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Care Home MANAGEMENT www.chmonline.co.uk

July/August 2019 • ISSUE 80

MENTAL CAPACITY Don’t get caught out by changes in the law UP, UP… AND AWAY How to keep your lift safe

KITCHENS

Your kitchen’s role in rehab

FLOORING

Sustainable options: good for you; good for the environment

Quality Nurses

Handpicked by you www.florence.co.uk


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

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

SAVE TIME

FEEL SUPPORTED

DELIVER BEST PRACTICE

ENJOY PEACE OF MIND

Compliance & Quality Assurance Made Simple

Call 0333 405 3333 or visit www.qcs.co.uk to start your free trial today


WELCOME EDITOR’S LETTER

WELCOME

to the July/August issue of Care Home Management magazine

T Care Home Management July/August 2019

Issue 80

Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Podcast Presenters and Editors Steve Hemsley Alan Rustad Design/Production Emily Hammond emilyh@freelancedesignpro.com Published by S&A Publishing Ltd Hillside office, 9 St James Park, TUNBRIDGE WELLS TN1 2LG Tel: 01892 680670 Email: editorial@chmonline.co.uk sales@chmonline.co.uk Advertising Rebecca Randall Head of Sales Tel: 01892 538880 Email: sales@chmonline.co.uk www.chmonline.co.uk Copyright:

he Residential and Home Care show, part of Health + Care, is always an interesting event to visit. As the name suggests, it has a very wide exhibition and conference remit, covering not just residential care, but also home care and health care. For the past two years it’s also been an event that has supported the Care Home Awards (for which Care Home Management is the exclusive media partner). You can read all about the winners and the runners-up in this year’s awards in the free Winners Book, which we are delighted to include with this issue. There are so many good qualities and features about this year’s winners that it is very difficult to pick out any one stellar performer. But, what is clear from the entries – and indeed, from our visit to Heathlands Village in Manchester, one of five new Teaching Care Homes (see page 20 for more information) - is that residential care does not stand still. Delivering integrated health and care, which is the reasoning behind the wide remit of Health + Care, is very much the challenge of the day, and it is clear from some of the care propositions detailed by this year’s awards entries, that care homes are already facing up to a very different future world. First time award sponsor Legal & General also deserves praise for its joined-up, longterm and holistic thinking. Recently, the City institution was applauded by Evening Standard journalist Anthony Hilton1 for its £4 billion Future Cities business investment in Oxford. Future Cities is a Legal & General initiative that invests in urban renewal to generate long-term results from regeneration, clean energy, infrastructure, housing and

SME finance. Yes, of course, Legal & General expects a return on its money from this partnership, but it’s a deal set up to enable both parties, and all the people that depend on them, to win. How refreshing for social care, a world that has been so buffeted and bashed about by the collapse of private equity funding, to find itself such a forward-thinking business partner. Legal & General has set up a Retirement Living Solutions business and has invested in Care Sourcer, the UK’s first comparison and matching site for care needs. I can only wonder how long it will be before care home providers, residents and their families will be using Care Sourcer to challenge sub-optimal care placements recommended by authority and NHS commissioners? Of course, without an infinite pot of money it is difficult - sometimes impossible - to make optimal decisions and this is the environment in which the public purse holders find themselves. That much is clear from the annual ADASS budget report also published this month (see news page 6) and also on our website. So, it is with vague optimism that this issue goes to press amid specific promises from the prime ministerial hopefuls of extra funding for social care to come from the Treasury’s (admittedly, to date, very well-hidden) magic money tree. Scooping the 2019 Care Home Award for Best Single Care Home in a Group, Manor Lodge (Care UK) said that outstanding care requires “an open mind and an open heart”. In my opinion, an open Treasury wallet would not come amiss, either.

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.

July/August 2019

1Evening Standard article. Anthony Hilton. Care homes would benefit from L&G thinking cap [online] via the link https://tinyurl.com/yxzo7lzy

editorial@chmonline.co.uk

Ailsa Colquhoun Publisher/Editor

@Carehomemanage Care Home MANAGEMENT 3


Care Home MANAGEMENT

Contents

www.chmonline.co.uk

7  Eleanore’s Words to the Wise

Time to take the bull by the horns

8 Market Barometer

A new, behind-the-scenes look at your operating business environment

13 Leadership

Exploring the road to outstanding in the well-led KLOE

14 HR

Get to grips with performance management

16 Health

Best practice in oral care

17 Ask the Expert

How to have difficult conversations with residents’ families

18 Best Practice

The Ombudsman critiques a home’s record-keeping

20 Care Home Profile

Heathland Village brings integrated thinking to National Teaching Care Homes programme

22 Outstanding

See who’s made it into the five-star Outstanding club

BES

ALTH HE

RACT TP

37 People and Events

LEGAL

E IC

REGULARS

UITME CR

NT

ERSH AD

IP

LE

HR

RE

July/August 2019 • ISSUE 80

p16

See who’s on the move and where to go during July-August

NEWS 10 Digital Social Care

find out how and why you should get involved

FEATURES

LEGAL 24 The Mental Capacity Act – changes and challenges – and you

26 Social media – understand your role in supporting vulnerable adults

29 Deputies – how to get the best out them

KITCHENS 30-33 Using kitchens for rehab; keeping

your catering team happy; and all you need to know about fire and ice

p22

LIFTS 35 Up, up and away – and how to do it safely

FLOORING 36-37 Be green – sustainable flooring

solutions are coming to your home. Plus: get some flooring inspiration

p31

p26 4 Care Home MANAGEMENT

www.chmonline.co.uk


NEWS ROUND-UP

Wear your care badge with pride

Care Home Awards 2019 And, the winners are… VALERIE MANOR IN STEYNING, West Sussex, has been voted the best individual care home in the 2019 Care Home Awards. It is joined at the head of the pack by Manor Lodge (Care UK), which took the top honours in the category of ‘Best single care home in a group’ and The Albert Suites, LifeCare Residences, which came away with the prize for ‘Best new care home’. The winners were revealed at the glittering awards ceremony held during this year’s Residential and Home Care show, in London, on 27 June. New and familiar faces from the care home world were on hand to congratulate the homes for their excellence in practice and their well-deserved wins. One of the judges, Ailsa Colquhoun, editor of Care Home Management magazine,

said: “The standards really were very high this year. It is great to see care homes deliver such great care.” As well as the categories for individual care homes, the awards include categories for best care home group, and for specialist activities such as nursing care, care of young people, and special needs care. Equipment, product or product service suppliers such as OMI Mobi Interactive table/floor and Bidfood also took top honours in the best supplier awards. To read all about the winning homes and suppliers, please see the Care Home Awards 2019 Winners book, included free with this issue. Erratum: Highly commended in the category: Best for special needs care should read Satya Nivas, Adjuvo Care, and not as printed in the Winners book included with this issue.

Read more information visit: www.chmonline.co.uk/ care-home-awards-2019-and-the-winners-are July/August 2019

Care Home Management magazine is proud to support the CARE badge, a new initiative designed to celebrate care workers. Care badges were given out free to care home staff at the recent Residential and Home Care Show, part of Health + Care, at London ExCel. CHM editor Ailsa Colquhoun said she was delighted to be able to share badges with staff, who can use it to show their pride at being a quality care worker. She said: “The huge amount of work that is done by millions of care workers – paid and unpaid – often goes unnoticed and unrecognised. With the help of the CARE Badge we hope to change that.” The CARE badge is a joint initiative between Care Home England and everyLIFE Technologies. For more information: www.chmonline.co.uk/wear-your-care-badge-with-pride

CQC inspections will add bite to oral care standards THE CQC HAS PLEDGED to “step up focus on oral care in future inspections, after routine inspections” in 100 homes found that care home residents are not supported to maintain and improve their oral health. To help care homes, Care Home Management has published a Wellness Whistlestop on oral health on page 16 of this issue. In a new report, the CQC finds that most homes (52) had no policy to promote and protect people’s oral health. In addition: • nearly half were not training staff to support daily oral healthcare (47 per cent) • 73 per cent of care plans reviewed only partly covered or did not cover oral health • it could be difficult for residents to access dental care • 10 per cent of homes had no way to access emergency dental treatment for residents. For more information: www.chmonline.co.uk/cqc-inspectionswill-add-bite-to-oral-care-standards Care Home MANAGEMENT 5


NEWS ROUND-UP

NEWS ROUND-UP

New LPS legislation expected on Oct 1, 2020, DHSC confirms

Care homes prove more resilient than home care CARE HOMES HAVE been less affected than home care by financial pressures over the past year, according to latest feedback from councils. In the 16th annual budget survey from the Association of Directors of Adult Social Care (ADASS), six fewer councils reported care home closures in 2018-19, compared to the 58 councils which reported closures a year earlier. In total, the closures affected 1,173 people, a reduction of 922 people compared to 2017-18. A total of 12 councils had contracts handed back by providers, impacting 310 people, up from 292 people in 2017/18 (+6%). This compares to a 50 per cent increase in the number of councils experiencing home care closures – up from 48 in 2017-18 to 72 in 2018-19.These closures impacted 7,019 people in 2018-19, up from 3,290 in 2017-18 (+113 per cent). Home care contracts were handed back to 38 councils, impacting 3,464 people, up from 2,664 people in 2017/18 (+30%).

Care England wins DHSC pledge to review 2019/20 funded nursing care rate IN RESPONSE TO A threat of judicial review, brought by Care England (with assistance from David Collins Solicitors), the Department of Health and Social Care (DHSC) has agreed to reconsider the 2019/20 Funded Nursing Care (FNC) rate. It will now engage with Care England as part of that process. The concerns raised by Care England, which formed the basis of its legal challenge, addressed the following aspects: • The assumption that providers will not employ more than 10 per cent nursing hours through agency nurses

For more information: www.chmonline.co.uk/carehomes-prove-more-resilient-than-home-care

Half of adults are disappointed with care quality

ALMOST HALF OF people (48 per cent) are disappointed with the quality of care available and 88 per cent are shocked at the cost, new research shows. Three in 10 people are also worried that Brexit will add to their quality concerns. In its 2019 care report, retirement planning company Just Group finds that more than 3.5 million 75+-year-olds have not made plans for long term care (68 per cent), and that 51 per cent of over-45s are delaying making financial plans on long-term care until new social care policy is clarified. As a result, one in four self-funders are running out of money and will need State support. For more information: www.chmonline.co.uk/half-of-adults-aredisappointed-with-care-quality

• That providers are able to make efficiency savings of 3.1 per cent

• The approach adopted in the

calculation of inflation, limiting it to £1.40. Professor Martin Green, chief executive of Care England, said: “We hope … a new rate decision increases the current rate to that which properly reflects the costs of providing nursing to many thousands of people living in nursing homes.” Care England is now in discussion with DHSC about the terms and timings of the review and will keep members informed as to progress going forward.

For more information: www.chmonline.co.uk/care-englandsecures-dhsc-pledge-to-review-2019-20-funded-nursing-care-rate

Care homes called to act on substance misuse ‘ageism’ SUBSTANCE MISUSE ‘ageism’ is failing people taking opioid/opiates, a new report has found. It calls for care home staff to receive training in substance misuse, so that older people might receive the help they need. The report finds that upper age cut-offs in substance use services, a lack of specialist staff, and a failure to refer older adults for treatment are among the factors driving substance misuse in older people. High-risk drug users aged over 40 may soon become the largest drug treatment population in Europe, it warns, adding that the complex and varied needs of older opiate/opioid users will increasingly become a mainstream treatment activity. For more information: www.chmonline.co.uk/care-homes-calledto-act-on-substance-misuse-ageism

6 Care Home MANAGEMENT www.chmonline.co.uk

THE DHSC HAS confirmed its intention to implement the new Liberty Protection Safeguards system on Thursday 1 October 2020. Implementation is subject to progress towards developing the Code of Practice and regulations for this reform. Care minister Caroline Dinenage has said that the Government’s priority is to ensure this code delivers on providing detailed and easy to understand guidance. Following input from those “with lived experience” and a full public consultation, the final draft of the Code is expected to be laid before Parliament in spring 2020. The Department of Health and Social Care is working closely with the Ministry of Justice to align this work with the review of the Mental Capacity Act Code of Practice. For more information: www.chmonline.co.uk/new-lps-legislationexpected-on-oct-1-2020-dhsc-confirms

apetito signs food waste pledge

HEALTH AND SOCIAL care food supplier apetito has signed a pledge to drive down food waste in response to a government call to action. apetito joins over 100 of the UK’s biggest food brands, including all major supermarkets, who have signed up to halve food waste by 2030, and help raise public awareness of the issue through a week of action. A report finds that in the UK an estimated 10.2 million tonnes of food and drink are wasted annually, worth around £20 billion. Look out for food waste reduction tips in our Food and Nutrition feature publishing in our next issue, out in early September. For more information: www.chmonline.co.uk/apetito-signs-foodwaste-pledge

ELEANORE’S WORDS TO THE WISE

Time to take the bull by the horns By Eleanore Robinson, freelance social care journalist

First it was Brexit. Now it is the Conservative party leadership contest. Once the latter is decided, it is widely anticipated there will be a general election. So when will politicians get around to dealing with the funding crisis affecting many in social care? Despite a two-part Panorama highlighting the peril social care is in and the resulting impact on society, the Government is still sitting on its hands. There is no date for the publication of the Social Care Green Paper. And it is only a Green Paper, meaning it is just a consultation document, as opposed to a White Paper that actually sets out the proposals the Government intends to put into law. Added to this, is the fact that is the lack of public confidence that politicians across the board will take action. A survey of over-45s last month July/August 2019

(June) by Just Group found that just 20 per cent of people thought it was likely that Labour would set out a social care policy within two years of forming a Government, 17 per cent for the Conservatives and 14 per cent for the Liberal Democrats. So what to do? The mood among delegates at LaingBuisson’s Social Care Conference in May was that the sector can no longer wait. It is going to have to move forward by itself. This could be by starting small, for example, by wearing your CARE badge to highlight the importance of work in the profession and the key role it plays in society. Or, it could be something big by working with commissioners to find solutions that work for both parties, for example, sharing the cost of training staff. It could be by embracing simple, cheap and accessible technologies. One example is HC-One partnering up with

trade union GMB through its Careforce project, which aims to professionalise careers in social care and recognise the hard work carried out by the workforce.The project also intends to hold the Government to account where it fails to deliver policy that achieves this. Continuing to point out the Government’s lack of action while moving forward by yourself appears to be the only option at the current time. It’s time to take the bull by the horns. Care Home MANAGEMENT 7


NEWS ROUND-UP

NEWS ROUND-UP

New LPS legislation expected on Oct 1, 2020, DHSC confirms

Care homes prove more resilient than home care CARE HOMES HAVE been less affected than home care by financial pressures over the past year, according to latest feedback from councils. In the 16th annual budget survey from the Association of Directors of Adult Social Care (ADASS), six fewer councils reported care home closures in 2018-19, compared to the 58 councils which reported closures a year earlier. In total, the closures affected 1,173 people, a reduction of 922 people compared to 2017-18. A total of 12 councils had contracts handed back by providers, impacting 310 people, up from 292 people in 2017/18 (+6%). This compares to a 50 per cent increase in the number of councils experiencing home care closures – up from 48 in 2017-18 to 72 in 2018-19.These closures impacted 7,019 people in 2018-19, up from 3,290 in 2017-18 (+113 per cent). Home care contracts were handed back to 38 councils, impacting 3,464 people, up from 2,664 people in 2017/18 (+30%).

Care England wins DHSC pledge to review 2019/20 funded nursing care rate IN RESPONSE TO A threat of judicial review, brought by Care England (with assistance from David Collins Solicitors), the Department of Health and Social Care (DHSC) has agreed to reconsider the 2019/20 Funded Nursing Care (FNC) rate. It will now engage with Care England as part of that process. The concerns raised by Care England, which formed the basis of its legal challenge, addressed the following aspects: • The assumption that providers will not employ more than 10 per cent nursing hours through agency nurses

For more information: www.chmonline.co.uk/carehomes-prove-more-resilient-than-home-care

Half of adults are disappointed with care quality

ALMOST HALF OF people (48 per cent) are disappointed with the quality of care available and 88 per cent are shocked at the cost, new research shows. Three in 10 people are also worried that Brexit will add to their quality concerns. In its 2019 care report, retirement planning company Just Group finds that more than 3.5 million 75+-year-olds have not made plans for long term care (68 per cent), and that 51 per cent of over-45s are delaying making financial plans on long-term care until new social care policy is clarified. As a result, one in four self-funders are running out of money and will need State support. For more information: www.chmonline.co.uk/half-of-adults-aredisappointed-with-care-quality

• That providers are able to make efficiency savings of 3.1 per cent

• The approach adopted in the

calculation of inflation, limiting it to £1.40. Professor Martin Green, chief executive of Care England, said: “We hope … a new rate decision increases the current rate to that which properly reflects the costs of providing nursing to many thousands of people living in nursing homes.” Care England is now in discussion with DHSC about the terms and timings of the review and will keep members informed as to progress going forward.

