHM: Should care home training be standardised?
Steven Embleton: “I’ve been in the sector for well over a decade in a variety of roles and one of the things that keeps coming back to me is people’s different approaches to learning and development in general, and the lack of understanding of what is required. Specifically, around a mandatory pathway for learners today in the complex arena of health and social care. Managers and learners don’t really understand what’s required or what they need to be doing, or which providers offer the best quality training.” Peter Hewitson: “When care moved into the private sector – that’s when private training providers emerged and there has never been one set standard for everybody. It’s always been down to interpretation of what each provider feels should be the best service and product for their customers. Companies do like the flexibility to tailor services.” Faye Oughton: “When we were looking at this question, we asked ourselves whether there was a 14 Care Home MANAGEMENT
recognised progression pathway within the health and social care sector with clear and defined qualifications at each level for a standardised approach. All the evidence supports the fact that there is no coherent strategy to inspire people to join the sector and to progress within it. The sector needs to recruit 120,000 new people every year, while 80 per cent of that workforce are female, so how can we recruit more males if we aren’t professionalising that pathway for them?”
CHM: What role can technology play when it comes to learning outcomes and improving overall knowledge within the care sector?
Peter Hewitson: “Technology is part of our everyday lives and is it there to make things simpler and easier. It already plays a huge role in the health and social care sector. “New technology such as virtual reality (VR) is a big step forward. It is ideal for training around dementia, for example. We are also looking at using virtual reality for first aid training. Rather than having first aid training in a classroom, you take things one step forward and use virtual reality headsets to place yourself in an environment where you could be dealing with a casualty.You can put the learner into a real time and enjoyable training experience.” Steven Embleton: “VR will be used more within learning and development and will increase the
Training is fundamental to the retention of staff, but you’ve got to ask yourself why staff leave in the first place. It goes back to low pay rates: people find that the roles and the tasks they’re being asked to do are much harder than they first expected www.chmonline.co.uk
TRAINING PODCAST SPECIAL
TRAINING:
MOTIVATED
Ultimately, training on any platform that encourages learners to train in and out of working hours has to be a positive
choice of how people wish to learn. The challenge we have in developing VR scenario-based learning is a resistance to change and getting care homes to migrate to new technologies. “Everything that we design and develop allows us to understand the needs and pressures of the end user. We also need to understand that learners who only go down one route, say, a face-to-face or a workbook model, are going down an isolated path of learning. Care homes need to empower learners to have a blended choice of learning, using technologies to enable that blended choice to be applied.” Faye Oughton: “Ultimately, training on any platform that encourages learners to train in and out of working hours has to be a positive. It’s important to note, however, that knowledge and behavioural training should be embedded within the web-based setting. We have also found that certain groups of individuals do not embrace technology as well as others and they can avoid accessing that type of training. This tends to be the older workforce.”
CHM: What role can training play in addressing the high rate of staff attrition in the section and inspire people to want to work within it?
Faye Oughton: “We need to look at how good schools and colleges are at starting a discussion with young people and inspiring them about a career in the health and social care sector: what roadmaps November/December 2019
there are to support them; what training there is. A training pathway that is clear, professionalised and shows people the many different routes through the sector, this would really inspire people to move into the sector. “We are trying to change the perception of the care professional and demonstrate that it’s a passionate sector: you have to have a passion for care to work in it. Many SMEs aren’t getting access to funding, particularly through the apprenticeship levy. Could SMEs work more closely with larger care organisations to share levy funding? Once skills gaps are identified the funds would be there to enable people to move forward and inspire them to take on higher level qualifications.” Steven Embleton: “Training can be a differentiator for care home providers. The challenge is that people do not necessarily see care as a career. It’s completely unrecognised for the hard work that people do and is underpaid. People see coming into the sector, specifically at the lower end of the scale, not as a career of choice, but a career of need.You can flip that as a good provider, by giving people the skills to grow through your organisation and to be absolutely amazing. We work with Skills For Care and have developed a learning MOT which is used as an onboarding or a recruitment tool. Providers can ask potential staff 20 random questions on a topic to identify skills gaps.” Peter Hewitson: “Training is fundamental to the retention of staff, but you’ve got to ask yourself why staff leave in the first place. It goes back to low pay rates: people find that the roles and the tasks they’re being asked to do are much harder than they first expected.”
STEVE HEMSLEY, PUBLISHING EDITOR OF CHM, COMMENTS: This was a fascinating podcast and it is worth readers tuning in to the full recording on chmonline. co.uk. As well as the above topics, our panel discussed how care homes should split their training budget, make more use of staff feedback on the training they receive and, when setting budgets, consider the entire workforce at all levels. After all, this is all about delivering great care.
Care Home MANAGEMENT 15
ADVERTORIAL
What to consider when purchasing a care home – the legal aspects The process of buying a care home requires input from specialist legal advisors who are experts in both business law and health and social care law. When purchasing a care home, you should consider the following: STRUCTURE Care homes are often operated by their owners through limited companies.Therefore, you need to consider at the outset whether the transaction should be undertaken by way of a purchase of the shares in the company or by way of a purchase of the business and assets of the company. DUE DILIGENCE Have you undertaken sufficient ‘due diligence’ on the care home? Have you looked at critical things such as whether the care home has a satisfactory CQC report or whether the care home has been the subject of any litigation or investigations?
are you familiar with the local authority’s CQC contract with the care home? If you are buying You will need to be registered with the CQC the shares in the company which operates the before you can take over the care home. care home, is there a ‘change of control’ clause This process can take several weeks and will in the local authority contract which needs to need to be factored into the timing of the be addressed? transaction. However, if the purchase will be FINANCING YOUR undertaken by way of a PURCHASE share purchase of the seller’s If you are seeking bank funding company which operates for the purchase, you will need to the care home, the company ensure that you fully understand should already be registered the terms of any loan and security with the CQC. documentation you will be required LOCAL AUTHORITY to enter into with your bank. If you FUNDING Contact: Faisal Dhalla, are using a limited company for the Are any residents of the care partner, Hempsons, e: purchase, your bank may require a home funded by the local f.dhalla@hempsons.co.uk personal guarantee from you. authority? If so, as a buyer,
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16 Care Home MANAGEMENT
Care Home Management
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Care Home Management and Hempsons offer a free advice line for Care Home Management readers. Simply telephone 01423 724056 and ask for the Care Home Management advice line or email socialcare@hempsons.co.uk
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LEGAL REPORTING TO THE HSE
ACCIDENT
IN THE WORKPLACE?
Are you aware of what, and how, to make a report to the Health & Safety Executive (HSE)? Poppy Prior, from law firm Brodies LLP, shares some advice
I
f you are an employer, self-employed or in control of work premises, you are defined as a “responsible person” under the Reporting of Injuries, Disease and Dangerous Occurrences Regulations 2013 (RIDDOR). This means that you may have to submit a report to the HSE if your employee has: an accident causing injury that was work-related, certain cases of disease, or a near miss.
Is the incident reportable?
An accident is only reportable if it happened “out of or in connection with work”. However, establishing if an accident was work-related is not simply a matter of location. Despite happening on work premises, an accident may
You must keep a record of any reported accident; disease or incident in relation to your employees. You can do this by retaining a PDF copy of your RIDDOR report November/December 2019
fall outside the definition of work-related if it occurred during an activity unrelated to your employee’s work role. Similarly, an incident which happens away from work premises might also require to be reported. An injury is reportable if: • it incapacitates a worker for routine work for more than seven days. • it is any of the specified injuries contained in the regulations (certain fractures; amputations; blinding; crushing; burns; scalping; head injury or asphyxia causing unconsciousness; hypothermia, heat induced illness or anything requiring resuscitation or hospital admittance for over 24 hours). • it causes death.
