‘In Our Own Words’ – What makes the Manager of an ‘Outstanding’ residential care home?

residentialforum:

Right now, less than 1% of the residential care homes for older people in England have an ‘Outstanding’ CQC rating. In the last couple of years there has been an increasing focus on what it takes to achieve this coveted rating.

Article Consulting Ltd, working with our partners at The Judgement Index, undertook ground breaking research to try and understand more about the Managers whose homes have achieved an Outstanding CQC rating. Who are they? What do they do that is different to other managers? What is it about them as leaders that despite the challenges they face, their care home has achieved the highly coveted ‘Outstanding’ CQC rating? We wanted to know! We thought others would want to know, so we thought the best way to find out was to ask them!

The ‘In our own Words’ report provides a unique insight into what makes the Managers of CQC rated ‘Outstanding’ care home.

We hope that the report contributes positively to the current debate about the critical importance of the Manager’s role in social care, encourages provider organisations to invest in their Managers and informs the future recruitment of Managers.

The ‘In Our Own Words’ report is available to download from Article Consulting’s website www.articleconsulting.co.uk

Call for views on the purchasing of care home services

Scotland Excel is seeking views on how Scotland currently purchases
care home services for older people and how it should do this in the
future.  

We are asking people who use services, organisations who represent
service users, carers, providers, health and social care partnerships
and councils, to tell us what they think.

Julie Welsh, Director of Scotland Excel explained: “Care homes are a
vital part of care services for older people and as the national centre
of procurement expertise for councils we are keen to do all we can to
support social care reform.  The procurement strategy for care homes for
older people needs to include everyone’s views on how best to do this.”

The strategy and survey are available until close of play on the 10th July 2017.

Registered Managers’ Membership Forum

Registered Managers are commonly the lead professionals in care home and
home care services, with wide-ranging and demanding responsibilities.
They have a pivotal leadership role and play a central part in ensuring
that people who use services experience high quality care and support.

Through
registered manager membership, we can help you make even more of a
difference and achieve the recognition you deserve. As part of this, you
have access to the Registered Managers’ LinkedIn forum, restricted to
members.

https://www.linkedin.com/groups/5144121

Get real about integration!

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Sharon Blackburn, the Policy and Communications Director of
the National Care Forum, gives a care sector perspective on the realities of
integration

There is nothing new about integration. It has long
been spoken about and many attempts have been made over many years to make it a
reality. People who use services, the public, generally assume it happens –
that is until they need to access or use a service. I believe many of us, if we
haven’t already, have stood where the people we serve stand. Working within
health and social care does not make you immune from responsibilities for your
own or loved one’s health and care needs.

I have had the opportunity as part of my Florence
Nightingale Leadership scholarship to look at integration more closely. There
is no shortage of writing about what should be happening, yet if it were so
simple, surely it should be much more of our everyday experience and reality? I
really believe that integration at its best is when two or more people from
different parts of the system are working with an individual or group of people
and agree what needs to be done; and it is done.

Talk to
each other

People who use services, that is you and me, not
them, have reasonable expectations that staff from different sectors talk to
each other and plan and coordinate care in a way that is in their best
interests. Whilst there are numerous examples of where this is happening, it
sadly doesn’t happen often enough and consistently enough.

The NHS England New Models of Care – Enhanced Healthcare in Care
Homes
have significantly contributed to the excellent
work already taking place. Great clinical outcomes have been reported but one
of the richest outcomes is that people from different parts of the system are
talking to each other; understanding each other and creating solutions
together, including those who use services.

I’ve had numerous conversations across the devolved
administrations. No one disagrees with my fundamental belief regarding
integration. As you read this you may be saying but we need new structures;
possibly legislation, pooled budgets, leadership, organisations to change their
cultures, the list could go on. The answer would be a resounding yes to all of
this. However, people are at the heart of what we do. Relationships are key to
positive change. In relationships, we need trust and a willingness to question
and learn from each other thereby exploring what we don’t know. I am a huge
advocate of being the change we want to see.

Our behaviours lead to unintended consequences,
because we don’t know what we don’t know. For instance, the different
environments, each with varied stresses and strains, that the parties to
integration work in. If we could start to recognise and constructively help
each other about practice, the ways in which we communicate and the use of
language across different settings, then positive changes can be made enabling
us to learn together and behave in a better way.

