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Care Home MANAGEMENT www.chmonline.co.uk

January/February 2020 • ISSUE 83

CARE TECH Making it work for residents, staff - and the regulator


How to keep a handle on visitors


Inclusive practice for hearing loss


Doing your bit for a sustainable supply chain

The exclusive media partner of the 2020 Care Home Awards

Enter by January 31. For more details, see page 2 or visit www.CareHomeAwards.com



N Care Home Management

January/February 2020 Issue 83 Annual Subscription £40.00 Where sold cover price of £7.50 Managing Editor Ailsa Colquhoun Publishing Editor Steve Hemsley Podcast Presenters and Editors Steve Hemsley Alan Rustad Design/Production Emily Hammond emilyh@freelancedesignpro.com Published by S&A Publishing Ltd Hillside office, 9 St James Park, TUNBRIDGE WELLS TN1 2LG Tel: 01892 680670 Email: editorial@chmonline.co.uk sales@chmonline.co.uk Advertising Rebecca Randall Head of Sales Tel: 01892 538880 Email: rebecca@chmonline.co.uk www.chmonline.co.uk Copyright:

to the January/February issue of Care Home Management magazine

ew year, new resolutions… did you make any? Have you joined the many thousands of people who resolved to lose weight, stop smoking or otherwise make healthy lifestyle changes? Are you still going to the gym you signed up for so resolutely on New Year’s Day, while nursing the hangover you promised yourself would be your last? For those with an eye on political matters, the key question moving forward is: what is our Government’s New Year’s resolution for social care? It now has a clear mandate, and a clear majority to take the country forward over the next five years and, as our guest political pundit, Professor Martin Green, makes clear on page six, there can be few excuses now for not ‘getting social care done’. Of all the parties pledging action on social care before the election, the Conservatives were, perhaps, the least specific about what would be in store for our sector.The pledge to build a cross-party consensus is welcome. But as we have seen in the distant, as well as the more recent past with Brexit, this can take time and sometimes quite significant political risk to achieve – and with the other political parties thrust into such fundamental disarray – it is, perhaps, questionable, whether there are any opposition health department ministers in post with whom to get building. My guess is that yet again, the care homes who will do best are those that look to their own resources and initiative to achieve the progress and improvements they want. It’s said that social care considers itself the ‘Cinderella’ of integrated care, given the time and resources that are lavished instead on the NHS. But, as anyone who saw a panto this Christmas will know, Cinderella did ultimately get to go to the ball, and it was not her ugly sisters who

ended up marrying the prince. Her story did have a happy ending. Cinderella got her guy because she made friends with the right sort of people and was not afraid to take her chances in the prince ‘marketplace’. As we see in this issue, in the profile of WCS Care’s Castle Brook care home on page 18, even care homes with limited funding models can find themselves at the forefront of tech-enabled care, if they approach the situation with a brave attitude and the support of friends in the right places. Sometimes, successful organisational development simply does come down to ‘taking a punt’. For us here at Care Home Management, we’re also looking forward to an exciting new year. We’ve introduced some new features in this issue – a new, regular focus on tech (page nine) and what’s new in care home research (page 16) to keep you up to date in our changing world - and a prize draw crossword on page 35 for you to enjoy over a well-earned cuppa. You’ll also notice that the magazine comes to you now in a recyclable paper wrapper. We hope this helps you do your bit for the environment. If you feel you want to do more, don’t forget that you can request a free copy of Care Home Management magazine in digital format - either as a page-turner version, or as a download, which is searchable and will come to you ahead of the print edition. All our issues are available online, from our website where you’ll also links to our monthly podcast and our daily coverage of all the best news and views in social care. If you sign up to my free weekly editor’s newsletter, you can be sure of staying completely up to date. Just email me now to sign up – why not do it on your way to the gym?

Care Home Management Magazine 2020 The Publisher holds all copyright and any items within may not be reproduced in any way, for any purpose, without the written permission of the Publisher. While every care has been taken to ensure accuracy, the information contained within this publication is based on submissions to the Publishers who cannot be held responsible for errors and omissions. The publisher does not necessarily agree with the views expressed by contributors and cannot except responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.

January/February 2020

Ailsa Colquhoun Publisher/Editor


@Carehomemanage Care Home MANAGEMENT 3




7  Eleanore’s Words to the Wise

Changing promises into reality

9 Tech Focus

Our new regular focus on all things ‘tech’

10 Legal

Ensuring compliance with residents’ contracts

11 Leadership

Explore the road to outstanding in the well-led KLOE

13 Research

A new study puts Dementia Care Mapping to the test

14 Market Barometer

A look at the market in care home sales

20 Best Practice

The Ombudsman defends action against a demanding family member

See who’s on the move and where to go during January and February


CARE TECH 22 How your home can benefit from digi-therapeutics

24 The ins and outs of data security and a just-for-fun tech quiz

INTERIOR DESIGN 28-31 Harnessing the power of plants

18 Care Home Profile

 Care home tech takes centre stage at WCS Care Group’s Castle Brook

p18 4 Care Home MANAGEMENT


35 People and Events

16 Outstanding

See who’s made it into the Outstanding club


Take a well-earned break with our new coffee time page

INFECTION CONTROL 26 Managing the infection risks posed

How to embed human rights in end of life care


34 Coffee Time

15 Ask The Expert












January/February 2020 • ISSUE 83

by visitors

& designing for hearing impaired residents

UNIFORMS 32 How to give your workwear a touch of sustainability


p16 www.chmonline.co.uk


Care Home Management launches first Readers’ Award CARE HOME MANAGEMENT is delighted to announce the launch of its first Readers’ Award for supplier service. To nominate the supplier of your choice, please fill in the form available online at the link below. Alternatively, please email the editor with the name of the supplier who, in your opinion, offers your home the best service. This can relate to a single episode of, or ongoing provision, of excellent service.

You may also vote more than once. The email address is: editorial@ chmonline.co.uk You do not need to identify yourself when making a nomination, and any identifying details will not be shared outside the Care Home Management editorial team or used for any editorial or marketing purpose. If you prefer you can post your entry to the Care Home Management office at Hillside office, 9 St James Park, TUNBRIDGE WELLS TN 2LG.

For more information, visit: https://chmonline.co.uk/ care-home-management-launches-first-readers-award

Time is running out!

THE DEADLINE FOR entries to the Care Home Awards 2020 is just a few weeks away on Friday 31 January – so don’t delay, get your entries in today. Your residents really appreciate all that you do to make your care homes better run, better designed, better equipped and better resourced and your staff better trained, so why not tell the Care Home Awards judges all about it? Check out the full list of categories online, and submit your entries before Friday January 31, 2020. You can also reserve your places online for the Awards lunch and ceremony on May 15, 2020 at the Royal Garden Hotel, London W8 4PT. Care Home Management magazine is delighted to once again support the Care Home Awards as media partner. See the ad on the inside front cover or visit www.CareHomeAwards.com

Each week, the Care Home Management team sends out a weekly newsletter, with quick links to the best of the preceding week’s news. Sign up is free. Please email the editor with your email address and we’ll add you to the subscription list. Don’t miss out on this easy way to stay up to date. Email the editor now at Editorial@chmonline.co.uk

Public “optimistic” about improving social care standards

Scottish Parliament to review the future of social care

A SCOTTISH PARLIAMENT committee is undertaking an inquiry into the future of social care in Scotland. Scotland’s Health and Sport Committee is seeking input from those who have received or provide social care in Scotland, as well as organisations who deliver social care. They are keen to hear about people’s experiences of social care, what an ideal model of care looks like and how to ensure the service is centred upon each individual’s needs. They also want to explore how social care could be set up so that there is equitable access and quality of services across Scotland. For more information, visit: https://chmonline.co.uk/ scottish-parliament-to-review-the-future-of-social-care/

January/February 2020

ALMOST ONE IN FIVE people expects standards in social care to improve over the next year – which is about the same expectation people have for the NHS, a poll by the Health Foundation has found. However, only six per cent of people think that standards of social care have improved over the past 12 months. Looking in detail at public perceptions of health and social care, the poll finds that women and people with disabilities are particularly likely to think the standard of social care has been getting worse, and women are more pessimistic about the next 12 months. By age group, those aged 45 and over are particularly negative about the standard of social care over the last 12 months, while those aged 35 to 64 are most pessimistic about the next 12 months. For more information, visit: https://chmonline.co.uk/ public-optimistic-about-improving-social-care-standards




IN 2020 AND BEYOND A look at the changes needed in social care in 2020 and beyond. By Professor Martin Green OBE, chief executive of Care England


he general election is over and we have a Government with a large majority and the ability to get legislation through Parliament. Hopefully, Brexit will soon be completed and this will leave the new Government the space to focus on the important issues that have so far been neglected. It was disappointing to see so little focus on social care throughout the election campaign. All parties and the media reverted to their normal obsession of the NHS. I do not know what it will take for politicians to understand the interdependency between health and social

care, despite so much evidence. The new Government has pledged £1bn a year for social care, and has talked about “building a consensus around social care” and how it will be funded. This cannot become the next excuse for doing nothing: over the past 22 years we have seen only endless commissions, inquiries and discussions. Politicians have used constant analysis as the excuse for a lack of action. Within its first 100 days, I want the new Government to set out its approach to ensuring social care sustainability: funding, staffing, capacity and the interface with the

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NHS. What citizens need is a clear idea of what they should expect when they have either a health or social care need and who is going to pay for it. If there is going to be co-payment, we need people to start thinking about social care when they start working. To some extent we have won the battle with pensions, and now we need to deliver similar thinking on long-term care. The challenges facing this new Government are enormous, and it’s a tough job, but the new Government asked for the task, now we expect them to deliver the outcome.



