5 tips on how to improve your Care Home

"It’s being vigilant every day to ensure standards are adhered to and the service is run well, with a sense of joy, service, love and contribution."

Care Home Manager, Liam Palmer, highlights how the fundamental principles of hospitality can dramatically improve your care home with 5 top tips.

Topics covered in this article

Introduction

1. Make the home appealing

2. Stand in the shoes of your residents every day

3. Set the tone around behaviours and culture

4. Build a community with the right mix of residents

5. Have a sense of pride about your home

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Introduction

I’m obsessive about making care homes appealing.

I’d like to explain why.

How does it smell when you walk in?

Fresh?

Or a faint smell of urine?

For me, that’s unforgivable unless there has been a recent unpreventable accident.

The reception area should be welcoming, clean, tidy, well laid out with clear signage.

Some places take it further with fresh flowers and the smell of fresh bread to make a first class impression, like a premium hotel.

These are nice touches but rather than a prescriptive set of do’s and don’ts, it’s a set of principles around hospitality and thinking of the customer experience, reflecting the level of customer you wish to retain / attract.

How you apply these principles is up to you.

1. Make the home appealing

The home needs to smell fresh

Firstly, the home should smell fresh at all times.

To achieve this, the housekeeping team needs to be well managed and the building needs to be well maintained.

The housekeeping team need to keep the carpets, floors, toilets and bathrooms, resident rooms, lounge and dining room all fresh, using the right materials and the right cleaning schedule.

The other essential element to this is about continence management and the impact this has on furnishings, floorings.

There are naturally 2 parts to continence management - urinary and faecal incontinence.

The 2nd is rarer but does happen as a complication – it can be brought on by stress for those with certain mental conditions and it can be an element of later stages dementia, it can also be in response to certain medications.

Urinary incontinence is a lot more common and managed by supporting people to access the toilet when they need to as well as the use of continence products, often continence pads and pants.

When these pads are removed by a resident and not replaced, there is a risk of their incontinence affecting the physical environment of the home.

In some cases, this can be managed with chairs and sofas that can be wiped as well as some type of hard flooring.

Before you think, oh that sounds great, this needs to be done with forethought and care.

How would you feel sitting in plastic type seating all the time?

It is not always welcoming.

Comforting, warmer fabrics can be part of feeling at home and relaxing.

This needs thinking through.

In regards to hard flooring, whilst it is easier to keep clean, what about the risk of falls?

Some older people are very prone to falls.

If the hallways or their bedroom has hard flooring, it may mean they hurt themselves more when they fall.

It all needs thinking through carefully, balancing risk with practicality.

The first experience of accessing the home needs to be positive

For me, first impressions are important. When someone comes by car to the facility, are the parking spaces clearly lined?

Is it clear where visitors park versus staff and professionals?

It is clear where the reception is / where you sign in?

Which book you sign?

Is there always a pen there?

Is the foyer / reception area clean and appealing, well laid out and tidy?

Does it have hand gel and a welcome sign?

Is there useful information about the home when you first enter the home, details of the manager or recourse if you are not happy?

All these little details create a first impression.

Is it clear what to do when you enter the home – press a buzzer, wait at reception?

No one wants to get it wrong, be presumptive or feel uncomfortable.

Make it clear and accessible.

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2. Stand in the shoes of your residents every day

This may sound self-evident or obvious but, I don’t apologise for including it. In my experience, it is very common for this to be lost as staff get into their own routine.

Slowly and subtly, the service can easily begin to serve the needs of the staff rather than the needs of the residents.

The home manager needs to be ever vigilant.

The same can happen in any organisation and is very common in healthcare.

The home manager needs to keep talking about this.

Talk about the customer experience and see every part of the experience of living there, through the eyes of the customer.

Here’s an example

A few years ago I worked for a premium branded home in the south east where the owners wished to attract more self-funding paying residents but sadly the owners didn’t fully understand what the needs of this group of customers.

The food budget was too low to serve these discerning top tier private residents.

At times, residents were given cheap powdered soup, minced low quality fish on Fridays, no alcohol with their meals, which many were used to.

They could not choose from a cooked breakfast each day.

The owners couldn’t understand what my issue was.

They were keeping to a tight budget, managing costs, they didn’t see what the “problem” was.

In my view, it was one of perspective.

The owners were deciding what this private pay resident wanted without listening.

They didn’t understand the expectation of this social group.

It was why so many respite stays did not become permanent residents.

Had the owners stood in the shoes of the residents, ate their food themselves, they wouldn’t have come to the same conclusion.

We need to remember that all elements of the service are put in place to meet the needs of these particular residents.

We need to step away from the bias of our opinions and judgements.

It is not about our wishes, preferences or what we think they should have or want.

We need to ask questions and listen to know their wishes and expectations.

We need give them the best we can, to challenge mediocrity and low standards wherever we come across them.

3. Set the tone around behaviours and culture

Culture is much talked about but not deeply understood by most.

Here I want to talk about it in the context of how to run a care home well (operationally sound, CQC compliant and commercially successful).

ALL visitors should FEEL welcome.

This means positive eye contact from every staff member toward visitors and a warm welcome.

All visitors should be acknowledged and find the staff team accessible.

This sets a culture within the home that is inclusive, customer facing.

We want all visitors to have a positive experience during their visit.

