• 31 July 2019
  • 43 min read

Care Home Quality Podcast - episode 5 with Isaac Theopholis, author of 'How to get Outstanding'

  • Liam Palmer
    Registered Home Manager

Liam speaks with Care Home Manager, Isaac Theopholis, about his incredible and inspirational journey to authoring a must-read book for Home Managers on how to get outstanding for your care home.

Topics covered in this podcast

0.00.59 Introducing Isaac

0.02.25 What Isaac is currently doing

0.03.19 How did the writing project come about?

0.09.10 How Isaac then positioned himself in Social Care circles

0.10.35 Who is the book for?

0.14.50 Where did it all start?

0.20.33 When Isaac started nursing

0.25.00 The MBA

0.27.15 Becoming Home Manager

0.33.44 - About the state of the home when you became its manager

0.38.20 How do you build a team that gets an outstanding rating

0.43.25 Preparing the team for inspection

0.47.00 The home needed a culture shift

0.56.50 The challenge of leading a multicultural team

1.00.36 Teaching the 5 Key Lines of Enquiry

1.05.53 Going the extra mile

1.09.40 Final tips and take aways

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Who is Liam Palmer?

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0.00.59.Introducing Isaac

Liam:

Very warm welcome to Episode 5 where I interview Isaac Theopholis. Isaac is the author of How To Get Outstanding where he gives his lessons of how he achieved overall rating of outstanding for his nursing home in West Sussex.

What's unique about Isaac is that he then did it again. He not only got another outstanding but got an outstanding for all 5 domains.

So a really interesting guy.

He's a Nurse. He's got an MBA. A nice mixture of practical business management plus Nursing expertise, plus a compassionate heart.

He's really quite an enigma.

He's quite a quietly spoken man but has a really great story and from that experience he wrote this book. 

So I highly recommend this book for those who work in care homes who want evidence that the care you're providing is at the level of outstanding.

Without any further ado a very warm welcome to Isaac Theopholis.

0.02.25 What Isaac is currently doing

Liam:

Can you just briefly explain what you are doing now, professionally?

Isaac:

I am a care home consultant.

I'm also author of the book 'How to get outstanding' which is one of the books which will help the providers to achieve outstanding rating from Care Quality Commission.

And yeah, my mission is to help Care Homes to improve and be the best and provide the best care for the people they look after.

0.03.19 How did the writing project come about

Liam:

Do you want to explain how that writing project came about and who you worked with?

Isaac:

I was a care home manager before and my care home, with the help of my team, we achieved outstanding twice and the second time we achieved outstanding on five domains of inspection.

After that, I thought okay, I should share this knowledge with all other providers in the UK because when I look at the stats, it was only 2.5% of the care homes achieving outstanding and there's not a lot of documents out there which will share and that time I didn't feel like there was a lot of documents which helps the providers.

Liam:

So let me summarise. You were running a care home in West Sussex?

Isaac:

Yes.

Liam:

And you got an overall rating of outstanding. And you got all 5 key lines of enquiry outstanding.

And then what, they came back and you got outstanding again?

Isaac:

Yeah.

Liam:

OK. So once you got the five you were like 'right, we need to share' and that's where the desire for sharing came about.

How do we go from wanting to share to there being a book in my hand?

Isaac:

I think it was a big learning experience for me and also it's a it was a big Challenge.

I left my job and I asked my wife and said, okay, how can we share this to all of the people?

And I thought initially I should do the consultancy, to go into Care Homes and share my knowledge with particular people that I go for work with.

My wife said, "that doesn't help other people in the sector.

"You can't go to all 16,000 care homes in UK."

So then she came up with the idea, why can't you write a book?

So then I thought, HOW do I even write a book?

Anyway, I had to put everything together and it took me about three months.

I asked my wife, how can we make this possible and without a job and without a salary for three months?

She said, let's take out a credit card, survive for next 3 months, and then you write the book.

She was really helpful.

We started writing from early in the morning till late in the evening.

She just locked me in the room and then I just got on with it.

Looking back, I know how tough it was and I think I learned a lot about writing books, how to structure it and then how to publish it.

I self-published it so I learnt how to publish the book.

