Shift planning, CQC and supported living versus residential

6th February 2017

I visited 18 services last week and was particularly impressed by Kings Road’s ‘fun fruit Friday’.  Every Friday they think of a fun activity to encourage the people they support to make and eat healthy snacks and desserts involving fresh fruit.  What a great idea!

Composition of various exotic fruits isolated on white background

At another service I got engaged in a discussion with staff about shift planning. It’s always seemed fairly obvious to me that shift planning, by definition, means planning at the start of the shift what’s going to happen as people go through their shift.  In this service, some of the staff thought shift planning involved recording afterwards what’s taken place.  Shift planning is a really important tool as it makes sure that the right staff are allocated to the right people we support and that they participate in meaningful activities.  I would be grateful if our managers could remind and re-enforce this point with our staff.

With a degree of trepidation, I am going to put my foot into the very controversial waters surrounding ‘registering the right support.’ This is a new initiative by CQC to try and make sure no new services are opened for people with learning disabilities which are large and institutionalised. Having spent a large part of my career closing dreadful old long stay hospitals, I feel very passionately that I don’t want to see any new institutions develop for people with learning disabilities. However, I am not sure I agree with CQC’s view that services should generally be for no more than 6 people. I have certainly seen larger services that can work very well for people.  For example, our Avenue Road supported living service, that was recently rating ‘outstanding’ by CQC supports 9 people each in their own studio flat. Sometimes, when we take over tenders from other providers supporting people in 3 person and smaller supported living services, they can feel quite lonely compared to some larger services which have a more buzzing atmosphere.  As non-disabled people, we all choose to live in a wide variety of different living situations and I don’t see why it should be different for people with learning disabilities.  In my experience, what matters most is the calibre of the registered manager and the values of the staff team.  However,  I do draw the line at larger services for people with very challenging behaviour.  Firstly services of that nature can easily become controlling and abusive with a punitive approach to responding to peoples’ behaviours. Secondly, people with very complex and challenging behaviour do require highly skilled and personalised interventions.

I am going to finish by reverting to a topic I’ve mentioned before; the downside of supported living which nobody apart from me seems to mention.  I am not anti supported living; in my time at CMG we have opened more than 30 supported living services. However I do feel frustrated by the simplistic attitude prevalent across our sector that residential care is bad and supported living is good. The quality of the manager and the staff team is far more important than the label over the door in determining the quality of life that people will experience. One of my concerns about supported living is the lack of inspection and oversight compared to residential care. For example, last week I visited a provider who has around 30 supported living services, all under one registered domiciliary care office. At their last inspection, the CQC inspector visited the registered office and only two of the services.  How can this be right?

Supporting some of the most challenging and complex people in the country

27th January 2017

I am going to focus this week’s blog on profiling Alderwood; the outstanding subsidiary of CMG which became part of our organisation just over a year ago.  I have visited Alderwood services regularly in the year since they have been part of CMG and I never fail to be massively impressed by the work that they do.  Alderwood support some of the most complex and challenging people with a diagnosis of Autism in the whole country and recently have been taking a number of people being discharged from hospital under the transforming care programme.

Whenever I visit Alderwood services, the staff are always hugely positive and motivated even if they have just experienced a very challenging incident and have been personally injured. The level of structure in place is quite exceptional; people have activity programmes broken down into every 15 minutes, which gives the people we support the security about what is happening in their lives that reduces the anxiety that can often lead to challenging behaviour.  Any time I visit an Alderwood service, the activity for the individual is happening exactly as planned and on time.  Alderwood also use a great deal of visual communication methods which work really well with many people with Autism and they have their own studio that designs bespoke visual tools for each person.

In CMG, as you know, we strongly emphasise social inclusion, particularly the importance of employment.  Every single one of the people supported by Alderwood has a voluntary or paid job.  Given that these are some of the most complicated people in the whole country, this is an amazing achievement.

I would like to finish with a brief case study of a young man who spent ten years in hospital settings. When he was living in hospital, he did very little and was heavily medicated. He very rarely saw his family.  Now he sees his family regularly, has learnt skills like managing simple financial transactions, how to dress himself and plays an active part of the community including developing a real passion for football. He is a Chelsea supporter and recently went on a VIP tour of the Chelsea football ground.  Last but not least, he was on a huge cocktail of medication which has now been significantly reduced.

Fauzia - Alderwood
Under Lock and Key

Some fantastic news about CMG’s CQC ratings !

23rd January 2017

Today I received some fantastic news about CMG’s CQC ratings, which I’m very proud to share with you all, especially our staff teams who work in our adult services in England.

Following on from CMG being awarded a 3rd ‘outstanding rating’ from the CQC last week, we did a review of CMG’s CQC ratings and compared them to all of the other major learning disability providers in the sector.

And CMG came out top!  We have achieved a higher percentage of ‘good’ and ‘outstanding’ ratings than any of the other major learning disability providers in the learning disability sector.  This is a fantastic achievement.  Congratulations to everyone in CMG for making this possible.