How and when to report?
specific guidance on reporting deadlines for each category incident. In the majority of cases, the report must be submitted within 10 days of the incident. However, it is best practice to report earlier if this is practicable.
Your record keeping
You must keep a record of any reported accident; disease or incident in relation to your employees.You can do this by retaining a PDF copy of your RIDDOR report.You will be given the option of saving a PDF copy following submission of your report on the HSE website.
Amending a report
If you have previously reported an injury that has later become a fatality, you must inform the HSE by submitting another report.You can do so via telephone or online form. The changes will be updated on the RIDDOR database.You should keep a record of any duplicate report submitted.
Reporting is done by completing and submitting an online form on the HSE’s website. The HSE can provide assistance by completing the form over the phone on your behalf, if needed. There is also a dedicated telephone line for reporting Make a report to the HSE [online] at: fatalities or specified injuries. http://www.hse.gov.uk/contact/concerns.htm The HSE website provides
Care Home MANAGEMENT 17
LEADERSHIP LEARN, IMPROVE, INNOVATE
OUTSTANDING LEADERSHIP:
DO YOU HAVE WHAT IT TAKES?
In the fourth of this new five-part series, Chris Gage, joint MD, Ladder to the Moon, explores what it takes to be outstanding in each of the five elements of the CQC’s Well-led KLOE IN THIS ISSUE: LEARNING, IMPROVEMENT, INNOVATION
How does the service continually learn, improve, innovate?” asks the fourth Well-Led Key Line of Enquiry (KLOE). To some providers, this KLOE asks three different things, but I would argue that learning, improving and innovating are all part of the same process that requires the same leadership: leadership that ensures you are focused on getting better, are willing to make mistakes, and that you always take on board the learning, both when things work out well, and when they don’t. Often people tell me: “I get that, but I can’t get my team to do it as well”. One of my favourite quotes on innovation is that the job of the leader of innovation is “to set the stage, not to perform on it”.Your role as a leader is to create the conditions for learning, improvement, and for innovation – note create the conditions, not be the one who does it. Yes, sometimes you need to model the way November/December 2019
Sadly, when organisations are assessed on their culture and climate for creativity and innovation in care, ‘idea time’ is consistently one of the lowest scoring domains. This KLOE also describes the sources of information that can be used as insight to drive improvement (QA, incidents, compliments, IT systems, etc). However, to maximise the insight these offer, organisations need to consider six things: 1) Bring the potential insights together 2) Review to draw out problems worth solving, or opportunities for improvement 3) Set priorities for attention 4) Articulate the problem/opportunity so colleagues are engaged and able to contribute 5) Solve the problem (focusing on selected options to pursue) 6) Evaluate progress, including failures. for others, and it does mean being the one to have the insights, generate ideas, and lead the reflection and learning, and when you do this, make sure people can see that you are doing it. More important, though, is that you create the time and teach the skills and processes that enable others to do it. That is where you build a culture.
The right investment
Within this KLOE is a question about investing resources in innovation. Often, the first things to come to mind are physical and financial resources. However, I believe the most important resource is time. Highperforming organisations provide the time for ideas. Time spent both formally and informally listening to colleagues about the barriers to, and opportunities for improvement, often yields a deluge of ideas from staff teams. This is particularly true when senior management has a reputation for taking such ideas seriously.
It’s crucial that people are recognised for ‘failures’ and are praised for trying things out (appropriate risk assessments notwithstanding). The key question to ask is: “What can we learn from that?”. In this way, organisations nurture a desire to experiment and innovate, rather than kill creativity with fear and anxiety about personal risk if things go wrong. Innovation is too easily regarded as bringing in technology and new ideas from outside, and there is a lot to be said for that. But in truth, the services that are consistently rated Outstanding are those that have developed an innovation culture, where everyone is learning and striving to improve. For more information on the Well-led KLOE, visit the CQC [online] at: https://www.cqc.org.uk/ guidance-providers/adult-social-care/keylines-enquiry-adult-social-care-services
Care Home MANAGEMENT 19
Are you a manager in adult social care? Are you looking for new ways to develop yourself? This year there’s £3 million of targeted funding, from the Workforce Development Fund (WDF), to support managers and deputies develop the skills and knowledge they need to lead high quality services. Skills for Care has launched three new continuing professional development (CPD) modules covering Understanding Performance Management, Understanding Self-management Skills and Understanding Workplace Culture. These new CPD modules are in addition to our existing leadership programmes: Lead to Succeed and Well-led and you can claim money from the WDF towards the cost of completing all of the CPD modules and learning programmes. Find out more at www.skillsforcare.org.uk//leadersandmanagers
20 Care Home MANAGEMENT
www.chmonline.co.uk
HR TEMPORARY STAFF
GET THE BEST OUT OF
temporary staff
Read these tips from Shehzad Jivraj, head of operations at care home operator Clearstone Care
S
ufficient numbers of staff in place with the right skills for each and every shift is fundamental to providing consistent quality care and support. But with a lack of funding and staff shortages a reality for most operators, care and nursing home managers need to call time on the taboo around temporary staff and accept that they are not only here to stay, but part of the solution to the staffing crisis. Establishing good working relationships with individual nurses and care workers who you can call on is a great first step to maximising
the value of a temporary staff member. At Clearstone Care we focus efforts on employing temporary nurses and carers who have worked in at least one of our homes before.This helps the nurse to familiarise themselves with the residents, supports the delivery of care and streamlines the process. It’s important for care home managers to use all the tools and resources at their disposal.There has been a rise in the number of online recruitment platforms operating in the sector and we have drawn up a list of ‘favourites’, particularly those
which enable care homes to rate and review the staff member after their shift. Building a solid relationship with a handful of different recruitment agencies is a good way for care homes to grow their pool of regular temporary staff. When temporary staff are with you, it’s important that they are made to feel part of a team.There needs to be strong emphasis on the fact that the work of social care is transformational rather than transactional, ie, that care teams are changing people’s lives for the better rather than going in and preparing them a meal. Although it isn’t possible to always wait until the ‘right’ candidate has applied for a shift, the long-term forging of direct relationships with temporary staff is vital in supporting core permanent workers.
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Care Home MANAGEMENT 21
PROFILE OAKLAND GRANGE
HEALTHY PROG Enhanced health in care homes doesn’t just benefit residents, it improves ratings, motivates staff and delights the local multidisciplinary team, says Charisma Williams, manager at Oakland Grange residential care home in Southsea, Hampshire
“Thank you so much for the excellent care given to mum. Nothing is too much trouble”.
