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May/June 2019 • ISSUE 79

IT’S WASH DAY! Why it’s time to turn your laundry green


OR NOT? What’s selling best and where

PR AND MARKETING How to sell the benefits of your home


How 5G will change care homes from the inside


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to the May/June issue of Care Home Management magazine

W Care Home Management May/June 2019

Issue 79

Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Design/Production Emily Hammond Published by S&A Publishing Ltd Hillside office, 9 St James Park, TUNBRIDGE WELLS TN1 2LG Tel: 01892 680670 Email: Advertising Space Marketing Tel: 01892 677721 Email:

ith Care Home Open Day just around the corner (June 28), care home managers may well be wondering whether it’s worth the effort to get involved. After all, unless you work in, or have a friend or relative in a care home, why on earth would you be interested in visiting one? This is certainly true, says Shona Bradbury, who manages the Care UK Appleby House in Epsom (see page 31 for more details) but this has not stopped her from supporting CHOD since its inception. This year, she’s delighted to see CHOD joining her on a ‘journey into the arts’ that for many years now has seen the home attract a wide variety of people through its doors – some of them temporarily: for arts groups or sessions hosted by the home, or simply for the open day – others more permanently: as residents. For Bradbury CHOD is not just about filling beds – although, of course, that is an important consideration - rather, it’s about making the home and its residents feel like a real part of the community, something that benefits residents, their families, the staff, the home, and the local community. There is no doubt that care homes have a PR problem. At a party recently, I was told: ‘Well, you can’t really believe a CQC ‘outstanding’ rating, can you?’ It was clear from the rather glazed expression that met my reassurances and explanations of the CQC’s inspection processes, that this person’s mind was well and truly made up. Sadly, it seems that my experience is also reflected nationally. In our recent exclusive online feature, Winning hearts in your local community (visit https://chmonline. the King’s Fund tells us that public dissatisfaction levels with care run at one in

three people. It goes without saying that this made more headlines than the Adult Social Care Survey 2017-18 that found only 2 per cent of service users were “extremely” or “very dissatisfied”. This kind of coverage doesn’t always make it easier to change people’s perceptions. Many homes can worry about receiving bad publicity and this could make them reluctant to take part in CHOD. But training is available to help homes deal with potentially difficult questions from the public and the media. In our work media training care homes, we know that the key is to be prepared. So, before the day think through what could go wrong and what you might be asked. What are the most difficult questions that could come your way? Once you have considered the difficult areas, you can think about your answers. Perhaps, people think residents are not active enough. If so, make sure you talk about all the activities you do and your investment in this area. Even demonstrate some of them on the day. Perhaps, the public have heard reports of poor food in care homes. Why not show people your weekly menu and allow people to taste it? If the media pick up on a more serious negative story from the past then think about what changes and investment have been made since that time to show that you have taken concerns seriously and improvements have been made. Events such as CHOD are designed to help change negative perceptions and raise awareness of all the good things care homes do. If you are at the events such as the Care Forum (see page 24) or Health + Care (we’re on stand G36) during June, we can give you some free advice in person. Just come along, and make sure your home gets the most out of the PR opportunities ahead.

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.

Ailsa Colquhoun Publisher/Editor

May/June 2019

@Carehomemanage Care Home MANAGEMENT 3



22 Health

9 Ask the Expert

37 People and Events

How to make the most of intergenerational activity

10 Training

The benefits of a nurse associate, plus the role of Hostmanship in your organisation

12 Leadership

Exploring the road to outstanding in the well-led KLOE

14 Legal

Contract compliance, and employer’s liability tested in the courts

16 B est Practice

Dying Matters, so how do you improve end of life care? Plus, Bupa basks in a four-star outstanding rating

See who’s on the move and where you can go during May/June


BUYING AND SELLING 25 What’s hot – and not? Where to grab yourself a care home bargain

27 Going on the market – the sales process in a nutshell

29 Going, going…gone – how to keep staff sweet through a care home sale

PR 30 Maximising the PR opportunities of Care


Home Open Day

18 B est Practice

20 Care Home Profile

Laundry 35 Be green – how sustainable laundry

How SPACE has transformed a Walsall care home


Understanding Urinary Tract Infection and the role of hydration

Alarms 33 Going 5G – and the impact on resident

The Ombudsman critiques a resident’s expulsion



7 Eleanore’s Words to the Wise Fail to plan, and you plan to fail












May/June 2019 • ISSUE 79

health. Plus: keeping staff safe when residents challenge

solutions will benefit your home


p17 4 Care Home MANAGEMENT


Alan Dedicoat confirmed as Care Home Awards presenter as tickets go fast THE ‘VOICE OF THE BALLS’ and Strictly Come Dancing announcer Alan Dedicoat will once again be presenting the Care Home Awards on June 27. This will be the third year Dedicoat has presided over the care sector’s number one awards show which takes place in the Platinum Suite at ExCel London. “The warmth of his personality and the utter professionalism with which he hosts the Awards and shepherds the action on stage - makes the occasion memorable for everyone attending,” says the Care Home Awards’ commercial director Helen Warrilow. The Care Home Management media brand is the official media partner for the Care Home Awards which will be attended by around 300 senior representatives of care home providers.

Warrilow adds that the event is firmly established as an annual celebration of innovation and excellence in the ownership, management and operation of care homes across the UK and of key suppliers to the sector. “It is less than two months until the lunch and the ceremony and the Platinum Suite is already three-quarters full,” she says. “Much of the growth has come from care homes and groups who have not entered before and this is very reassuring for the future.” With the Platinum Suite at almost capacity extra space has been created to add more tables. Final stage judging is currently under way to discover this year’s winners. To book your table for the Care Home Awards on June 27 in London please visit

Read more online at: May/June 2019

Why we need a commissioner for older people In the latest Care Home Management magazine podcast, sponsored by Hallmark Care Homes’ Avnish Goyal talks about the need for more political will to solve social care problems and why a Commissioner for Older People is a must. Also, Neil Eastwood, author of the book Saving Social Care, explains how to recruit and retain the best frontline staff. We also talk to Tracey Campbell, managing director of The Paterson Group about the new T Level courses that will operate alongside apprenticeships and which have been developed in collaboration with health and social care employers. Check them all out online at: or just scan the QR code.

Some Green Paper reform could be six years away, minister admits

Care minister Caroline Dinenage has admitted that some Green Paper reform measures may take until the “middle of the next decade” to happen. In a debate on local government and social care funding, she admitted that only some of the reform to be unveiled in the social care Green Paper would happen in the current Parliament. She said: “The Green Paper is a big document which covers a range of issues. It will be possible for some developments to take place immediately, but others will take longer.”She admitted to Dr Sarah Wollaston (Totnes, Change UK) that a version of the Green Paper does exist but that it was being improved and evolved “so that when we do publish it—as soon as possible—it will be in the best possible shape”. However, MPs have been told not to expect the Green Paper to just ‘throw money’ at the sector. She said: “While money is undoubtedly tight, if we are to face the challenges of an ageing population, we need to do more than just put more money in. We need a large-scale reform of the system.” Read more online at: Care Home MANAGEMENT 5


‘Son of DOLs’ Bill makes it to Royal Assent THE LONGAWAITED Mental Capacity Bill has completed its passage through Parliament after a long series of ping-pong amendments by the Commons and the Lords. The final amendment, made at the end of April, prescribes that “the code of practice must contain guidance on what kinds of arrangements amount to a deprivation of liberty”. The Bill will now become law, after receiving Royal Assent. VODG (Voluntary Organisations Disability Group) has expressed significant concerns over the Bill, which include: • The financial costs of implementing the new

system will fall to care providers in a sector that is already at full stretch following successive funding cuts • Too much weight being given to a code of practice which sits outside of the proposed legislation. Analysis undertaken by a consortium of care provider membership organisations identifies problematic assumptions with the Government’s own impact assessment that could lead to badly implemented law. This includes additional financial costs being passed onto independent and voluntary sector providers with no comparable diversion of funding away from local authorities.

Read more online at:

Resident numbers fall by 11 per cent in three years

THE NUMBER OF PEOPLE entering residential and nursing care homes has fallen by 11 per cent over the past three years, according to new research from think-tank the King’s Fund. Research designed to provide a 360° snapshot of social care, finds that among older people, the rate of admission to residential care has fallen from 659 per 100,000 people in 2014/15 to 586 per 100,000 in 2017/18. For working-age adults, the fall has been marginal, from 14.1 per 100,000 in 2014/15 to 14.0 in 2017/18. Compared to 2012, the report finds a small increase in the number of nursing beds, compared to a slightly larger decrease in residential beds in care homes. The report also looks at care home ownership, the average size of care homes, workforce and quality issues. Read more online at:

Care home nurses raise Dementia conversations understaffing concerns enhanced through the arts CARE HOME NURSES have raised concerns about chronic understaffing in the sector, in a new poll in nursing magazine Nursing Standard. One respondent to the magazine said: “I’m expected to look after 44 residents on two floors for a 12-and-a-half-hour shift.” Even though almost all respondents said they had reported a safe-staffing concern, employers were often incapable of, or unwilling to, address the issue. “Patients’ wellbeing is the last thing on the system’s agenda,” one said. Another added: “I was told it wasn’t unsafe, just not ideal. That was me and one carer on a night shift for 34 residents in a nursing home.” Read more on this research online at: care-home-nurses-raise-understaffing-concerns/

MEANINGFUL INTERACTIONS with residents with dementia that are creative, ‘in the moment’, spontaneous and improvised are possible using the arts, a Welsh study has found. In the study, published in the journal Aging & Mental Health care home staff in 14 homes in Flintshire used a range of creative activities (poetry, film, music, art making) to develop nonverbal communication skills and the confidence to try more creative approaches to care. Key skills gained included using simplicity and subtlety, the confidence to experiment and the development of empathy.

