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Care Home MANAGEMENT www.chmonline.co.uk

March/April 2019 • ISSUE 78


Pre- and post-surgical support for bariatric patients


Dignified bathing for the plus-size resident


Weigh it up before you weigh in NEW-BUILD

How the changing population is feeding newbuild design inspiration


for your care home

At apetito, we believe that great food is a source of joy. We are passionate about serving food that is nutritious, delicious and above all enjoyed. Dedicated to working in partnership with our customers, we are adaptable and flexible to rise to any challenge. Whatever the vision for your home, we can work with you to tailor a dining experience that’s just right for you and your residents.




Care Home MANAGEMENT www.chmonline.co.uk

to the March/April issue of Care Home Management magazine

March/April 2019 • ISSUE 78



Dignified bathing for the plus-size resident

Pre- and post-surgical support for bariatric patients


Weigh it up before you weigh in NEW-BUILD

How the changing population is feeding newbuild design inspiration

Care Home Management March/April 2019

Issue 78

Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Design/Production Emily Hammond emilyh@freelancedesignpro.com Published by S&A Publishing Ltd Croham Lodge, Croham Road, Crowborough East Sussex TN6 2RH Tel: 01892 680670 Email: editorial@chmonline.co.uk sales@chmonline.co.uk Advertising Space Marketing Tel: 01892 677721 Email: davidh@spacemarketing.co.uk www.spacemarketing.co.uk www.chmonline.co.uk


n mid-February commercial mobile network operator O2 announced that it will begin rolling out its 5G network during 2019. 5G is being hailed as the next generation of wireless technology that will provide faster connections with much higher capacity and very fast response times. Government strategy for the UK’s future digital infrastructure sets out a target that the majority of the population will be covered by a 5G signal by 2027. Big cities such as Belfast, Cardiff, Edinburgh and London are expected to be the first places to get access to its 5G network, with other parts of the UK getting the improved connectivity from 2020, which is apparently aimed to coincide with the wider availability of 5G handsets. Of course, the wait in rural areas which still don’t have 4G, might be considerably longer… In an article titled ‘The Path to 5G’, O2 chief operating officer Derek McManus highlights the improvements 5G will bring to our lives. This includes collaborating with colleagues virtually – using augmented reality (AR) or virtual reality (VR) to visually interact with colleagues, but without leaving home. As for health and socialcare, the benefits can include video conferencing and real-time remote health monitoring, including sensory devices that can share vital signs of an impending health event before it happens. O2 describes 5G in healthcare as a “new ecosystem”. For care homes charged with caring for residents with chronic and ever more complex healthcare needs (such as the bariatric care we discuss in this issue), 5G seems a welcome development.

JOIN THE FIVE-STAR CLUB In the latest Care Home Management podcast [available online at: https://chmonline.co.uk/ podcast/] CQC interim adult social care chief inspector Debbie Westhead discusses the use of technology to improve residents’ experience and quality of care. She says that those providers who make it into the outstanding club – and, even more impressively, into the five-star outstanding club by nailing that rather elusive outstanding rating for safety – are usually those that are prepared to use technology creatively and innovatively to improve the care experience. That means investing in solutions that support residents to have a better care experience (for example, mood lighting that encourages restful sleep) and which improves care safety, for example, medication administration software (especially, as pharmacies begin to withdraw their dosette box services). However, as O2 hints in a report, and as every good SWOT aficionado can tell you, every opportunity also comes with an inherent threat: O2 believes that 5G has the potential to enable families (and service commissioners) to consider alternatives to placing loved ones in private residential care. Providers may also find recruitment becomes more problematic, as tech begins to offer alternative employment streams from the comfort of people’s homes. Clearly, 5G has the potential to make that five-star rating a reality for more homes. It also has the potential to pull the rug from under providers’ feet. Eight years from now, where will you be?

Copyright: Care Home Management Magazine 2019 The Publisher holds all copyright and any items within may not be reproduced in any way, for any purpose, without the written permission of the Publisher. While every care has been taken to ensure accuracy, the information contained within this publication is based on submissions to the Publishers who cannot be held responsible for errors and omissions. The publisher does not necessarily agree with the views expressed by contributors and cannot except responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.

USEFUL READING: House of Commons Library Briefing on 5G [online] at: https:// researchbriefings.parliament.uk/ResearchBriefing/ Summary/CBP-7883#fullreport Ofcom report: Enabling 5G in the UK [online] at: https:// www.ofcom.org.uk/spectrum/information/innovationlicensing/enabling-5g-uk O2 report.The value of 5G for cities and communities [online] at: https://businessblog.o2.co.uk/the_path_to_5g/

editorial@chmonline.co.uk March/April 2019

Ailsa Colquhoun Publisher/Editor

@Carehomemanage Care Home MANAGEMENT 3




7  Eleanore’s Words to the Wise

Planning ahead in an ever-changing political and economic landscape

9  Data Security Protection Toolkit

Get enrolled to start seeing the benefits

10 C  are Home HR

Find out what’s new in HR law in 2019 and how to recruit younger people

12 Recruitment

How to embed your care values right from the start

15 Legal

How to answer a Subject Access Request

16 B  est Practice

Learn from two outstanding homes – and the ombudsman

20 Care Home Profile

Healthcare Homes: back to the floor for the senior management team














March/April 2019 • ISSUE 78

22 Health


Caring for residents with diabetes; creating a healthy workforce

37 People and Events

See who’s on the move and where you can go during Mar/Apr


Bariatric care catering 25 The state of the nation’s waistlines – in numbers

26 Catering for the pre- and post-surgical bariatric patient

Bathing & personal care 28 How to bring dignity to


plus-size bathing

29 Avoiding skin problems New build 30 Changing population

changing care homes: read the market forecast

33 Inspiration: See the look – get the design inspiration

35 Finance: Understand the climate for investment

36 Where to find that land-grab bargain


p17 4 Care Home MANAGEMENT



CARE HOME AWARDS 2019 finalists announced

ARE YOU ON THE LIST TO WIN? It’s been a bumper year for entries to the Care Home Awards 2019 – but only the very best can make it through to the judging stage and to the glittering awards ceremony in London on Thursday June 27. The successful shortlist of care homes and suppliers are as follows:


Adept Care Homes Amberley Lodge Aura Care Living Broadwater Lodge Canford Healthcare Canwick House Care UK Carebase Clara Court Compton View Residential Care Home Cornerstone Healthcare Group Dorset House Encore Care Homes Exemplar Health Care Ferndown Manor Field Lodge Great Oaks Gwen Walford House Hamble Heights Innovative Aged Care JS Care Ltd Jubilee House Kitnocks House L&M Healthcare LifeCare Residences Ltd Manor Lodge Mercia Grange

March/April 2019

Middleton Hall Limited Mountfitchet House Perry Manor PJ Care Rotherwood Group Limited Rowallan House Sherwood Grange Signature Senior Lifestyle South Africa Lodge St George’s Park Tanglewood Care Homes The Close Care Home The Marbrook Centre The White House Nursing Home Valerie Manor Wellburn Care Homes Ltd

CHM Podcast heading here

Listen out for the latest CHM podcast with exclusive interviews with interim CQC adult social care chief Debbie Westhead, discussing that elusive outstanding safety rating, and Luke Wiltshire, training manager at Encore Care Homes in Bournemouth who talks about their innovative dementia training programme that involves residents’ family as well as staff. Check them all out online at:

https://chmonline.co.uk/podcast/ or just scan the QR code


Adjuvo Care Bidfood Fulcrum Care Ltd GHM Care Little Islands New Healthcare Solutions OM Interactive PLMR ROMPA Ltd The Daily Sparkle Winslow Resources (ROMPA)



Scottish care homes can expect “tough” inspection conversations from August SCOTTISH CARE HOMES should be prepared for “tough conversations” as the Scottish Government forges ahead with health and social care integration plans, a progress review has made clear. This states that from the end of August, care homes in Scotland should expect an inspection “fundamentally focused” on the outcomes being achieved by integrated arrangements. In addition, the performance of the whole partnership – the Health Board, Local Authority and Integration Joint Boards – will be examined for its contribution to effective integration.The aim of the new-look inspection is to bring “a more balanced focus across

health and social care”, ministers have said. The new-look inspection is part of a raft of recommendations made by the Scottish Government to improve integration of health and social care in Scotland. • Almost half of the 4,696 complaints about Scottish care providers were about care homes, the Scottish Care Inspectorate has revealed in its report for 2017/18. During the year, at least one complaint was made about 68 per cent of care homes for older people – in a quarter of cases investigated by the regulator, at least one complaint was upheld. Complaints related to problems with nutrition, medication, tissue viability, and inadequate care.