For more information: www.chmonline.co.uk/care-englandsecures-dhsc-pledge-to-review-2019-20-funded-nursing-care-rate

Care homes called to act on substance misuse ‘ageism’ SUBSTANCE MISUSE ‘ageism’ is failing people taking opioid/opiates, a new report has found. It calls for care home staff to receive training in substance misuse, so that older people might receive the help they need. The report finds that upper age cut-offs in substance use services, a lack of specialist staff, and a failure to refer older adults for treatment are among the factors driving substance misuse in older people. High-risk drug users aged over 40 may soon become the largest drug treatment population in Europe, it warns, adding that the complex and varied needs of older opiate/opioid users will increasingly become a mainstream treatment activity. For more information: www.chmonline.co.uk/care-homes-calledto-act-on-substance-misuse-ageism

6 Care Home MANAGEMENT www.chmonline.co.uk

THE DHSC HAS confirmed its intention to implement the new Liberty Protection Safeguards system on Thursday 1 October 2020. Implementation is subject to progress towards developing the Code of Practice and regulations for this reform. Care minister Caroline Dinenage has said that the Government’s priority is to ensure this code delivers on providing detailed and easy to understand guidance. Following input from those “with lived experience” and a full public consultation, the final draft of the Code is expected to be laid before Parliament in spring 2020. The Department of Health and Social Care is working closely with the Ministry of Justice to align this work with the review of the Mental Capacity Act Code of Practice. For more information: www.chmonline.co.uk/new-lps-legislationexpected-on-oct-1-2020-dhsc-confirms

apetito signs food waste pledge

HEALTH AND SOCIAL care food supplier apetito has signed a pledge to drive down food waste in response to a government call to action. apetito joins over 100 of the UK’s biggest food brands, including all major supermarkets, who have signed up to halve food waste by 2030, and help raise public awareness of the issue through a week of action. A report finds that in the UK an estimated 10.2 million tonnes of food and drink are wasted annually, worth around £20 billion. Look out for food waste reduction tips in our Food and Nutrition feature publishing in our next issue, out in early September. For more information: www.chmonline.co.uk/apetito-signs-foodwaste-pledge

ELEANORE’S WORDS TO THE WISE

Time to take the bull by the horns By Eleanore Robinson, freelance social care journalist

First it was Brexit. Now it is the Conservative party leadership contest. Once the latter is decided, it is widely anticipated there will be a general election. So when will politicians get around to dealing with the funding crisis affecting many in social care? Despite a two-part Panorama highlighting the peril social care is in and the resulting impact on society, the Government is still sitting on its hands. There is no date for the publication of the Social Care Green Paper. And it is only a Green Paper, meaning it is just a consultation document, as opposed to a White Paper that actually sets out the proposals the Government intends to put into law. Added to this, is the fact that is the lack of public confidence that politicians across the board will take action. A survey of over-45s last month July/August 2019

(June) by Just Group found that just 20 per cent of people thought it was likely that Labour would set out a social care policy within two years of forming a Government, 17 per cent for the Conservatives and 14 per cent for the Liberal Democrats. So what to do? The mood among delegates at LaingBuisson’s Social Care Conference in May was that the sector can no longer wait. It is going to have to move forward by itself. This could be by starting small, for example, by wearing your CARE badge to highlight the importance of work in the profession and the key role it plays in society. Or, it could be something big by working with commissioners to find solutions that work for both parties, for example, sharing the cost of training staff. It could be by embracing simple, cheap and accessible technologies. One example is HC-One partnering up with

trade union GMB through its Careforce project, which aims to professionalise careers in social care and recognise the hard work carried out by the workforce.The project also intends to hold the Government to account where it fails to deliver policy that achieves this. Continuing to point out the Government’s lack of action while moving forward by yourself appears to be the only option at the current time. It’s time to take the bull by the horns. Care Home MANAGEMENT 7


MARKET BAROMETER

MARKET

BAROMETER

By Michael Hodges, Christies & Co managing director – healthcare consultancy

A

s I write this first column on the care market environment, I do so against the backdrop of Brexit uncertainty, the recent resignation of Prime Minister Theresa May and subsequent leadership race, and the arrival of Donald Trump in the UK on his first state visit.The phrase “we live in interesting times” certainly comes to mind when one reflects on these macro events and is also very appropriate to the current landscape in the social care sector. During the past month, the two holding companies of Four Seasons Health Care entered administration in a move to decouple the operational business from the burden of debt and facilitate the commencement of an orderly sale process.Whilst clearly any insolvency situation is disappointing news, many observers including myself see this as a welcome development as it will enable the business to be placed on a new, and hopefully more sustainable, financial footing, for the benefit of all concerned and the sector as a whole. Positively, market sentiment and investor activity remain extremely good, illustrated by the success of Impact REIT’s fund raise, which was materially oversubscribed and concluded shortly after the Four Seasons administration was announced. Along with these opportunities, the sector still has its challenges, most notably with local authority funding and staffing. Over the last four years, Christie & Co has undertaken an annual survey of

8 Care Home MANAGEMENT

operators and local authorities to gather benchmark data on these two critical topics, with this now commencing for 2019. It will be fascinating to see the outcome, particularly given the issues highlighted in the recent Panorama program by the BBC, and I will keep you updated on these findings over subsequent columns.

NEW

CAPABILITIES, ESTABLISHED EXCELLENCE From Gainsborough Specialist Bathrooms, the new name for Gainsborough Specialist Bathing.

As of April 2019

15,738

care homes

6.5%

down on January 2016

456,333 beds

1.2%

down on January 2016

NEW G360 SERVICES DELIVER: MANAGEMENT COST AND TIME SAVINGS

Specialist assisted baths Trusted enablement, installation and management Lifetime support and servicing

O

IMPROVED CQC COMPLIANCE

NEW Seamless transfer, washing and toileting solutions

info@gainsboroughbaths.com

© Gainsborough Healthcare Group. 10 & 11 The Oaks, Clews Road, Redditch, Worcestershire, B98 7ST.

GENUINE SUSTAINABILITY REDUCED HR PRESSURES

NEW Project design with vision

01527 400 022

ENHANCED BUSINESS FOCUS AND PERFORMANCE STRONGER SPECIALIST CARE

NEW Safe accessible bathrooms and wet rooms

Source: Care Homes: Closures: House of Commons written question [online] via the link: https://tinyurl.com/y3ukx749

www.chmonline.co.uk

MAXIMISING YOUR INTERNAL RESOURCES

REDUCED RISK AND LITIGATION

www.gainsboroughbaths.com


MARKET BAROMETER

MARKET

BAROMETER

By Michael Hodges, Christies & Co managing director – healthcare consultancy

A

s I write this first column on the care market environment, I do so against the backdrop of Brexit uncertainty, the recent resignation of Prime Minister Theresa May and subsequent leadership race, and the arrival of Donald Trump in the UK on his first state visit.The phrase “we live in interesting times” certainly comes to mind when one reflects on these macro events and is also very appropriate to the current landscape in the social care sector. During the past month, the two holding companies of Four Seasons Health Care entered administration in a move to decouple the operational business from the burden of debt and facilitate the commencement of an orderly sale process.Whilst clearly any insolvency situation is disappointing news, many observers including myself see this as a welcome development as it will enable the business to be placed on a new, and hopefully more sustainable, financial footing, for the benefit of all concerned and the sector as a whole. Positively, market sentiment and investor activity remain extremely good, illustrated by the success of Impact REIT’s fund raise, which was materially oversubscribed and concluded shortly after the Four Seasons administration was announced. Along with these opportunities, the sector still has its challenges, most notably with local authority funding and staffing. Over the last four years, Christie & Co has undertaken an annual survey of

8 Care Home MANAGEMENT

operators and local authorities to gather benchmark data on these two critical topics, with this now commencing for 2019. It will be fascinating to see the outcome, particularly given the issues highlighted in the recent Panorama program by the BBC, and I will keep you updated on these findings over subsequent columns.

NEW

CAPABILITIES, ESTABLISHED EXCELLENCE From Gainsborough Specialist Bathrooms, the new name for Gainsborough Specialist Bathing.

As of April 2019

15,738

care homes

6.5%

down on January 2016

456,333 beds

1.2%

down on January 2016

NEW G360 SERVICES DELIVER: MANAGEMENT COST AND TIME SAVINGS

Specialist assisted baths Trusted enablement, installation and management Lifetime support and servicing

O

IMPROVED CQC COMPLIANCE

NEW Seamless transfer, washing and toileting solutions

info@gainsboroughbaths.com

© Gainsborough Healthcare Group. 10 & 11 The Oaks, Clews Road, Redditch, Worcestershire, B98 7ST.

GENUINE SUSTAINABILITY REDUCED HR PRESSURES

NEW Project design with vision

01527 400 022

ENHANCED BUSINESS FOCUS AND PERFORMANCE STRONGER SPECIALIST CARE

NEW Safe accessible bathrooms and wet rooms

Source: Care Homes: Closures: House of Commons written question [online] via the link: https://tinyurl.com/y3ukx749

www.chmonline.co.uk

MAXIMISING YOUR INTERNAL RESOURCES

REDUCED RISK AND LITIGATION

www.gainsboroughbaths.com


TECH DIGITAL SOCIAL CARE

TECH DIGITAL SOCIAL CARE

to use when procuring new IT systems, as well as best practice for managing IT suppliers. The intention is not to be prescriptive or to set down hard and fast procurement rules, because providers have to be free to use their own systems. The aim is to get processes in place for care homes to be able to make the right purchasing decisions. This may include signposting to reviews and recommendations for certain digital systems/innovations.

Watch this (digital) space!

Digital Social Care is a new NHS Digital project to improve the use of ‘tech’ in care homes. Here, Daniel Casson, Care England’s newly-appointed and first ever digital development executive, and Katie Thorn, digital engagement manager for the Registered Nursing Home Association, explain why care home providers should watch the ‘digital’ space

GDPR In year one

Q: What is the Digital Social Care initiative?

A: Digital Social Care, which launched at the end of June, is a tangible first step in a two-year programme to encourage digital innovation in social care. The website, www.digitalsocialcare. co.uk aims to offer social care providers the resources and support they need to get to grips with the digital agenda and to share knowledge and insight of current digital possibilities.

Q: Why should I get involved?

A: Using NHS Mail, and being au fait with the Data Security and Protection Toolkit all put care homes on a par with health service providers, and it gets them round the table of integrated care delivery. On a practical level, engagement with the digital agenda enables homes to share knowledge and expertise, and avoid ‘reinventing the care wheel’. It also supports regulatory compliance, including

140,000+ queries and complaints logged

89,000+

data breaches logged

with data sharing legislation such as the GDPR. Rather than looking at tech for tech’s sake, the programme is about identifying and sharing effective solutions to challenges such as resource capacity constraints and how preventative/ anticipatory care tech and resident monitoring tech, etc, can help to free up resources. That’s the sort of ‘game-changer’ that we want to see.

Q: Who’s involved, and where is the money coming from for this? A: NHS Digital funding of

10 Care Home MANAGEMENT

33%

of European citizens say they have never heard of the GDPR. SOURCE: European Data Protection Board news online via the link https://tinyurl.com/ yxqxrhnc

Q: What’s next for the initiative?

NHS Digital funding of around £784,000 will support the project until March 2021

Q: Will this project mean I will need to replace all my tech?

A: The project remit includes the development of a core set of requirements for care providers

A: Look out, in late September, for the launch of a (provisionally titled) digital maturity assessment tool. This aims to help providers to assess their progress towards full

digital engagement. It’s a selfdevelopment tool for internal use, and it will link to other useful digital guidance and materials which Digital Social Care is developing.

Katie Thorn

around £784,000 will support the project until March 2021. Seven provider-led organisations are now developing national guidance to set the foundations for open digital standards within the sector. Participating organisations include: Care England; the National Care Association; the National Care Forum, the Registered Nursing Home Association; Skills for Care; United Kingdom Homecare Association and Voluntary Organisations Disability Group.

Q: Why now? What’s the urgency to get involved? A: As the NHS continues with its ‘axe the fax’ policy, digital communications are set to become the norm, and if care homes want to be seen as part of the team, they will need to get involved. Engagement with NHS mail varies as does healthcare professionals’ engagement with care homes, so this is an attempt to get everyone on the same page.

www.chmonline.co.uk

July/August 2019

Care Home MANAGEMENT 11


TECH DIGITAL SOCIAL CARE

TECH DIGITAL SOCIAL CARE

to use when procuring new IT systems, as well as best practice for managing IT suppliers. The intention is not to be prescriptive or to set down hard and fast procurement rules, because providers have to be free to use their own systems. The aim is to get processes in place for care homes to be able to make the right purchasing decisions. This may include signposting to reviews and recommendations for certain digital systems/innovations.

Watch this (digital) space!

Digital Social Care is a new NHS Digital project to improve the use of ‘tech’ in care homes. Here, Daniel Casson, Care England’s newly-appointed and first ever digital development executive, and Katie Thorn, digital engagement manager for the Registered Nursing Home Association, explain why care home providers should watch the ‘digital’ space

GDPR In year one

Q: What is the Digital Social Care initiative?

A: Digital Social Care, which launched at the end of June, is a tangible first step in a two-year programme to encourage digital innovation in social care. The website, www.digitalsocialcare. co.uk aims to offer social care providers the resources and support they need to get to grips with the digital agenda and to share knowledge and insight of current digital possibilities.

Q: Why should I get involved?

A: Using NHS Mail, and being au fait with the Data Security and Protection Toolkit all put care homes on a par with health service providers, and it gets them round the table of integrated care delivery. On a practical level, engagement with the digital agenda enables homes to share knowledge and expertise, and avoid ‘reinventing the care wheel’. It also supports regulatory compliance, including

140,000+ queries and complaints logged

89,000+

data breaches logged

with data sharing legislation such as the GDPR. Rather than looking at tech for tech’s sake, the programme is about identifying and sharing effective solutions to challenges such as resource capacity constraints and how preventative/ anticipatory care tech and resident monitoring tech, etc, can help to free up resources. That’s the sort of ‘game-changer’ that we want to see.

Q: Who’s involved, and where is the money coming from for this? A: NHS Digital funding of

10 Care Home MANAGEMENT

33%

of European citizens say they have never heard of the GDPR. SOURCE: European Data Protection Board news online via the link https://tinyurl.com/ yxqxrhnc

Q: What’s next for the initiative?

NHS Digital funding of around £784,000 will support the project until March 2021

Q: Will this project mean I will need to replace all my tech?

A: The project remit includes the development of a core set of requirements for care providers

A: Look out, in late September, for the launch of a (provisionally titled) digital maturity assessment tool. This aims to help providers to assess their progress towards full

digital engagement. It’s a selfdevelopment tool for internal use, and it will link to other useful digital guidance and materials which Digital Social Care is developing.

Katie Thorn

around £784,000 will support the project until March 2021. Seven provider-led organisations are now developing national guidance to set the foundations for open digital standards within the sector. Participating organisations include: Care England; the National Care Association; the National Care Forum, the Registered Nursing Home Association; Skills for Care; United Kingdom Homecare Association and Voluntary Organisations Disability Group.

Q: Why now? What’s the urgency to get involved? A: As the NHS continues with its ‘axe the fax’ policy, digital communications are set to become the norm, and if care homes want to be seen as part of the team, they will need to get involved. Engagement with NHS mail varies as does healthcare professionals’ engagement with care homes, so this is an attempt to get everyone on the same page.

www.chmonline.co.uk

July/August 2019

Care Home MANAGEMENT 11


LEADERSHIP GOVERNANCE & MANAGEMENT

OUTSTANDING LEADERSHIP:

Quality Nurses Handpicked by You

DO YOU HAVE WHAT IT TAKES?

In the second of this 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: GOVERNANCE AND MANAGEMENT It’s often said that a simple ‘thank you’ is a great place to start, but the more specific you can be with your feedback, the more impact you will have. The key is to identify and reflect in your commentary an individual’s strengths and values, particularly where their behaviours are in line with your vision.

Supervision and appraisal

Take control and handpick your staff from our pool of dedicated nurses and carers. Give your residents quality continuous care for 30-50% less.

G

overnance frameworks and risk management processes may be central to the Well-led Key Line of Enquiry (KLOE) and as an outstanding leader, the basics will already be in place: you are thoroughly versed in the CQC provider guidance book (see below, right); policies and procedures are up to date and accessible; you’re registered for CQC updates; data management and training are top notch. But at the heart of outstanding governance and management, are the people you lead: systems and processes can only ever be as good as the people using them. And people are only ever effective if they are enabled to act. So, how do you enable and empower your colleagues, communicating effectively, and be motivating and constructive at the same

Perfect.

For more information contact us: managers@florence.co.uk

0203 911 2555

www.florence.co.uk

July/August 2019

time? Do your staff know and understand what is expected of them? And, do you have a clear and transparent leadership style that ensures that quality is integral to all that you do and is focused on people, rather than the regulator?

People, processes, outcomes

To address the questions above is to think of the service as a system comprising people, processes and outcomes that work in synergy with each other, and within the culture and climate of the organisation. Your process should be such that it supports your vision and at the same time ensures that relevant checks and balances are in place. People then need to be motivated and empowered to follow the processes you have established.

Regular supervision and appraisal are key elements in the governance and management KLOE, particularly for registered managers who can be easily overlooked, or who are covered only by informal contact (this won’t be good enough come inspection time). Supervision is an opportunity for appreciation and for people-focused learning in their area of responsibility. In a learning culture (and you will need one to get to Outstanding) positive behaviours and actions need to be acknowledged, and where things go ‘wrong’, the focus is on mutual learning rather than blame and criticism. Supervision is successful when people learn and come away more motivated than when they went in. Too easily governance and ‘quality assurance’ can become exercises in risk minimisation. However, quality is all about positive risk-taking so that people can live their lives to the full. It is critical to ensure that your quality processes support the vision for the service and are focused on improvement rather than avoidance. Quality should be linked to the vision and values of the service, and focused on the real-life experience of the people you support. For more information on the Wellled KLOE, visit the CQC [online] at: https://www.cqc.org.uk/guidanceproviders/adult-social-care/key-linesenquiry-adult-social-care-services

Care Home MANAGEMENT 13


LEADERSHIP GOVERNANCE & MANAGEMENT

OUTSTANDING LEADERSHIP:

Quality Nurses Handpicked by You

DO YOU HAVE WHAT IT TAKES?

In the second of this 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: GOVERNANCE AND MANAGEMENT It’s often said that a simple ‘thank you’ is a great place to start, but the more specific you can be with your feedback, the more impact you will have. The key is to identify and reflect in your commentary an individual’s strengths and values, particularly where their behaviours are in line with your vision.

Supervision and appraisal

Take control and handpick your staff from our pool of dedicated nurses and carers. Give your residents quality continuous care for 30-50% less.