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Time and lack of resources are to blame for poor oral health in care homes Let care home nurses nurse, survey results say NURSES IN SOCIAL CARE are the most likely to complain about spending too much time on non-nursing duties, a nurse employment survey has found. Three in five private care home nurses say their job has been deskilled (61 per cent) over double the number working in GP practices with the same sentiment. Care home nurses are also the most likely of all nurses to say they are under too much pressure and too busy to provide the level of care they would like. They are also among the least satisfied with their working hours. For more information, visit: https://chmonline.co.uk/ let-care-home-nurses-nurse-survey-results-say

INSUFFICIENT TIME TO carry out effective mouth care for residents with challenging behaviour and failure by homes to purchase essential non-prescription resources such as low foaming toothpaste are among the barriers to improving oral health in older people in care homes. A report into the delivery of oral health programme in Wales shows that staff and residents have benefited from better oral health. Anecdotal reports suggest that residents have fewer chest infections and episodes of oral thrush since introducing the programme. For more information, visit: https://chmonline.co.uk/ time-and-lack-of-resources-are-to-blame-for-poor-oralhealth-in-care-homes


Changing promises into reality By Eleanore Robinson, freelance social care journalist LAST YEAR WAS ANOTHER TORRID year for care home operators, with no long-term funding solution in sight despite growing costs and demand for services, all the while dodging accusations of neglect and profiteering from vulnerable people. Think tank the Centre for Health and the Public Interest was the latest body to take a potshot at the sector, claiming some for-profit providers are “leaking” public sector money, with it often ending up in shareholders’ and directors’ pockets or being paid out to landlords, instead of being spent directly on services.This claim has further dented the image of social care, portraying private providers as heartless individuals who care more about their profits than the people they look after. And while we can’t eliminate the negative, January/February 2020

surely the key to fixing social care’s broken image is to accentuate the positive.There are thousands of instances of care workers going the extra mile to look after vulnerable people in the nation’s care homes during the cold winter months. Care homes up and down the country are opening their doors to the wider community so older people don’t have to spend every day by themselves.There are the trusted assessors working for care home groups to ensure that no-one has to unnecessarily spend time in hospital when they could be in a homely environment. These are just a few of the good stories that could be put out there this year. While there are countless stories of heroic doctors and nurses, police officers and firefighters carrying out their crucial duties in difficult circumstances, the efforts of social care staff should be recognised alongside them. It is only when the importance of care work is at the forefront of the

public’s consciousness, as it is with the emergency services, will politicians start to take notice and, crucially, do something about the issues facing the sector. Until then any Government will follow the decades-old strategy of promising a vague plan at some point in the future, instead of addressing the complex issues affecting the sector now. The sector’s New Year’s Resolution should be to blow its own trumpet and demonstrate it is as deserving as other essential services. Care Home MANAGEMENT 7


24 & 25




BUILDING A BETTER FUTURE FOR CARE The Residential & Home Care Show returns on 24th - 25th June 2020 at London ExCel, it’s the event where Senior Management teams from care homes, dementia homes, nursing homes, care villages, housing associations and all forms of home care providers gather to gain ideas, products and services to boost their business and improve levels of care.



residentialandhomecareshow.co.uk #RandHCS Part of:

24 - 25 JUNE 2020 + ExCeL LONDON

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



Education partner:

Organised by:



E-CARE PLANNING Nuno Almeida, founder/CEO, Nourish Care Systems Ltd, explains how to achieve seamless e-care implementation


t’s hard to believe that over 75 per cent of care providers still use a pen and paper for record keeping. The perceived risk of digitalisation includes: • The scope of risk involved • Data loss and data breach • Device security • Care workers’ ability to use new technology. However, paper can present an even bigger risk: paper records can be lost, information can be



PREPARE Communicate with residents, families and care teams in a way that is reassuring and clear about the reasons for adopting digital, building excitement and demonstrating positive change.


TRAIN Agree whether your supplier or internal training team will train staff. Give your team reassurance and help them feel in control by sharing your clear plans for training and roll-out.


ROLL-OUT Agree how devices are prepared and deployed. Tell staff where they need to be and when. Ensure you know how user accounts are created and how records are created for the people you support.

January/February 2020

hard to find, or may be hard to see in context. Data may not be used in a way that can help to improve and enhance care. The benefits of digital care management: • Staff spend less time on paperwork and more time providing face-to-face care • Teams carry out internal audits quickly, allowing more efficient processes • Better coordination around individuals’ personal needs, enabling tailored care • Care teams can provide safer, more transparent care • Care providers save time and money • Teams make more timely decisions based on real-time information. Getting digital care management right is a five-step process... Define what you want to get from digital care planning

1 2

Identify potential suppliers based on business needs and criteria

3 4 5

 omplete due diligence, C meet the suppliers and involve your team  hortlist suppliers based on S feedback from your team and ask for proposals Invite the top supplier to negotiate and agree timescales for roll-out.

YOUR IDEAL PROVIDER: WHAT TO LOOK FOR… • Does the company have a good reputation? • Are their company values similar to yours and your care service? • Do they have case studies available of similar care services to yours? • How long has the company been trading? • Do they have a business continuity plan? • What’s the company’s track record with the regulator?


Call, email or click online to book your training needs today! T: 01622 766078 | E: info@edify-consultancy.co.uk W: www.edify-consultancy.co.uk Care Home MANAGEMENT 9


Are your residents’ contracts compliant?

The Competition and Markets Authority has published guidance highlighting the key changes to consumer law and the possible need for care homes to update their agreements to ensure compliance


ver the past decade, consumer law has developed and evolved significantly, and a number of new acts and regulations have been introduced throughout the UK within this period. In November 2018, the Competition & Markets Authority (CMA) published guidance for care home providers on the updates to consumer law and how it directly applies to care homes. The guidance is designed to help care homes comply with their consumer law obligations and may require you to make changes to your existing residents’ contracts or terms and conditions. Although consumer law has a far wider reach, the CMA guidance is designed specifically for care homes with residents over 65. Failure to comply with consumer law may result in action being


brought against a care home by the CMA or Trading Standards and it is therefore important to ensure that you are compliant. The changes in legislation introduce several key principles and the guidance separates them into the following core sections; upfront information, treating residents fairly, quality of service and complaints handling. The core sections introduce ‘do’s and don’ts’ for care homes and offer suggestions and guidance to enable a care home to comply with their consumer law responsibilities. The obligations apply to a care home both before and after a resident has moved in and require care homes to provide upfront information so that a resident can make informed decisions. All contracts must be transparent and unambiguous and not place

residents at an unfair disadvantage. The scope of the services that a care home provides, and the pricing associated with each aspect of the service should be clearly outlined within a contract also. There are also specific requirements outlined relating to price increases, varying terms, notice periods and resident absences to be considered and comply with. Hempsons can assist with reviewing existing contracts and ensuring yours are fit for purpose – contact us for a no obligation initial free discussion. Matt Donnelly, Solicitor, Hempsons e: m.donnelly@hempsons.co.uk www.hempsons.co.uk





In the last of this five-part series, Chris Gage, joint MD, Ladder to the Moon, explores what it takes to be outstanding in each of the five elements of the CQC’s Well-led KLOE IN THIS ISSUE: WORKING IN PARTNERSHIP


he need to create a culture and climate conducive to creativity and innovation is as important in your work with partners as it is with your internal colleagues. If you want to be doing something new and valuable with your partners – something that the inspectors see as outstanding - then you need to work hard at that relationship. That means really focusing on trust, being open and honest, and being willing to challenge each other to create something really innovative. The good news is that there is plenty of low hanging fruit to be had: partnerships with local communities, nurseries and schools are obvious examples. But, what about the other services, clubs, and community groups around you? And, crucially, how do you use those connections to make a personal difference to the lives of your residents? With a bit of effort you could make a partnership that can deliver something amazing for a resident with an unusual need or personal history.

The cornerstone of relationships

In terms of those relationships that are expected of care homes - membership of the local care association, relationships with GP surgeries and other health services, for example - to make those outstanding, you need evidence. Could you develop a collaborative project that impacts on residents’ lives and which can be evidenced through testimonials? When working with health professionals, you should have a secure NHSmail email for sharing patient identifiable and sensitive information. Using technology is now standard and staying on top of it is a given for any service aspiring to be rated outstanding January/February 2020

Relationships with commissioners may also be critical to your business, and the obvious difficulties aside, being able to demonstrate creativity with scarce resources is a win all round. It will help to know what commissioners say about your service so ask yourself: Do they visit regularly? Are they invited? Do you include them in your special events and let them know about your innovation? Fundamentally, are you leading and inspiring them? It can be beneficial to flip assumptions on their head: care services are often seen as places of need which ask for contributions. So, what can you do to turn your home into a net contributor to your community? Can you build reciprocity, which builds status and

meets the psychological need we all have – including your residents - to feel valuable and valued? One nursing home puts on a major charity event and raises thousands of Pounds for the local homeless shelter, with users expressing pride and meaning in the difference they are able to make. To summarise this article and the series, if you want to be outstanding then you need to do something that makes you stand out across the board.You can’t control what your inspector has seen before, and what will come as a surprise. But, if you have got loads of new and different things happening that are making things or the people that you support better, then you will certainly increase your chances. Care Home MANAGEMENT 11

The soft skills training experts for your Care Home

Hendrix Training is one of the UK’s leading providers of soft skills training

Face to Face Care – workshops covering body language and tone of voice to help your employees interact more effectively with residents, their families and other stakeholders Presentation Skills – give your managers a confidence boost when public speaking

Media Skills – let our professional journalists help you tell your positive care home story and deal with a crisis effectively when the worst happens

Actors supplied for training Role Plays and Forum Theatre – use professional actors to bring your role play to life or to perform the role plays so your staff don’t have to. Instead they direct the action based on their own experiences.

