Care home facing 'series of nightmares' transforms from 'special measures' to 'good'

Care inspectors have praised a care home’s dramatic turnaround with a ‘good’ rating in December - a year after undocumented bruises and isolated residents triggered the home’s move into ‘special measures’.

’Quite terrifying and worrying’

The man driving the transformation at Lound Hall care home in Lowestoft, Suffolk and its latest good report - speaks plainly when he talks about what made the home enter ‘special measures’ back in December 2017.

“It was a series of nightmares”, says Vinay Patel, the managing director of KRG Healthcare, which runs two care homes.

“It was quite terrifying and worrying.

“Rogue employees were shredding care plans”, says the director who learned detailed care plans had been scrapped and replaced with single page plans for residents.

Describing sporadic documentation on paper, he says: “All the care staff knew the residents in full but when you looked at it on paper, changes to residents’ needs and wishes went undocumented”.

In November 2017, January 2018 and May 2018, the care home was rated ‘inadequate’ following Care Quality Commission (CQC) inspections and put into special measures for multiple breaches of care regulations. The home was also barred from taking on new residents. The breaches largely related to record keeping and care planning.

At the time, care inspectors noted undocumented bruises, poor medication management, unsecured substances and poor record-keeping, which raised risks such as the threat of malnutrition, dehydration and choking among residents. The CQC also found clear action was not taken where people had unexplained bruising.

Mr Patel says: “There was perceived abuse for lack of documentation. There was no records to demonstrate. No one had any real concerns to follow record keeping and follow things by the book.”

Staff shortages also affected the home, as “when a staff member was off sick, management weren’t calling in for replacements”.

He describes a “flawed” quality assurance process where “no one would challenge the manager”.

Care home was ‘yo-yoing between good and inadequate’

The care home supported 43 residents but residents were found to be socially isolated and disengaged and those receiving nursing care in bed had little chance to interact or get involved in an activity.

Mr Patel says: “The care home has been yo-yoing between good and inadequate for years”. He also says his role as care provider was brought into sharp focus a year ago, with a need for him to be involved "very closely”.

“I felt really disappointed by the management team because they had let me down very badly", he says. "And I had let down residents and staff.”

To transform the care home’s culture, Mr Patel dismissed some staff and made no less than five referrals of former employees to the Nursing and Midwifery Council (NMC) in relation to medical support failures.

“Nurses are the ship leaders in a nursing home” he says. “We had to have an open culture.”

As part of a 12-month turnaround, with support from the new care home manager Andrea Deakins, monthly staff meetings replaced twice a year meetings, while meetings with residents and their families were held every month and began to generate much needed feedback.

He says: "Residents told us they wanted to go out.” With no dedicated activities coordinator and few activities for residents, the care home began organising activities seven days a week, hosting visiting performers and taking residents on trips out into the local community and to the beach in Great Yarmouth.

Residents can now be seen playing cards with staff at their bedside, indulging in a round of chair-based table tennis or simply reading daily newspapers – which are now delivered to the home.

Once a month, there is even a themed celebration of food from around the world, served up to residents by staff dressed in the relevant country’s national costume.

The care home has also begun building a relationship with a local school - with a view to having children (aged three to seven) visit residents at the care home once a month.

Culture change: ‘There is no hiding things’

Technology has been adopted to document everything and raise alerts. The care home’s new dependency mobile app is called KareInn and records the level of need for each resident and how much staffing should be present each day.

“If someone hasn’t been seen for two hours, it raises an alert. Staff can use it to check who was the last person to care for someone an hour before, what food or drink they had, what mood they were in etc.

“There is a clear trail of evidence. There is no hiding things. That’s the new culture – transparency, trust and honesty. It is a different culture."

The care home has also undergone a makeover with a new coffee shop area for residents and families to meet. A new five-star dining experience courtesy of the same chef Lina Maw, who with the support of new management, was nominated last November as a finalist in the chef category for the East of England in the Great British Care Awards.

“Thanks go to the staff team that stuck with us, they also had options and could have left but they stayed and went through a 12-month turnaround.

“Families could have taken their residents away from Lound Hall but they stuck with us.”

KRG Healthcare’s other care home Manor Farm Care Home in Lowestoft also received a ‘good’ rating last year, in April 2018, and Mr Patel was there to drive changes there after. He says “We found the same issues at the other care home."

“Being a good-rated home is what you want. No more yo-yo-ing”, says the managing director.

“But we have now set our sights on outstanding. The only way is up.”

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