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Take the sting out of workplace injury Why employersâ€™ liability insurance is more important than ever Signature moves Reigate Grange opens doors for Revera
Fire safety quiz Test your knowledge
Medicines after Brexit? How pharmacy services might change
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Welcome to the November/December edition of Care Home Management
Care Home Management November/December 2018
Annual Subscription £30.00 Where sold cover price of £4 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Design/Production Phil Cunningham www.creative-magazine-designer.co.uk Published by S&A Publishing Ltd Croham Lodge, Croham Road, Crowborough East Sussex TN6 2RH Tel: 01892 663350 Email: firstname.lastname@example.org email@example.com Advertising Space Marketing Tel: 01892 677721 Email: firstname.lastname@example.org www.spacemarketing.co.uk www.chmonline.co.uk Copyright: Care Home Management Magazine 2018
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Leaders from health and social care have written to the Chancellor urging him to tackle the substantial funding gap facing adult social care and public health in the forthcoming Budget. Ahead of last month’s Budget, the NHS Confederation, the Association of Directors of Adult Social Services (ADASS) and NHS Providers wrote to the Chancellor urging him to tackle the substantial funding gap facing adult social care and public health. He was told that since 2009-10, local authorities have faced cuts of 26 per cent while spending on adult social care fell by 8 per cent on average in real terms. For service users this has meant 400,000 fewer people able to access publicly-funded social care in 201617 (compared to 2009-10), resulting in an unmet need for social care affecting at least 1.2 million people. For providers in health and social care there have been equally dire consequences: for the NHS increased pressure on services, which are likely only to get worse as the cold weather kicks in; and for social care, which is already seeing major providers get into trouble. But, as managers will already know, the Budget has promised only a small proportion of what care homes believe they must have to “plug the funding gap” and address the population’s growing unmet social care needs. So, what is the next step for care home providers? Simply, wait and see what largesse the long-awaited Green Paper or the Spending Review will bestow? The problem with wait-and-see, of course, is that promised riches do not always materialise, and if they do, in a growing market, the demand for service provision may outstrip the money provided once it arrives. Just think about the M25 – and how at the time of its construction it was held up as the answer to all London’s traffic problems. Growing numbers of road users have clearly put an end to that particular dream. Nor is the solution of ‘more money’ always the right answer – you only need to hear one cautionary tale of a former lottery winner gone bankrupt to know how easy it is to throw good money after bad. If and when the shackles on the public purse relax, care homes will find they are not the only people in the queue for a hand-out. If social care is ever to even the playing field with national treasures such as the NHS and our schools, it will need to show that it is equally deserving of the investment. If your home needs help to get to that position, it’s time to act – and that is where magazines like Care Home Management, its new virtual network for care home managers (see p6 for more information) and our podcast series starting next month can help. When the money starts to flow, it will go first to those at the front of the quality queue.
Take the sting out of workplace injury Why employers’ liability insurance is more important than ever Signature moves Reigate Grange opens doors for Revera
Fire safety quiz Test your knowledge
Medicines after Brexit? How pharmacy services might change
Ailsa Colquhoun Publisher/Editor
November/December 2018 | Care Home Management 3
Contents 6 Get connected! Care Home Management launches a new virtual network for best practice sharing 9 Care Show 2018 Care Home Management was there – were you? 10 It’s all about the bling, kerching How to take care of your care home finances 12 Outstanding practice Take a look at the learning points from two outstanding care homes 14 Avoid the ombudsman Lessons to learn from the Local Government and Social Care Ombudsman case reports
10 16 Staffing success Are you doing all you can to make staff feel valued? 17 Improve your staff meetings Effective presentation skills 18 It’s Movember Time to care for your male residents’ health 20 Care home profile Care Home Management magazine visits Signature’s new Reigate Grange care home, now under Canadian ownership 23 Ask the expert Your asbestos questions answered – as best we can 24 Focus on care home insurance If you are dealing with an accident at work, should you say sorry? Plus: the 10 top care home insurance mistakes 26 Fire, fire! Take our just-for-fun quiz to test your knowledge of fire safety in care homes
17 4 Care Home Management | November/December 2018
27 Health and safety Get a health and safety culture in place before you end up in the dock. Plus: Pest control – how to avoid unwanted guests in your home
30 Four industry experts go head-to-head Top tips on buying management software
32 Focus on medicines How to get that outstanding rating for medicines management. Plus: Brexit – understand the implications of a no-deal for your residents’ health 37 Hall of Fame Acknowledging the great and the good in our business 38 People and events Who’s new and what’s happening in the care home world
39 Product spotlights CHM’s preview of this issue’s new products
Eleanore’s words to the wise Waiting for a winter warmer By Eleanore Robinson, former editor at LaingBuisson and freelance healthcare journalist While the extra £240m funding for social care announced by Health Secretary Matt Hancock last month (October) was very welcome, most of it is to be spent on homecare services to reduce delayed transfers of care over winter, leaving care homes out in the cold once more. And this month’s Budget has done little more than offer a sticking plaster rather than a proper salve for the sector, after part of the £2 billion allocated in last year’s settlement was for the current and next financial year. All this makes it seem like short-term cash injections are all social care can hope for. But a funding settlement similar to that announced for the NHS this summer - which will see its collective coffers increase by £20.5 billion in real terms in 2023/24 - is what commissioners, providers, investors and even medical professionals are crying out for.
Recent research from Christie & Co found that councils receiving the highest budget allocations are generally implementing larger fee increases (see page 16 for more information). On the face of it, this suggests that public monies for social care are being passed on to providers directly, although this could just reflect adjustments for greater need: residents with more complex care needs, who cost more. This, of course, simply leaves margins just as tight, and some operators still in a precarious position. Last month (October) the Royal College of Physicians was among a coalition of colleges and health faculties to write to Chancellor Philip Hammond urging him to use the budget to deliver a long-term investment in adult social care. The Local Government Association has called on the Chancellor to fully fund the existing gap in adult social care of £1.5 billion by 2019/20 and commit to “proper funding in the future”. Once again the Green Paper on adult social care - still due “later in the year” - is the only hope on the horizon. But rumours are rife that it will now only offer a short-term funding solution rather than the long-term one originally promised. This means more short-term cash injections to prop the sector up rather than the life-saving surgery this ailing sector desperately needs. November/December 2018 | Care Home Management 5
Join the new LinkedIn care home managers’ group Official recognition of the lack of support felt by care home managers ‘on the ground’ has prompted Care Home Management magazine to set up a care home managers’ virtual forum. The aim of the new group is to help care home managers to network in an informal, accessible way; without leaving your office you can ask questions of your peers, and share good practice. This forum will only
£650m budget boost is a
«drop in the ocean» be open to care home managers and senior level admin staff so you can be sure of seeing only the most relevant comments and advice. To read more, and to join, visit: https://chmonline.co.uk/join-the-newlinkedin-care-home-managers-group/
2019 wall planner now available
Care Home Management magazine is delighted to bring you your annual free Care Home Management magazine wall planner. The 2019 wall planner is brought to you courtesy of the following supporters: Cater Plus Services; Compass Associates;
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Care providers have expressed disappointment at the extra £650m announced for social care in the October budget. The Independent Care Group says the new money is welcome – provided it reaches the front line – but warns that it is nowhere near enough to end the crisis in the care of older and vulnerable adults. And it is calling on the Government to come clean over when the muchdelayed Green Paper on social care will finally be published. The Independent Care Group’s chair, Mike Padgham, said: “The extra £650m to support social care is obviously welcome, but in reality it is just a drop in the ocean compared to what has been pledged for NHS care and to what is needed for social care.” For more information: visit: https:// chmonline.co.uk/650m-budget-boostis-a-drop-in-the-ocean/
Unison sets out charter for residential care
Trade union body UNISON will campaign for decision makers to adopt a new Residential Care Charter setting out minimum standards and
employment conditions to deliver decent care. This includes employment levels, pay, conditions and training. The charter comprises five elements including the call for decent pay for quality work. This stipulates minimum pay of the Living Wage, including for sleep-ins, and extra payment for working unsocial hours, including weekends and Bank Holidays.