Read more online at: https://chmonline.co.uk/scottish-care-homescan-expect-tough-inspection-conversations-from-august/ https://chmonline.co.uk/care-homes-attract-most-complaints-in-scotland/

Providers double up on handed-back contracts THE FINANCIAL pressures crippling the social care sector could start to directly impact the vulnerable adults it supports, according to a report from learning disability charity HF Trust (HfT). This shows that the number of providers handing back contracts in the past 12 months has more than doubled. Independent research commissioned by Hft found that in 2018 more than half (59 per cent) of providers had been forced to close down some parts of their organisation or hand back contracts to local authorities as a means of dealing with cost pressures. A further 68 per cent envisaged having to do the same “in the near future” while 11 per cent foresaw a reduction in the quality of care if their financial situation did not improve. The survey also found that recruitment remains a challenge with 80 per cent of providers reporting low wages as the biggest barrier to recruiting and retaining staff. Read more online at: https://chmonline.co.uk/providersdouble-up-on-handed-back-contracts/

Why older workers are the answer to social care’s recruitment crisis NEW FIGURES from the Office of National Statistics show that there are 866,000 potential workers between aged between 50 to 64 years old, just under half of whom have caring experience, whether for a parent or a grandchild. Could encouraging these people into the care workforce ease the recruitment crisis the sector is currently experiencing? “There is no doubt that older people are much more suited to frontline care roles than they often think – if, indeed, they have any awareness of care as an appealing part-time, local and flexible work option at all”, said Neil Eastwood, founder of Sticky People, in an exclusive feature on CHM Online. He explained that older people have more life experience, often more empathy and have put down roots in their community. They also are more likely to want to ‘give back’ and stay active, and to stave off loneliness due to a shrinking social

There is no doubt that older people are much more suited to frontline care roles than they often think.

circle once they retire. HC-One head of employee relations Lynne Fraser also finds that care workers within this age group tend to stay for longer, offering the provider more stability, particularly if they are offered flexible hours or a position with the care worker ‘bank’. Read more online at: https://chmonline.co.uk/portfolio/why-olderworkers-are-the-answer-to-social-cares-recruitment-crisis/

6 Care Home MANAGEMENT www.chmonline.co.uk


Sleep-in legal saga will go on UK CARE PROVIDERS were dealt another blow in mid-February as the Supreme Court granted Unison, acting on behalf of Tomlinson-Blake, the right to appeal in its sleep-in shift legal battle with Mencap. The decision, which is set to increase uncertainty in the sector, could see care providers forced to pay an estimated £400million in

arrears allegedly owed to care workers deemed to be underpaid for overnight shifts. The date for the Supreme Court hearing is yet to be set but is unlikely to be before October this year. Read more online at: https://chmonline. co.uk/sleep-in-legal-saga-willgo-on/

Delays and missing information spark complaints, CQC finds

DELAYS TO A service or appointment, lack of information and poor care are among the reasons why people complain to providers, the Care Quality Commission has highlighted in a new campaign. The ‘Declare Your Care’ campaign is calling on more people to speak up about their experiences of care, so that the CQC can support services to improve. Its research shows that people also want to raise concerns about the lack of communication between health and care services. The CQC believes that almost seven million people have kept quiet about poor care over the past five years. Read more online at: https://chmonline.co.uk/delaysand-missing-information-spark-complaints-cqc-finds/

ELEANORE’S WORDS TO THE WISE Gaining Pounds the hard way By Eleanore Robinson, former editor at LaingBuisson and freelance healthcare journalist

With obesity levels rising, the demand for bariatric services looks set to soar. And this is just one type of specialist care service that can be provided in residential care. With the cost of keeping a person in hospital post-surgery significantly higher than using a care home, letting someone recover in a homely environment, while receiving care around the clock, seems like a no-brainer. Furthermore, for people with complex and ongoing mental health needs, stepping down into a less institutional setting can have a positive impact on their recovery. Offering these types of services could be a golden opportunity to boost occupancy rates and help a service user make a full recovery. However, the wide spread provision of these services has March/April 2019

yet to really take off in the UK. There are investors, both in the UK and abroad, poised to put money into these services, particularly those that offer post-surgery, stepdown care. So, it is not the business model or attracting finance that is holding them back. Neither is it demand both now and in the future. Research published last month by the Nuffield Trust [online via the link: https://tinyurl. com/y36tsm9x] found British teenagers have the highest levels of obesity in Europe and one in five young people are estimated to have a longstanding health condition. But finding qualified nurses to provide this intensive type of care is a problem. With Brexit looming, and no relaxation on immigration rules on the horizon, finding enough staff to provide specialist care services will be a challenge. Talking to care providers, another barrier seems to be NHS commissioning practices. Finding Trusts

that would consider contracting out specialist services is a postcode lottery. For example, one provider told me NHS Trusts in London were willing to provide Continuing Healthcare contracts, whereas outside the M25 they were not. Some care providers are making inroads into this market in certain areas, but they report that every Pound they earn is hard won. But with the pressure, both physical and political, to get people out of hospital, using care homes to help them recover could be the next big thing. Care Home MANAGEMENT 7

LET LOOSE SAFELY WITH WEARABLE NURSE CALL No matter where the action takes place, you’ll know if there’s a call or a fall


0800 068 7419 Find out more at www.c-t.co.uk






CQC compliance and access to NHSmail are just two advantages of signing up to the new Data Security and Protection Toolkit (DSPT) says Mandy Thorn MBE, chair of care provider Marches Care and vice chair of the National Care Association


magine being able to receive swiftly all the information you need from hospitals, GPs, pharmacies, without having to decipher scruffy handwritten notes, faxes or, even, waiting for the postman to arrive. This is the reality for providers who use NHSmail, one of the advantages of signing up to the Data Security and Protection Toolkit (DSPT). Care homes which provide nursing care under NHS and/or local authority contracts will already be aware of the expectation to complete the new Data Security and Protection Toolkit (DSPT) before the end of this month (March). However, with advantages such as access to NHSmail on offer, all care providers should think very carefully before dismissing it as ‘not relevant to me’.

Signing up to the DSPT offers many advantages:

Access to NHSmail: Providers who use NHSmail report improved margins and increased staff retention as well as greater satisfaction with the services they offer from those they support and their relatives.With fax machines on the way out, it will be increasingly important to have a replacement secure digital information transfer service. Information governance assurance: Following the introduction of GDPR last year homes are increasingly being asked to demonstrate data integrity and governance: within the updated well-led KLOE, the Care Quality Commission asks providers to evidence how the service assures the security,

March/April 2019

availability, sharing and integrity of confidential data and records, and data management, in line with data security standards.The DSPT should help you with this. Better quality care and better outcomes for residents: Both flow from having the right information at the right time.

Getting on with it

How long it will take you to complete the DSPT will depend on how much your organisation has already done towards reviewing and amending your policies and procedures - and it’s important to answer each area honestly. The worst-case scenario is to state that you are compliant with the DSPT and then to have a data breach, after which an investigation (potentially by the Information Commissioner’s Office ) finds that you do not have the right policies and procedures in place and insufficient staff training and knowledge. At best you may face contractual penalties, at worse a significant fine from the ICO.

WHAT IS THE DSPT? The DSPT is an NHS online tool that allows organisations to measure their performance against legislative and regulatory standards for information governance. For more information about the DSPT and how to register, visit the Care Provider Alliance [online] at: https:// www.careprovideralliance.org.uk/ information-governance.html



HR issues to know about in

April 2019 will see some changes to employment law that managers need to be aware of. By Alison King, founder of Bespoke HR Increases in National Living Wage and National Minimum Wage

As announced in the Autumn budget, the National Living Wage will increase by 4.9 per cent from April 2019. This sees it rising from £7.83 per hour to £8.21 for employees who are 25 and over. The National Minimum Wage will increase from April 2019 for the following groups: • 2 1 – 24-year olds: from £7.38 per hour to £7.70 per hour • 1 8 – 20-year olds: from £5.90 to £6.15 per hour • 1 6 – 17-year olds: from £4.20 per hour to £4.35 per hour • A pprentices: there is a 5.4% national minimum wage increase from £3.70 per hour to £3.90 per hour if the apprentice is under 19, or if they are 19 or over, they must be within the first year of their apprenticeship. These changes will need to be in place for the April 2019 payroll.

Increase in autoenrolment contributions

From April 2019 auto-enrolment contribution rates will rise from a minimum of 5 per cent to 8 per cent of earnings: 5 per cent from the employee and 3 per cent from employers. The changes apply to all employers with staff in a pension scheme, whether its auto-enrolment

or an existing scheme. According to the Pensions Regulator, you don’t need to take any further action if you don’t have any staff in a pension scheme for automatic enrolment or if you are already paying above the increased minimum amounts. This will vary according to the type of scheme you hold, and its rules. The Pensions Regulator advises: “Most employers use pension schemes that from April 2018 require a total minimum of 5 per cent contribution to be paid. The calculation for this type of scheme is based on a specific range of earnings.” Current rates:

•M  inimum employer contribution: 2% •M  inimum employee contribution: 3% •M  inimum total contribution: 5% From April 2019: •M  inimum employer contribution: 3% •M  inimum employee contribution: 5% •M  inimum total contribution: 8% With nearly 10 million people using the scheme, now is the time to communicate this to staff.

If you are in doubt about an employee’s right to work or remain in the UK, take specialist advice”

Settled status for EU nationals

Workers from Europe living in the UK may be able to remain indefinitely in the UK after December 2020 if they apply for settled status in 2019. To do this they must prove that they have been living in the UK for five years at the date of application. Applications open on 30 March 2019. If in doubt about an employee’s right to work or right to remain, we’d recommend taking specialist advice from a provider that specialises in immigration services.