All our courses are delivered by professional actors and media experts Hendrix Training delivers innovative, experiential and rewarding training to boost your employees’ confidence and improve your care home business To find out more visit: www.hendrixtraining.com tel: 01892 519504 email: training@hendrixthedog.org

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Does training in Dementia Care Mapping lead to improved person-centred care? A study has explored the role of external experts in supporting staff to implement dementia care mapping in care home settings. By Centre for Dementia Research (Leeds Beckett University) researchers Professor Claire A Surr and Dr Alys Griffiths


ementia Care Mapping (DCM) (Bradford Dementia Group 1997) has been widely used for over 20 years in care home settings internationally to improve the delivery of person-centred care, usually for people with dementia. It is usually implemented by training two staff from the care home to become ‘mappers’ so there is no reliance on external support over time. DCM involves delivering care improvement “cycles”, which include: 1. Briefing - briefing sessions to inform staff about DCM, the process of implementation, and provide an opportunity to raise any questions or concerns. 2. Observation – mappers observe one to eight people in communal areas of the home, for up to six hours on a single day, although observation periods can be adapted. They record each resident’s behaviour and mood/engagement every five minutes as well as instances when care workers say or do things that ‘put down’ a person with dementia, and examples of good care. 3. Analysis - the data is analysed by the mappers. 4. Report writing and feedback – data is presented in a written report and feedback sessions are held to share this with the staff team and discuss good care practices and areas for improvement. 5. Action planning - action plans to improve care are then produced jointly with care staff. January/February 2020

This cycle is repeated every four to six months to monitor progress and revise action plans. A randomised controlled trial named EPIC (Enhancing Person-centred care In Care homes) was set up to explore whether DCM improved resident outcomes in measures such as agitation and other behaviours that staff find challenging, depression, quality of life, anti-psychotic use, use of services such as A&E and GPs, and whether the quality of staff interactions with residents improved. In EPIC, researchers recruited 50 UK care homes and nearly 1000 residents and asked 31 to undertake DCM (intervention group) and 19 to continue their usual care (control group). The DCM group completed three cycles over the study period, and data relating to the two groups were compared at the start of the study (baseline) and the end (16 months after baseline).


The study found that using DCM did not lead to improvements in any of the outcomes, compared to the control group. Likely causes include that trained staff (mappers) struggled to implement DCM despite additional support including input from an external expert mapper, and the provision of standard documentation and on-going DCM support. Only 26 per cent of care homes managed to complete more than their first supported cycle. One or both mappers left their role in over half the DCM homes during the trial,

meaning DCM was not sustainable. Mappers reported not having the confidence, time, and in some homes, the managerial support to put DCM into practice. The expert mapper role was considered crucial to implementation.


• • •

It is vital for researchers and care home managers to consider how they will be able to put costly approaches like DCM into practice, before they consider training This may be true of other interventions that involve training care home staff External experts can provide valuable support, but this may need to be sustained over time until the intervention becomes part of everyday practice. The costs of this need to be considered Managers should consider how an intervention can be sustained over time In the event of staff turnover.

More information:

1 Surr, C.A., Shoesmith, E., Griffiths, A.W. et al. Exploring the role of external experts in supporting staff to implement psychosocial interventions in care home settings: results from the process evaluation of a randomized controlled trial. BMC Health Serv Res 19, 790 (2019) doi:10.1186/ s12913-019-4662-4 [online] via the link: https://tinyurl.com/w3ntxxv

Dementia Experience Toolkit can be found [online] at: https://www.alzheimers.org.uk/ dementia-professionals/dementia-experiencetoolkit/research-methods/dementia-care-mapping





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


activity in the secondary market has also been steady, with funds like Impact REIT announcing a number of deals involving regional operators. In 2020, we expect to see more portfolio merger and acquisition activity once uncertainty associated with Brexit is resolved. Workforce and funding-related issues are the main ongoing challenges for the sector and Brexit will exacerbate these issues until the departure terms are clear. We also anticipate that new build development and investment activity will remain very active, as obsolescent product continues to be removed from the market.

019 was an outstanding year for buying and selling property across the care sector. There was excellent volume within the market. Investment appetite remained very strong throughout the year with high quality single or small groups of assets let to leading covenants, reflecting demand from an ever-increasing number of institutional investors and specialist funds with substantial amounts of capital. Several of the transactions we have seen have created new yield benchmarks for strong regional and Special Purpose Vehicle-type (SPV) covenants.What’s more, investment

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Life after death

Understanding how staff feel and what they have to go through when a resident dies will help your home retain your valuable workforce. By Matt Oakley, chief executive officer of Dechoker UK


here is an expectation that when a person enters a care or nursing home that the move there will be their last. However, the effect on staff when a death is sudden and in traumatic circumstances can cause additional stress on staff. This is particularly relevant in the adult care sector where there are a significant number of unexpected deaths. Following an unexpected death of someone in care, particularly one where there is evidence of a trauma from a fall or choking, there will almost certainly be an inquest. Held in court, the proceedings for reports can take several months, during which time staff will encounter the authorities, and statements will need to be made. A Coroner has the power to call any witness to give evidence at an inquest, regardless of their current working situation. A likely visit from the regulator, and a potential Police investigation only add to the stress. When people share their experiences of a resident choking they use terms such as ‘panic’, ‘scared’ and ‘upsetting’. When staff tell you: ‘It was the most frightening thing I’ve ever had to deal with’ and ‘I couldn’t sleep for days afterwards’ it is hardly surprising that many decide to leave their current employment or to take long-term leave caused by stress. Being able to offer support to staff when these things happen is a strategy that can benefit the home in the long and short-term.

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

The training programme uses a human rights approach to address the challenges associated with shared and ethical decisionmaking at end of life

IN THIS ISSUE: WHAT IS A HUMAN RIGHTS APPROACH TO END OF LIFE? Jacqui Graves, human rights lead at Sue Ryder, helps care staff to take a human rights approach to end of life


are workers often face dilemmas about how best to support those in our care and those important to them, in what are often distressing circumstances. It can be difficult to know what to do when there is not a clear right or wrong way forward or there are differences of opinion. We worry about how to navigate family dynamics if we know that some family members’ expectations are different from those of the person in our care. In the middle of all this, we may forget the basics of human rights. Human rights support many of the everyday situations facing professionals caring for people at the end of their lives. For example, pain control must be balanced against the person’s wish to be able to communicate with their relatives immediately before death.


However, often the main barriers to implementing human rights in practice are a lack of knowledge and understanding amongst colleagues, conflict between the personal beliefs of family members and the patient, and lack of confidence to challenge colleagues. That’s where education and training can empower frontline care workers to ensure that the human-tohuman approach is central to all aspects of care and compassion, helping and supporting care workers to enjoy a better quality of work in the care environment.

Understanding what matters

Charity Sue Ryder offers an end of life training programme called “What Matters to Me”, designed for nursing and social care practitioners working in end of life

care. The training programme uses a human rights approach to address the challenges associated with shared and ethical decisionmaking at end of life. The purpose is to ensure that the voice of the person is listened to and their decisions respected and protected – even when as care workers we believe those decisions to be ‘unwise’. This is the real ethos behind person-led care. The framework of human rights addresses the rights of both patients and care workers. By applying human rights principles to the context of patient care, this framework looks beyond the individual patient-staff relationship to examine the issues, and the responsibility for dealing with them. In the context of end of life care, these include the patient’s rights to: • be free from torture, inhuman and degrading treatment (safeguarding from harm) • life • liberty • respect for private and family life, home and correspondence • freedom of thought, conscience and religion • not to be discriminated against. They also encompass care workers’ rights to decent working conditions and freedom of association. Using the Human Rights Act as a framework enables a more holistic, balanced approach to care. As human rights apply to everyone, this framework acknowledges that care workers do not solely have obligations but are also entitled to rights, which is essential to fostering a culture of respect for human rights within the care delivery systems. To find out more about human rights training at Sue Ryder please visit www.sueryder.org/humanrights




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

Lucerne House, Exeter Effective:


Lucerne House is a residential care home providing personal and nursing care to up to 75 people. What Lucerne House did: Effective

Very thorough initial assessments include documenting residents’ goals and aspirations. The care home also has links with universities, taking part in research, and has also been featured in a national specialist publication. When supporting people with reduced capacity, the home makes every effort to identify what the person can consent to using, for example, a sensitive approach, communication aids, the individual’s history, and the advice of relatives. Training is viewed as important: all staff are qualified to at least level 1 in dementia care training and some to level 3. New staff, including some agency staff, complete a five-day, face-to-face induction and shadow or buddy-up with more experienced staff members. There are also regular supervision and competency checks. The service’s in-house physiotherapist links with other community agencies to ensure the best package of care and equipment are in place, subject to constant review. Staff are also trained to identify when a 16 Care Home MANAGEMENT


Read the full inspection report [online] at: https://www.cqc.org.uk/location/1-125856395


resident’s medical needs can wait for the GP’s routine weekly visit.There are also regular visits from opticians, dentists and foot care specialists. Mealtimes are sociable and inclusive, with specially created eating spots for people in special chairs and with adequate staffing levels to keep all people engaged. People’s rooms are decorated according to an individual’s tastes, and inside and outside spaces are designed with residents’ needs in mind.

