Home improvements

Recovering from a disappointing CQC rating can be tough, but not for the team at Devonshire Court residential care home, where management and staff excelled themselves by moving up from Inadequate to Outstanding in less than two years. Jenna Lomax talks to senior figures at RMBI Care Company and asks how they did it

It’s fair to say that the private health and social care sector has had a bad rap lately – whether that concerns the Cygnet Whorlton Hall scandal, or headlines about the Ian Paterson inquiry.

Amid these bad news stories, newsdesks sometimes omit to celebrate the sector’s achievements – good news doesn’t often make the headlines, attract the clickbait or bring in the viewers.

But every day, without fail and without any praise from newsanchors, the UK’s social care workers and their home managers carry out intensive and necessary tasks taking kindly care of others that we can all agree deserve more note. Devonshire Court, based in the small town of Oadby near Leicester and owned by The Royal Masonic Benevolent Institution Care Company (RMBI Care Co), is one of many that deserves such praise.

The care home, which offers residential services for the over 65s, was rated as Inadequate by the Care Quality Commission in November 2016; Requires Improvement in May 2017, but managed an Outstanding less than two years on, in September 2018.

But how exactly did Devonshire Court turn it around? What did staff do differently to others to achieve this accolade, and how are they planning to maintain this status for the future?

Devonshire Court’s November 2016 CQC report, written after an unannounced inspection the previous August, issued the provider with a warning notice in relation to governance and safe care and treatment at the service and said it needed to improve.

Juliet O’ Connor, Devonshire Court’s home manager, had been in her role just six months when that inspection was carried out and the verdict delivered. But she was determined to take the reins and do something about it.

One vision “A clear plan of where we were going and what we wanted to achieve with clear timescales” was how Devonshire Court managed a successful turnaround between 2016 and 2018, explains O’Connor.

xx

1842 the year RMBI Care Co was established

Since O’Connor’s appointment Devonshire Court has certainly steadied its operational ship, which O’Connor’s colleagues say is largely down to her resilience and vision, an integral part of hoisting the sails and heading for an Outstanding from the regulator.

Lucy Tupenny, assistant director, quality and governance at RMBI Care Co, says: “Juliet was determined to get to Outstanding in three years and she actually did it in two. We knew when Juliet first came in, her leadership was going to be a new chapter.”

After the 2016 inspection, O’ Connor created a robust plan to improve ratings which was also shared with stakeholders. She explains that this new chapter involved a “strong experienced leadership team” that reflected “a combination of strengths and knowledge base.”

“The team had one shared vision and had clear actions to achieve within the plan”, she adds.

This shared vision is the reason for a more cohesive approach within the care home today, O’Connor says. “Everyone knows what their job is and what is expected of them and they are busy achieving it to the highest standard, demonstrating pride in their work”, she says.

Tupenny also sung praises to the whole team at Devonshire Court, when she told HealthInvestor UK the care home’s improvements were also down to the commitment of “a very cohesive management team”. “There is great communication between our team – they are all singers using the same song sheet. It’s such a cohesive environment. If you walk around the home, you’ll see every member of staff knows what they’re doing and they take pride in it. It’s a great example of how good care can be delivered.” “I lead on policy and governance across all of our homes”, comments Tupenny, “and Devonshire Court has become a template of what we want to achieve in our other homes.” Looking back Discussing her personal role in changing Devonshire Court for the better, Tupenny says her approach was centred on going “back to basics” with a “robust action plan that was heavily evidence-based, so staff at Devonshire Court could confirm every action that had been taken and what the outcomes were.”

And when asked about the main differences between Devonshire Court in 2016 and Devonshire Court now, Tupenny says the main difference is “a strong ethos and change of culture within the home.”

Tupenny emphasises that the team “has worked and continues to work exceptionally hard.”

Discussing the vast level of change that has come about at the home since 2016, Tupenny again accredits staff, saying: “Once staff saw the new systems in place and the positive effects it was having on residents, that’s when the momentum really started to gather. They are all immensely proud now of what they have achieved, which is wonderful.” ▶ Everyone knows what their job is and what is expected of them and they are busy achieving it to the highest standard

1,000 number of people in RMBI homes across England and Wales

17 number of RMBI Care Co residential care homes

New initiatives Devonshire Court has every intention of maintaining its Outstanding status and one measure, among other initiatives, ensuring the rating stays for good, is the Dreams Come True programme. This encourages residents to fulfill their unfulfilled dreams, or to resume activities they once enjoyed but haven’t done for a long time.

It’s clear to see this initiative is one that senior staff and other members of the care home are particularly proud of. And, as O’Connor says, it is “one of the most inspiring things at Devonshire Court”.

“We took a resident to the zoo, and another to see his favourite football team play; something they hadn’t been able to do in a long time”, comments Tupenny. “It sounds like a very simple thing, but actually, it’s not. When you see reactions from residents who never thought they’d be able to do these activities again, it’s quite emotional.” In February, a horse loving resident, had her dream come true, getting back in the saddle for the first time in years. She had mentioned to staff that she dreamed of getting back on a horse, having enjoyed a long and successful career as a professional horse rider and trainer. Activities coordinator Fiona Collins set about making it happen, arranging a special trip for the resident to visit Witham Villa Riding Centre in Broughton Astley.

But Devonshire Court hasn’t stopped at the Dreams Come True programme. Not only has it introduced recreational activities, but it has also built facilities within the home to improve social interaction for everyone, especially those ▶

who may not be able to travel far. The home has been adapted throughout to include a fully functioning mall which holds a cinema and hairdresser, which Tupenny describes as “really positive changes”.

Dementia care As a care home caring for the over 65s, Devonshire Court cares for a number of residents with dementia. Across its homes, RMBI Care Co offers 255 dementia placements across 17 of its 18 facilities.

Away from Devonshire Court, RMBI Care Co’s Connaught Court in Fulford, York, celebrated the opening of its new enhanced care Dementia Support House at the end of February. The home provides residential, nursing and dementia care for up to 94 residents and was also rated Outstanding by the CQC earlier this year.

In addition, the charity is in the process of creating its own dementia accreditation scheme. Set up by the Alzheimer’s Society, RMBI Care Co’s Dementia Friendly Area Scheme outlines different tiers of evidence to measure how care homes and other organisations can better their care and surroundings to enable a friendly and safe environment for those living with dementia.

A community initiative, being carried out across England and Wales, the scheme outlines eight steps toward becoming a “dementia friendly community” and Anne Child, RMBI Care Co’s dementia specialist lead, is working toward gaining this accreditation, not just for Devonshire Court, but across the whole RMBI Care Co community and beyond.

Child says: “This includes people in the community coming to the home. It’s about how we’re forging relationships with the communities where our homes are located. RMBI Care Co is working on this pathway so we can accredit our services – testing them to the standard that we want them to be.”

Other aspects of the accreditation programme links to specific measures such as Dementia Care Mapping (DCM). Recognised by the National Institute for Health and Clinical Excellence, DCM is a tool designed to prepare and help carers take the perspective of the person with dementia in assessing the quality of the care they provide through a five-point ‘cycle’ guide. This includes observation, analysis, report writing and feedback, action planning and preparation, and briefing.

Training in DCM is provided by University of Bradford approved trainers, and by the university’s partner organisations in more than 10 countries. Developed at the university by the late professor Tom Kitwood, the mapping tool has been revised and updated since its inception more than 20 years ago and used as a reference point by RMBI Care Co, among others.

It goes without saying that dementia care is something Child is extremely passionate about. “Every day is different”, she says. “With dementia, the person always comes first. Good dementia care is really rooted in a relationship; it’s part of a feelings-based, relationship-based model of care – it’s person-led.”

“The care recipient has to be at the heart of what you’re doing. And you have to know who they are”, Child continues. “You might know the basic needs of someone you don’t fully know, but to truly care for someone, you have to understand them very well.”

Working with residents living with dementia within a care home that has achieved Outstanding “really does raise morale” adds Child. “To be recognised as Outstanding in a job that can be so challenging lets staff know that they are appreciated for the incredibly hard work that they do. I always feel we’re privileged to care for people, it’s a privilege to work for the organisation.”

What’s next? It’s impossible not to be inspired by the senior team at RMBI Care Co. It’s clear to see there’s now a cohesive understanding, enthusiasm and shared vision for what the future holds, especially among the staff at Devonshire Court. As for maintaining its achievement of Outstanding Tupenny says: “Right now it’s about how we carry on and develop the home and make the most out of it. RMBI Care Co. has three Outstanding homes now, which is amazing. It’s easy to have a preconceived idea of what a care home is like, but we like to think we have broken the mould a little bit. That’s what I’m most proud of. People’s wellbeing is really at the forefront of what we’re about and our residents at Devonshire Court love it – they absolutely love it.

“I also have to praise the team; when the inspectors came back for the most recent inspection, they were quickly able to see the improvements.” n