Changes to payslips

From 6 April, all employers will be required to itemise payslips for employees and these will vary depending on how much time they have worked. These must now include: • T he number of hours the employee is being paid for • S how the combined number of hours worked for which the employee is being paid or itemise the figures for different types of work and / or rate of pay. This new legislation is aimed to help those employees who work varied hours and therefore whose pay changes accordingly. Employers will need to make sure that their payroll process can collect and display the information required and amend the format of their payslips ahead of the implementation date.

10 Care Home MANAGEMENT www.chmonline.co.uk



YOUTH PIPELINE Some 800,000 young people are not employed or in education1, which for care homes can mean 800,000 new and fresh care ideas going to waste. So, what can you do to attract young people into roles within your care home asks Will Shepherd, CEO at recruitment company Cohesion


Create a specific recruitment strategy solely focusing on young people – consider careers fairs, social media advertising and customise the recruitment process itself – make it short and use language that younger people understand. Values-based techniques may be more encouraging than ‘minimum requirements’. Work closely with schools and colleges – especially those that teach a health and social care course. Consider offering work experience, with a view to employment at the end. And, don’t forget tomorrow’s generation: inviting pre- and infant-school children into your home is a great opportunity to sow the seeds of a career in care, and it benefits residents as well. Occasions such as Harvest


Festival, Christmas and Easter are a perfect opportunity. Engage parents and guardians – parents have one of the greatest influences on their children’s careers – but do they know enough about the sector in order to encourage care as a rewarding career route? When recruiting young people, it is a good idea to create a section on your careers website for parents answering any typical questions they may have. Use case studies on your website and social media – under-25s who are already working in care will make a great case study. Don’t forget that social media sites can be used to advertise and emphasise the benefits of working in care but that

young people use a wide range of channels including YouTube, Instagram and Snapchat. Make the job attractive to young people – flexible hours, and the opportunity to earn a good wage are great starting points for attracting young people. However, don’t forget that the most important benefit of a career in care is giving someone the opportunity to come away from a shift feeling that they have made a difference to someone’s day. Showcase your employees’ achievements – awarding ‘star’ employee status can really demonstrate a positive working environment and the opportunities you offer for career development.





1. https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/unemployment/bulletins/youngpeoplenotineducationemploymentortrainingneet/may2017

March/April 2019





From compiling the first job adverts through to the interview stage, providers are realising it makes business sense to ensure the people delivering care share a home’s ethics and goals, says CHM publishing editor Steve Hemsley

alues-based recruitment has been part of the NHS since 2014 and the concept has now transferred to social care. Providers realise that putting more emphasis on personal values when recruiting can help to achieve positive CQC inspections. Values become embedded into an organisation which is then regarded as well-led. Care homes are starting to ask certain questions at interviews to assess a candidate’s character and morals.There is also an increase in the use of profiling software to identify values (see box below). CQC improvement consultant and care home manager mentor Taruna Chauhan says that before implementing a values-based recruitment

strategy a care home must be clear about what its existing values actually are and at each stage of recruitment there should be a process for checking value alignment. One way of identifying whether a candidate’s approach matches the care home’s is to ensure the interview process has a practical element. This could include sharing an activity with a resident to see if the candidate demonstrates compassion and treats people with dignity. An activity might be something as simple as a hand massage. Other advice includes introducing a buddy/ shadowing system so a new employee can see what is expected when care is delivered at this particular home.

USING TECH TO MAKE THE RIGHT DECISION Profiling technology can help managers avoid making the wrong recruitment decisions. Notable Change International director Colin Stevenson says. “Some people hide their talents at interview and do not show positive traits that will enhance a workplace. The profiling can also reveal to employers a personal attribute in someone that they had not thought about but which


would be a real asset to the care home.” Advanced profiling software can reveal the personality traits of people applying for different roles, for example, a dominant character that might be harder to manage in the workplace, whether someone is collaborative, enthusiastic and dependable, how they respond to criticism, and whether they can they work as part of a team.

WHAT ARE THE VALUES NEEDED FOR GREAT CARE? According to Skills for Care, which offers guidance on organisational values and culture, the key signs of value based care are: • Can treat people with respect and dignity regardless of their culture, religion, age, sexual orientation or disability • Respect people’s individuality • Take time to listen to people • Communicate in an open, accurate and straightforward way • Respect personal information • Allow people to feel comfortable when receiving personal care • Check how people want to be addressed • Use humour appropriately • Respect someone’s family relationships • Appreciate the position of trust they are put in • Deal appropriately with sensitive and challenging behaviour


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March/April 2019

Specialist uniform suppliers Care Home MANAGEMENT 13


Challenging CQC inspections Worried about whether you should? Don’t be: just do it. Your business and clients depend on you, says Philippa Doyle, partner at Hempsons


ne care home in Bradford was served a Notice of Decision to be closed down. It challenged the CQC.The CQC accepted it got it wrong. Now it has a requires improvement rating and will go from strength to strength. One care home near Heathrow was served a Notice of Proposal to be closed down. It challenged the CQC.The CQC accepted it got it wrong.The provider got an apology. Now it has a requires improvement rating and will go from strength to strength. If you don’t ask – you don’t get. The CQC used to have you believe that the Factual Accuracy process was about picking up on errors about the number of staff on duty at anyone time. It’s far more than that and since the GP Judicial Review in Summer 2016 (SSP Health –v- CQC) the process has changed for the better. You can now submit additional evidence that


might not have been immediately available on the day and rather than just the lead inspector reviewing your factual accuracy submissions, these, and the draft report, now have to be reviewed by someone out of area in the CQC, to check for consistency of approach and proportionality. This is your service – showcase it and shout about it! Sometimes the CQC gets in wrong. Sometimes the inspectors are unprofessional or inexperienced. Use the CQC complaints process – straightaway if necessary. A separate arm of the CQC will investigate your concerns: inspectors have been moved, and have been subject to retraining, on the back of a provider’s complaints. The CQC is quick to pick you up on deficiencies – make sure you pick it up too – everyone always has something to learn. Hempsons have had a number of successes

Hempsons are exhibiting at the Dementia Care and Nursing Home Expo 2019 at the NEC. You can find us on Stand No 636 or come to our workshop on ‘CQC Inspections and Reports – when to action, when to challenge’ on 27 March from 13.15 to 13.45 in Theatre 5. Contact: Philippa Doyle, e: p.doyle@hempsons.co.uk or tel: 01423 724028 against the CQC – give us a call on the Care Home Management social care advice line for support and information.



DATA DO YOU HOLD? Almost half of complaints to the Information Commissioner’s Office last year related to subject access requests (SARs). So, what are the rules of engagement for an employer receiving an SAR? Read this advice from Keystone Law lawyers Emmanuel Vranakis, Jimmy Desai, and Sara Hyder


hen employees are let go, what sometimes follows is a request by the employee for their personal data from the employer. This can sometimes be used as ammunition by the employee to support any legal claims, including data protection act breaches, that they may have against an employer. So, what are the rules of engagement for an employer receiving a subject access request (SAR)?

What is a Subject Access Request?

Under the General Data Protection Regulation, individuals are given the right to access the personal data that a company or employer holds about them and ask questions including: ‘What data do you hold on me?’ ‘Why are you holding this?’ ‘Where did you get this information from?’ and ‘Who are you disclosing it to?’ A subject access request (SAR), although it must be in writing, does not have to be presented in a particular form, and it does not have to include the words ‘subject access’.

Five things for employers to consider

To find out more information: Visit the Information Commissioner’s Office [online] via the link: https:// tinyurl.com/y99csuva Read the full article from Keystone Law online at: https://tinyurl.com/ y8oknkt5

March/April 2019

1. RECEIVING A SAR Within one month an employer must: • confirm if the employer processes the personal information of the data subject • provide information about the data processing • provide a copy of the personal data that is being processed. If you are unable to respond this must be communicated and explained to the data subject promptly. You have a legal duty to make reasonable adjustments for SARs from disabled employees. You cannot make a charge for a SAR.

2. EXTENSIONS If you want to extend the one-month time limit, you must inform the data subject within one month of receiving the request and give an explanation detailing why the delay is necessary. This could buy you potentially an extra two months where the requests are complex. 3. IDENTIFICATION Always be sure that you know the identity of the requester! You can ask questions to help identify the person, but be reasonable. 4. THIRD-PARTY INFORMATION In some situations, a data subject will request information that contains the personal information of a third party. How do you respond to this? Step 1: Consider if the information request strictly requires the information on the third party. Could this be redacted? Step 2: If you cannot separate the information of the data subject and the third party, consider if the third party has consented to the disclosure. Step 3: If you do not have consent, consider if it is reasonable in all circumstances to give a copy of the requested information without consent.Your decision should be based on the following: your duty of confidentiality to the third party; the steps you have taken to obtain their consent; whether the third party is capable of giving consent; if the third party has refused to give consent. 5. GUIDANCE It is good practice to have guidance on making a SAR on your company website, along with a form for people to fill in.You cannot force an individual to use your form to make a SAR. It is recommended that you state where the form is to be sent to, what information you need to action the SAR, and contact details for the relevant person actioning the request. Care Home MANAGEMENT 15



Care Home Management is delighted to be able to share with you these examples of outstanding care home practice

St Johns House, Kirk Hammerton Effective:


What St Johns House did: Effective

Staff kept up to date with new research and development and were supported through appraisals and internal promotion. As a result, staff were innovative in their approach. Champions actively supported staff to improve care, for example, two medicine champions had been trained to take blood samples reducing the time required for this intervention. Residents were involved in the running of the home: feedback resulted in improvements such as an outside gravel surface being replaced with tarmac; people were supported to take part in the recruitment of staff and volunteers. The service had attained regional and national recognition through accredited schemes which acknowledge quality practice, for example, Customer First. The service placed a strong emphasis on the importance of eating and drinking well, and it sought and acted on specialist dietetic advice. People had access to a specialist computer


Read more on St Johns House at https://www.cqc.org.uk/location/1-110224681


system called Simply Unite, an IT system designed for older people using email, the internet and Skype.The service also developed a Facebook page to improve communication with relatives.