Comments like this, taken from the visitors’ book at Oakland Grange in Southsea, Hampshire, are just one way in which manager Charisma Williams knows the home is getting things right for residents and their families. CQC inspectors, as well as other healthcare professionals, have also expressed their satisfaction at the home’s progress. As far as Williams is concerned, a key driver of quality is the Portsmouth Enhanced Care Home Team (ECHT) pilot project. ENGAGING STAFF In its 2017 inspection report on the 42-bed residential care home, CQC inspectors said they found a home where staff were well-informed about the health status and needs of residents. Awarding Oakland Grange a rating of ‘Good’ for Key Lines of Enquiry, including ‘effective’, inspectors quoted a community nurse linked to the ECHT. They said: “Staff are passionate and enthusiastic. They are engaging well with the project and coming up with good ideas. I’m very impressed by their commitment.” Inspectors visited the home during a routine weekly meeting of the ECHT multidisciplinary team (MDT). They could see how professionals including a GP, pharmacist and occupational therapist were working collaboratively with care staff to help reduce unnecessary admissions to hospital. As part of the ECHT project care staff receive training to enable them to check people’s blood pressures, blood sugar levels and oxygen saturation levels – information which enables other healthcare professionals to diagnose problems more quickly by telephone. Care staff learn to monitor and evidence the nature and causes of unplanned admissions including actions that might have been taken to avoid them. They are also supported with end of life care planning, taking into account residents’ preferences, culture and decisions. Visiting 22 Care Home MANAGEMENT
professionals take responsibility for delivering residents medication reviews. In their analysis of project outcomes involving 104 residents in Oakland Grange, and two other pilot programme care homes, researchers showed that in a nine-month period from April to December 2018, the project achieved the following: • A fall in ambulance hospital journeys required by residents at two of the homes compared to falls in the same period by residents at homes not within the pilot • A drop in hospital attendances compared to an increase in care homes not within the pilot • A reduction in hospital admissions, compared to an increase in homes not within the scheme • A reduction in wasted/overprescribed medicines. Project organisers, NHS Portsmouth Clinical Commissioning Group (CCG), Solent NHS Trust, the Portsmouth Primary Care Alliance and Portsmouth City Council, conservatively estimate that by reducing emergency attendances by 21 per cent, and attendances that result in admission by 16 per cent, the project has achieved a “cost avoidance” total to the NHS of about £80,000. But, as well as the cost savings to the NHS, other benefits have arisen out of the programme, says Williams, who joined the home in 2015 when it was under a local authority embargo. These include: • Better trained staff in care homes (identifying training needs) • Enhanced relationship of trust between health and social care professionals • Improved continuity of care • Improved patient safety through better clinical outcomes • Increased satisfaction of residents and their carers • Development of long-term sustainability for service from quality and financial perspectives. Commenting on the results, Dr Linda Collie, the CCG’s clinical lead, said: “The big difference now is that we have either nursing staff and or
other clinicians and social care staff working proactively in the homes to review the residents’ health and medication and spot early warning signs that might otherwise have led to a deterioration in their health - so they can be treated and looked after to prevent their condition warranting having to go to hospital. “This is clearly much more beneficial to the resident, especially if they don’t need to be kept in hospital, and it’s a much better and more effective service.” ROAD TO OUTSTANDING In her second managerial post, following a move from the Anchor Trust where she was regional homes manager in the south region, Williams has overseen the home’s journey to a Good rating. She now has her sights set on ‘Outstanding’ and she believes that taking part in the ECHT project will make a key contribution to this process. She believes staff have become empowered and have gained competence in managing residents’ care, thanks to the training and support of the MDT. “Increased contact with the GP and other MDT members also means that professionals have got to know the home and their residents, and they know what they will find when they visit,” she adds. Residents too have felt a difference, gaining in confidence to raise concerns because they know that staff can deal with them. Williams says: “We’ve stopped what could be described as “nuisance” calls to the GP, which has improved relationships there too.” Such is the confidence of the MDT in the abilities of staff that visits to the home have reduced in frequency from weekly to monthly. “This shows that it is working,” she says. NATIONAL PLANS Enhanced health in care homes has been part of NHS policy since 2016 when NHS England rolled out its vanguard projects. Improving care home residents’ health is now a national service specification for GPs in England who take up the financial incentives to develop primary care networks (PCNs) and roll out this workstream on a national basis from April 2020. www.chmonline.co.uk
PROFILE OAKLAND GRANGE
RESS Williams believes the home was chosen by their local NHS partners to take part in the project for two reasons: • Staff ’s proactive attitude to improving standards at the home • The team’s willingness to learn from identified shortcomings. Most importantly of all, she says that residents and their families are very happy with the changes they have seen at the home as a result of participation. Williams says: “Families are happy that there is more support for medicines, that reviews happen quickly, and that staff are able to triage health issues and can deal more effectively with emergencies. Residents tell us that they feel safe. If they have a problem, they know they only have to ask.”
Increased contact with the GP and other MDT members also means that professionals have got to know the home and their residents, and they know what they will find when they visit. November/December 2019
Care Home MANAGEMENT 23
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ASK THE EXPERT POWER OF ATTORNEY
ASK THE EXPERT:
Care Home Management asks our panel of experts to answer your common care queries
IN THIS ISSUE: UNDERSTANDING LASTING POWER OF ATTORNEY By Iain Dougall, head of power of attorney services at the Office of the Public Guardian (OPG)
Further information Help and guidance about LPAs and deputyships is available from the OPG [online] at http://www.gov.uk/opg/ Search the OPG register [online] at: https://www.gov.uk/government/ publications/search-public-guardianregisters
What is a lasting power of attorney? A lasting power of attorney (LPA) is a legal document that lets an individual (known as the ‘donor’) appoint one or more people (known as ‘attorneys’) to help them make decisions or to make decisions on their behalf if they lack mental capacity. Having an LPA allows trusted people to quickly, legally and easily step in and support or act in the best interests of the donor. There are two types of LPA – one covers health and care decisions and the other financial decisions – individuals can choose to make either one or both. Both types of LPA must be registered by OPG before they can be used. The OPG also supervises deputies appointed by the Court of Protection, so it is possible you may have residents with a deputyship in place. Appointed deputies will have a court order saying what they can and cannot do as a deputy.
November/December 2019
How can care home staff check if a resident has an LPA or a deputyship? The OPG has a legal duty to establish and maintain a register of LPAs and deputyships. Care homes commonly use the register which is free to search (see right for more information). Results are normally issued within five working days of receipt of a search form. Requests for additional information made by public authorities are considered a priority. This is to make sure that information is shared quickly in cases where there might be a safeguarding concern. If there is no record but a safeguarding concern has been raised, the OPG may refer the case to social services or the police.
How should an LPA affect care home practice, particularly in terms of record-keeping and care? If there is an LPA in place for a resident, the attorney should always support the resident/ donor to make their own decisions, as far as is practical. It’s important that the attorney and care home staff keep talking to the resident and involve them as much as possible. As there are two types of LPA, care homes should be very clear as to what kind of LPA is in place and to document what decisions have been made involving both the donor and attorney. Health and care LPAs are less common than LPAs that cover financial decisions. Health and care LPAs give attorneys the power to make certain decisions and to be an advocate for the donor in care and medical decisions by a professional. If there is a health and care LPA in place, you should ensure you’re aware of its details. For example, if there is more than one attorney, are they able to act independently or must they act together? Are there any specific instructions or preferences in the LPA about life-sustaining treatment? If you keep these records, you can more easily share this information in an acute situation to help health care professionals.