What Lucerne House did: Caring

All people were treated with the upmost respect, including their faith and cultural preferences. Residents are encouraged to feel more cared ‘about’ rather than cared ‘for’. Examples include staff using their own car to enable a resident to spend Christmas day with their family.

What Lucerne House did: Responsive

Every staff member involved in the inspection was seen to know the people they were caring for very well. Regular care plan reviews involve the resident and their family, and staff are careful about documenting the care plan from the person’s viewpoint.The home employs an activity team, which has developed excellent links

to the outside community including voluntary groups, churches and schools. Regular activities include a quiz night, coffee morning, ‘gentleman’s club’, yoga, music sessions, ‘chatterbox’ intergenerational sessions and church services, provided in groups and on a one-to-one basis. On their birthday, people are offered their choice of day out. Staff and residents are supported to grieve for people who have passed away and staff are able to attend people’s funerals if they want to. After a death, the home holds a “happy half hour”, where people and staff get together, raise a toast and discuss memories of the person.

What Lucerne House did: Well-led

The registered manager has an empowering management approach that, for example, gives staff control over a monthly budget, subject to monitoring. Staff at the service have been nominated for regional and national awards. Examples of how the service links with others include social meetings of “Lucerne Friends”, comprising families and friends of people living in the service, and cross-generational activities. One person has the role of Residents’ Ambassador, to liaise with the registered manager, who is described as a ‘promise keeper’. www.chmonline.co.uk


Riverview, Teignmouth Safe:



Riverview is registered to provide accommodation and personal care for up to nine young adults with learning disabilities. What Riverview did: Safe

Positive risk taking is promoted and people are empowered to take maximum control of their lives: this is demonstrated by a reduction in the use of PRN medication. Restrictive practices are minimised, in consultation with families and a positive behaviour support specialist, and after detailed risk assessment. People are supported on a one-, or two-to-one basis, by consistent staff who know them extremely well. To reduce noise and disruption and excessive visual stimulation in communal areas, staff have changed practices to communicate with walkie talkies, to stop the weekly food delivery and to remove pictures. Staff are also trained in conflict resolution and personal emergency evacuation planning, and evacuation plans are available in easy read format in residents’ accommodation. The deputy manager is accessible and available to offer staff support. Inspectors heard there is almost no use of agency staff. Safe use of medicines is promoted through participation in the national STOMP project, which aims to stop over medication of people with a learning disability, autism or both with January/February 2020

Read the full inspection report [online] at: https://www.cqc.org.uk/location/1-539180304


psychotropic medicines. There is also a personcentred approach to medicines administration: people keep their medication with them at all times so medicines can always be taken at the prescribed time.

What Riverview did: Caring

Staff demonstrate a passion for providing high quality care, describing themselves not as carers, but as “support workers who support people to live the best life they can with no limits, and as independently as possible”. People’s achievements are celebrated through media including a personal scrapbook, which is updated annually with photographs of significant events. Service users are also given a ‘user guide’ in an appropriate format, with information on topics including the service, keeping safe, policies, training and person-centred services. Service users also take part in monthly one-to-one ‘Your Voice’ meetings, during which care is reviewed. Regular satisfaction surveys are used to develop the service.

What Riverview did: Responsive

After observation lasting up to six months, people are allocated a key worker based on their personality and interests, to facilitate positive working relationships, push boundaries and achieve goals. Care plans include statements in

areas such as: “What people like and admire about me” and “What is important to me.” Staff also use communication dictionaries, sign boards, symbols and pictures, and assistive technology for people who cannot use words to communicate.

What Riverview did: Well-led

Each year, the manager identifies a new ‘vision’ which is formally shared with staff: in 2019 the vision was ‘to promote positive outcomes through positive risk taking’. The management team acts as a role model, working alongside staff to allow issues or concerns to be raised as they arise. The management team conducts regular checks and ongoing monitoring, including to review the service based on the CQC’s key lines of enquiry. Audit results are analysed to improve the quality and safety of the service, and these are reviewed at monthly governance meetings. To develop relationships with the local community, staff carry the home’s business cards. Staff excellence is also celebrated and recognised in local and national awards, and staff are supported to attend events and conferences. A weekly newsletter is distributed to staff to provide an update on legislation, policies and procedures and good practice stories. Care Home MANAGEMENT 17


TECH, BUT NOT FOR TECH’S SAKE “If we can do it, then anyone can do it”.That’s the tech challenge laid down to other care homes by WCS Care Group chief executive Christine Asbury

tion Hub Castle Brook’s Innova 2017 and has officially launched in sts (centre welcomed over 650 gue f executive; - Christine Asbury, chie director of and right, Ed Russell, pment) innovation and develo


ome 50 per cent socially-funded, the not-for-profit Castle Brook care home in Kenilworth, Warwickshire, has forged a name for itself as an innovator of care tech. In 2019, to celebrate the hosting of some 650 visitors to its speciallycreated Innovation Hub, Castle Brook welcomed health and care minister Caroline Dinenage. In visiting, Dinenage became the latest in a long line of stakeholders in social care to see how tech can be used to innovate care. EVERY DAY IS WELL-LIVED Catering for the demand from visitors wanting to see care technology in action, the hub accommodates working mock-ups of the technology and concepts that the Warwickshire-based charity already uses in its 13 care homes, including the latest addition, the Woodside Care Village in Warwick, which opened in Autumn 2019. In the hub, visitors can see a recreated bedroom with a night-time acoustic monitoring system and a non-recording camera which gives


carers a live visual prompt on which to base their care decisions. There is also a mock-up of the installed circadian rhythm lighting that mimics the natural light cycles of the day. This helps to keep the body in a solid circadian cycle, helping to improve sleep and daytime alertness. According to research done by WCS, this has delivered a 34 per cent reduction in falls. Also featured are electronic care planning and an advanced nurse call system that alerts staff through hand-held devices. There are also twoway microphones to allow night staff to support residents, for example, by providing audible reassurance that staff are on hand if needed. Asbury believes the hub has benefits for WCS, as well as its visitors. She says: “The hub gives us the opportunity to share our approach with other providers (and learn from their experience), to show them the systems in action in a real-life setting and try new innovations before rolling them out to our homes. Our philosophy is that for residents ‘every day is welllived’ and tech simply forms a subsection of how a building enables that.”

As an example, she cites the introduction of the acoustic monitoring system, which gives residents more independence as they know they are being looked after and will get help if they need it. Staff can also be more effectively assigned to residents, according to their need, and are supported in cases of challenging behaviour as colleagues can listen or look in in real-time. Asbury says that when it comes to making the business case for new tech, WCS is fortunate in having a Board that is supportive of investment that it considers will bring enough benefit to residents. Key criteria include quality of life improvements and reduced admissions, and how the tech fits in with person-centred care. It helps, she says, when an organisation does not have private investors to accommodate, and is free from centralised procurement processes. Even so, sometimes the decision to introduce tech is simply a question of ‘taking a punt’. She says: “The Board see that the worst that can happen is if an investment doesn’t deliver all outcomes and another system has to be laid on top of it.” WAITING LISTS Opened in 2016 as a new-build home, Castle Brook is designed with modern care principles in mind. Community facilities include a cafe, cinema, hair salon, shop, and traditional launderette used by residents and staff alike. There is a communal aromatherapy spa bath that residents and external visitors can enjoy, as well as real books on shelf for residents to touch and feel, and even read if they are well enough. Each household has a large, open plan living area with a lounge, dining area and domesticstyle kitchen where people can make their own snacks and drinks or even bake a cake, anytime day or night, and where part-prepared main meals are finished off. Outside there are walkways and a cycle path suitable for a buggy-style bike-for-two, and



A view of the front entrance of Castle Brook in Kenilworth

vegetable and flower gardens. The idea behind the layout is to make all activities, even tasks such as laundry, an “entertainment”, says Asbury. Finishing the food in the households themselves means that enticing cooking smells permeate each area of the home, making food preparation something all residents can take part in and enjoy. INNOVATION DISRUPTION As England’s first care home provider to have six homes recognised as outstanding by the Care Quality Commission, WCS is clear that tech plays a key role in enabling staff to deliver better care. As Asbury says: “to bring their own magic to their work, every day.” In the latest CQC report for Castle Brook, tech is mentioned in the ‘Well-led’ domain, with staff telling inspectors that the use of technology had improved people’s experience of the service, in particular the acoustic monitoring, because it was, “better than night checks and disrupting their sleep.” Other staff applauded the home’s commitment to

Residents at Castle Brook enjoy rehearsals for their choir performance in the run-up to Christmas

improving its rating following a recent visit to an outstanding dementia care service in Amsterdam. Inspectors were told how the provider’s senior managers had shared the results of the visit with staff and were keen to implement the good practice they saw. Asbury describes the home as a “disruptor of expectations of care”, using tech to move boundaries. And, in a message for the new Government, she says that the key facilitator for the adoption of tech in residential care would be free wifi in every home. ”Smart devices are becoming an increasingly important part of our lives. Residents will come to expect it,” she says. Looking forward, she says there are a number of innovations on the market that might be

You don’t just roll in tech and it works on day one: it has such an impact that you have to work through issues for years getting things really right” the home’s next IT ‘thing’. Health monitors that measure blood oxygen, for example, are being piloted. But WCS is not an organisation that introduces tech “for tech’s sake”, she says, admitting that the next investment could even be ironing boards for the residents to use if it’s felt to improve their engagement in daily life. She says: “You don’t just roll in tech and it works on day one: it has such an impact that you have to work through issues for years getting things really right. But we are on a journey together. The more it can do, the more we can learn.”