What St Johns House did: Caring

A member of staff called a ‘care partner’ was allocated to each resident, to enable a deeper relationship to form. Pictures of the person’s care partner were placed in the person’s room to aid familiarity. Staff looked for ways to build people’s selfesteem, for example, on the outside of bedroom doors (where people had consented to this) there was a ‘bee’s knees’ picture designed to make the person feel special or to remind them of a happy time in their life.

What St Johns House did: Responsive Technology was used to involve families in the home’s activity programme and in the lives of residents, for example, putting them in contact with relatives via Skype.

The service also took a key role in the local community, for example, making knitted poppies for the school and for sale locally.They also invited people in the village to join residents in their knitting activities. Residents were also invited to internal department meetings, so staff could get firsthand feedback.

What St Johns House did: Well-led

The service had achieved accreditation from the Living Wage Foundation in recognition of its investment in staff. Staff and residents were visited regularly by the group managing director. The registered manager organised a monthly home quality assurance audit to audit care plans, medicines, accidents and incidents and complaints. Residents were invited to shape interview questions for new staff, decide which charities to support and have a say in menu development and meal planning. People said this made them feel empowered and consulted.

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


Wisteria House, Plymouth Safe:



What Wisteria House did: Safe

Safety was not seen in isolation but as a result of knowing people as individuals with variable needs. People were encouraged to be involved as much as possible in daily routines such as cleaning/taking the rubbish out, and were thanked for their involvement. Various champions were appointed at the home, for example, for medicines and for diet and nutrition to ensure best practice, and there were robust protocols in place, for example, for cleaning.

What Wisteria House did: Effective

Staff were routinely allocated time for administration, to carry out extended observations, attend training (including bespoke) or devise workshops or resources for families. Staff were encouraged to take on specialist roles and were allocated time to complete ‘specialism’ work. Working shifts were organised so that staff had an effective work/home life balance, and staff were able to complete ‘worthy and proud’ statements to promote a positive working environment. The home was furnished for different stages of advancing dementia, including specialist chairs and easily accessible weighing equipment. A weekly taste-testing challenge among residents was held to inform the following week’s menu. March/April 2019

Read more on Wisteria House at: https://www.cqc.org.uk/location/1-1491869654


What Wisteria House did: Caring

Staff’s actions, which included small, caring moments that valued people’s input, reflected the home’s vision statement: shared cutlery, crockery, toilets and foods, lack of uniforms and a staff rest room all were intended to remove barriers between people and staff; there was a focus on meaningful conversations between individuals rather than just superficial small-talk. Staff had laminated cards of prompts showing particular items and activities of interest each individual. People and relatives were regularly encouraged to complete quality assurance forms. All staff were trained in equality and diversity and were able to act sensitively when they heard relatives not acting in respectful or person-centred ways.

What Wisteria House did: Responsive

Staff took time to get to know people and there was an extensive pre-admission assessment, involving health and social care professionals, family and friends.When people moved in, an extra member of staff was on duty to help them and their family settle in. Care plans were ‘live’ on the computer system and updates were communicated instantly using the in-house computer messaging service. There were no designated ‘activity’ staff because all staff were involved in engagement and stimulation. A Functional Behaviour Profile

Well-led: assessment tool was used to provide appropriate activities and stimulation, ‘match’ people at similar stages of dementia, and to inform the relatives’ yearly review. The provider and staff were very clear that people should not be dozing because they were bored. Staff tried to encourage loved ones to visit for activities, and a wide range of activity items were located around the home so people could help themselves or with staff support.

What Wisteria House did: Well-led Managers have a hand-over day and cover seven days a week; they spent lots of time with residents and have created a shared passion with staff promoting the service’s visions and values. Wisteria House Dementia Care Limited has achieved a Level One (level one being the highest) Butterfly award five years in a row for ‘Exceptional person-centred dementia care of the highest quality of life level’, one of eight level one awards in the country. The provider actively shares ideas and good practice and has a track record in using continuing professional development and training to practically enhance people’s quality of life. The home has a sense of pride about standards, and staff have created their own ‘whistleblowing policy’. Unannounced checks on staff feed into annual reviews. Care Home MANAGEMENT 17


My care provider hasn't resolved my complaint. What can I do now?


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 Bupa Care Homes (CFHCare) Limited

• The Council and the CCG did not adhere

SUMMARY: Inadequate review of a


resident’s care and nursing needs led to a selffunding resident being in a nursing placement longer than they should have been which cost more than a residential placement. The organisations have agreed to pay the resident £7,682, which is the amount they were overcharged because of the faults identified.


• The home had a duty under the Regulations to ask the CCG and/or the Council to review the suitability of her placement and therefore her NHS-funded nursing care needs (FNC). It did not do this.


to the relevant standards.

• Mrs G complains on behalf of Mrs B about

BUPA Care Homes (CFC Care) Ltd. (the Home), Lancashire County Council (the Council) and Greater Preston Clinical Commissioning Group (the CCG). In particular, she complains the home, the council and the CCG failed to review Mrs B’s nursing care needs for a 34-month period.

• Mrs G does not consider Mrs B needed

nursing care from soon after she moved to the home and this meant Mrs B, who ultimately became self-funding, was paying a higher rate than was necessary.


Mrs G says care records show Mrs B did not need nursing care after the first few months of her stay at the home. When she became liable to pay her own fees, she was charged more as a private nursing care resident than she would have been as a private residential care resident. Mrs B’s nursing needs on admission related to her pressure sore care and support with medication. However, her pressure sore healed soon after and although she remained at high risk of developing pressure sores, she no longer had needs that specifically needed nursing care. The home’s review assessments five months after her admission record her as ‘stable and predictable’ and/or under band 1. This suggested residential care would meet Mrs B’s needs. The home also stated its opinion that Mrs B no longer had nursing needs after her pressure sore healed. The home had a duty under the www.chmonline.co.uk

Regulations to ask the CCG and/or the Council to review the suitability of her placement and therefore her NHS-funded nursing care needs (FNC) – but did not do so. Under the National Framework, the CCG should have reviewed Mrs B’s FNC needs three months after her placement and then each year. The CCG told the Ombudsmen that due to pressure on resources, it did not follow National Framework guidance on the schedule of review of Mrs B’s care needs. The Council had a duty under the Putting People First guidance and, more latterly, the Care Act to review Mrs B’s care needs. It should have done this between one to three months after she moved to the home then yearly thereafter. Due to pressures of work, these reviews did not take place.

AGREED ACTION/S The care provider, the Council and the CCG have agreed the following actions: • to apologise to Mrs G for the distress, time and trouble caused to her and Mrs B by the faults identified • to pay Mrs B’s account £7682 (split equally between the three organisations) to cover the amount she has overpaid due to the faults identified • the CCG will take steps to ensure reviews are carried out in accordance with the National Framework • the Council will take steps to ensure reviews are carried out in accordance with the Care Act.

Read the whole decision [online] at: https://www.lgo.org.uk/ decisions/adult-care-services/residential-care/17-011-976

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March/April 2019



Group finance directo r Matt King swaps spreadshe ets for baking sheets dur ing his Back to the Floor visi t

GETTING A REAL TASTE OF CARE At the end of last year, the senior team of the Healthcare Homes Group exchanged their suits and ties for uniforms, cleaning equipment and kitchen aprons to get a real taste of life on the frontline of resident care


David Smith, head of Estates & Property Services, in the kitchen at Ashley Gardens in Maidstone, Kent


he ‘Back to the Floor’ project saw eight members of the management team, including group CEO Gordon Cochrane, group finance director Matt King and HR director Sam Dixon spend some time in several different homes in a bid to get closer to the business, to immerse themselves in the daily lives of staff and residents and to learn more about the organisation. Group CEO Gordon Cochrane is of the belief that senior leadership should be visible to the team, and easily accessible to everyone, regardless of their role. He felt that immersing the senior team into different roles across the group would be an effective way of not only supporting staff, but gaining real operational insight, while supporting colleagues through a period of growth. For the project to be a success, it was imperative that staff were confident in

showing the senior team every aspect of their daily work, and that the team would be willing and able to carry out any role alongside them. From preparing meals to ironing, sewing, washing up, cleaning carpets, serving refreshments and delivering personal care, there were very few daily tasks that the management team were not involved in.

