Time for CQC to recommence the inspection process

At the beginning of the Covid-19 Crisis the Care Quality Commission, the English health and social care regulator ceased undertaking all but essential inspections, to maintain the safety of both the public and their own staff.

They instead established a system known as “The Emergency Support Framework”. This was a way in which they could keep in contact with health care providers across England. The focus remained on the five standards used to monitor health care in England: Caring, Safe, Effective, Responsive, and Well Lead.

Despite the emergency support framework telephone calls being documented and a summary being circulated, the evidence gained was not used to re-evaluate grades or allow action to be taken. As well as gathering information from outside sources and from statutory reporting alongside the emergency support framework calls, it seems the inspection process has stopped.

Only where serious concerns were identified was an inspection considered. We believe the inspection process now needs to start again in earnest. As time goes on and no inspections take place the issues care providers face exacerbate day by day. We fully understand that every provider whether they be rated Outstanding or Inadequate, have gone through a period of enormous pressure managing all the various issues surrounding the Covid-19 Crisis, but there is now a need to focus on inspection.

This may be a strange concept for some to grasp, but it is important to understand the picture faced by some care providers. There are several care providers who have suffered high numbers of deaths during the recent crisis. They have come under criticism from the media when the situation was in some instances out of their control. They will need to demonstrate that all standards are being met. A regulatory review of services will give the public reassurance.

The homes however that really do need urgent inspection are those that before lockdown were rated inadequate. The team at Swift Management Services Limited undertake support of care homes who need to improve following an inadequate rating and where enforcement action has been taken or is likely to be taken. Looking at one of our client’s stories may illustrate the situation:

We started working with one of our clients in late October 2019 when they had received their second inadequate inspection report. Since our engagement we have worked with the provider and supported them through a change process. We have provided regular updates for both the local authority and CQC. The improvements are clear to see. Under CQC guidelines a home rated inadequate should be inspected within six months. We contacted CQC to ask that the inspection be brought forward. The inspector advised that they had planned an imminent review, and would be within the six- month timeframe. This meant that our client only had a few weeks to wait. Then lockdown happened and the inspection process did not take place.

The home has been left for an additional three months without an inspection. Given the last inspection was the second inadequate inspection, should they be allowed to operate for a further nine plus months if the care was not safe without enforcement action being taken? Fortunately, this is not the case for our client. We are pleased to say our client has move on substantially, the care they provide is of a high standard and this can be evidenced. The difficulty they have is their published rating shows as inadequate. This is preventing them from admitting to the home, as the CQC ratings are very much taken into consideration by both local authorities and private clients alike.

If they are to continue to improve, they need the support of the regulator to review their grades which will allow them to admit new clients.

Any home that is rated as inadequate faces extreme financial hardship, as admission levels fall and costs of improvements increase, with no way of servicing the expenditure over an extended period. This uncertainty influences both the provider and the staff. There is uncertainty all around. Thankfully in our client’s case, the Swift Management Team, have been there to support them, and both the management and the staff appreciate our support, advice, and encouragement. They say that our team are part of the family, but that they are not receiving the recognition they need to take their business forward. They need a regulatory visit to review their grades.

Once the inspection happens, we will await with interest the grade they are given. In many cases a home will move from inadequate to requires improvement as the provider needs to demonstrate a sustained improvement. Given the delay in inspection we will be watching with interest as the sustained improvements can be evidenced to the regulator, through our regular submission of audits, feedback and record keeping.

Whilst we have only mentioned one specific client in this article, they are not the only client we have in the same position. We therefore welcome the inspection process starting again in earnest.

To find our more email: info@swiftmangement.org.uk Or visit our website at www.swiftmangement.org.uk

Care Home Engagement Surveys can help more than you think!

How Prepared are you for Covid

As the lockdown eases, the care home industry will be looking forward to returning to normal. Engagement Surveys can help this process in a number of ways.

There will have been lessons learned in so many aspects of care home life during the lockdown and it is a real opportunity to demonstrate that the provider has good levels of governance in place and lessons have been learned and acted upon for the future.

Another aspect of Engagement Surveys from an external provider can be the validation of the services you provide to both the public and the regulators.

Many care home providers who were expecting the regulators to call, due to inadequate rating being awarded within the last six months, will have worked extremely hard to make service improvements. Given that the regulators are not maintaining their usual inspection regime, if an inadequate rated home has complied with the notice of decision issued by the regulator, they are unlikely to have had a revisit. This will impact on the published rating and this is likely to impact on referrals.

Using engagement survey results to demonstrate satisfaction and service improvement can be an invaluable way to demonstrate a responsive and well-led service. The results can be published on your website to counterbalance a regulatory report or indeed confirm a great report.

Swift Management Services offer both Resident and Relative and Employee engagement surveys and the subsequent report to the provider is anonymised, the data is benchmarked year on year and can be benchmarked against industry standards. We provide templates for actions from surveys. Our team can further assist with advice to complete action plans and keep your teams informed if required.