I approached a few publishers and they said the timeline is 6 months or 1 year, okay, and you have to pay this much amount of money, which I didn't have so I thought okay, I should do something about it and then self-published it from the person who can print the book and then yeah they did.

Liam:

Wow. There's a lot there. I absolutely love it. It's a great story.

A quick mention to Mrs Theopholis. What a great story of companionship and partnership and helping each other.

Quite a sacrifice she made. What delights me with this podcast is it confirms what I guessed which is that you're a value-based leader and that you're all about making a positive impact for residents.

You're out there for genuinely raising the quality of care.

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0.09.10 How Isaac then positioned himself in Social Care circles

Liam:

So tell me about when you got that book written to meeting with Professor Martin Green.

You know, you're quite out there with some of the key figures of social care and you've done a great job of positioning yourself well.

How did you go about doing that? Or was it fortuitous circumstances? Or a deliberate plan?

Isaac:

There was no deliberate plan.

Liam:

Okay.

Isaac:

Okay, it all came together very well. I think I had an ambition of launching the book at the Helpers Care Show 2018.

And and and then that was a deadline for me in order to get it printed out then I was working towards that target.

I think the good thing about our sector is people are so helpful.

So I called all these key figures and asked them, 'I'm writing a book about this and this is where I'm coming from, can you help me with this?'

And they were all fantastic and the people who I send a PDF copy of the book to then they were all like delighted to read this book and apple in came back to me in four/five day's time.

0.10.35 Who is the book for?

Liam:

Let's just recap.

So the book is called How To Get Outstanding, The Ultimate Guide to Care Homes.

So who's the book for and what and how should people use the book?

Isaac:

It's not a book to read while you're in bed.

That was not my intention when I was writing my book.

It's sort of structured like a guide for registered managers and providers.

There are quite loaded guidelines out there, you know from Care Quality Commission.

You have to meet this, but there was little documentation about how to do these things so that was my key priority.

They have key lines of inquiry but very limited information on what you can do in order to evidence against that.

So that was the purpose of doing this book.

Liam:

OK, and then, so Home Managers use the guides so they can move their home towards outstanding or their home will more accurately reflect what outstanding is considered to be by the CQC, right?

Isaac:

That's right.

The biggest problem in the sector in the sector is that some of the Care Homes do a great job by having external audits happening in their care home.

So they know when an external person is coming to their care home, telling them OK, these are the things that you need to improve which is a great thing.

But I think most of the Care Homes doesn't have this process. And this is a guide.

I think this is one of the cheapest versions where they can actually look against it and see where they stand.

If they are very organized and systematic in doing that I can assure you that if they follow the book they can jump from good to outstanding.

Or even from inadequate to outstanding, not straight away, but in a few inspections.

Liam:

Again, for the listeners we're not promoting your book for the book's sake. But this podcast is about Care Home Quality.

You've done the leg work about how care homes are measured and you've put the answers in there with real life examples of how to do it.

I encourage all the care home managers out there to get this book because it raises the quality of your care home. I endorse this book for that very reason!

Isaac:

I still feel like it's an unfinished book.

I feel like I should add more on to it and there are some key elements missing.

Iit was my wife who told me, okay, let's not make it perfect and let's release it.

Along with the examples that I have written, I'm sure there's a lot more you can add to it yourself.

So I think I have done the 90% of the work, and the other 10% is the people who have used the book.

Liam:

Yeah, that's perfect. Extremely helpful.

Congratulations on doing that because, you know, I'm a care home manager and in order to get to outstanding, I'm going to read your book!

0.14.50 Where did it all start?

Liam:

You've got your consultancy. You want to help providers get to outstanding using both the model and the formula you've got and you want to coach them in that.

I also happen to know you've got a background in nursing and you've got an MBA. 

So you're a pretty well rounded individual for this work which is excellent.

So let's talk through then, take us back to University where professional life started, where today you've got a book out, you're spearheading this revolution about Outstanding.

Where did it start?

Isaac:

I recently did a speaking session for some children up in Manchester.

It was about the topic was how to be outstanding, how to be resilient.

While I was doing this presentation I was actually doing a little bit of reflection on my life.

