Resolving Special Measures

Definition of special measures for care homes

Being in special measures means that a set of interventions and procedures has been implemented by regulatory bodies as a result of serious concerns about the quality of care being provided to residents.

These measures are put in place when a care home fails to meet the required standards, or when there are instances of serious neglect or mistreatment reported.

When a care home is put under special measures, it means that it has been identified as requiring significant improvement or immediate action to safeguard the well-being of its residents. This can occur after a routine inspection by regulatory bodies such as the Care Quality Commission (CQC) in the UK or equivalent organisations abroad.

Special measures are not implemented lightly and are reserved for care homes that are deemed to be providing inadequate care or exhibiting systemic failures. They act as a regulatory intervention to ensure that the care home meets predetermined benchmarks in terms of quality and safety.

The exact measures may vary depending on the severity and nature of the concerns identified. Typically, they involve close monitoring of the care home’s operations, increased scrutiny from regulatory bodies and mandatory actions that the care home must undertake to rectify the issues causing concern.

It is also likely that there will be a restriction on admissions, be that voluntary,  contractual or regulatory. It is always prudent that providers consider a voluntary moratorium with regular reviews to give the service the space to implement the action plan and improve the care delivery, without the pressure of new admissions.

These actions may include:

• Improving the safety and cleanliness of the premises.
• Developing and implementing robust policies and procedures.
• Providing additional training to staff.
• Bringing in external consultants to support necessary improvements.
• Reporting incidents to the relevant safeguarding authority or the health and safety executive.

The goal is to help the care home make the necessary changes to reduce the risk of harm, securing the health, safety, and well-being of its residents.

During the period of special measures, regular inspections and assessments are carried out to monitor progress and evaluate whether improvements have been made.

Regulatory bodies work closely with the care home management team and provider to provide guidance and support, as well as to ensure compliance with the recommended actions. The relevant local authority or ICB/partnership will likely also be involved.

Depending on the effectiveness of the implemented measures, care homes can either be removed from the special measures status if satisfactory improvements are achieved, or alternative  regulatory action may be taken if progress is deemed unsatisfactory.

The primary objective of special measures is to protect vulnerable individuals who reside in care homes and promote quality care provision.

As of February 2024, according to Gov UK statistics 85.7% of beds in UK care homes were occupied. As well as:

• 2% of beds in care homes were vacant and admittable
• 1% of beds in care homes were vacant and non-admittable

Care homes have never been more in-demand, and special measures serve as a mechanism to address deficiencies and prevent potential harm to residents.

Understanding the reasons for being in special measures

The key question for adult care homes providing poor care is understanding WHY the care home has been placed in special measures. 

The following list outlines the common reasons an adult social care home will be put into special measures: 

• Poor leadership and management – Miscommunication and problems at management level in a care home results in the breakdown of trusting relationships and a lack of accountability. This in turn negatively impacts staff morale, creating a toxic and poorly functioning work environment.

• Financial mismanagement – Care homes that don’t carefully control and monitor their finances also contribute to receiving a special measures rating. Financial mismanagement often results in a lack of resources, putting care at risk.

• Incorrect care plans – This can range from personal care plans for residents being too brief, to care plans lacking the correct information and putting people at risk.

• Disregard for safety procedures –  Ineffective risk assessments is a hazard to people’s safety and is a major contributor to being placed in special measures.

• Care not being person centred – Taking a person centred approach ensures that the needs and preferences of the patients are listened to and put at the centre of how services are organised and delivered.

The charity National Voices carried out a survey about person-centred care, and it found that:

• 76% of inpatients who had an operation or procedure said that what would happen was “completely” explained.

• Only 46% of inpatients said they did not get enough further support to recover or manage their condition after leaving hospital comparatively.

Importance of getting out of special measures

Being placed in special measures is undoubtedly a distressing experience for any organisation or institution. However, it is important to recognise that being placed in special measures is not the final word.

Why take steps to evade special measures?

• The impact on reputation – The special measures label is often associated with incompetence and failure. It is best to take every form of action possible to attempt to avoid receiving this rating.
• Consequential decline in service – A poor rating from the Care Quality Commission affects multiple aspects of maintaining a functioning service financially and operationally.
• Poor image surrounding management and resident care – Shortcomings in care management have a significant and direct impact on the well-being of individuals who rely on such services.

When an organisation is placed in special measures, its fate rests mostly in the hands of external regulators or inspectors.

Though the loss of autonomy can be demoralising for staff and can hinder their motivation to improve, taking our recommended steps to abolish this rating will allow your care home to regain independent control of its own future.

Step 1: Self-evaluate

Review previous inspection reports

Reviewing previous inspection reports is an essential step for any care home or care facility.

One of the primary benefits of reviewing previous inspection reports is the ability to identify recurring issues and negative trends.

By going through past reports, it is easier to identify areas that consistently fail inspections or have received recommendations for improvement.

This information can help to better prioritise actions and allocate direct resources to address these critical areas swiftly.