G

overnance frameworks and risk management processes may be central to the Well-led Key Line of Enquiry (KLOE) and as an outstanding leader, the basics will already be in place: you are thoroughly versed in the CQC provider guidance book (see below, right); policies and procedures are up to date and accessible; you’re registered for CQC updates; data management and training are top notch. But at the heart of outstanding governance and management, are the people you lead: systems and processes can only ever be as good as the people using them. And people are only ever effective if they are enabled to act. So, how do you enable and empower your colleagues, communicating effectively, and be motivating and constructive at the same

Perfect.

For more information contact us: managers@florence.co.uk

0203 911 2555

www.florence.co.uk

July/August 2019

time? Do your staff know and understand what is expected of them? And, do you have a clear and transparent leadership style that ensures that quality is integral to all that you do and is focused on people, rather than the regulator?

People, processes, outcomes

To address the questions above is to think of the service as a system comprising people, processes and outcomes that work in synergy with each other, and within the culture and climate of the organisation. Your process should be such that it supports your vision and at the same time ensures that relevant checks and balances are in place. People then need to be motivated and empowered to follow the processes you have established.

Regular supervision and appraisal are key elements in the governance and management KLOE, particularly for registered managers who can be easily overlooked, or who are covered only by informal contact (this won’t be good enough come inspection time). Supervision is an opportunity for appreciation and for people-focused learning in their area of responsibility. In a learning culture (and you will need one to get to Outstanding) positive behaviours and actions need to be acknowledged, and where things go ‘wrong’, the focus is on mutual learning rather than blame and criticism. Supervision is successful when people learn and come away more motivated than when they went in. Too easily governance and ‘quality assurance’ can become exercises in risk minimisation. However, quality is all about positive risk-taking so that people can live their lives to the full. It is critical to ensure that your quality processes support the vision for the service and are focused on improvement rather than avoidance. Quality should be linked to the vision and values of the service, and focused on the real-life experience of the people you support. For more information on the Wellled KLOE, visit the CQC [online] at: https://www.cqc.org.uk/guidanceproviders/adult-social-care/key-linesenquiry-adult-social-care-services

Care Home MANAGEMENT 13


HR PERFORMANCE MANAGEMENT

ADVERTORIAL

Time to say goodbye?

Julia Gray looks at how settlement agreements can be used effectively in social care

E

mploying the right people means that dismissing staff is an inevitable - if occasional - part of a manager’s role. Settlement agreements (formerly known as “compromise agreements”) can facilitate a lower-risk and mutually beneficial termination.They are the only legally binding method for staff to waive employment rights, such as the right to claim unfair dismissal or discrimination. Once those rights are waived, they can’t be pursued in a court or tribunal. Settlement agreements tend to be used where: • An employee is facing possible dismissal (for example for redundancy, or capability reasons) and wants to leave quietly and with dignity. • The parties agree to expedite a dismissal process to save cost and minimise stress. • The parties acknowledge that the employee has been mistreated and want to resolve a potential legal claim by agreeing an out-of-court settlement; • The parties have amicably agreed to go their separate ways and want to achieve a tax-efficient

exit (although the tax rules have changed and they are no longer as efficient as they used to be). • One or both parties want to keep the circumstances of a dismissal, or events leading up to it, confidential. A recent report by the Women and Equalities Committee was critical of the use of confidentiality clauses (also known as non-disclosure agreements) where there have been allegations of harassment or other forms of discrimination. It’s possible that settlement agreements will become more regulated in future, as recommended by the report.There are already rules governing settlement agreements; they only have legal effect if they conform to certain statutory requirements.These requirements change from time to time, so it’s important to ensure that an old agreement you might have used in the past has been updated. In addition, as with any contract, each party must have something to gain from signing a settlement agreement, even if no money changes hands.

As a care home manager, you must be confident that the agreement does not restrict you from complying with reporting obligations to commissioners or regulators. Such considerations may arise, for example, where you are considering a settlement agreement for a nurse or other regulated professional in the context of potential misconduct. Introducing the idea of a settlement agreement to a member of staff can be daunting, not least because broaching the subject could itself be grounds for complaint. If you’re not sure how to raise it or you are concerned about saying the wrong thing, you could start by looking at the guidance produced by ACAS, but consider whether you need more detailed advice based on your circumstances. Julia Gray, Associate, Hempsons, e: j.gray@hempsons.co.uk www.hempsons.co.uk

POSITION YOUR STAFF FOR

TIP-TOP PERFORMANCE Emma Edis, partner, and employment lawyer at Moore Blatch, explores the difficult balance that is addressing performance and conduct concerns, whilst promoting a supportive culture

W

orking within the care sector can be a very rewarding career. However, it can also be very emotional and demanding. Unlike in most businesses, mistakes in a care home don’t just impact the employer and its employees, they can also impact the individuals being cared for and their families. It is therefore of vital importance to make sure that staff and managers are aware of the performance and behaviour that is expected, so that concerns and issues can be immediately and appropriately addressed. The most important consideration for care home managers is having performance management policies and procedures in place, and ensuring that all employees are aware of them. So, when an issue arises, the management can refer to, and base actions on documented procedure. This ensures they will be consistent in their approach, regardless of which employee is under review. It is often inconsistency that can lead to accusations of unfairness, confusion and ‘possibly’ tribunal proceedings.

14 Care Home MANAGEMENT

www.chmonline.co.uk

July/August 2019

Training in performance investigation and management are vital for the management team as investigation meetings and chairing disciplinary and capability hearings can be a stressful and, often, difficult process for all involved. If not handled correctly, and regardless of how unjustified it may be to the employer, it is quite possible that an employee may seek compensation for unfair dismissal or discrimination in an employment tribunal. An added complication for care homes is that in addition to following their own procedures they also need to follow

The most important consideration for care home managers is having performance management policies and procedures in place, and ensuring that all employees are aware of them

regulatory and legal requirements. Serious incidents involving, for example, allegations of abuse, need to be reported to the regulator, as well as the police in many situations.

It’s all in the description

The key to performance management is to ensure employees have a clear job description, which can be reviewed at regular intervals. This is the benchmark from which the management team can address any performance concerns, and also to highlight positive behaviour and evidence when staff go over and above what is expected of them. This in turn will help boost staff morale and benefit the business as a whole. It’s a difficult balance: addressing performance and conduct concerns, whilst promoting a supportive culture, and the key is communication and consistency. If staff are clear on what behaviour is expected of them, and this is consistently upheld and positively promoted by management, staff will feel engaged and will want to help support the success of the business. Care Home MANAGEMENT 15


HR PERFORMANCE MANAGEMENT

ADVERTORIAL

Time to say goodbye?

Julia Gray looks at how settlement agreements can be used effectively in social care

E

mploying the right people means that dismissing staff is an inevitable - if occasional - part of a manager’s role. Settlement agreements (formerly known as “compromise agreements”) can facilitate a lower-risk and mutually beneficial termination.They are the only legally binding method for staff to waive employment rights, such as the right to claim unfair dismissal or discrimination. Once those rights are waived, they can’t be pursued in a court or tribunal. Settlement agreements tend to be used where: • An employee is facing possible dismissal (for example for redundancy, or capability reasons) and wants to leave quietly and with dignity. • The parties agree to expedite a dismissal process to save cost and minimise stress. • The parties acknowledge that the employee has been mistreated and want to resolve a potential legal claim by agreeing an out-of-court settlement; • The parties have amicably agreed to go their separate ways and want to achieve a tax-efficient

exit (although the tax rules have changed and they are no longer as efficient as they used to be). • One or both parties want to keep the circumstances of a dismissal, or events leading up to it, confidential. A recent report by the Women and Equalities Committee was critical of the use of confidentiality clauses (also known as non-disclosure agreements) where there have been allegations of harassment or other forms of discrimination. It’s possible that settlement agreements will become more regulated in future, as recommended by the report.There are already rules governing settlement agreements; they only have legal effect if they conform to certain statutory requirements.These requirements change from time to time, so it’s important to ensure that an old agreement you might have used in the past has been updated. In addition, as with any contract, each party must have something to gain from signing a settlement agreement, even if no money changes hands.

As a care home manager, you must be confident that the agreement does not restrict you from complying with reporting obligations to commissioners or regulators. Such considerations may arise, for example, where you are considering a settlement agreement for a nurse or other regulated professional in the context of potential misconduct. Introducing the idea of a settlement agreement to a member of staff can be daunting, not least because broaching the subject could itself be grounds for complaint. If you’re not sure how to raise it or you are concerned about saying the wrong thing, you could start by looking at the guidance produced by ACAS, but consider whether you need more detailed advice based on your circumstances. Julia Gray, Associate, Hempsons, e: j.gray@hempsons.co.uk www.hempsons.co.uk

POSITION YOUR STAFF FOR

TIP-TOP PERFORMANCE Emma Edis, partner, and employment lawyer at Moore Blatch, explores the difficult balance that is addressing performance and conduct concerns, whilst promoting a supportive culture

W

orking within the care sector can be a very rewarding career. However, it can also be very emotional and demanding. Unlike in most businesses, mistakes in a care home don’t just impact the employer and its employees, they can also impact the individuals being cared for and their families. It is therefore of vital importance to make sure that staff and managers are aware of the performance and behaviour that is expected, so that concerns and issues can be immediately and appropriately addressed. The most important consideration for care home managers is having performance management policies and procedures in place, and ensuring that all employees are aware of them. So, when an issue arises, the management can refer to, and base actions on documented procedure. This ensures they will be consistent in their approach, regardless of which employee is under review. It is often inconsistency that can lead to accusations of unfairness, confusion and ‘possibly’ tribunal proceedings.

14 Care Home MANAGEMENT

www.chmonline.co.uk

July/August 2019

Training in performance investigation and management are vital for the management team as investigation meetings and chairing disciplinary and capability hearings can be a stressful and, often, difficult process for all involved. If not handled correctly, and regardless of how unjustified it may be to the employer, it is quite possible that an employee may seek compensation for unfair dismissal or discrimination in an employment tribunal. An added complication for care homes is that in addition to following their own procedures they also need to follow

The most important consideration for care home managers is having performance management policies and procedures in place, and ensuring that all employees are aware of them

regulatory and legal requirements. Serious incidents involving, for example, allegations of abuse, need to be reported to the regulator, as well as the police in many situations.

It’s all in the description

The key to performance management is to ensure employees have a clear job description, which can be reviewed at regular intervals. This is the benchmark from which the management team can address any performance concerns, and also to highlight positive behaviour and evidence when staff go over and above what is expected of them. This in turn will help boost staff morale and benefit the business as a whole. It’s a difficult balance: addressing performance and conduct concerns, whilst promoting a supportive culture, and the key is communication and consistency. If staff are clear on what behaviour is expected of them, and this is consistently upheld and positively promoted by management, staff will feel engaged and will want to help support the success of the business. Care Home MANAGEMENT 15


COMMUNICATION SKILLS ASK THE EXPERT

WELLNESS ORAL HEALTH

Oral health

ASK THE EXPERT:

In this regular series, Care Home Management looks at health conditions affecting care home residents and advises staff how to best support rapid diagnosis and treatment

Q: What is the CQC’s view on oral health in care homes? A: The CQC has produced a ‘Smiling Matters’ report on oral health in care homes and has found failings in the awareness of oral care and support offered to residents, specifically around policy, training, care plans and access to treatment. Inspections will include questions about oral health and evidence that residents have had oral health assessments, and staff know how residents can access dental care (registration with a dentist, supply of oral health/ denture care products) and that staff have had specific training in oral health. Providers must demonstrate awareness of the National Institute for Care and health Excellence (Nice) guidelines (NG48) and implement them in their home. Q: Why is there so much interest in older people’s dental care? A: According to Nice, more than half of older adults who live in care homes have tooth decay, 16 Care Home MANAGEMENT

compared to 40 per cent of over-75s outside residential care. People in residential care are at greater risk of oral health problems due to physical health conditions associated with age, and some medicines. Q: What’s involved in an oral health assessment? A: All residents should have an oral health assessment when they move into the care home, with the result recorded in their care plan. Questions should include: • How do you usually manage your daily mouth care and what help would you like? What dental aids do you currently use? For example, manual or electric toothbrush, mouthwash, floss. • Do you have dentures, and if so are they marked with your name? If not, would you like them to be marked? • When did you last see a dentist, and who did you see? Would you like us to arrange an appointment?

Q: How can care staff be involved in ongoing assessment of people’s teeth? A: A handy care assessment tool, available online via the link https://tinyurl.com/y6p6acex advises staff to ‘score’ residents’ oral health, looking at physical aspects such as lips, tongue and gums/mouth tissue, as well as general issues such as the state of their dentures and general oral cleanliness. Changes or signs of problems should trigger a visit to the dentist. Q: How can I prepare for emergencies? A: Contact your local NHS commissioning organisation (CCG, health board) to find out which community or emergency dental services are available in your area, and what the options are for transport for residents. Q: What if the resident doesn’t consent to treatment? Staff who obtain the consent of people who use their service should be familiar with the principles and codes of conduct associated with the Mental Capacity (Amendment) Act 2019, which is expected to become law next year (see page 24 for more information), and are able to apply those as appropriate. Q: How do we go about marking dentures? Dentures can easily be marked using the following simple technique. Towards the back of the denture and on the polished surface roughen a small area of the denture using fine-grained sandpaper. Write the person’s initials using a soft pencil. Cover with two coats of clear varnish allowing the first coat to dry before applying the second coat. The process may need to be repeated every six to nine months. For further information Nice guidance (NG48) [online] Oral health for adults in care homes CQC Guidance [online] at: https://www. nice.org.uk/guidance/ng48 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11 (need for consent) [online] via the link https://tinyurl.com/y53h8rch

www.chmonline.co.uk

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

IN THIS ISSUE: COMMUNICATING DIFFICULT DECISIONS By Dan Parry, head of content at training company Working Voices Q: How can I successfully broach the subject of ‘moving on’ a resident we can no longer care for? A: Discussing a resident’s deteriorating health with relatives, and the need for other accommodation can quickly become difficult. Worse still for many care home staff is the prospect of having to repeat the whole conversation again, in the hope that some progress can be made. When it comes to having a difficult conversation, the first step is to acknowledge that the discomfort you may be feeling is normal. Having a clear, step-bystep plan for the conversation can bring a reassuring sense of clarity, easing the process. The second step is to have some empathy with those you are talking to. A difficult conclusion about a resident might be the most appropriate decision for the cared-for person, as well as the wellbeing of other residents and the staff, but simply hammering home your message to those involved is unlikely to be successful. Instead, you should aim to guide those you are speaking to along the same thought process that led to your decision. At the start of the conversation, rather than confronting someone with a fait accompli, it can be more helpful to set out the challenges that face you both. This would be the moment for a manager to cite responsibility to the cared-for person, as well as all residents and staff.

Next steps

You can then discuss the alternative possible courses of action. Your next step is to manage emotion. Although some decisions are the appropriate course of action, with positives and benefits, they may still trigger an emotional response: we’re all human, and emotion must be expected and accepted.. As much as people might see the logical value of your thought process, they may still feel something is being missed or forgotten. Emotion needs to be acknowledged. In difficult conversations, people tend to emphasise positives and benefits almost as a way of hastening an end to the discussion. But the person you are talking to might not be in quite the same rush. By recognising the negative impact of a decision, you’re engaging with their emotion – rather than just fending it off - which to some people might seem to inflame an alreaady tense situation. If you share their emotion, perhaps they – rather than you – will then seek to move the discussion forward to a suitable solution. Maybe, that’s when you can move onto other things, for example, reemphasising the positive aspects of your decision. Together these simple steps will help to validate the other person’s concerns.They will feel listened to, and consequently, more likely to accept your decision.There’s no escaping emotion, but by working together you are more likely to agree that ultimately you both want the same thing – the best care for the person concerned.

Further reading: Independent Age research: We need to talk about caring: dealing with difficult conversations, available [online] via the link https://tinyurl.com/y6yu53az

July/August 2019

Care Home MANAGEMENT 17


COMMUNICATION SKILLS ASK THE EXPERT

WELLNESS ORAL HEALTH

Oral health

ASK THE EXPERT:

In this regular series, Care Home Management looks at health conditions affecting care home residents and advises staff how to best support rapid diagnosis and treatment

Q: What is the CQC’s view on oral health in care homes? A: The CQC has produced a ‘Smiling Matters’ report on oral health in care homes and has found failings in the awareness of oral care and support offered to residents, specifically around policy, training, care plans and access to treatment. Inspections will include questions about oral health and evidence that residents have had oral health assessments, and staff know how residents can access dental care (registration with a dentist, supply of oral health/ denture care products) and that staff have had specific training in oral health. Providers must demonstrate awareness of the National Institute for Care and health Excellence (Nice) guidelines (NG48) and implement them in their home. Q: Why is there so much interest in older people’s dental care? A: According to Nice, more than half of older adults who live in care homes have tooth decay, 16 Care Home MANAGEMENT

compared to 40 per cent of over-75s outside residential care. People in residential care are at greater risk of oral health problems due to physical health conditions associated with age, and some medicines. Q: What’s involved in an oral health assessment? A: All residents should have an oral health assessment when they move into the care home, with the result recorded in their care plan. Questions should include: • How do you usually manage your daily mouth care and what help would you like? What dental aids do you currently use? For example, manual or electric toothbrush, mouthwash, floss. • Do you have dentures, and if so are they marked with your name? If not, would you like them to be marked? • When did you last see a dentist, and who did you see? Would you like us to arrange an appointment?