Leading Change, Adding Value, a framework for
nursing, midwifery and care staff
, enables
all nursing, midwifery and care staff to be that change. To change the
narrative of how we communicate with each other and the people who use
services. This excerpt from the framework gets to the heart of what we need to achieve
not just for the people we serve, but for us:

To repeat: we do need new structures, possibly
legislation, pooled budgets, leadership and organisations to change their
cultures. However, if we do not talk to each other, learn to trust each other
and learn from and with each other, all the above will not achieve the desired
outcomes of integration.

Deprivation of Liberty

There is nothing about living in a care home or supported accommodation which gives authority to deprive people of their liberty. But what does this mean in practice for frontline practitioners and managers?

Well…“Care providers don’t have to  be experts about what is and is not a
deprivation of liberty. They just need to know when a person might be
deprived of their liberty and take action.”

Find out more by looking at what doctors and lawyers say:

https://www.bma.org.uk/advice/employment/ethics/mental-capacity/deprivation-of-liberty-safeguards/deprivation-of-liberty-in-care-homes

Or see chapter 6 of http://www.lawsociety.org.uk/support-services/advice/articles/deprivation-of-liberty/

Post the Residential Forum about action you have been able to take in your care home to make sure people are not deprived of their liberty or to get proper authorisation to keep people safe.

ICHA Commissioning Handbook 2016

residentialforum:



The Independent Children’s Homes Association handbook includes
messages from the CEO and Chairperson plus the code of practice and
mission statement along with a full directory of members in England and
Wales. CONTACT: email admin@icha.org.uk or telephone 07794 779893

ICHA Commissioning Handbook 2016

The office

image

John Burton,
who has managed a variety of care homes, looks at the only part of a children’s
home that isn’t therapeutic. Noting that most of our own homes don’t have an
office but “residential homes” generally do, he asks: why?

At one level, it’s fair enough: we must keep money and other
valuables, medicine and confidential records somewhere safe and secure. After
all, you don’t keep your cleaning chemicals in a locked COSHH cupboard at home,
but you do have to in a children’s home.
If the use of the office was restricted to the absolute essentials, it
wouldn’t be the problem that it often is.

The problem with the office in a children’s home is that it can
very quickly become the centre of the home and the trouble-spot – the location
of argument and incident. It’s the one room in a home that isn’t therapeutic.

Many children’s homes now claim to be “therapeutic”. Some are and
some aren’t. The therapy we are talking about is contained in the good
experience of living together and relationships with grown-ups who really do
care about you. So, cooking, food and mealtimes, getting up and going to bed,
watching TV and playing games, going off to school and being welcomed home,
gardening and enjoying outdoors, talking together and just being together,
being happy and sad, coping with pain, anger, envy, resentment, disappointment,
emptiness and loss, and so on … this is the therapy of a children’s home.
Just as being a good parent to one’s own children is very demanding, so being a
reliable and loving grown-up to the children of parents who have usually – and
for whatever reason – failed their children can be even more demanding.

In making a restorative and healing relationships with children,
therapeutic residential workers are giving children the chance to be
emotionally held and supported, to heal and make attachments, to grow and take
charge of their lives. Such work takes place in the kitchen, sitting room and
garden, in their bedrooms and bathrooms, in the hall and on the stairs, out
shopping or walking in the park together. While the work must be planned and
structured, much of it is done by simply being with the children and, when you
are not with the children, by holding the child in mind.

Diversionary
delinquency

Even in a really good home, it’s common to find staff in the
office when the children are around. If the staff are in the office, the
children are likely either to want to be in there with them or, finding
themselves at a loose end and unconnected with staff, they may stray into
harming themselves with all manner of diversionary delinquency. 

The office should not be a staff room, a bolt-hole, or a fortress.
It’s not somewhere to get away from the children but that is how it’s used. The
excuses range from having to write up records (including the blasted “log book”
every five minutes), answering the phone, dealing with money/petty cash,
checking the rota, doing the handover, making appointments, talking to “head
office” … the list is endless. But, let’s face it, somewhere deep down
underneath it all, in the murky depths of our unconscious defences, is simply
getting away from the children.

Therapeutic work doesn’t really get going until there’s a
therapeutic structure to work within. There are times when it’s OK to get the
office work done but much of what is done in the office now should be done
elsewhere. Take handovers for example. Why would you hold such a potentially
richly therapeutic meeting away from the children? They should be involved.
It’s not uncommon for staff to be locked in the office having a handover, while
the children are peering in the window or banging on the door. If you must get
petty cash for travel or whatever, sort it out before the children get up and
have it ready for them. One of the most predictable sources of unproductive and
harmful incidents is children being in the office and picking up keys, phones
etc. I’ve known homes where eggs have been kept in the office because they’ve
been thrown around. That seems like a total abandonment of therapeutic
principles and aspiration.

