Fulcrum Turns Around Bedfordshire Care Home for Group Owner

This case study is about an 84-bed care home in Bedfordshire. It provides expert care for older people, including those living with dementia. It is part of a larger group that runs more than 60 residential care homes in England and Northern Ireland, caring for around 4,000 residents in total.

60+ Home Group Unable to Turn Around an ‘Inadequate’ Rating

In May 2018, the home was inspected by the CQC and was rated ‘Inadequate’. Following this, the local council imposed an embargo on admissions, meaning the care home would not be able to take on any new residents.

To address this, the home’s owner deployed its regional management, quality assurance personnel and other support teams, including estates, wellbeing, and training.

A follow-up inspection by the CQC in January 2019 delivered the same ‘Inadequate’ outcome. This was even after additional resources had been allocated to turn around quality compliance at the home.

As there had been no improvement during the period in special measures, the CQC issued a proposal to close the home. In turn, in late February 2019, the council expressed a lack of confidence in the provider and gave them a five-week deadline to improve quality at the home. After five weeks, if there was no improvement in the quality of care, then the council contract with the home would be cancelled.

This was the background to Fulcrum Care being engaged by the group in March 2019 to turn around the quality of care delivered at the home and prevent it from being closed.


Engaging with Stakeholders and Regulatory Bodies

As a first step, the Fulcrum consultants engaged with council. It had lost confidence that the home would be turned around and was on the verge of moving residents out overnight. Moving residents with dementia can result in distress and disorientation – and a higher mortality rate. Keeping residents in their home and avoiding any upheaval was a high priority.

Fulcrum also engaged with the local Clinical Commissioning Group to keep them appraised of developments, and set up a relatives’ committee to communicate with residents’ families.

Working with a firm of solicitors, Fulcrum also led the preparation of representations to the CQC to stay the closure of the home.


Implementing New Action Plans and Systems

Fulcrum prepared a comprehensive action plan and began implementing a number of new systems, based on best practice in care home management to address areas of concern at the home identified by the CQC, the council and Fulcrum itself.

The plan involved management oversight of the home. It included a range of comprehensive audits, staff training, care observations, and ensuring that the required levels of care were being delivered. Systems were also put in place to evidence the new practices and to Fulcrum devised new competency assessments for staff.

Amongst the staff, new leads for various aspects of care were introduced: in dementia, nutrition, hydration and dignity. Special emphasis was placed on improving service users’ meal-time experience and this was a significant area of concern for the CQC and council.

Fulcrum examined the home’s activities and was able to improve them by making them less generic and more person-centred.

Fulcrum advised the management that it should proactively make any safeguarding alerts, to report any concerns over abuse or neglect of its residents.

Fulcrum helped analyse stakeholder survey data, call bell data and falls data to identify trends. The consultants helped the team at the home to interpret the data and to learn lessons and take necessary action. Changes at the home meant that it became more proactive in its approach, the number of falls was reduced, and the number of complaints from families also declined.


Fulcrum Turns Around Home and Prevents Closure

By mid-April, the council validated the improvement in quality and stayed the decision to cancel the home’s contract.

The council carried out a number of spot checks, including some undertaken at night, and was able to observe continuous improvement.

The CQC returned to the home in July 2019 to reinspect it. They noted that there were significant improvements made since the January inspection. The CQC confirmed that the closure notice would be stayed.

The home has improved from ‘Inadequate’ in all areas to ‘Requires improvement’ overall, with a ‘Good’ in Effective.

Fulcrum achieved a successful quality of care turnaround for the home, not only preventing the closure of the home, but also rebuilding confidence in the group as a whole. A home closure would have caused costly damage to its reputation.

As the threat of closure has now passed and the home anticipates the lifting of the admission restrictions, the group plans to invest in refurbishing the home. The new-look home with improved quality of care will enable it to admit and provide services for its full complement of 84 residents, improving its commercial performance. Not only has a business been saved, but Fulcrum has also successfully improved the quality of care and kept residents in their home, avoiding unnecessary upheaval to their lives.

Does your care home have similar issues? If you’d like to improve your CQC rating, get in touch today.

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