John Kennedy, Julia Clinton and Preston Walker - What makes an outstanding care home - Tuesday 3 April 2018

When Sonnet took over a new care home in late 2013 they quickly discovered that an undercover Panorama reporter had been filming in the facility for months, CEO Julia Clinton told Care Conversation delegates. “When the program aired we entered a media storm, as you can well imagine. Make no mistake, CQC were closing us down if things didn’t change very quickly, which was fair enough.”

Her management team immediately set about identifying the problems, and found a top-down culture with ingrained silo working, and a place where residents and staff had no voice. “The question was ‘what would a new culture look like?’” she said.

“We came up with ‘Kindness, Comfort, Respect’ (KCR),” she said, which was backed up by phrases such as ‘Mission Outstanding’, ‘Don’t Walk By’ and ‘1,000 Little Things’ to reinforce the messages that quality came first, having the best team, and residents being at the heart of everything. The first step in changing the culture was a series of 30-minute briefing sessions for staff to clearly explain “where we are now and why we need to change”. Getting their buy-in inevitably presented challenges, however, as they’d “been through the mill” after the media scandal. “We felt we were right at the foot of a mountain with a huge climb ahead of us.”

A set of guiding principles were used throughout the process, such as ‘Openness and Open-Mindedness’ and ‘Good Is Not Good Enough’, consistently emphasising themes like simplicity, straight-talking and avoidance of jargon. “Another one was ‘Be Relentless’,” she said. “That was really important – we had ‘Kindness, Comfort, Respect’ on mugs, pens, posters. We were never off-message.” The most important thing, however, was eliminating the gap between leadership teams and frontline workers, she stressed. “All of it fed into that principle of there being no board-to-floor gap.”

After about six months a series of workshops was arranged, giving staff the opportunity to rate their own teams and suggest ways they could be improved. These now take place twice a year, alongside weekly management meetings, and the improvements have been pronounced. Both the care home and its nearby sister establishment now have overall ‘Good’ ratings with ‘Outstanding’ for Welll-led, and they have also been national winners of a Skills for Care Accolades award for leadership – “a huge morale-booster”. As a number of original staff had been exited it had left a “hole where people should have been”, she said. “So we raised the bar in terms of recruitment entry requirements, which is possibly counter-intuitive, but it worked for us.”

Key lessons from the whole process included the importance of keeping things simple, identifying champions and blockers early on and always asking and learning. “We never stop asking ‘could this happen again – could someone hurt one of our residents?” she said. “It’s never ‘job done’, there’s no room for complacency.”

The people moving into old age now were “a very different consumer group” than in the past, independent social care consultant John Kennedy told the seminar. “But the market for social care hasn’t created the same kind of change we’ve seen in other sectors. In the main it’s still domiciliary care or care homes – and there are good care homes, and not so good. But we don’t seem to have been able to harness that consumer sovereignty in the marketplace to get more diversity of services.”

When it came to ensuring quality it was clearly important to regulate care, he said, “but it’s not a census – they’re not all inspected on the same day”. Around 25 per cent of ‘Good’ facilities would go on to lose their rating, he pointed out, while most ‘Outstanding’ ratings were the result of “individual super humans” who achieved the results despite their companies.

“It’s very difficult to get that consistent quality, although some organisations do,” he said. “Everybody recognises that the manager is key, but we need to create an environment where a good manager can be outstanding.” Although most ‘Outstanding’ care homes were self-funded, money was “not enough in itself”, he stressed. “But you do need the resources on the ground, and the culture. In ‘Outstanding’ care homes the values are held at the top, and there’s no ‘residents’, ‘staff’, ‘relatives’ – only people.”

It was also vital to allow fun, he stated, and to make sure everyone felt included. “You should also deal with problems and mistakes positively, and cherish your ambassadors. In care we can’t seem to get our heads around the fact that things go wrong – we don’t have an environment that can foster and help innovation.” It was also vital to have the courage in the system to think differently, he said. “The system – including the regulator and commissioners – should be more like those ‘Outstanding’ facilities. We need a system that can support the majority to be good, and build that in. It’s easy to get into a sort of groupthink where we think that if we have a regulatory system that’s punitive it’s going to create a caring, compassionate system. It’s not. If you want people to be kind, you have to have a kind system.”

The day’s final presentation was from award-winning chef Preston Walker and his colleague James Ball, from Oak House, a small independent care home run as a family business. “It was never on my radar to work in care,” said Walker. “I was very focused on being a chef.” After working in high-end restaurants for 20 years, however, he found that it was a ‘perfect transition’ from hospitality to healthcare. “There’s so much that’s transferable – I view our residents as guests,” he said. “One thing I’m very proud of is our staff team. Turnover is very low, and having that consistency really does help.”

Changing the structure of mealtimes allowed staff to be more observant, Ball told delegates, and the facility had also become very creative in presenting the food, using visual aids, innovative description techniques and flavour enhancements. “We wanted to take away that institutionalised nature of mealtimes, and we also introduced nutritional care plans so everyone in the kitchen always knew who was at any kind of risk and why, and had the ability to cater for people with a wide range of needs. This whole idea of ‘it’s not my job’ really needs to go out of the window.”

“We’re the only care home I know of that are putting the kitchen in that position,” said Walker. “It was really important to us that we could implement things like this straight away.” Kitchen staff had full information around issues like BMI and weight, and were also using ‘ode’, an appetite-stimulant for people with dementia as part of an overall holistic package.

Oak House’s innovations had proved so successful that the organisation was now providing training and consultancy for healthcare professionals and other care businesses, and had also launched a successful e-learning program. “Thinking outside the box can have a massive impact on people’s lives,” said Ball, while Walker added: “There’s a stigma around social care, but there’s such untapped potential. You really can make a difference. It’s so much more challenging working in this sector, but it’s so much more rewarding.”