6 Care Home Management | November/December 2018
Other elements of the charter cover care home management aspects such as • Training and support for care staff • Protecting and supporting residents • Giving staff time to care • Union recognition. For more information, visit: https:// chmonline.co.uk/unison-sets-outcharter-for-residential-care/
Troubled Four Seasons in boardroom coup
Former senior executives of Barchester Homes and Sunrise Senior Living have been brought into rescue troubled care home operator Four Seasons Healthcare. In a move widely seen as a first step in preparing the top care home operator for sale, former Barchester chairman Baroness Margaret Ford (pictured) and former Sunrise Senior Living chief executive officer Mark Ordan, have been appointed to the board of Four Seasons holding company Elli Finance UK, ousting former directors Claire Royston, Ben Taberner and Iain Lynam. However, Taberner, Royston and Hammond remain as Group CFO, Group Medical Director and CEO of the Four Seasons Health Care business, respectively. The Board room coup follows longterm concerns over the operating performance of Four Seasons Healthcare. In February, 2018, Four Seasons Health Care received a £70 million cash injection to assist ongoing operations and ensure continuity of care for residents. Ordan’s success with Sunrise Senior Living has earned him the reputation of a corporate turnaround artist, specialising in troubled companies. In June 2018, the Four Seasons group operator, Elli Investments, reported a net debt of £573.0m, and at Four Seasons increased agency costs, higher payroll costs and falling occupancy rates. For more information, visit: https:// chmonline.co.uk/troubled-fourseasons-in-boardroom-coup/
Lords urged to safeguard against “judge and jury” DoLS bill Care home managers cannot be “judge and jury” on mental capacity issues, care sector leaders have said as the ‘son of DoLS’ bill continues making its way into law. In a joint statement sector leaders agree that reform is necessary because the current system is underresourced and unworkable. But concerns continue to mount over the government’s plans which they say will save local authorities £200 million or more each year without any evidence that this will be achieved. These proposals will dilute human rights safeguards for the most vulnerable including older and disabled people who will often lack the
capacity to speak for themselves. To read more, visit: https:// chmonline.co.uk/lords-urged-tosafeguard-against-judge-and-jurydols-bill/
Social care is past “tipping point” Social care has reached a tipping point, with some people not getting the good quality care they need, the Care Quality Commission has warned in a new report. CQC chair Peter Wyman said: “Two years ago, we warned that social care was ‘approaching a tipping point’ – as unmet need continues to rise, this tipping point has already been reached for some people who are not getting the good quality care they need.” He also said that continued fragility of the adult social care market poses a threat to effective collaboration between health and social care. “Without a long-term funding settlement for adult social care, the additional funding for the NHS will be spent treating people with complex conditions for whom
care in the community would have been more effective both in terms of their health and wellbeing and use of public money.” The new report from the CQC, the 2017-18 report into the State of Health and Adult Social Care in England, concludes that the capacity of adult social care provision continues to be very constrained, with very stark regional variations: • An ‘average’ residential social care provider with 26-30 beds at one location could see a fee reduction of £64 under new CQC registration fee proposals, out for consultation until Thursday 17 January 2019. To read more, visit: https://chmonline.co.uk/social-careis-past-tipping-point/ https://chmonline.co.uk/cqc-fees-tofall-by-64-consultation-proposes/
November/December 2018 | Care Home Management 7
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8 Care Home Management | November/December 2018
20 years of the Care Show People-centred care was the main message echoed across the Care Show 2018 from the 3,340+ visiting care professionals, to esteemed speakers and suppliers. Opening the show - which turned 20 years old this year - Debbie Ivanova, Care Quality Commission deputy chief inspector, adult social care services (London and South regions), congratulated the audience for their continuing hard work. Reinforcing how much should be celebrated across the sector, she said: “It really is down to you and your hard work.” As the UK’s largest event dedicated to the care sector, the Care Show welcomed its largest ever audience of operators and senior professionals across residential and domiciliary care. Over 60 new supplier brands joined the marketplace show floor to demonstrate the latest in care sector technology.
Integrated services Over 80 industry key opinion leaders took to the stage across two days, echoing the call for a people-centric approach to exemplary care. To deliver this, many industry experts shared their desire for one umbrella care service. Bluebird Care’s Yvonne Hignell said industry must think differently, collaboratively delivering the care a person needs. Calling on industry to follow Government’s example and merge health and social care into one portfolio, she said: “True innovation will come as we drop our egos and think more about the people than our individual job titles.”
State of the nation In her presentation to the conference, Ivanova took delegates through the findings of the latest CQC ‘State of Care’ report on the adult social care sector (for more information, see page 7 and outlined the five key areas of focus for the CQC’s social care inspectorate. Top of the list, she said, is ‘quality of care’, which is all about person-centred care, underpinned by leadership and governance. As for ‘access to care and support’, she highlighted the need to address the UK’s ‘access lottery’, whereby ineffective coordination of services has led to fragmented care in some areas. Next, looking at ‘capacity to meet demand and the right workforce to deliver care’ Ivanova highlighted the immediate need to recruit the right talent, and reduce over-dependency on agency staff. Commenting on funding, she said that while the short-term injection from Government has helped, costs keep going up. This means that long-term funding for adult social care remains a priority. November/December 2018 | Care Home Management 9
Why cash is the care home king
Care home managers have never been under so much financial pressure. Across the country cashstrapped councils are cutting care budgets to the bone, prompting warnings of mass closures and bed shortages. According to an annual survey of the sector by the Association of Directors of Social Services (ADASS), almost 50 councils have seen care home providers shut in their area in the last six months. Regardless of the size of your care home, it is important to be familiar with the company books and to understand the four golden rules for staying in business.
Understand your books It is no good basing decisions on inaccurate or out of date financial information. Directors must have a clear understanding of the key financial documents such as the profit & loss, balance sheet and cashflow, and be aware of what the home owns and owes. Many profitable businesses cease trading because of cashflow problems: the money simply isn’t in the bank to meet all their commitments. A business can only make expenditure decisions once they know the impact on profits, and cashflow.
In today’s cash-strapped care world it has never been more important to get a basic grip of your home’s finances. By Lee Murphy, founder of Pandle cloud accounting software
Get the housekeeping in order Make sure you have an annual cashflow forecast that is updated at least monthly, and weekly if finances are tight, and that someone is chasing any overdue payments. Also, make sure senior managers are aware of how their decisions can affect budgets and profits. Create a clear payment policy For many people, moving into a care home will be an emotive time. If you are dealing with self-funded residents it is important to be clear with them and their families about fees at the start of your relationship. Creating a payments policy that you can agree with residents or their appointed carers in advance will give you an enforceable contract when it comes to chasing payment. You may want to draw up bespoke payment policies that offer discounts to those
10 Care Home Management | November/December 2018
who pay on time, or clients who might prefer to make phased payments on a weekly, monthly, or quarterly basis. You may also want to include penalties for late payers. As far as possible let your residents know what their money is paying for. Providing itemised bills that go into detail on the level of care provided will give residents and their families confidence that they are not being ripped off, making them more likely to pay on time. Reduce late payers Whether you are dealing with private clients or local authority funders, always check you have sent the invoice to the right person and the details are exactly correct. Errors will not help you get paid on time. An automated payment reminder system could do the legwork for you; it can be surprising how a gentle early reminder can speed up payments. Remember, the longer a client takes to pay, the less likely they are going to pay.
Take it step by step
By Chris Stevens, restructuring advisory partner at FRP Advisory LLP
The key to managing costs is to set and track Key Performance Indicators (KPIs), which can be developed using industry-wide guidelines. Ultimately, the most important metrics any care home manager needs to look to is the average occupancy of your home and staff wages both in absolute terms and as a percentage of the annual turnover. Budgeting closely based on this will give a clearer view of where the home is heading. It’s fundamental that care home directors review budget spreadsheets on a monthly basis. Rigorously accounting for overheads will help directors set out clear strategic plans and forecasts and help ensure that facilities are operating within their capacity. By keeping on top of cashflow, any red flags can be identified in the early stages. This gives care home
operators the opportunity to act and speak to a specialist adviser before any irreversible money struggles come into play. For publicly-funded care homes, building strong relationships with local authorities will sometimes mean there is an ability to negotiate and improve fees, particularly if many residents have a higher level of dependency and require greater care than when first entering the home. Having lineby-line budgets will support a case when pitching for further funding, as each item has been accounted for as accurately as possible and will qualify any financial claims.
Seeking advice at an early stage can be vital in tackling financial problems head on. This is why it is so important to plan, budget and plan again until an economical structure suitable to an individual home’s needs is established and running. If management fails to create these working documents and processes, financial difficulties may only be fully realised when it is too late, and the business can no longer be saved.
Metro Bank doubles care home finance
Metro Bank is looking to double to £300m the amount of funding it provides for the care home sector to help operators open new sites and upgrade existing ones. Health and social care is one of five specialist sectors identified by the bank where it wants to support strategic growth.
For example, in August 2017 Metro Bank provided Capital Care Group with £10.2m to refinance its existing portfolio of care homes and enable it to purchase a 47bed care home in Anville Court in Wolverhampton. “We have lent £150m to the care sector so far and we want to work with more care home operators to help them grow,” says Metro’s director of specialist sectors Roger Fenwick. He urges operators to consider more new builds rather than just looking to acquire existing homes. “This approach is attractive to a lender because it brings new beds into the market,” he says. “It you purchase a home that is already well-run and successful there are fewer ways to add real value to your portfolio.”
Metro Bank is also calling on care homes to make the most of their existing facilities by applying for funding to build extensions, for example. Fenwick also advises care home operators to look beyond their traditional geographical area when considering expansion so they can open up the CCG network. “We have one operator in Surrey that has now also moved into Hampshire and Sussex and is working with a number of CCGs.” He adds that care homes should work closely with a bank like Metro to manage their costs and expansion plans at a time when they are under financial pressure from relatively flat fees and rising staff costs. The loans offered to re-finance existing care home portfolios are usually for five years.
November/December 2018 | Care Home Management 11
And, it’s congratulations to… Care Home Management is delighted to be able to share with you these examples of outstanding care home practice
Birkenhead Court, Blackpool
✔ Effective: Outstanding ✔ Responsive: Outstanding ✔ Well-led: Outstanding
“[Managers]… firmly believed in the positive effects of well trained and educated staff on the wellbeing of people living in the home” “Nothing was too much trouble”
“Admissions were coordinated, individualised and focused on the current need of the person” “Staff wanted people to experience life as an ordinary citizen”
“The manager… made staff feel valued and empowered” “A [previous] outstanding rating under one domain spurred [staff] to improve their service to people living with dementia”
What the inspectors saw:
What the inspectors saw:
What the inspectors saw:
All staff skilled in offering help and support to increase people’s quality of life and promote positive experiences. People encouraged to share their views and consent to any care or treatment.