Read more on this research online at: dementia-conversations-enhanced-through-the-arts/



NHS rolls out capacity tracker after pilot success

Staff turnover challenges care of UTIs, research finds

A DIGITAL PORTAL is being introduced by the NHS and councils to reduce delayed discharge from hospital. The Capacity Tracker details care home vacancies, which will allow health and social care staff to assess suitability for a placement. In 2018, around a quarter of a million hospital bed days in England were taken up by people who were medically fit enough to be discharged, but who faced delays in an appropriate care home being found, according to NHS England.

OVER ONE IN four care home residents are prescribed antibiotics on a just in case basis, but only eight per cent are taking them, according to new research published in an academic journal. Researchers conclude that high staff turnover can make it challenging “to maintain training levels and enforce good antimicrobial practice”. They say: “Provision of healthcare services for residents in long-term care facilities (LTCFs) is variable and can result in disjointed care between carers and NHS healthcare professionals. • A new report from the Royal Pharmaceutical Society, Putting residents at the centre of pharmacy care home services, recommends that care homes receive dedicated time from pharmacists and their teams to reduce inappropriate polypharmacy and improve quality of life for residents. Read more on the challenges of caring for urinary tract infection in the Wellness Whistlestop on page 22 of this issue.

Read more online at:

Read more on this research online at: staff-turnover-challenges-care-of-utis-research-finds/

ELEANORE’S WORDS TO THE WISE Fail to plan, and you plan to fail By Eleanore Robinson, former editor at LaingBuisson and freelance healthcare journalist

When running a successful care home business planning is key. Providers need to know how many staff members will be available to cover services, how much food to buy to serve enough meals, and to invest in the right healthcare equipment and support to keep residents fit and well. Crucially, providers need to know how much funding they will receive to be able to do all of these things and more. And while operators can plan for wage increases, particularly those such as the wellpublicised National Living Wage by central Government, once more providers are reporting that this rise is not being covered by local authorities in the form of an increase in fees. Furthermore, Care England now reports that the NHS is following suit. It says that a number of May/June 2019

clinical commissioning groups (CCGs) are failing to take into account rising wages and will not increase fees in 2019/20 for NHS Continuing Healthcare. On top of this, efficiency savings required by the Department of Health and Social Care mean that fees for NHS-funded nursing care are not due for an uplift any time soon. With nursing staff akin to gold dust, how are care home providers expected to recruit and retain people to provide these services without paying them a fair wage? And if care homes find themselves without enough nursing staff or are unable to cover the costs of the care of people with complex health conditions, such residents are likely to remain in hospital for longer.This is hardly conducive to the patient’s recovery or the NHS’s finances. Years of experience of the short-sightedness of some commissioners is leading care providers to change their business model and stop offering

these services. And who would blame them? Having the way ahead mapped out in terms of proposed fee increases for the current and the following year, and when they will come into effect, as the Low Pay Commission does with the National Living Wage, would go some way to helping care home providers plan and, ultimately, deliver better services. Care Home MANAGEMENT 7


Join the finalists and celebrate!

Picking up a Care Home Award lets you share the winning feel-good factor. Smiles all round and good feelings for you, your staff, your suppliers and best of all, for your residents. The Awards celebration lunch and ceremony take place from 12 noon on June 27, 2019 in the Platinum Suite at ExCel London. Make sure you reserve your places well in advance. Book online at: HEADLINE SPONSOR




Care Home Management asks our panel of experts to answer your common care queries THE BENEFITS OF INTERGENERATIONAL CARE


By Judith Ish-Horowicz, principal and co-founder Apples and Honey, working with Nightingale Hammerson. Q: I’d like to invite children into my home but am not sure where to start. A: Bringing children into your care home is a very positive step in enhancing the wellbeing of your residents. Recent research shows that it not only alleviates depression and loneliness, it also improves residents’ quality of life - and can even extend it. Both the CQC and Ofsted encourage regular visits between nursery and school children, and the elderly as they understand the benefits for both age groups. Of course, you will need a suitable space for the activities to take place, and you should check with the early years team that suitable DBS checks have been made, as well as with your insurance company to ensure that the visits are covered. If you encounter problems, most early years insurers would be happy to help. You will also need to do risk assessments of all areas of the home to be used. Through experimentation and experience, you will

May/June 2019

soon learn how to lay out the room to best encourage interactions. Collectively, the children and your residents will show you the pace and direction of travel they wish the sessions to go in, so let them take the lead. Regular communication with the children’s staff, including joint planning and reviewing of the session, will go a long way to creating a mutually developmental, and cognitively appropriate programme.

On or off-site settings

• Middle age demographic: Accompanying adults introduce a new age demographic - 30-50 yearold adults - and new befriending opportunities for care home residents • Child-centric setting: The bright colours and sensory stimuli used in intergenerational care often trigger personal childhood memories for residents, and creates a very different feel and experience for residents • The activity: Activities trigger memories, stimulate the senses, promote learning and physical activity, and provoke curiosity and exploration. Tasks designed with learning and development at their core are usually entirely novel for care home residents, and can provide relief from being an ‘object of care’, removing the focus from their aches and pains • Engagement skills: Early years teachers are experienced in looking for spontaneous opportunities to extend participation and learning one to one; they encourage participation by elderly residents as well as by nursery children.

their children to achieve and will be looking to your residents with time, experience and skills to share to help the children reach their goals. Activities need to be well-structured and planned. And, remember, it’s not just the children and the residents who benefit. Families often feel less guilt at having their loved one in a home if they know that s/he has become part of a new extended family, and has daily interactions with people of all ages.

Ideally, your early years visitors will attend a setting co-located within the grounds of the care home, or adjacent to one but if this option is not available to you, it is still possible to develop strong intergenerational bonds with an off-site For more information: An introductory guide organisation – it just takes to intergenerational care is available [online] at: regular, purposeful interaction. It is not enough for the groups Care home nursery model information and full to come together for a cup intergenerational research available [online] at: of tea and a chat every week. Schools have learning goals for




NURSE ASSOCIATE? Emily Burton qualified in January as one of the first ‘nurse associates’ to be able to register with the Nursing and Midwifery Council. This new post aims to bridge the gap between nurse and carers


awn Whitt, manager at the Stewton House nursing home, now has an extra pair of nursing hands to help her manage care at the 47-bed home. As one of the first nursing associates to enter the workforce, Emily Burton can support the nursing workforce and has expanded capacity through existing resources. Emily had been working as a health care assistant at the Amber Care nursing home in Louth, Lincolnshire, for eight years when her manager alerted her to the nursing associate training scheme. “I was ready to do a bit more in the home but didn’t feel that training as a nurse was for me,” she says. Emily found out about the new

skills she would acquire, particularly in areas of existing interest such as dressing and woundmanagement, and the range of experiences the placements would offer, she said: “It sounded perfect.” Starting her course in January 2017, Emily found herself doing training rotations in settings including in hospital, as well as studying at the university. While she learned a great deal from the practical experience in a non-care home setting, she says the experience also reinforced her desire to return to care. “In care homes you can build stronger, more lasting relationships with the people you care for.” As a newly-qualified and registered nursing

associate at Amber Care, Emily is now able to deliver the care pathways that her nurse colleagues create, freeing them to do the more complex nursing needs in the home. Her managers feel that this role is a great opportunity for care staff who wish to progress in a nursing role. Emily believes this is a role that any carer could do, provided they are motivated to take on a two-year study programme and are open to experiencing different care settings. But she adds that support from colleagues, particularly management, was also key to the success of the training, in particular supernumerary status which allowed her the time and space she needed to learn.

TRAINING AND FUNDING A NURSE ASSOCIATE Currently, the only way to train a nurse associate is through a recognised nursing associate programme, often an apprenticeship, at one of the test sites across England via the Health Education England programme. After 26 July 2019, new students can only train on a nursing associate programme that has been approved by the NMC.

As a newlyqualified and registered nursing associate at Amber Care, Emily is now able to deliver the care pathways that her nurse colleagues create 10 Care Home MANAGEMENT

Once students have completed their training, they must apply for registration with the Nursing & Midwifery Council (NMC) before they can be employed and practise as a nursing associate. The register is now open. The standards of proficiency set out what all nursing associates will know and be able to do when they join the NMC register. Like other regulated professionals, nursing associates will be subject to re-validation in the same way as all other NMC registrants.

Further information is available from Skills for Care [online] via the link:




ostmanship is a Swedish concept that can be defined as ‘the art of making people feel welcome’ – seeing those we face as our guests, whether they are residents, patients, or colleagues. Good Hostmanship encompasses areas such as customer care, quality, friendship and hospitality. It begins with a welcoming and open attitude to the people and situations we encounter, and often results in huge benefits – especially in care home settings, where the impact can be felt by residents and visitors, as well as the bottom line. After all, prospective residents, and their families

May/June 2019

Hostmanship is a skill that can benefit residents and patients, and it makes good business sense. says Jan-Hein Hemke, managing director of Facilicom UK

are unlikely to choose or recommend a care setting if they are not made to feel welcome, or if the people there, including the staff, seem unhappy.