Residents are able to do as much or as little as they like at Castle Brook including their own laundry if they want to

A shop, launderette, cafe and cinema are some of the facilities residents enjoy using at Castle Brook

January/February 2020

Castle Brook has its own cinema showing films three times a day



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



The Local Government and Social Care Ombudsman decisions relating to complaints about local public services offer useful learnings for care home providers


Pilgrims’ Friend Society SUMMARY: Mrs B complained about

the care provider placing restrictions on the hours she is able to visit her father in a care home. No fault has been found with the actions taken by the care provider


The Care provider’s policy states: •S  taff are managing a service, using their time and resources to best effect. They cannot do so if someone tries to dominate their attention with frequent, lengthy contacts and repetitive requests for information. Unreasonably

persistent complainants are those who, because of the frequency or nature of their contacts with the service, hinder the service’s consideration of the complainant, or other people’s complaints. When necessary, the service will take action to restrict access to their service when unreasonable behaviour of this nature persists. • T  he list of unacceptable behaviours includes: ‘making excessive demands on the time and resources of staff with lengthy phone calls, emails to numerous staff, or detailed letters every few days, and expecting immediate responses’.



Mrs B’s father Mr C is in a care home some distance away from Mrs B’s home. He is nearing the end of his life and, since the beginning of this year, Mrs B has been visiting more regularly. Mrs B does not hold any power of attorney for Mr C. Since January 2019 the care provider has kept records of the interactions Mrs B has had with the staff in the home during visits and via email or telephone call at other times. The provider began to have concerns about the time Mrs B was taking up with these interactions, affecting the care that staff were able to provide to residents, and distressing Mr C. The home also had reports that Mrs B had gone into the room of another resident inappropriately, was spending lengthy periods in the communal lounge working, asking staff to provide drinks for her and give her lifts, and using the facilities inappropriately. January/February 2020

In February 2019 the care provider wrote to Mrs B asking her to restrict her telephone calls to once a week and to call between 9am and 5pm, and at other times, if necessary. It reassured her that if Mr C’s health deteriorated it would inform her straight away. In early April 2019 the home reported safeguarding concerns to the Council and the Care Quality Commission (CQC). On 9 April 2019 the home sent a letter to Mrs B asking her to limit her visits to the home to between the hours of 10am to 4pm, and 7pm to 8pm, to stay in Mr C’s room, not to use the communal lounge for lengthy periods and to stay out of other residents’ rooms. It said it would review these restrictions if Mr C’s health deteriorated or otherwise in three months. Mrs B replied to the letter disputing the allegations regarding her conduct and asking for full details. The care provider replied on 15 April 2019 repeating the restrictions and confirming they had been put in place under its policy for unreasonably persistent complainants. It explained that it was trying to balance the tension between Mrs B’s wishes and right to visit her father, and the needs of the residents and staff in the home. In late April 2019 the home allowed Mrs B to stay all night as the doctor indicated Mr C may be nearing the end of his life. He then improved and stabilised. The following day the doctor advised Mrs B that two-hour visits to Mr C would be best. On 25 April 2019 the home held a best interests meeting in respect of Mrs B’ s visiting hours. The meeting agreed to restrict her visiting hours to between 10am until 12pm, and 2-4pm. The home held a further best interests meeting on 20 May 2019. Mr C’s social worker was present along with Mrs B. The social worker agreed with Mrs B to keep to the current restrictions and review in

four weeks. A further meeting was held on 18 June 2019 and Mrs B asked if the afternoon visit could be changed to between 4-6 pm. This was agreed by the provider. Mrs B had first contacted the Ombudsman in February 2019 about her complaints.


No fault is identified in the way that the care provider has dealt with the situation. It has documented numerous concerns about the staff time Mrs B takes up with queries, concerns, complaints and requests. These include concerns about Mrs B’s conduct

while in the home affecting other residents including Mr C, and has prompted concerns from other residents and staff members. The provider wrote to Mrs B raising these concerns, and to restrict her visiting hours. On advice from the GP, visiting hours were restricted further. Mrs B was fully informed of the reasons for these restrictions (wellbeing of Mr C, other residents and staff).The provider also allowed flexibility when Mr C’s health deteriorated and at the request of Mrs B. It has held monthly meetings to review the restrictions and consider what is in the best interests of Mr C.

Read the whole decision [online] via the link: https://tinyurl.com/srs2nvb



What will I learn from this feature? How digi-therapeutics will change residents’ activities



Digi-therapeutics have the potential to revolutionise health and social care, and at the same time, can be fun. By McKinsey partners and experts Mike Joyce, Olivier Leclerc, Kirsten Westhues, and Hui Xue


igital therapeutics have made much progress over the past decade, harnessing technology to supplement or potentially replace traditional clinical therapy. Some devices complement traditional treatment by helping people to manage their condition, including informing when and how much medication to take. Other devices offer alternative treatments to drugs, such as sensory stimuli delivered through a tablet computer to manage insomnia or depression. Two distinct segments of digital therapeutics are emerging. The first consists of therapies that extend the value of traditional pharmaceutical treatments, through companion software providing adherence management and personalised treatment recommendations, for example. The second segment consists of therapies that potentially could replace traditional pharmaceuticals. Digital companions empower people to


self-manage their treatment or treatment symptoms in collaboration with a remote healthcare team. Using an app, a person can document daily observations on a smartphone. The app then gives the individual instant recommendations about dosage, changes to behaviour, or when to call the doctor, while it shares data with healthcare professionals via a dedicated web app, enabling them to intervene between visits if necessary and prepare for the next examination. Replacement therapies are softwarebased, algorithmically-powered sensory stimulus delivered through ‘gaming’. Therapy targets the brain’s interference-processing system. During the interaction, the game deploys real-time interventions that adapt as a person progresses through the game. At the same time it collects data that can be used to tailor therapy, track progress, and continuously improve the product. Products in development include those to

target insomnia with cognitive behavioural therapy, and to facilitate recovery after a stroke. Other uses may include attentiondeficit/hyperactivity disorder, depression, Alzheimer’s disease, and traumatic brain injury, reducing or eliminating the need for pharmaceutical or face-to-face therapy.

Advantages of digi-therapeutics

Digital therapeutics tend to target conditions that are poorly addressed by the healthcare system, such as chronic diseases or neurological disorders. In addition, they can often deliver treatment more cheaply than traditional therapy by reducing demands on clinicians’ time, and with an emerging evidence base. For instance, the US Food and Drug Administration (FDA) recently approved a mobile application to help treat alcohol, marijuana, and cocaine addiction, citing clinical trials that showed 40 per cent of patients using the app abstained for a www.chmonline.co.uk


three-month period, compared with 17.6 per cent of those who used standard therapy alone. So, why have digital therapeutics not yet joined the mainstream in healthcare? As a segment digital therapeutics are often not distinguished from the digital health and wellbeing market, which includes anything from sleep trackers to fitness apps and where there are well over 300,000 healthrelated apps available to date. So, how do you separate those that are merely entertaining downloads from those that are safe and, importantly, of therapeutic value? A definition of digital therapeutics, grounded in clinical evidence and meeting regulatory standards would help build confidence in the technology, separating it from general digital wellness in the same way that pharmaceuticals are separated from supplements.

More information:

A longer version of this article was first published by McKinsey & Co [online] via the link https://tinyurl.com/wpmm3qk

Using digi-therapeutics in activity-based care By Simon Hooper, co-founder, RemindMeCare Regular contact, conversation and activity have a positive impact on an older person’s mental health, which in turn can help manage dementia and other health concerns. But most care facilities fail to unlock the true potential of resident engagement: the quality of engagement achieved by activities is not always of the highest standard. And unless the activity ignites a spark of interest or plays to the individual’s interests, competencies and skills, the activity can become exasperating, wearisome and stressful, both for participant and for the care giver who feels responsible for the shortfall in their care offer. DIGITAL INTERVENTIONS IN PATIENT-CENTRED CARE Patient centred-care is the cornerstone of quality in social care, involving real knowledge of the person – their likes/dislikes, memories, habits, life story, family data, recent activities, and history of engagement. And, just as people are dynamic in their preferences and choices, so the latest generation digital products can support providers by learning from people’s choices and preferences to provide bespoke and dynamic activity recommendations: apps that can learn as people ‘play’ and then teach carers about the people they support are now defined in NHS parlance as ‘digi-therapeutics’. Mediums of engagement can include tablets, the TV, voice-activated assistants such as Alexa and Google Home, as well as digi-enabled sensory touch tables.


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All in hand What does good a care tech data handling policy look like? Bob Ingham, operations director of Nuagecare, offers some pointers


very care home is different but there are certain core aspects to the responsible handling of sensitive data. 1 Understand and apply the General Data Protection Regulation 2 Understand and apply the CQC’s standards for the governance and management (key line of enquiry for adult social care services) 3 Consider signing up to NHS Digital’s Data Security & Protection Toolkit 4 Understand and apply the Caldicott Principles (see further reading: NHS Information Governance Toolkit) 5 Choose your supplier and devices with care.