To effectively review previous inspection reports, care homes should establish a systematic approach. Developing a standardised template or checklist for extracting pertinent information from these reports can also aid in the analysis.

This reviewing process is an overall proactive approach, allowing care homes to learn from past mistakes, track progress and ensure ongoing compliance and improvement.

Seek feedback from residents and their families

Seeking feedback from residents and their families is essential for a care home that respects and looks out for their residents. Hearing directly from those who utilise the services is invaluable in gaining a better understanding of patients’ needs and improving their overall experience.

Residents and their families are the true stakeholders in any institution that caters to wellbeing. They are the ones who experience the services firsthand and have the most accurate insight into what works, what can be improved, and what might be missing from the equation.

One of the most effective ways to obtain feedback is through surveys.

Surveys can either be distributed electronically or in paper format and should focus on areas such as: staff interaction, quality of care, facility cleanliness, programming and overall satisfaction.

By allowing residents and their families to anonymously voice their opinions and concerns, it creates a safe environment for honest and constructive feedback.

Collection of feedback shouldn’t end there though.

It is imperative that care homes ensure that they have a reliable system in place to collect, analyse, and act upon the feedback received. This entails having a designated team or individual responsible for regularly reviewing the survey responses and addressing any specific issues raised. This commitment to addressing feedback not only demonstrates the institution’s dedication to continuous improvement but also fosters trust and confidence among residents and their families.

In addition to formal surveys, informal avenues for feedback should also be encouraged. Institutions can establish suggestion boxes, organise regular family meetings or forums, or even appoint a family liaison to bridge the gap between administration and families. These methods allow for open dialogue and encourage families to share their observations and suggestions, leading to a more responsive and transparent organisation.

Seeking feedback from residents and their families is not a one-time event but an ongoing process. Care homes should make it a priority to periodically reassess their practices and services in light of the feedback received.

Step 2: Develop a plan of action

Ensuring safe care for residents

Delivering on safe care for residents is paramount in any care facility. It is the responsibility of both management and staff to foster an environment that promotes safety and effectively safeguards the people at risk.   

Creating an all-round safe physical environment is crucial as responsible care providers. Adequate lighting, unobstructed walkways, and well-maintained equipment play vital roles in preventing accidents.

Both preventive measures and ongoing monitoring are recommended methods of sustaining high standards of hygienic and safe care.

One of the most critical aspects of care is maintaining well-trained and competent staff. All employees should undergo thorough training programmes to learn the best practices for resident care and safety protocols. This includes certification in first aid, CPR and medication administration.

Furthermore, regular inspections and maintenance of the facility should be conducted to identify and address potential hazards promptly. This includes everything from checking grab bars in bathrooms to ensuring secure handrails in hallways.

Additionally, easily accessible emergency call systems should be installed throughout the facility, allowing residents to request assistance at any time.

Medication management is another critical aspect of resident care. It is crucial to establish stringent protocols for administering and handling medications.

This means proper storage and accurate documentation, as well as regular medication reviews to prevent adverse drug interactions.

Staff should be trained thoroughly in medication administration and must follow consistent procedures to minimise the risk of medication errors.

Regular assessments and personalised care plans are integral in providing safe care to residents. This is especially important for those who live with physical disabilities for example, where ongoing monitoring of residents’ physical and mental well-being can help identify any changes or potential risks.

This includes assessing mobility, cognitive abilities and susceptibility to falls.

Based on these assessments, personalised care plans can be developed to meet the specific needs of each resident, ensuring they receive the appropriate level of care and support.

Lastly, staff should be encouraged to report any incidents, near misses or potential hazards to help identify and address recurring issues.

Step 3: Implement new policies and procedures

By regularly reviewing and updating policies and procedures, care services can effectively address emerging challenges and enhance productivity.

This process requires a systematic approach that involves careful planning, effective communication, and employee involvement.

First and foremost, it is a priority to clearly define the purpose and objectives of the proposed changes. Whether it is to comply with regulatory requirements, improve operational efficiency, or mitigate risks, a well-documented rationale will help gain support and understanding from all stakeholders.

Once the purpose is established, the next step is to develop a comprehensive plan outlining the specific steps and timeline for implementation. This plan should highlight key milestones, designate responsibilities, and allocate resources accordingly.

It is important to involve relevant departments and employees in this planning phase to ensure that the new policies and procedures are aligned with the care home’s overall goals and culture.

It is crucial to inform all employees about the upcoming changes, emphasising the benefits and addressing any concerns or anxieties that may arise.

Regular updates through meetings, emails, or internal forums will help foster transparency and allow employees to actively participate in the transition.

Overall, making sure there is a high quality and safe level of effective care for residents is a multidimensional task that requires the combined efforts of management, staff and residents themselves.

By prioritising staff training, maintaining a safe physical environment, facilitating effective communication and conducting regular assessments, social care services can make the necessary changes to avoid slipping into special measures, all while upholding an environment of excellent care where residents feel secure and well looked after.