How Targeted Clinical Leadership Stabilised a High-Risk Care Home - Dover House
This case study explores how Fulcrum Care provided targeted clinical leadership and governance support to stabilise a care home facing environmental, clinical and safeguarding risks.
Case Study Overview
When Fulcrum Care began working with Dover House, the service was facing a number of significant challenges linked to clinical quality, environmental standards and staff confidence. There were immediate concerns relating to infection prevention and control, care planning, safeguarding and the consistency of clinical oversight.
The home required urgent stabilisation, but this project was not commissioned as a full turnaround or interim management arrangement. Fulcrum was brought in to provide focused, directive support in clearly defined areas of risk and quality improvement, while working alongside the existing management team.
This included targeted work to strengthen governance systems, improve environmental standards, build clinical capability and support more consistent, person-centred care. The aim was to create practical, repeatable systems that would reduce risk immediately while supporting longer-term improvement.
The Approach
Fulcrum Care delivered a structured programme of targeted clinical and governance support tailored to the needs of Dover House.
This included:
Clinical Oversight and Governance Strengthening
We introduced practical systems to improve day-to-day oversight, risk visibility and accountability. This included daily management walkarounds, structured flash meetings and a clinical oversight matrix to support clearer monitoring, more consistent communication and stronger assurance across the service.
Environmental Recovery and Infection Prevention
Initial audits identified significant concerns relating to cleanliness, infection prevention and environmental management. Fulcrum supported a recovery programme that included a full deep clean, replacement of contaminated furniture and mattresses, and follow-up inspections to ensure standards were sustained and environmental risks were reduced.
Workforce Support and Clinical Skills Development
Clinical supervisions with registered nurses highlighted gaps in confidence, emergency response and documentation. In response, Fulcrum delivered targeted face-to-face training and competency support across areas including infection prevention and control, dementia awareness, behaviours that challenge, food safety and reflective clinical practice.
Scenario-based testing was also introduced to strengthen emergency response and escalation skills in real-world situations.
Safeguarding and Positive Behaviour Support
As the project progressed, safeguarding concerns became a key focus, particularly in relation to distressed behaviour and resident altercations. Fulcrum introduced a Positive Behaviour Support framework and provided practical staff training focused on de-escalation, distraction and proactive support planning. This helped reduce reactive responses and supported safer, more therapeutic care.
Care Planning Improvement
At the provider’s request, Fulcrum also supported the transition to a more wellbeing-focused, person-centred care planning model. This included testing a new AI-based care planning system in live practice, providing structured feedback and ensuring that clinical safety, safeguarding and residents’ wishes remained central to the documentation.
The Result
The impact of the intervention was significant.
Dover House moved from a position of heightened concern to a far stronger and more stable footing, with practical systems in place to support continued improvement. Environmental cleanliness and infection prevention standards improved substantially, nursing staff became more confident and consistent in their practice, and governance systems were embedded to strengthen day-to-day oversight.
Staff capability in managing behaviours that challenge also improved, alongside more structured and person-centred care planning. The work helped build confidence both within the service and among external stakeholders, who were able to see clearer clinical direction and measurable progress.
By the conclusion of the project, both the provider and Registered Manager confirmed that sufficient progress had been made and that the systems introduced were supporting continued improvement without the need for an ongoing consultant presence.
More broadly, the project demonstrated the value of targeted clinical leadership delivered in partnership with an existing management team. By focusing on clearly defined risks, strengthening staff capability and embedding practical governance systems, meaningful and sustainable improvement was achieved within a short timeframe.
Client Feedback
TJ Adamson has provided consultancy support to us at Dover House during a period where additional clinical leadership and staff development were particularly important. His work has focused on providing high-quality clinical supervision to our registered nurses, as well as mentoring and supporting care workers through practical training in de-escalation techniques and distraction strategies for residents who may become distressed or agitated.
TJ has done an excellent job of building confidence and competence across the team. His approach to de-escalation is calm, practical, and rooted in real-world experience, and he has been highly effective in mentoring staff both in clinical skills and in assessing and developing their professional competency. Staff have found his guidance approachable and constructive, and it has had a positive impact on practice on the floor.
In addition, TJ has supported us by testing and putting into practice our new wellbeing care plan concept. His feedback has been extremely valuable in strengthening our ability to document care in a genuinely person-centred way, ensuring that residents’ preferences and wishes are clearly reflected in how care is planned and delivered. He has not only provided thoughtful critique, but has also demonstrated how the approach can work effectively in practice.
Overall, TJ’s contribution has been highly beneficial to Dover House. His combination of clinical expertise, mentoring ability, and commitment to person-centred care has added real value to our service, and I would have no hesitation in recommending him.
Will Graham
Director
Looking for Clinical and Governance Support?
Fulcrum Care supports care providers through challenge, risk and improvement. Our consultants work alongside services to strengthen oversight, reduce operational and clinical risk, support staff capability and create practical systems that lead to measurable progress.
From targeted governance support and clinical leadership to workforce development, safeguarding and quality improvement, our approach is practical, collaborative and focused on helping services move forward with confidence.
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