I would like to call my life the three phases - each phase has different seasons. So the first season was winter, which is from 0 to 18 years of age and then the second season was from 18 to 32.

The spring is between 18 and 32, and summer - I'm still not sure whether my summer has started or not!

Liam:

Okay!

Isaac:

I think I am moving in that direction!

So which phase do you want me to talk about?

Liam:

I think within the context of you becoming a professional you are today take us back through any moments in that winter phase that give us a hint of you becoming this professional of this particular career trajectory.

Isaac:

I am naturally a caring person and I call the first phase of my life winter because I had a tough time in my life up to 18.

My grandfather was a doctor. He was the first doctor to teach in my home town in India where I am from.

When I was 10 years old, I lost my mother and after three months I lost my father as well.

Ah, this is a story that I really didn't share because I didn't really want other people telling me, you are a child without parents and I'm so sorry for that.

I really didn't want that sympathy and I kept that quiet myself.

Liam:

Fair enough.

Isaac:

I start to realise, I think that's really connecting the dots in order to help me achieve the things that I have achieved in life, and going forward as well it's really going to help me in my life.

I think losing parents at that age is one of the worst things that can happen in your life.

But I think it was a good thing that my parents actually taught me never complain and move on with life.

That's one of the key areas that I still remember about their parenting or is great.

I think I never complain about anything them more than happy with what I have got at any moment in life.

Yeah did very well in school.

I was in a boarding school for all my schooling.

Just one of the most fantastic periods of my life and it was all funded by one of my aunties who was a professor in U.S.

Liam:

Wow, really! Okay.

Isaac:

She was really helpful and she was so caring, she comes and visits us every year.

She was really going to adopt us as children and take us take us to U.S.

But unfortunately when I was in 11th grade, she passed away as well in a road traffic accident.

I thought I had two tragedies in life but then came the third one. That was really the last hope again.

We had to move on, we have to be resilient and be happy with what had got and move on with life and do everything that I can to do the best wherever I am.

Liam:

Yeah Okay.

0.20.33 When Isaac started nursing

Isaac:

So I did my nursing when I come from Kerala in India.

It's really like a factory for Nurses!

Liam:

Oh really! Okay!

Isaac:

We have a lot of nurses coming out every year and that supplies the entire world.

Liam:

So what do you mean by that? A factory of nurses?

Isaac:

I didn't mean it in a bad way.

Liam:

No, no. But what did you mean by that: university, a popular profession?

Isaac:

It's a popular profession because that is the easiest way for people from Kerala to migrate to different countries.

Liam:

Right, Okay.

Isaac:

To emigrate.

So that's when I did my nursing.

My two elder sisters studied nursing and whenever they came home we'd have talks about nursing so they were always talking about going to hospital, what's happening with the ward, operation theatre, and it actually triggered my mind to head towards Health Care Direction.

So as soon as I passed my schooling the only option in front of me was nursing because nobody else is there to tell me there are different options.

Liam:

Hah, Okay! There's nursing or nursing. I'll get back to you on that one!

Isaac:

I did look after my grandfather, my grandfather was bedridden so I had to look after him for like several months.

I stopped my nursing and went back home and looked after him.

I didn't know any basics about nursing during that time.

So I call my sisters and I asked them 'how should I turn him? how should I move him?'

Yeah, I think I did a good job because he never had any pressure sores, he was well cared for and he had a peaceful ending as well, which I'm really proud of.

I think that was when I look back, you know, caring about other people was always with me.

I think that means that will definitely stick with me throughout my life as well.

So yeah, I did nursing and then migrated to UK in 2010, when I was 24.

I became the manager when I was 25.

Liam:

Pretty quick then, OK!

Isaac:

I had a passion to learn new things and move forward.

I would say I get easily bored when I do something for an ongoing basis.

I love to have challenges in order to move forward so good.

0.25.00 The MBA

Liam:

Tell us a little bit about, you know, you did a nursing degree.

You also did an MBA.

When did you do that was that before you came or after that?

Before you became a home manager or after?

Isaac:

I did it as a part-time along with my manager job which was not a good choice, it was really tough!

Liam:

Hah, brilliant, okay!

