The importance of Food Hygiene Standards in Care Homes

Older people are more likely to suffer from food poisoning and become ill because aging weakens the immune system’s ability to fight infection. So, it is important that kitchen staff take extra care when dealing with food intended for people in care homes.

The Food Safety Act 1990, Food safety (General Food Hygiene) Regulations 1995 and food safety (Temperature Control) Regulations 1995 covers the preparation, storage and service of food. The CQC requires that care services ensure that the food and drink they provide is handled, stored, prepared and delivered in a way that meets the requirements of the Act. The local authority is responsible for enforcement through environmental health and Trading Standards. The Food Standards Agency (FSA) can intervene where local authorities fail to meet the requirements and in emergency situations.

It would seem however that not all providers are complying to the regulations and the requirements of CQC. A recent inspection into the hygiene standards of a care home highlighted a series of very poor practices. The inspector on his visit had found:
• Out-of-date food
• Dirty equipment
• Badly stored produce
• Dirty uncleaned work surfaces
• Dirty microwave and cookers
• Chopping boards used for ready to eat food and raw meats were stored together.

When observed, staff did not even wash their hands!

It is critical, that care providers run a tight ship within their kitchens and the general handling of food by staff and the working environment is operating safely. Failure to do so can have grave consequences for service users. Listeria is quite common where basic hygiene and preparation is not observed and can result in fatalities particularly amongst the frail.

I would suggest several actions that providers could take to prevent poor food hygiene practices in care homes including:
• Management involvement in kitchen practice
• All staff should receive comprehensive training and be aware of their responsibilities when handling food.
• Food hygiene training must be up to date.
• Monitoring and auditing kitchen practice.

The manager has the overall responsibility for ensuring that excellent standards of food hygiene are observed. The manager should always take an active role in monitoring both the practices of staff and the environment in the kitchen. This incident could have been avoided if the manager regularly put on their white overalls and looked in on the kitchen staff and observed the practice of kitchen staff and the environment. In addition, the manager should have carried out scheduled written audits and monitoring to ensure that standards were being upheld.

It would appear that in this case, the monitoring and auditing of the kitchen environment by the manager and senior kitchen staff had fallen short of acceptable standards, or has not been carried out at all. It is essential that the Manager monitors all environments including the kitchen area within the home to ensure that they comply with regulation and standards and safeguard the health and safety of service users who eat out of their kitchens.

Summary
The responsibility of preparing and dealing with food in care home kitchens is often left to the cook or chef. However, the registered manager carries overall responsibility for the food provided to service users. The recent inspection that highlighted poor practice in food hygiene, provides a timely reminder to registered managers that responsibility for food cannot be delegated solely to cooks and chiefs. It is their duty to ensure best practice is carried out in the kitchen and the wellbeing of service users is safeguarded.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Supporting staff to cope with stress in social care settings

Working in the social care industry is unlike any other profession – it requires a much deeper emotional involvement. The foundation of social care comes down to the relationship between carers and the most frail and vulnerable people within a community. Frankly, worrying about your resident’s or client’s condition is a lot more difficult to leave at the office than paperwork.

It is important however that staff learn to strike a work-life balance, although recognizing how difficult this is when your work is all about taking care of people. Dealing closely with tense situations such as health deterioration and residents passing away is emotionally burdening. The increased level of stress that comes thus not only impacts care workers’ wellbeing but can also lead to mistakes, such as medication errors.

Professor Jill Maben, Director National Nursing Research Unit King’s College London study Poppets and Parcels explored the links between staff wellbeing and patients’ experiences of care. The influence of staff motivation, affect and wellbeing. She found that contextual factors that influence staff motivation, affect and wellbeing included:

Demanding work
• high-demand work with little control
• a family at work
• local work climate

High Demand – low control work
• Inadequate or unpredictable staffing levels.
• The movement of staff at short notice into other staff depleted service areas.
• The lack or inadequacy of training in specialist care skills (e.g. dementia and delirium) for nursing staff.