Care plans centred on each person. A wide range of activities that promoted people’s hobbies and interests and family inclusion.
The registered manager consistently promoted strong values and a person-centred culture. The registered manager excelled at creating an inclusive environment.
Read the full CQC report at: https://www.cqc.org.uk/location/1-3531809455 12 Care Home Management | November/December 2018
Options Watermill House
✔ Effective: Outstanding ✔ Responsive: Outstanding ✔ Well-led: Outstanding
“Staff knew the people they worked with exceptionally well and involved them in decisions” “Staff worked thoughtfully… to set up more constructive routines”
“Care plans were personcentred and showed what each area was aiming to achieve” “The service was extremely dedicated to protecting people from social isolation and loneliness”
“Strong and experienced leadership and… clear vision” “Effective methods of communication… systems to discuss matters arising”
What the inspectors saw:
Staff said they could raise any issues or concerns and their opinions were valued and always listened and responded to. The registered manager was part of a group of providers who had achieved a rating of outstanding, who met regularly to network and share best practice.
What the inspectors saw: Clear guidance how to improve people's health and well-being to meet their assessed needs. Staff showed desire that was effective in improving a resident’s quality of life.
Staff created bespoke activity programmes to empower people to take part in suitable activities. Certificates of achievement, emphasising the progress people had made to be independent.
What the inspectors saw:
Read the full CQC report at: https://www.cqc.org.uk/location/1-125064118 November/December 2018 | Care Home Management 13
My care provider hasn't resolved my complaint. What can I do now?
Lessons from the ombudsman The Local Government and Social Care Ombudsman decisions relating to complaints about local public services offer useful learnings for care home providers
This time in CHM Magazine: Able Care (Menwinnion) Limited vs ‘Mrs B’ Summary: Mrs B complained that the home had not provided adequate or professional information about the fees and charges in respect of Mrs D’s account. Decision: Upheld. The home was at fault for not providing full invoices and receipts when asked, meaning Mrs B was unable to properly administer Mrs D’s finances. The home was also wrong to charge administration fees which were not included in the contract. The complaint Mrs B complains on behalf of Mrs D that Able Care (Menwinnion) Limited (the home): ■ Had not provided clear and timely invoices explaining the care charges ■ Had inappropriately added administration fees to the account ■ Had been rude and unprofessional when dealing with Mrs B.
14 Care Home Management | November/December 2018
Analysis The Care Quality Commission (CQC) expects care providers to provide clear information in writing about the fees, contracts and terms and conditions of service prior to the commencement of the service. The contract signed by Mrs D seven months after she entered the home provides written information about the fees, the expected method of payment and the due date. It also makes provision to apply interest at 5 per cent above the base rate for outstanding fees not paid 30 days after the due date. It does not mention any administration or management costs. The CQC regulations do not specify that invoices and receipts have to be issued as a matter of course but [the ombudsman] considers it good practice to do so, to ensure that all parties are aware why and when arrears have accrued. [The ombudsman] also considers it is inadequate to say that the resident’s bank statement can act as a substitute for a receipt. The statement would show that the money had left their account but does not prove it was received by the home. The contract provides for interest charges to be applied, but in the absence of an invoice it is impossible
Ombudsman cases to see how the charge has been calculated and from what date. The home has not provided sufficient information to enable Mrs B to check, on behalf of Mrs D, that this calculation is correct. This was fault. The contract did not allow for management costs or administration charges to be made. It is immaterial whether the charge is reasonable or warranted; if it is not written into the contract it cannot be applied at a later date. It was fault to make this charge without notice or explanation as to how it had been calculated. Even if the home had not provided invoices or receipts as a matter of course, it should have provided them when requested by Mrs B to enable her to properly account for Mrs D’s money in accordance with her responsibilities as an attorney. The failure to do so was fault. The home was also at fault in adding unprofessional and rude comments to the account when Mrs B said she could not read the copy she had been sent.
Agreed action In recognition of the injustice caused to Mrs B, acting on behalf of Mrs D, [the ombudsman] recommends the home: ■ Apologises to Mrs B for the failure to provide adequate financial information in respect of Mrs D’s account and for the inappropriate comment added to the account ■ Considers issuing invoices and receipts at least on a quarterly basis so residents can see how charges have accrued and any problems can be dealt with promptly ■ Provides evidence that the contract now includes reference to management charges, including how much they are, along with how and when they will be applied ■ Provides Mrs B with full receipted invoices for Mrs D’s entire stay at the home. Read the whole decision [online] at: https://www.lgo.org.uk/decisions/ adult-care-services/residentialcare/17-014-385
In other news from the ombudsman… The Local Government and Social Care Ombudsman is encouraging care providers to sign up to a new statement which sets out best practice in receiving and dealing with comments, complaints and feedback about their services. This has been created with Healthwatch England to help adult social care providers set out what service users, their families and representatives can expect when making a complaint. The LGSCO has also created a free poster for care providers who would like to signpost clients to its services as a followup to their own complaints processes.
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November/December 2018 | Care Home Management 15
Social care staffing – a workforce in crisis? Two important reports published this autumn spell out the challenge facing social care employers
cial the adult so The state of e and workforc care sector in England
social 2018 of the adult from the ‘State rce aphic is taken and uses workfo Care for this infogr 2018’ report Set for Social The information workforce in England, Minimum Data and the National care sector on data from estimates based . (NMDS-SC) adult r of additional The workforce Projected numberequired by 2035 jobs +40% social care has increased by 21% since 2009. This rate 650,000 in 1,600,000 has slowed 65+ model . years t recen +59%
l care in adult socia (2017) in England Summary of
proportionally ce if it grows ion. of the workfor over in the populat project the size 65 or 75 and These models of people aged to the number
authority and jobs in the local t recipients and 1.35 million is based on for direct paymen The data below 2017/18. Jobs sectors as at not included. independent in the NHS are those working Mar 2018 real Sept 2012 Care worker pay 7% £7.89 term median ed has increas £7.38 by 7% since 2012 September
turnover 27.1% 30.2% 31.2%
Less than 30%
30% to 32%
More than 32% 82% of workers were female
of workers ed were employ full-time
110,000 (8.0%) vacancies at any given time
is the average age of a worker
) 390,000 (30.7% leavers in the past 12 months
of leavers remain in the sector
© Crown copyright
of workers were aged 55 or above
25% of workers ed were employ on zero-hour contracts
40% 25.8% 24.1% 30% 23.1% 20% 10% 2016/17 2017/18 2014/15 2015/16 0% 2012/13 2013/14
rt which can r to the full repo rmation refe For more info /stateof. rcare.org.uk www.skillsfo West Gate Skills for Care, 2RP Leeds, LS1 6 Grace Street,
ded at be downloa
In its annual report, State of the adult social care sector and workforce in England, Skills for Care sets out the big workforce picture for social care employers in 2018. The infographic, left, sets out the key findings from this year’s report.
1716 T: 0113 245 rg.uk skillsforcare.o
Another report, Christie & Co’s Adult Social Care 2018 report, spells out the future challenges relating from a hard ‘Brexit’. This forecasts an estimated
shortfall of 17,000 FTE UK nurses Uncertainty around Brexit saw a 35 per cent reduction in new EU nurse registrations and a 23 per cent increase in de-registrations Applications to nursing and midwifery courses fell by 23 per cent Following the abolition of bursaries for nursing students Agency usage and average staff costs stand at 59.9 per cent of revenue.
agency usage has fallen as operators Whilst
strive to recruit and maintain full time staff, average costs
increased, indicating that agency staff are becoming more expensive. Focus on care worker wellbeing A report published to celebrate the first annual Professional Care Workers’ Day on September 4, gives a glimpse into the emotional wellbeing of care staff. The report from the National Association of Care and Support Workers (NACAS) finds that almost all care staff (90.5 per cent) see themselves as professionals, however, they feel this view is not shared by society nor by employers who may sometimes only provide basic training. Young care workers, in particular, said this was affecting their willingness to work in care long term.
Commenting on the research, Mohammed Gbadamosi, NACAS cofounder and chair, said: “This highlights the need for the sector to ensure capable young staff see working in care as a viable and worthwhile career choice.” The first Professional Care Workers’ Day was celebrated with a picnic in London. To get involved in the 2019 event, staff and employers can contact NACAS (Karolina Gerlich) at Karolina@ nacas.org.uk The full care staff research is available online at: www.nacas.org.uk/ research
16 Care Home Management | November/December 2018
Is AI the answer to staffing crisis in social care? Artificial Intelligence (AI) in healthcare has scored a number of successes in healthcare: robotic surgery, automating administrative tasks, image analysis, advanced diagnostics and digital drug design. Faced with growing demand for elderly care services, but a shortage of skilled labour, governments across the world are looking to elderly care AI to bridge the gap. For example, Stevie the robot could take care of mundane activities such as doing routine checks or reminding residents to take their medicines, allowing human carers to get on with more interactive, patientfacing tasks. For all its strengths, and ability to make speedy, purely logical decisions, AI is yet to master the ‘human touch’ so often needed in care. Just as doctors have to learn how to treat people, rather than just diseases, so carers develop the knack of providing person-centred care. There is, perhaps, some way to go before care can be fully automated. By Katie King, managing director, Zoodikers consultancy
How to make your team meetings more effective
Are you winning or losing your colleagues? People tend to be engaged in what you are saying if they do any of the following:
Useful hints and tips from Hendrix Training Preparing for your meeting What is your objective? Who will be in the meeting and how do they feel about you and your contribution. Are you the expert or are they? Could there be conflict and confrontation or do they expect you to provide information and insight? The meeting starts A meeting does not start when the first person begins to speak. It starts for you as soon as you enter the room. People are judging you before you open your mouth: how did you walk in? Were you looking confident or sheepish, or even like you would rather be elsewhere? It all gets noticed, so walk in like you mean business.
