The home had a “Requires Improvement” rating following its CQC inspection in November 2015. This had also resulted in a warning notice served by CQC which had expired when Fulcrum took over. An initial Fulcrum Care Home Health Check in February 2016 revealed that the home was still non-compliant. It had 11 open safeguarding alerts and a dysfunctional management team. The team was unable to lead the home, which had a direct impact on how the home ran on a day-to-day basis. Occupancy was dwindling and staffing the home had become almost impossible due to the managers’ inability to work together. The 20 unused beds in the new building were causing a huge financial deficit. This financial instability was not just of concern to the home’s owners, but also to the bank financing the operation.
The care systems in the home had been changed to an “electronic system” without any thought to the implications. This led to a need for intense training and a restructure on the whole care planning, policy and documentation side of compliance. The same had happened with the medication system and this was also in a bad state of disarray.
There had been concerns raised to CQC on several occasions. Family groups and the local Contracts Monitoring Team from Croydon Council had lost faith in the home and its direction for the future.
Fulcrum Care Consulting was appointed to manage the home and to oversee a number of problems, including gaining compliance following the CQC inspection. Croydon Council had placed the home into provider concerns and this relationship needed fixing. Plus, the home was under the spotlight of the bank financing it.
When Fulcrum took over, the home had been through two different “care consultants” who had failed to improve on the compliance and commercial aspects of the business.
Following Fulcrum’s Care Home Health Check it was clear there were several areas that needed addressing and following the dismissal of the two managers, Fulcrum took over the full running of the home with a view to appointing a “fit and proper” home manager.
Compliance: Fulcrum’s team worked to support the home’s existing staff group and the company directors to ensure no embargo on admissions was imposed on the home. Within weeks the home’s risk level was de-escalated by Croydon Council audit and at a subsequent unannounced CQC inspection the warning notice was removed and the home achieved a Good in the Well Led aspect. Since then we have had two unannounced inspections from Croydon Council’s Contracts Monitoring team without any requirements made. Croydon’s contracts team have continued to place residents at the home.
Risk assurance for financiers: Fulcrum had several meetings with the bank with a view to assuring the bankers of the future viability of the home.
Fulcrum was able to produce documented evidence of the work done and provide information regarding the future plans for the home. This resulted in a greatly stabilised relationship with the bank.
Safeguarding Status: Croydon Council closed all of the 11 safeguarding alerts. Though some of these had been substantiated Croydon Council was assured that the home was on the right path with Fulcrum leading it.
Safeguarding referrals dropped to nil, and Croydon Council’s monitoring team continued to review the home’s progress with successful outcomes on an ongoing basis. This was made possible with a transparent and open culture of management which resonated with staff very quickly. Complaints and whistleblowing to CQC and Croydon Council ceased. Meetings with families went from being hostile to friendly and forward-looking with trust being restored in the home.
Staffing: We made a concerted investment in training and moulding the staff group very quickly to an open and transparent culture. Accountability
was at the foundation of what everyone at Morven did, and the staff worked together as a team for the benefit of the residents in their care. We have appointed a competent management team with the skills to take Morven further. Agency use fell to just two shifts per week, at worst.
Reputation: Feedback from residents and relatives improved remarkably soon after Fulcrum took over. Complaints dropped to zero.
Occupancy and Fee Levels: Despite the CQC report, warning notice, eleven safeguarding alerts and concerns of Croydon Council, Fulcrum averted an embargo on the home. Occupancy and fee levels continued to rise with the admission of new private residents. This is uncharacteristic for a home that has been under the spotlight.
Registration of new beds: The new wing was registered with CQC in August 2016 adding a further 20 beds ready for trading and poised to
take advantage of the momentum in occupancy growth at the home.
Fulcrum’s overall performance
The home was yet to be inspected by CQC when Fulcrum’s team withdrew in December 2016 after handing over to the home’s new management team and Board. However there had been two separate unannounced inspections by Croydon Council, both noted improvements and no requirements. CQC’s warning notice was removed to have a Good rating in the Well Led domain. The 20 additional beds which had not been registered for around two years are now ready for trading and filling up at higher bed yields. Care planning audits and medication audits reached the 95% compliance bracket. A new management team was appointed and with focused recruitment efforts and training investment in the staff team, agency bills have become negligible.
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“At Morven, we required specialist, hands-on consultancy support to make the additional 22 beds that we developed fully operational and CQC-compliant. After Fulcrum stepped in, all CQC compliance issues were resolved and the home became fully operational. We now have a smooth-running care home with 40 beds. More importantly though, Fulcrum’s improvements helped us to build a professional team as well as improve our CQC rating that resulted in an increase to our occupancy, thus releasing the financial pressure that was such a concern to us and to our backers.“
Dr C Vivekananda
Director, Morven House