Q: How can care staff be involved in ongoing assessment of people’s teeth? A: A handy care assessment tool, available online via the link https://tinyurl.com/y6p6acex advises staff to ‘score’ residents’ oral health, looking at physical aspects such as lips, tongue and gums/mouth tissue, as well as general issues such as the state of their dentures and general oral cleanliness. Changes or signs of problems should trigger a visit to the dentist. Q: How can I prepare for emergencies? A: Contact your local NHS commissioning organisation (CCG, health board) to find out which community or emergency dental services are available in your area, and what the options are for transport for residents. Q: What if the resident doesn’t consent to treatment? Staff who obtain the consent of people who use their service should be familiar with the principles and codes of conduct associated with the Mental Capacity (Amendment) Act 2019, which is expected to become law next year (see page 24 for more information), and are able to apply those as appropriate. Q: How do we go about marking dentures? Dentures can easily be marked using the following simple technique. Towards the back of the denture and on the polished surface roughen a small area of the denture using fine-grained sandpaper. Write the person’s initials using a soft pencil. Cover with two coats of clear varnish allowing the first coat to dry before applying the second coat. The process may need to be repeated every six to nine months. For further information Nice guidance (NG48) [online] Oral health for adults in care homes CQC Guidance [online] at: https://www. nice.org.uk/guidance/ng48 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11 (need for consent) [online] via the link https://tinyurl.com/y53h8rch

www.chmonline.co.uk

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

IN THIS ISSUE: COMMUNICATING DIFFICULT DECISIONS By Dan Parry, head of content at training company Working Voices Q: How can I successfully broach the subject of ‘moving on’ a resident we can no longer care for? A: Discussing a resident’s deteriorating health with relatives, and the need for other accommodation can quickly become difficult. Worse still for many care home staff is the prospect of having to repeat the whole conversation again, in the hope that some progress can be made. When it comes to having a difficult conversation, the first step is to acknowledge that the discomfort you may be feeling is normal. Having a clear, step-bystep plan for the conversation can bring a reassuring sense of clarity, easing the process. The second step is to have some empathy with those you are talking to. A difficult conclusion about a resident might be the most appropriate decision for the cared-for person, as well as the wellbeing of other residents and the staff, but simply hammering home your message to those involved is unlikely to be successful. Instead, you should aim to guide those you are speaking to along the same thought process that led to your decision. At the start of the conversation, rather than confronting someone with a fait accompli, it can be more helpful to set out the challenges that face you both. This would be the moment for a manager to cite responsibility to the cared-for person, as well as all residents and staff.

Next steps

You can then discuss the alternative possible courses of action. Your next step is to manage emotion. Although some decisions are the appropriate course of action, with positives and benefits, they may still trigger an emotional response: we’re all human, and emotion must be expected and accepted.. As much as people might see the logical value of your thought process, they may still feel something is being missed or forgotten. Emotion needs to be acknowledged. In difficult conversations, people tend to emphasise positives and benefits almost as a way of hastening an end to the discussion. But the person you are talking to might not be in quite the same rush. By recognising the negative impact of a decision, you’re engaging with their emotion – rather than just fending it off - which to some people might seem to inflame an alreaady tense situation. If you share their emotion, perhaps they – rather than you – will then seek to move the discussion forward to a suitable solution. Maybe, that’s when you can move onto other things, for example, reemphasising the positive aspects of your decision. Together these simple steps will help to validate the other person’s concerns.They will feel listened to, and consequently, more likely to accept your decision.There’s no escaping emotion, but by working together you are more likely to agree that ultimately you both want the same thing – the best care for the person concerned.

Further reading: Independent Age research: We need to talk about caring: dealing with difficult conversations, available [online] via the link https://tinyurl.com/y6yu53az

July/August 2019

Care Home MANAGEMENT 17


BEST PRACTICE FROM THE OMBUDSMAN

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

over time although there was a changing pattern of weight loss and gain. The home’s evidence showed staff were checking his weight, and when he lost more than 2kg it carried out a review. GP actions: The GP could evidence that good clinical care and treatment were provided for Mr B’s symptoms. Examinations

Laundry in a muddle? ...You need

of Mr B were robust and clearly documented Mr B’s changing condition. AGREED ACTION/S The home should apologise to Ms A and the family for the uncertainty and distress caused by its poor record keeping, and by not providing enough fluids to Mr B.

From only £9.95 for 25 tags (inc VAT)

Label all your residents’ clothes in a snap! * * * *

Nutrition and hydration: CQC fundamental standards

LESSONS FROM THE

OMBUDSMAN

The CQC’s Fundamental Standards state people should have “adequate nutrition and hydration to sustain life and good health and reduce the risks of malnutrition and dehydration while they receive care and treatment”. People should have “enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so”. Care providers must assess people’s nutritional needs and provide food to meet those needs. This includes where people take nutritional supplements. Also, care providers must consider people’s food and drink preferences.

Secure & will not fade Quick to apply Discreet Re-usable

As recommended by

www.snappytags.co.uk

T: 0344 5611994

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 Alpine Health Care Limited SUMMARY: Ms A complains on behalf

of her late father, Mr B, about the actions of Alpine Health Care Limited at Alpine Lodge Nursing Home (the home) and Dr C E Atkin (the GP). Ms A says that the home and the GP failed to recognise Mr B was suffering with pneumonia, malnutrition and dehydration, causing him significant distress. The home’s record keeping was poor, so it is impossible to say if he received the care he should have. Ms A says her father’s death was avoidable. Events have caused Ms A and her mother lasting distress. Ms A would like the organisations to admit fault and carry out service improvements to stop this happening to other families.

DECISION UPHELD:

Hydration: The home could not provide evidence that it provided Mr B with appropriate fluids during the time in question. It also failed to complete a robust assessment of his hydration needs on admission. This caused Mr B to suffer chronic dehydration, and the family suffered distress as a result. This is fault Nutrition: The home’s approach to nutrition was not felt to fall below the Care Quality Commission’s (CQC) fundamental standards. GP actions: The GP’s actions are not considered to be at fault.

Read the whole decision [online] via the link: https://tinyurl.com/yyzoszjt

18 Care Home MANAGEMENT

ANALYSIS

Mr B suffered with ataxia (a disorder that affects co-ordination, balance and speech).The home assessed Mr B’s needs before admission and recognised that he needed supervision and prompting when eating and drinking. Mr B’s care plans were updated three months later to specify that staff should record daily food and fluid intake on charts and should encourage Mr B to drink two litres of fluids a day. Hydration:The home’s care records for Mr B’s hydration needs did fall below the CQC’s fundamental standards. As Mr B had a catheter, fluid charts should have been in place. In their absence, there was uncertainty about Mr B’s hydration status. Staff were also confused about Mr B’s daily fluid target. During a six-month period, Mr B only reached his hydration target on three days.This left Mr B at increased risk of developing infection.The home admits that It was not clear when supplement drinks were offered, refused or consumed. Nutrition: The home measured Mr B’s weight each month for three months following admission, and each week afterwards. There was no significant decline in Mr B’s weight www.chmonline.co.uk

Early Booking and Multiple Booking discounts available - Quote CHM

July/August 2019

Care Home MANAGEMENT 19


BEST PRACTICE FROM THE OMBUDSMAN

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

over time although there was a changing pattern of weight loss and gain. The home’s evidence showed staff were checking his weight, and when he lost more than 2kg it carried out a review. GP actions: The GP could evidence that good clinical care and treatment were provided for Mr B’s symptoms. Examinations

Laundry in a muddle? ...You need

of Mr B were robust and clearly documented Mr B’s changing condition. AGREED ACTION/S The home should apologise to Ms A and the family for the uncertainty and distress caused by its poor record keeping, and by not providing enough fluids to Mr B.

From only £9.95 for 25 tags (inc VAT)

Label all your residents’ clothes in a snap! * * * *

Nutrition and hydration: CQC fundamental standards

LESSONS FROM THE

OMBUDSMAN

The CQC’s Fundamental Standards state people should have “adequate nutrition and hydration to sustain life and good health and reduce the risks of malnutrition and dehydration while they receive care and treatment”. People should have “enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so”. Care providers must assess people’s nutritional needs and provide food to meet those needs. This includes where people take nutritional supplements. Also, care providers must consider people’s food and drink preferences.

Secure & will not fade Quick to apply Discreet Re-usable

As recommended by

www.snappytags.co.uk

T: 0344 5611994

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 Alpine Health Care Limited SUMMARY: Ms A complains on behalf

of her late father, Mr B, about the actions of Alpine Health Care Limited at Alpine Lodge Nursing Home (the home) and Dr C E Atkin (the GP). Ms A says that the home and the GP failed to recognise Mr B was suffering with pneumonia, malnutrition and dehydration, causing him significant distress. The home’s record keeping was poor, so it is impossible to say if he received the care he should have. Ms A says her father’s death was avoidable. Events have caused Ms A and her mother lasting distress. Ms A would like the organisations to admit fault and carry out service improvements to stop this happening to other families.

DECISION UPHELD:

Hydration: The home could not provide evidence that it provided Mr B with appropriate fluids during the time in question. It also failed to complete a robust assessment of his hydration needs on admission. This caused Mr B to suffer chronic dehydration, and the family suffered distress as a result. This is fault Nutrition: The home’s approach to nutrition was not felt to fall below the Care Quality Commission’s (CQC) fundamental standards. GP actions: The GP’s actions are not considered to be at fault.

Read the whole decision [online] via the link: https://tinyurl.com/yyzoszjt

18 Care Home MANAGEMENT

ANALYSIS

Mr B suffered with ataxia (a disorder that affects co-ordination, balance and speech).The home assessed Mr B’s needs before admission and recognised that he needed supervision and prompting when eating and drinking. Mr B’s care plans were updated three months later to specify that staff should record daily food and fluid intake on charts and should encourage Mr B to drink two litres of fluids a day. Hydration:The home’s care records for Mr B’s hydration needs did fall below the CQC’s fundamental standards. As Mr B had a catheter, fluid charts should have been in place. In their absence, there was uncertainty about Mr B’s hydration status. Staff were also confused about Mr B’s daily fluid target. During a six-month period, Mr B only reached his hydration target on three days.This left Mr B at increased risk of developing infection.The home admits that It was not clear when supplement drinks were offered, refused or consumed. Nutrition: The home measured Mr B’s weight each month for three months following admission, and each week afterwards. There was no significant decline in Mr B’s weight www.chmonline.co.uk

Early Booking and Multiple Booking discounts available - Quote CHM

July/August 2019

Care Home MANAGEMENT 19


PROFILE HEATHLANDS VILLAGE

Valuable leisure space for residents and their families

and people with mental health problems, dealt with 2,600 enquiries for advice and support.

INTEGRATING FOR SUCCESS

Strengthened links with integrated care commissioning could have valuable learnings for social care, believes Heathlands Village in Manchester, one of five new Teaching Care Homes

I

The beach garden is proving really popular among the home’s residents with dementia

20 Care Home MANAGEMENT

n partnership with Salford University, Heathlands Village, run by social care charity The Fed, has become one of five care homes to be selected this year as a National Teaching Care Home. Heathlands Village chief executive officer Mark Cunningham says the programme ties in perfectly with Heathlands Village’s vision to become a place of learning and research. “[Selection] is a big step in that direction,” he says. The Teaching Care Homes Programme is a partnership between Care England, the Foundation of Nursing Studies (FoNS) and the Burdett Trust for Nursing, and has the aim of raising the profile of care home nursing by sharing learning and developments and research. Participants also hope to be part of a burgeoning network of care homes that can act as ‘critical friends’ or ‘buddies’ to other homes. To date, there are a total of 15 homes in the programme, and other homes

selected alongside Heathlands Village this year include: Priscilla Wakefield House Nursing Home, Haringey, London; Coloma Court, West Wickham, Riversway Nursing Home, Bristol; and Kineton Manor Nursing Home, Warwick. Heathlands Village opened in 1867 as a support centre for Manchester’s Jewish Community, although its doors are now open to people of other religions. Its service caters for an average of 95 people in residential and 36 in nursing care, and in the supported living environment there are 30 flats. A staff of over 300, as well as an army of 380 volunteers a month (giving 28,500 hours of support), also enable the organisation to deliver community services such as mental health support, carers’ breaks and support, a community café, groups and play-schemes for children with special needs, and social work for adults and children and families. During 2017-18, the Community Advice and Support Team, which supports families in crisis www.chmonline.co.uk

A new decade

As well as the year in which Heathlands Village joined the National Teaching Care Home programme, 2019 marks the 10th anniversary of the old Fed and Heathlands Village. Cunningham says that the next decade for the new organisation looks set to bring in a host of new opportunities and challenges. Recent developments at the home include redeveloping the care facilities to include a specialist dementia care unit. The refurb has also introduced a new ‘sunny lounge’, and café area with patio and garden access. “The benefits are beyond expectations,” says Cunningham. “It has brought the outside in, for residents and their families. The beach garden (developed for the home’s dementia care residents), in particular, is very well used.” This year, the organisation will be doing its bit to further health and social care integration agenda in Manchester. Plans are well underway to rent space to an NHS/social care integrated commissioning office, and 20 of the home’s beds have been allocated to a local discharge to assess service. Cunningham sees these as having the potential to raise the profile of care among commissioners, as well as of the Jewish culture and the home’s care service. As a good-rated home rated as outstanding for responsiveness, as well as holding Platinum Gold Standards Framework status for endof-life care, Cunningham believes Heathlands Village is well-placed to educate commissioners as to the potential role of social care in the wider integrated care economy. “Yes, we have a lot of plates spinning, but you can’t sit still for a moment, or else the world will have changed around you,” he says. July/August 2019

Financial balance

Currently Heathlands Village is approximately 60 per cent privately-funded, a ratio which Cunningham says has almost completely reversed over the past five years. Higher occupancy and a higher percentage of selfpaying clients have increased the charity’s operating income, but caring for an ageing resident population has also increased costs. Residents’ demographics, funding, workforce, and the regulatory environment have all changed, says Cunningham, who notes that the average age at admission is now around 90 years old, and that residents usually have multiple health conditions, as well as mobility problems to cater for. As a charity, the organisation subsidises publicly-funded residents rather than pass on costs to private clients, but that comes at a cost, he says. “We need around £1.2m in funds just to break even, and it’s a very competitive environment for donations.” Although the facility has been, and clearly continues to be, cherished by generations of Jewish families, the Jewish population in Manchester stands at around 40,000, and background wealth is simply not as high as in London, Cunningham says. As well as fee income, the organisation is highly dependent on donations and extensive fundraising to achieve financial balance. “As a charitable organisation we have to be careful with the resources that we have. We often can’t move as fast as other privately-funded organisations,” he says.

Workforce challenges

Located close to four major hospitals, offering competitive NHS terms and conditions, as well as career development, Heathlands Village operates in a challenging workforce

environment, and the organisation has had to look at creative recruitment solutions, including non-EU recruitment, as well as developing more junior roles, such as level three carers and, possibly nurse associates. Cunningham hopes that participation in the National Teaching Care Homes programme, as well as the local Manchester equivalent, will help put Heathlands Village - and social care in general - back to the top of prospective career choices. Cunningham first came to Heathlands Village as a social work student, and it is his passion for this field that has taken his career to the role of chief executive. He says: “I hope we can create a strong and tangible pathway for social care, and that in 10 years time people will be talking about Heathlands as a centre of excellence.” He sees being part of the programme as giving the home a chance to be part of a dialogue and conversation that can influence strategy, and how care homes are perceived and valued. He says: “We see it as us playing our part. If we can act as a springboard to inspire fantastic people into social care through quality learning and development, and improve the quality of care overall, then social care will be a winner. And if some of those people would then like to stay and play with us, well, then, we’ll be a winner, too.”

More information Heathlands Village: www.heathlandsvillage.co.uk The Fed www.thefed.org.uk National Teaching Care Homes programme: https://www.fons.org/ programmes/teaching-care-homes

Care Home MANAGEMENT 21


PROFILE HEATHLANDS VILLAGE

Valuable leisure space for residents and their families

and people with mental health problems, dealt with 2,600 enquiries for advice and support.

INTEGRATING FOR SUCCESS

Strengthened links with integrated care commissioning could have valuable learnings for social care, believes Heathlands Village in Manchester, one of five new Teaching Care Homes

I

The beach garden is proving really popular among the home’s residents with dementia

20 Care Home MANAGEMENT

n partnership with Salford University, Heathlands Village, run by social care charity The Fed, has become one of five care homes to be selected this year as a National Teaching Care Home. Heathlands Village chief executive officer Mark Cunningham says the programme ties in perfectly with Heathlands Village’s vision to become a place of learning and research. “[Selection] is a big step in that direction,” he says. The Teaching Care Homes Programme is a partnership between Care England, the Foundation of Nursing Studies (FoNS) and the Burdett Trust for Nursing, and has the aim of raising the profile of care home nursing by sharing learning and developments and research. Participants also hope to be part of a burgeoning network of care homes that can act as ‘critical friends’ or ‘buddies’ to other homes. To date, there are a total of 15 homes in the programme, and other homes

selected alongside Heathlands Village this year include: Priscilla Wakefield House Nursing Home, Haringey, London; Coloma Court, West Wickham, Riversway Nursing Home, Bristol; and Kineton Manor Nursing Home, Warwick. Heathlands Village opened in 1867 as a support centre for Manchester’s Jewish Community, although its doors are now open to people of other religions. Its service caters for an average of 95 people in residential and 36 in nursing care, and in the supported living environment there are 30 flats. A staff of over 300, as well as an army of 380 volunteers a month (giving 28,500 hours of support), also enable the organisation to deliver community services such as mental health support, carers’ breaks and support, a community café, groups and play-schemes for children with special needs, and social work for adults and children and families. During 2017-18, the Community Advice and Support Team, which supports families in crisis www.chmonline.co.uk

A new decade

As well as the year in which Heathlands Village joined the National Teaching Care Home programme, 2019 marks the 10th anniversary of the old Fed and Heathlands Village. Cunningham says that the next decade for the new organisation looks set to bring in a host of new opportunities and challenges. Recent developments at the home include redeveloping the care facilities to include a specialist dementia care unit. The refurb has also introduced a new ‘sunny lounge’, and café area with patio and garden access. “The benefits are beyond expectations,” says Cunningham. “It has brought the outside in, for residents and their families. The beach garden (developed for the home’s dementia care residents), in particular, is very well used.” This year, the organisation will be doing its bit to further health and social care integration agenda in Manchester. Plans are well underway to rent space to an NHS/social care integrated commissioning office, and 20 of the home’s beds have been allocated to a local discharge to assess service. Cunningham sees these as having the potential to raise the profile of care among commissioners, as well as of the Jewish culture and the home’s care service. As a good-rated home rated as outstanding for responsiveness, as well as holding Platinum Gold Standards Framework status for endof-life care, Cunningham believes Heathlands Village is well-placed to educate commissioners as to the potential role of social care in the wider integrated care economy. “Yes, we have a lot of plates spinning, but you can’t sit still for a moment, or else the world will have changed around you,” he says. July/August 2019

Financial balance

Currently Heathlands Village is approximately 60 per cent privately-funded, a ratio which Cunningham says has almost completely reversed over the past five years. Higher occupancy and a higher percentage of selfpaying clients have increased the charity’s operating income, but caring for an ageing resident population has also increased costs. Residents’ demographics, funding, workforce, and the regulatory environment have all changed, says Cunningham, who notes that the average age at admission is now around 90 years old, and that residents usually have multiple health conditions, as well as mobility problems to cater for. As a charity, the organisation subsidises publicly-funded residents rather than pass on costs to private clients, but that comes at a cost, he says. “We need around £1.2m in funds just to break even, and it’s a very competitive environment for donations.” Although the facility has been, and clearly continues to be, cherished by generations of Jewish families, the Jewish population in Manchester stands at around 40,000, and background wealth is simply not as high as in London, Cunningham says. As well as fee income, the organisation is highly dependent on donations and extensive fundraising to achieve financial balance. “As a charitable organisation we have to be careful with the resources that we have. We often can’t move as fast as other privately-funded organisations,” he says.