When it’s your turn to speak: • Take in the room and do not direct your comments to just one person • Think about eye contact and how people perceive you as you talk. Be aware of your voice: To keep people engaged your voice must be motivated and convey light and shade. Remember to articulate clearly, particularly the words and phrases that are important to the points you need to make. Don’t be afraid to stop speaking! Pauses are effective, they allow you to gather your thoughts and they give your audience the opportunity to digest the information you are communicating.
• Mirror your body language • Nod to the points you are making • Smile and lean in towards you. They are not so engaged if they: • Touch the side of their neck with their hand • Bite their lip • Do not return eye contact • Squint or frown, which often means they do not understand the points you are making • Use defensive body language such as crossing their arms. To book a Hendrix Training Confidence in Meetings workshop, visit: https://hendrixtraining.com/ confidence-in-meetings/
LET LOOSE SAFELY WITH WEARABLE NURSE CALL No matter where the action takes place, you’ll know if there’s a call or a fall
WANT TO TRY? CALL
0800 068 7419 Find out more at www.c-t.co.uk November/December 2018 | Care Home Management 17
First person view
My life with prostate cancer
Jim Watson, a volunteer for Prostate Cancer UK, shares his experience of living with prostate cancer and gives care home staff some tips on how they can help residents with the condition James ‘Jim’ Watson, a retired pastor from East Lothian, was diagnosed with prostate cancer five years ago at the age of 71. He describes it as a life-changing experience and says that good support has been the key to getting through the hard times. Jim’s cancer was treated with hormone therapy, and he still has injections today. Among the current side effects of his treatment are pain in the back of his legs, to the point where he can’t walk, loss of libido and some negative effects on his emotional wellbeing. Going to the toilet a lot was a key reason why Jim sought medical help but even after treatment he still has problems with continence. This can mean getting up every two hours during the night or having to plan activities carefully. “Sometimes there
can be a very short gap between the first indication that you need the toilet, and an urgent need to go.” Good continence products - which are defined as those that suit the individual best – will help an individual enormously, but most important says Jim, is that “care home staff are aware of the problems and are sympathetic to them”. Self help to better health To help with the management of his pain and fatigue, Jim keeps a diary, which has helped him to identify - and accept – that living with prostate cancer can be a continuous cycle of ‘ups’ and ‘downs’. Jim says it helps to know that the ‘downs’ do come to an end. He also tries to keep as active as possible, which has produced a lot of benefits. He says: “I know from my diary that walking
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makes me feel very much better mentally and physically, and it has helped reduce weight gain. Anything that care home staff can do to encourage folk to take pride in their appearance will have a real impact on their health and give them back their self-respect.” Most importantly, he urges care home staff to be prepared to listen to residents who have been diagnosed with prostate cancer, and to be prepared to support them through the down-times that the condition can bring. “Being able to chat through what’s on my mind; having the ability to talk – this helps me to overcome a lot of my problems.” For further information on prostate cancer and to speak to a Prostate Cancer UK specialist nurse, visit prostatecanceruk.org, or call: 0800 074 8383.
First person view
Grow a mo… save a bro November is the annual Movember Foundation fundraising month, which aims to reduce the number of men dying prematurely by 25 per cent by 2030. Improving lives affected by prostate cancer is just one of its aims Prostate cancer is the most common cancer in men in the UK. By 2030 there’ll be 1.7 million men living with prostate cancer. It’s already killing hundreds of thousands of men each year, and those who survive face serious side effects. The symptoms of prostate cancer do not usually appear until the prostate has become large enough to affect the tube that carries urine from the bladder out of the penis (urethra). When this happens, you may notice male residents: ■ Having an increased need to pee ■ Straining while they pee ■ Expressing the concern that their bladder has not fully emptied.
What is the prostate? The prostate is a small gland in the
How is prostate cancer treated? For many men with prostate cancer, treatment is not immediately necessary and the doctor will advise ‘watchful waiting’. In cases where there are no symptoms, prostate cancer should have little or no effect on everyday activities, although men can report feeling anxious or depressed, which may affect their sleep. If the cancer has progressed and treatment (radiotherapy or chemotherapy) is required, men can become tired. All treatment options carry the risk of significant side effects, including erectile dysfunction, fatigue and urinary symptoms, such as needing to use the toilet more urgently or more often. Other problems can include weight gain, increased risk of heart disease and diabetes, and bone thinning, strength and muscle loss and hot flushes.
pelvis, found only in men. About the size of a satsuma, it’s located between the penis and the bladder, and surrounds the urethra. The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.
Living with complications Mild urinary incontinence can be controlled through some simple pelvic floor exercises. If men have the opposite problem - difficulty urinating (peeing) – it can help to up the fluid intake to 1.5 to 2 litres (3 to 4 pints) a day, and to avoid fizzy drinks, alcohol and drinks that contain caffeine – like
tea, coffee and cola – as these can irritate the bladder. Men should try to avoid drinking a lot late in the day to avoid having to get up in the night. More severe urinary problems may require surgery. Diet can also help with bowel problems caused by radiotherapy: for diarrhoea high fibre foods with plenty of water are helpful, as are peppermint or dill. If constipation is the problem, it can help to up the fluid intake, as per the advice above for men who have difficulty peeing. High-fibre foods such as wholemeal bread, porridge and fruits, prunes in particular, can also help restore natural movement, as can gentle exercise. Further information on good continence care is available from the Continence Foundation, www.continence-foundation.org.uk. Self help Exercise is a great way to keep weight down, strengthen bones and help reduce anxiety and depression. Good exercise routines can include: ■ Gentle resistance exercise, such as lifting light weights or using elastic resistance bands ■ Weight-bearing exercise such as walking, climbing stairs, tennis and dancing. Men living with prostate cancer can also benefit from relaxation techniques, such as yoga or meditation. To find out more about the Movember Foundation, visit : www.uk.movember.com
November/December 2018 | Care Home Management 19
Revera makes a Signature move in Reigate
Reigate Grange opened its doors in July, ushering in a new era of wholly-owned Signature homes for Canadian operator Revera Market opportunity Revera’s plans to develop a UK presence are predicated on the prospect of a doubling by 2036 of the numbers of people aged over-85 age group, plus what Revera believes is a gap in the UK market for high quality communal living establishments. ‘Hurricane Hazel McCallion’, Revera’s first ‘chief elder officer’ (CEO), is yet to make a visit to Reigate Grange in Reigate. As one of Revera’s first fullyowned new Signature-branded homes, Reigate Grange marks an important first step in Revera’s new UK growth strategy, which aims to open around three to four homes a year. Appointed in 2015 to challenge ageism and to advise Canadian care home owner/operator Revera on senior living, McCallion, now aged 97, is likely to be impressed at the décor of Reigate Grange: a Liberty of London design treatment communicates the company’s commitment to high quality senior living; Reigate references sprinkled throughout the home – like Milligan’s café near reception named after former Reigate resident Spike Milligan – add to the ‘British’ appeal.
years to find the right site in Reigate, which was only acquired after proactive approaches to three private home owners. Asked about Revera’s plans for its new wholly-owned Signature homes business, Wellner says that there is no intention to significantly change the Signature offer. Following the acquisition, the Signature management team remains in place and there are no plans to change the branding. Wellner said: “We are now getting to a critical mass where [the Signature] brand is recognisable with families and synonymous with bespoke quality care and homely luxury. Both companies have very similar values and these can be summed up by stating that it is our joint mission to help all seniors live the best and fullest life they can.” He says Revera sees itself as “a ‘knowledgeable investor’” in Signature. “We are very comfortable with the Signature team and are happy to stand behind what the management team is doing.” Having said that, some Revera characteristics and values will filter through to Signature, Wellner says. Evolution in new homes and in refurbishments will see the development of cosier communal areas, new spas and bistros, and dementia-friendly design and facilities. Key features at Reigate Grange
Revera’s ‘other’ CEO, chief executive officer Tom Wellner, told Care Home Management magazine that the south east and other urban centres with wealth (higher value housing) and high walkability (proximity to local health and leisure facilities) are key targets for the company. Demonstrating commitment to this principle, Reigate Grange home manager Sarah-Jane Carpenter says that it took the company about 13
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87 apartments for independent and assisted living with nursing, plus integrated Hilltops dementia suite designed with the University of Stirling (24 guests in total)
Accessible courtyard garden with rural views
Hair salon and beauty therapy room
P rivate dining room
A ctivities room
C hoice of accommodation complete with ensuite wet rooms with heated flooring and a kitchen facility
O nline care plans
Profile Under the tutelage of ‘Hurricane Hazel’, there is also an intention for the UK homes to adopt the Revera philosophy of “celebrating age”, which Wellner says covers aspects such as recruitment policies for the over-65s, investment in staff training and the creation of ‘innovation ambassadors’ who can facilitate improvements for older adults. He says: “It takes time but we plan to export as much as we can, and have already started sharing and adapting innovations for the UK market.” Revera values in Reigate
To meet customers’ expectations the home offers a wide menu of fine-dining meal choices; there is a varied daily activity programme, including a cinema with ice cream and popcorn. In line with the home’s policy of bespoke care, care plans are created in consultation with the resident, their families and healthcare team, and updates are shared with families so they are always informed about their relative’s care. Hilltops residents, who have the highest dementia care needs, have the freedom of the whole home so they can feel fully integrated, although the designated area has dementia-friendly adjustments and a higher staffing ratio to ensure residents receive the care they need.