Care Home MANAGEMENT 25
MEDICINES ENVIRONMENTAL MANAGEMENT
Environmental influences have a huge role to play in medicines safety
KEEPING YOUR
MEDICINES MANAGEMENT ON THE RIGHT ROAD W To fully rid care homes of medication errors, managers need to understand the reasons why they happen, says Dominic Furniss, PhD, pharmaceuticals and patient safety champion for the Chartered Institute of Ergonomics & Human Factors
What will I learn from this feature? How to make my home a safe environment for medicines administration 26 Care Home MANAGEMENT
incing as I open my article with it, the term ‘human error’ is frequently scribbled on case notes across the social care system, isolating thousands of carers every day as the sole reason behind a patient medication administration incident. But, is this really the whole story? And, what more can care homes do to ensure they meet current National Institute for Health and Care Excellence guidance which states that care home providers ‘should ensure that a robust process is in place
for identifying, reporting, reviewing and learning from medicines errors involving residents’? Certainly, the term ‘only human’ has its place: as humans we are fallible and we make mistakes. However, as hugely adaptable creatures, we are also heavily influenced, for good or for bad, by the systems and environments we operate in. The majority, if not all of medication administration incidents, are multi-causal, meaning there are different factors that contribute to the end outcome. Essentially safety needs to understand systems, not blame individuals. CREATE A SAFE SYSTEM As humans, we have a bias for the simple story, where the blame lands in the lap of individuals (the first order story). For example, when Lewis Hamilton wins a race, we attribute that win to him and don’t think about the team of people, equipment, funding, etc. that has put him on the podium (this is the second order story). It’s similar for medication incidents, and even normal performance at work: we think of individuals and training them, when really the biggest gain will come from making improvements in their working conditions, the forms and procedures www.chmonline.co.uk
MEDICINES ENVIRONMENTAL MANAGEMENT
they follow, the technology they use, and the way their environment is organised (the second story). The second story is where deeper systemic changes can be made for lasting improvements: draining the swamp rather than swatting gnats. In the case of medication incidents, there are several factors to investigate: was the care worker fatigued from a long shift? Were the lighting conditions in the dispensary adequate? Were measurement vessels clear to read? Was the resident in an unfit mental state at the time of administration? Taking a step back can reveal some often very simple changes that care homes can make to support the performance of their staff and the safety of residents. To help people better understand the concept, I often use the analogy of the motorway. Many of us do the blue commute every day, safely arriving at our destination. However, add a dark winter’s night and torrential rain after a long night shift, and we begin to feel the impact of the environmental influences surrounding us. As a safety critical industry social care has to take a proactive approach to safety. From a human factors point of view, this involves conducting a detailed task analysis to understand ‘work-as-done’, to identify potential for deviations, and to try to redesign the system (how work is organised) so it is easier for frontline staff to work with medicines efficiently, effectively and safely, and to manage other influences on performance that can affect safety. MEDICATION PACKAGING AND LABELLING Unsafe pharmaceutical packaging, together with look-alike labelling, have both been identified as major contributing factors to medication incidents, which are the single most preventable cause of patient harm. However, labelling is only one aspect of the process for ensuring safe use. Feedback from reports of medication incidents indicate that a systems-wide approach to how the label is developed, used and amended is needed. PHARMACIST MENTORSHIP According to regulatory work conducted by the Care Quality Commission (CQC), there is an increased risk of poorer experiences and outcomes when people’s November/December 2019
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Call, email or click online to book your training needs today! T: 01622 766078 | E: info@edify-consultancy.co.uk W: www.edify-consultancy.co.uk care is transferred between services. At this critical time, communication can break down around prescribing and supplying medicines, which means people may not always get the right medicines quickly enough, and this can lead to harm. Human factors will strongly support the work of social care pharmacists in reducing medicines-related harm. It was fantastic news to hear Health Education England (HEE), on behalf of NHS England, initiating the ‘Medicines optimisation in care homes’ training pathway for 600 pharmacy professionals from April 2018 to March 2021.
Taking a step back can reveal some often very simple changes that care homes can make to support the performance of their staff and the safety of residents
However, often with these things there can be too much focus on training, competences and individuals and not enough on human factors that can target system risks and issues. A little bit of thought about human factors knowledge and systems could go a long way. Pharmacists are extremely busy people.Yet, equipped with human factors training or consultant support, pharmacists can create an even safer dispensary environment. From the simple evaluation of how medication is stocked and arranged, to dispensing and clinical workflow to run smoothly. There is growing human factors input across social care, but it is crucial that care homes come together to share their experiences and learning. No machine in the world is up to the job of providing the love, care and empathy our care workers do every day. Technology and greater knowledge around their daily challenges could transform the lives of care workers and of those they care for. Care Home MANAGEMENT 27
MEDICINES DEMENTIA CARE
SUPPORTING
PEOPLE WITH
DEMENTIA TO TAKE MEDICINES
The challenges - and some survival strategies. By pharmacist consultant Francesca Aaen
The important thing is to try different approaches until you find what works for that individual. And, remember, their needs will change over time so the same should be true of your approach
F
or a person living with dementia, taking medicines is likely to be part of their daily routine: as well as taking medicines for their dementia they are also likely to be taking medicines for at least one other condition, complicating the daily dosage regimen. Adding to the complexity for carers is that each person living with dementia will face different challenges with their medicines, so individual solutions are required if care teams are to successfully address the problems residents have. REFUSAL A common problem in people with dementia is a refusal to take medicines. When this happens on a regular basis, it’s worth looking for any patterns, eg, does it happen at a certain time of day? Is it only certain members of staff who have difficulties? Where and when do you administer medicines? This may help identify an easy fix to the problem. CONFUSION A person with dementia may also have difficulty understanding what you are asking them to do or why you are asking them to do it when you approach them with medication. They may not remember that they take medicines at all, which can lead to fear or paranoia. It is essential that you take a reassuring approach, reminding the person why they take a medicine, who prescribed it and how it will help them. COMMUNICATION PROBLEMS Communication problems can also come into play, so a solution is to keep it simple. Taking medicines involves a series of tasks: taking the medicines from the carer, putting
28 Care Home MANAGEMENT
them in their mouth, and swallowing with a drink of water. It will help some people if you can break this process down into individual steps, talking the person through each individually. Repeat instructions as needed and make sure the person can hear you.You may also need to use a communication aid, such as a picture. Make sure you have these to hand and know how they should be used for the individual. NEW SKILLS Learning new skills can be challenging for a person with dementia, even in the early stages, and a new medicine is no exception. If complex devices like inhalers and spacers are prescribed, you will usually need to repeat the instructions on a daily basis for as long as it takes for the person to start using the device properly. Using an inhaler correctly is tricky, so if a person in your care is struggling with their device – new or old - you can ask their GP or other prescriber to review and provide an alternative. Make sure your own device handling knowledge is up to date too, and that you are teaching people the right technique. Ask a pharmacist for help if you are not sure.