A family at work
• local work climate
• Ward leadership
• Co-worker relationships

Fissures in co-worker relationships
• Qualified staff (registered nurses) and unqualified staff (HCAs)
• Staff from different cultural or ethnic backgrounds
• Staff who practised or experienced incivility and bullying

“Poppets and Parcels”
• Staff talked of ‘Poppets’ – favoured patients – a term of affection for a sweetheart
• Less favoured patients felt like ‘Parcels’

Challenging a few care quality myths
• “A smile costs nothing”
• “It’s not about nurse staffing”
• “It’s not rocket science”

Jill Maben’s study shows the effect of staff wellbeing on the quality of service that patients receive. It could be argued that the contextual factors she identified could have an equal bearing on care home and domiciliary care staff.

How to recognise if you are stressed
It is important to recognise the symptoms of being overly stressed so you can deal with the pressures early on. Staff should be aware and take account of:

• Emotional cues: If you feel that you get easily irritated and overwhelmed or anxious, then you’re under unhealthy stress.
• Physical indicators: Stress is not only a psychological and emotional condition; it physically affects us as stress hormones interrupt the normal processes in the body. The physical signs of stress are tense muscles, tiredness or increased blood pressure and pulse rates, skin conditions, hair falling out, etc.

These symptoms can potentially lead to more serious medical problems such as heart disease, diabetes and others if they are not identified and treated by appropriate medical means.

Four tips to help staff manage stress
James Browning, the UK Product Manager at Sisu Wellness, gives staff some tips to help cope with stress:

‘Just relax’, ‘don’t worry about it’, ‘everything will work itself out’ are common phrases used by those who don’t understand and appreciate how much responsibility you have. Relaxing is easier said than done. In order to reduce stress levels staff need to take into account all aspects of their life. These include:

1. Balanced diet and healthy lifestyle choices. Getting enough sleep along with healthy eating habits are good places to begin. Your body needs its normal daily nutrition dosage. Not more, not less – so monitor your eating habits and try to stick to your normal eating routines.
2. Make time for yourself. Learning to relax is a skill which, when practiced regularly, will help you control your emotions and improve your physical wellbeing. Even if you work long hours, waking up half an hour early to have a peaceful breakfast provides a great platform to start your day.
3. Exercise. Being physically active is a great way to reduce your anxiety levels. Whether it’s swimming, yoga or your own made up dance, being active helps give your brain some time away from your busy daily schedule. It also triggers the release of mood-enhancing hormones, making you feel naturally happy and more in control.
4. Communicate. Sometimes it’s difficult to figure out what the exact stressor is. When you talk it out, it helps you better understand what stresses you out and why. It will relieve the tension that you feel, and if you talk to someone who would understand the type of pressure you are under, you may come to a solution together. Feeling overworked and under pressure is a serious matter that you don’t have to deal with it on your own.

If you, however, still find yourself feeling hopeless or the problem is much deeper and you find it difficult to manage the pressure, don’t hesitate to seek professional medical and psychological advice.

Management responsibilities
Managers can support staff by providing training on recognizing and coping with stress. Stress and overall staff wellbeing should form part of the supervision agenda and the monitoring reasons for staff sickness.

Summary
Those responsible for the management of social care services and the staff who work with in it are fully aware that the very nature of social care care comes down to the relationship between carers and the most frail and vulnerable of people. As such the work is demanding and stressful. Jill Maben identified the links of staff wellbeing to the quality of service people will receive and some of the coping mechanisms they used. James Browning provides some tips to enable staff to manage stress. Above all however managers have a duty to ensure that staff receive support to manage stress levels through training and supervision recognising that staff suffering from stress will not only effect their own wellbeing but that of service users.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Money is not the only reason why care homes fail to reach standards

In recent months, the social care sector has been preoccupied by the lack of funding for the provision of social care. Care homes and domiciliary care providers have rightly brought to the attention of the powers that be the serious plight of the industry, and their inability to provide quality care without an increase in funding. Government has now responded with the provision of a funding package for social care, but it remains to be seen if this will be the answer to the problem.

Everyone who works in social care is fully aware of the serious impact on the delivery of a quality service caused by the lack of funding. The question needs to be asked is this the only reason why some care homes and domiciliary care services fail to reach the CQC standard of good. I believe there is more to it than that.