For my staff, it was an opportunity for them to showcase their world. They wanted to show the challenges and struggles they face every day, but also the areas they are extremely proud of. Jo Mazza, centre manager www.chmonline.co.uk


Group CEO Gordon Coc hrane (fourth left) with HR director Sam Dixon (centre) at the Shipdham Manor hom e

WHAT STAFF SAID Ashley Gardens Care Centre manager Jo Mazza has come away from the experience feeling positive about the impact on staff. She said: “For my staff, it was an opportunity for them to showcase their world. They wanted to show the challenges and struggles they face every day, but also the areas they are extremely proud of. “Opportunities like this support everything we feed back to the senior team, whether this is comment and suggestions over resources or strategy, or proudly demonstrating our achievements.” THE FUTURE Commenting on the project, Cochrane said: “This has never been about policy re-design or widespread business change. It’s really important that we [don’t] become corporate and anonymous. I hope that when staff see me in uniform, joining them in their daily work, it March/April 2019

reinforces what they regularly hear from the senior team: we’d be nothing without our staff, and we want to hear what they have to say.” Cochrane has now committed to carrying out ‘Back to the Floor’ visits every six months across the group, and is creating a system whereby care homes can apply for a senior team member to join them for the day. He said: “I’m often asked what I have taken from the project and whether there is anything we will be changing as a result. The stories of compassion, care and absolute commitment to dignity and respect across our homes were really quite humbling. Alongside this, we listened to very honest accounts of the challenges our staff face, which we know are shared throughout the industry. “It’s now my job to ensure that we continue to listen, that we act, and that we build on our culture of quality care for our service users and our staff.”

About the Healthcare Homes Group

Launched in 2005, the Healthcare Homes Group provides residential and nursing care to residents in 37 homes located in Suffolk, Norfolk, Bedfordshire, Cambridgeshire, Dorset, Kent, Avon, Hertfordshire, Oxfordshire, Middlesex, Berkshire and East Sussex. The homes employ specialist carers in dementia or physical disabilities.



Focus on diabetes care In a new series, Care Home Management magazine looks at health conditions affecting care home residents and how care home staff can support rapid accurate diagnosis and treatment Q: What are the signs of diabetes?

There are many common symptoms of diabetes. These include: • Passing urine a lot, especially at night • Being really thirsty • Feeling more tired than usual • Losing weight without trying to • Genital itching or thrush • Cuts and wounds taking longer to heal • Blurred vision. However, it’s worth remembering that six out of ten people who are diagnosed with Type 2 have no symptoms when they’re diagnosed. Any concerns about a resident’s wellbeing should be referred to a GP. Interestingly, an audit into diabetes care in care homes, commissioned in 2013, showed that 64.5 per cent of homes had no policy for screening for diabetes, and 63.5 per cent had no designated staff member responsible for diabetes management.

Q: Why is diabetes management important?

Poor diabetes management can lead to dangerously high blood glucose levels, which 22 Care Home MANAGEMENT

can result in complications including limb amputation, sight loss, cardiovascular disease and stroke to name a few. If blood glucose becomes too low (hypoglycaemia), people can become disorientated, confused and drowsy, all symptoms which are easy to miss as they are often associated with other health conditions, such as dementia.

Q: How can I help?

A good diabetes plan is one that controls blood sugar effectively and in a way that works for the person with the condition. Good diabetes management is a constant process, and the plan should detail the care required, the treatment targets, and what staff can do if there’s a problem (including who to contact in an emergency). Keeping active is also a key component of diabetes management, as well as being important for staying healthy in later life. Keeping active can help strengthen muscles, maintain mobility and balance as well as improve insulin sensitivity. Light resistance and balance training can be nuanced to each resident’s strength level. All people with diabetes should have a nutritional assessment

by a dietitian to address their specific needs. People with diabetes often do better when they take care of their own condition, but dementia and increasing frailty can affect their capacity. Staff can review the assistance that residents need.

Q: What health checks are needed in diabetes?

Diabetes UK believes there are 15 essential diabetes checks including blood glucose tests, eye screening, foot and leg checks, kidney tests, dietary advice, diabetes education courses, and emotional/psychological support. Depression is also more common in people with diabetes, but the symptoms of depression can often be masked by other health problems. Don’t forget to ask the resident’s GP or pharmacist about the healthcare checks to support people with diabetes. And, remember to make time to ask about resident’s emotional wellbeing.

More information is available from Diabetes UK [online] at: www.diabetes.org.uk




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


By Peninsula Group operations director Alan Price Q: I’m fed up with my staff calling in sick. What can I do as an employer to make them healthier? A: Employee sickness is estimated to cost UK employers £77 billion a year. Doing your best to keep staff healthy is even more important in a care home environment, where staff are caring for people who are old, frail and possibly, unwell themselves, and who need to receive the right level of support. Rest is the first step to keeping staff healthy: the Working Time Regulations 1998 (WTR) outline the rules on rest breaks and maximum working time. For night workers there is a separate set of rules: the limit is an average of eight hours in a 24-hour period as working for prolonged periods at night can be taxing on health. Before starting night work, staff must undergo a health assessment, which is repeated at regular intervals during the night work.

Stress is known to be very damaging for health so introducing a designated mental health first aider, or employee assistance programme (EAP) may encourage staff to disclose and address any mental health issues. Perks such as subsidised gym subscriptions are also helpful to mental as well as physical health. This can be combined with free fruit as a way of reducing unhealthy comfort eating or snacking. Despite your best efforts, staff will succumb to ill health from time to time: enhanced occupational sick pay can reduce the financial implications of time off work and avoid staff coming back to work too early. When staff do return from sick leave, a back to work interview will help shine a light on any measures which would improve their situation, including making reasonable adjustments to the working environment.


Research by flexible payment services provider Hastee Pay reveals that one in four workers suffers from concentration lapses at work due to financial concerns. Workers who are paid monthly are also twice as likely to use short-term credit compared to those paid weekly, which can add to their financial woes, the company says. Flexible payment schedules may be one way to improve their financial worries, particularly, if supported by a sensible withdrawal limit to ensure pay cannot be spent all at once.

Further reading: The Working Time Regulations 1998 (WTR) [online] at: http://www.hse.gov.uk/contact/faqs/workingtimedirective.htm University of Cambridge: Example Health Assessment Questionnaire for night workers [online] at: https://www. oh.admin.cam.ac.uk/files/b_night_workers_-_form_v5.pdf

March/April 2019



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The Care Forum – Two days of networking, learning & business building

Join 65+ senior care professionals this summer at the Care Forum.


his two-day event takes place on June 10th & 11th at Whittlebury Hall, Northamptonshire and provides an ideal environment for the care sector to share forward-thinking ideas, meet new partners and discover new ways of further building their care businesses. It’s entirely free for care professionals with a VIP ticket to attend including:

• A bespoke itinerary of pre-arranged meetings with product and service providers who match your requirements and upcoming projects; • Access to a series of seminars by industry thought-leaders; • Networking with like-minded peers; • Overnight accommodation; • All meals and refreshments; • An invitation to our gala dinner with entertainment. Throughout the day there will also be a series of seminars to provide delegates with inspiration and insight. Already confirmed is Craig Goldblatt, leadership speaker, coach and philanthropist who will be hosting a session on ‘Leading With Passion’. 24 Care Home MANAGEMENT

You’ll be joining other senior care professionals representing the likes of Alacris Health Care, Burlington Court, Caring Homes Healthcare Group, Cinnamon Retirement, Community Integrated Care, Impact Healthcare, Oaklodge Care Home, Rhino Spirit Care, Serene Care, Sue Ryder and more. The Care Forum has established itself as the leading event for care procurement professionals in the UK, as previous delegates testify… The Care Forum allows us to focus on sound purchasing decisions and is very professionally run” – St Matthews Healthcare An excellent opportunity to learn from suppliers and providers” – Innova House Healthcare Valuable and good time well spent” – Essex County Council To find out more about attending, contact Katie Bullot on 01992 374049 / k.bullot@forumevents.co.uk If you’re a supplier to the sector, contact Lisa Rose on 01992 374077 / l.rose@forumevents.co.uk to find out about a range of event partner packages.

KEY AREAS COVERED BY OUR EVENT PARTNERS INCLUDE: Sensory Access Control Bathing Aids Catering Equipment & Solutions CCTV Dementia Products Employment Law Fire Management Food Supply Health & Safety Hoists/Lifts Incontinence Control Laundry Nurse Call Systems Pest Control Recruitment Training Agency Software Care Planning Systems Daily Records, Risk & Incident Reporting Electronic Visit Verification Medication Management Payroll & Invoicing Rota Management






Did you know? Telford and Wrekin unitary district has the highest rates of bariatric surgery, at 53 per 100,000 population


Finished Consultant Episodes (FCEs) with a primary diagnosis of obesity and a main or secondary procedure of bariatric surgery. This is 23% less than the peak in 2011/12, but 5% more than in 2015/16

Of adults were classified as obese in 2016/17. This has increased from 15 per cent in 1993 but has remained at a similar level since 2010


Of patients receiving bariatric surgery are female


Of patients receiving bariatric surgery are aged 55-74 years


Of men aged 85+ years are obese


Of women aged 85+ years are obese

Source: NHS Digital. Statistics on Obesity, Physical Activity and Diet England: 2018

March/April 2019



What will I learn from this feature? How to care for the bariatric patient pre- and post-surgery



A good diet pre- and post-bariatric surgery is the key to surgical success and long-term healthy weight maintenance What is bariatric surgery?

