- 14 October 2019
- 8 min read
Four essential Care Home Manager tips to help with assessments, care plans and managing incidents
Liam Palmer offers essential tips for Care Home Managers around assessments, care plans, care reviews and dealing with incidents and accidents.
Assessments for potential new residents / assessing levels of support required
Your needs assessment for potential new residents will determine whether you can meet their needs or not.
Different companies use different assessment templates.
It’s important a standard form is used so you compare those you assess objectively and so you get skilled in using it.
Most assessment templates have a scoring system. I use the bethel dependency tool.
I looked for potential new residents that scored within the “low rating” and stuck to that.
As my care home becomes more established and the skills-mix of the team changes, I may take some residents with greater needs (medium rating) on a case by case basis.
Assessments need to be especially clear on some important things – a person’s level of mobility, any serious risks or allergies, any recent surgery or serious health conditions that need managing, special dietary needs, current medication – particularly any strong medication to manage conditions.
Also family details - next of kin, previous GP surgery, date of birth and NHS number are all needed.
You have to keep in mind if a resident moves into your care home and becomes poorly enough to pass away, you would need detailed information to manage this appropriately.
Particular care needs to be taken regarding their wishes, who to contact etc, do they have a current and signed do not resuscitate (DNAR) in place? It all matters.
Care plans are the home manager’s roadmap and control document to enact the resident’s wishes, needs and wants, demonstrating they respected and acted upon.
The details will come from the assessment document. When your resident moves in, the fundamentals needs within the care plan need acting upon.
Different organisations have different protocols – but a rule of thumb that within 48 – 72 hours of admission, you need to have an operational, sufficiently detailed care plan in place.
Some organisations have respite care plans (a more concise version) for shorter stays.
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Good practice includes the following FOUR touchstones
1. The importance of using person centred language
For example “I enjoys cereals / toast for breakfast and occasionally love to have a cooked breakfast – no beans.”
Versus “he has a good appetite / likes any type of breakfast food.”
This is significant as it helps the carers to see the person, to have a sense of the resident expressing preferences and it also opens the idea that over time, their preferences may change and the care plan will need to evolve and reflect this.
The term “person centred” is more than just using someone’s name; it is honouring their individuality and getting the care service to adapt to that individuality as much as practically possible.
2. Conduct regular care reviews with resident and their family
ometimes it is monthly, sometimes quarterly.
This can be held with the resident alone, sometimes with family also, sometimes with a person appointed with power of attorney ( POA) for care for that individual.
There is a balance to be struck here. What is not good is where all the sections of the review are simply signed without due regard.
There should be a proper conversation to ensure all aspects of care delivery are fit for purpose and to note and respond to any changes or other preferences.
The key point is that as a resident’s needs change, it needs to be reflected in the care plan and care delivery.
Failing to do this can be a breach of the CQC guidelines around “safe” and “caring” and “effective and “responsive.”
For example, if a resident came to the home using a stick and now occasionally needs a wheelchair to get the dining room, this must be covered in the care plan.
Risk assessments MUST to be reviewed too. I met with the outgoing Chief Inspector of the CQC a couple of times and she made it very clear that the “voice” of the service user /resident should be at the heart of all care.
The views of the recipients of care must be solicited, considered and acted upon and documented accordingly.
3. Care plans – paper versus Electronic
In much of social care, there is a marked general distrust of electronic care plans.
There is a strange commitment to paper plans and the use of paper for record keeping which is practical but archaic.
The argument for paper records is that having one record in your hand is a great way of keeping track of care but the downside is significant – lots of repetition, duplication and time taken away from residents through the writing up of records.
I believe the distrust of electronic care plans is based on reviewing care plan technology from about 10 years ago.
These were simply desktop versions of paper care plans.
I think the distrust was merited at the time (I did a project on offerings available in 2018).
However, the next generation of care software is mobile / PDA driven, intuitive (icons not words to capture activity) and well designed to manage risks, including alerts for changes in condition.
Several of the leading brands of care monitoring are Person Centred Care (PCS) and Nourish.
If a care home uses electronic care plans, the benefits need explaining and staff need to be consistent in their use of them.
The CQC is positive about the adoption of tech where it is used consistently and fit for purpose.
After personally running many residential services, I believe the primary benefit of well designed care planning software is about managing risks – if something adverse is happening there is an alert (paper plans don’t do this).
The secondary level of benefits are ease of access, ease of update and ease of accessing / sharing info on a resident in an organised and consistent way (subject to usual GDPR guidelines of good practice.)
4. Dealing with incidents /accidents
Firstly we need to go back to first principles about why a service needs to keep track of incidents and accidents.
It is to capture potentially significant occurrences involving mainly residents (also staff) that will be reviewed / with possible further actions taken to demonstrate good and effective care.
It also context if there are further complications with an individual, it can help to demonstrate a build up occurrences e.g. with a person with declining mobility, they may start to slip or fall more or a change of medication may lead to more falls.
Recording these means action will be taken, family will be informed. These are my basis of first principles around what to record.
Next, you need to agree the specific definition of an incident or accident within your organisation and team.
What is the threshold? This is not being pedantic; it is an important aspect of your home governance.
Some homes will define an accident as anything causing actual harm (a skin tear) or something more significant.
The threshold needs to be clear and used consistently.
Some homes see incidents as occurrences that didn’t cause any harm.
For example, residents who have hit their head will often be monitored for the next 24 hours and have their well-being recorded every 2 hours to note any change.
Some high risk residents who hit their head will be admitted to hospital as a precaution immediately after as per agreement with their doctor / care plan.
The other important part of this is the loop –there needs to be a loop of reviewing, checking, monitoring and signing off if any action needs to be taken before closing the incident investigation.
This is a tool used in care homes to ensure residents are kept safe and that the registered manager is evidencing that they are providing safe and effective care for those they support.
There will also be a monthly analysis showing the times of falls (any patterns), the location of falls etc – this is helpful info, for example there may be more falls at handover if the handover takes too long with the whole team in attendance.
The management data will reveal this and action MUST be taken in response to these findings and documented.