Outside expectations and demands don’t help. If your external
managers, or social workers, or inspectors think that you should be in the
office whenever they call, they are adding to and reinforcing your own
avoidance of the children’s needs and the therapeutic task. As always, the
misuse of the office is a whole system issue and outsiders need to reflect on
the part that they play in it.

Reflect on this and ask yourselves:

·       
How is the
office used in your children’s home?

·        Where do you hold your handover meetings and are the residents involved?

·       
What views do
the children have about staff being in the office?

Post your thoughts to share with Forum members

Where is the customer in residential care services?

residentialforum:

Des Kelly OBE, Trustee of the Residential
Forum, reflects on a workshop that asked whether the residential care market
was a myth or reality.  He shares the
flavour of contributions and concludes that the customer can easily get
overlooked in the worlds of regulation, commissioning and procurement.

I
admit I wasn’t sure that ‘Residential care market – myth or reality?’ Would be
a theme to generate the sort of lively discussion we are used to at Residential
Forum workshops. But it turned out my doubts were completely unfounded and the
debate was a stimulating as ever!

The
event held on 4 and 5 May 2017 started with presentations from John Kennedy
(The Residential Forum), Margaret Flynn (NISB Wales) and Jonathan Stanley (NCERCC).
Their combined input proved to be more than sufficient to spark the engagement
of the attendees at the workshop.

There
was universal agreement that efforts to create a market for residential care
services – whether for older people, adults or children or young people – had
not been successful. Whilst splitting commissioning from providing had
introduced competition and stimulated new providers, especially in the
independent sector, the result has been something of an imperfect market which arguably
does not operate in the interests of consumers. The market for residential care
services has always been a monopsony as the local authorities have, and
continue to be, the main purchaser of services.

The
mechanisms that generally monitor and control the entry and exit from the
market don’t work in the same way in the care sector. Local authorities
effectively set and maintain the price paid for the service. In addition, there
is no financial regulator for the care sector either at local or national
level. There has been little consumer legislation to protect people receiving
residential care and the levers of control remain rather limited. If any
thought is given to the issue at all it is assumed that the inspection process
will pick up any shortfalls.

Margaret
Flynn argued in her presentation, drawing on a major review of provision and
challenges in Wales, that when safeguarding concerns are overlaid on
residential care it highlights the cracks in the system. She suggested that the
evidence required to close care homes is such that few are actually pursued to
closure with operators exiting the market by other means.

Jonathan
Stanley suggested that residential child care is a socially constructed sector
made up of a series of markets. He felt that there is no real commissioning
only procurement. As price is always the dominant factor and social value
rarely seems to feature. Furthermore, there is little sector development and
limited innovation. The introduction of competition per se was regarded as a
good thing for residential care according to John Kennedy. However, shaping and
managing the market had proved difficult for local authorities and consequently
the outcomes were uneven which has had an impact on supply, choice and quality.

Who
is the customer?

All presenters highlighted the
dominance of price and the lack of meaningful commissioning. The absence of
consumer power in residential care was considered an indication there is not a
true market. Neither choice nor control are sufficiently well-developed. In
fact, agreeing who is the customer in relation to residential care services is
not always straightforward. This compounds the power imbalance that exists.

An
effective market may depend on the user and the purchaser being the same
person. That would certainly make being an informed consumer more meaningful.
Without a system of consumer- directed influence over residential care, caused
by the dominance of local authorities as the major purchaser, market shaping
and market management has rarely been developed in an effective way. Issues of
consumer power and control are important. So too, the purpose of residential
care services and the availability of alternative forms of community support
services. A market model implies the ability to exercise choice together with a
knowledge of alternatives.

The
workshop groups explored a range of factors including the role of regulation,
workforce issues, finding, information and marketing. Two key themes emerged:
the need to drive consumer sovereignty and the need for greater leadership for
the residential care sector. Both aspects are vital to create a responsive and
flexible ‘market’ of provision. Some participants felt that licensing providers
and regulating commissioning would be beneficial. The need for citizen-led
approaches was advocated in which residential care facilities might be regarded
as community assets – now that would amount to innovation!

The
Residential Forum is keenly interested to hear from you – as customers, workers
and stakeholders – how care homes can be a positive choice within the social
care ‘market’. Any suggestions then do click on: submit a post

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