Isaac:

I always wanted to study more and I think when I became the manager that is the time when it was financially viable to take proper formal qualification.

So when I looked at different qualifications provided in the UK on a part-time basis, I think it was only Canterbury Christ Church University within reach for me to do a Part-Time MBA.

Liam:

Did you turn up there, as in go there face to face?

Isaac:

We had once a week sessions. I think the group was very small like 10 - 12 people.

I was the only one in social care.

Liam:

So following that chronologically, we've got you coming into your nursing in India, coming to the UK at 24, manager at 25, studying your MBA. How long did you do that for?

Isaac:

I was supposed to finish it in three years. It took me three and a half a years because I was so busy.

Liam:

Fair enough. You were busy, so that's alright.

0.27.15 Becoming Home Manager

So, you were a nurse, you turn up at this nursing home.

Went from nurse to home manager.

Tell us what happened there.

How did you do some of that stuff; how did you find it?

Isaac:

I think the passion for learning is always there for me.

I think everything came together in 2011.

There was a rule in the UK that anybody who is on a Visa here has to earn £35,000 in order to get settled in the UK.

At that time the salaries for nurses were very, very low, like £22,000 per year.

There's no way you can achieve £35,000 in five years time.

Some of my friends moved from the UK to Australia in order to get settled there and some some wanted to move to Canada.

And then me along with a few of my friends we decided to take on a challenge.

What can we do in order to achieve that salary scale?

So I did a level 5 diploma in leadership and management.

I realised that the manager of the home had been managing for a long time and probably wouldn't be stepping down any time soon.

I didn't think I will get an opportunity there in order to move up because this lovely lady has been managing this care home for such a long time.

So I went up with my notice to the office.

And it was an interesting day because the day I went in with my notice I found out the home had been sold to another person.

Liam:

No!

Isaac:

He took my notice of resignation and I was so disheartened because nobody asked me why I was leaving!

Liam:

Ooooh.

Isaac:

He asked me from the management side during that particular moment in time.

And then later on one of my went into the office while I was not around, she went into the office and she got really angry at the management.

And she said 'this person is leaving because he's not going to get far, you need to start making people stay here!'

Liam:

Brilliant! Nothing like a bit of emotional bribery!

Isaac:

I didn't know about it and I realized about the story only after some time.

And then this lovely gentleman called me while I was travelling to London to get a new Visa.

A gentleman called me and said 'come back to the care home'.

We will have a chat about it.

So I stepped from the train back into the platform.

I took a taxi, went back to the care home and he said okay, here's the same salary, you're going to be the deputy manager status.

Why not I said, because I don't want to move away from the place where I'm living.

Then the journey started.

The old manager, because of the new structural changes, she didn't want to stay too long.

So she left and this lovely gentleman asked me if I wanted to become manager! And I wanted to say yes straight away.

But I said, okay, I will come back to you.

The next day I said yes.

Liam:

Wow. So when was that?

Isaac:

This was in 2012 or 2013.

Liam:

So you were a nurse. You went to resign as a nurse because you needed £35K. 

And they said, we'll sort you out, and make you Deputy Home Manager. 

How long after that before you did the Home Manager role?

Isaac:

Three months!

Liam:

So three months later the previous manager stepped aside and then you became her manager - did you get any training for that?

Isaac:

No, when I was Deputy manager I wanted to do this LPA and I asked the new manager, will you be allowing me to do this at University?

He said yes to that and that was one of the other reasons why I chose to stay there.

It was flexible and he was a great man and he supported and I think this was his first care home and we learned the process together how to develop a fantastic care home.

0.33.44 - About the state of the home when you became its manager

Liam:

So what was the compliance rating when you picked up the home and how did that sort of first-year unfold? What did you do?

Isaac:

We didn't have an inspection in the new system yet.

Liam:

OK, yeah, because that was about 2014 / 15.

Isaac:

In my first year of my manager job it was a big learning curve because nobody was there to tell me how to be a good manager.

Of course the director was there to help me and guide me to support me with the difficulties, but I did put a lot of effort as well.

Working overtime and putting systems and processes in place, getting the right team around me as well.

There was a lot of cultural shift as well because when the old manager left, I think that part of the culture went along with them and then I had to put new one in.