Workforce challenges

Located close to four major hospitals, offering competitive NHS terms and conditions, as well as career development, Heathlands Village operates in a challenging workforce

environment, and the organisation has had to look at creative recruitment solutions, including non-EU recruitment, as well as developing more junior roles, such as level three carers and, possibly nurse associates. Cunningham hopes that participation in the National Teaching Care Homes programme, as well as the local Manchester equivalent, will help put Heathlands Village - and social care in general - back to the top of prospective career choices. Cunningham first came to Heathlands Village as a social work student, and it is his passion for this field that has taken his career to the role of chief executive. He says: “I hope we can create a strong and tangible pathway for social care, and that in 10 years time people will be talking about Heathlands as a centre of excellence.” He sees being part of the programme as giving the home a chance to be part of a dialogue and conversation that can influence strategy, and how care homes are perceived and valued. He says: “We see it as us playing our part. If we can act as a springboard to inspire fantastic people into social care through quality learning and development, and improve the quality of care overall, then social care will be a winner. And if some of those people would then like to stay and play with us, well, then, we’ll be a winner, too.”

More information Heathlands Village: www.heathlandsvillage.co.uk The Fed www.thefed.org.uk National Teaching Care Homes programme: https://www.fons.org/ programmes/teaching-care-homes

Care Home MANAGEMENT 21


BEST PRACTICE OUTSTANDING

BEST PRACTICE OUTSTANDING

CONGRATULATIONS TO...

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

The Old Hall, Sleaford Safe:

Effective:

What The Old Hall did: Safe

Hassingham House Care Centre, Norwich Effective:

Caring:

What Hassingham House did: Effective

The home develops assessments that are holistic and comprehensive, involving the multidisciplinary team and national guidance. This encourages staff to discuss and share experiences with other professionals. Staff have also received specialist experiential training in the sensory impacts of dementia and in the negative effects of poor quality care. Nutrition at the home is developed in consultation with residents with specialist health needs such as risk of pressure sores, and with diabetes and kidney problems. Creative ways to ensure people eat well include pairing foods on a plate by colour, and using foods as a way of increasing hydration. To reduce the use of prescribed artificial nutritional supplements the cook has introduced a range of homemade supplements called ‘Pots’. 22 Care Home MANAGEMENT

Responsive:

Well-led:

What Hassingham House did: Caring

The manager runs a programme called ‘Make someone’s day every day’ and staff record on a display board how they make someone’s day better. People’s dignity is supported through a ‘Dignity Champion’, dignity days and a ‘dignity tree’ where people and staff can detail what dignity means to them.

What Hassingham House did: Responsive

An electronic care records system supports real time care. Staff help residents to access the local community, for example, walking with them to the local shops. A recent initiative to support people’s engagement included creating a movie featuring residents. The service also had accreditation in end of life care.

What Hassingham House did: Well-led

The leadership team often shares learning and best practice with other providers of care, local authorities and healthcare professionals. The home also runs a ‘Shining Star Award’ staff award to recognise exceptional staff and provide inspiration. Innovation in care includes the ‘People like me’ programme, which matches staff with residents with common interests. The service’s activity co-ordinator also organises a network of activity co-ordinators and a local volunteers group to support activities and shared interests. Read more on Hassingham House care centre at: https://www.cqc.org.uk/ location/1-135132089

www.chmonline.co.uk

Caring:

Each week the home’s activities team dedicates 107 hours to residents’ wellbeing. In addition, five ‘wellbeing therapists’ offer emotional and psychological support. Staffing rotas, which include the manager, are informed by a ‘red/amber/green’ experience rating for staff members, to ensure a balanced skill mix on every shift. Staff recruitment also involves interaction with, and input from, residents. There is organisational learning at the home, including anonymised case studies, which are commented on by staff to ensure learning is embedded. Staff meetings are also used as a forum to discuss incidents and agree changes to policies and practice. ‘Homely remedies’ are now available for staff to administer without the need for a prescription, and a ‘self-medication’ assessment sheet supports residents capable of self-administration. Preprinted MARs supplied by the home’s pharmacy provider include a picture of each medicine to support staff.

What The Old Hall did: Effective

The registered manager was studying for a Masters degree in frailty, using learning to improve care at the home. Innovations include: a pet dog; a ‘welcome bar’; portable electronic scent diffusers; wi-fi enabled ‘smart’ speakers for July/August 2019

Read more on The Old Hall at: https://www.cqc.org.uk/location/1-110419339

Responsive:

sensory stimulation; ‘sepsis kits’ and an encrypted ‘chat room’ service, so that staff and managers can receive real-time care updates.There is also a ‘token economy’ in which residents can undertake jobs in return for tokens to be spent in the home’s ‘shop’. Relatives and keyworkers can earn tokens for people who are unable to take on jobs themselves. A home refurbishment also introduced wi-fi in every room, a cordless phone system and dementia-friendly design. All staff have at least an NVQ Level 2 and most are doing Level 3, 4 or 5 training, and the home is part of a network of service providers rated as Outstanding.

What The Old Hall did: Caring

Inspectors noted a wide range of small but compelling examples of staff’s focus on care. These included contacting the singer Vera Lynn for an autographed photograph. Two ‘dignity trees’ were created in the home – one for staff and one for residents – to explain dignity. The home also has obtained an NHS email address, to share people’s confidential medical information securely. Local lay advocacy services are also used.

What The Old Hall did: Responsive

The registered manager visits potential residents personally to carry out a pre-admission

Well-led: assessment. A ‘resident checklist’ of 46 items is used to ensure personalised care when they move in. Key information from an ‘All About Me’ folder is also included on laminated posters in bedrooms, detailing the resident’s likes and dislikes, pet names, etc. End of life care includes an ‘angel watch’ where staff volunteer to come and sit with someone as they near the end of life; training with a local hospice on palliative care assessment, and information on death and bereavement for different faiths.

What The Old Hall did: Well-led

The registered manager has a principled, personcentred leadership style and shows great interest in the welfare and happiness of her team.This is demonstrated by regular treats for staff, including paid-for social outings. Each staff member also completes a one-page profile to describe their personality and personal preferences. Staff are able to take part in inter-staff competitions and earn ‘stars’ by picking up a shift at short notice or going ‘the extra mile’.There is also a monthly ‘incentive’ award. Inspectors were told of plans to develop ‘dementia awareness’ sessions for relatives, and to redesign the communal dining arrangements in the home, in consultation with residents. The provider also participates in pilots and projects that aim to identify and disseminate best practice, for example, reducing hospital admissions. Care Home MANAGEMENT 23


BEST PRACTICE OUTSTANDING

BEST PRACTICE OUTSTANDING

CONGRATULATIONS TO...

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

The Old Hall, Sleaford Safe:

Effective:

What The Old Hall did: Safe

Hassingham House Care Centre, Norwich Effective:

Caring:

What Hassingham House did: Effective

The home develops assessments that are holistic and comprehensive, involving the multidisciplinary team and national guidance. This encourages staff to discuss and share experiences with other professionals. Staff have also received specialist experiential training in the sensory impacts of dementia and in the negative effects of poor quality care. Nutrition at the home is developed in consultation with residents with specialist health needs such as risk of pressure sores, and with diabetes and kidney problems. Creative ways to ensure people eat well include pairing foods on a plate by colour, and using foods as a way of increasing hydration. To reduce the use of prescribed artificial nutritional supplements the cook has introduced a range of homemade supplements called ‘Pots’. 22 Care Home MANAGEMENT

Responsive:

Well-led:

What Hassingham House did: Caring

The manager runs a programme called ‘Make someone’s day every day’ and staff record on a display board how they make someone’s day better. People’s dignity is supported through a ‘Dignity Champion’, dignity days and a ‘dignity tree’ where people and staff can detail what dignity means to them.

What Hassingham House did: Responsive

An electronic care records system supports real time care. Staff help residents to access the local community, for example, walking with them to the local shops. A recent initiative to support people’s engagement included creating a movie featuring residents. The service also had accreditation in end of life care.

What Hassingham House did: Well-led

The leadership team often shares learning and best practice with other providers of care, local authorities and healthcare professionals. The home also runs a ‘Shining Star Award’ staff award to recognise exceptional staff and provide inspiration. Innovation in care includes the ‘People like me’ programme, which matches staff with residents with common interests. The service’s activity co-ordinator also organises a network of activity co-ordinators and a local volunteers group to support activities and shared interests. Read more on Hassingham House care centre at: https://www.cqc.org.uk/ location/1-135132089

www.chmonline.co.uk

Caring:

Each week the home’s activities team dedicates 107 hours to residents’ wellbeing. In addition, five ‘wellbeing therapists’ offer emotional and psychological support. Staffing rotas, which include the manager, are informed by a ‘red/amber/green’ experience rating for staff members, to ensure a balanced skill mix on every shift. Staff recruitment also involves interaction with, and input from, residents. There is organisational learning at the home, including anonymised case studies, which are commented on by staff to ensure learning is embedded. Staff meetings are also used as a forum to discuss incidents and agree changes to policies and practice. ‘Homely remedies’ are now available for staff to administer without the need for a prescription, and a ‘self-medication’ assessment sheet supports residents capable of self-administration. Preprinted MARs supplied by the home’s pharmacy provider include a picture of each medicine to support staff.

What The Old Hall did: Effective

The registered manager was studying for a Masters degree in frailty, using learning to improve care at the home. Innovations include: a pet dog; a ‘welcome bar’; portable electronic scent diffusers; wi-fi enabled ‘smart’ speakers for July/August 2019

Read more on The Old Hall at: https://www.cqc.org.uk/location/1-110419339

Responsive:

sensory stimulation; ‘sepsis kits’ and an encrypted ‘chat room’ service, so that staff and managers can receive real-time care updates.There is also a ‘token economy’ in which residents can undertake jobs in return for tokens to be spent in the home’s ‘shop’. Relatives and keyworkers can earn tokens for people who are unable to take on jobs themselves. A home refurbishment also introduced wi-fi in every room, a cordless phone system and dementia-friendly design. All staff have at least an NVQ Level 2 and most are doing Level 3, 4 or 5 training, and the home is part of a network of service providers rated as Outstanding.

What The Old Hall did: Caring

Inspectors noted a wide range of small but compelling examples of staff’s focus on care. These included contacting the singer Vera Lynn for an autographed photograph. Two ‘dignity trees’ were created in the home – one for staff and one for residents – to explain dignity. The home also has obtained an NHS email address, to share people’s confidential medical information securely. Local lay advocacy services are also used.

What The Old Hall did: Responsive

The registered manager visits potential residents personally to carry out a pre-admission

Well-led: assessment. A ‘resident checklist’ of 46 items is used to ensure personalised care when they move in. Key information from an ‘All About Me’ folder is also included on laminated posters in bedrooms, detailing the resident’s likes and dislikes, pet names, etc. End of life care includes an ‘angel watch’ where staff volunteer to come and sit with someone as they near the end of life; training with a local hospice on palliative care assessment, and information on death and bereavement for different faiths.

What The Old Hall did: Well-led

The registered manager has a principled, personcentred leadership style and shows great interest in the welfare and happiness of her team.This is demonstrated by regular treats for staff, including paid-for social outings. Each staff member also completes a one-page profile to describe their personality and personal preferences. Staff are able to take part in inter-staff competitions and earn ‘stars’ by picking up a shift at short notice or going ‘the extra mile’.There is also a monthly ‘incentive’ award. Inspectors were told of plans to develop ‘dementia awareness’ sessions for relatives, and to redesign the communal dining arrangements in the home, in consultation with residents. The provider also participates in pilots and projects that aim to identify and disseminate best practice, for example, reducing hospital admissions. Care Home MANAGEMENT 23


LEGAL DOLS

LEGAL DOLS

P

aper-pushing and headache-inducing or an important way of protecting liberty? Whatever your views are on the Deprivation of Liberty Safeguards (DoLS) they have transformed the way care home admission decisions are made.

Background

Article 5 of the European Convention on Human Rights protects everyone’s right to liberty. The general rule is that a person cannot be deprived of his or her liberty, except for certain exceptions where the deprivation is “in accordance with a procedure prescribed by law.” Schedule 1A of the Mental Capacity Act 2005 – the DoLS system - provides that procedure: it empowers a supervisory body (which is usually the local authority) to grant a standard authorisation, often following a request from the managing authority of a care home, and the local authority is responsible for arranging six different assessments that must take place. The biggest change over the past 10 years since DoLS were introduced is the broadening of the definition of a “deprivation of liberty” in the UK Supreme Court case of Cheshire West v P [2014] UKSC 19. This has meant that many more people are (and have been) deprived of their liberty. As a result, there has been a huge increase in requests for standard authorisations since that decision (at great cost to local authorities).

What will I learn from this feature? How changes to DoLS will affect care home managers

A decade of learning

MENTAL CAPACITY ACT:

changes and challenges

The Court of Protection has been clear that: • requests for standard authorisations must be made in a timely manner and before an individual is deprived of his or her liberty • any forms of restraint and other significant interferences with Articles 5 or 8 rights such as the use of covert medication must be properly considered as part of the best interests’ assessment and spelled out in the DoLS authorisation • self-funders are not exempt from DoLS • where the cared-for person, ‘P’, objects to the DoLS authorisation, reviews and legal challenges should be facilitated for them.

Liberty Protection Safeguards (“LPS”)

On October 1 next year the DoLS system will be completely replaced by the new Liberty Protection Safeguards (LPS). Barristers of 39 Essex Chambers, Victoria Butler-Cole QC and Stephanie David set out the key changes for care home managers

When it comes into force1, the Mental Capacity (Amendment) Act will sweep away the DoLS regime and replace it with the LPS. Broadly speaking, the changes will allow a care home to deprive a person of his or her

24 Care Home MANAGEMENT

July/August 2019

www.chmonline.co.uk

It is likely that after LPS come into force, there will be numerous cases in the courts. Care home managers are well-advised to keep abreast of these events liberty in certain circumstances: (a) Where a decision as to whether there is authority to deprive a person of their liberty is being sought from the Court of Protection; (b) Where steps are being taken by a responsible body or care home manger to obtain authorisation under Schedule AA1 (the LPS provisions); or, (c) In an emergency; or (d) Where LPS authorisation is in place. The LPS scheme will apply to those aged 16 and over. Under the LPS, a responsible body will authorise arrangements – for care homes, that means a CCG or Local Health Board where the care arrangements are organised through NHS Continuing Healthcare - or otherwise by the local authority. The responsible body must be satisfied that three conditions are met: 1. The person who is the subject of the arrangements lacks the capacity to consent to the arrangements 2. The person has a mental disorder; and 3. The arrangements are necessary to prevent harm to the cared-for person and are proportionate in relation to the likelihood and seriousness of harm. The responsible body must also consult the person and a range of other people, in particular to try to ascertain the cared-for person’s wishes or feelings in relation to the arrangements (and whether they object). A key development affecting care home managers is that the responsible body can delegate some of the assessments and consultation needed for LPS authorisation to care home managers. Accepting this responsibility could be potentially risky for care home managers, who could be found liable for breaches of Article 5, if assessments are not carried out correctly or speedily enough. This development also presents a potential conflict of interest since care homes have a financial interest in securing placements and the outcome of the assessment may determine whether a placement is secured. This conflict is only partially addressed by another feature of the LPS - the pre-

authorisation review. That review must be carried out by a person who is not involved in the resident’s day-to-day treatment to determine whether it is reasonable for the responsible body to conclude that the authorisation conditions are met. If the resident objects to the arrangements, then an Approved Mental Capacity Professional (AMCP) must carry out that review – a bit like the DoLS’ Best Interests Assessor role. Ultimately, though, the responsible bodies and reviewers will be relying on information they have been given. Furthermore, it will be for the care home manager, during the consultation process, to ascertain whether the resident is objecting to the proposed arrangements, and accordingly triggering the role of the AMCP.

Implications for care home managers

For care home managers, the tasks of undertaking the assessments and consulting with the resident will require time, resources and skills. For example, establishing whether the resident is objecting to the arrangements might not be straightforward, because the person’s responses might change from day-to-day or they might not be able to communicate the decision. There is also the practical issue of how the assessments and consultation can happen effectively before the person becomes a resident. Finally, access to advocacy will be significantly weaker under the LPS – why? First, there is no duty to appoint an Independent Mental Capacity Advocacy (IMCA), only to “take all reasonable steps to appoint an IMCA.” That duty is only engaged if there is no appropriate person to represent and support the cared-for person and the person lacks capacity consent. Second, a best interests test is incorporated into deciding who gets an IMCA where the resident lacks capacity to request one. It is not clear that these provisions will be found by the Court of Protection to be adequate, and it is likely that in the months and years after LPS come into force, there will be numerous cases in the courts. Care home managers are well-advised to keep abreast of these events. At the time of writing the Mental Capacity (Amendment) Bill is awaiting the final stage of Royal Assent: the date on which the Royal Assent will come into force. An announcement in June states that this is expected to be 1 October 2020.