Being human

Hostmanship is a skill to be learned by all staff members – from frontline to senior management. It adds value for clients and enriches colleagues’ wellbeing and it reminds people of what it should mean to ‘be human’. Training in hostmanship includes reminding staff of their own experiences of being made to feel welcome (or not) and highlights that

even the smallest changes – for example, a smile or taking ten minutes to chat to an elderly resident – can lift somebody’s day, improving quality of life or workplace productivity. Staff are encouraged to see how their actions contribute to the overall wellbeing of the home, as well as people and communication skills, and the confidence to interact with colleagues, patients, residents and their families in a friendly, caring yet professional manner. Staff develop a desire to go above and beyond a minimum job specification. They become a more valued part of the workforce.





In a new five-part series, Chris Gage, MD of Ladder to the Moon, explores what it takes to be outstanding in each of the five elements of the CQC’s Well-led KLOE In this issue: VISION AND STRATEGY


f a CQC inspector walks into your home and asks you what the vision for your service is, what will you say? More importantly, if they ask your cook, carer, resident or family member what the home’s vision is, will they say something that aligns with what you said? Those organisations that achieve a rating of ‘outstanding’ are absolutely clear on their purpose. As employees, they know what they exist for; as a group, they understand

As a leader, your role is to model the way. People see what you do far more than they listen to what you say 12 Care Home MANAGEMENT

their values. From that clarity will flow your business strategy - how you allocate your resources - and the behaviours you expect in your organisation. For the vision and values to be “owned by everyone”, as stated by CQC in their outstanding characteristic, then everybody needs to feel connected to them. INSPIRING OTHERS Part of your job as a leader is to inspire a shared vision within your service. This doesn’t mean you have a clear vision and let everyone know what it is. Instead, it means looking for shared values and aspirations, and articulating them in a way that connects with everyone. Research on values shows that to engage and motivate your staff, it is more

important for an individual to understand their own values than to understand the values of the organisation.Values are not something to be learnt and repeated parrot fashion, when they are effective, they are something that is expressed in everything a person says and does. Effective leaders spend time weaving the vision and values into the fabric of the service, making it a key part of supervisions, team meetings, lifestyle, handovers. Some organisations allocate ten minutes within every team meeting to shine a light on behaviours that reflect a corporate value and to assess how effective they are. As a leader, your role is to model the way. People see what you do far more than they listen to what you say. If you want an open person-centred culture in your service, then you need to be open and person-centred in everything you do, including in your relationships with your colleges, residents and families: your door should be always open; you should share challenges with colleagues; be open about your own life. Perhaps, most importantly, share stories about positive outcomes and the impact they have. Most of all, never walk past behaviour that falls short of your values. Finally, you need to build trust and you do this by acting with integrity, following through on what you say you’ll do, and clearing up the mess if you can’t.You build trust by aligning your words and actions with the agreed vision and values of your community.You treat everyone fairly, by having a clear and fair process for making decisions. Research shows that people actually care more about the process than the outcomes, and they will accept an outcome they don’t like if the decision is fair. Favouritism has no place in a people-centred business like social care.

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May/June 2019

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Are your resident contracts fit for purpose?

2017 saw the Competition and Markets Authority (CMA) conduct a survey of care homes to determine whether residents are being treated fairly by providers.


ate 2018 saw the issue of an open letter to providers, coupled with short form and more detailed advice, reminding providers of care homes of their responsibilities under consumer law and urging providers to review their contracts urgently. Changes to contract terms and business practices may be necessary, otherwise the CMA, working in conjunction with trading standards, may look to take action against providers if they are found to be treating residents and their families unfairly and are breaking the law. The CMA has already taken action against providers who charged compulsory upfront fees or continued to charge for extended periods after a resident’s death.

The new guidance sets out:

• What upfront information to give to potential


residents and when, including an indication of likely fees and highlighting any special important or surprising terms – do you require a deposit? Do you charge extra for a member of staff to accompany a resident on a hospital appointment? H ow to ensure contract terms are fair – do you have a trial period? How often do you review your fees? Are fees payable when a resident is absent from the home? How long are fees payable for after death / how quickly must a room be emptied? How to ensure residents and families are treated fairly – what notice periods apply (on both sides)? In what circumstances can you ask a resident to leave? H ow to handle complaints fairly and ensure your complaints procedure is easy to use.

HERE TO HELP Hempsons specialist social care team can review your contracts and business practices and ensure you don’t get caught out.

Contact: Philippa Doyle, e: or tel: 01423 724028





Should an employer face liability for injuries suffered by an employee assaulted by a service user to whom the employee was providing care, asks Nicola Hyam, partner at DAC Beachcroft LLP

his question arose in a recent case Shaw v Northumberland County Council. Shaw, the claimant, was engaged to provide care and support to service users. She noticed a service user who had moved toward a perimeter fence, and, as the service user was hard of hearing, touched him gently on the shoulder in order to attract his attention and suggest that he return to the building. Without warning, the service user struck out at the claimant and threw a mug into her face, causing her facial and psychological injuries. The claimant presented a claim on the basis that her employer had breached its duties to her and had not provided her with sufficient training. The claim was defended to trial at which the claimant conceded, in evidence, that the incident occurred very quickly and without warning, and that she had been trained in intervention techniques, albeit she asserted

that she had not received adequate training as she had not been trained in dealing with an assault coming from the side. At trial, the judge decided that it was not foreseeable that the service user would act in a violent manner in response to his being touched on the shoulder (there being no history of violent behaviour in 11 years), and that the incident was unforeseeable. He concluded that the claimant’s training had been adequate, and, in any event, as the claimant had not perceived a risk of violent response when she touched the service user on the shoulder, the provision of further training would not have prevented the incident. The claim was dismissed. This claim is a helpful reminder that incidents can occur, and that their occurrence is not evidence of breach of duty. Whilst the incident was unpleasant for the claimant, the fact that she suffered injuries does not establish her entitlement to compensation.

More information on this case is available online via

Briti sh Mad e

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May/June 2019






Care homes have a key role to play in helping residents and their families prepare for death. By Roger Daniel, CEO Red Homes Healthcare


and Care England, which consider that good homes don’t just concentrate on the person living in the home, but also on the people who matter to them. CQC inspectors will consider how family and friends are treated as part of their assessment of services: they will want to see an open and inclusive culture and a key aspect of that is for residents to be able to be surrounded by the people they love when they want to be. The best homes welcome family and friends, value their insights and treat their feedback as the gifts to inspire improvement that makes a difference for everyone involved.

eath has always been (and will probably remain for the foreseeable future) something we avoid talking about: fear, or the fear of upsetting those closest to us are often the reasons why. But in the care home environment death is a large part of the experience, and the best way to help families cope is by encouraging them to plan, and to make the end of their loved ones’ lives as comfortable as possible. This helps them to treasure last moments, rather than fear them.

The importance of planning

When families plan for death, it can often provide some relief. Helping them to consider the legal and financial matters takes away a lot of worry around logistical arrangements, which can sometimes be uncomfortable or cause disputes. It’s also important that the resident, their families and the care team have discussed the resident’s preferred end of life care.

It’s important that the resident, their families and the care team have discussed the resident’s preferred end of life care 16 Care Home MANAGEMENT

DYING MATTERS WEEK 2019 A resident’s family knows them better than anyone else, and if the time comes that they can no longer express their wishes, those closest to them will play a large part in deciding the next course of action.

In 2019, the Dying Matters campaign (May 13-19) asks the question: Are We Ready? It’s a question that challenges each of us on several levels, and it highlights that to face death and dying is a challenge greater than any one of us can face alone. Questions to be asked during the week include:

Get involved

• Are We Ready to help others get their affairs in order?

John’s Campaign [online at: www.] invites care homes, as well as other organisations, to pledge to support all people’s rights to be supported by their loved ones. Currently, there are 880 care home signatories. This position is supported by the CQC

• Are We Ready to help people we know who are caring for someone who is dying? • Are We Ready to support someone who is grieving? • Or even something as simple as “Are We Ready to talk about it?”



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

Knights’ Grove Care Home, (Bupa) Southampton Effective:


What Knights’ Grove did: Effective

Staff received regular support and training. To encourage staff to see care as a ‘career’, the provider developed a staff development scheme called ‘Flying High’, which enabled staff to visit other homes owned by the provider and undertake additional training and development. People and visitors were actively involved in care assessments and reviews and a member of staff attended visits by other healthcare professionals, to ensure accurate information transfer. Staff proactively considered health improvement. Dementia-friendly food options were introduced, including finger foods, extra snacks and supplements; confused residents received a bum bag of snacks to take with them, to increase their nutritional intake. Residents could comment on how rooms were redecorated, adding personal touches while incorporating best practice guidance for people with dementia.

What Knights’ Grove did: Caring

Staff took time to introduce themselves to people at the beginning of each interaction and did not assume that people could remember who the staff were or what their role might be. There were many examples of staff “going the extra mile” for the people living at the home, May/June 2019



for example, sourcing a birthday card signed by a resident’s favourite football team. People and staff had also introduced a project called, ‘Never too late’, to encourage people to fulfil life-long ambitions. Staff had a very good understanding of people’s histories and used this information to inform activities, conversations and other interactions.