About Nuagecare

Nuagecare provide apps for evidenced-based and cloud-based care supervisory systems. We specialise in affordable and comprehensive solutions for single care homes and smaller care home groups. There are no-upfront costs and you only pay for what you use, from as little as £45 pcm. 7-day free trial available. Website: nuagecare.co.uk Email: sales@nuagecare.io Phone: 07923 424678

• Access controls that support the need-to• •

• • • •

Robust purchasing

Your chosen device should support the following principles of good data handling practice:


know principle Personal information can be limited to those residents the user is caring for If you use artificial intelligence for predictive care analysis, personal data should be separated from care action data and appropriate consents put in place Data should be encrypted and held in-app, not in the device’s general local storage Passwords are strong and are not stored on a device Data can be removed Device operation should be limited to a particular wi-fi network or within a given radius from a geolocation to protect against theft of a device Bring-your-own-devices using a supplier’s app

should not allow for copying or cutting and pasting data between apps Suppliers should demonstrate compliance with the ISO27001:2013 Information Security Management System Standard (ISMS)

Further reading:

Information Commissioner’s Office guide to GDPR [online] at: https://tinyurl.com/y43yappl Care Quality Commission advice for providers. Check the way you handle personal information meets the right standards [online] at: https://tinyurl.com/s9644w3 NHS Digital Data Security and Protection Toolkit [online] at: https://tinyurl.com/vt4jl2c NHS Information Governance Toolkit [online] at: https://www.igt.hscic.gov.uk/Caldicott2Principles.aspx ISO27001:2013 is the internationally recognized Information Security Management System Standard (ISMS) [online] at: https://tinyurl.com/tfg47ey

How tech aware are you?

Take our just for fun quiz to assess your knowledge of all things tech. The answers are at the bottom of the page







What percentage of adults own a smartphone? a) 56 b) 67 c) 78

What percentage of households use a virtual assistant? a) 22 b) 33 c) 44 What percentage of care home use electronic care records? a) 22 b) 33 c) 55





How many people are now signed up to use digital services through their GP practice a) Over 10 million b) Over 15 million c) Over 20 million What percentage of households own a digital tablet? a) 58 b) 68 c) 78


Wifi is crucial to technology enabled care, but what percentage of care homes do not have wifi: a) 10 b) 20 c) 30 In 2018, the wearable tech market was worth approximately how much? a) $23bn b) $54bn c) $76bn

Smartwatches in 2018 accounted for nearly what percentage of the overall wearables market a) 40% b) 50% c) 60% What are hearables?

a) Ear-worn devices that communicate health information to doctors b) E  ar-worn devices that translate languages c) An ear-worn device that combines a medical device with an entertainment system d) All of the above.

Answers: 1a; 2c; 3b; 4a; 5a; 6a; 7b; 8a; 9c; 10d

By when does the NHS commit to “Axe the Fax”? a) April 2020 b) December 2020 c) April 2021


40% OF STAFF TIME RELEASED PER NIGHT WITH ACOUSTIC MONITORING Courtney Thorne, the UKs leading designer and manufacturer of wireless nurse call systems, have been on the bleeding edge of technology for over 50 years. With their finger on the pulse of the industry and a constant desire to improve the efficiencies of care homes through technical prowess, they are proud to partner with outstanding tech provider – Ally Labs. Ally Labs ground breaking acoustic monitoring technology is available exclusively through Courtney Thorne.

Wireless Acoustic Night-Time Monitoring by Ally Labs A Care Home provider, who support 750 service users across 12 care homes wanted to understand if using Ally Smart Check-ins wireless acoustic monitoring solution could reduce the need for night-time staff to check their residents every 2-hours.

Removing the 2-hour checks has given my staff more time to be with higher dependency residents Care Home Manager

Residents Received Instant Care Improved staff responsiveness, rather than waiting for regular checks Ally Smart Check-ins acoustic monitoring was deployed in a 40-bed dementia nursing home. Having an acoustic monitor activated in a resident’s room meant staff were alerted when residents called for assistance, were restless, or up and active, allowing rapid response and appropriate care.

40% of Staff Time Saved Each Night Residents sleep better & have an improved quality of life during the day Before Ally Smart Check-ins, it was found that 20% of all regular night-time checks disturbed the resident to the point of being fully awake. With Ally, staff reduced the frequency of the 2-hour checks ensuring residents were woken up less often.


fewer 2-hour checks


fewer nightly disturbances

We have more time now and can leave the residents to sleep peacefully Night Shift Leader


of time saved per staff each night

For a free demo, please call Courtney Thorne: 0800 068 7914 and quote “CHM” Courtney Thorne | Nursecallsystems.co.uk Contact: info@c-t.co.uk

Ally Labs Ltd | https://www.allycares.com


HANDY HYGIENE TIPS FOR VISTORS A shared care home environment is a breeding ground for bacteria, which can lead to infection outbreaks.Visitors have an important part to play in keeping infections at bay, says Chris Brooks, Technical Product Manager at SC Johnson Professional



s a source of outside germs in care homes, visitors have a role to play in infection control: influenza and norovirus, common causes of outbreaks in care homes, can survive for between one to two days on surfaces and on people themselves, where MRSA can survive for several months. Research by the University of Arizona has shown that a virus placed on a doorknob could be picked up by 40-60% of visitors to a facility. So, what can be done to improve infection prevention and control? During the winter months it is crucial that a visitor policy is well implemented by staff and understood by those coming into the facility. During winter colds and flu circulate more widely, as people spend more time indoors, and in closer contact with people who may be ill. In individuals not taking supplementation, fewer hours of sunlight can also reduce vitamin D levels, weakening the immune system. Elderly residents, with inherently weaker immune systems, are often less able to fight off

infection effectively. In the elderly, complications of flu include pneumonia and bronchitis. Public Health England (PHE) advises the following: • Visitors with any symptoms of illness should be excluded from the home until fully recovered • If there is a flu risk, the home should be closed to visitors.Visitors should be informed in advance in order to reduce spread of infection among residents, staff and visitors alike • Visitor access should be restricted to symptomatic residents, ideally for 24 hours in the case of flu or 48 hours for a stomach upset. However, visitors cannot be forced to stay away (see panel, right).

TACKLING COMPLIANCE Human factors, such as intentional or unintentional non-compliance with handwashing policy, are a key reason for low hand hygiene in care homes. Individuals www.chmonline.co.uk


Visitor policy in detail

Prevention is better than the cure Hand hygiene compliance is the most effective way to prevent infection. PHE advises the following: • Handwashing should be encouraged in all visitors, by providing accessible sinks or, if not readily available, alternatives such as hand sanitisers • Hand sanitiser station installation should be subject to risk assessment, covering the use of alcohol-free sanitisers/portable pump packs in areas where risk of consumption may be high, and also the position of dispenser points • Visitors should clean hands on arrival and on leaving the resident’s room. Hand rubs and dispensers should be placed at bedsides for both staff and visitors • Staff and visitors should clean their hands before and after any contact with residents.

may need to be reminded of the correct handwashing technique, as recommended by the World Health Organisation, and supported by the My 5 Moments for Hand Hygiene campaign resources (see more information panel, far right). Posters and other information can be placed in high January/February 2020

By Quentin Steele, managing director, Aroma Care Solutions Public Health England defines an “outbreak” as an incident where two or more people have the same disease or similar symptoms and are linked in time or place or through a person; or when the observed number of cases exceeds the expected number at any given time. In some instances, however, only one case of an infectious disease may prompt the need for further infection control, for example, an itchy rash that could be scabies. Planning in advance is prudent. Every care home should have a written policy on prevention and control of infection. Each is also under a duty to report suspected outbreaks to the local Health Protection Team. There should also be a nominated Infection Control individual. Communicating your visitor policy on infection control in advance can help manage visitors’ expectations and make it easier to challenge visitors who look unwell. If there is an outbreak of diarrhoea and vomiting, managers should close the home to new admissions, transfers and hospital outpatient appointments. Visiting friends and relatives should be advised to stay away until 48 hours after residents’ symptoms stop – but crucially, they cannot be forced to stay away. PHE advises that visitors should be warned of the risks, and that they must report to a person in charge on arrival. Non-essential visits, even by healthcare professionals, should be limited, and special arrangements should be made for essential outpatient appointments or A&E visits to ensure other people are not unnecessarily exposed to germs.

If ‘flu is suspected, similar measures to restrict visitors may be necessary after taking advice from the health protection team. Any respiratory illness should be accompanied by a deep clean, twice a day in the case of respiratory illnesses. To keep risks to a minimum, fruit and other snack items should be covered, for example, in plastic boxes or stored in lockers. Difficult spills and stains, such as vomit or diarrhoea, on surfaces that cannot be treated by bleach, can be treated with a bio-enzyme cleaner. At the end of an outbreak, a deep clean should be carried out.

The winter months can prove a challenging period, but a combined approach to infection control - bringing together visitor policy, effective product and well-placed facilities - can have a positive impact on infection prevention traffic and other strategic positions around the care home to encourage compliance. The winter months can prove a challenging period, but a combined approach to infection control - bringing together visitor policy, effective product and well-placed facilities - can have a positive impact on infection prevention.

FOR MORE INFORMATION: My 5 Moments for Hand Hygiene (WHO) resources available [online] at: https://www. who.int/infection-prevention/campaigns/cleanhands/5moments/en/ Infection Prevention and Control: An Outbreak Information Pack for Care Homes [online] via the link: https://tinyurl.com/uef3tyq



What will I learn from this feature? How to maximise plant ‘power’ in interior design



Designing interiors for care homes involves a lot more than selecting an attractive colour palette and the most practical seating options. Joyce McLelland and Dana O’Donell, senior interior designers at Blueleaf, explain the potential of biophilic design in care homes


he design world has adopted the term biophilic design to communicate design that increases people’s connection to nature to the benefit of health and wellbeing - improving mood and social interaction in residents and staff, and encouraging independence, improved comfort and safety, and even reducing symptoms of stress and dementia, A key principle of biophilic design in care homes is to ‘bring the outside in’, specifically for those who are unable to go outside physically on a regular basis. True biophilic design goes beyond using natural colours or hanging pictures of flowers, and dotting a few plants here and there. Rather, biophilic design promotes a true connection between the exterior and 28 Care Home MANAGEMENT

interior, achieved through features such as full height windows, bi-fold doors and skylight windows. Natural light is important for human functioning: not just for activity, but also to reduce depression and fatigue and to regulate the human body clock. When access to natural light throughout the day is not possible, artificial lighting and design solutions come into play, specifically, ‘smart lighting’ solutions that simulate daylight patterns and the use of biophilic design elements.