1

Care Home MANAGEMENT 25


LEGAL DOLS

LEGAL DOLS

P

aper-pushing and headache-inducing or an important way of protecting liberty? Whatever your views are on the Deprivation of Liberty Safeguards (DoLS) they have transformed the way care home admission decisions are made.

Background

Article 5 of the European Convention on Human Rights protects everyone’s right to liberty. The general rule is that a person cannot be deprived of his or her liberty, except for certain exceptions where the deprivation is “in accordance with a procedure prescribed by law.” Schedule 1A of the Mental Capacity Act 2005 – the DoLS system - provides that procedure: it empowers a supervisory body (which is usually the local authority) to grant a standard authorisation, often following a request from the managing authority of a care home, and the local authority is responsible for arranging six different assessments that must take place. The biggest change over the past 10 years since DoLS were introduced is the broadening of the definition of a “deprivation of liberty” in the UK Supreme Court case of Cheshire West v P [2014] UKSC 19. This has meant that many more people are (and have been) deprived of their liberty. As a result, there has been a huge increase in requests for standard authorisations since that decision (at great cost to local authorities).

What will I learn from this feature? How changes to DoLS will affect care home managers

A decade of learning

MENTAL CAPACITY ACT:

changes and challenges

The Court of Protection has been clear that: • requests for standard authorisations must be made in a timely manner and before an individual is deprived of his or her liberty • any forms of restraint and other significant interferences with Articles 5 or 8 rights such as the use of covert medication must be properly considered as part of the best interests’ assessment and spelled out in the DoLS authorisation • self-funders are not exempt from DoLS • where the cared-for person, ‘P’, objects to the DoLS authorisation, reviews and legal challenges should be facilitated for them.

Liberty Protection Safeguards (“LPS”)

On October 1 next year the DoLS system will be completely replaced by the new Liberty Protection Safeguards (LPS). Barristers of 39 Essex Chambers, Victoria Butler-Cole QC and Stephanie David set out the key changes for care home managers

When it comes into force1, the Mental Capacity (Amendment) Act will sweep away the DoLS regime and replace it with the LPS. Broadly speaking, the changes will allow a care home to deprive a person of his or her

24 Care Home MANAGEMENT

July/August 2019

www.chmonline.co.uk

It is likely that after LPS come into force, there will be numerous cases in the courts. Care home managers are well-advised to keep abreast of these events liberty in certain circumstances: (a) Where a decision as to whether there is authority to deprive a person of their liberty is being sought from the Court of Protection; (b) Where steps are being taken by a responsible body or care home manger to obtain authorisation under Schedule AA1 (the LPS provisions); or, (c) In an emergency; or (d) Where LPS authorisation is in place. The LPS scheme will apply to those aged 16 and over. Under the LPS, a responsible body will authorise arrangements – for care homes, that means a CCG or Local Health Board where the care arrangements are organised through NHS Continuing Healthcare - or otherwise by the local authority. The responsible body must be satisfied that three conditions are met: 1. The person who is the subject of the arrangements lacks the capacity to consent to the arrangements 2. The person has a mental disorder; and 3. The arrangements are necessary to prevent harm to the cared-for person and are proportionate in relation to the likelihood and seriousness of harm. The responsible body must also consult the person and a range of other people, in particular to try to ascertain the cared-for person’s wishes or feelings in relation to the arrangements (and whether they object). A key development affecting care home managers is that the responsible body can delegate some of the assessments and consultation needed for LPS authorisation to care home managers. Accepting this responsibility could be potentially risky for care home managers, who could be found liable for breaches of Article 5, if assessments are not carried out correctly or speedily enough. This development also presents a potential conflict of interest since care homes have a financial interest in securing placements and the outcome of the assessment may determine whether a placement is secured. This conflict is only partially addressed by another feature of the LPS - the pre-

authorisation review. That review must be carried out by a person who is not involved in the resident’s day-to-day treatment to determine whether it is reasonable for the responsible body to conclude that the authorisation conditions are met. If the resident objects to the arrangements, then an Approved Mental Capacity Professional (AMCP) must carry out that review – a bit like the DoLS’ Best Interests Assessor role. Ultimately, though, the responsible bodies and reviewers will be relying on information they have been given. Furthermore, it will be for the care home manager, during the consultation process, to ascertain whether the resident is objecting to the proposed arrangements, and accordingly triggering the role of the AMCP.

Implications for care home managers

For care home managers, the tasks of undertaking the assessments and consulting with the resident will require time, resources and skills. For example, establishing whether the resident is objecting to the arrangements might not be straightforward, because the person’s responses might change from day-to-day or they might not be able to communicate the decision. There is also the practical issue of how the assessments and consultation can happen effectively before the person becomes a resident. Finally, access to advocacy will be significantly weaker under the LPS – why? First, there is no duty to appoint an Independent Mental Capacity Advocacy (IMCA), only to “take all reasonable steps to appoint an IMCA.” That duty is only engaged if there is no appropriate person to represent and support the cared-for person and the person lacks capacity consent. Second, a best interests test is incorporated into deciding who gets an IMCA where the resident lacks capacity to request one. It is not clear that these provisions will be found by the Court of Protection to be adequate, and it is likely that in the months and years after LPS come into force, there will be numerous cases in the courts. Care home managers are well-advised to keep abreast of these events. At the time of writing the Mental Capacity (Amendment) Bill is awaiting the final stage of Royal Assent: the date on which the Royal Assent will come into force. An announcement in June states that this is expected to be 1 October 2020.

1

Care Home MANAGEMENT 25


LEGAL SOCIAL MEDIA

LEGAL SOCIAL MEDIA

• If you look at or share extremely rude or

offensive images, messages or videos online you may get into trouble with the police, because you may have committed a crime The judge did not envisage precise details or mechanisms of privacy settings needed to be understood, but rather that the person needs to understand that such mechanisms exist and be able to decide whether to apply them. Descriptions of online risk are set out in the UK Council for Internet Safety’s Guidance, ‘Child Safety Online: A Practical Guide for Providers of Social Media and Interactive Services’. This is considered equally relevant to other vulnerable classes of internet users, including those with learning disabilities. For more information Full article online via the link https:// tinyurl.com/yym2ujbk Child Safety Online: A Practical Guide for Providers of Social Media and Interactive Services’ available [online] via the link: https://tinyurl.com/yxv63z87

In a Social capacity

Two cases have clarified the specific tests to apply in cases of capacity and use of internet and social media, as well as guidance for providers regarding social media policies. By Holly Bridden, solicitor at RadcliffesLeBrasseur

26 Care Home MANAGEMENT

People need to understand that privacy settings exist and [they should] be able to decide whether to apply them. www.chmonline.co.uk

Chu

1950’s Re

r c h Se

rvice

1970’s

BINGO

m i n i s c e n c e M u s i c Q u i z ze s

R e m i n i s c e n c e O w n M e di a P i a n o B a r S in g - a - L o n g

Relaxat io n 1950’s Reminisc e

n

The ‘relevant information’ which the person needs to be able to understand, retain, and use and weigh, is as follows: • Information and images (including videos) which you share on the internet or through social media could be shared more widely, including with people you don’t know, without you knowing or being able to stop it • It is possible to limit the sharing of personal information or images (and videos) by using ‘privacy and location settings’ on some internet and social media sites • If you place material or images (including videos) on social media sites which are rude or offensive, or share those images, other people might be upset or offended • Some people you meet or communicate with (‘talk to’) online, who you don’t

otherwise know, may not be who they say they are (‘they may disguise, or lie about, themselves’); someone who calls themselves a ‘friend’ on social media may not be friendly • Some people you meet or communicate with (‘talk to’) on the internet or through social media, who you don’t otherwise know, may pose a risk to you; they may lie to you, or exploit or take advantage of you sexually, financially, emotionally and/or physically; they may want to cause you harm

“Jolly Trolley” nce

s Food & Drinks M u s i c Picture Qui z z 1960’s R eminisce nce Happy B i r thday! Fish Tank S l i d e shows Afternoon Tea Select - a - Theme arty Songs 1940 i n i s c e n c e K a r a o ke

P

CASE B: Miss B’s use of social media had been the cause of repeated concern to her adult social care workers. She had been known to send money, intimate photos and readily provide information such as her address to male strangers.

Capacity test and social media

We are excited to introduce our AWARD WINNING

e

BACKGROUND TO RELEVANT CASES

CASE A: Court of Protection proceedings were commenced in 2017 when concerns emerged in relation to A’s capacity to make decisions regarding residence, care, contact and internet use. Concerns in relation to use of the internet arose in 2016 when his parents discovered he had used his Facebook account to share intimate photographs and videos with others. When unsupervised, A is said to compulsively search for pornography and has developed an interest in paedophilic images and extreme sexual activity.

INTERNET ACCESS AND SAFETY PLANS

Use of internet and social media is likely to be an issue that a provider’s staff may be involved in on a regular basis and therefore it would be advisable to have an appropriate policy in place for staff to refer to. It will be important to set clear expectations as regards how and where capacity decisions are to be recorded. Training may also be useful. Where service users are considered to lack capacity, care plans in the service user’s best interests will be required. In ‘Case A’, the judge approved an access plan, which included supervised use of the iPad for set periods and provision for staff to check his phone each day to assist him deal with unwanted messages. It was noted that the staff working with A are aware of the need for vigilance around their own devices and that A was very able to delete call and message history. In ‘Case B’, the judge commented that interference such as use of filters or supervision would have to be proportionate, justified and not unduly restrictive.

2019 SPECIFIERS GUIDE

’s Rem

TO FLOORING AND CERAMIC TILING The go-to guide for flooring and tiling Essential reading for Architects, Building Specifiers, Facilities Managers, Interior Designers and Housing Associations

Register online to receive your free copy today

www.specifiersguide.co.uk July/August 2019

• Traditional ‘Ice Cream Cart’ design and sensory lighting stimulate the anticipation of pleasure • Use in lounges, bedrooms, corridors, reception or even outside on a nice day • Wireless micophone, lyrics and PA system inspires everyone to sing along • Theme your Trolley to promote eating, drinking, events and occasions • Saves costs by reducing dependance on outside entertainers • Easy to add your own music, images and videos • Simple touch screen operation • Enhances the quality of care you deliver • Complete with reminiscence videos, quizzes and music

To find out more or to book a FREE demonstration please call 0800 093 8499 or email hello@littleislands.org

Care Home MANAGEMENT 27


LEGAL SOCIAL MEDIA

LEGAL SOCIAL MEDIA

• If you look at or share extremely rude or

offensive images, messages or videos online you may get into trouble with the police, because you may have committed a crime The judge did not envisage precise details or mechanisms of privacy settings needed to be understood, but rather that the person needs to understand that such mechanisms exist and be able to decide whether to apply them. Descriptions of online risk are set out in the UK Council for Internet Safety’s Guidance, ‘Child Safety Online: A Practical Guide for Providers of Social Media and Interactive Services’. This is considered equally relevant to other vulnerable classes of internet users, including those with learning disabilities. For more information Full article online via the link https:// tinyurl.com/yym2ujbk Child Safety Online: A Practical Guide for Providers of Social Media and Interactive Services’ available [online] via the link: https://tinyurl.com/yxv63z87

In a Social capacity

Two cases have clarified the specific tests to apply in cases of capacity and use of internet and social media, as well as guidance for providers regarding social media policies. By Holly Bridden, solicitor at RadcliffesLeBrasseur

26 Care Home MANAGEMENT

People need to understand that privacy settings exist and [they should] be able to decide whether to apply them. www.chmonline.co.uk

Chu

1950’s Re

r c h Se

rvice

1970’s

BINGO

m i n i s c e n c e M u s i c Q u i z ze s

R e m i n i s c e n c e O w n M e di a P i a n o B a r S in g - a - L o n g

Relaxat io n 1950’s Reminisc e

n

The ‘relevant information’ which the person needs to be able to understand, retain, and use and weigh, is as follows: • Information and images (including videos) which you share on the internet or through social media could be shared more widely, including with people you don’t know, without you knowing or being able to stop it • It is possible to limit the sharing of personal information or images (and videos) by using ‘privacy and location settings’ on some internet and social media sites • If you place material or images (including videos) on social media sites which are rude or offensive, or share those images, other people might be upset or offended • Some people you meet or communicate with (‘talk to’) online, who you don’t

otherwise know, may not be who they say they are (‘they may disguise, or lie about, themselves’); someone who calls themselves a ‘friend’ on social media may not be friendly • Some people you meet or communicate with (‘talk to’) on the internet or through social media, who you don’t otherwise know, may pose a risk to you; they may lie to you, or exploit or take advantage of you sexually, financially, emotionally and/or physically; they may want to cause you harm

“Jolly Trolley” nce

s Food & Drinks M u s i c Picture Qui z z 1960’s R eminisce nce Happy B i r thday! Fish Tank S l i d e shows Afternoon Tea Select - a - Theme arty Songs 1940 i n i s c e n c e K a r a o ke

P

CASE B: Miss B’s use of social media had been the cause of repeated concern to her adult social care workers. She had been known to send money, intimate photos and readily provide information such as her address to male strangers.

Capacity test and social media

We are excited to introduce our AWARD WINNING

e

BACKGROUND TO RELEVANT CASES

CASE A: Court of Protection proceedings were commenced in 2017 when concerns emerged in relation to A’s capacity to make decisions regarding residence, care, contact and internet use. Concerns in relation to use of the internet arose in 2016 when his parents discovered he had used his Facebook account to share intimate photographs and videos with others. When unsupervised, A is said to compulsively search for pornography and has developed an interest in paedophilic images and extreme sexual activity.

INTERNET ACCESS AND SAFETY PLANS

Use of internet and social media is likely to be an issue that a provider’s staff may be involved in on a regular basis and therefore it would be advisable to have an appropriate policy in place for staff to refer to. It will be important to set clear expectations as regards how and where capacity decisions are to be recorded. Training may also be useful. Where service users are considered to lack capacity, care plans in the service user’s best interests will be required. In ‘Case A’, the judge approved an access plan, which included supervised use of the iPad for set periods and provision for staff to check his phone each day to assist him deal with unwanted messages. It was noted that the staff working with A are aware of the need for vigilance around their own devices and that A was very able to delete call and message history. In ‘Case B’, the judge commented that interference such as use of filters or supervision would have to be proportionate, justified and not unduly restrictive.

2019 SPECIFIERS GUIDE

’s Rem

TO FLOORING AND CERAMIC TILING The go-to guide for flooring and tiling Essential reading for Architects, Building Specifiers, Facilities Managers, Interior Designers and Housing Associations

Register online to receive your free copy today

www.specifiersguide.co.uk July/August 2019

• Traditional ‘Ice Cream Cart’ design and sensory lighting stimulate the anticipation of pleasure • Use in lounges, bedrooms, corridors, reception or even outside on a nice day • Wireless micophone, lyrics and PA system inspires everyone to sing along • Theme your Trolley to promote eating, drinking, events and occasions • Saves costs by reducing dependance on outside entertainers • Easy to add your own music, images and videos • Simple touch screen operation • Enhances the quality of care you deliver • Complete with reminiscence videos, quizzes and music

To find out more or to book a FREE demonstration please call 0800 093 8499 or email hello@littleislands.org

Care Home MANAGEMENT 27


LEGAL DEPUTIES

Don't leave your journey to chance. Book a MediCab®

Working with deputies

What personal information should a care home share with a finance deputy who isn’t appointed for health and welfare? Amy Chater, solicitor at Coffin Mew, gives some advice

C A MediCab® is equipped to meet your medical needs, a minicab isn't. Our fleet of wheelchair accessible MediCab® vehicles provide superior transport to those with medical or mobility needs, for little more than the price of a minicab. Hosted by our driver companions, we don't just drive with care, we are driven by care. Suitable for all levels of non-emergency transport, our services are available to the public and our partners 24 hours a day, 365 days a year.

BOOK NOW Call 020 3642 3330 or email bookings@oncuetransport.co.uk oncuetransport.co.uk

are homes will most likely deal with residents’ finance deputies when signing care contracts for residents, setting up direct debits for fees, and corresponding about changes in fee rates or other sundry bills. And, to do this effectively, there will be occasions when this role will require further information about the individual: it is difficult to make financial plans without an awareness of health, care needs and prognosis. Giving health and welfare information to a finance deputy is allowed if it is in the best interests of a resident and is to of an extent that helps them to make a particular decision. For example, if deputies were applying for attendance allowance or continuing healthcare funding (CHC) funding, care homes could release information about the resident’s care needs and medication, but it may not be relevant to provide them with the resident’s entire medical history. Financial deputies may need to know about a resident’s dental care needs if, for example,

July/August 2019

Giving health and welfare information to a finance deputy is allowed if it is in the best interests of a resident and is of an extent that helps them to make a particular decision

there is a significant financial cost. The Mental Capacity Act Code of Practice contains some excellent guidance about releasing information when someone lacks capacity.

Costs

There is of course a cost to having a professional deputy, but care homes should not let that put them off contacting them or their legal team. The deputy might be working on a fixed cost set by the court or they might have their costs assessed. Either way they are only allowed to charge the resident what is reasonable and necessary, so care homes don’t need to worry about unnecessary costs to their resident.