For families with loved ones in the home, the relationships and kindness from the staff team reassures them that their loved ones are well cared for and the home is professionally run.

The positive emotional interaction with the staff team also helps family members cope with their own grief, difficult emotions and in some cases a sense of trauma that their mother or father is poorly / has dementia and is now living in a care home.

How does the management team respond when things go wrong?

Does the manager ignore it?

Use it as a stick to beat staff?

Are they impartial or do they they overlook when it is one of their friends / someone they like?

How the home manager responds here will play a crucial rule in setting the behavioural norms, establishing the patterns of interaction between staff and management.

In time, these unspoken truths embody the feel and therefore culture of the home.

How is the culture amongst the staff team?

Either positive, engaged, valued for the most part or the opposite.

Does the home manager bend the rules for their favourites?

That will weaken morale.

It sends a message to the staff team that says “there’s no point in what you do.

It is all about who you know”.

Needless to say that is a toxic message.

There needs to be a kind, supportive approach toward staff by the home manager, with neutrality displayed at all times.

The purpose is that all staff feel that good work will be acknowledged and vice versa.

Serious breaches of your policies should be dealt with in a proportionate and consistent way.

Every significant action or warning by management needs to be considered as a message to the staff team.

For example, if mobile phone use is frowned upon, when a staff member is on shift seen using their phone instead of observing a vulnerable resident, the staff members could be seen to have neglected the resident and potentially put their safety at risk.

Management needs to provide objective feedback to the staff member promptly.

Repeatedly failing to act on these type of breaches will eventually bring a sense of chaos and disorder in the home.

Effective leadership entails focussing on and addressing significant breaches, with action that is proportionate to the risk / severity of that breach and being consistent, taking into account context and mitigating factors in how those breaches are responded to.

As leaders with responsibility for the quality outcomes of the service, we need to take very opportunity to be continually reminding staff of good practice so they avoid breaching the company policies.

That way when there is a serious breach, we can demonstrate we’ve been supporting our team, championing good practice around care delivery.

We should put our primary focus on prevention and upskilling staff by coaching and training people so they are better.

It’s tempting to focus on problem staff but it should be done whilst nurturing your team.

Many care home teams become broken and dysfunctional where a new care home manager becomes too harsh in meting out punishment / removing too many existing staff which often will destabilise a service.

It’s all about balance.

Being fair and proportionate, focussing on good care and nurture the talent and capability within your current team.

What behavioural standard do your senior carers adhere to?

Seniors should be in post because they are the best within the team, promoted because of their work standards, ethics and respect from the team.

Their work and behaviours should be excellent.

They should be role models, highly trained, knowledgeable and competent.

They should reflect the ethos of the home as defined by the registered home manager.

They should be part of the management team, aligned to the home manager.

If this sounds like an ideal, a dream which no-one achieves, you are right and herein is the problem in most homes.

Most problem staff teams have their roots in overly dominant / anti-social staff members that have not been tackled / managed properly.

Often these are senior carers in post with skills and knowledge deficits relative to their position.

Without a deep understanding of how to manage people well, deal with interpersonal problems, they will often revert to undesirable management behaviours including bullying.

This is usually to maintain their sense of power / position or in dealing with staff not working in the way they want.

This often experienced as bullying by their team members which harms the morale of the home and can cause mental health issues amongst team members.

The misuse of power at work can be very damaging to a persons self esteem.

These senior carers need to be shown how to lead confidently and use supportive language to get work done without bullying,

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4. Build a community with the right mix of residents

There are 2 levels of community I’m talking about here, the first level is the overall sense of community that is nurtured, celebrated with rituals, events, traditions and the depth of relationship and support and friendship between the staff and residents – this is the first level of community.

The second level of community I’m referring to here is about the home manager being deliberate and discerning in the specific mix of people that make up your community.

Placements should continue on the basis that a persons needs are able to be met by the provider and it works for both parties.

In some cases, a persons needs change so much that after adjustments have been made, different approaches tried, the placement is no longer adequately meeting their needs or in doing so, it is having a serious, ongoing impact on the quality of life of the balance of the residents.

In these cases, the resident will need to be moved to another service which will better cater for their needs.

Failing to do this can mean the majority being adversely affecting by one or two dominant individuals in the home.

It is very hard but we need to remember we are here to create a sense of home and community for vulnerable people who’ve often lost much in spending their final days in a care home.

We need to try and make our homes nice places to live, with a sense of joy and happiness.

We need to be clear about what mix of needs we are able to meet within the home and closely manage where residents needs change and manage that creatively and supportively.

Only after all options are exhausted, with constructive meetings with other professionals and the family, do we acknowledge the placement is no longer working.

Managing the mix of people living in the home is key to running it well.

5. Have a sense of pride about your home

This is the something extra that great homes have.

Some have it due to history, values (eg Royal British Legion homes – very well regarded), others have it due to an inspirational manager or leader.

In these cases, there will be a strong team.

Poor staff members will have been moved on / left voluntarily – the reputation will be strong.

It will be well managed and staff will hear and want to come and work at the home.

I think we need to have a sense of pride in our service, we should stand for something, have standards, strive for the very best, strive to win and retain a good reputation.

Recruit the best.

Give our residents the best every day.

A sense of pride is an attitude that everything matters and that our residents deserve the best every day.

It’s being vigilant every day to ensure standards are adhered to and the service is run well, with a sense of joy, service, love and contribution.

Pride.