To some extent there is evidence for my premise which can be found in a report published by Independent Age Charity on the 11th April 2017. The analysis, conducted by old people’s charity Independent Age and based on Care Quality Commission (CQC) inspections, found that five local authorities have more than half of care homes rated “inadequate” or “requires improvement”.

Old people are being forced to live in unsatisfactory care homes in some parts of the country, according to the new analysis. One in three care homes in the North West performed poorly, compared with 20.3% in London, with the elderly and their families having little choice of quality care in places.
More than 62% of homes in Stockport, 61% in Salford and 54% in Tameside were poor performers, according to findings. However, no care homes in the Isles of Scilly, Islington and Rutland were labelled inadequate or require improvement.

The charity said the variation in quality was caused by low levels of funding by local authorities, difficulties recruiting staff, and low pay, as well as a lack of a support mechanism for improving struggling care homes.

Simon Bottery, director of policy at Independent Age, said: “No one should be forced to live in an unsatisfactory care home but our analysis shows this is the grim reality in some parts of the country.
“The market is simply not providing a decent choice for older people and their families but there is little indication that local authorities or the Government are giving the problem the attention it deserves.

The report goes on to say that “Money is likely to be one cause but not the only one.
“The Government has an opportunity to address this in its upcoming Green Paper on social care but, in the meantime, councils must demonstrate that they understand the reasons for care home failures and are working to resolve them.”

Margaret Willcox, president elect of the Association of Directors of Adult Social Services (ADASS), said: “High quality care is essential to providing good adult social care to professional standards expected by elderly and disabled people and their families, who both need and deserve it.
“Most health and adult social care services in England are providing people with safe, high quality and compassionate care, as recognised in last year’s annual CQC report, with 71% of adult social care services inspected rated as “good”. But this leaves a staggering 29% who have not yet reached the standard.

The question needs to be asked why are some services reaching the standard and others struggle to do so? Why are 71% of care homes able to provide quality services with the same level of funding. There are I believe several reasons for this including the following:

• Lack of good management
• Difficulties in recruiting staff and high staff turnover.
• The residential care home mix of residents
• Lots of inspection and enforcement, but little in the way of supporting mechanisms

Good management

Good managers are like gold dust and the whole performance of the service flows from their ethos, values, skills knowledge and commitment.

Difficulties in recruiting staff

The social care sector is not only in crisis because of the lack of funding, it is because of the difficulty in recruiting staff who have the appropriate skills, ability and commitment, and the turnover of staff due to poor career opportunities, and low pay.

The residential care home mix of residents

There are some care homes who have a large number of private fee payers who contribute more financially to the running of the home. This in turn offsets the lower fees paid by the local authority. This enables the home to provided more staff training, and better conditions of service. Conversely, where there are none or few private fee payers it becomes more difficult to fund staff training and conditions that are essential to recruiting and retaining staff.

Lots of inspection and enforcement but little in the way of supporting mechanisms

I have said in my blogs before that CQC have done a considerable amount of good work in raising quality in care services and safeguarding service users. However, in addition to ever increasing demands by CQC and local authority commissioners we need to take stock. Someone needs to take responsibility (a role for the local authority) for analyzing why so many homes are under achieving and what support do they need.

We need to get away from threatening legal action all the time as is often the case with CQC, which should only be used in extreme cases. At the present time we place no emphasis on support structures when there is a shortfall in standards. Rather, we should move towards a dual approach combining enforcement with support for struggling providers from a separate agency.

Summary

A great deal has been written about the lack of funding being the major cause of so many care
Homes failing to provide good quality services. The analysis, conducted by the old people’s charity Independent Age based on Care Quality Commission (CQC) inspections, showed that funding undoubtedly impacts on the provision of services and the quality that can be achieved. However, there is sound evidence that this is not the only cause, otherwise why can 71% of care homes achieve good quality gradings with similar levels of funding. If we are to improve those homes that are under achieving, we must adopt a dual approach recognising the importance of enforcing agencies but introducing some form of supporting mechanism for struggling providers.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

A carers view of supporting a person with dementia

I recently read an article by Sophy Wilkinson in the guardian has shed a great deal of light on the trauma faced by those who care for people with dementia. The following gives her perspective on the difficulties faced and the support she and others need in providing care, and in doing so improve the quality of life of those who suffer from the disease.