SWALLOWING DIFFICULTIES As dementia progresses, people can start to experience oral and swallowing problems. If a person in your care is choking or spluttering when taking a medicine, make sure you seek advice from a Speech and Language Therapist (SALT). For true swallowing difficulties, it may not be appropriate just to switch a person to liquid medicines, so getting the right advice is essential. Sometimes, you may be advised to give a medicine in a small amount of soft food, eg, to help the person swallow it. Again, seek www.chmonline.co.uk
MEDICINES DEMENTIA CARE
the advice of a SALT therapist and pharmacist as this is not suitable for all medicines. Never administer medicines in food or drink with the intention of hiding it from the person with dementia, unless the decision to use covert administration of medicines has been made by their multi-disciplinary team and all the correct documentation, including assessment of capacity and administration advice from a pharmacist, is in place. MOUTH PAIN Mouth pain can also make it difficult to take some medicines. Good oral care is the starting point in prevention and when pain does occur, take advice from a dental care professional who can advise on treatment including using painkillers. OVERLY-COMPLEX REGIMES Simplifying the medicines regime to as few medicines on as few occasions as possible reduces the burden November/December 2019
of the medicines administration, not only for the person taking the medicine but also for care staff. As people become older or frailer, their physical health and their tolerance of side effects of medicines will change. They may no longer need some of the medicines they take, or they may experience new side effects from long-standing medicines. Your pharmacist or GP can advise on the most appropriate medicines regime to improve adherence: a good medication review will ensure the person is only on the medicines they need. No more, no less. KEEP TRYING It’s unlikely that you’ll find a onesize-fits-all solution to medication administration challenges. The important thing is to try different approaches until you find what works for that individual. And, remember, their needs will change over time - so the same should be true of your approach. Care Home MANAGEMENT 29
HEALTH & SAFETY MEDICAL GAS SAFETY
YOU AND O2? Oxygen cylinders present a range of health and safety hazards that are important for care teams to know, says Jamie Morrow, technical services manager at Health Technical
What will I learn from this feature? How to protect your staff and residents from oxygen cylinder incidents 30 Care Home MANAGEMENT
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handling and transportation techniques, and xygen cylinders may not appear if cylinders fall. Correct handling of oxygen to present many dangers, after cylinders is dependent on the cylinder size: all, oxygen is all around us in the some are small enough to carry and even atmosphere. However, they actually carry have handles to help, whilst others are much significant risks for the home, its residents bigger and require the use of a specially and staff. made cylinder trolley. Under the Health and Safety at Work Act 1974, it is the responsibility STORAGE: In itself, oxygen of employers to train is not a flammable gas but their employees on the it is a vigorous catalyst for recommended safeguards combustion. The hazards relating to products and of smoking and/or naked equipment used at work. A flames around an oxygen Therefore, all staff who increase in oxygen cylinder should be obvious, are involved in prescribing, levels doubles the however, correct storage administering, handling and rate at which a of oxygen cylinders is often managing oxygen and oxygen fire burns overlooked. Storage areas for equipment must receive annual oxygen cylinders should be welltraining. ventilated, as a leaking cylinder can create an The following hazards relate to the environment where oxygen levels rise above handling and storing and administration 21 per cent (usual atmospheric levels) and of oxygen cylinders: increase the risk of combustion with any HANDLING: Oxygen cylinders can be ‘spark’ or ignition. heavy and injuries can occur from incorrect
Did you know?
4%
www.chmonline.co.uk
HEALTH & SAFETY MEDICAL GAS SAFETY
ADMINISTRATION: High pressure gasses carry the risk of spontaneous combustion in the presence of hydrocarbons. This can also include hand creams/moisturiser on hands when administering oxygen, as they can create a reaction with the high-pressure cylinder. Carers and residents are advised to switch to alcohol gels but they should take care to ensure the gel has evaporated before exposure to oxygen cylinders or the equipment associated with oxygen cylinders. No part of the cylinder itself should be lubricated or contaminated with oil or grease.
Under the Health and Safety at Work Act 1974, it is the responsibility of employers to train their employees on the recommended safeguards relating to products and equipment used at work
OXYGEN ON YOUR CLOTHES: Smokers beware! Smokers may think it is safe to smoke once they have finished using their oxygen. Not so. Several people die each year because of oxygen enrichment of their clothes. This happens when oxygen leaks down from their nasal tubing into their
clothes causing ‘oxygen enrichment’. Any ‘ignition’, for example, from a lighter or any falling ash from a cigarette will catch fire and burn very rapidly. When administering or using oxygen cylinders, people should walk around in normal air conditions for 10 minutes before handling an ignition source, such as a cigarette.
Heath Technical Ltd.
Specialists in providing medical gas services all over the world
Oxygen Cylinder Training within Care Homes Providing essential training to all staff within care homes in the safe use of oxygen cylinders.
info@healthtechnical.co.uk November/December 2019
Train the Trainer
E-Learning
Our fully qualified team will provide you with the necessary skills, knowledge and materials to train your own staff in the safe use of oxygen cylinders.
Courses available to staff to ensure annual training is maintained. Free trial available.
www.healthtechnical.co.uk
01452 260800 Care Home MANAGEMENT 31
HEALTH & SAFETY GAS SAFETY
KEEPING RESIDENTS GAS SAFE • Carry out a risk assessment for any gas usage and storage appliances to identify potential hazards, controls and policies that are needed. • Ensure every gas appliance, flue and any ventilation are safety checked and serviced annually by a Gas Safe engineer. You should also keep records of each check for at least two years.
BE GAS
SAFE
David Holmes, founder of Boiler Guide, outlines the dangers associated with unsafe gas appliances and how care home managers can minimise the risks
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as central heating and hot water systems are popular in residential settings as they are often the most cost-effective and convenient, but they can carry significant safety risks if not maintained. UNDERSTAND THE RISKS Fires or explosions: leaking gas is highly flammable. A tiny spark of static electricity or flame could lead to a fire or, in extreme cases, an explosion. Carbon monoxide poisoning: Carbon monoxide is produced when gas does not burn properly or when there is inadequate ventilation. Carbon monoxide poisoning can lead to permanent brain damage and causes around 50 deaths in the UK each year. Colourless and odourless, carbon monoxide can only be detected using a carbon monoxide detector. Symptoms of carbon monoxide poisoning could include: • • • • •
Tiredness/drowsiness Headaches Nausea Loss of consciousness Chest and stomach pains.
32 Care Home MANAGEMENT
If you suspect you have a gas or carbon monoxide leak, you should:
• Open all windows and doors • Shut off the gas supply at the meter • Evacuate everyone from the building • Call the Gas Emergency Freephone Number 0800 111 999 • Ensure that investigations and repair work is carried out by a competent Gas Safe engineer. Do not:
DO NOT:
• Use electrical equipment • Switch lights on/off • Enter confined spaces below ground • Light matches. If you are concerned that staff or residents have been exposed to carbon monoxide, turn off all gas appliances, take them to a well-ventilated area and call 999 for an ambulance.
• Check the engineer’s Gas Safe accreditation number using the Gas Safe register available online at www. gassaferegister.co.uk • Educate all staff about the signs, symptoms and risks associated with gas leaks and carbon monoxide poisoning, for example: – Staining or discolouration around gas appliances. – Experiencing carbon monoxide poisoning symptoms at work (e.g. headaches, nausea, tiredness) which improve when they leave. • Remember that gas appliances should always burn with a bright blue flame. If you see an orange, yellow or red flame, call a Gas Safe registered engineer immediately.
CO MONITORS: DO’S AND DON’TS DO
• Install CO detectors on every floor of the property and at knee height. Carbon monoxide blends with air and, unlike smoke, does not rise • Test the detector monthly • Keep the CO detector clean. Wipe the detector with a cloth and vacuum it at least once a year or more as needed • Listen for low-battery alerts. In any case, change your batteries at least once a year
DON’TS
• Locate the detector near any gas or fossil fuel source, ie, the gas boiler • Avoid humid or moist areas including bathrooms • Place in direct sunlight as it could overheat • Avoid windows or windy areas • Avoid doors, cabinets, curtains or other barriers to detection
www.chmonline.co.uk
HEALTH & SAFETY FIRE SAFETY
FIRE! FIRE!
Karen Trigg of Allegion UK discusses fire safety obligations for care home providers
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andlords and providers of specialised housing and houses of multiple occupancy (HMOs) have a duty of care under the Regulatory Reform (Fire Safety) Order 2005 to ensure that their properties meet all aspects of fire safety compliance. Yet, right now, question marks remain over the state
of fire safety in the UK. Each week, the news highlights fire-related incidents. VULNERABILITY AT NIGHT The 2017 National Fire Chiefs Council guide, Fire Safety in Specialised Housing, includes a series of recommendations designed to protect the estimated 750,000 residents in specialised housing. As well as escape routes and warning signs, fire doors are recognised in the document as a major contributing factor to fire safety. Most fires in the home occur when people are asleep (between the hours of 10pm and 6am): when a fire breaks out, fire doors prevent or slow down smoke and fire from spreading by between 20 and 120 minutes – depending on the specification of the door. Correct installation and maintenance are crucial to the effectiveness of
a fire door. However, to cut costs they are sometimes the first item to be downgraded in specification. Even if the correct fire door is installed, they can often be used incorrectly, being left propped open or even locked, and are often badly maintained and damaged. Fire door failure is still a prominent problem in many residential settings. In 2015 alone, 58 per cent of all fire door fines were issued to landlords of HMOs in the UK: in 61 per cent of inspections, fire doors had fire or smoke seals missing or were installed incorrectly. At the same time, one in three had gaps of 3mm or more between the door and the frame – making them susceptible to increased fire damage. Failure to meet the stringent regulations associated with fire safety compliance can result in legal action and heavy financial penalties.