Bariatric surgery encompasses a group of procedures that can be performed to facilitate weight loss, although these procedures can also be performed for other conditions. It includes stomach stapling, gastric bypasses, sleeve gastrectomy and gastric band maintenance. In general, such surgery is used in the treatment of obesity for people with a BMI above 40, or those with a BMI between 35 and 40 who have health problems such as type 2 diabetes or heart disease.



etting into the right diet plan before bariatric surgery and sticking to it is important for three reasons: The higher the body mass index before surgery, the more likely the person is to develop complications. Getting the diet in line well before surgery will bring down the BMI and reduce the surgical risk



It gives the body the energy and nutrients it needs to heal from surgery and function properly during extreme weight loss


It helps to reduce the risk of subsequent complications from bariatric surgery, while maximising weight loss and maintenance.

Typically, a pre-surgical bariatric diet will most likely be high in protein and low in carbohydrate with plenty of fluids. For the two weeks leading up to surgery, the bariatric diet will most likely be a liquid one (with vitamin supplementation) with a daily calorie count of at or below 1,000. A high-protein/lowcarbohydrate bariatric diet is important for three big reasons… 1 Reduces bleeding 2 Promotes healing 3 Shrinks and softens the liver – an enlarged liver can make surgery more difficult by blocking the surgeon’s view and increasing the risk of damage during surgery. www.chmonline.co.uk


How much carbohydrate am I allowed?

The diet is designed to provide approximately 60 – 90g of carbohydrate per day. It is low in fat (although the extent will depend on the foods chosen and the way in which they are cooked) and moderate in protein. The energy value of the diet is approximately 600 – 800 kcal. AND, AFTER SURGERY…

Post-surgical patients will leave hospital with a detailed bariatric surgery diet plan for the first few weeks, as a rule this will be a liquid diet comprising only around two tablespoons (one fl oz/30ml) of broth, water and possibly juice, although juice carries with it a high risk of an upset stomach. At around week two, smoothies and pureed meals can be introduced as a complement to the bariatric diet and to add dietary protein if necessary.Then, from the second through to the sixth week meals will get thicker (but still completely pureed with no small bits remaining). Foods appropriate for this stage include cream soups and yogurt-based smoothies. Quantities are still tiny – only 15 fl oz (440ml) for the whole day – and residents can expect to feel full very quickly. By week eight, the bariatric diet will consist of three very small (four ounce “normal” meals per day. Keeping hydrated is very important throughout – residents will need around two litres of water/sugar-free drinks a day.

Get out and be active! Swap computer and TV time with physical activities to improve fitness and energy levels. For more information: Meat-free recipes and catering training, visit Vegetarian for Life online at www.vegetarianforlife.org.uk or call 0161 257 0887. Post-surgery bariatric care, visit: NHS North Bristol NHS Trust [online] at: https://www. nbt.nhs.uk/our-services/a-z-services/bariatricsurgery/eating-after-bariatric-surgery

March/April 2019

In the FOG about healthy eating?

Healthy eating is not just for bariatric residents. It’s for everyone, and to be successful, it’s all all about the ‘what’ and ‘how’.


A healthy diet is one that consists of FOG foods • FARM – The food is raised on a farm (i.e. chicken, turkey, eggs, dairy products) • OCEAN – It comes from the ocean (i.e. fish) • GROUND – It is grown in the ground (i.e. fruits, vegetables, nuts, whole grains) Lower fat diets are associated with a reduction in the risk of developing type 2 diabetes and, according to Amanda Woodvine, chief executive of charity Vegetarian for Life, this is where plantbased meals really come into their own. The UK National Diet and Nutrition Survey states that over half (53 per cent) of the saturated fat in the diets of people aged over-75 comes from meat products, dairy, eggs and fish. Woodvine says: “In care homes [meatfree dishes] can be an easy and costsaving measure and are often a popular choice with residents.”


As for the ‘how?’ to eat healthily, the golden rules are: • Have three small meals a day. Choose

quality over quantity – go for healthy, great tasting, textured food in smaller but delicious servings • Avoid snacking between meals unless there is genuine hunger. Try to choose

a piece of fruit or other healthy option

• Eat slowly: the trick is small amounts of food chewed very well. Eating at a table without any distractions (no TV) and putting down cutlery between mouthfuls can help • Do not aim to eat until you are ‘full’. After surgery, overeating will stretch the stomach pouch, causing discomfort and may induce vomiting • Do not drink with meals. Wait at least 30 minutes after a meal before drinking. In total at least two litres of fluid a day should be consumed • Avoid all fizzy drinks • Choose textured foods that satisfy your stomach. Drinking high calorie liquids or eating foods that ‘melt’ (crisps, chocolates, cakes, biscuits, ice-cream) don’t produce a feeling of being full, and will be very high in calories. Ask the resident’s dietician for information on appropriate ‘textured’ foods • Get out and be active! Swap computer and TV time with physical activities to improve fitness and energy levels.




What will I learn from this feature? How to bathe a bariatric resident



Bathing, this most intimate of interaction between carer and client, can be greatly improved if both are confident of the surroundings, equipment and accessories available, says ENdynamics bariatric support manager John Nuttall


hen it comes to bathing and cleansing, for individuals the main concern is maintaining their dignity, whereas for carers, there is the added responsibility of ensuring the bathing process is safe and effective. For the bariatric or plus-size resident, managing hygiene brings additional concerns: as well as their physical size, bariatric residents may have limited mobility and ability to maintain daily cleansing and toileting; they may also be deeply self-conscious about their size – and too embarrassed to maintain their personal hygiene, particularly if they need help. For staff handling the risk assessment, the key issue is that bathing equipment and furniture, including grab rails, should be suitable for both the size and weight of the bariatric user. Equipment should also be sited in locations that are useful to carer and client: getting into the bath is one thing, getting out while wet is entirely another. This is a moment when the bariatric user can feel most vulnerable. With its inherent slip risk, the bathroom is a particularly hazardous place for all residents, including those with bariatric needs.With bathroom space at a premium, very few facilities are purpose-built and wet-rooms with stepdown, adjustable height, walk-in or plus-sized baths, non-slip flooring, and overhead transfer hoists and safety rails are fairly few and far between. In this scenario, a shower room may be an option, allowing the carer to move shower and furniture to meet the needs of the user. 28 Care Home MANAGEMENT


The ideal shower seat, commode and perching stool comes in a range of weightbearing capacities, should be adjustable for seat width, height and backrest, have forward extended armrests to allow for easy access and exit, and have a lockable mechanism that gives stability in situ, while allowing for easy installation/removal. Seating surfaces should be easy-clean, and ideally, dual function, converting easily into a commode. With correctly placed temperature controls, shower heads and hoses, the bariatric user can often bathe independently and confidently. For larger-body sized individuals, or where the user requires more personal assistance from one or more carers, underside access is important.

Are you seeing red?

The colour red is universally associated with warning and danger, hence its use on ‘STOP’ signs, emergency buttons and release levers. Red is used because the human eye can see red more clearly than other colours: red light is scattered the least by air molecules. In people with dementia red is also a stimulating colour, increasing brain wave activity, according to research. A study by The Chartered Society of Physiotherapy found that four out of five patients were significantly more mobile when using red frames as opposed to alternative colours. In a bathroom environment the high contrast of red against white can lead to improved toileting.



Use the word OBESE as a mnemonic tool to help you remember key clinical issues in bariatric skin management

OBESE: AN APT MNEMONIC O: Observe for atypical pressure ulcer development B: Be knowledgeable about common skin conditions E: Eliminate moisture on skin and in skinfolds S: Be sensitive to the patient’s emotional distress E: Use equipment to protect the skin and for safe patient handling


Bariatric patients are at higher risk for pressure ulcers, as their extra padding doesn’t necessarily protect them from the forces of pressure and shear. Also, bariatric patients commonly are malnourished and less mobile than others, making it hard for them to avoid excess pressure on the skin. Many have multiple comorbidities, such as diabetes, that further increase their pressure ulcer risk. In this population, pressure ulcers can develop in atypical and unique locations—hips, lower back, buttocks, in skinfolds, and in areas with medical devices, such as tubes. Also, foreign objects, such as medicine cups and TV remote controls, can get lost in the bed and lead to pressure areas. Bariatric patients require frequent turning and repositioning to help prevent breakdown from pressure and shear forces. March/April 2019


Intertriginous dermatitis is an inflammatory skin condition commonly seen in the skinfolds of bariatric residents behind the neck, under the arms and breasts, under the abdomen or pannus, on the side, and on the inner thigh. It results from the weight of skin, which creates skin-on-skin contact, coupled with friction forces and trapped moisture from perspiration. Initially, the affected area of the skin shows mild redness, but may progress to more intense inflammation with erosion, oozing, drainage, maceration, and crusting. Associated findings include pain, itching, burning, and odour. Other skin conditions commonly found in obese patients include fungal conditions (candidiasis and chafing).