Our engagement surveys can be digital, or paper-based, and all reports are presented in an easy to understand PDF document which is easily adapted for use on your own web pages or printed as required.

We are able to offer “Off the Shelf” surveys and we are also able to provide bespoke surveys as required.

Many Care Home Providers use internal staff and resident surveys and may consider an external survey as an extravagance, this is most certainly not the case. We have found staff to be more open and truthful in an external survey as the anonymity aspect gives more confidence.

The public and the regulators take more comfort from a survey that has been managed externally as the results are collated externally from the company.

The results are presented in an easy to understand format which enables the participants and the readers to see that comments have been taken on-board and action if required has or is being taken. An external engagement survey can be a really valuable tool for any care home operator.

As a provider there is a need to be constantly monitoring and building your business, our engagement packages gives you the reassurance that your business is moving in the right direction and there are no surprises around the corner.

To find our more email: info@swiftmangement.org.uk

Or visit our website at www.swiftmangement.org.uk

Technology changed the way we work and just in time for the lockdown

As a company built on the expertise of Nurses and Care Professionals, we are all about the people we work with. The care industry until recently has been less than up to date with the digital age. Both these factors meant that the Swift Management Team preferred to hold face to face meetings, use direct marketing and work on paper based systems.

When I say this, I do not mean we were total technophobe’s we did use technology, but we certainly did not use technology as fully as we could have.

In early January we started discussions with our web design company Vikinguru Interactive, looking at ways in which we could improve our website, and increase its usefulness. As part of these discussions, we decided to change our email hosting and servers all at the same time. Although the advice was excellent, for a group of people who talk to people it was hard to imagine why we would require some of the technology we now had available to use as part of this major upgrade. We were learning all about Blogs and Wikki’s social media and much more.

In early March we held our staff conference and rolled out many of the new apps available to use and demonstrated their use. At this point Covid-19 was not the daily discussion point it is now, and the UK was going about its business even if the panic buying had started.

Over the coming weeks the team became proficient with the new software. Then the UK began to change, people were self-Isolating, travel was becoming more restrictive and we could not justify our team driving around the country to visit care homes, who were at the time considering reducing visitors or closing to visitors altogether.

In order to maintain the support, our customers wanted without putting either our consultant or the care homes at risk we began to unpack some of the tools we had in our technology armory but thought we would never use.

As a result, our clients now have access to the files we hold for them giving all of us real-time information as we work together on projects. We now hold meetings using Skype or MS Teams meaning those costly time-consuming meetings can be managed without leaving home. We have also been able to provide bespoke face to face type training over the internet, with online question papers and instant marking.

Our teams have been collaborating on projects in ways we have never done before. As we look to a future without infection and without lockdown, we have looked at how we can help those operators who have struggled during the last few months and whilst needing support simply do not feel the time is right, as they need to recover financially. We have decided to respond to this need by keeping our new technology working for us in the new world after Covid-19. This has meant we are able to put together low-cost packages of support for care home providers, as we use technology to assist our consultants to support our clients. They say something good comes from every disaster, and whilst we mourn the tragic loss of life, celebrate the excellent dedication of the NHS and Social Care Staff along with every other front line worker, here at Swift Management Services Limited, we know that our methods of working have been enhanced by the need to use technology more fully.

To find out more email: info@swiftmangement.org.uk

Or visit our website at www.swiftmangement.org.uk

Social Care Workers PPE

How Prepared are you for Covid

A few our client’s staff have contacted us very worried that they do not have the same levels of PPE as hospital staff. There are also lots of discussions on social media and we do not want to add to the confusion. The guidance appears to change regularly as everyone understands more about the Covid-19 virus. Therefore, the information we are giving is correct as of 5th April 2020. We have done the research, so you do not have to!

The advice currently available states that Covid-19 is an infection passed by droplets expelled from an infected persons body by coughing or sneezing it may also be passed by aerosol actions during specific medical procedures, such as placing a tube into a persons windpipe to place them onto a ventilator or during the removal of the same tube. Therefore, some hospital staff are seen wearing more complex PPE that care home staff are being provided with.

The advice from the government on the wearing of PPE for staff who are caring for residents with no signs of the disease are as follows:

If neither the care worker nor the individual receiving care and support is symptomatic, then no personal protective equipment is required above and beyond normal good hygiene practices.

General interventions may include increased cleaning activity to reduce risk of retention of virus on hard surfaces, and keeping property properly ventilated by opening windows whenever safe and appropriate. [1]

Many staff have been concerned about not being issued with full protective PPE as shown in the picture below.

This level of PPE is NOT required in a care home setting to keep care workers safe.

The government has issued guidance for care home staff who are caring for people diagnosed with Covid-19 and this guidance clearly states:

Care workers should use personal protective equipment (PPE) for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.

Aprons, gloves and fluid repellent surgical masks should be used in these situations. If there is a risk of splashing, then eye protection will minimise risk.

New personal protective equipment must be used for each episode of care. It is essential that personal protective equipment is stored securely within disposable rubbish bags.