“I ought to get to dinner. We must not cogitate” says my 97-year-old grandmother, who has lived with vascular dementia for three years, after a series of strokes. Now, though she does not recognise me, she can still pluck from the dusty attic of her mind a word I – shamefully – didn’t know.

The word, like many polysyllables my erstwhile crossworder grandmother surprises me with, is now one I understand. But the act (to deeply think about something, with intent to do something about it) is unfamiliar not only to me, with my millennial distractions of boxsets, Instagram memes and eternal financial and societal insecurity, but to those in charge of the nation’s social care.

Funding for adult social care is in crisis. By 2026 it will require an extra £2.6bn. After the NHS chief Simon Stevens told the government care “must be front of the queue” in the waiting room for governmental cash injections the communities secretary, Sajid Javid, unveiled new measures to give £240m of funding for social care in 2017/18.

Councils will see their new homes bonus delivered differently, and will pass on to their citizens a 3% precept on their taxes for two years. The Local Government Authority has warned this will not only create a postcode lottery for services, but put pressure on already struggling taxpayers.

But the money is direly needed, in part to cover the specific training carers and nurses need for bodies that have outlasted minds. Dementia, including Alzheimer’s disease, afflicts 850,000 people. This number is both underestimated and rising.

Dementia and Alzheimer’s twine around sufferers’ minds with such fecund entitlement that it’s sometimes hard to make out the individual within. But now that my grandmother is in a residential care home, I no longer need to help her with her food or commode, or assist my tired and nervous grandfather to wake her at 2pm, 4pm, 6pm. With the luxury of good quality, state-run care I now have time to cogitate – to think about finding a way through to my grandmother.

Validation therapy, developed by Naomi Feil, is not a cure, she says. But: “It restores their dignity and feeling of self-worth. It’s a way of being with them, a way of stepping into their world, feeling what they feel.”

Its techniques are kind and empathetic. Patients are encouraged to describe fantasies and reminiscences, a carer mirroring their language and movement. The carer must accept the patient’s reality, and eye contact and physical touching are recommended.

A YouTube video of Feil at work shows her guiding a nonverbal Alzheimer’s sufferer to sing hymns and tap out a rhythm. She’s magic, an old-whisperer. It’s as if David Blaine were charming and enlightening, instead of, well, David Blaine.

Validation therapy seems to work on my grandmother. After one hour, she regained skills previously withered, such as reading the clock and gossiping about a co-resident. She also stopped her normal mantra (“I ought to throw myself out of the window”) and taught me a word I didn’t know. This method won’t work for everyone, and the NHS advises there’s not enough evidence to suggest it works for anyone. But, after so long feeling powerless to help, and this in turn making me reluctant to visit, it felt good.

We can all bicker about funding social care. “We” might be micro: a family flapping through files to find all the relevant bonds, savings and Isa’s. Or it could be macro: the government and local authorities tussling over how best to stuff the mattress. Yet as we become so wrapped up in this, we let the bar drop so low – are they being fed and wiped? – that we lose sight of any requirements for a dignified end of life.

In the meantime, family members, especially female ones, will be drafted in to do the manual care work. And while we’re commended for our communication skills, even Feil couldn’t work her magic with dirty dishes to be done. It’s also hard to pay taxes if you’re doing unpaid work.

The Alzheimer’s Society’s recent survey of sufferers found that more than half, since diagnosed, see less of their family at Christmas. Regardless of your take on validation therapy, Feil’s concern that social isolation and memory-loss conditions work in toxic coalition is just common sense.

It’s hard to gauge its precise cost, but easy to imagine how families could thrive if they were equipped with the time to find the right way through to their older people. Instead of longing to keep older people with dementia safely swaddled in madness, we must aim higher, to guide them into finding peace with their madness. How’s that for some cogitation?

Summary
Wilkinson’s article describes clearly the anguish suffered by relatives and others who care for people with dementia. She sets a good example by exploring techniques such as validation therapy that can support people who suffer from this debilitating disease. She wants to raise the bar and equip people with the skills and afford them time to get through to people who suffer from dementia, thereby allowing them to find peace in the loneliness of this crippling disease.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy