New Skills for Care advice on safe staffing


Skills for Care as part of their ‘Good and Outstanding Range’ have produced guidance for managers on safe staffing. The guide explains what the CQC looks for in terms of safe staffing and how a service can meet the regulation requirement. It includes guidance around deciding and maintaining safe staffing levels, safe recruitment practices and how to ensure staff are safe and competent.

It draws on evidence from over 60 CQC inspection reports and case studies from residential and community-based services who are rated ‘good’ and ‘outstanding,’ to help providers to understand what ‘good’ looks like and learn from best practice.

What is safe staffing

According to the guide safe staffing is about having enough staff, who have the right values and skills, to deliver high quality care and support. It involves:

  • having safe staffing levels, including putting contingency plans in place;
  • recruiting the right people, with the right values, skills and experience to deliver safe care and support;
  • doing the right recruitment checks;
  • ensuring staff are competent and safe to do their role.

Safe staffing is not just about numbers it about having experienced and competent staff who have a clear understanding of the requirements of service users care plans, who stay with the service long enough to establish meaningful relationships with those who they care for.

Identifying characteristics of services who have inadequate staffing

There are some common characteristics of services who have inadequate staffing. If some, or all, of these apply to your service this could indicate that a service is not meeting the requirements for safe staffing.

  • High turnover of staff;
  • Struggle to recruit enough staff;
  • New staff leave within a short time of joining;
  • High sickness rates that are particularly stress related;
  • Unorganised rota system and processes that are difficult to use and review;
  • Rota’s are constantly changing;
  • Staff only have time to perform duties and tasks with no time to ‘care’;
  • Staff don’t have time to communicate with
    people they support, families and professionals;
  • Little consistency in staff;
  • Over-reliance on temporary workers;
  • Staff inductions are limited and/or rushed;
  • Staff learning, and development is restricted to mandatory training;
  • Limited support for staff such as supervisions.

Impact on service users

  • staff have no time to respond to calls for help;
  • there is not enough time to do an effective handover;
  • staff support people to get ready and have meals at a time that best suits them rather than the individual;
  • not enough staff to support people at meal times;
  • medication documentation is rushed.

CQC checks on safe staffing

CQC will require managers to demonstrate how they arrived at the numbers of staff to ensure service users are safe. Dependency tools can help the manager to decide how many staff will be needed. They can be used to collate information about the needs (or dependency) of people who need care and support, how many hours/staff support will be needed, and enable the manager to log other requirements such as time for administration, record keeping and communicating. This can help to make informed decisions about how many staff will be needed in your service to meet safe staffing levels. In addition, it provides evidence of how you arrived at your decision about the numbers of staff.

When using a dependency tool, the manager must ensure staff are competent to use it and use it consistently. If they don’t, this can have a negative impact on the outcome of a services inspection.

One residential home graded inadequate by CQC, found that having checked the records following the use of the dependency tool, that records of the assessment hadn’t been completed for some weeks. The provider was unable to demonstrate on what basis they’d decided the current staffing numbers per shift against the needs of people.

Summary

This latest guide by Skills for Care on safe staffing gives providers useful advice on how to ensure CQC requirements can be met. It helps providers to recognise the characteristics of services who have safe staffing issues. Dependency tools can be useful in providing evidence of how managers decided on staffing levels, but they should only be used by competent and experienced staff capable of keeping records up to date. Managers are strongly advised to obtain the guide on safe staffing by visiting the Skills for Care Website.

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

Extending the range of social activities in care homes


Although older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing, staff are always on the lookout for new and interesting activities to engage service users. This week’s blog article brings together two new activities which readers may find of interest.

It has long been known that activity helps to sustain both physical and mental health, so it is important that older people living in care homes are able to maintain interests and have opportunities to develop new ones.

The challenges of providing good care for older people with complex needs in care home settings, as well as the culture of the care home, can result in staff prioritising practical tasks above supporting people to take part in meaningful activities. Risk management can also be an issue, with staff not feeling empowered to support people if there is an element of risk involved in activities.

Even when taking these important issues into consideration care homes can still greatly improve levels of activity for the people living there by ensuring that they have opportunities throughout the day to take part in the daily life of the home. To achieve this, staff need to know that engaging with people living in the home and encouraging activity is central to their caring role. SCIE’s film Excellence in residential settings – older people demonstrates the success of this approach in a care home. Meaningful activity can include routine personal care tasks, such as getting dressed and brushing teeth. If older people are encouraged to carry out these tasks for themselves, rather than have others do them on their behalf, it will contribute to their sense of wellbeing.

Pen pal scheme

A new initiative aiming to be the UK’s biggest pen pal scheme is to partner nursery and primary school children with care home service users of the same name.

The initiative, dubbed ‘Letters from a Namesake’, aims to bring together two different generations to share experiences and life stories.

Launched by the nations’ biggest supplier of name tags and labels for schools and care homes, My Nametags, the educational scheme aims to help develop children’s letter writing skills, while tackling loneliness among care home residents.

My Nametags are appealing for care homes in all parts of the UK to come forward and sign up if they are interested in taking part.

Lars B Andersen, Managing Director at My Nametags, said: “The way the scheme will work is we will match people and children with the same names.

“For example, a ‘Mary’ from a local nursery will be given the opportunity to write to ‘Mary’ in a residential care home and vice versa.

“No personal details will be shared as all the letters, pictures and drawings will be sent to us and passed on directly. We’re excited to be launching the scheme, and hope that it will help the local community enormously by bringing these two very different generations together.”

Care homes wishing to take part can register their interest by contacting Mynametags@energypr.co.uk or calling 01993 823 011.

Tailoring social activities to people’s choice and preferences

Organised activities contribute to the sense of community in a care home, but they aren’t for everyone. Some people prefer activities that they can pursue on their own, such as reading or listening to the radio. Other people prefer group activities, but a group activity that is enjoyable and meaningful to one person may be of no interest to another. People need a range of activities to choose from and support to maintain existing interests. The College of Occupational Therapy’s Living well through activity in care homes toolkit has plenty of ideas for building meaningful activity into the daily life of a care home and Staying involved and active from the Alzheimer’s Society provides tips on how to involve people with dementia in activities.

Summary

The importance of social activities to service users in care homes as a means of sustaining physical and mental health is well documented. Staff are always searching for new social activities. SCIE’s film Excellence in residential settings – older people, the My Nametags, educational pen pal scheme and The College of Occupational Therapy’s Living well through activity in care homes toolkit may well help to extend the range of social activities available in care homes. It must always be remembered that service user choice and preference are strong motivators towards engaging service users in social activities.

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

CQC Driving Improvement Report


This month CQC published its Driving Improvement Report. The report sets out how services who had previously been graded as inadequate improved to achieve a good grading.

Andrea Sutcliffe Chief Inspector of the CQC has stated that their work is guided by a simple principle – is this a service I would be happy for my Mum or anyone I love to use? If it is, that’s fantastic; but if it’s not good enough for my Mum, it’s not good enough for anyone’s Mum and we’ve got to do something about it.

Lots of services have taken up that challenge and improved. We wanted to share some of their experiences to help others to improve too. In the Driving Improvement Report a number of different services were approached who had been given an inadequate grading by CQC.

For each service interviewed a range of people, including people who use services and their families, registered managers, providers and owners, care staff, administrative and other staff, commissioners and social workers. CQC staff used the following questions to interview providers and managers, and adapted them when interviewing people who use services, staff and others:

  • What was your reaction to the service being rated as inadequate?
  • How did you approach improvement?
  • What support did you ask for and what support did you receive?
  • What were the obstacles to improvement? How did you overcome them?
  • Did the inspection report help you improve your service and outcomes for people?
  • How did you involve staff and support them further in their work?
  • How did you involve people, their families and carers and volunteers, who use the service?
  • How did you involve and work with local partners?
  • Could you give us some examples of tangible improvements?
  • Could you give us some examples of improved outcomes for people?
  • Looking back on the improvement journey, what have you learned, and is there anything you would do differently?
  • What are you doing to ensure improvements are sustainable? What’s next on your improvement journey?
  • To summarise, what would you say are the top five actions you took that helped your service improve?

Key Themes

Reaction to the initial inspection report

Most providers, and not just in the adult social care sector, react to a report highlighting failures with shock, surprise and disappointment. But usually when people stand back and have time to reflect, they understand the failings. As one care worker told us: “In the report we recognised the failings and could see the truth in what was said.” For committed staff the report can come as a relief, as in some of our case studies staff were struggling – doing their very best but unable to deliver the care they wanted to. Several case studies highlight the impact that a rating of inadequate and report of poor practice can have on a service’s reputation.

Leadership

The value of a good leader cannot be underestimated. In most of the providers we spoke to, a new manager had come into the service to deliver the improvements. They engage with staff, people who use services and their families; they are open to suggestions but set parameters and take tough decisions where necessary. Staff and family members in some of our featured providers commented about a manager’s door always being open.

Cultural change

Leadership and culture go hand in hand. It’s the leader’s job to shape the culture of an organisation. Failing organisations tend to have cultures in which staff are afraid to speak out, don’t feel they have a voice and are not listened to. Involving staff is one of the best ways to drive improvement.