This result is made all the more significant, because most other providers group their supported living services under their domiciliary care business.  This means that CQC is only required to inspect the registered office of the domiciliary care business not each of the individual supported living services, so it is possible for 30 odd services, for example, to be grouped under one domiciliary care business. (CQC is required to inspect every individual adult residential service).

In CMG, we register all of our supported living services individually, so each has to get inspected.

We will continue striving to improve still further on these results, but my thanks to all our staff for their amazing contribution to our ongoing success.

A third ‘Outstanding’ rating for CMG in England!

13th January 2017

Avenue Road achieves a third ‘Outstanding’ rating for CMG by the CQC 

It joins our Kings Road service in Hampshire and our Ridgeway service in Essex.

Avenue front 1

We also have an amazing 70 CMG services now rated as ‘good’ with the vast majority of these rated ‘good’ in each of the 5 areas, which is a fantastic achievement.  Unfortunately we do have 5 services rated as ‘requires improvement’ but we are working hard to improve these.

These ratings put CMG well ahead of the national average.  CQC’s national figures report there are 71% of services good, 1% outstanding, 26% requires improvement and 2% inadequate. Ours are significantly higher than these and we have zero services rated as inadequate.

So what does Pam Hirsch our manager at Avenue Road attribute to Avenue Road’s success:

“The overriding feeling I have is that it wouldn’t be possible without the loyalty and responsiveness of the whole staff team. They are a very diverse group with a range of strengths (and weaknesses) but apart from some everyday minor issues they appreciate each other and are so supportive of the service and our goals. They are also incredibly patient with me when I’m asking them to do something ‘extra’ or to change the way they do things and they have a good understanding of why we do what we do. They are not afraid to challenge and will not accept second best. I am so proud of them all.”

Ula Peazold, Regional Director for Avenue Road has added:

“Having a manager in place who has a consistent, fair, competent and supportive approach to her staff  has definitely contributed to the success of the service.  Staff know the tenants really well and respond to small issues before they get too big. Pam also ensures outstanding communication with families, service users and external professionals and has an extremely good eye for detail and understanding of procedures and CQC requirements.”

CMG’s Welsh services are inspected by CSSIW. All CMG’s Welsh services currently have ‘no requirements’ for improvements.

These ratings speak volumes about the care and support that CMG provides nationally to the people we support.  It also provides further evidence of what can be achieved by a competent manager and great staff team who work so cohesively together.  Many congratulations to Pam, her team and the tenants at Avenue Road.

Perseverance and creativity brings benefits to diabetes outcome

15th December 2016 3 Comments

I’ve just returned from two weeks annual leave and was really impressed today to see a presentation from Kellie Barker, Lead Support worker at Kings Road in Hampshire (and keyworker to ‘C’). The presentation demonstrated the fantastic efforts the staff team at Kings Road have made in managing C’s complex diabetes type1.

Diabetes is a serious life-long health condition that occurs when the amount of glucose (sugar) in the blood is too high because the body can’t use it properly.  Type 1 diabetes is an auto immune condition where the body attacks and destroys insulin producing cells, meaning no insulin is produced. This causes glucose to rise quickly in the blood.

C not only has complex diabetes, he also has a complex learning disability, so there was no standard solution to his diabetes and when he arrived at Kings Road, his condition had been badly managed and relations with the community support team had broken down.

The Kings Road staff team supported C to better understand his diabetes, better manage his insulin and also gave him restrictions with his diet, which although improved things, made his life more restrictive given it revolved a lot around eating the right foods at the right time. Even with these improvements, C’s insulin levels continued to fluctuate badly.

In 2015, the manager Sophie and Kellie became even more determined to make improvements for C. They re-established the relationship with the community health nurse and made visual representations of C’s glucose levels via colour coded spreadsheets.  It took over a year to see success with staff working daily at some points with the community team, but C’s blood glucose levels are now stable.  This is clearly represented by the graphs below:

Pink = too high

Green = about right

Blue = too low

C’s blood glucose levels in 2015

Diabetes-2

C’s blood glucose levels in 2016

 Diabetes-2016

The resulting health benefits to C are obvious but he is also now able to eat a less restrictive diet and can once again enjoy eating with his housemates and not feel so isolated because of his diet.

This is a great result and shows that with perseverance, creativity and good working relationships great results can be achieved which can make a real difference to a person’s quality of life.

Chris-at-Kings-Road-diabetes-2

Four great social inclusion audits

25th November 2016

As mentioned in a previous blog, I have started carrying out social inclusion audits when I visit services each week. I’ve done a few now, but I’d like to highlight four of them as they were particularly good: Masons Hill in Bromley, Heathcote in Epsom, The Green in Sutton and Cheam Road in Sutton. I score them on a scale of 0–3 in each of the 10 categories (below) and in each of these four services their scores ranged from 25/30 to 29/30.