Preventative care of the skin of an obese resident centres on eliminating moisture on skin and in skinfolds, avoiding skin-to-skin contact, minimising heat build-up on these tissues, and keeping the skin clean using a pH-balanced cleanser, applied using gentle strokes to avoid harming fragile tissue. Handheld showers and no-rinse cleansers can simplify this process. Residents should dress in loose-fitting clothing made of absorbent material.


Everyone involved in caring for bariatric patients should receive sensitivity training to increase their awareness and compassion. Many carers can unconsciously hold a negative view of obesity, which can manifest into unprofessional treatment. Bariatric patients frequently suffer from depression, altered self-esteem, and social isolation. Take care not to demonstrate prejudice through your actions and words, or to show reluctance to care.


Fear of injury or inadequate equipment/staffing can increase staff ’s reluctance to care for the bariatric patient. Equipment must be the proper size and construction to bear the resident’s weight, and prevent rubbing and pressure points (for example, from the side panels of a too-small chair or bed). Specialist mattress and bedding can help reduce the risk of skin conditions. Care Home MANAGEMENT 29


TOMORROW’S WORLD What will I learn from this feature? How to future-proof my care home

Today’s new-build developers are designing for tomorrow’s generation of care home users, says David Ward, managing director of DWA Architects



n the current climate for public funding, it is, perhaps, unsurprising, that the lion’s share of new residential homes centres on areas of wealth that may be relied upon to pay for beds: the south of England. But, where wealth and the ability to pay enhanced fees prevail, so too does the expectation of ever-improving facilities: elderly couples today expect to be able to continue their later life in their accustomed style and with some semblance of independence. If their previous home was large, it follows that they will want the same from their residential care moving forwards. Today’s developers are typically seeking to achieve economies of scale for their new-build clients, resulting in more institutional, multistorey complexes of 800 beds, perhaps, with specialist care wings, that are flexible enough

to adapt readily to the requirements of the next generation of clients. For most building designers this will mean building homes with multiple but small units or households that can be changed as needs arise.

CHANGING CLIENTS, CHANGING NEEDS The average age of today’s UK care home stock is over 20 years old, which increases the likelihood of a refurbishment or renovation to keep it fit for purpose in line with changing service user demographics. As the statistics show (see page 25 for the latest data) bariatric care is one such population change, but this does not come without the need for a home to assess its space, equipment and staffing capabilities: space requirements will include clear access routes as www.chmonline.co.uk


Today’s developers are typically seeking to achieve economies of scale for their new-build clients, resulting in more institutional, multi-storey complexes of 800 beds, with specialist care wings. David Ward, managing director of DWA March/April 2019

well as increased bedroom sizes and plus-size bathing/toilet facilities (see page 28 for more information on bariatric bathing). The internet of things is another driver of change: plans for a digital NHS are underway; elsewhere in the healthcare continuum, technology assisted care is already reality. Forward-thinking developers are already looking to embed the ‘internet of things’ in building design for the mutual benefit of residents and managers keen to keep a lid on running costs. And, of course, following the Grenfell Tower tragedy of 2017 and the resultant Hackett report, construction safety is now an even bigger consideration. The report makes 51 recommendations to improve the safety of residential construction and while currently, high-rise residential buildings are the focus, the expectation is that other high-risk buildings will be brought into scope – and this could include care homes. Changes in the regulatory framework will include a revision to the Construction (Design and Management) Regulations (CDM) and the creation of a new body, the Joint Competent Authority (JCA), that will regulate fire safety design, construction and the provision of fire safety information. The requirements of the CQC for care home registration already include comprehensive building fire safety information and procedures. Undoubtedly, these provide a good taste of the legislative environment to come.

Future-proofing your build

By Jitesh Patel, project developer from development and investment firm Kajima UK Future-proofing means building for…. …FLEXIBILITY: the accommodation can be adjusted structurally to allow for changing care requirements, for example, hoist installation or door widening. …A SENSE OF COMMUNITY: buildings that allow for social interaction, for example, a hair salon, shop or restaurant, communal dining and cooking spaces to support interaction and independence, while allowing for quiet break-out when required. …INCLUSIVITY: in care homes there are a full range of users, including those living with dementia. Design should be able to cater for lifestyle preferences and different abilities, even including ability dependent wings. Dementiafriendly design has a role to play in improving orientation, reducing the potential for confusion or perceptual difficulties. Circulation areas should be wide enough and level for mobility aid users and the more able-bodied to use simultaneously. …OUTDOOR LIVING: green spaces and gardens should be planted with small trees and shrubs that attract wild life. External paths and wander loops, allotments and recreational spaces encourage outside activity. Outdoor sitting spaces with individually designed seating and sheltered conservatories and greenhouses can be orientated to maximise access to natural light. …NEW TECHNOLOGY: from simple self-care systems to telesystems that help with disability or illness, technology has a role in many aspects of care.


NEW BUILD INSPIRATION Pickering House in Dorking is located in an Area of Outstanding Beauty so the planning process required some clever management. The home footprint falls over 12m (three storeys) from front to back. Design by Cowan Architects has produced a building that feels ‘at one’ with the ground structure and avoids the institutional feel of a large building

The redeveloped 64-bed Barchester Healthcare home at Fulford village,York, is arranged over three floors, and built to traditional construction methods by McGoff Construction. The eternal façade has been specifically designed to reflect York’s architectural heritage, incorporating red facings, timber cladding, timber window and doors as well as slate-style roof coverings



Get some architectural inspiration for care home design

Opened in 2018, Barchester’s most recent care home is The Spires, in Lichfield, Staffordshire. Replacing a demolished care home, the building was slightly elevated so natural light could be brought in to the building, allowing for clear views of relaxing surroundings. Residents were invited to comment on the design, including the layout of the home, and the furnishings. Each group of 10-20 beds is presented as a separate community. The home was shortlisted in the best new elderly care home category in the Pinders Healthcare Design Awards 2019

Baycroft’s new care home in Flitwick includes a beautiful landscaped garden and luxury dining area, on-site cinema, library, hair salon, treatment room and physio gym

Brockington House will be a luxury 70-bed care home in Hereford, due to open in August 2019. The home uses the site of the former Hereford council offices and has numerous Tree Preservation Orders in place, resulting in the complex building footprint

March/April 2019

Planners have paved the way for the development of a £15m care village in Beeston, Nottingham. The scheme by Charterpoint Senior Living, Peveril Securities and care provider Belong, features a 75-bedroom care facility, 30 supported living apartments and village centre amenities. Design features include an entrance bay stepped forward from building frontage and introduced in alternative brick colour, to identify building entrance and a contemporary roof design to reduce the height of the building. The frontage has been designed to complement the existing streetscape, while at the rear specially created pockets of space will allow for green features



SMALLER PLAYERS UNDER PRESSURE Significant corporate development activity has put pressure on some smaller operators, as regulators and operators focus on the quality of operations as well as the physical environment.The search for greater economies of scale has led to a consolidation in the market (number of homes), despite the number of beds increasing overall.



A YEAR OF BUSINESS CONFIDENCE An upturn in business confidence in the care market is expected this year, as more ‘alternative’ lenders are coming to the fore, believes care home advisor Christie & Co.


n a new report, ‘Business Outlook 2019: Navigate, Innovate, Accelerate’ care home advisor Christie & Co notes that traditional banks have become more cautious to lend. However, the emergence of alternative players such as smaller banks, funding circles, and venture capitalists will create “greater opportunity for business owners looking to embark on their first venture or expand,” it says. The report highlights a shift in investor appetite in the commercial property market towards ‘alternative’ property, such as care, fuelled by Asian and European investors, and diverse global capital providers. These include: private equity, international real estate, and infrastructure funds. And, even though the care home market remains highly fragmented, with some strong local independent provision, competition for prime sites has increased.









Prices: what’s up and what’s down?










Location and demographic factors continue to influence the value and performance of care settings and the attractiveness of investments, with the South East of England maintaining leading levels of supply and demand. Many other regions still have an undersupply of market standard beds: according to regional director Rob Kinsman, the South-west and Wales are particularly prime for on-going new-build activity.Where new-builds are not considered viable – often in smaller, more affluent towns – there is demand for converted care homes. CHALLENGES The key challenges facing operators relate to staffing, funding and a tougher regulatory environment.The current 20,000 UK nurse deficit looks set to increase further; agency staffing costs continue to plague many operators, particularly those who cannot mitigate the costs through increases to private fees. Brexit may exacerbate existing challenges particularly around workforce, however, it may also benefit some businesses taking advantage of the relatively low value of the Pound. OUTLOOK FOR PRICES Average prices remained economically positive throughout 2018 with care showing the fourth highest rate of growth, behind childcare, dental and hotels (see below left). However, the availability of financing may prove a spanner in the works. John Mitchell, head of business mortgages, says that traditional lenders are shying away from small care home deals, looking instead to the larger, purpose-built developments for business. Lending criteria for first-time buyers in the care sector has also significantly tightened. For more information, read Christie & Co’s Business Outlook 2019 report [online] via the link: https://tinyurl.com/y5e85vw2




MONEY IS Raising finance for your care home is about giving investors the chance to make a difference to the wellbeing of our elderly population, says Ben Penaliggon, director at Octopus Healthcare


or investors, care homes represent an appealing investment option: they come with advantages including a long-term, needs-based client base, and long-term leases which frequently include RPIlinked annual rent increases and income returns. Care homes can also be an ethical investment, which is becoming increasingly important for investors who want to help create quality homes that improve elderly wellbeing. A recent survey from Octopus Healthcare found that the UK is the top destination globally for institutional inward investment in healthcare infrastructure.The survey, which covered 100 global institutional investors with a total of USD 6.8 trillion under management, found that 37 per cent of respondents expect to increase their allocations to healthcare infrastructure by more than half over the next five years. However, investing in the elderly care home sector is not straightforward: there is a shortage of modern, purposebuilt homes. Development finance, to build new homes, is seen as risky –

March/April 2019

and, as a result, is often de-risked, for example, with a guarantee of acquisition on completion. The sector also has a limited number of operators with substantial balance sheets, which are often what investors are looking for to improve the security of their income.There are braver investors who are willing to work with small or nascent corporate entities but this is perceived as being a higher risk, which can increase the cost of the capital investment. Writing a financial covenant into a lease may be one way to reduce this risk – and, consequently, the cost of finance. An engaged, supportive relationship between landlord and tenant is fundamental to helping investors see a quality return on their investment. The value and liquidity in an elderly care home is underpinned by its performance: investors and operators should be prepared to work together to understand the operating challenges, monitor trading performance, maintain the physical fabric of the building and obtain the best possible regulatory outcomes.