Person-centred care

Typically, when a new manager took up the reins, they wanted to see care plans. And in most cases, these were lacking in detail and did not demonstrate that the care being provided was person-centred. It is simply not possible to provide good care if the care staff do not understand the needs of the person being cared for.

Staffing

A range of issues to do with staffing contributed to the low rating in most of the providers featured in this publication. Too many providers were struggling along without having enough staff to deliver safe and effective services. It wasn’t generally because the staff didn’t care; it was because they didn’t have the time to care as well as they should. And that put a great deal of stress on staff as well as putting people who used services at risk.

Working with partners

Most of the services we feature received support to help them improve – mainly from the corporate provider, if there was one, or commissioning bodies. The starting point was having a manager and staff who were willing to ask for support, were honest about the issues they faced, and were open and transparent about their plans for improvement.

Building a community

Providers that are good and aspire to be outstanding look beyond their own walls and seek to be part of the local community. We saw great examples of providers opening their doors to local groups, working with local schools and bringing the families of the people who use their services.

Summary

The CQC Driving Improvement Report raises a number of interesting questions regarding inadequate social care. Most managers of care services will now be fully aware of the key themes identified in this report which constantly appear in literature produced by CQC. This does not demean their importance. It would appear however, there are still too many providers graded inadequate who have still not taken on board their importance.

The services who took part in this study must have been committed to improvement when approached by CQC, otherwise they would not have agreed to it. The elements of good practice identified in this report can be followed by all providers with the same level of commitment.

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

Communicating with someone with dementia


The Alzheimer’s Society have published some useful tips on communicating with people with dementia, which may be useful to staff in adult social care services.

Before you speak

  • Make sure you’re in a good place to talk – quiet, with good lighting and without too many distractions (e.g. no radio or TV on in the background).
  • Get the person’s full attention before you start.
  • Position yourself where the person can see you as clearly as possible (eg with your face well-lit) and try to be on the same level as the person, rather than standing over them.
  • Sit close to the person (although not so close you are in their personal space) and make eye contact.
  • Make sure your body language is open and relaxed.
  • Have enough time to spend with the person. If you feel rushed or stressed, take some time to calm down.
  • Think about what you are going to talk about. It may be useful to have an idea for a particular topic ready. You can also use the person’s environment to stimulate topics.
  • If there is a time of day where the person will be more able to communicate (eg in the morning) try to use this time to ask any questions or talk about anything you need to. Make the most of ‘good’ days and find ways to adapt on ‘bad’ ones.
  • Make sure any of the person’s other needs are met before you start (eg they’re not hungry or in pain).

How to speak

  • Speak clearly and calmly.
  • Speak at a slightly slower pace, and allow time between sentences for the person to process the information and respond. This might seem like an uncomfortable pause to you, but it is important for helping the person to communicate.
  • Avoid speaking sharply or raising your voice.
  • Use short, simple sentences.
  • Try to communicate with the person in a conversational way, not question after question (it can feel like an interrogation).
  • Don’t talk about the person as if they are not there or talk to them as you would to a young child – be patient and have respect for them.
  • Try to laugh together about misunderstandings and mistakes – it can help. Humour can help to bring you closer together, and may relieve the pressure. However, be sensitive to the person and don’t laugh at them.
  • Include the person in conversations with others. This may be easier if you adapt what you say slightly. Being included can help a person with dementia to keep their sense of identity and feel they are valued. It can also help to reduce feelings of exclusion and isolation.

What to say

  • Try to avoid asking too many questions, or complicated questions. People with dementia can become frustrated or withdrawn if they can’t find the answer.
  • Try to stick to one idea at a time. Giving someone, a choice is important, but too many options can be confusing and frustrating.
  • If the person is finding it hard to understand, consider breaking down what you’re saying into smaller chunks so that it is more manageable.
  • Ask questions one at a time, and phrase them in a way that allows for a ‘yes’ or ‘no’ answer (eg rather than asking someone what they would like to do, ask if they would like to go for a walk) or in a way that gives the person a choice (eg ‘would you like tea or coffee?’).
  • Rephrase rather than repeat, if the person doesn’t understand what you’re saying. Use non-verbal communication to help (eg pointing at a picture of someone you are talking about).
  • If the person becomes tired easily, it may be better to opt for short, regular conversations. As dementia progresses, the person may become confused about what is true and not true. If the person says something you know is not true, try to find ways of steering the conversation around the subject and look for the meaning behind what they are saying, rather than contradicting them directly. For example, if they are saying they need to go to work is it because they want to feel useful, or find a way of being involved and contributing? Could it be that they are not stimulated enough?