What Knights’ Grove did: Responsive

The numbers of activities managed by staff, or the hours they worked, were flexible and adjusted according to the programme of events and activities each day. Activities were reviewed to support improvement. People were also given ‘choice boards’, to inform activities, as well as the menu. Staff had developed good relationships within the wider local community. At Christmas a market stall was set up with items for residents to choose and give to their loved-ones, including those residents who could not leave their room. The service worked with people and staff to ensure that people were treated equally and were respected. Examples included acknowledgement of same-sex relationships, physical disabilities and use of foreign languages

for non-English speaking residents. Staff also created an end-of-life comfort box of useful items, such as moisturisers and creams. Relatives and friends of people living in the home were also supported via a group.

What Knights’ Grove did: Well-led

There was a very strong emphasis on continual improvement, through polling of a wide range of views, including relatives and external health and social care professionals. Communication media include: informal conversation and a daily head of department ‘huddle’; formal care reviews; residents’ and relatives’ meetings and quality assurance surveys. Feedback was given to people through a system known as “You said, we did”. The home engages in trialling new projects with the CCG and can show high staff engagement scores. The registered manager had a strong focus on developing a permanent staff group and teamwork. Staff were supported to adopt the provider’s principles and values, and there were in-house staff recognition rewards. More information on Bupa Knights’ Grove care home is available [online] at: sites/default/files/new_reports/INS22723722041.pdf



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 Private Medicare Limited (PML) SUMMARY: Mrs B complains about the way the care home handled the ending of her mother’s residence in a care home. She says that it affected her mother’s wellbeing, her abilities declined and she had to move to another care home. The home failed to provide and retain a copy the contract, to inform the family of the emerging concerns about Mrs C’s mental health, to provide proper notice of the termination of the contract and there were errors in the complaint handling.


The home failed to provide and retain a copy the contract, to inform the family of

the emerging concerns about Mrs C’s mental health, to provide proper notice of the termination of the contract and there were errors in the complaint handling


• Mrs B complains on behalf of her mother Mrs

C. Mrs C was living in St Mary’s Care Centre. Mrs B complains about the way the home handled the ending of her mother’s residence there. She says the home didn’t warn the family it could not manage her mother’s behaviour or provide the care she needed.

• She complains also about aspects of the

standard of care provided. She says that as a result it affected her mother’s well-being, her abilities declined and she had to move to another care home

Read the whole decision [online] via the link:



The specimen contract PML has provided says that notice of the termination should be given in writing with four weeks’ notice. This did not happen. No written notice was given. That is fault. A wider concern is that the family had no knowledge that the home had found Mrs C’s mental health to be declining. The home’s care records show that when the care plan was reviewed staff had sufficient concerns to note that if Mrs C’s behaviour continued to decline then closer monitoring with the use of behaviour charts would be needed. The family were not told of these emerging concerns. The first the family were aware was when the decision was made several months later that the home could no longer meet Mrs C’s needs. This was wrong. The family should have been told of the concerns as they became an issue. There are also concerns about the potential loss of a report containing details of Mrs C’s behaviours. The provider considers that the possible loss of data does not meet the threshold for reporting the breach to the

Information Commissioner. Mrs B has been informed that if she is concerned that there has been a possible loss of data then she can raise that with the Information Commissioner.


WHEN AND TO WHOM? The GDPR defines personal data breach as ‘a breach of security leading to the accidental or unlawful destruction, loss, alteration, unauthorised disclosure of, or access to, personal data transmitted, stored or otherwise processed’ (Article 4(12)). Article 33 obliges the data controller to notify a personal data breach to the supervisory authority (determined in accordance with Article 55) only when it is likely to ‘result in a risk to the freedoms and rights of natural persons.’ The breach resulting in a risk to the freedoms and rights of data subjects also has to be communicated to the data subjects affected (Article

May/June 2019

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AGREED ACTION/S The provider has already provided financial compensation to the family. The provider will apologise to Mrs B for the faults found. 34, subject to several exceptions). The notification has to be made ‘without undue delay’ and up to 72 hours after becoming aware of it. If the notification to the supervisory authority is not made within 72 hours, it must be accompanied by reasons for the delay.

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SPACE has given the Richmond Hall team a real voice in residents’ care

RICHMOND HALL’S ‘LIGHTBULB’ MOMENT Taking part in a local quality improvement project has revolutionised life for the staff and residents of Richmond Hall care home


aren Beale, manager of Richmond Hall care home in Walsall, says it was a ‘lightbulb’ moment when she saw how quickly residents’ behaviour could change as a result of changing their fluid intake. Staff were able to make the link because they were auditing fluid intake using the quality improvement tools developed by local clinical commissioning groups and a Trust as part of the SPACE (Safer Provision and Caring Excellence) quality improvement (QI) project. She says: “If we had never started collecting the data, we would never have known.” The SPACE project was rolled out into local care homes by Walsall and Wolverhampton CCGs and the Walsall Healthcare Trust in January 2017, and the two-year project is now in its evaluation stage. Researchers say that as a result of the SPACE initiative quality improvement tools, around 1,000 care home managers and staff have been able to improve their day-to-day practice, particularly in the realm of safety processes and in the safety culture of the participating homes. (see box far right for more information). 20 Care Home MANAGEMENT

SAFETY CROSSES A key element of the SPACE programme is the use of safety ‘crosses’, a calendar-type tool that allows staff to document resident data daily, for example, hydration status. By cross-referencing with other safety crosses, for example, incidence of challenging behaviour/ need for sedation, staff were able to see connections and call in healthcare professionals as needed, for example, GP review. As a result of the improved health outcomes, among other improvements, Richmond Hall has substantially reduced the number of falls. “Wow!”, said Beale, who manages the 64-bed (25 for dementia) care home on the outskirts

of Walsall. “We felt that as a Good (rated) home, we didn’t need to improve; that we didn’t need anyone to tell us what to do. But when we started looking at the safety crosses we realised that we had an issue with hydration after all.” EMPOWERING STAFF Initially, it was peer pressure from other participating homes that encouraged staff to adopt the initiative, as well as the enthusiasm of the home’s management and the project developers. In recognition of her efforts, last year Beale was awarded SPACE nursing home manager of the year. But since adopting the initiative, Beale says that staff have become their own best advocates of change. As well as improving residents’ health outcomes and quality of life, the SPACE QI tools have empowered staff to take a more active, informed role in residents’ healthcare. She says: “They see the crosses as giving them a ‘voice’ in discussions about a resident’s care. Nurses no longer feel like second-class citizens to their NHS colleagues;


Elegant dining adds to residents’ dignity

Plans are underway to transform the garden into a dementiafriendly space

carers say that they now feel part of the home, and part of the nursing family.” She says that using the safety crosses has encouraged staff to engage with incident reporting and audit, which has been well-received by the CQC. It has also led staff to think more widely about safety determinants in the home, and has led to improvements such as reduced interruptions during medication rounds. Beale says: “SPACE has given staff the confidence to respectfully challenge and it has given them professional satisfaction that they are as important as other members of the care team. Relationships between nurses and carers are better and we’ve had positive feedback from families. I’m really proud of my staff.” POST-EVALUATION FUTURE In today’s climate of financial and political uncertainty in care, it is not clear whether the SPACE project will continue in its current form. However, Walsall CCG has indicated some support for extending QI support to local residential as well as nursing homes. Across the West Midlands region, the Academic Health Science Network (AHSN) will champion continued take-up of the SPACE model within its safety service specification. Caroline Maries-Tillott, WMASHN quality improvement lead, says: “This is fantastic news for care homes. The sector is characterised by high workloads, high staff turnover rates, and difficulties in recruiting and retaining skilled staff May/June 2019

which pose challenges for quality improvements. Quality and safety in care homes regionally and nationally is an issue of increasing concern.” Locality developments aside, at Richmond Hall there is every intention to keep going with the SPACE QI model. Care is a challenging business, Beale admits: “Nursing homes are now ‘mini-hospitals’. Increasingly, people are frail and can be acutely ill, yet we don’t have a GP at the end of a bleep. Neither do we have the funds to look after elderly people as they deserve: we are seeing residential clients that really should have nursing packages.” SPACE fits neatly into the local demand management pathway by managing frailty and ill health at home, avoiding admissions, Beale believes. To cater for this growing care home population, Richmond Hall has developed ‘virtual wards’ of highly dependent people who receive specialist care designed to prevent avoidable admissions. The home is also planning to develop an annex of 26 additional beds, possibly for dementia care, as well as to revamp the outdoor space to create a secure dementia garden. Beale says the improvements are all part of a renewed home ethos to improve which has been encouraged by the SPACE project. She says: “In the beginning we didn’t think that we needed to improve but now we think: ‘What can we do to make things even better?’ At the end of the day, all we want are happy, healthy service users. If they are 100 per cent safe, we can’t ask for more.”

SPACE: What it achieved

SUMMARY: Overall, SPACE was successful: care home managers and staff reported numerous benefits, quality improvements and changes to their day-to-day practice, and there was clear evidence of widespread change to safety processes and safety climate in participating care homes. AVOIDABLE HARMS: there were encouraging reductions in a number of avoidable harms: rates of falls and UTI rates, grade 4 pressure ulcers, and in the incidence of ‘any events’. SAFETY PROCESSES: Care homes increasingly saw the collection and interpretation of their own data as a means of facilitating QI and monitoring their effects, and tools were used to improve communication between care home staff and outside agencies. There was widespread involvement in external and care home-based training, and reports of improvements to teamwork, communication and sharing of best practice. SAFETY CLIMATE: • All staff engaged in QI initiatives • Staff were empowered to suggest ideas and gained autonomy to implement changes and liaise with external agencies • Improved use of data to support QI • A growing culture of information sharing within and between care homes e.g. staff attending training cascading learning to others



Focus on Urinary Tract Infections

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 and symptoms of urinary tract infections?