Next of kin

It will help if all staff members, not just head office, know a resident has a deputy, and if the deputy is treated as a second next of kin. This means they should be kept abreast of any relevant information as and when necessary to promote the resident’s best interests. Care Home MANAGEMENT 29


LEGAL DEPUTIES

Don't leave your journey to chance. Book a MediCab®

Working with deputies

What personal information should a care home share with a finance deputy who isn’t appointed for health and welfare? Amy Chater, solicitor at Coffin Mew, gives some advice

C A MediCab® is equipped to meet your medical needs, a minicab isn't. Our fleet of wheelchair accessible MediCab® vehicles provide superior transport to those with medical or mobility needs, for little more than the price of a minicab. Hosted by our driver companions, we don't just drive with care, we are driven by care. Suitable for all levels of non-emergency transport, our services are available to the public and our partners 24 hours a day, 365 days a year.

BOOK NOW Call 020 3642 3330 or email bookings@oncuetransport.co.uk oncuetransport.co.uk

are homes will most likely deal with residents’ finance deputies when signing care contracts for residents, setting up direct debits for fees, and corresponding about changes in fee rates or other sundry bills. And, to do this effectively, there will be occasions when this role will require further information about the individual: it is difficult to make financial plans without an awareness of health, care needs and prognosis. Giving health and welfare information to a finance deputy is allowed if it is in the best interests of a resident and is to of an extent that helps them to make a particular decision. For example, if deputies were applying for attendance allowance or continuing healthcare funding (CHC) funding, care homes could release information about the resident’s care needs and medication, but it may not be relevant to provide them with the resident’s entire medical history. Financial deputies may need to know about a resident’s dental care needs if, for example,

July/August 2019

Giving health and welfare information to a finance deputy is allowed if it is in the best interests of a resident and is of an extent that helps them to make a particular decision

there is a significant financial cost. The Mental Capacity Act Code of Practice contains some excellent guidance about releasing information when someone lacks capacity.

Costs

There is of course a cost to having a professional deputy, but care homes should not let that put them off contacting them or their legal team. The deputy might be working on a fixed cost set by the court or they might have their costs assessed. Either way they are only allowed to charge the resident what is reasonable and necessary, so care homes don’t need to worry about unnecessary costs to their resident.

Next of kin

It will help if all staff members, not just head office, know a resident has a deputy, and if the deputy is treated as a second next of kin. This means they should be kept abreast of any relevant information as and when necessary to promote the resident’s best interests. Care Home MANAGEMENT 29


KITCHENS REHABILITATION

KITCHENS WORKFORCE HEALTH

WHAT CHEFS WANT

More freedom to be creative in the kitchen

USING KITCHENS

87%

What will I learn from this feature? To understand the role of an adjustable kitchen in rehab and training

FOR REHAB

How an adjustable kitchen can support skills retraining. By Peter Davies, from accessible kitchen supplier Ropox

R

ehabilitation is a vital part of the recovery programme for anyone who has suffered a stroke, brain or spinal injury. Depending on the level of injury and mobility, some people can regain their independence relatively quickly, while for others, it can be a case of learning how to do things from scratch and nowhere is this more challenging than in the kitchen. There are a huge number of activities performed in a kitchen, all of which need to be taken into consideration. These include: • Moving between work stations • Worktop food preparation • Cleaning vegetables, etc, at the sink • Washing up • Cooking at the hob • Using the oven • Accessing the fridge and freezer • Cleaning Many care settings and rehabilitation centres now use adjustable kitchens to help their patients regain some independence and increase their confidence. People can learn or re-learn individual skills at the three main working areas – the hob, 30 Care Home MANAGEMENT

preparation area and sink while also having access to the oven and fridge. A training kitchen may be used for teaching specific skills, testing and assessing ability and monitoring how a patient is progressing. Individual users will often need to carry out kitchen activities at different heights. For example, cooking at the hob may be easier at lower heights than when washing up at the sink as could be using a mixing bowl at a lower worktop height than when slicing vegetables. The electric height adjustment makes it possible for people to work at the most ergonomic height and with good leg access below: seated patients can get the best possible position in relation to the work surface while people who stand can work at the best height for their balance or reach. The linear design of a worktop split in two allows two people to work in the same area and therapists/trainers can help from the left- or the right-hand sides of an individual in the aim of speeding up recovery of important skills.

Changing lives through kitchen rehabilitation

Two years ago, at a cost of £10,000, Homerton Transitional Neurological Rehabilitation Unit in east London installed a therapy kitchen consisting of an oven with a fold-away door, hob, sink, two adjacent electric height adjustable worktops and an adjustable wall unit system. The worktops have a 300mm height adjustment which provides a worktop height range of 690mm to 990mm making it suitable for most wheelchair users. Specialist occupational therapist Joanna LyndonCohen explains the benefits: “We have patients here with a range of neurological conditions ranging from strokes and traumatic brain injuries to spinal cord issues, Parkinson’s and MS. For many of our patients, being able to make their own meals is hugely important as it can help with their independence and confidence and the training kitchen provides them with the opportunity to practice their meal preparation skills.” Among the patients currently using the training kitchen is Mustafa who is using the kitchen to make his own meals.

Joanna explains: “When Mustafa arrived he was using a wheelchair. He has now progressed to just using a walking frame, and thanks to the height adjustable worktops he has been able to use the kitchen from day one. From our perspective, seeing the difference a training kitchen can make is just fantastic.”

www.chmonline.co.uk

Shifts that offer a better work-life balance

62%

Put a kick into

YOUR KITCHEN A survey of 102 chefs has highlighted five factors that can improve kitchen efficiency

1

Create a workplace that supports the physical and mental wellbeing of chefs: this is less to do with environment, and more to do with how the demands of the kitchen are managed. Work to understand your chefs’ needs. Create an environment where mental wellbeing is talked about. Build wellbeing conversations into regular meetings and take a genuine interest in people’s mental health. Create working hours that are flexible Create working patterns that include regular breaks: Regular breaks are an opportunity to clear the mind and to cool down. Heat stress, when the body’s natural thermostat starts to fail, can result in inattentiveness and cause a serious accident.

2

3 4

July/August 2019

5

Create support mechanisms: Encouraging connections between people at work promotes a sense of fulfilment, as do opportunities for learning, regular feedback and celebrations of a good job well done. According to the survey, conducted by Nestlé Professional/Chef, being a chef no longer means just cooking good food. Chefs are expected to be creative, personable with customers and tuned into social media. Eight in ten chefs surveyed said this had impacted on their mental health. Dave Turnbull from Unite said: “We all remember an incredible meal, shared with family and friends. Chefs carry this weight when they step into the kitchen, and with that comes pressure.”

Mental health first aid training in the workplace

60%

A chef buddy scheme pairing more and less experienced chefs

40%

Source: Nestlé Professional/Chef report, At Boiling Point available [online] at: https://www.nestleprofessional.co.uk/oursolutions/chef/welcome

Care Home MANAGEMENT 31


KITCHENS REHABILITATION

KITCHENS WORKFORCE HEALTH

WHAT CHEFS WANT

More freedom to be creative in the kitchen

USING KITCHENS

87%

What will I learn from this feature? To understand the role of an adjustable kitchen in rehab and training

FOR REHAB

How an adjustable kitchen can support skills retraining. By Peter Davies, from accessible kitchen supplier Ropox

R

ehabilitation is a vital part of the recovery programme for anyone who has suffered a stroke, brain or spinal injury. Depending on the level of injury and mobility, some people can regain their independence relatively quickly, while for others, it can be a case of learning how to do things from scratch and nowhere is this more challenging than in the kitchen. There are a huge number of activities performed in a kitchen, all of which need to be taken into consideration. These include: • Moving between work stations • Worktop food preparation • Cleaning vegetables, etc, at the sink • Washing up • Cooking at the hob • Using the oven • Accessing the fridge and freezer • Cleaning Many care settings and rehabilitation centres now use adjustable kitchens to help their patients regain some independence and increase their confidence. People can learn or re-learn individual skills at the three main working areas – the hob, 30 Care Home MANAGEMENT

preparation area and sink while also having access to the oven and fridge. A training kitchen may be used for teaching specific skills, testing and assessing ability and monitoring how a patient is progressing. Individual users will often need to carry out kitchen activities at different heights. For example, cooking at the hob may be easier at lower heights than when washing up at the sink as could be using a mixing bowl at a lower worktop height than when slicing vegetables. The electric height adjustment makes it possible for people to work at the most ergonomic height and with good leg access below: seated patients can get the best possible position in relation to the work surface while people who stand can work at the best height for their balance or reach. The linear design of a worktop split in two allows two people to work in the same area and therapists/trainers can help from the left- or the right-hand sides of an individual in the aim of speeding up recovery of important skills.

Changing lives through kitchen rehabilitation

Two years ago, at a cost of £10,000, Homerton Transitional Neurological Rehabilitation Unit in east London installed a therapy kitchen consisting of an oven with a fold-away door, hob, sink, two adjacent electric height adjustable worktops and an adjustable wall unit system. The worktops have a 300mm height adjustment which provides a worktop height range of 690mm to 990mm making it suitable for most wheelchair users. Specialist occupational therapist Joanna LyndonCohen explains the benefits: “We have patients here with a range of neurological conditions ranging from strokes and traumatic brain injuries to spinal cord issues, Parkinson’s and MS. For many of our patients, being able to make their own meals is hugely important as it can help with their independence and confidence and the training kitchen provides them with the opportunity to practice their meal preparation skills.” Among the patients currently using the training kitchen is Mustafa who is using the kitchen to make his own meals.

Joanna explains: “When Mustafa arrived he was using a wheelchair. He has now progressed to just using a walking frame, and thanks to the height adjustable worktops he has been able to use the kitchen from day one. From our perspective, seeing the difference a training kitchen can make is just fantastic.”

www.chmonline.co.uk

Shifts that offer a better work-life balance

62%

Put a kick into

YOUR KITCHEN A survey of 102 chefs has highlighted five factors that can improve kitchen efficiency

1

Create a workplace that supports the physical and mental wellbeing of chefs: this is less to do with environment, and more to do with how the demands of the kitchen are managed. Work to understand your chefs’ needs. Create an environment where mental wellbeing is talked about. Build wellbeing conversations into regular meetings and take a genuine interest in people’s mental health. Create working hours that are flexible Create working patterns that include regular breaks: Regular breaks are an opportunity to clear the mind and to cool down. Heat stress, when the body’s natural thermostat starts to fail, can result in inattentiveness and cause a serious accident.

2

3 4

July/August 2019

5

Create support mechanisms: Encouraging connections between people at work promotes a sense of fulfilment, as do opportunities for learning, regular feedback and celebrations of a good job well done. According to the survey, conducted by Nestlé Professional/Chef, being a chef no longer means just cooking good food. Chefs are expected to be creative, personable with customers and tuned into social media. Eight in ten chefs surveyed said this had impacted on their mental health. Dave Turnbull from Unite said: “We all remember an incredible meal, shared with family and friends. Chefs carry this weight when they step into the kitchen, and with that comes pressure.”

Mental health first aid training in the workplace

60%

A chef buddy scheme pairing more and less experienced chefs

40%

Source: Nestlé Professional/Chef report, At Boiling Point available [online] at: https://www.nestleprofessional.co.uk/oursolutions/chef/welcome

Care Home MANAGEMENT 31


KITCHENS FIRE SAFETY

KITCHENS REFRIDGERATION

GIVE YOUR KITCHEN A FIRE

SAFETY MOT New certification for kitchen fire protection systems gives care home managers a helping hand with safety compliance, says Richard Jenkins, chief executive of the National Security Inspectorate (NSI).

K

itchen fires are statistically the third most likely cause of large fires behind situations involving open flames or applied heat or friction, and arson, according to BAFE, the UK’s independent register of quality fire safety service providers. Mitigating risk by installing a kitchen fire protection system is recommended by Government, and the fire and rescue services across the UK. These systems protect premises by automatically activating as soon as fire is detected, preventing the spread of fire to other parts of the building. This can be crucial, particularly when fire breaks out ‘out of hours’ in an unattended area. In conjunction with

certification body NSI, BAFE now offers a Kitchen Fire Protection Systems Scheme, providing safety certification for kitchen fire protection systems installed in care homes. This will support managers in their risk assessment responsibilities and related legal obligations under the Regulatory Reform (Fire Safety) Order (2005). The first certificates of compliance under the new scheme were issued in the first quarter of 2019. Care home operators should note that the new NSI/BAFE scheme for commercial kitchen fire protection systems has the broad support of insurers. Managers are advised to check policy terms before or after installation of a kitchen fire protection system.

During 2017 and 2018 a series of fires in care homes across the region prompted the London Fire Brigade to conduct a detailed inspection of 177 properties. 57 per cent of care homes assessed received formal notification of fire safety breaches requiring urgent action. These include:

wallpaper murals

• Fire risk assessments conducted by people without

designed exclusively for care homes Create colourful feature walls that engage and inform View our wallpaper collection online

32 Care Home MANAGEMENT

carehomemurals.co.uk 01283 712171

CareHome Murals

proper skills and experience • Roof voids omitted from fire risk assessments (lack of adequate compartmentation in roof voids is known to increase the spread and severity of a fire) • Inadequate or poorly maintained fire doors • Confusion within premises about fire evacuation strategies was widespread.

www.chmonline.co.uk

MAKE A nICE PURCHASE Energy labelling, climate testing and the types of refrigerants used in your equipment have joined price, quality, and suitability on your list of purchasing considerations. After 2020, the law is changing on the refrigerants you can buy, says Simon Frost, director UK & Ireland, Hoshizaki UK

T

he commercial refrigeration sector is currently undergoing the largest change in living memory. Environmental concerns have translated into legislation, which in the UK will see manufacturers switch product development towards more environmentallyfriendly solutions - changing the purchasing landscape for care home operators.

An immediate change takes place this month (July): energy labelling will remove the F-rated option, pushing product development towards more efficient, and more sustainable refrigeration options. From 2020, refrigerants with a GWP factor (Global Warming Potential factor) higher than 2500 will be prohibited.

Get classy about your refrigeration ‘Climate class’ is also an important consideration for equipment efficiency: in a hot and humid professional kitchen, operators should look for a minimum of climate class 4 testing (30°c ambient temperature and 55 per cent relative humidity) or ideally the top-level climate class 5 (40°c ambient temperature and 40 per cent relative humidity). This will ensure your equipment works in the way highlighted on the energy label.

This will effectively phase out today’s commonly used synthetic refrigerants including hydrofluorocarbon (HFC), hydrochlorofluorocarbon (HCFC) and chlorofluorocarbon (CFC) based refrigerants, HFOs, HFCs, F-gases, in favour of natural alternatives with a greener footprint.

Facing enforcement action from CQC? Need to challenge a draft report? Meet the LA Care Team – we’re here to help We can support you with: • Advice on compliance with the regulations and Fundamental Standards

• Funding disputes and unpaid care fees

• Defending CQC enforcement action

• Sales and acquisitions

• Challenging inspection reports and ratings

• Court of Protection cases

• Safeguarding investigations

• Employment issues

• Coroner’s inquests

• Requirements for charities

Laura Guntrip, Head of Healthcare

• Criminal investigations and prosecutions Peter Grose, Partner

Alison Wood, Solicitor

Pauline Belloni, Solicitor

Sarah Price, Solicitor

Specialist Solicitors to the Care Sector

Please contact our team of experts today laura.guntrip@LA-law.com July/August 2019

0344 9672 741 www.lesteraldridge.com Care Home MANAGEMENT 33


KITCHENS FIRE SAFETY

KITCHENS REFRIDGERATION

GIVE YOUR KITCHEN A FIRE

SAFETY MOT New certification for kitchen fire protection systems gives care home managers a helping hand with safety compliance, says Richard Jenkins, chief executive of the National Security Inspectorate (NSI).

K

itchen fires are statistically the third most likely cause of large fires behind situations involving open flames or applied heat or friction, and arson, according to BAFE, the UK’s independent register of quality fire safety service providers. Mitigating risk by installing a kitchen fire protection system is recommended by Government, and the fire and rescue services across the UK. These systems protect premises by automatically activating as soon as fire is detected, preventing the spread of fire to other parts of the building. This can be crucial, particularly when fire breaks out ‘out of hours’ in an unattended area. In conjunction with

certification body NSI, BAFE now offers a Kitchen Fire Protection Systems Scheme, providing safety certification for kitchen fire protection systems installed in care homes. This will support managers in their risk assessment responsibilities and related legal obligations under the Regulatory Reform (Fire Safety) Order (2005). The first certificates of compliance under the new scheme were issued in the first quarter of 2019. Care home operators should note that the new NSI/BAFE scheme for commercial kitchen fire protection systems has the broad support of insurers. Managers are advised to check policy terms before or after installation of a kitchen fire protection system.

During 2017 and 2018 a series of fires in care homes across the region prompted the London Fire Brigade to conduct a detailed inspection of 177 properties. 57 per cent of care homes assessed received formal notification of fire safety breaches requiring urgent action. These include:

wallpaper murals

• Fire risk assessments conducted by people without

designed exclusively for care homes Create colourful feature walls that engage and inform View our wallpaper collection online

32 Care Home MANAGEMENT

carehomemurals.co.uk 01283 712171

CareHome Murals

proper skills and experience • Roof voids omitted from fire risk assessments (lack of adequate compartmentation in roof voids is known to increase the spread and severity of a fire) • Inadequate or poorly maintained fire doors • Confusion within premises about fire evacuation strategies was widespread.

www.chmonline.co.uk

MAKE A nICE PURCHASE Energy labelling, climate testing and the types of refrigerants used in your equipment have joined price, quality, and suitability on your list of purchasing considerations. After 2020, the law is changing on the refrigerants you can buy, says Simon Frost, director UK & Ireland, Hoshizaki UK

T

he commercial refrigeration sector is currently undergoing the largest change in living memory. Environmental concerns have translated into legislation, which in the UK will see manufacturers switch product development towards more environmentallyfriendly solutions - changing the purchasing landscape for care home operators.

An immediate change takes place this month (July): energy labelling will remove the F-rated option, pushing product development towards more efficient, and more sustainable refrigeration options. From 2020, refrigerants with a GWP factor (Global Warming Potential factor) higher than 2500 will be prohibited.