Providing Customised Solutions for Equipment, Servicing and Unique Training Programs Across the Care Sector
Since 1997, Britton Price Ltd have become experts in providing patient moving and handling equipment across the United Kingdom. We are proud to deliver excellent standards, innovative designs and compliancy with regulations. As you care for your residents, we care for the equipment which supports your employees in their day to day tasks. At Britton Price, we are immensely proud to lead the Care Sector in training, exceeding the required fundamental standards as set by the Care Quality Commission. Our bespoke training and open courses provide fully certified training and ongoing support. We are one of a select few training providers that are ROSPA and OFQUAL regulated and certified. Our newly launched National Centre for Learning offers the first nationally recognised qualification for People Handling and Risk Assessor ‘Train the Trainer’ program.
www.brittonprice.co.uk November/December 2019
Tel: 01273 231012
Care Home MANAGEMENT 33
MANAGEMENT TECH COMPLIANCE
What will I learn from this feature? How to use tech to turn inadequate into outstanding
Tackle that techinspired turnaround Five years after the introduction of the CQC’s five regulatory KLOEs (Key Lines of Enquiry), an increasing number of care home providers continue to fall into ‘special measures’. Helen Fuller, managing director at Care 4 Quality, explains how care homes can avoid joining their ranks
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ecent analysis of inspection reports, focusing on inadequate rated care homes across England, has identified the factors that impact a provider’s ability to achieve a positive rating. Moreover, research shows that almost all of the care providers that were rated inadequate overall, were rated inadequate in the categories of being ‘Safe and Well-led’ Some of these providers will now find themselves facing enforcement action, even closure, as a result. Given the right support, however, many providers can make the necessary changes to improve their rating. Knowing the common areas of poor performance may help to raise awareness, shift their mindset, improve care services and prepare more proactively for future inspections. Key areas for improvement include medicine management, health & safety and poor care planning. 34 Care Home MANAGEMENT
Medication management
Medication issues are present in 83 per cent of care homes that are rated inadequate. Key to successful medication management is to know and audit the home’s medication practices thoroughly and regularly. The best audits are not overly regimented but instead are flexible enough to focus on a specific area for improvement, as and when this is needed to improve compliance. Once compliance is achieved on a consistent basis, the audit schedule can be reduced to weekly and later, monthly.
Health & Safety – Managing risk
While managed risk-taking is encouraged in the care sector, there are still several concerns around people’s safety and wellbeing. In 2015 regulatory bodies were granted the authority to prosecute care providers for failure to adequately manage and prevent health and safety incidents: falls, environmental risk, choking, challenging behaviour, fire safety, moving and handling, pressure care and nutritional risks are commonly cited as areas for improvement. Part of the problem is that risk assessment and care planning are often seen in isolation, but risk management becomes far less complex, and is www.chmonline.co.uk
MANAGEMENT TECH COMPLIANCE
TACKLING THE TECH BARRIERS TO TECHNOLOGY IN CARE easier to manage, review and monitor if it is directly linked with the relevant plan of care. A straightforward checklist process can help to keep things simple and focused.This consists of several steps: • Determine what the risk is • Evaluate and rank the risks (low/medium/high/very high etc.) • Mitigate the risk by putting in place a clear management plan using a multi-disciplinary approach where appropriate • Monitor and review.
Improve care planning
Complex care planning, regular monitoring and review are extremely time intensive for care home staff to manage. For nine in ten care providers, poor care planning contributed to their inadequate rating. The main care planning issues identified were: • Lack of input received from those in care and their families • Wishes, preferences, likes and dislikes missing • Lack of staff guidance and triggers identified • Missing information • Incorrect information • Failure to monitor plans • Out of date planning. Effective care planning can be achieved via a paper-based system or by using specialist software. The important thing is that the chosen system is consistent, comprehensive, easy to navigate with a people-centred approach at the core while being easy to review and maintain. It is often discovered during audits that paper-based systems are added to in a repeated or haphazard manner, which can lead to a disjointed, and potentially ineffective care planning system.
Given the right support, many providers can make the necessary changes to improve their rating November/December 2019
In a chapter of the recent CQC report, State of health and adult social care report, 2018-19, the Care Quality Commission (CQC) looks at innovation and technology in the care sector. It concludes that the adult social care sector has faced challenges in its adoption of technology, specifically, in five key areas: • a lack of funding to invest in technology and ability to make economic returns, particularly for smaller providers • a low level of knowledge and awareness among providers and staff – adoption of technology tends to rely on confident individuals • the perception that people who use adult social care are not interested or will respond badly to technology • concerns about ethical or data protection implications in adopting technology that uses personal information, or GPS and surveillance techniques • fear that technology could replace personal support. Organisations that represent the public have also stressed that technology should not replace human support. However, CQC inspectors have also seen technology support staff and improve care delivery. For example, electronic recording systems can make it easier to access people’s care plans, freeing up staff time to focus on the person they are supporting and making it easier to involve people in their own care. Online communication platforms and social media can help residents connect with loved ones and to participate in family life. As people’s familiarity and expectations of technology
increase, there will be greater use of digital devices, such as virtual assistants, tablets and apps to improve people’s quality of life. Online communication platforms are also being used to improve access to healthcare services, for example, providing direct access to GPs and specialists for first line appointments through the internet, supported by on-site nurses. This has successfully reduced hospital admissions and visits to a GP. Inspectors have also seen social media play a growing role in recruitment, with examples of providers using social media campaigns, rather than traditional methods, to attract new staff.
As people’s familiarity and expectations of technology increase, there will be greater use of digital devices
Care Home MANAGEMENT 35
MANAGEMENT TECH Q&A
In conversation with… Care Home Management sat down with Leah Cooke, a qualified and registered general nurse, and the residential policy lead for Quality Compliance Systems (QCS), to discuss how and where tech can be used to best effect in care home management CHM: To what extent can management tech support care home managers with recruitment and budget shortfall challenges? LC: Addressing a funding shortfall is one of the greatest challenges that the industry faces, and it goes hand-in-hand with the workforce shortage, documented at about 122,000 vacancies on any given day. While I am not a politician, government ministers just don’t seem to get the fact that the NHS and the social care sector are intrinsically linked. Social care is actually the backbone of the NHS. Why? Well, once acute care is delivered, many patients – especially those who are terminally ill - find themselves in care homes. Those residents expect the same care they receive while in the NHS system, but with severe budget restraints, the local authority can only provide a fraction of the funding needed. Technology, which forms an open bridge between the NHS and social care sector,
could, however, make a big difference. It could mean more joined-up services. Imagine a technology system that directly linked a care home team, a GP and an NHS cancer team. Such a system would shed greater light on funding bottlenecks, and would promote a culture of joint working, rather than one where two organisations operate independently of each other. CHM: A leading charity, Alzheimer’s Research UK, recently warned that dementia is the greatest challenge of our time. How is dementia impacting on care homes and how do care home managers use technology to tackle it? LC: According to Dementia UK, around 70 per cent of residents in care homes present with some symptoms of dementia. But, it’s important to recognise that in addition to caring for individuals with dementia, care home practitioners must provide expert
care to residents with long term conditions, frailty and mental health issues. Malnutrition, hydration and rising levels of obesity are also national problems that place a greater burden on care homes. In this challenging landscape, technology can be a game changer. Take malnutrition and hydration, for example. Firstly, care home managers can use technology to monitor the amount of fluid that care home residents take on board. They can make the information available to staff with a single click of a button, enabling care home staff to act swiftly.