Urinary tract infection (UTI) is an umbrella term for infections affecting any part of the urinary tract. The most common type is lower UTI, also called cystitis. This is an infection of the bladder. Signs and symptoms include: • Pain when passing urine • New groin pain • New frequency or urgency of passing urine • New incontinence • New or worsening confusion • Higher temperature than usual • Blood in the urine • Cloudy looking urine Sometimes, the infection travels higher up the urinary tract to affect one or both of the kidneys. This is called an upper UTI or pyelonephritis. This is more serious than a lower UTI. Signs and symptoms include: • Pain in the side(s), back or under the ribs • Muscle pains or flu-like illness • Nausea and vomiting

Q: Why are UTIs important to treat? With any infection it is important to think of sepsis. Sepsis is a life-threatening condition caused by an overwhelming response of the body’s immune system to the infection. The risk of developing sepsis is higher in those aged over 75 years, those who are frail or have an impaired immune systems or diabetes, and those with pre-existing urinary tract conditions. Signs and symptoms include: • Altered behaviour 22 Care Home MANAGEMENT

• Drowsiness • New or significantly worsening confusion • Significantly reduced mobility • Not passing urine or significantly reduced output through catheter • Mottled or pale looking skin • Shaking chills (rigors) or perfuse sweating • Fever (>37.9oC) or low temperature (<36oC) • Fast breathing or short of breath (>24 breaths per minute) • Fast heart rate (>130 beats per minute) • Low systolic blood pressure if available (<90 mmHg or more than 40 below normal)

antibiotics and if used, ideally without a catheter in place. If a catheter is required, ensure the mid-stream sample is taken immediately after the catheter is sited. The sample is important because there is a high incidence of antibiotic resistance in care home residents. Ensure the resident is well-hydrated and provide adequate analgesia.

Q: What should I do if I suspect someone has a urinary tract infection?

Q: What should I do about recurrent UTIs?

If there are any signs or symptoms of sepsis, or the resident is very unwell or unable to maintain good hydration, then you should call 999 for urgent hospital review, as admission is likely to be needed. If a UTI is suspected, seek the advice of a clinician, either the resident’s GP or out of hours service. Men, all people aged 65 years or over and all those at high risk of developing sepsis should receive an antibiotic. A recent study of UTIs in those aged 65 years and over [online at] found a significantly higher rate of bloodstream infection, hospital admission and mortality when antibiotics were not given or delayed. Take a mid-stream urine sample for culture as soon as possible, preferably before starting

Q: What can I do to reduce the risk of urinary tract infections?

It is important to ensure residents remain well-hydrated. Nice also recommends good toilet hygiene such as wiping ‘front to back’, and regular visits to the loo. Catheterisation should be avoided where possible, and if not, supported by good aseptic technique.

Speak to the GP if the resident experiences two or more UTI episodes within six months or three or more in a year.

Q: What are my responsibilities?

All health and care staff have a responsibility for preventing, identifying and managing infections appropriately. Infection prevention guidance includes the development and audit of appropriate policies for infection prevention and management, and antibiotic stewardship. Technology and computerised data analytics can support compliance. With thanks to to Fiona Fiona Headley, Headley,KTP KTP With thanks Associate – Cardiff University, and Associate – Cardiff University, and Invatech Health, for this article

Invatech Health, for this article



HYDRATION Keeping residents hydrated is important, but it can be fun too. By Repose OT service


he risk of dehydration is much higher with older people, rising even higher when the person also has dementia. The reasons may include that people may simply forget to drink; they may not recognise the cup or glass as something to drink from; thirst signals from the brain can be altered with dementia; various medications can exacerbate dehydration, particularly diuretics and laxatives; people may be concerned about incontinence.

SIGNS OF DEHYDRATION • The person is warm to the touch • The person seems more confused than usual • Lips appear dry and/or cracked • The skin is a lot drier than usual and may peel or shed

If dehydration is not recognised or treated in a timely manner residents can find themselves at increased risk of a hospital admission or even, death. Even with mild symptoms, cognitive function can be impaired, affecting mood and motivation. Physically, individuals can become weak and dizzy and at increased risk of falls. Pressure sores and skin conditions, urinary tract infections and acute kidney injury are also possible. • The person may complain of headaches • A person’s blood pressure is lower than usual • A person’s pulse is faster • The person’s urine appears darker and has a strong odour • Eyes can become sunken


• Provide staff training regarding the importance of hydration • Provide a daily fluid intake goal for the individual • Make available the individual’s preferred fluids • Ensure fluids are available all the time • Ensure the drink is appealing visually as well as the taste • Ensure fluids are actually offered or given to the person regularly throughout the day • Use opportunities at specific points of the day such as routine appointments or activities • Make it an event – see Dementia UK’s ‘Time for a cuppa’ resources online via the link • Make available a variety of fluids, some hot and cold • Provide some assistance if required or suitable receptacles/drinking aids • Always give a full glass of fluid with any medications to be taken • Put up notes or reminders • Make the process easier and more visual – put a jug of water and glass out • Include hydrating foods in diet.

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May/June 2019


DISCOVER HOW TO LEAD WITH PASSION AT THE CARE FORUM Register now for the Care Forum – which takes place on June 10th & 11th at Whittlebury Hall, Northamptonshire It is entirely free for senior care professionals to attend and will provide unrivalled business building via a series of pre-arranged meetings with solutions providers, as well as plentiful opportunity for networking. In addition, access to a series of insightful seminar sessions is included with each free VIP ticket, with the current line-up of presentations including: How To Change The World, presented by Martyn Sibley, World Changer, Disability Horizons. From serious spinal fusion surgery to managing a team of Personal Care Assistants at University; life with SMA has never been straight forward for Martyn Sibley. He’s gone on to change the world for others, and wants to show you how. Leading With Passion, hosted by Craig Goldblatt, Leadership Speaker, Coach and Philanthropist Craig believes that the development of our culture in business is key and that when we ensure our personal beliefs and values are strong, we see immense business growth.

Investigating Your Pressure Ulcer Incidents – Root Cause Analysis – What Next? Presented by Siobhan McCoulough, Tissue Viability Nurse Specialist – Clinical Support Manager OSKA Completing internal root cause analysis is a standardised practice for pressure ulcers. Where it may be a tool to highlight themes and gaps, how do you implement and sustain improvement plans? The Learning Landscape, presented by Rob Newby, Director of Sector Development – Skills, Skills for Care & Jane Brightman, Project Manager, Skills for Care Learning and development is vital for social care workers but employers face a bewildering choice. What are the skills and knowledge that a 21st century workforce needs to provide excellent care. Just 65 VIP places are available for care professionals, which also include overnight accommodation, all meals and refreshments, plus and invitation to our networking dinner with entertainment.

To register your place, head to For further information or for our supplier packages, contact Lisa Rose on 01992 374077 /


HOT OR NOT IN 2019? What will I learn from this feature? What buyers are looking for in a care home

Want to know where to pick up a care home bargain? Michael Hodges, managing director of healthcare consultancy Christie & Co shares a few tips

May/June 2019


ver recent years, the elderly care sector in the UK has become a core area of focus for an increasing range of investors. This interest has been reinforced by challenges in other property sectors such as high street retail where technology and online alternatives have been notable disruptors. In contrast, the need-driven fundamentals of the care sector make it a far more resilient alternative. However, there is a perception that investors will only focus on care businesses in prime locations, in the home counties and the South East, with weaker appetite for those in other areas of the UK. It is certainly fair to say that most new care home developments have been focused on locations where there is good private pay potential, driven predominantly by the economics of the investment. Putting it into perspective, the cost of building a new care home, excluding land, is likely to be in the order of £100,000 per bed, and when land and other costs are factored in, a total figure of up to £150,000 per bed is not uncommon.