I wanted to improve the morale of the team and look after people and talk to each other, listen to each other that kind of leadership.

Liam:

Can I ask Isaac, so this is before you did your MBA. So how did you know what to change the culture to?

Isaac:

I didn't know the culture in a broader term during that time, yeah, but I still knew the feeling.

I can see you people are not talking to each other, that means there is a clash, so there's something going on between them.

Okay, so my role was to immediately understand what's going wrong with between them and how we can make it better.

So it was all working on the team, how we can build a relationship between the staff, In order to deliver the best care for the people.

And also I would say I was a very good reader, so I read a lot of books.

I think that has really opened up my eyes on how we can improve the team well-being.

0.38.20 How do you build a team that gets an outstanding rating

Liam:

It's not just about ticks and check lists. There's some train of thought. I've visited lots of care homes, not as many as you have. 

But what I notice straight away is the emotion in those homes is different. People are warm, engaging, emotionally sharing. Not being robots, not being policemen.

In my limited experience a leader can only take people to the point they're developed to.

So the more developed you are the more you can encourage your team.

Isaac:

Because I was learning I wanted my team to also having a career progression with me.

I thought everyone is good at something, so my aim was to find out what they're good at and really inspire them to take for the qualification based on what they are good at.

The key was to develop the relationship between the staff, hence they have a reason to stay there.

And to be honest, there's not a lot of options we can give to them to progress but we can direct them to different things which can make their life better and also their profession better.

So by the time I was leaving my care home, there were quite a lot of staff who were already in doing management qualifications.

The people who told me they weren't going to learn anything more have now completed level 5.

So it was really great to see the team was also developing along with our mission of delivering the best care.

Liam:

That's fascinating. I find it so interesting that in different disciplines people stumble across ideas that just work. They might put different labels on it. But they just work.

In another discipline they come across the same idea but they just put a different label on it.

For example in the 80s and 90s in industry they have these concepts about learning organisations and what you're talking about is a sense of embedding a sense of learning in people.

That is, to my mind, an integral part of why the team developed to an outstanding level.

To get 5 Outstandings is really exceptional.

So I just want to take a moment to see if we can pull out some things we can try to emulate.

So you said you:

- focussed on the staff

- focussed on the emotions of the staff

- you had a passion for learning and personal development

- you've wanted to inspire them with learning

- you actually helped your staff to develop

I'm looking at that as some of the DNA of the things that got you your Outstanding.

You've got a genuine emotional care for the staff.

I try to do that... don't get it right all the time! But it's about putting across that you do care.

There are moments where you are a home manager where instead of telling someone off you say, 'you know what - just take five'.

0.43.25 Preparing the team for inspection

Liam:

OK, perfect. So let's back that up slightly.

So, you were in post. You assess the culture. You're working on the culture.

So where do we go from there to where you left, and inspections and you did your MBA.

Isaac: 

After one year the team was already there.

It was very hard to bring everyone into the into our mission and the people who didn't adapt to it, they found it very very hard to change and ultimately they left and I think that was good for the organization.

And then we had more quality people coming in through referrals, which is very good.

But we also had staff bring in one of their friends to come and work for us.

Once the team was set, we did a lot of stuff initiations like we did parties together, we did trips out together, training together.

The trainings are not like boring training. It's also a lot of fun and we enable our staff to do the training for other staff.

It was a good learning for them as well to stand up in front of the crowd and do the sessions for their colleagues.

So there was a lot of fun going into it and then they bring the family as well.

So this part is we bring the staff family and children and they have little fun together and then we took the staff out for trips as well.

We divided people into groups, meet the staff in the different groups and take them for outings.

The key was to develop the relationship between the staff, hence they have a reason to stay there.

They just get along very well and it's a lot of fun and happiness.

Liam:

Really, okay. So tell us a bit about that to tease that out a little bit. What was the purpose intent of that? Was that about the staffing dynamics in that area of Sussex. Or was it about the change of culture?

I mean, why did you go that way - to decide to really engage the staff socially?

It sounded like you were sort of drawing everyone together. So what was the intent there?

Isaac:

It's the feel, I would say.

To improve the feel of the care home in general.