Instant and accessible online training ensures that carers are equipped with the right training for the right resident at the right time
Leah Cooke 36 Care Home MANAGEMENT
www.chmonline.co.uk
MANAGEMENT TECH Q&A
Instant and accessible online training ensures that carers are equipped with the right training for the right resident at the right time. CHM: How can technology help a manager to inculcate a culture of continuous learning in a care home? LC: In a thriving home, there is a culture of continuous learning and reflection: the trick is to provide this in an accessible, easily digestible and - in an industry where every
penny counts - a costeffective way. This is where online training courses, webinars, and policy keypoint summaries - available in a range of languages and on different devices - come into their own. Social media forums are another useful tool, as are forums run by industry professionals which share ideas and best practice. Anecdotally, care homes that invest in online training alongside practical teaching are more likely to retain their staff than those who don’t. CHM: Recruiting the right person for the job is time consuming and difficult. How can technology solve this key issue? LC: I think this is one area where human judgment has proved itself much more
effective than technology. To get a true reflection of the applicant’s abilities, many care homes like to observe the candidate at close quarters: how they interact with service users, with fellow members of staff, and how they respond to what they’re seeing in a care home. But that’s not to say that technology can’t support this, helping to select competencybased interview questions, profiling and screening. In time, maybe AI and machine learning will play a greater role in recruitment.
In a thriving home, there is a culture of continuous learning and reflection: the trick is to provide this in an accessible, easily digestible and - in an industry where every penny counts - a cost-effective way
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November/December 2019
Care Home MANAGEMENT 37
MANAGEMENT TECH BLUE SKY THINKING
The future of care homes The combination of the UK’s ageing population and people living for longer, alongside people entering care homes and retirement villages at a younger age, poses many challenges for health and social care systems. It’s hoped that these issues can be successfully tackled due to the technological advancements made in both AI and robotics, according to a new Blueleaf whitepaper, The Future of Care Homes
“Systems and processes are becoming increasingly digitised and automated; if the care sector doesn’t continue to adapt, it is at risk of being left behind”
“Home hubs, which manage everything from “Assessment and lighting, to thermostats, evidencing of care and playing residents’ via apps [make] medical favourite songs… assessments more increasing residents’ accurate and wellbeing and saving “Wearable efficient” care homes time technology enables and money” caregivers to accurately track residents, without caregivers having to individually monitor every “Software single resident” solutions speed up administrative tasks allowing for a more efficient business and enhanced care for patients”
“Used correctly, AI and robotics will allow carers to better focus on peoples’ social and emotional needs that are often overlooked in the current system”
38 Care Home MANAGEMENT
www.chmonline.co.uk
INSURANCE LIABILITY COVER
What will I learn from this feature? How to protect yourself from the risk of an abuse claim
SAFEGUARD YOURSELF AGAINST
ABUSE CLAIMS Does your insurance cover you against allegations of abuse? It’s time to check, says Markel Insurance Technical Line Manager – Social Welfare Wendy Cotton
November/December 2019
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vidence of abuse - mental, physical and sexual - in care homes and the wider care sector have become more frequent in recent years. In 2018, the CQC received 67,590 allegations of abuse. The figures show an 82 per cent rise over 2014 and were released by social care minister Caroline Dinenage amid concern that the CQC was not taking a firm enough line with non-compliant providers. The CQC’s new chief executive has indicated his organisation will take a harder line against poorly performing providers to protect people across the care sector. This position makes it even more important for the care home sector to comply with regulation and be aware of how and when their insurance cover will respond to allegations. Many insurers offer abuse protection as part of a wider insurance cover for the care sector. However, not all cover is the same and care home providers should consider a variety of factors to ensure they have the right protection in place. One such consideration whether to take out a claims occurring or a claims made policy.
Claims occurring vs claims made insurance
A claims occurring policy covers incidents that occur during the period of insurance. As long as the incident is reported in accordance with policy terms and conditions, it does not matter how far in the future a claim is made because they are linked to the original incident, rather than the claim date. Claims made policies, on the other hand, provide cover for claims made and reported during the period of insurance. Claims notified after the policy period has ended will not be covered, even if the incident took place during the period of insurance.This makes it risky for care home providers to switch insurers at renewal, although most will provide retrospective cover (to fill the gap). Insurers are usually very careful when offering retrospective cover to ensure that historical risk management policies and procedures were robust, regulatory positioning was consistent (where appropriate) and there are no pending abuse claims. Often insurers’ approach to pricing will be reflective of the cover type, and claims made policies tend to be less expensive than claims occurring due to the shorter term nature of cover provision. Care Home MANAGEMENT 39
INSURANCE LIABILITY COVER
Other insurance considerations
While the basis of cover is crucial to longterm protection for providers, consideration should also be given to: • the limitation of liability and basis of the cover for the limit itself • adherence and compliance with safeguarding risk management conditions.
Limitation of liability
Limitation of liability — the expiry of a relevant prescribed period after which a claim cannot be made — is not straightforward. Abuse claims can be made in both the civil and/or criminal courts, although civil claims are subject to a limitation period whereas criminal claims are not.
Safeguarding risk management
Some safeguarding basics are inherent in risk management, irrespective of your organisation’s size: Get your structures right: In a larger organisation this may include having a safeguarding lead on the Board or leadership team/s; for smaller organisations the task might fall to a senior manager. Safeguarding should be embedded in the relevant employee/s job description/s and should include the task of updating senior managers on the latest safeguarding guidance and practice issues. Training: Safeguarding policy should be part of staff inductions, and in ongoing training, during supervision and one-to-one development sessions, eg, appraisals. Policies (and, therefore, training) should cover whistleblowing and the Duty of Candour, mental capacity and the incoming Liberty Protection Safeguards (LPS). Senior staff should also understand liability defence or handling of safeguarding investigations. Communication with Local Authority safeguarding teams and regulators: Clarify with your local authority Safeguarding Team their thresholds for reporting. Be clear on what notifiable safeguarding incidents should be reportable to CQC or OFSTED. Include appropriate reporting guidance in your safeguarding training. 40 Care Home MANAGEMENT
Account for events in writing: Incident reporting is part of safeguarding and should be linked to notifications. Safeguarding investigations should be discussed/agreed with safeguarding authorities and the Police where they are involved. Keep your broker/insurer informed, whilst respecting confidentiality considerations. Involving service user/carer: Policies and procedures should help staff understand how and when to involve service users and carers when allegations or concerns are raised. Policies and procedures should cover the Duty of Candour, whistleblowing and complaints policies and procedures. Be clear on the local authority’s safeguarding team’s expectations for reporting suspected abuse between service users where there are no mental capacity concerns. Key employment actions: Benchmark your safer recruitment practices with similar organisations. Employee recruitment and performance management processes should cover safeguarding Check recruitment agencies for their policies on previous convictions and frequency of DBS checks. Patterns and trends: Use incident and accident reports to identify any patterns or trends that might suggest safeguarding considerations. Job descriptions of senior managers and quality assurance/control systems should include formal consideration of safeguarding areas.