To make such a development worthwhile, the new care home generally needs to be able to trade at over £15,000 per bed at the absolute minimum. This requires the facility to be located in an area where there is good localised demand, underpinned by sufficient wealth, to attract a high proportion of private fee-paying residents and, equally importantly, a supply of labour which enables care to be delivered in a cost-effective way. These factors, combined with the nature of the competitive landscape surrounding the home in question, are crucial drivers of informed investment decisions. They also help to explain why investors and developers are now expanding their focus to a much wider geographical area than the original key hot spots around the South East. OUTSIDE THE SOUTH EAST We are now seeing new care homes developed in a range of locations across the UK although, given that building costs remain largely fixed, irrespective of location, these homes are mostly situated in areas of sufficient demand Care Home MANAGEMENT 25


and affluence to achieve the required performance metrics. New build homes in these strong markets are proving very attractive for institutional investors and, with an increasing range of operators looking at leases as a cost-effective way of achieving growth, yields continue to compress. Super prime assets let to the strongest covenants (propositions) are now trading at yields of around 4 per cent and, for specialist covenants, yields in the region of 5-6 percent are possible. The above begs the question, what is the market for locations which are less affluent and more reliant on funded clients? Generally, the answer is mostly positive: remember that building costs remain largely fixed, irrespective of location. In addition, the vast majority of UK care home stock consists of older assets with, generally,

It is certainly fair to say that most new care home developments have been focused on locations where there is good private pay potential, driven predominantly by the economics of the investment. different performance metrics to a premium end home built for the private-pay market. In a predominantly non private-pay market, a well-invested, older-style, purpose-built home may represent a real barrier to entry for new-build competitors. Another very important factor is the accessibility of the location to staff members, residents and their families who all value easy-to-reach locations. Asset (business) specific factors will include the specification of the home, its condition, the quality of the home’s assets and facilities, and the need for CAPEX (Capital expenditure or expense required to maintain, or improve the home’s fixed assets), scope for further development, regulatory compliance, financial performance, and the potential for adding value to the business. At the top end of the market, demand continues unabated for high quality assets in the strong private-pay locations with this reflected in the high prices typically achieved. Older homes or assets situated in less affluent locations remain in good demand, particularly if they offer an attractive price point. 26 Care Home MANAGEMENT

Care homes are a buyers’ market

Sameer Rizvi, Founder and CEO, private equity firm RD Capital

RD Capital Partners is among those to recognise the potential of the middle market. Sameer Rizvi, founder and CEO of the private equity firm RD Capital, believes that creating five-star hotel-style homes is extremely costly and may not produce a sustainable long-term revenue model that will survive business cycles. He says: “It costs so much money to build these that break even is often some years down the line. And you have to persuade people to pay £1500 to £2000 a week. They are the opposite of recession proof. People can always move to a cheaper alternative.” Instead, he is aiming for the middle market with homes that are attractive to both self-payers as well as funded places. The company’s home operator, RD Care, is on the look-out for purpose-built or converted care and nursing homes at reasonable prices, and which offer a good working environment for staff. All six of the company’s homes currently have “good” ratings with the Care Quality Commission or the Welsh equivalent. Also on the company’s shopping list are homes offering nursing and specialist dementia care as well as potential to expand: the company’s strategy is to grow to around 2,000 beds, particularly in areas such as the Midlands and in the South. Currently, the portfolio stands at 254 beds and employs 280 staff members, at a value of around £30 million (revenue: £9m). Mr Rizvi believes the climate is currently a buyers’ market. He says: “The sector has seen a decline in the non-corporate father-son or husbandwife style of businesses. It is becoming

increasingly difficult for these businesses to grow and stay profitable.” Similarly many of the institutional investors – private equity and real estate funds - who came into the market right after the last financial crisis are now at the end of their fund cycle and are contractually required to exit. Finally, there are a number of investors who acquired large care home groups pre-financial crisis, overpaid, borrowing substantially, and their debt is now looking unsustainable. Adding to this, of course, is the Brexit uncertainty. While care and nursing homes may not have the glamour of many other investment sectors, he believes there is an opportunity for those who can combine financial discipline with the ability to manage care quality well. “At the moment the sector is filled with either healthcare professionals who don’t understand their balance sheets or institutional investors who have got over-excited and overpaid,” he says.


Selling a care home is as easy as 1, 2, 3 1. Pre-marketing 2. Marketing 3. Progressing the deal


HOME FOR SALE Follow these steps for a pain-free care home sale. By Christie & Co care team members: Martin Gould, head of brokerage, and Julie Kitson, director


elling a care home is a major decision for business owners and it can be a stressful and emotional time. Expert advice is needed from an experienced agent, accountant and solicitor, who all have track records in the care sector. Firstly, the care home needs to be appraised. This determines an appropriate market price and kicks off the pre-marketing phase. The appraisal will include a review of the business financials, the building condition, and the trading profile, all of which contribute to the price achieved. This appraisal can also highlight things that could be improved to achieve a higher price. ATTENTION TO DETAIL Although it might seem simple, taking care of any minor refurbishment or outstanding items of capital expenditure (CAPEX) will help present the business in a much more attractive light. Make sure that the car park and garden areas are as tidy as possible, as this provides the vital first impression upon

May/June 2019

visiting a home. These all count towards showing that the business is well cared for and well-invested, and ultimately helps to get the best price. It’s important to remember that you are not just looking to appeal to your purchaser – you may need to appeal to their bank or financier as well. This means getting detailed management information together and up to date as soon possible. This provides the buyer and their financiers with a picture of how the business is trading now, and instil confidence in the quality of the operation moving forward. You will also need to produce an EPC (energy performance certificate) and, if applicable, an asbestos management survey. An accountant should be consulted to ensure that the structure of the sale, i.e. an asset sale or share sale (or a combination of both), is the most tax efficient disposal method. Your agent will be able to compile a buyers’ data pack that can be used alongside the sales details or information memorandum, which Care Home MANAGEMENT 27


provides a potential buyer with a full overview of the business. Ideally, this information should be shared prior to any tour of the business - but only after a potential buyer has signed a confidentiality agreement, to ensure that only serious buyers visit your home, limiting intrusion into the care home and any disturbance of its residents. ROLLING WITH YOUR RATINGS With regards to CQC ratings, it is no doubt preferable for a home to have ‘Good’ or ‘Outstanding’, however, good prices can still be achieved for homes which aren’t currently rated at these levels. Buyers understand that it is a highly regulated sector, so the key point is to be able to demonstrate how the service is improving on its most recent rating. Being transparent about an action plan that has been implemented and any local authority inspections that have taken place is paramount. The points considered at the pre-marketing phase of process are important as they feed into not only how a buyer views a home, but

also how a potential funder or bank will view the business as well. LET THE MARKETING BEGIN After all the hard work preparing the business for sale, it’s now time for your agent to present it to the market, starting the marketing phase. The aim is to make the right people aware of the opportunity and this will entail using a wide range of media: electronic mailshots, which send a direct email to a targeted network of operators or investors; advertising with trade publications; online advertising on the estate agent’s website, either on an open or confidential basis. As the enquiries roll in, the agent will assess the strength of a potential buyer’s interest and their buying position. This can be broken down into a review of their experience, their funding strategy, and the CQC ratings of their existing business, if applicable. When an offer is received, your agent will liaise between you and the buyer on all these areas, negotiating the best price possible for

you. At this stage, there may be more than one interested party, so your agent will advise on how to manage multiple offers. THE OFFER Once an offer is accepted, you move into deal progression, which hopefully ends with exchange and completion of contracts.Your agent will help you through the process, making sure that all parties are communicating in a timely fashion. If any contentious issues arise, they will be there to help you to resolve them. A buyer and their advisors will carry out detailed due diligence on the operational and financial sides of the business and their financier will want a valuation survey, and possibly a building condition survey. Once contracts are agreed and exchanged, the next step is completion (which sometimes happens simultaneously with the exchange). The CQC re-registration process can add some time to this stage although if the business is sold via a sale of the shares of the owning company, then generally speaking re-registration isn’t needed, as the registered provider is unchanged.

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CARE HOME SALE So, you’re selling up – but have you properly considered your staff? Read the advice of Peninsula associate director of advisory Kate Palmer


usiness transactions involving the purchase, and sale, of care homes generally focus on the financial and administrative requirements and one key factor that can often fall to one side is the home’s staff, and how they will be affected by a sale. In most cases, where there is the sale of a home as an ongoing business, staff are covered by the Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE). In practice, this means that any staff employed at the date of the sale, known as the transfer, will automatically move over to be employed by the new owner. The TUPE regulations protect staff’s existing employment rights and terms of conditions, which means they keep their original start date of employment and all other terms, including pay rates, holiday, working hours, etc. Staff, of course, do have a choice whether to automatically move over to the new care home owner. In this case, they can ‘object’ to the transfer and they should be treated as if their employment ends on the date of the transfer.

May/June 2019

Speaking to staff through the sale process and the transition is vital if both parties are to stop any feelings of uncertainty that may make employees feel unsure about their future and, perhaps, start looking for work elsewhere. New managers holding meetings with their transferred workforce to introduce themselves and set out their vision and aims for the company will reassure employees that they remain a key part of the home’s business.

Making changes

A new care home owner is likely to re-assess the structure, operations and practices of the home to see whether any improvements or changes are needed; simply putting these in place may cause undue friction or complications as staff struggle to adapt or

Speaking to staff through the sale process and the transition is vital if both parties are to stop any feelings of uncertainty

are hostile to change. Thus, a good manager will include employees in any review from the outset: meeting with staff; discussing the current and future practices with them; asking for their ideas and feedback can be key in helping to identify improvements that they support. Once a plan of action has been decided on, managers can consult with staff on how, and when, changes will be introduced. Sometimes, of course, changes to the business will mean changes to the rights/ terms and conditions of TUPEd staff. There may even need to be a reduction in the workforce. These changes can only take place if the new care home owner has an economic, technical or organisational reason for doing so. For example, an economic reason may be the loss of a contract which requires a reduction in the number of employees, eg, a redundancy. To ensure this is carried out fairly, the new home owner will be required to carry out a full and fair redundancy procedure to avoid any claims for unfair dismissal. Care Home MANAGEMENT 29



David Huckerby, director at PR and marketing company Conteur, talks care homes through some nifty PR and What will I learn from marketing techniques this feature?


ou can often gauge the feel of a care home as soon as you walk through the door.The challenge for providers has always come in trying to package this ‘feel’ and showcase it effectively to prospective residents and families. Equally, it is true that the care home sector is often misunderstood by the general public and this has led to a lot of negativity about the sector as a whole. For more information on the details, read the CHM Online exclusive feature on our website at Combine this with the rise of digital marketing and social media and it can be challenging to know where to put your time, energy and investment in trying to attract new residents. So, here are some techniques to help you showcase your home to prospective clients and their families.