During the early part of my manager career the resistance from the staff was so high I didn't implement any new changes.

0.47.00 The home needed a culture shift

Isaac:

And then I started realizing okay, it has to be a culture shift and also there has to be a way of teaching them, you know, why we are doing the things that we are doing.

When we tell them to do things without a reason and they don't understand the genuine reason there is going to be resistance all the time.

That was really important for this time.

And when they are on board admit, okay, we need to do this because of this and this it was easier for me.

And when the culture was tight and the team was better it became a team mission, like a collective Mission.

I think we started using the term Outstanding.

So we all have our meetings where we were discussing about how we really want to be outstanding and we want to deliver the best care possible.

Liam:

Really! Okay.

Isaac:

Through all the leadership, throughout all the staff meeting and anything less than that, anything average we didn't accept it.

There was an expectation of high-quality from everyone who's working there.

I think that really worked.

And as soon as somebody is dropping down it's easy to identify and it's easy to pick up as well.

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Liam:

And was that just an idea in your head. You just thought, right at this next meeting I'm going to talk about outstanding.

Isaac:

I attend the hand over every morning which is a must for me and I think what worked very well was being in the handover and having the love with my team.

It's a positive thing about a team and give a bit of a smiley face in the morning, that really motivates the team to do a good job on the day.

On a day to day basis we were really pushing like, you know, we are going to only accept the best here, not in a threatened type of way, but in a very motivating type of way.

The people we look after - all the vulnerable people of the society and they can't talk for themselves, they can't raise their voices - so we are here to protect and that's a style of tone that we used all the time in our conversation with the staff.

So I think that has become really imprinted in the culture abilities.

Even the errors when I'm not around or when the nurses are not around they could handle any complaints very easily.

So if they can't manage it, they will refer to me straight away.

I think it was sort of like an automatic high-quality machine running all the time. The handover was a very important time for me.

Liam:

It sounds like you encapsulated the 'lead by example' type of leader. Very much in the midst of your team. But what's also very interesting to me about coaching and mentoring and educating your staff indirectly is how you've done it with all the stratas of the team. Not just your managers. You've embedded it throughout the team.

No doubt that's why the care home's team became so strong.

You're taking time to communicate. But in each communication you're sowing seeds. You inspire through your own positivity. You then lift the people who work with you.

You've taken that to extraordinary levels. 

I'm obviously interested to know how and I suppose like many things in life it's all about the detail?

Isaac:

Yes, I think the hand over in the morning is very crucial.

A lot of the time, staff come in very tired, they've worked very hard, they work three or four long days in a row and they're very tired and when they come in the morning, they're probably still half sleep.

Giving them a bad start isn't it a good idea for the residents, so it's important to give a bit of motivation a bit of love in the morning.

Not even going beyond the boundaries and it really worked out for me very well.

Liam:

So, I love what you're saying. Showing that deep respect, empathy. Can you explain... so you walk in. Is it a slap on the back, is it a hallelujah? Is it a 'great to see you!' What is it in those first 5 minutes that makes people happy?

Isaac:

It's very hard to explain but I think it's either giving them the bright smile early in the morning.

As soon as I walk in I make sure that I say hello to everyone and good morning to everyone.

So I go into the kitchen, I go into the house keeping people.

I go into the staff room as well, say good morning before I start the Handover. And yeah and the laundry and the maintenance man, and then the comments toward the Handover.

That's between the nurses and the whole team sitting around a table.

So we don't allow anybody to go away from the table because to keep them engaged.

Liam:

Are they sitting down or are they standing up?

Isaac:

Sitting down.

If somebody is standing we just asked them to come and sit along with us.

We go through everything we need to do, like a mission.

I can do this, you can do this, then we share the responsibilities and then the mission starts.

The morning time is dedicated to seeing what's happening on the floor. So I spend time with them.

We have been made breakfast and putting some lovely music early the morning.

And yeah, it just energizes people.

Liam:

Yeah, lovely. I think I want to go and move into this care home! The feel that you've engendered there IS different. There's lot of care homes that do that. 

But the degree to which you've done it to is interesting.

It's good care practice. 

But it's the difference between an amazing golfer and a good golfer is little subtle differences.