Biophilic design promotes a true connection between the exterior and interior www.chmonline.co.uk


Biophilic design elements To add colour to walls and calm the atmosphere, this Wallsauce mural is rich with flowers and features a mood-boosting blue sky with stunning summer sun. The layered landscape design almost tricks the eye to extend the room. Introduce some real or fake plants in pots nearby for a textural element

Plants/vegetation - Introducing greenery establishes a direct relationship between residents and nature, promoting physical and mental health, performance, and productivity. Risk assessment should cover the dangers associated with residents eating the soil or proximity to a water feature. Animals - Aquariums, animal feeders, animal therapy sessions, as well as robotic pets, can promote interest, mental stimulation, and pleasure among residents. Paintings – Paintings, photos, sculptures and murals can all be used. Colours - Natural colours or “earth-tones” - brown, green, and blue – promote a sense of calm and reduce distractions.

Old-fashioned sweet shops, grocer and barber shops were handpainted onto a basement corridor wall to create a vibrant space and encourage reminiscence. By Joanna Perry Murals

Did you know?

African sunset lounge, blossom lounge, and jungle palm entrance murals give inspiring views and images of outdoors. By Joanna Perry Murals

January/February 2020

Hand-painted murals from Joanna Perry can become a feature in lounges, corridors, dining rooms, entrance halls and, even, residents’ kitchens

Biophilic design originated from Biophilia Hypothesis, which is the idea that humans possess an innate tendency to seek connections with nature and other forms of life. The term biophilia was used by Germanborn American psychoanalyst Erich Fromm in the Anatomy of Human Destructiveness (1973), which described biophilia as “the passionate love of life and of all that is alive.” The term was later used by American biologist Edward O.Wilson in his work, Biophilia (1984), which proposed that the tendency of humans to focus on and to affiliate with nature and other life forms has, in part, a genetic basis.




HEARING LOSS Is your home merely accessible or inclusive to people with hearing loss? Find out which you are, from Andrew Thomas, chair of the International Hearing Loop Manufacturers Association (IHLMA)


earing loss may be a ‘hidden’ disability but with an ageing population, its prevalence in care homes is growing. By 2032 almost 80 per cent of people in residential care in England could have some form of hearing loss. Inability to hear clearly can contribute to feelings of isolation, depression and even a need for greater care. Someone who was previously very sociable may suddenly decline invitations to go out; they may be reluctant to answer the phone, and a love of the theatre or music may vanish. People may come to a care setting with a recognised hearing loss but there will be some who are either not aware of, or don’t want to admit to, a hearing impairment. Initial indicators could be asking for things to be repeated, a reluctance to take part in group

activities or withdrawing to their room, or low mood. It’s important to identify hearing loss because it could be mistaken for cognitive decline. And behavioural changes can happen even if the person wears a hearing aid: hearing aids amplify all sound, meaning the sounds a person wants to hear must compete with unwanted background noise. This assault on the senses can be overwhelming and frustrating. In family members with hearing loss, there could be reluctance to engage in conversations with staff because of a difficulty hearing what’s being said.

A care home’s obligations

Under the Equalities Act 2010 all people should be treated equally. In a care home this requires

providers to make changes, where needed, to improve services for disabled customers. The Act also requires “reasonable” adjustments to be made and legally obliges homes to “provide auxiliary aids and services” which can include hearing loops. “Reasonable” is not clearly defined and will depend on the size of the home and the relative costs involved – so what may be “reasonable” in an 80+ bed home will be different to what’s expected of a 10-bed home. Furnishings that absorb noise such as carpets, curtains and soft tablecloths all help to make interactions more comfortable for people with hearing loss, preventing sound bouncing off hard surfaces and allowing speech to be more clearly identified.

“Inclusive” or “accessible”? British Standards Institute BS8300 guidelines govern the design of buildings to meet the needs of disabled people. Updated in January 2018, the guidelines detail how to create an “inclusive” rather than an “accessible” environment. This means the needs of someone with a disability should be met within a general space and not set apart in a separate area. For the first time, the guidelines also contain detailed guidance for meeting the needs of people with hearing loss.

The role of hearing loops

In a noisy care home environment, hearing aids may cause residents to become frustrated and irritable


Rather than making all sound in a room louder, loops amplify the sound a person wants to hear. They convert speech, music or the television through a specially positioned microphone into a magnetic signal. This is transmitted by a loop aerial and is picked up by the telecoil in a wearer’s hearing aid and is converted back to speech. The guidelines give clear examples of settings where loops should be used such as communal rooms where homes might hold entertainment. A large area loop around its www.chmonline.co.uk


perimeter plus a microphone for the activity leader means that by switching their hearing aid to the ‘T’ or telecoil position, residents with hearing loss can clearly hear the words to the songs and join in, the number called in bingo or the next movement required by the fitness instructor. Full compliance with the guidelines would also see homes installing loops in residents’ rooms so they can watch television comfortably and at a volume that doesn’t disturb their immediate neighbours. Sound is relayed to their hearing device via a small loop pad placed under a seat or via a cable installed around the edge of the room. Portable loops with a built-in microphone are an option for one-to-one conversations and allow staff to greet people at reception or chat to an individual while they enjoy lunch in the dining room. Installing loops can even benefit those who don’t have or don’t want to wear hearing aids. Portable listening devices allow residents to ‘tune in’ to the sound they want to hear through standard headphones.

The benefits of good acoustics By Andrea Harman, concept developer healthcare – at Ecophon Moving to environments with stronger acoustic performance can have benefits for residents and staff. One study of intensive coronary care found the number of chest pain patients in need of extra intravenous beta blockers was reduced by 67 per cent by changing the sound-reflecting ceiling to a Class A sound-absorbing ceiling. In other research, a sleep disruption study found that changing ceiling tiles from plaster to class A sound-absorbing tiles reduced waking by 40 per cent. For staff, when dealing with complex tasks, performance is approximately 50 per cent less accurate in noisy environments. In quieter environments, staff are also

more able to communicate without shouting, which helps them appear calmer and, possibly, more ‘helpful’. All building materials have some acoustic properties in the way they will absorb, reflect or transmit sound. Sound absorption is classified on a scale between A-E; generally speaking, care homes would benefit from installing more class A solutions. In addition, acoustic solutions in care homes should be easily cleanable, ideally withstanding steam cleaning, and be resistant to mould and bacteria growth. When looking for tile or ceiling panels it is important to look for products that have low volatile organic compounds (VOC) to improve indoor-air quality, and which are aesthetically pleasing. Some products can even be supplied as artwork.

The business case for loops The NHS Action Plan on Hearing Loss 2015 estimates that by 2032 almost 500,000 people living in care homes will be affected by hearing loss. Installing hearing loops can give a home a marketing ‘edge’ as well as support with regulatory compliance, as it suggests a commitment to dignified care – personal issues can be discussed with staff and healthcare professionals at a normal volume and without unnecessary repetition. Installation can be part of a refurbishment or when designing a purpose-built home.

Loops can be laid underneath existing flooring

MORE INFORMATION: British Standards Institute BS8300 are available [online] at: https://www.contacta.co.uk/ hearing-loop-hub/hearing-loops-legislation/ NHS Action Plan on Hearing Loss 2015 is available online at: https://tinyurl.com/hw2uucw

January/February 2020





What makes your workwear ‘green’? Sarah Herbert, head of marketing at uniform supplier Meltemi, explains how to improve the sustainability of your workwear What will I learn from this feature? How to reduce the environmental footprint of your workwear Durability: Care work is often quite manual. To reduce repairs and replacement of worn clothing, it’s important that the uniforms are fit for purpose. A good uniform is one that fits well and allows for ease of movement. The fabric used should be washable at 85 degrees for infection control and should be of sufficiently high quality to retain a professional appearance for a minimum of two years. Choice of fabric weight is important too. Care homes are, by nature, warm places. Lightweight poly cotton fabrics can be nearly 25 per cent lighter in weight than standard tunic fabrics, and will help staff to keep cool, while still offering the same durability. Quality production standards: Ask your supplier to present evidence that its fabrics meet European standards for durability, abrasion and colour fastness as well as resistance to snagging and pilling. Fastenings, for example zips and studs, should be guaranteed as meeting the garment’s use requirements. It is helpful if you can find a supplier who has complete control over their quality standards: this may mean that they own their manufacturing facilities and can demonstrate regular and, ideally, independent quality audit. A reputable supplier will also be able to detail customer return information, resulting from garment quality problems. Green credentials: Of course, quality, service and price are all key factors when choosing a uniform supplier but how ‘green’ are their operating credentials? In the main healthcare garments tend not to be manufactured in the UK, due to high labour costs. A good supplier will know where their garments are made and should be able to 32 Care Home MANAGEMENT



demonstrate that working conditions in its manufacturing plants reflect the best practice in the local environment. Manufacturers can join the Ethical Trading Initiative (ETI), which has a code of practice setting out how staff are treated, paid a living wage, given working hours that are not excessive and that working conditions are safe and hygienic. For further reassurance that your chosen supplier is committed to ethical and sustainable trading look out for accreditation (ideally, level four) under the Labour Standards Assurance Scheme (LSAS) which is a requirement when supplying to the NHS. This is evidence that the organisation is focused on reducing the risk of undetected or unresolved child labour standard abuses within their supply chain. It is also evidence that the organisation is audited on an annual basis to ensure on-going compliance. Respecting and supporting the communities within their supply chain also involves monitoring and improving the supply chain’s environmental impact. Most UK uniform

companies will be compliant with the ISO14001 environmental standard so ask to see their environmental policy and explain their environmental processes to mitigate their impact on the environment and improve sustainability. Supply partner compatibility: Finally, to save wasted time, money and resources on an unsuitable supplier it is important to choose a partner with the capacity to meet your project requirements. Your supply partner should have the right level of account management for your project, particularly if it is a large standardisation or ‘roll out’, requiring careful planning and implementation to meet the agreed time frame. Bear in mind that non-standard garments, for example, bespoke garments, special sizes or cultural requirements are likely to have an extended lead-time compared to standard, stocked garments. It’s advisable to ask your proposed supplier to show you case studies of other projects of a similar specification, and to take

references from the customers involved. Whatever their size, a good supplier will have a robust quality management process in place. They should be straight forward and committed to delivering proactive customer service, with a culture of continuous improvement. They should be honest and transparent. Ideally, your partner will have a business continuity plan in place to ensure that their business and services can be sustained in the event of a disaster.