Carpenter admits that Reigate Grange is fortunate to be located in the prosperous south-east, where recruitment is easier and where a privately-funded model allows the home to offer competitive rates of pay. “People are recruited here for their kindness, compassion and empathy,” says Carpenter, who is happiest when relatives can leave reassured that ‘mum is going to be alright’. “We are all about living,” she says in the belief that Reigate Grange is the only establishment in the area of offer such a truly bespoke model of person-centred care. “We aim to give people what they want, when they want it. We say that if it feels easier for us, then it’s probably institutional, and that’s not what we are about.”
Reigate Grange general manager Sarah-Jane Carpenter likens working in the home to “a cruise ship with care”. She says: “Residents have very high standards; they have led very blessed and affluent lives, and they expect it to continue here. This is a place where people come to start living.” Signature portfolio
Moorlands Lodge in Hindhead The Beeches in Brentwood Coombe Hill Manor in Coombe Hill Rosebery Manor in Epsom Cliveden Manor in Marlow Bentley House in Hertford Pembroke House in Camberley Ascot Grange in Ascot Parklands in Chertsey Signature of Wimbledon in Wimbledon Reigate Grange in Reigate (open 2018) Elton House in Bushey (open 2018) Signature of Wandsworth in Wandsworth (open 2020)
Revera, which was founded in 1961, owns or operates in excess of 500 senior living sites in Canada, the US and the UK. It employs more than 55,000 staff to offer independent living, assisted living, memory care and long term care. Revera’s UK financial holdings include interests in Signature Senior Living, Sunrise Senior Living, Gracewell Healthcare and Avery Healthcare. Revera and Signature have had a working relationship since 2015, when Revera and real estate investor Welltower funded a management buy-out by the then management team. Signature Senior Lifestyle was established in 2006 and was originally funded by private equity investment. November/December 2018 | Care Home Management 21
Sleep-ins - SOLVED?
Martin Cheyne, partner, Hempsons The saga of sleep-ins has been longstanding, with staff paid a set allowance for undertaking a “sleep-in” shift. They are paid to sleep on site, but no duties are usually performed. The Royal Mencap Society, like many, paid a nominal sleep-in allowance. Their payments were challenged as a breach of the National Minimum Wage (NMW) and underpayments were successfully claimed by staff in the Employment Tribunal leading to what has been described as a £400m black hole in funding.
In July 2018, the Court of Appeal heard Royal Mencap Society’s appeal and concluded that sleep-ins were not work which needed to be paid the NMW. Appeal to the Supreme Court Permission has been sought by the employees’ union to further appeal. The Supreme Court is expected to decide whether to accept the appeal some time between October 2018 and January 2019. If they refuse to accept the appeal, then the Court of Appeal’s judgment ought to be final. However, if the Supreme Court allows the appeal to proceed, uncertainty will return until the hearing later in 2019 or even 2020. Social Care Compliance Scheme (SCCS) In light of the Court of Appeal’s judgment, HMRC, the regulator for the NMW, has recently updated its SCCS guidance on calculating the
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minimum wage. The SCCS continues but participating employers are now asked to examine periods when the sleep-in worker may be working, rather than sleeping. These include handover arrangements and disturbed nights. Local Authority commissioners Local authorities are already looking to move forward on the basis of the Court of Appeal’s judgment: that sleep-in payments need not be paid as part of the minimum wage. Way forward for providers Those providers who are already in the SCCS ought to now consider their own sleep-in practices in line with the Court of Appeal judgment and the revised SCCS guidance. Contact: Martin Cheyne, Partner, Hempsons t: 01423 724121 e: email@example.com www.hempsons.co.uk
Care Home Management asks our panel of experts to answer your common care queries In this issue: ASBESTOS Nick Pullan, director at Alpha Surveys Ltd, responds: Q: We have asbestos in our building, and we are planning building work. What are the health and safety implications for my residents? A: For a commercial property, or even a private residence planning major building work or demolition, you need to get an asbestos survey done. This will establish if and where any asbestos material is present, as well as if identified asbestos material will be disturbed by or, is in immediate proximity to, the planned works. The location and specification of the asbestos material will determine the health and safety implications for residents, staff and the contractor’s team likely to be involved in or close to the planned building work. An accredited asbestos surveyor
(P402 qualified) should be engaged to look at your existing asbestos register, and review the building work plans. Under the Control of Asbestos Regulations 2012 (CAR2012), the surveyor may need to conduct an intrusive asbestos survey, known as a refurbishment & demolition survey.
This will detail the actions to be taken before any works begin and may include action such as the removal of asbestos material by a licensed asbestos contractor. He will submit documentation to the local HSE inspector for approval, as well as carrying out an air test following the removal work to ensure that no asbestos fibres are present. In some cases, small amounts of non-licensed asbestos material will be able to be removed by specialist contractors who hold an asbestos carrier’s licence. Your asbestos surveyor will be able to advise on the type of contractor required for any removal work. Once the asbestos material is removed, building work can then proceed safely.
CARE AT QUBE 09:00 - 14:30 | Tuesday 22nd January 2019 Derby Conference Centre | DE24 8UX Qube Learning’s team of experts will be on hand to demonstrate ways in which they can support your organisation via presentations, workshops and Q&A throughout the day – highlighting best practises for an unused Apprenticeship Levy pot and our all-encompassing service including recruitment, funding options, account management and a guide to a students learning journey.
If you’re interested in attending our ‘Steps to Success Roadshow - Care at Qube’ event, please visit www.qube-learning.co.uk/events/careatqube or call Qube Learning on 01235 83 38 38
November/December 2018 | Care Home Management 23
Insurance Employers’ liability insurance is one of the few is one of the few policies required by law in the UK. It protects employees should they ever be injured at work. Unfortunately, the number of employers’ liability claims are increasing, and with them, are driving an increase in the cost of care home insurance.
Employer’s liability insurance – are you properly covered? Richard Barnes, business development executive for the care sector at Towergate Insurance Brokers explains how an employer should react if an employee is injured by a service user at work
East Sussex, BN9 9BA
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Q: What will I learn from this feature? A: How to manage an employee liability claim
Should you say sorry? Apologising to an employee who has suffered harm at the hands of a service user does not mean you are admitting fault. Just because an accident has happened, it does not mean that you are legally liable or that compensation should be paid What records to keep If a claim is going to be successfully defended, you’ll need significant records to show the right procedures were in place at the time of the incident. In the event of an alleged incident, always contact your insurance provider – they will tell you what documentation you need should a claim arise.
Top 10 cover mistakes. Don’t be caught out
By Chris Perrin, schemes manager of Quality Care Insurance Services
1. Caught out by the difference between between ‘claims occurring’ and ‘claims made’ – ‘claims made’ policies only cover claims made while the policy is still active, whereas ‘claims occurring’ policies will provide cover for incidents occurring during the life of the policy, even after the policy has expired. Don’t be left in a situation where a claim isn’t covered because it happened before your current (claims occurring) policy was taken out but after your previous (claims made) insurance expired. 2. Not asking first – the majority of legal expenses policies operate on a “seek and obey” basis. This means you should contact your insurer before making a decision that could involve legal fees. Such decisions could include; disciplinary procedures, complaint handling and issues with payments. 3. Fail to check policy conditions and warranties – insurers apply their own conditions and warranties to a policy, examples include electrical installation inspections, kitchen ducting cleaning, flat roof inspections, as well as the statutory obligations of the CQC, HSE etc.
4. Fail to report building works – your insurers will be paying to rebuild your property if something goes wrong with building work, so they need to know about the work you are planning, particularly, if this requires areas to be cordoned off for a prolonged period. General redecoration is not normally notifiable. 5. Not taking emergency measures – a prudent insurer will have no problem if you take emergency action to prevent a situation from worsening, ie, using an emergency plumber to stop a leak or boarding up a broken door or window. 6. Insufficient turnover projection – as the name suggests, you should base your cover on future, not previous/current turnover levels – particularly If you have plans to expand or increase fees in the next 1224 months. 7. Underinsure your contents – most insurances provide cover on a new-for-old basis; therefore, it’s important that you use the ‘new’ replacement value when calculating the cover you need. For multiple rooms, take the average contents
value of a resident’s room and multiply this by the number of your rooms. Don’t forget communal and staff areas, including the whitegoods! 8. Underinsure your buildings – buildings insurance usually needs to cover the reinstatement cost of the property: the cost of demolition and rebuilding from scratch, as well as the associated professional fees (architects, solicitors etc.). Most policies apply an ‘average’ to claims where the sums insured are too low, which will act to reduce your claim in proportion to the amount that you’re underinsured. To avoid problems, ask for a reinstatement cost report from a professional surveyor, at least every five years. 9. Opt for local rather than specialist - care is a specialist market and should be dealt with by a specialist who understands the requirements of your organisation. 10. Ignore good housekeeping – requests by an insurer to store data back-up off-site, install a lockable cabinet for keys and reduce cash holdings should be considered good practice rather than an obstacle to putting cover in place.