What I like are the little details about making people feel included. Making them feel valued.

0.56.50 The challenge of leading a multicultural team

Isaac:

It's more challenging in the care sector because we have staff from multicultural society and leading a team of multicultural people is so different.

In itself it's the leadership challenge.

I don't think we have enough training to adopt that challenge or how to deal with that challenge.

Because the way in which you deal with somebody from Spain is different from how you deal with somebody from India.

I think it's all talking about their language is that's their priority.

So talking about their interests and telling them to share what and how they do things in their country and learning about each other, talking about their family - communicating based on that and it really works very well.

Liam:

So that was what you did was it? Kind of culturally appropriate yourself to each culture.

Isaac:

I think even when I came to England, I started as a carer in a care home first, and I was watching, my first month, to see how people are talking to each other how they greet each other, what are the common terminologies used and we never had any training on this: 'This is what the culture looks like, this is what you should do.'

I don't think any of the migrant nurses get that sort of training in any sector, I mean, there might be, I don't know which I'm unaware of but whenever I have a new staff from a different country, I always tell them during my introduction, okay, this is how you deal with the people that you are caring for, this is how you deal with staff from this country, you know, to enable them to work with a Multicultural Society.

Liam:

Brilliant. Yeah, that's really quite profound.

I wouldn't have expected that.

That's the whole purpose of interviewing interesting people. They do things in interesting ways.

Isaac:

But I think the leader has to take all the steps to put all these people together for the same mission.

And that mission is to deliver the best care for the people, and if we don't understand the cultural barriers between the team nothing is going to work out.

Coming from different countries, with different backgrounds: that itself is a barrier to perform as a team.

If leaders don't put things in place to allow the team to work together, then nothing is going to work out.

Liam:

Because naturally there will be barriers between ethnic groups in some shape or form.

1.00.36 Teaching the 5 Key Lines of Enquiry

Liam:

So did you teach your key people about the KLOES - the 5 Key Lines of Enquiries (KLOES)? How did you embed that into your care home team?

Isaac:

I think that when I become a manager it was good that I was starting as a fresh manager.

I mean, I wasn't conditioned in anyway to becoming a bad manager.

My director as well, we both wanted the best.

So we started learning ourselves, you know, what are the CQC guidelines and how we can map everything, what we do against it.

So that was a deep learning curve for me as well.

When I looked at this regulations and the guidelines and the Health and Social Care Act on all those documents you see on the CQC website, if it is done properly, it should serve a purpose.

We don't have to reinvent the formula in order to deliver outstanding care, the formula is already there and we just follow it.

We don't have to reinvent the wheel.

We look at - How are we going to do these things?

In the first year of working at the home, it was putting machine like systems and processes in place and getting the right team in the home.

Everything needs to be very disciplined. Like Jim Collins mentioned - he's one of my favorite authors.

He mentioned that there has to be discipline.

I don't remember the code, but they have even though there is a friendly atmosphere there has to be some kind of discipline which we don't have to enforce but it has to be automatic in the organization, so we put systems in place.

In the three four months, it was very difficult to get it organized.

What is our system? What is our process of encouraging creation?

And how are we going to deal with that in our care planning?

How often is it updated?

If it's monthly who is going to do the updation?

So we divided them into key workers and then they do the updating.

They come at a specific time for doing the care plans and then cleaning schedule.

So we put systems for all aspect of the care home.

And then we monitored for few months to see if it's running automatically, and then including the governance of the care home as well.

Manager audit is so important, I need to make sure that I do my job as well.

So for the first 15 days in a month I'll be focused on my work, like doing the audits and doing the action plans.

And then rest of the 15 days in a month, I will focus on outstanding things.

So how we can be innovative and how we can make progress on creative stuff.

Liam:

So that's how you split your time, really? How fascinating. So it wasn't by accident then was it!

Isaac:

I think being organised is needed to deliver the best.

We had good systems and process in place. We had a good team.

They were all ready to go an extra mile when we just tell them an idea, they'll organise it and they will do it.

1.05.53 Going the extra mile

Isaac:

An amazing story that I have is, we decided to take our residents to the Brighton Beach on a sunny day, which is like 12 miles from the place where I worked.

