• 21 November 2019
  • 6 min read

How to successfully manage night staff in care homes

  • Liam Palmer
    Registered Home Manager

Managing the night staff in your care home is essential to the safe operation of the service, and assists a positive CQC inspection. Here's our guide on night shift staffing for home managers.

Topics covered in this guide

The benefits and drawbacks of having dedicated night staff

What is it like to work night shifts in a care home?

A few key tips to manage quality of care at night

Care home management is too often absent at night

How to manage quality in your care home with an effective audit process

Common errors in audits

The importance of the internal mock audit / the last CQC report

The benefits and drawbacks of having dedicated night staff

There are advantages for a care home to have care staff who only work nights. It means that the other care staff don’t need to rotate their shift pattern from days to nights and back which can be difficult.

Where a staff team have regular night staff there is often a tension and rivalry between the night team and the day team. This is usually based around the following assumptions:

- a perception that on some nights, the night team should do more (more cleaning, get more people up in the morning and lighten the workload for the incoming day shift)

- a perception that days are harder and nights are easier

What is it like to work night shifts in a care home?

I’ve worked nights in a care home for 4 years. I found the following that working nights permanently has a bearing on an employee’s sleep patterns and appetite. I found this can lead to brain fog, excessive eating and weight gain.

Working nights is NOT easy on the body and mind. Staying up through 3am – 5am time is VERY difficult.

Working on nights, by virtue of the lack of managerial support is a very responsible position.

There is a level of stress in working nights: needing to deal with all eventualities, as well as having a small team to deal with any problems.

I found the pressures and challenges working nights to be different from those working days. You could say that the tensions between the two shifts are caused by a lack of understanding of the differences.

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A few key tips to manage quality of care at night

- have a good skills mix in your team

- take regular staff supervisions

- organise team meetings (where the care home manager acts on feedback from night staff)

- ensure sound care home recruitment and a thorough induction

- carry out regular unannounced night visits and audits (these act as a deterrent to those who might sleep on shift

- evidence that you are carrying out spot checks on care at night by performing audits of the service and building during night time

Care home management is too often absent at night

For me, I find it interesting that care homes will have a robust management presence in place during the day and then often no management presence at night.

I think it is hard for carers who work nights, they often miss out on regular guidance from the deputy / home manager.

I would suggest developing a current senior on nights to become duty manager - nights. I would task them with specific responsibilities, give them extra training, an amended job description and with it, an uplift in pay.

It would be better for someone working nights to lead the night shift. There are night specific routines and habits of the residents which they will better understand. There should be a lead on nights inputting into care plans too.

How to manage quality in your care home with an effective audit process

Quality audits are a line of defence against poor practice which can lead to non-compliant care and, ultimately, potential harm to residents.

Audits need to be well designed and relevant for the service. Where there are gaps / weaknesses identified in an audit, there needs to be action taken swiftly and the home manager needs to be aware of the particulars.

Common errors in audits

- an audit tool that’s poorly designed / not suited for the service.

- an audit tool so comprehensive that it only gets used a few times a year and takes too long to use (one care provider I worked with made it so complex that it will take 2 or 3 days to complete – this is impractical and means audits will be less frequent, which increases risk).

- assigning audits to junior staff who don’t understand the significance of items that need some extra attention.

a company culture where completing the document (box ticking) is considered more important than actually auditing the service and taking remedial action.

- under resourcing the audit function – where audits are just copied from the month before. This shows a lack of rigour and exposes the home to risks.

- a lack of follow-through by the home manager – actions left / not dated or signed off*

*These audit errors are regularly listed in CQC inspection reports where the rating is “requires improvement” or “inadequate”. Key theme is, it was picked up on an audit and you didn’t follow through.

The importance of the internal mock audit / the last CQC report

There are 3 types of full home quality audits that need to taken especially seriously by the home manager:

One - external professional

The first is an audit by an external professional (mock CQC audit). The actions identified should be completed and signed and dated in full. It should be taken seriously as getting the home ready for a potential CQC inspection, ensuring the standards of the home meet the CQC key lines of enquiry (KLOE - find out more about KLOEs here). Is the service safe, caring, effective, well-led, responsive?

Two - regional manager

The second is an audit by the regional manager / director / quality lead employed directly by the operator of the care home. This needs to be taken seriously as it maps the home against the standards and tools used by the provider to evidence good care. Failing to do this could be considered a breach of job performance as well as putting the home at risk. Audits are there to help the home manager run a good, safe service.

Three - the last CQC inspection

The third audit and actually the most important is the last CQC inspection. The Home Manager should take great care, providing written evidence to ensure that the actions identified in the last CQC inspection have been taken into account, acted upon and the new controls / standards maintained.

The CQC will be very through in checking these matters when they come, failing to do so is a further more breach and shows contempt for the CQC inspection.

This in turn can lead to significant problems for the provider and home manager. The home manager and provider should take efforts to show a responsible and responsive approach to any matter raised by the cqc to demonstrate that the home and service are well managed.

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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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  • Liam Palmer
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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.