Wendy Cotton
Do you understand the difference? CRIMINAL ABUSE CLAIMS: The UK does not impose a limitation period on the prosecution of crimes except for some lesser summary offences. Sexual assault, for example, is usually a serious indictable abuse offence in the Crown Court CIVIL ABUSE CLAIMS: A civil claim is one for compensation made by the injured person against the person at fault PERSONAL INJURY CLAIMS: Sexual and physical abuse claims are categorised as ‘personal injury’ claims and are generally subject to a three year limitation period. Expiry of a relevant limitation period is a valid civil-claim defence. However, there is judicial discretion available to the civil courts to extend the limitation period indefinitely due to the nature of these claims LIMITATION PERIODS: A limitation period normally starts from either the date on which the cause of action occurs, or from the date of knowledge of the person who suffered the abuse (if this date is later). The limitation rules are different for adults who do not have mental capacity. Time will not start to run against a person who does not have mental capacity if they did not have mental capacity at the date when the injury occurred. By contrast, time will run against a person who does have mental capacity at the date of the incident but subsequently develops a mental disorder. This is because if the individual has ever had mental capacity at any time since the incident then the limitation period has started to run. Once the limitation period starts it does not stop; any period of capacity means the limitation period has started. In addition, the limitation period is never “suspended” once it starts.
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INSURANCE PAPER TRAIL
GET IT ALL IN DOWN IN... Businesses are generally getting health and safety right – so why do their insurers continue to pay out so much on employer and public liability claims? Stan Ratcliffe, systems consultant at Global ID, explains the dilemma facing care homes and their insurers
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ver the past five years British businesses were faced with around a million successful claims for damages under either employer or public liability.That’s one employer in four and one in 12 of all businesses. However, this rate of claim is far from reflected in the number of Health & Safety (HS) enforcements that we see: for example, in 2017-18, there were 11,522 enforcement notices and just 517 prosecutions, equating to one firm in 500 and one in 11,000
For many insurers a claim can only be defended if there is written evidence taken at the time of an incident: the normal defence of “innocent until proven guilty” is not available for the business being sued November/December 2019
BLACK AND WHITE
respectively. The penalties may have been big – fines exceeded £70 million and over 20 people were given prison terms - but compared to the number of liability claims, the numbers involved are much smaller. If, from the HSE’s point of view, businesses are generally doing things right, why is so much being paid out by insurers? The answer: that businesses just don’t have the evidence they need to successfully defend a claim.
Guilty until proven innocent For many insurers a claim can only be defended if there is written evidence taken at the time of an incident: the normal defence of “innocent until proven guilty” is not available for the business being sued. Instead, the business needs to present evidence of what they did before, during and after an incident in order to have any chance of demonstrating that there was contributory negligence by the care worker who suffered the damage and is making the claim. Inspection reports are important, but they
are just evidence of how things were at that particular point in time – and not when the incident actually happened. Similarly, to the insurer’s legal team risk assessments and staff training are simply plans or intentions and not necessarily evidence or proof that they were, in fact, carried out at the time. If the claim is relatively small – for example, under £30,000, and there is little written evidence to defend the claim - the insurer will probably just take the economic view and pay up.This simply pushes the costs back onto the premiums of their insured clients, albeit with a fair spread according to the industry sector involved and factors affecting the risk probability of each specific client. Better documentation of the actions taken by care home teams at the time of an incident will not replace all the health and safety administration that they already do. But it might just give your insurer the paperwork they need to defend a claim and save you the cost of an increase in next year’s insurance premium. Care Home MANAGEMENT 41
PEOPLE EVENTS
PEOPLE
Care home movers and shakers The new chairman of HC-One is Sir David Behan CBE. Sir David (pictured left with HC-One CEO Justin Hutchens) has been a HC-One director since November 2018.This follows the retirement of Dr Chai Patel CBE FRCP. Sir David will also maintain his current role as chair of Health Education England. Sir David was formerly chief executive of the Care Quality Commission.
Scottish provider Bield has revealed its new-look leadership team, comprising a new chief executive, Dr Lynne Douglas (pictured) who heads up a revised structure of directors and heads of service. The move has seen the number of directors reduce from five to three. Reporting to the directors are 13 new heads of service.The new senior management team is composed of: interim director of customer service, Matt Lock; director of business development director, Val Hunter, and director of finance & resources, Scott Smith. Douglas replaces Brian Logan, who stepped down following nine years in the role. Charlie Dickson will also revert to his role as director of customer services. Somerset Care Group has appointed Gary Ridewood as chief executive officer, following a period acting as interim chief executive. Ridewood originally joined Somerset Care Group in September 2017 as chief financial officer. Care Management Group (CMG) and The Regard Group (Regard) have appointed Emma Pearson as CEO designate of the new merged organisation, Achieve together.The merger and rebrand took effect on Tuesday 1 October creating a residential care organisation for 2,000 people with learning disabilities, mental health needs and acquired brain injuries. Pearson will join Achieve together in January 2020. In the meantime, Peter Kinsey will continue as CEO, and ultimately, will move into the role of special advisor, remaining as a non-executive director Complex care provider Consensus has appointed Iain Anderson as non-executive chairman. Balhousie Care Group has made four appointments to its ASC specialist healthcare arm, all of whom join from NHS Tayside. Pictured left to right and back to front, the new recruits are: • Dr Fabian Haut, to the role of advisor. Haut was previously a consultant • R ussell Low, to the role of deputy manager. Low is a registered mental health nurse • R obert Bain, as operations manager. Bain was formerly head of nursing in learning disabilities • Leanne Williamson, as general manager. Williamson previously designed specialist services for adults with complex mental health needs.
42 Care Home MANAGEMENT
Heathcotes Group has appointed Colin Ramwell as head of recruitment. Ramwell was previously group recruitment manager at Turning Point. Lynne Taylor has been promoted to group governance and safeguarding lead across the Bradford-based Czajka Care Group’s homes.Taylor was previously the registered manager at the group’s Fairmount Nursing Home.
Business partners
The National Association of Care Catering (NACC) has appointed Sue Cawthray as its national chair. Cawthray is chief executive officer of Harrogate Neighbours Housing Association. She takes over from Neel Radia. Fiona Millington joins recruitment app Florence as chief nurse to drive quality governance and clinical compliance procedures. Millington previously held the position of associate chief nurse at the University Hospital North Midlands and of lecturer at Keele University.
EVENTS
NOVEMBER Skills for Care roadshows: various locations throughout November. For more information, visit https://www.skillsforcare.org.uk/Getting-involved/Events/Events.asp Care Forum Wales Autumn Essential Update Seminar (South West Wales) Tuesday 12 November, Parc y Scarlets, Llanelli. For more information, visit: https://www.careforumwales.co.uk/ events/ Care England conference. Wednesday 13 November. Church House Conference Centre, London. For more information, visit: http://www.careengland.org.uk/news Scottish Care Care Home Conference and Awards. Hilton Hotel, Glasgow, Friday 15 November. 8:00am - 11:30pm. For more information, visit: http://www.scottishcare.org/event/scottishcare-care-home-conference-and-awards/ Digital Social Care Data Security and Protection Toolkit and NHSmail Roadshows in locations including:York, Rotherham, Blackpool. Running throughout November and December. 9.30am1pm. For more information visit: https://www.digitalsocialcare. co.uk/events/
DECEMBER Digital Care Conference. Exploring the Development and Ethics of Technology in Social Care. Birmingham, Thursday 12 December. Free entry for care workers. For more information, visit: https://www.digitalsocialcare.co.uk/events/digital-care-conference/
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