November/December 2018 | Care Home Management 25
Fire! How much do you know? Test your knowledge in this fire safety quiz from the Fire Protection Association
1. True or False? You must inform non-employees such as temporary or contract workers of the relevant risks to them and provide them with information about your organisation's nominated “competent persons”, and the fire safety procedures on the site. 2. True or False? The agency has the responsibility for fire safety instruction of agency workers on your site? 3. How often should a member of staff check the fire panel is in working order with no faults? 4. Within fire safety what is a hazard? 5. List the three things required to start a fire 6. What three types of evacuations are used in care homes (and hospitals)? 7. What sort of extinguisher is used for a fire in an electrical item or piece of equipment? 8. What are the intervals that emergency lighting should be tested at? (three) 9. What are the two main high-risk areas in a care home? 10. What is a refuge? Answers are at the bottom of the page
Legally, a building’s fire doors must be self-closing. It is recognised that it is sometimes necessary to hold fire
Fire quiz answers
Fireco publishes a free eBook, entitled: ‘Everything you need to know about care home fire safety’ [online] at: fireco.uk/care Fire door supplier Hoppe UK offers free CPD seminars on fire safety. Contact: 01902 484439 or email firstname.lastname@example.org Fire Protection Association training courses: Fire safety for fire wardens [online] at: https://tinyurl.com/ ybb535ox or email: training@thefpa. co.uk
Resources: For building regulation in England, view the Fire Safety: Approved Document B [online] at: https://www. gov.uk/government/publications/firesafety-approved-document-b annual full discharge test; 9. Kitchen and laundry room; 10. Place of reasonable safety
A quick fire door checklist from Geofire: ■ Check the door’s hinges. Are they CE-stamped and do they fit correctly? ■ Check the correct fire signage is displayed ■ Check your door holder/closer device is working ■ Check your locks and hatches are CE marked and not damaged ■ Check that the seals and vision panels are free from damage.
doors open for practical reasons e.g. easing access, increasing ventilation. Wedging open fire doors will Hoppe UK put the people in the building at risk: the door will not automatically close. If you want to hold the fire door open, it must have a device installed to release the door upon activation of the fire alarm system. This is not a comprehensive list and further advice should be sought directly from your fire door supplier.
progressive horizontal evacuation, delayed evacuation; 7. Carbon dioxide extinguisher; 8. Daily visual check; a monthly function test (flick test), 1. True; 2. False; 3. Every day; 4. Anything that has the potential to cause harm; 5. Source of ignition (heat), fuel, oxygen; 6. Staged evacuation,
26 Care Home Management | November/December 2018
Health & Safety
Health and safety in the dock
You’re in the dock over an alleged breach of health and safety law. You could be facing an unlimited fine, and a prison sentence of up to two years. Could you defend your health and safety policy, asks Moira Gelman of health and safety training and consultancy organisation Safety Now
Your legal challenge That, on the balance of probability, you did everything reasonably practical to comply with health and safety law (the Health and Safety at Work Act 1974). Unfortunately, you cannot rely on the prosecution having the normal burden to prove the case ‘beyond reasonable doubt’. In health and safety cases, the defence carries the burden of proving the balance of probability.
Your defence You have a health and safety culture The agreed definition of culture is “shared beliefs and values within an organisation”. The key word is “shared”. When the senior team believes that health and safety is intrinsically important from moral, legal and financial standpoints - then this belief will filter down to all members within an organisation. The employer knows that the benefits of a positive attitude towards health and safety include a happier workforce who, in turn, are more productive, take fewer absences and stay loyal to an organisation knowing that it sees the workforce as an asset worth nurturing and care.
civil claims for compensation. Indirect costs: Loss of reputation, loss of contracts, high absenteeism rates, loss of key members of staff, lower production rates, undue waste, poor quality etc.
You have carried out a thorough risk assessment Risk is defined in two ways: T he likelihood that a hazard will cause harm ● The seriousness of the consequences of this harm. A hazard with the potential to cause harm generally falls into five main groups: physical; chemical; environmental; psychological and ergonomics. Hazards are not always visible: carbon monoxide cannot be seen, heard, smelled, tasted or touched but it is a hazard that causes death. A proper risk assessment will determine the ‘cost’ of controlling the hazard against the risk. For the risk assessment to be reasonably practicable, a balance of the two should be reached. Some costs can be insured against: damage to property; a civil claim for compensation (but, watch out for your excess contribution, and an increase in your insurance premiums! ●
Direct and indirect costs – can’t. ● Direct costs: Fines, FFI (Fee for Intervention), overtime pay, sick pay, recruitment costs, training costs, investigation time, legal costs to defend criminal prosecutions and
You are told to improve the culture of your organisation.
The court order To improve your safety culture you must: 1. Consult with your employees: Your workforce has a vast amount of knowledge and experience at the ‘ground level’ of your organisation. By consulting with employees, you will more easily find the solutions you need, and will make your workforce feel valued. Your staff will feel some ‘ownership’ of the project, improving compliance and morale, resulting in improved loyalty and reduced absenteeism. 2. Provide training: Give your employees the knowledge to make informed decisions and to understand their responsibilities. Training shows commitment from the employer. 3. Get to grips with near-miss reporting and investigation: A user-friendly reporting system with a ‘no-blame culture’ will ensure that near-misses are reported and investigated to reduce the risk of recurrence. A positive attitude and commitment to ‘no-blame’ by senior managers can motivate employees to become involved in the process for continual improvement. 4. Establish a safety committee: Regular safety committee meetings create good relations between management and employees. Senior managers should make this a diary priority, demonstrating the importance of employee input into health and safety to the business.
November/December 2018 | Care Home Management 27
Time to renew your staff uniforms? Meltemi offer a great choice of uniforms in a variety of styles, colours and in lightweight options ideal for those working in a care environment
To request a brochure or order samples 01603 731332 or email@example.com
Specialist uniform suppliers
Health & Safety
How to stop pests in their tracks
Residents feeding the squirrels may paint an enchanting picture, but have you considered the health and safety implications, asks Jason Rout, head of pest control at Atalian Servest UK Enjoyable though it is to see wildlife feeding outside the window, food scraps left for wild animals can attract unwanted attention. Rodents, which include squirrels, as well as mice and rats, are well known for gnawing their way through cables and pipes, and for encouraging diseases such as salmonella, hantavirus and gastroenteritis. In a care home these diseases could prove fatal. If you want to keep your utility
supply off the local menu, encourage your residents to feed birds with any of the rodent-proof products on the market. One of the most common pests found in care homes is the garden ant. Soft drinks, food spillages and sweet treats kept in residentsâ€™ cupboards and bedside cabinets act like a siren call to an ant, which can then bite the hand that feeds it. The easiest way to prevent ants from coming inside is to
clear up spillages as soon as possible and store sweet food sources in a sealed container. Infestations can be dealt with using sprays, dusts and gel baits, and it can be tempting to nip down to the local DIY store to find a cheap solution. However, managers should note that products sold off the shelf are generally not designed for commercial use and do not come with the necessary COSHH and product data sheets. If not used correctly, they can at best simply move rather than eradicate the infestation, and may even encourage pests with resistance to eradication products. Pest control technicians have years of training and experience in eradication. In more extreme cases the pest control technician may have to drill holes into the wall cavities to control theÂ infestation. Fleas are another common pest often introduced into the home by a support animal or an adopted cat. Fleas feed by sucking the blood of an animal or human, and once found should be treated by a professional pest controller. Animals can be treated using vet-approved products. Some care homes have regular spray treatments to keep the biting parasites at bay. Unlike fleas, bedbugs can be difficult to spot until they have already spread. Bedbugs multiply in very large numbers and can survive up to a year without having to feed. They travel on clothing, in suitcases and hidden in furniture, but are most often found in sleeping areas. They are very small but can be seen by the naked eye: the tell-tale signs are small dark stains on mattresses and a musty odour around beds and bedding.
Servestâ€™s top tip? Be vigilant! If you know what to look for, and who to call, you can stop pest problems in their tracks
November/December 2018 | Care Home Management 29
Management Software Systems
Take four suppliers How can care home managers get the best out of their management tech? Four suppliers give their views CHM: Why should a care home install a care management system? Fastroi UK managing director Jim Ward: If a care home is still using a pen and paper system there is a good chance information flow, procedural adherence and data security are below the standards required to achieve an outstanding review from the CQC. Installing a care management system is a big decision, but the benefits can be easily demonstrated. There are cost savings from having an electronic scheduling system, for example. Automated staff schedules and planning mean more time to spend caring, while increased accountability and traceability reduce the chances of mistakes with medicinal adherence. Nourish Care Systems head of digital transformation Luis Zenha Rela: Software provides care teams with a level of control and management that is impossible with paper systems. It’s not about ‘going digital’; a good care home management system directly benefits the care provided. It saves time when recording notes, ensures information is always accessible and improves communication. iCareHealth head of implementation services Craig Flood: When looking at leading nations of care provision such as Australia and the USA we can see the future for
the United Kingdom. Both countries require care providers to use a digital care record. This ensures there is an auditable trail of all care provision for monitoring purposes. A care home could be providing the best possible care but without a way of accurately evidencing this, it can be difficult to receive the credit that is deserved from inspectors. Access Health & Social Care divisional director Steve Sawyer: Care management software removes much of the administrative burden that weighs down care homes. Carers have more time to provide valuable face-to-face support to improve an individual’s level of care, and software makes services significantly safer. Care home managers can spot areas of concern using data-driven reports and use alerts and monitoring to prevent errors escalating into serious incidents.