Get classy about your refrigeration ‘Climate class’ is also an important consideration for equipment efficiency: in a hot and humid professional kitchen, operators should look for a minimum of climate class 4 testing (30°c ambient temperature and 55 per cent relative humidity) or ideally the top-level climate class 5 (40°c ambient temperature and 40 per cent relative humidity). This will ensure your equipment works in the way highlighted on the energy label.

This will effectively phase out today’s commonly used synthetic refrigerants including hydrofluorocarbon (HFC), hydrochlorofluorocarbon (HCFC) and chlorofluorocarbon (CFC) based refrigerants, HFOs, HFCs, F-gases, in favour of natural alternatives with a greener footprint.

Facing enforcement action from CQC? Need to challenge a draft report? Meet the LA Care Team – we’re here to help We can support you with: • Advice on compliance with the regulations and Fundamental Standards

• Funding disputes and unpaid care fees

• Defending CQC enforcement action

• Sales and acquisitions

• Challenging inspection reports and ratings

• Court of Protection cases

• Safeguarding investigations

• Employment issues

• Coroner’s inquests

• Requirements for charities

Laura Guntrip, Head of Healthcare

• Criminal investigations and prosecutions Peter Grose, Partner

Alison Wood, Solicitor

Pauline Belloni, Solicitor

Sarah Price, Solicitor

Specialist Solicitors to the Care Sector

Please contact our team of experts today laura.guntrip@LA-law.com July/August 2019

0344 9672 741 www.lesteraldridge.com Care Home MANAGEMENT 33


LIFTS SAFETY

UP, UP AND

AWAY! A guide to managing your lifts by Nick Mellor, MD of the Lift & Escalator Industry Association (LEIA)

K A law firm with a different perspective

Scaling the heights to reach your goals is never easy but is profoundly rewarding. At Gordons Partnership, we are proud to help providers overcome what may seem like insurmountable challenges. When we work together, the sky’s the limit.

neil@gordonsols.co.uk | 01483 451900 | www.gordonsols.co.uk

eeping your lifts safe, reliable, and retaining their value takes time and attention: there are various regulations which set minimum requirements for maintenance and third-party inspections, and there are many sources of guidance to support compliance. Misuse of unlocking keys for lift/lifting platform landing doors has been the subject of an HSE eBulletin, following a fatality and several incidents. Landing door unlocking keys are used as part of the procedure to release trapped passengers, for example, due to power failure or lift fault. Since unlocking a landing door may expose people on the landing to a risk of falling, the use of the

landing door unlocking key must be carefully controlled. Several accidents have occurred due to the use of the landing door unlocking key by untrained people. When a lift or lifting platform is new, and handed over to the owner, the lift contractor must provide a landing door unlocking key with a warning label setting out that it must be used only by trained and authorised persons. Also relevant to care homes is the need to risk assess the home’s lift use, especially after a change of use, change of users or even a change in intensity of use. Cases such as the death of a care home worker in Herne Bay highlight the need for regular reviews of lift safety and for the use of protective devices.

Further information and guidance LIFTEX 2019 seminar presentation: Survival guide for lift managers and dutyholders available [online] via the link: https:// tinyurl.com/y5ntn2h6 HSE Information sheet, How the Lifting Operations and Lifting Equipment Regulations apply to health and social care [online] at: http://www.hse.gov.uk/pubns/hsis4.pdf LEIA training and guidance [online] at: www.leia.co.uk July/August 2019

Effective lift management For lifting equipment, which is used at work, the Lifting Operations and Lifting Equipment Regulations (LOLER) apply. It should be noted that HSE have brought prosecutions under the more general sections 2 and 3 of the Health and Safety at Work Act which place general duties on owners and employers to ensure the safety of their employees and others such as users. Third-party inspection/ thorough examination can also provide a useful check that maintenance is being carried out effectively.

Following a fatality, a prosecution may involve the care homeowner, maintenance contractor and thirdparty inspection body. The owner/duty holder/responsible person arranges for maintenance of lifts/lifting appliances, arranges for third party inspections, and acts on the reports they receive, in particular, addressing safety issues The maintenance contractor is employed to fulfil maintenance in compliance with regulations and risk assessments relating to equipment wear and tear. Maintenance consists of physical visits and remote monitoring. The third-party inspection body will carry out periodic inspections (also known as thorough examination).

1

2

3

Care Home MANAGEMENT 35


LIFTS SAFETY

UP, UP AND

AWAY! A guide to managing your lifts by Nick Mellor, MD of the Lift & Escalator Industry Association (LEIA)

K A law firm with a different perspective

Scaling the heights to reach your goals is never easy but is profoundly rewarding. At Gordons Partnership, we are proud to help providers overcome what may seem like insurmountable challenges. When we work together, the sky’s the limit.

neil@gordonsols.co.uk | 01483 451900 | www.gordonsols.co.uk

eeping your lifts safe, reliable, and retaining their value takes time and attention: there are various regulations which set minimum requirements for maintenance and third-party inspections, and there are many sources of guidance to support compliance. Misuse of unlocking keys for lift/lifting platform landing doors has been the subject of an HSE eBulletin, following a fatality and several incidents. Landing door unlocking keys are used as part of the procedure to release trapped passengers, for example, due to power failure or lift fault. Since unlocking a landing door may expose people on the landing to a risk of falling, the use of the

landing door unlocking key must be carefully controlled. Several accidents have occurred due to the use of the landing door unlocking key by untrained people. When a lift or lifting platform is new, and handed over to the owner, the lift contractor must provide a landing door unlocking key with a warning label setting out that it must be used only by trained and authorised persons. Also relevant to care homes is the need to risk assess the home’s lift use, especially after a change of use, change of users or even a change in intensity of use. Cases such as the death of a care home worker in Herne Bay highlight the need for regular reviews of lift safety and for the use of protective devices.

Further information and guidance LIFTEX 2019 seminar presentation: Survival guide for lift managers and dutyholders available [online] via the link: https:// tinyurl.com/y5ntn2h6 HSE Information sheet, How the Lifting Operations and Lifting Equipment Regulations apply to health and social care [online] at: http://www.hse.gov.uk/pubns/hsis4.pdf LEIA training and guidance [online] at: www.leia.co.uk July/August 2019

Effective lift management For lifting equipment, which is used at work, the Lifting Operations and Lifting Equipment Regulations (LOLER) apply. It should be noted that HSE have brought prosecutions under the more general sections 2 and 3 of the Health and Safety at Work Act which place general duties on owners and employers to ensure the safety of their employees and others such as users. Third-party inspection/ thorough examination can also provide a useful check that maintenance is being carried out effectively.

Following a fatality, a prosecution may involve the care homeowner, maintenance contractor and thirdparty inspection body. The owner/duty holder/responsible person arranges for maintenance of lifts/lifting appliances, arranges for third party inspections, and acts on the reports they receive, in particular, addressing safety issues The maintenance contractor is employed to fulfil maintenance in compliance with regulations and risk assessments relating to equipment wear and tear. Maintenance consists of physical visits and remote monitoring. The third-party inspection body will carry out periodic inspections (also known as thorough examination).

1

2

3

Care Home MANAGEMENT 35


FLOORS DESIGN INSPIRATION

FLOORS DESIGN INSPIRATION

DESIGNED FOR

Impervious backed carpets are essential in the care home environment to comply with health and safety and maintain cleanliness standards….

DEMANDING ENVIRONMENTS

What will I learn from this feature? How technical development is opening up a world of environmentally-friendly flooring

Flooring tech goes sustainable Science and technology are leading the development of high-performance, environmentally-friendly resin floors, says Dale Banton, regional sales manager of Sherwin-Williams Protective & Marine Coatings

T

www.danfloor.co.uk 36 Care Home MANAGEMENT

0330 014 3132

he flooring industry faces increasing pressures through the supply chain to develop environmentally-friendly yet hardwearing and durable safety flooring. In the health and care environment, this means products that can also withstand frequent cleaning. Resin floor finishes have a key role to play in meeting the demanding slip resistance requirements of Health and Safety regulations, while also being aesthetically pleasing. Flexible, cushioned resin flooring can add benefits such as being soft underfoot as well as reduced acoustics – both important factors in a care environment. Improvements in UV stability have also eliminated risks of discolouring, tainting, and for floors to harbour lingering unwanted odours. Reductions in the levels of solvents and harmful Volatile Organic Compounds (VOCs) have also boosted resin floors’ environmental and safety credentials, without any loss of performance.

Performance compliance

The Building Research Establishment Environmental Assessment Method (BREEAM) provides purchasers with a certified score of environmental sustainability while demonstrating compliance to best practice performance for wear and tear, and adhesion. Each project presents its own specific challenges so the choice of flooring must be appropriate to the performance requirement. Once your floor is down, it’s time to look at your cleaning regime – and the materials and the processes you are going to use to keep your home up to regulatory standards. Before the first clean, the floor must be allowed to fully ‘cure’, and any possible contamination from the application should be removed. Check your cleaning machine too – there is a tendency for them to be run too fast and either miss areas or not work as effectively as they should. www.chmonline.co.uk

Ffabulous flooring Contrast flooring ensure that people living with dementia can navigate their surroundings and feel safe

IS FOR

Get some flooring inspiration from these fabulous care home projects

…. But performance doesn’t have to come at the expense of aesthetics

Wood-effect vinyl is a good non-slip choice for dry environments

Studded vinyl can be safely used in a wetroom

Pictures courtesy of Spearhead Healthcare

July/August 2019

Care Home MANAGEMENT 37


FLOORS DESIGN INSPIRATION

FLOORS DESIGN INSPIRATION

DESIGNED FOR

Impervious backed carpets are essential in the care home environment to comply with health and safety and maintain cleanliness standards….

DEMANDING ENVIRONMENTS

What will I learn from this feature? How technical development is opening up a world of environmentally-friendly flooring

Flooring tech goes sustainable Science and technology are leading the development of high-performance, environmentally-friendly resin floors, says Dale Banton, regional sales manager of Sherwin-Williams Protective & Marine Coatings

T

www.danfloor.co.uk 36 Care Home MANAGEMENT

0330 014 3132

he flooring industry faces increasing pressures through the supply chain to develop environmentally-friendly yet hardwearing and durable safety flooring. In the health and care environment, this means products that can also withstand frequent cleaning. Resin floor finishes have a key role to play in meeting the demanding slip resistance requirements of Health and Safety regulations, while also being aesthetically pleasing. Flexible, cushioned resin flooring can add benefits such as being soft underfoot as well as reduced acoustics – both important factors in a care environment. Improvements in UV stability have also eliminated risks of discolouring, tainting, and for floors to harbour lingering unwanted odours. Reductions in the levels of solvents and harmful Volatile Organic Compounds (VOCs) have also boosted resin floors’ environmental and safety credentials, without any loss of performance.

Performance compliance

The Building Research Establishment Environmental Assessment Method (BREEAM) provides purchasers with a certified score of environmental sustainability while demonstrating compliance to best practice performance for wear and tear, and adhesion. Each project presents its own specific challenges so the choice of flooring must be appropriate to the performance requirement. Once your floor is down, it’s time to look at your cleaning regime – and the materials and the processes you are going to use to keep your home up to regulatory standards. Before the first clean, the floor must be allowed to fully ‘cure’, and any possible contamination from the application should be removed. Check your cleaning machine too – there is a tendency for them to be run too fast and either miss areas or not work as effectively as they should. www.chmonline.co.uk

Ffabulous flooring Contrast flooring ensure that people living with dementia can navigate their surroundings and feel safe

IS FOR

Get some flooring inspiration from these fabulous care home projects

…. But performance doesn’t have to come at the expense of aesthetics

Wood-effect vinyl is a good non-slip choice for dry environments

Studded vinyl can be safely used in a wetroom

Pictures courtesy of Spearhead Healthcare

July/August 2019

Care Home MANAGEMENT 37


PEOPLE EVENTS

PEOPLE

Care home movers and shakers

Runwood Homes has appointed Peta Mandleberg as head of commissioning and premium services. Among her key roles, Mandleberg will launch a new sister brand to Runwood Homes, to deliver the company’s premium senior living proposition. Older person’s charity MHA has brought together the management of its care home, retirement living and community-based Live at Home schemes.The new role, director of operations, has been filled by Dan Ryan. Ryan’s most recent role was chief operating officer for Orchard Care Homes Sarah Gordon has been appointed as Balhousie Care Group’s new operations manager. She was formerly operations manager with Renaissance Care. Also joining from Renaissance Care is Amanda Sword, who becomes general manager at Balhousie Coupar Angus. She was previously manager at Beech Manor Care Home in Blairgowrie. Claire Alexander has also been appointed manager for Balhousie Lisden. She was previously home manager at HC One in Dundee. Balhousie Care, which operates care homes across the north, east and central Scotland has made a number of other executive appointments: • Jill Henderson: group head of finance (formerly, financial controller at Balhousie Care Group from 2008 to 2011) • David Blackwood: hospitality services manager (from Meallmore) • Alison Bennett, head of property services (from facilities management company Mitie) • Gillian Drummond, as brand and communications manager (formerly Balhousie’s outsourced PR) Thomas Cook has joined Silverline Care as financial reporting & systems manager. Silverline Care operates six nursing homes across Scotland and two in Yorkshire. Cook is a qualified accountant, previously working at House of Fraser. David Smith, head of estates and property services at The Healthcare Homes Group, has joined the Board.The Healthcare Homes Group runs 37 residential and nursing homes across the East and South of England. Care provider and charity The Fremantle Trust has appointed Krista Brewer as head of care and clinical governance. Brewer is a registered general nurse who recently worked for a Clinical Commissioning Group in adult safeguarding. Edinburgh care home Cramond Residence has appointed Denise Williams as care manager. Cramond Residence is managed exclusively by Walker Healthcare. Ashley Carroll takes up the role of resident experience manager, overseeing hospitality services and wellbeing across New Care’s six homes. These are based in the North West and Midlands.

38 Care Home MANAGEMENT

Business partners

Suria Webb, operations manager at Country Court Care, has joined the Board of directors at the Lincolnshire Care Association (LinCA). LinCA is managed by a voluntary board of directors appointed by its members, and it represents the interests of care and support providers within Lincolnshire’s independent and voluntary sectors. Webb (pictured right) is one of Country Court Care’s longest serving employees. Welsh regulator, Care Inspectorate Wales has appointed Margaret Rooney as deputy chief inspector. Rooney was previously head of registration and enforcement at the inspectorate and led on the implementation of the Regulation and Inspection of Social Care (Wales) Act 2016. Care home financier, developer and manager the Octopus Group has announced the merger of two businesses, Octopus Healthcare and Octopus Property, to form Octopus Real Estate. The new company will be led by Benjamin Davis, the current CEO of Octopus Healthcare.

EVENTS JULY

Beyond Dementia Care – All Care Matters Conference. Friday 19 July. University of Surrey, Guildford. More information available [online] at: https://careinfo.org/event/beyonddementia-care/ Breakfast networking event. Monday 22 July, Barchester Tandridge Heights Nursing and Care Home, Tandridge Heights, Oxted RH8 0NH. RSVP by Saturday 20 July to: 01883 715595

AUGUST

Health and care explained: how the system works and how it is changing. Kings Fund conference. London. Thursday 8 August. More information [online] at: https://www.kingsfund.org.uk/ events/health-and-care-explained-0 Moving and Handling People conference. De Vere Beaumont Estate, Windsor. Wednesday 7 – Thursday 8 August 2019. For more information, visit Disabled Living Foundation [online] at: https://training.dlf.org.uk/moving-and-handling-peoplesouth-2019/ Train the Trainer (Leicester) – Moving and handling and First Aid. Curve Learning & Development. Tuesday 13 – Thursday 15 August. For more information visit: https://www. curvelearning.org.uk/ Care Tech 2, Technology in Care conference. Friday 23 August. Scottish Care Technology in Care. More information available [online] at: http://www.scottishcare.org/event/care-tech2/

www.chmonline.co.uk


The Specifier’s Guide to Flooring launches at CDW 2019

The Specifier’s Guide to Flooring has launched in the UK. Officially unveiled at Shaw Contract’s showroom during Clerkenwell Design Week, the ‘definitive guide’ will provide a specification tool for architects, designers, facilities managers and specifiers on all aspects of flooring. Exploring key materials, it will provide a rich resource for industry, in hard-copy format and online at http://www.specifiersguide.co.uk

Building a better future for care 9-10 October 2019 NEC Birmingham

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”.

Regulations! Regulations! Regulations!

“The Guide to Flooring is the must-have publication for every architect, designer, FM and specifier from Land’s End to John ‘o Groats. Never before has there been such a comprehensive guide to all aspects of an installation,” added David Strydom, editor of CFJ. Echoing these sentiments, John Heath, Kick-Start Publishing’s CEO added, “The Guide will light the way for those seeking inspiration for their flooring requirements.” For more information, please visit http://www.specifiersguide.co.uk or contact Kick-Start Publishing on tel. 01892 752 400.

inally booked arah on for her moving handling course

7– 8 June 2019 Olympia London

• Practical activities • Dementia Experience

?

w less?Ho

• Specialist exhibitors • Latest products & services

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

TICKE

£15 ONLIN

TS

E

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

www.alzheimersshow.co.uk Sponsored by

In partnership with

Research Charity partner

Supported by

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Caring has its problems. Let us help with solutions

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38 Care Home MANAGEMENT www.chmonline.co.uk

Learn more... WWW.CARESHOW.CO.UK


Created by experts, for your peace of mind.

apetito Nutritionist, Kelly Fortune

Our specialist team takes pride in creating high quality, delicious meals that meet all your residents’ dietary needs.

Make a real difference with apetito

apetito.co.uk/care-homes

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Care Home Management July 2019 issue  

The best news and views from the care home world, with special features on mental capacity, kitchens, lifts and floors

Care Home Management July 2019 issue  

The best news and views from the care home world, with special features on mental capacity, kitchens, lifts and floors

Profile for chmonline