The people that we looked after was elderly nursing, dementia type of residence and they were in the latest stages of their life and quite frail and weak.

They decided, okay, let's take them in disabled type of bus, very easy to wheel them up.

And then we realized the wrong bus arrived on the day, they had a few steps to go up there and we had to carry some of them to their seats.

It was done with the willingness of myself and my team and we had some tough guys and the residents were ready to take that risk as well.

So we just said okay, the wrong bus arrived, we can't postpone this, let's do it.

Some of them were able to walk and some of them had to be carried. When we reached Brighton beach, it was a pebble beach and then the wheelchair won't go in the pebbles, of course.

So we had to carry them to the right spot as well, right in front of the sea, and put gazebos and things like that and it was a very big success and that is a type of team we have.

It was a bright sunny day as well.

Liam:

Beautiful. And I suppose in a more traditional setting those lovely individual would never get to do that. Experiencing being able-bodied, being independent, risking a little bit. That's an inspiring story.

Thinking, how can we give the residents in our care better experiences that are more natural to what they have done before.

Isaac:

I'm sure a a lot of Care Homes out there are doing similarly exceptional things but when it comes to inspection, they're not good at evidencing it and that's where they lose their outstanding rating.

I think that's something that I want to give a tip for all the care home managers out there.

I'm sure you are all doing a great job and you're doing amazing things much better than what I did, but it's all about putting it together in the evidence folder.

You want to show the inspector because if they're doing a great job, you should shout out about it.

That's how the care setting improves.

Liam:

I think we've covered it pretty thoroughly, but is there anything else that stands out in that journey of becoming the management consultant and author that you'd like to share?

1.09.40 Final tips and take aways

Isaac:

There'll be a lot of things that I could share and learn from other people too.

If anyone wants to contact me I'm more than happy to learn from them and share with them as well if I can help them.

But yeah, I think if I would give a single piece of advice, it'd be never stop learning.

Keep the mind open to everything so that you will learn.

Every other person you meet will know something better than you.

Liam:

So keep learning, stay humble, learn from others. I think you've shared some very personal anecdotes about how you came into nursing. Is there anything else around your formative years that you want to share?

Isaac:

When I look at my life and what I'm doing now and what I'm going to do in the future I think we all need to improve what we are doing.

The people that we look after they all come to us during the vulnerable part of their life.

We are in a fortunate position that we are able to provide the care now and I think as a sector we all need to try to improve and improve the sector in a such a way that when we or our younger generation get older, you get the best care possible.

So if there's bad care in the future, we are responsible for it. So we all need to strive forward to improve the sector so that elderly and vulnerable people in this is a problem throughout the world.

During the last stages of life they deserve the best because they had a lifetime of experience, lifetime of achievement they have done throughout their life and which we should evaluate respected and we do our best in order to provide the best for them.

So that's what I believe in, you know, everyone deserves outstanding care.

Listen to more episodes

• Care Home Quality Podcast - episode 1 with Jeremy Walford, CEO of Middleton Hall

Care Home Quality Podcast - episode 2 with Samuel Barrington, CEO of Care Improvement Associates

Care Home Quality Podcast - episode 3 with Dr. Keren Wilson, the pioneer of Retirement Villages

Care Home Quality Podcast - episode 4 with author and recruitment specialist, Neil Eastwood

Who is Liam Palmer?

Liam has authored two books about care home management.

He is an advocate of raising standards in social care through developing leadership skills, and he has worked in many healthcare and care home settings.

In this podcast series, backed by Nurses.co.uk, Liam interviews inspirational social care and care home leaders and innovators.

Who is Isaac Theopholis?

Isaac Theopholis is the author of the book, 'How to get Outstanding' an ultimate guide for care homes. In it he shares how he has managed to achieve outstanding across all his domains. He is committed to improving the quality of care delivered in care homes.

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• Should I look for jobs managing small care homes or large ones?

• What is the difference between a residential home and a nursing home?

• Peripatetic / Operations / Regional Managers and Operations Director - what's the difference?

• Do Nurses make the best Home Managers?

• How can I research whether a care home is well run and good to work for?

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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Managers” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.

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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Managers” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.