Listening

  • Listen carefully to what the person is saying, and offer encouragement.
  • If you haven’t understood fully, rephrase what you have understood and check to see if you are right. The person’s reaction and body language can be a good indicator of what they’ve understood and how they feel.
  • If the person with dementia has difficulty finding the right word or finishing a sentence, ask them to explain it in a different way. Listen out for clues. Also pay attention to their body language. The expression on their face and the way they hold themselves can give you clear signals about how they are feeling.
  • Allow the person plenty of time to respond – it may take them longer to process the information and work out their response. Don’t interrupt the person as it can break the pattern of communication.
  • If a person is feeling sad, let them express their feelings. Do not dismiss a person’s worries – sometimes the best thing to do is just listen, and show that you are there.

Body language and physical contact

  • Non-verbal communication is very important for people with dementia, and as their condition progresses it will become one of the main ways the person communicates. You should learn to recognise what a person is communicating through their body language and support them to remain engaged and contribute to their quality of life.
  • A person with dementia will be able to read your body language. Sudden movements or a tense facial expression may cause upset or distress, and can make communication more difficult.
  • Make sure that your body language and facial expression match what you are saying.
  • Never stand too close to someone or stand over them to communicate – it can feel intimidating. Instead, respect the person’s personal space and drop to or below their eye level. This will help the person to feel more in control of the situation.
  • Use physical contact to communicate your interest and to provide reassurance – don’t underestimate the reassurance you can give by holding the person’s hand or putting your arm around them, if it feels appropriate.

Summary

Adult social care services are always looking to improve their ability to communicate with people with dementia. Managers of adult social care services are well advised to bring to the attention of their staff and carers the tips on communicating with people with dementia produced by the Alzheimer’s Society.

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

NHS Digital innovation £1m up for grabs for adult social care technology pilots


It was good to hear that Local authority projects that use digital innovation to help benefit people who access adult social care can bid for share of £1 million in funding.

The funding, provided by NHS Digital and managed by the Local Government Association (LGA), with support from the Association of Directors of Adult Social Care (ADASS), will be awarded to local authorities that put forward projects that support forward-thinking uses of digital technology in the design and delivery of adult social care.

Twelve will receive £20,000 to design a digital solution to address a specific issue with their service, with six receiving up to a further £80,000 to support its implementation.

Those bidding will need to focus on one of three themes:

  • efficiency and strengths-based approaches;
  • managing marketing and commission; and
  • sustainable and integrated social care and health systems.

Formerly known as the Local Investment Programme, the Social Care Digital Innovation Programme aims to encourage the adult social care sector to make better use of technology.

This new initiative builds upon support for the strategy advocated by the CQC who for some time have been encouraging providers to make more use of technology in the provision of care services.

James Palmer, programme lead for the social care programme at NHS Digital said: “Last year’s projects delivered inventive, forward thinking and creative solutions to local challenges in social care. They have led to successful outcomes for both services and the people who use them.

“This year, the funding will help to identify and address some key pinch points within local authority services, especially those around the integration of health and social care systems. We are looking forward to seeing the innovative solutions that councils come up with in response to our latest round of funding.”

Previous projects to have received support include home video-conferencing in Essex, voice-activated home support in Hampshire and electronic referrals for home care packages in Hampshire and electronic referrals for home care packages in Sefton and Knowsley.

Sefton and Knowsley Mayor Kate Allsop, deputy chair of the LGA’s Community and Wellbeing Board said: “We are committed to enhancing the role that information and technology can play in the commissioning and delivery of health and social care services.

“As part of this agenda we are pleased to run another funding round in collaboration with NHS Digital, to stimulate digital solutions to social care challenges at a local level.”

The closing date for applications is 4pm on 1 June.

An NHS Digital-commissioned review of the state of IT in social care revealed a myriad of challenges.

This latest initiative by NHS Digital is just one of many such funding approaches with the aim of increasing the use of technology in social care. There is little doubt that the funding crises that is affecting social care, has prevented investment in the use of technology. Many providers ae aware of the benefits that technology can bring to adult social care services but where is the money coming from to pay for it?

Those who work in the social care industry are full aware that the use of technology will play an increasingly important role in the future provision of adult social care services. We can also expect it to be included in the Governments Green Paper on the future of social care services to be published in the summer.

Summary

The offer of more funding from NHS Digital to fund specific technology projects should be welcomed. But this piecemeal approach is only scratching the surface when it comes to the technology needs of adult social care services.  What is needed is a government funded worked-out strategy for the implementation and use of technology that is available to all providers and commissioners.

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