Plan for business success

By James Thomas, commercial manager at d&t

A good business plan is vital if you want to appeal to an investor/lender. It should be realistic and achievable using existing financial records to help with forecasting. It will need to include information on cash flow, budgets and projections, and the objectives for the business, as well as the strategy to make them happen. This will include milestones and a roadmap indicating thresholds when, for example, additional staff can be taken on, or when the business can afford to expand further. There should also be an analysis of strengths, weaknesses, opportunities and threats. This will include information on the individual’s or company’s background, assets and liabilities and the trading environment for the business idea.




Nigel Marcoolyn, director of architecture, Cowan Architects, guides the would-be care home builder through the maze of where to look, what to include and how to grab yourself a land ‘bargain’ Level of demand Social need Proximity to established communities

Site size Planning requirements



are home architects today work with a challenging brief: they must appeal to the ‘baby-boomer’ generation of the 1950s and 60s, who are able to make their own decisions about care, and/or their children and grandchildren charged with finding suitable


provision for their ageing loved ones. As a result, community factors play an increasingly important role in the selection criteria: would-be customers want to know whether the new home is within a community, provides all the facilities they are used to and is located within easy commuting distance of friends and relatives. Typically, the south-east has been a prime care home building ground, popular both for new-builds or renovation/extension of pre-owned homes,

but as prices surge, developers have to think a little outside this location box.This is where good building design can come into its own. Affordable sites are often outside of town centres, on sloping sites or within protected spaces. However, that does not mean they cannot work well: on a sloped site, for example, it is possible to build a ‘stepped’ building comprising, effectively, individual, small communities on different levels and with external or social spaces that do not overlook each other. A more expensive design will easily be offset by the reduced land price.

Join your local registered manager network today Skills for Care supports networks for registered managers covering every local authority area in England. They are chaired and led by registered managers, for registered managers. Networks offer peer support and access to experts, best practice and information.

73% said they had shared ideas and good practice with other managers.

74% felt more confident in their role. 74% agreed/strongly agreed that they now have better knowledge of legislation and policy.

www.skillsforcare.org.uk/networks 36 Care Home MANAGEMENT




Care home movers and shakers

Chris Wall (right) has been named as the chief executive of Shropshire care home provider Coverage Care Services, taking over from David Coull from May 1. Wall is currently the company’s finance director; he is also the immediate past chairman of both the National Care Forum and Shropshire Partners in Care. Coull has been CEO of Coverage Care Services for the past 15 years. Nicky Hopkins, the current chief financial officer of the Regard Group will take over leadership duties on an interim basis following the resignation of Carole Edmond. Regard provides residential and other care for people with learning disabilities, mental health needs and acquired brain injuries.

Cornerstone Healthcare Group has appointed Jens Kleyenstuber (right) as finance director. Cornerstone Healthcare Group runs two specialist nursing homes caring for people with complex neurological, physical and mental health needs associated with challenging behaviours: South Africa Lodge in Waterlooville (and not as stated in the Cornerstone profile in the Jan/Feb issue – apologies) and Kitnocks House in Curdbridge. Kleyenstuber comes with experience in commercial finance at Lifeways Group and the Cambian Group. He takes over from Geoff Hiskett, who is retiring. Independent Care Group operations director Beverley Proctor has become acting chief executive, following the resignation of Lisa Pickard. Pickard is to join the not-for-profit organisation Five Lamps, which provides an integrated range of social, economic and financial inclusion services. Anthony Beorby has joined Healthcare Homes Group in the new post of operations director – care homes. Beorby has held roles at senior regional and operational director level, as well as in home management. Stockport provider Borough Care has appointed Lee Omar to its board of directors. Omar’s role will include developing relationships with external stakeholders. Omar is CEO of healthcare app developer Red Ninja. Silverline Care, a residential care provider in Yorkshire and Scotland, has appointed two regional operations managers: Belinda Dennis (right) for Yorkshire and May Prentice (left) for Scotland. Dennis is currently manager of Silverline Care’s Linson Court Care Home in Batley, a role she will continue alongside the new post. Prentice previously managed Silverline Care’s Spiers Care Home in Beith.

March/April 2019

Suppliers and business partners

The Care Quality Commission (CQC) has appointed Kate Terroni as chief inspector of adult social care (ASC).Terroni is due to start the role in May, taking over from Debbie Westhead, the interim chief inspector since Andrea Sutcliffe’s departure in December last year. Terroni, a registered social worker, is currently director of adult social care at Oxfordshire County Council.Terroni is also co-chair of the ADASS (Association of Directors of Adult Social Services) workforce network. Joining Terroni at the CQC is Mark Sutton from education equality charity Teach First as its chief digital officer. Sutton will join CQC’s board and executive team in April. Andy Tilden has been appointed interim CEO of Skills for Care. He takes over from Sharon Allen, who leaves at the end of March.Tilden is currently Skills for Care’s national director of sector development.

Care home consultant Carterwood has appointed Henry Crosby as data and technology manager to strengthen its research systems and data management.


Future of Care Conference 2019. To be chaired by BBC broadcaster and dementia charity founder Sally Magnusson. Tuesday 19 March. The King’s Fund, London. For more information, www.futureofcare.co.uk The Cleaning Show 2019. Thursday 21 March, ExCeL, London. For more information, visit: https://cleaningshow.co.uk/ Dementia Care and Nursing Home Expo 2019. Wednesday-Thursday 26-27 March, NEC, Birmingham. For more information, visit: http://www.carehomeexpo.co.uk/


Nutricia Clinical Care introduction to the International Dysphagia Diet Standardisation Initiative (IDDSI) for food textures. Thursday 14 March to Friday 26 April in Glasgow, Clydebank and Alexandria. More information via the link https://tinyurl.com/yyqmaqeu or by email from: SouthCommunityDietetics@ggc.scot.nhs.uk Care Roadshows 2019. The dates and locations for 2019 run from Tuesday 30 April (Glasgow) to Tuesday 19 November (Epsom). For more details visit: https://www.careroadshows.co.uk/


June 10-11 Care Forum. Whittlebury Hall, Northants. For more information, visit: https://thecareforum.co.uk/


The Specifier’s Guide to Flooring launches at CDW 2019

The Specifier’s Guide to Flooring has launched in the UK. Officially unveiled at Shaw Contract’s showroom during Clerkenwell Design Week, the ‘definitive guide’ will provide a specification tool for architects, designers, facilities managers and specifiers on all aspects of flooring. Exploring key materials, it will provide a rich resource for industry, in hard-copy format and online at http://www.specifiersguide.co.uk The flooring-focused Guide includes commentary from prominent names in industry, as well as technical analysis and inspirational imagery. Its launch at CDW included an address from Fiona Bowman MBA CBIFM, FCMI Senior Facilities Management Consultant. Fiona praised the resource for its “compelling, substantive, clear and concise content; an invaluable guide for the complex specification process,” - whilst Simon Jackson, Design Consultant and sjjdc founder described it as an “expert at your elbow”. “The Guide to Flooring is the must-have publication for every architect, designer, FM and specifier from Land’s End to John ‘o Groats. Never before has there been such a comprehensive guide to all aspects of an installation,” added David Strydom, editor of CFJ. Echoing these sentiments, John Heath, Kick-Start Publishing’s CEO added, “The Guide will light the way for those seeking inspiration for their flooring requirements.” For more information, please visit http://www.specifiersguide.co.uk or contact Kick-Start Publishing on tel. 01892 752 400.

7– 8 June 2019 Olympia London

• Practical activities • Dementia Experience

• Specialist exhibitors • Latest products & services

• Expert speakers • 1-2-1 advice clinics n • Q&A sessions informatio & tips Helpful •





Come along to the UK’s leading event for dementia information, resources, help and advice for healthcare professionals, carers and families. To book tickets and for more information visit

www.alzheimersshow.co.uk Sponsored by

In partnership with

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