CHM: What must a care home do to prepare for the installation of a care management system? iCareHealth: A review of operational policies and procedures should be undertaken. What type of device(s) will lead to the best adoption across the care teams? Is the internet connection good enough? Care homes need business-grade broadband and separate guest/resident and operational networks. Also, consider how the care home will continue to operate if there is a service outage. Access Health & Social Care: Care homes must plan the most efficient way to roll out their chosen system. In our experience, many operators test the water by beginning with a single care home, perhaps one that they feel has the team who are the most positive about digital. In many cases moving to electronic records is a care home’s best opportunity to standardise and improve their processes.
30 Care Home Management | November/December 2018
Fastroi UK: Once the decision has been made to install our system the care home just needs computers and mobile devices to run the service – plus enthusiasm. Digital transition works best when everyone can see the value. Many providers give their staff a mobile device which allows them to control the content and apply restrictions to secure any data. If staff are using their own devices there must be a clear policy about how these are used in a professional environment. Nourish Care Systems: We find the most successful care providers adopting digital follow an educational and transparent approach. They talk to staff about the changes and receive feedback on which systems they prefer. Our two tips are to ensure that before making the transition to digital your paper records are in good order, and that one person is chosen to focus on the roll out of any new system.
CHM: This is a complex and crowded vendor market so how do care homes spot a good supplier? Nourish Care Systems: Research is crucial and you should meet with vendors to ensure they understand the care sector. Then receive a demonstration of their technology. Any system must be easy to use. Fastroi UK: A good way to see is to compare the CQC inspection criteria with what the software can deliver. A good software provider will guide you and identify the areas in your business that will benefit from a digital strategy. Access Health & Social Care: The solution must meet the care home’s needs and continue to adapt and grow with the company. Sourcing systems from one supplier is normally easier to manage and more cost effective. It is also vital care homes look at the scale of a vendor’s client base and how it is funded. Will it be around for the longterm? iCareHealth: Consider how long the company has been in the industry and whether the vendor specialises in software for social care. Also ask
Management Software Systems what is the client retention rate and are there case studies and references available? The software must help the care home with its specific needs. For example, does it have the capacity to produce the reports you need and can data and information be easily exported?
CHM: Does a care home have to go through a complete digital transformation at once or can it introduce technology gradually? Access Health & Social Care: A digital transformation changes how a care home operates day-to-day so the option should be available to go through a complete transformation or to take a more gradual approach. This decision will ultimately depend on the systems each provider is using and the specific circumstances of their business. For example, if they are going to use systems that are integrated and share records it makes sense to set both systems up at the same time, or without much of a gap. iCareHealth: A complete digital transformation of any business is a huge undertaking. The key is identifying areas most at risk or with the biggest opportunity to make them leaner, more agile and more cost-effective. Where can digital produce the biggest changes in value for residents? Once the wider business has been exposed to the technology, the excitement grows. Nourish Care Systems: We would recommend a gradual process. No one likes too much change at once and you want this to be an enjoyable experience. We’ve always adopted a staged approach. For example, we start with simply recording the daily notes on the system in our Resident Timelines and then we gradually move to digitalising the care plans. Fastroi UK: Each care home is unique and should plan its digital strategy according to its own needs. The speed at which it introduces technology may be a factor, although change may often be difficult to manage. Ours is a modular system that allows the customer to implement different aspects depending on their schedule or budget. For example, the payroll and invoicing module can be implemented alongside staff scheduling and care planning.
CHM: What after-sales support should a care home expect? Fastroi UK: As soon as a new customer signs we begin training for nurses and administrators and we ask for their feedback as their experience grows. A dedicated customer technical support team provides online support and there is also a helpdesk, training services, user manuals and video guides. We also invite customers to a special event to say thank you and receive feedback. Access Health & Social Care: After-sales support is crucial. There is nothing more irritating than sitting on hold when you need help with your business. Alongside telephone and desk-based support to solve bigger issues, we have user portals and online guides. The speed of resolving any problem is vital to allow management teams to focus on providing a high standard of care.
Nourish Care Systems: A technology supplier for the care industry has an extraordinary responsibility because it is indirectly supporting people receiving care. If something does not go to plan we need to provide support and find a resolution. We’ve been told that ‘Nourish is a part of the team’, which lets care homes focus on the people they care for. iCareHealth: Care homes need to be in full control of their future and able to customise the software to meet their needs. Yet there must be on-going support from the vendor. We have a dedicated office-based project management team which is available throughout the implementation process. Care homes receive full training to become confident in using the system and we have experts on-site when the system goes live.
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Care homes and pharmacies come together as medicines management goes digital
Q: What will I learn from this feature? A: How to achieve an outstanding rating for medicines management
Principles of safe and appropriate handling of medicines in social care
The use of technology to manage residents’ medication more effectively is increasing thanks to a closer working relationship between pharmacies and care homes. According to a white paper produced by care management software company iCareHealth, pharmacies are helping care homes reduce errors, improve compliance and save time and money by switching to electronic medication management. The iCareHealth white paper entitled ‘The Business Case for Electronic
Medication Management’ outlines how and why pharmacy support and technology can make care home medicine management more efficient. Care homes will reap the most benefit from medication management technology if the software integrates with a pharmacy’s own medication record system and the home has a strong broadband and WiFi connection. View the iCareHealth white paper [online] at https://tinyurl.com/ y732hm26
What the CQC wants to see in care home medicines management Staff work creatively to closely involve people in the management and administration of their medicines, including medicines that are not prescribed. The provider continually assesses this in partnership with the person. They look for new ways to promote independence, and work closely with other agencies and advocates in doing so. The service is creative and innovative when administering medicines to people who may lack mental capacity to make decisions about medicines. Further advice on medicines management is available from the CQC’s learning from safety incidents series [online] at: https://tinyurl. com/y7owvdbl Source: CQC medicines management advice for social care providers [online] at: https://www.cqc.org.uk/guidance-providers/adult-social-care/ medicines-management 32 Care Home Management | November/December 2018
1 People who use social care services have freedom of choice in relation to their provider of pharmaceutical care and services including dispensed medicines. 2 Care staff know which medicines each person has and the social care service keeps a complete account of medicines. 3 Care staff who help people with their medicines are competent. 4 Medicines are given safely and correctly, and care staff preserve the dignity and privacy of the individual when they give medicines to them. 5 Medicines are available when the individual needs them and the care provider makes sure that unwanted medicines are disposed of safely. 6 Medicines are stored safely. 7 The social care service has access to advice from a pharmacist. 8 Medicines are used to cure or prevent disease, or to relieve symptoms, and not to punish or control behaviour. Source: Royal Pharmaceutical Society: The handling of medicines in social care, available [online] at: https://tinyurl.com/ycam6rxm
Case study: Rossall (Belsfield Care), Fleetwood, Lancashire
Case study: Willersley House, Hull Willersley House was inspected in 2017 and was rated outstanding on all five measures, including safety. In terms of medicines management, inspectors saw that Willersley House was trialling a new electronic eMAR (electronic medication administration record) system. Staff were fully aware of the policy and procedures in place to implement this system. Staff showed an excellent knowledge of how the system improved the safe provision of medicines. Where further improvements could be made, staff provided feedback. This demonstrated their confidence, knowledge and skills to drive forward improvements in medicine administration. People received support with their medicines according to their individual needs and there were clear examples of positive risk-taking, for example, the creation of systems and processes that were monitored and regularly reviewed to support people to take their own medication. Staff had excellent knowledge of people’s medicines and the signs or indicators of when medication would be required. Records showed medicines review by a doctor twice in one year (at the request of the staff). Read the full report [online] at: https://www.cqc.org. uk/location/1-117976897 Key guidance and standards for providers and managers around managing medicines: Nursing and Midwifery Council standards for medication [online] at: http://www.nmc.org.uk/standards/additionalstandards/standards-for-medicines-management/ NICE managing medicines in care homes [online] at: https://www.nice.org.uk/guidance/sc1 NICE quality standard (July 2018) Medicines management for people receiving social care in the community (QS171) [online] at: https://www.nice.org.uk/guidance/qs171 NICE medicines management in care homes quality standard [online] at: https://www.nice.org.uk/guidance/qs85 CQC medicines information for adult social care services [online] at: https://www.cqc.org.uk/guidance-
Rossall was rated outstanding for safety in 2017, and on all other measures. In terms of medicines management inspectors found: Care records with detailed, personalised and specific medicines management care plans. The provider was the only service in the region to train their nurses to deliver intravenous fluids and antibiotics. These safe systems meant staff maintained people’s related care to a very high degree. Staff utilised evidence-based tools to monitor pain and when required medicines for people who could not verbalise their needs. This included the Abbey Pain Scale, which was a clear indicator of the presence of pain. The process enabled staff to quickly manage, relieve and assess the effectiveness of associated medicines. Specific care plans and risk assessments detailed the person’s requirements and agreed support, along with symptom management and potential side effects. The highly personalised documents also assisted staff to understand any impact medication may have on the individual’s mental and physical health. Documentation was built around consent, best interests and covert medicines protocols. View the full report [online] at: https://www.cqc.org. uk/location/1-2483008449