About Meltemi Meltemi is a key provider of garments to the NHS, residential care homes, private healthcare and GP surgeries across the UK, designing, manufacturing and supplying uniforms for staff in all types of roles. Our aim is to make the supply of high-quality uniforms straightforward, transparent and easy to manage. Web: www.meltemi.co.uk Email: customersupport@Meltemi.co.uk Telephone: 01603 731330



85 Washable at 85° for infection control

www.meltemi.co.uk • 01603 731330 • sales@meltemi.co.uk

January/February 2020

An extended range of colours and fabrics with options for male and female wearers to help create identity across the team

Approved Supplier LSAS Level 4




Put your feet up with a cuppa while you enjoy these bits and pieces from the care home world




Aliyyah-Begum Nasser shares the ups and downs of her life as a director at rehabilitation and care community Askham Village Community ‘Tis the season to be jolly... Isn’t it? And with over a hundred families trusting us with caring for their loved ones it’s quite the responsibility to keep our jolly levels high. In my experience, jolly residents require jolly staff. But as we all know, our industry economics means that Christmas time can often simply serve to put added strain on staff as they feel the pinch on their finances. We look to minimise the stresses on our staff who diligently work the bank holidays at least every other year – and one way we can do that is through staff loans. By helping to ensure our carers’ families have a good Christmas it sure does strengthen staff willingness to work the NYE night shift! And, of course, increase the overall level of jolly-ness! In more scrooge-like fashion though, we do have a policy – like many care homes – that staff are not allowed to take annual leave over the holiday period.What could be more bah-humbug than this? As if care staff need another reason to re-think their career choices! And yet, every year, I am blown away by how few groans and moans there are on the floor, how many genuine smiles I see, and the willingness of the staff to ensure that residents have the most festive, fun-filled, fantastic time ever. One of our kitchen assistants always hosts her grandchildren at hers after serving turkey up to all the home’s residents. It’s an annual tradition and she hasn’t missed a Christmas in over a decade.Truly, the staff and the residents together enjoy one big family Christmas.


WIN a bottle of fizz!

ACROSS 3 The final element in outstanding leadership 5 Partner that runs the Care Home Management legal helpline 8 Care Home Awards will be presented in which Royal hotel? 10 Outstanding care home Riverview is based where? 12 Biophilic design can be said to harness ________ power 14 Charity that offers Human Rights end of life care training 15 A common infection in care homes during winter 16 A cause of sudden death in care homes 17 The third step in rolling out digital care management 18 Name of the new chief executive of Skills for Care 20 CMA stands for ____________ and Markets Authority

DOWN 1 Surname of our post-election pundit 2 Name of a media training partner specialising in care homes 4 Surname of researcher in Dementia Care Mapping 6 Key subject of the uniforms feature on page 32 7 Featured company in the uniforms feature 9 Author company of p24 article on data storage 11 What can be installed to aid residents with hearing loss? 13 Surname of WCS chief executive Christine 19 See you at the Residential and Home Care Show in which month? HOW TO ENTER: To enter the January Care Home Management crossword, simply cut out or scan your completed crossword, and send by post or email to the editor at Care Home Management (details on page 3) by January 31, 2020. The winner will be the first correct entry drawn. Name: ……………………………………………………… Care Home name & address:…………………………… ………………………………………………………………… ………………………………………………………………… To receive the free CHM weekly newsletter, please provide your email address: …………………………………………………

Terms and conditions The winner will be the first correct entry by a care home operator, manager, provider or director drawn by the Care Home Management editorial team after the closing date stated above. No alternative prize is available and the editor’s decision is final. No correspondence will be entered into. Employees and agents of Care Home Management are not eligible to enter.




Care home movers and shakers

Joining the Board at Somerset Care are nonexecutive directors Emma Glynn (left) and Professor Elizabeth Robb OBE following the resignation of Roger Davies after three years of service. Glynn is a chartered surveyor and director at property consultancy, JLL. Professor Robb is a midwife. Administrators have merged the management teams for the troubled Four Seasons and brighterkind branded businesses to create a single care home business. Current brighterkind CEO Jeremy Richardson has been appointed as the CEO of the unified care home business, with immediate effect. Other group company, the Huntercombe Group, continues to operate under its existing management team and support structure. Brendan Kelly has been promoted by the Chesterfield-based Heathcotes Group to the role of group managing director. Kelly has worked in the Heathcotes Group since 2009 as regional director. Complex care provider Exemplar Health Care has appointed a commissioning home director in three new care homes: Sharon Burton (right, top) at the newly opened Copperfields in Leeds, Denise Hampson at Ribble View in Preston and Kath Dye (right, bottom) at St Andrew’s Court in Hull. Burton’s previous experience includes: the Royal Hospital for Neuro-Disability, BMI Healthcare and BUPA; Dye from Barchester Healthcare and The Huntercombe Group and Hampson from Bury Social Services and the Pennine Acute Trust. Stocks Hall Nursing & Care Group has appointed Przemyslaw Pakowski as the new manager of Stocks Hall Andrew Smith House, a 60-bed nursing & care home in Nelson, Lancashire. Joining Home Meadow care home in Toft near Cambridge is Laura Adams. Adams began her career in care as a care assistant 15 years ago. Canford Healthcare has appointed Anne Trigg RMN as manager of Hampton Care Home.Trigg has previously held senior management posts in operators including Caring Homes and Royal British Legion, and is a registered mental health nurse. Supporting her and the team is the recently promoted Mobin Jacob Philip, the home’s former clinical lead. Ann Poulton has joined Balhousie Forth View care home as manager. Poulton was previously a director of nursing in the middle East.

January/February 2020

Business partners

Oonagh Smyth has been appointed as the new chief executive of Skills for Care. Smyth is currently executive director of strategy and influence in Mencap. The incoming CEO is also a co-chair of the Care and Support Alliance, a cross-sector alliance of 80 social care organisations influencing at the highest government levels.


JANUARY Care Inspectorate Wales half-day provider events on the following dates and locations: • 16 January 2020 – North Wales • 24 January 2020 – South West Wales • 28 January 2020 – South East Wales. Providers will be emailed shortly with further information. Safety in Care Open Day. Care Campaign for the Vulnerable. 12-3pm Wednesday 29 January. Crowne Plaza Hotel, Gerrard’s Cross, Buckinghamshire.To book a free place email ccftv.cares@gmail.com

FEBRUARY The future for NICE in health and social care. Westminster Health Forum policy conference.Thursday 6 February. 9am - 1pm. Cost: £230 plus VAT. Book via the link: https://tinyurl.com/rv8h2an Nursing and Midwifery First. Royal College of Nursing event. Friday 7 February. £15 Royal College of Nursing, London,W1G 0RN. For more information, visit the event link: https://tinyurl.com/yx42p589 Improving End of Life Care for People with Dementia. Friday 14 February De Vere West One Conference Centre, London. Cost: £365. For further information and to book your place visit via the link: https://tinyurl.com/y52hyrq7 or email kerry@hc-uk.org.uk Breaking down the barriers. LGBTQ+ equalities. Tuesday 25 February. Royal College of Nursing, London,W1G 0RN. For more information, visit: https://tinyurl.com/szzkfpq Pain in Older People Workshop. Royal College of Nursing Pain and Palliative Care Forum and the RCN Older Persons Forum Wednesday 26 February 10:30am-3pm. RCN London,W1G 0RN. For more information, visit via the link: https://tinyurl.com/yxmmqua7

MARCH Breaking down barriers: gender equality. Tuesday 3 March, Royal College of Nursing, London,W1G 0RN. For more information, visit: https://tinyurl.com/ryelyuo Meeting expectations with digital telecare – London. Appello sponsored event.Thursday 5 March, Kia Oval, London. For more information, visit: https://appello.co.uk/events/ Dementia, Care & Nursing Home Expo. NEC Birmingham. Tuesday-Wednesday-17-18 March. See Care Home Management on Stand D474. Register for your free tickets [online] at: www.carehomeexpo.co.uk


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Care Home Management magazine January 2020  

The January issue of Care Home Management magazine contains new features in research and in tech, as well as a new coffee time page. This is...

Care Home Management magazine January 2020  

The January issue of Care Home Management magazine contains new features in research and in tech, as well as a new coffee time page. This is...

Profile for chmonline