It is vital to get a sound understanding of who your audiences are. Only by doing this will you be able to craft messaging and content


that will resonate with them. Whilst it will be your residents that you will provide care and support for, it is important to remember that they may not be the primary decision-maker in the process.You should consider the demographics of, and motivations for both the decisionmaker (a son or daughter for example) and the person who will actually be moving in. Smaller care home owners can sometimes worry when a big corporate plans to build a large new care home close by and the effect it may have on their business, but it’s worth remembering that different people will want different things from a care home and every home has its strengths and unique personality.


You will want to showcase your home’s unique strengths and give people a clear reason to consider your home. Being open, honest and consistent are the watchwords here – nothing frustrates people more than visiting a glossy website that shows off a fabulous establishment, only to arrive

How to make the most of local publicity opportunities

at a home that doesn’t bear even a passing resemblance to that advertised. Photos play an integral part in this part of the process. Real photographs of both your property and your people will give an honest account about life at your home, and they can show that you take real pride in who you are and what makes you special.Video content is a great way to showcase daily life at your home and what people can expect, breaking down barriers and reservations that prospective residents and relatives may have. People will be far more forgiving of a few bits of peeling paintwork if they feel they’ve been given a fair reflection of the home before visiting (and actually, some of the best homes around have zero curb appeal).


Your care home is an integral part of the community. It provides essential care to the older generation, just as the local school provides care to children.You’d think this was reason enough for everyone to know about you, but unfortunately modern day living generally means people are too busy to give too much thought to what is going on in their


local communities. It’s a sad fact that people only tend to pay attention to care homes when they are actively looking for one. PR (public relations) activities can help to build awareness of your care home and this is normally at a fraction of the cost of advertising. They can inform local communities of who you are, what you do and why you are making a difference to the lives of older people. Editors of local publications especially love stories that have a human-interest angle such as a resident with an inspiring past or a unique event that the home has hosted. Care Home Open Day on Friday 28 June is a great chance to open up your care home to your local community. The CHOD website, uk, has a wealth of resources to help home staff host events and meet the public on your own terms, exhibiting the virtues of your services, the commitment of your staff and the outcomes you provide for your residents and their families. On-going PR provides you with the opportunity to build a positive long-term perception of your home and will give you a definite advantage over your competitors. A home that a community talks positively about, combined with a host of good news stories, photographs and blogs, will be the one that stands out from the crowd.


Using social media is now the norm. It’s a fastpaced way to reach your community and the families of those in your care. Photographs, updates, latest news and advice and guidance all make for interesting posts for your followers, and potentially new audiences. There are a host of ways that you can use online presence to make your home shine. These could include video clips, thought leadership blogs, forum advice or community partnerships, but whatever you choose, it’s still important to keep it in line with your company values and the personality you want to convey as a home. It’s worth bearing in mind that social media channels are

The challenge is to package the ‘feel’ of your home and to showcase it effectively May/June 2019

Appleby House

Appleby House in Epsom has used the medium of Care Home Open Day to stimulate links with the local community. Adopting this year’s Open Day theme of ‘the role of arts in care’, the home has invited local organisations including the police, senior Council members and social services to design mosaic pillars in a ‘pillars of the community’ art project. It has also set up weekly intergenerational art classes involving both care home residents and local primary

increasingly leveraging advertising spend by controlling the amount of organic content they will show your followers, so make sure that your staff and home network are sharing your content to ensure it gains as much coverage as possible in the local area. Outside of the local area, you will likely need to consider some level of pay-per-click advertising to give your home extra visibility. This could be through Google AdWords, Bing, which has an increasing presence in audio searches, or social media. All of these enable you to carefully target your audience, which reinforces the need to understand who you

school children. Care home manager Shona Bradbury says inviting the press and posting pictures and articles on social media is a great way to introduce the home to a wider audience. She says: “It’s difficult to get people to come into a care home – why would people give up the time to do this. But if we make it interesting, and they leave with a good experience, that changes the way they think about us. Care Home Day is a day to challenge misconceptions and show ourselves off.”

want to be talking to. It’s also important to vary the content that you produce, as different audiences will consume information in different ways, so you don’t want to alienate a potential audience by always sticking to one form of media. Public relations, and the many activities that fall under its remit, should form an integral part of your overall marketing strategy. Ultimately, PR will build a positive image for your home, communicating key messages to your target audiences and protecting your reputation. Good public relations is not just writing a press release and receiving some coverage in the local news. It is about understanding your strengths and weaknesses, your values and missions, and the audiences you need to connect with. Care Home MANAGEMENT 31

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Challenges such as the ageing population and workforce shortages – estimated by the World Health Organisation to reach around 13 million by 2035 – will place a huge strain on health and care systems. But 5G technology, coming into use this year, could be the ‘great white hope’, says Richard Farrell-Smith, product marketing director at Tunstall Healthcare What will I learn from this feature? How the 5G network will change techenabled care

Getting the right information into the hands of the right people at the right time is essential for care May/June 2019


etting the right information into the hands of the right people at the right time is essential for care. It sounds straightforward, but large-scale digital transformation within healthcare has been anything but. The deployment of technology in healthcare has been cumbersome and piecemeal. Two decades into the 21st Century, and the UK’s public healthcare system (the NHS) is still the largest procurer of fax machines in the UK. This doesn’t mean technology and innovation don’t and can’t help. In fact, such is the potential of technology that data analytics and predictive analytics are set to become some of care’s most important assets. One example is telecare, the remote monitoring and management of health and social care, typically (but not exclusively) for the third generation. Today, around the globe most telecare is reactive, based on alarm response systems. However, future care will rely increasingly on proactive and personalised programmes. Health and care systems are spending more time looking at how they can make this work, because they know it is a path to better care management at a lower cost. The mechanics are simple. Proactive care programmes contact users and carers to support dayto-day living. The aim is to manage issues before they happen or become chronic in nature. If we can live independently for longer, our quality of life improves; we reduce the strain on carers, family and health care systems and we reduce the need for acute health and care services. Pilot testing in Spain,

which in many ways is ahead of the curve in telecare prevention, shows the potential to predict a fall with more than 80 per cent accuracy. This reduces one of the largest causes of hospitalisation in the elderly.


Today Radio Frequency (RF) is used for device communication, with cellular (3G and 4G) increasingly being used alongside ethernet connectivity for secure transmission to services. Bluetooth (BLE) and wi-fi also enable greater integration between third party devices and the care ‘hub’. Adding to these technologies, 5G will reduce ‘latency’, meaning it will take less time for signals to go from A to B. The potential impact of information flowing more quickly between devices and networks – which 5G will offer – is hard to understate: ultrafast mobile streaming will add more communication options; ultra-high data rates, energy efficiency and high reliability will offer greatly enhanced capability. In the care environment, this could mean live streaming of high data volumes, real-time analytics including predictive analytics, and the ability to directly feedback real-time information and support to service users and their carers. Connectivity is a key enabler of proactive telecare. Telecare and telehealth technology have a dual role: to optimise existing technology, and to evolve new models of care using new technology, with the aim of transforming care-user experience. As an enabler of information-flow, 5G will be at the heart of this evolution. Care Home MANAGEMENT 33



SAFETY RECORD An outstanding home is one that keeps its staff as safe as its residents, says Dave Hewitt, sales and marketing director at Courtney Thorne


here residents are considered not only a risk to themselves but also to those looking after them, stakeholders are right to think about their duty of care. However, all too often the risk to staff becomes a secondary consideration – until, perhaps, a grievance situation arises. Many organisations will be well versed in de-escalation training and have personal safety strategies in place, for example, limiting lone working, establishing safe areas and the means to escalate and alert to problems as they occur. Technology may also play a part in helping care homes achieve outstanding ratings in the five CQC Key Lines of Enquiry: SAFE: Personal, door and attack alarms, tracking and location alerts and fall detection equipment all help to keep residents and staff safe. EFFECTIVE: Measuring and monitoring response times, understanding trends, knowing where staff and residents are


There can be significant cross-over between the functions of staff attack and nurse call systems, which should inform a manager’s choice of a single or dual functionality system: • Call buttons in fixed locations around the site • Wearable devices • Alerts (audible and visual) in multi-locations • Tracking and location finding • Fall detection

located, having this data available anywhere instantly, allows management to set goals for performance and continuously monitor how it’s being achieved. CARING: Carers feel safe and motivated in a work environment that is wellmanaged; having time to care becomes less of a luxury and more of a given. Being able to resolve residents’ concerns reduces challenging behaviours and reduces the number of critical events. RESPONSIVE: Accurate information on the volume and types of alarm calls made, and response times, allows managers to effectively allocate staffing levels. WELL-LED: A happy and motivated workforce, coupled with positive feedback from residents and their families, are signs that an organisation is wellmanaged.These organisations will usually have few empty beds, will be able to charge higher than average fees, resulting in profitability and success. • Logging all incidents • Logging tracking locations • ID tagging •A ccess control integration into CCTV • Data reports As well as functionality, user-friendliness is another consideration. Multiple devices require multiple chargers and charging points, and each has a size and weight implication for the user. Multiplicity also adds to the risk of loss and damage to equipment, as well as the purchase/running costs.