These bags should be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being put in the usual household waste bin. [2]

It is understandable why care workers are worried as I have not been able to source a picture with the correct level of PPE despite an extensive search. The picture to the left shows someone wearing scrubs and PPE.  Scrubs are not required, a normal clean uniform is adequate.

References:

[1] https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-home-care-provision

[2] https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-home-care-provision

Covid-19 Advice for Small Providers

Covid-19

As many corporate companies prepare for staff to work from home and put contingencies plans in place for a national major outbreak of Covid-19, Local Authorities are asking care home providers to consider their own plan. Within service lead industries including healthcare, it is highly unlikely that many staff will be able to work from home and reduce contact with others as far as possible. Yet many providers care for elderly and other clients with chronic pathology, which places them at greater risk of the most serious symptoms of the virus. Swift Management have been asked by many of it’s clients to assist in the process of contingency planning.

CQC have written to providers; the statement below is an extract-

“Dear colleague,

We are writing to share an update on how we are responding to the outbreak of Covid-19, as well as how we plan to approach any future decisions as the situation develops.

We will always act in the best interests of people who use services – so while it’s appropriate to recognise the need for you to focus on delivering care, we will always balance this with our responsibility to check that the safety of service users is maintained.

This is a fast-moving situation which may involve us changing what we do and how we do it. We have, therefore, established three key principles that we will use to make sure services continue to be safe, whilst limiting the impact on you and our own colleagues.

  • We will be focusing our activity where it is needed most to ensure people receive safe care – this means concentrating on those areas where we see that the risk to the quality of care is the highest and where we can make the biggest difference.
  • We will support providers by looking at how we can act flexibly and proportionately to reduce the asks that we make of you – including reducing what you need to do to prepare for inspection and looking at what we can do to limit our need to be on site.
  • We will honour our duty of care to our colleagues at CQC.
Covid-19

We will still be carrying out inspections, but inspection managers will be reviewing inspection plans on an ongoing basis to make sure our activity is aligned with the very latest position. Most inspections will continue as planned in the short term, we will keep the position under review and may decide to postpone an inspection, perhaps with relatively short notice. We will take a pragmatic and flexible approach to how and when we regulate as and when this situation develops, and we commit to continuing conversations with providers and their representative organisations.” (Ian Trenholm, Chief Executive Care Quality Commission March 2020)

To ensure that our clients are ready, we are assisting them to consider the situation, undertake a risk assessment and write a contingency plan.

We appreciate that every care provider has an infection control policy, we are encouraging them to ensure that staff have refreshed themselves on the policy including ensuring staff understand the importance of the correct techniques for handwashing.

When planning for a risk assessment consider:

Staff, Visitors, staffing levels, The Physical Environment and wider issues such as supply chains.

Visitors: Visitors should be advised not to visit the home if they are exhibiting flu like symptoms unless it is absolutely essential. They should be asked to use hand gels and wash hands on arrival and on leaving. In the event of an outbreak within a care home, Public Health England will advise on visiting controls.

Staff: Ensure staff have the knowledge to protect themselves and others from the risk of infection, that they are able to wash their hand effectively, and understand their duty to the residents, by either self-isolating, isolating residents and or excluding visitors who may be high risk. Staff should also have the confidence to ask visitors to use hand gels etc. Public Health England will be on hand to assist any care home which has an outbreak.

Staffing Levels: CQC is clear that standards of care must be maintained. Consider how you would maintain staffing levels in the event of an emergency, it is also important to consider that other healthcare organisations will be looking to fill gaps in staffing. So, consider carefully how this will be managed. Consider that you might need additional staff, from agencies, is it possible to bring staff from within the organisation or from another care home? What staff groups are absolutely essential, and could other staff help with some tasks if required? Encourage your staff to be flexible.

The Physical Environment: This is not complicated for most care homes as they have already considered infection control measures. Review the need for Alcohol Gel dispensers, clinical waste bins and soap and paper towel dispensers. Do you need more? Regularly check stock levels of both cleaning and clinical equipment, do you have sufficient stock levels as usual and some additional stock in case your supplier lets you down? Remember some people are stock piling and that means supplies may run out if you plan to order just in time, so please consider ordering early, but taking care not to stock pile.

Are there additional items that you want to keep in stock?

This is the opportunity to review the environment and perhaps put in place those items you have been meaning to put into place for ages.

The Supply Chain: At this stage it is hard to predict if the supply chain will be affected. Other than the issues we already know about such as difficulty in obtaining face masks, alcholol gels and toilet rolls, other items may become highly sought after. Consider what impact it would have if the supply chain which you rely upon breaks down due to their staff being ill or unable to deliver the supplies you normally order, do you have an alternative? Could you use local shops, do you have back up supplies.

Risk Assesments and action plans may be requested in the near future by contracting authorities so be prepared. Swift Management Services are happy to talk these plans through with you or indeed write them for you just contact us on enquiries@swiftmanagement.org.uk