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November/December 2018 | Care Home Management 33
A bitter Brexit pill
Medicines shortages, pharmacies closing. These are just some of the concerns voiced about the impact of Brexit on the medicines used by care home residents With fewer than six months to go until Brexit D-day, the Department of Health and Social Care (DHSC) has been vocal in its reassurances about the security of the medicines supply chain. In a letter issued in August, health and care ministers told UK community pharmacies that there is “no need to stockpile additional medicines”. Prescribers were also advised that there is no reason for them to write longer NHS prescriptions to ensure patients can obtain their medicines. Plans are in place, the DHSC has said, to ensure that pharmaceutical companies will hold an additional six weeks supply of medicines, and for the air freight of medicines with short shelf-lives. In the pharmaceutical sector Brexit alarm bells have been ringing for some time. In a debate in May, MPs voiced concerns about the UK’s ability to maintain a medicines supply chain that is highly European in character (see box, opposite) Giving evidence to MPs on Brexit, UK medicines wholesalers and distributors represented by the Healthcare Distribution Association (HDA) have warned that any disruption
to the cross-border flow of medicines has the potential of placing patient safety at risk. A so-called ‘hard Brexit’ and departure from the single market would disable the UK’s right to parallel trade across the European Economic Area (EEA), the HDA warns. Depending on the item, parallel trade – which supplies the UK with medicines marketed for use across the
Q: What will I learn from this feature? A: The potential impact of a hard Brexit on medicines supply
EEA – can account for up to 70 per cent of available stock, creating muchneeded resilience in the UK medicines supply. Although the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) has begun to plan for a Brexit no-deal, according to the HDA problems may still occur: “However good demand forecasting is, there will always be unexpected supply issues, which, without parallel imports (PIs), will be harder to address as there will be no way of sourcing
Brexit could have a significant impact on the global supply chain for pharmaceuticals
34 Care Home Management | November/December 2018
Pharmacy services product from the EEA to cover the availability gaps.” Punitive changes to NHS pharmacy funding in England introduced from 2016 have put pharmacy finances under pressure, with the result that during 2017-18 well over double the number of pharmacies closed, compared to 2016-17. Pharmacies use the profits from activities such as dispensing more competitivelypriced PIs to fund free services to care homes such as medicines delivery services and medicines dosette boxes. Already some pharmacies have started charging for home deliveries, notably Lloydspharmacy, and most recently, the Rowlands chain. Rowlands explains: “This is an important service, but one which is not funded [by the NHS].” Paul Mayberry, a pharmacist and director of Pilltime, says that the care home dosette tray service is equally under pressure. For the pharmacy it takes a lot of time and dedicated manpower to fill the trays, and it is an area where the risk of error - both at the dispensing and administration
stages – is high. And despite advances in dispensing and administration technology, many pharmacies remain deeply concerned about the place of this service. For the care home, this could mean the days of the free dosette tray service are numbered. Mayberry says: “More and more
pharmacies are refusing to offer trays or simply won’t take on the homes that demand them.” For more information, visit: Parliamentary debate. The impact of Brexit on the pharmaceutical sector [online] at: https://tinyurl.com/ y7m55cdj
Key Brexit issues for the NHS and our medicines Medicine licensing: Many medicines used in the UK are licensed by the European Medicines Agency (EMA) regime for use across Europe, saving the time and costs of individual licensing. (The UK accounts for only 2.3 per cent of the global market, compared to the EU27’s 22 per cent plus share). The UK may become considered an unattractive small market for specialised medicines, risking the loss of access entirely to some products. Delays: Non-tariff barriers could risk delays to time- or temperature-sensitive products at the border, rendering them unusable. Research embargo: From 2020 (during the UK’s transitional period) new legislation will facilitate clinical trials across EU member states. The UK could find itself outside this legislation and unable to contribute to the search for new medicines. Workforce issues: Research by recruiter DHR International suggests that senior applicants for UK pharmaceutical roles from outside the UK have dropped from 40 per cent to 15 per cent since the referendum due to uncertainty around the rights of EU citizens to live and work in the UK. Courtesy of Reed Smith LLP. To read more, go to: https://tinyurl.com/ y7u62yzb
PillTime pre-sorts all the medication needed for a particular dosing time into clearly labelled, easy to open pouches in the order that they need to be taken. Each pouch is optically checked using image recognition technology to ensure maximum medication accuracy.
Sorted and delivered for free. Reduces medication errors. Improves adherence. MAR charts provided. As used in Salford Royal Hospital. PillTime’s technology was recently featured in headlines as, “Part of Matt Hancock’s personal prescription for the NHS.” Find out more about improving adherence and reducing NHS costs at www.pilltime.co.uk.
November/December 2018 | Care Home Management 35
The Workforce Development Fund
Money towards developing your employees Are you an adult social care employer in England? Do you want help to make your training budget go further? If youâ€™re an adult social care employer in England, you can claim up to ÂŁ1,200 per learner, per funding year to help towards developing your workforce. Funding can be claimed towards the costs of listed qualifications and learning programmes.
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Hall of Fame
Proud to present…
…The Care Home Management magazine care home hall of fame
Care homes and staff scoop top catering awards The National Association of Care Catering (NACC) care establishment of the year 2018 is Primrose Bank care home. Judges said it was a care home where a “focused approach to nutrition ensures [residents’] wellbeing”. Care homes and staff also winning in the awards are: the catering team at Avery Lodge, Brighterkind (catering team of the year) and Debbie Wright, cook-in-charge for Norse Catering, Munhaven care home. For more information about NACC Awards 2018, visit www.thenacc.co.uk.
The Old Vicarage care home in Leigh, near Sherborne, has progressed from ‘beacon’ to ‘platinum’ status of the National Gold Standards Framework (GSF) in recognition of the high quality end-of-life care it provides to its residents. The Healthcare Homes group home is one of 62 homes from across England to win a Quality Hallmark Award for a second time, giving it platinum status. It is joined in platinum status by Sunrise of Purley, [below] which was also shortlisted for the Gold Standards Framework (GSF) Care Home of the Year 2018. For more information on the Gold Standards Awards, visit: https:// tinyurl.com/ybcexert
Knight Frank rewards Hallmark design in Tunbridge Wells Chamberlain Court, Hallmark Care Homes’ facility in Royal Tunbridge Wells, has won the ‘luxury care home’ title in the Knight Frank awards. These recognise design excellence in care home businesses across the country. Chamberlain Court also won a national Pinders Healthcare Design award earlier this year. Facilities include a walk-in musical therapy bath, barbers, an outdoor activity room, and an aviary.
Excellent care home vegetarian dining has been recognised in the Vegetarian for Life Awards. The winners are:
• Innovative Veggie Dish: Phil Jay, head chef of Gracewell at Sutton Coldfield • Veggie Care Chef of the Year: Jacek Binienda, Badgeworth Court Care Centre • Special Recognition Award: Primrose Dawn Mist, resident at Highland House, Kent, for encouraging more vegetarian and vegan dining in her care home • Wholesaler of the Year: Bidfood For more information on the Vegetarian for Life Awards, visit: https://vegetarianforlife.org.uk/veggiehero November/December 2018 | Care Home Management 37
Events and Appointments
Events line-up November Tuesday 13 November Care Roadshow London For more information, visit: www. careroadshows.co.uk November 14, 20. Skills for Care training: Apprenticeships: Be clever with your levy. Various locations For more information, visit: https:// www.skillsforcare.org.uk/Gettinginvolved/Events/Events.aspx Wednesday 14 November Care England 2018 technology conference & exhibition, ‘Logging On’, London For more information, email: email@example.com
Appointments Your fellow care team Congratulations to Marie Harris, who takes over the helm at the Stocks Hall Andrew Smith House, in Nelson, Lancashire. Kirstie Wood also chose to make her debut at the Stobars Hall residential home in Kirkby Stephen by hosting a Macmillan coffee morning and raising £100. Marie Harris
Meanwhile, Elaine Rankin takes over the management of Meallmore’s Mearns House care home in Glasgow. A nurse by training, Elaine has worked in social care management since 2002 and joined Meallmore in January as a project manager in Inverness.
Tuesday 20 November. Skills for Care workshop ‘Getting started with values and behavioursbased recruitment and retention’, Telford For more information, visit: https:// www.skillsforcare.org.uk/Gettinginvolved/Events/Events.aspx Wednesday 21 November Innovation in social care conference, Harrogate For more information: www. independentcaregroup.co.uk/ conference.php Tuesday-Wednesday 27-28 November. The King’s Fund annual conference 2018, London For more information: visit: www. kingsfund.org.uk/events Thursday 29 November Future of Ageing Conference, London For more information: visit: http:// www.futureofageing.org.uk/
An apology To Rob Cousins, managing director of eLearning for You, and to Simon Qasir, director of sales at Workforce, whose pictures were transposed in the cloud training feature (p12 & 13) in our September edition. Sorry, guys.
Oaklands House care home in Reydon, near Southwold, welcomes new manager Hanro Steytler (right). Joining Hanro is new head of care Alice Chapman (left), who was previously a senior care assistant.
Wellgate Care, which specialises in support for young people and adults with learning disabilities and physical disabilities, has appointed Debbie Smith as director of care after acquiring Folkestone-based MNP Group in May. Also joining Wellgate Care is Andy Denness who joins as compliance director.
Your representatives Baroness Barker has been appointed patron of the National Association of Care Catering. Baroness Barker is a longstanding member of the AllParty Parliamentary Group on Older People. Baroness Barker succeeds Baroness Sally Greengross OBE who was NACC patron for six years.
38 Care Home Management | November/December 2018
Independent provider representative Care England has appointed Rosanna Vellacott as an assistant policy officer.
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