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What will I learn from this feature? The seven secrets of a sustainable laundry service



A well-run laundry is critical to a home with happy and healthy residents. But, increasingly, that laundry neds to be sustainable too, says Nicky Whittaker, national account manager at the professional division of Miele

May/June 2019

ustainability is fast becoming as important to a care home’s laundry service as cost effectiveness, efficiency and infection control. Get your approach right and your pocket, as well as the environment, will benefit. This is a point recently made by The King’s Fund, which notes that the NHS accounts for 25 per cent of public sector CO2 emissions in the UK. Given that the health and social care system is facing an unprecedented financial challenge, it says: “The concept of sustainability can be helpful in addressing both of these imperatives”. In a nutshell, innovative approaches improve efficiency from both a carbon and cost perspective, while maintaining or improving the quality of care. So how can every care home do their bit for the planet and realise the other benefits too? Unfortunately, it’s not simply a case of looking for laundry equipment with an ecosetting or reducing electricity consumption. It takes a holistic approach - and these ‘seven secrets’ show how.

Get the lowdown on load ratios Machine capacity can have a massive impact on the environment as well as the speed and efficiency of a laundry. Essentially, larger ratios mean more laundry per wash. This can be useful when washing large volumes of the same items, such as bedding or towels. Maximising output in each wash results in less water and energy consumption. However, it’s important to strike the right balance – overloading a machine can result in a less effective clean, meaning some items may need rewashing, counteracting the original benefits.


Polish up on programmes Most modern commercial washers and dryers come with a myriad of programmes and settings to suit every possible item of laundry. However, while these programme choices may seem all about the right care for different fabrics, or serving a specific purpose such as infection control, they play a vital environmental role too. If everything got washed using only a couple of programme Care Home MANAGEMENT 35


choices, it’s highly likely some are being washed at unnecessarily high temperatures, or for too long. The symptom of this could be excessive energy use. It’s important to make sure staff are well trained on the different programmes and settings.

Making it feel like home

Pristine laundry goes a long way to making people feel at home, says Liz Smith-Mills, expert advisory council member for P&G Professional


Make your machine last Electricity and water consumption aside, choosing a machine with a long lifespan and a good service record can help to reduce waste to landfill. But on top of this, Miele’s Nicky Whittaker: the longer a piece of laundry sustainability equipment lasts, the greater is good for the return on the investment. residents, the care When shopping for a home and the commercial washing machine, environment care homes could consider the input of raw materials used to make the appliance and whether the machine (or parts of it) can be recycled at end-of-life. The carbon footprint of parts is important, too; the fewer parts that need to be replaced, the less waste will be generated (making a smaller dent on the care home’s pocket too!)


Curb contamination A laundry may be running like clockwork and doing well in terms of saving money, energy and water, but what is it doing to the wider world? One key area of consideration for homes dealing with infection control is Water Regulations Advisory Scheme (WRAS) compliance [online at:]. Washing soiled items potentially places harmful infections and diseases in the water used by the machine. If that waste water can enter the water supply infection could spread. That’s where WRAS compliance comes in. WRAS compliant machines are designed to stop waste water backflowing into the water source, and all care homes are required to have WRAS compliant equipment.

Ensuring that laundered items aren’t left ‘too dry’ can be a great ally – both in terms of ease and eco-friendliness 36 Care Home MANAGEMENT

It’s the role of the hospitality industry to take care of people and create a ‘home away from home’ experience: anticipative service from friendly staff, clean, tidy and fresh smelling public and private areas and pristine laundry all go a long way to reassuring residents and their families that they’ve made a good choice in coming to you. There are five main areas of focus for the care home laundry service operator:


Moisture matters Ensuring that laundered items aren’t left ‘too dry’ can be a great ally – both in terms of ease and eco-friendliness. Residual moisture is a feature on some commercial dryers, which allows the user to leave a chosen amount of water moisture in the washing. This has the direct benefit of making items easier to iron than if they are bone dry. However, it also ensures that the laundry isn’t using energy unnecessarily by over-drying everything.


Longer lasting linens The sustainability of your laundry service covers more than just the running costs and effectiveness of the equipment you use: sustainability also includes the fabrics you are washing. If you can reduce damage to clothes, whether made of natural fibres or from man-made materials that may never fully decompose, by installing a ‘kinder’ machine, you can reduce your environmental impact still further.


Chemical considerations Using washing chemicals may seem intrinsically eco-unfriendly, however, take the right approach and washing chemicals become less of an enemy. For example, if you need to disinfect a laundry item, it can be more eco-friendly to use a chemical detergent than to rely on a high temperature wash. Add in a machine with automated dispensing and you will maximise your laundry eco credentials.


SOFTNESS OF LINENS AND RESIDENTS’ PERSONAL CLOTHING: this is key for comfort, as well as reducing the chance of bedsores


PLEASANT SMELLING SHEETS AND TOWELS: foul-smelling or bleach-tainted linens can have a negative effect on a resident’s mental and emotional wellbeing


STAIN REMOVAL: care homes will have to deal with challenging stains, and this requires careful choice of products that effectively remove stains whilst maintaining the whiteness of linens


DISINFECTION: there’s a difference between ‘cleaning’ and ‘disinfection’: disinfection is crucial for frail elderly people. Care homes must ensure the laundry detergents they use meet health industry standards and kill bacteria including MRSA and E.Coli.


MANAGEMENT AND HYGIENE: soiled laundry should be kept separately from clean laundry; colourcoded bags are helpful to differentiate between types of linen. Wet laundry should be dried quickly to reduce the risk of bacterial contamination and staff should wash their hands before and after handling laundry. Clean gloves and waterproof plasters to cover any cuts or wounds are musts.



Care home movers and shakers

Park House nursing home in Peterborough has taken on a new manager Mungwaluku Mupatu (pictured, right, with his team). Mupatu, a nurse, has been a clinical lead and care home manager.

Joining Beaumont Park nursing home in Biggleswade as manager is Colleen Brothers. Colleen began her career in women’s health, working as a midwife and a gynaecological nurse, and for the past 10 years, in the care sector. Beaumont Park is part of the Healthcare Homes Group. The new residential care home from Ideal Carehome in York will be managed by Rachel McNally. Handley House will provide a home for 66 residents. Michael Gledhill becomes general manager. Chrisi Williams and Geraldine Blow (left) have joined Borough Care as area managers. Like Williams, Blow has also been a Care Quality Commission inspector. Care South has appointed Aaron Whitehead (right) as its new director of residential care. Whitehead is a mental health nurse and has held several director level posts. Care South has also appointed Nick Fry, a chartered surveyor, as property director. Clare Silvester has joined Runwood Homes as head of quality and governance. Silvester’s previous role have included inspection management and quality improvement and resident-facing care.

Business partners

Care England debuts digital role Care England has appointed Daniel Casson as its first digital development executive.The post aims to connect Care England members with the NHS-funded digital technology engagement project, as well as exploring the role of technology in quality care. Prior to joining Care England Casson was head of business development at Jewish Care. Legal & General has made two senior appointments to its retail retirement business: Steve Ellis as CEO of Legal & General Retail Retirement Living Solutions and Claire Singleton, currently CEO of Legal & General’s Mature Savings business, and who succeeds Ellis as CEO of Legal

May/June 2019

& General Home Finance. Retail Retirement Living Solutions supports individuals with funding care they need for themselves or their elderly relatives and includes the Care Sourcer care ‘matching’ technology platform. Melissa Kershaw has joined Miele’s professional business as senior marketing manager in the UK. Kershaw joins from vehicle leasing company Arval. Water, air and hygiene management provider Clearwater has appointed Paul Wilson as head of risk assessment consultancy SafeCare. Paul has served over 14 years with Clearwater in sales and general manager roles. Research organisation Future Care Capital has welcomed four trustees to its board: NHS England lead for care experience and reducing inequalities Dr Neil Churchill OBE; assistive technology executive Lise Pape, marketeer Sylvia Lowe and businessman Joe Steel.


The Southern Care Show. Farnborough International Centre. May 14. More information online at: Dementia Action Week 20 - 26 May. More information online at: https://www.alzheimers.


The Alzheimer’s Show. Olympia, London. June 7-8. Free VIP tickets to the Care Forum including free accommodation at Whittlebury Hall, Northamptonshire, are on offer for senior care professionals visiting the Care Forum on June 10-11. For more information, contact Charlie Petre on 01992 374075, email The Residential & Home Care Show at Health+Care, ExCel, London.Wednesday & Thursday 26-27 June. Come and meet the Care Home Management team on Stand G36. Care Home Awards 2019 Winners announced at The Residential & Home Care Show on Thursday 27 June.

Care Home Open Day. Friday 28 June More information online at: http://www.


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 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 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 Sponsored by

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Research Charity partner

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BUILDING A BETTER FUTURE FOR CARE The Residential & Home Care Show returns on 26th - 27th June 2019 at London ExCel, it’s the event where owners, directors, CEO’s, head of departments, registered managers and senior management teams from care homes, dementia homes, nursing homes, care villages, extra care specialists, housing associations and all forms of home care providers gather to gain ideas, products and services to boost their business and improve levels of care.



Debbie Westhead Interim Chief Inspector for Adult Social Care CQC

Part of:


David Holmes Chairman Ashcroft Care Services

Paul Hayes Chief Commercial Officer Four Seasons Healthcare

Mike Smith Managing Director Trinity Homecare

Michael Hodges Director & Head of Consultancy Christie & Co

The Residential & Home Care Show is run in association with:

26 - 27 JUNE 2019 + ExCeL LONDON Organised by:

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