10 categories:
Active support
Employment
Regular us of community facilities
Independence training
Promoting sport and physical health
Promoting emotional well being
Maintaining contact with family and friends
Sensory stimulation
Use of public transport
Involvement with clubs and societies

Scoring:
0 = No evidence
1 = Limited evidence
2 = Stronger evidence, but patchy
3 = Regular evidence

PTAIT_20160728_0619

I saw so many great examples of how this social inclusion is being achieved and the fantastic outcomes that have resulted for service users that we are going to create a best practice book highlighting these examples. This should be available in the New Year.

For now I’d just like to just mention a few of the social inclusion achievements from Heathcote in Epsom. TC has taken on a voluntary job at Head Start which is a homeless shelter in Leatherhead. Here TC not only does the cooking, but is given the responsibility of deciding on the menus each week and buying and serving the food. For someone who is incredibly quiet and shy, this is a fantastic achievement. For 7 years now, Dan has done paid work, 5 days a week, in a club in Epsom as a cleaner. He also has the additional responsibility for unlocking the club and managing the alarm system. Crystal moved to Heathcote from foster parents and now attends an organisation known as KCFC (Kingston Children and Foster Care). Since joining she was asked to put together an article on the Summer BBQ . She was also successfully nominated for an AQA Award and will be presented with her award by the Exec Director on 7th Dec.

(Dan and Crystal have given permission to use their names)

Evidence of what a difference a good and effective manager can make

14th November 2016

I would like to dedicate this week’s blog to a letter I received from the staff team at our Charmandean Road service in Worthing. It is such a great demonstration of how a good and effective manager can make so much difference to the lives of people we support and the morale of our staff teams:

Dear Peter
We would like to begin with a quote from a recent blog: ‘To others aspiring to provide the highest quality care and support’. You mentioned the ten tips of leaders of social care and as outlined we again remind ourselves of the importance and relevance of these:

• To personally answer all complaints from families
• To personally check improvement plans for any required improvements or inadequate services at least once a month
• Do not take peoples word for it; ask to see evidence
• Be on top of the details that matter; such as turnover, sickness, and up to date training in compliance in the service
• And the list goes on

As a staff team we agreed on the points given and believe this is relevant to what makes good leadership in a social care environment.

Our purpose of writing this letter to you is to acknowledge the phenomenal and outstanding work our manager Jennifer Broadway is doing since taking the mantle as our service manager in Charmandean Road. She has delivered quality service, benefiting all service users and staff, and we wish to continue to support her work.

With her open door policy, Jennifer has valued and respected the needs of her service users dignity and treated staff equally. She has built good rapport and relationships with parties partnered with our service such as GP’s, nurses, OT’s, parents and visitors.

As you are aware, in the past Charmandean has struggled with staffing levels and the attrition rate was increasing. Jennifer has recruited several enthusiastic staff members that complement the needs of running the service.

With her pragmatic leadership, Jennifer has built a strong and competent staff team that execute their duties effectively. Jennifer has been very instrumental in ensuring all shifts are covered where necessary working late, early, long days and night shifts on top of her official schedule.

How could we not be inspired? Seeing our manager take the lead when it comes to service users personal care, laundry and cleaning duties.

We can report to you with sincerity, all the compliances set by CQC have all been followed, for example health and safety checks are regular, and recently all of the electrical supply routes have been tested and the carpets have been professionally cleaned.

Jennifer has booked appointments with health professionals for example, health reviews, flu jabs, occupational therapist reviews. She will personally support them to their appointments.

Jennifer volunteers to drive service users to appointments, activities and to visit family. She does not want them to miss out on opportunities due to lack of drivers on shift.

Over the period as house manager, Jennifer has conducted regular staff, service user and parent meetings, staff appraisals and supervisions. She is vigilant in her work and approachable towards her team.

Jennifer will ensure staff are reminded to follow protocols, complete all documentation for example fire checks, water temperature checks, daily diaries and healthy files.

As the environment is vital to our work she has been advocating for the garden to be maintained and the surroundings we work in to be a clean and safe environment.

The staff morale here at Charmandean is boosted and the atmosphere is very welcoming to work in. We are one happy family which can be demonstrated through our participation celebrating birthdays and Christmas.

Any complaints we are to receive are treated as constructive feedback to help us improve the quality of the service we provide.

We are confident that with Jennifer’s leadership without any doubt we will achieve Outstanding in our next CQC rating. We are therefore appealing to you to give Jennifer the support she needs to continue her hard work to make Charmandean the best service in CMG.

Kind regards
Charmandean staff team

Celebrating annual staff awards and social inclusion audit tool

8th November 2016

We held a fantastic Annual Staff Awards Ceremony on Friday evening at a hotel in London’s Kensington. I love this event as it really does highlight the amazing work that our staff do on a daily basis, with nominations made by staff, people we support, family members and external professionals.

This year we had over 400 nominations which is a record number in the 7 years we have been running these awards. A significant amount of these come from families whose nominations were often very moving and demonstrate their appreciation of an employee who has made such a difference to the quality of life of their family member.

What is also great is that staff are invited to this event knowing they are a finalist, but not knowing until the night, which of the 14 categories they have won in or whether they have a 1st, 2nd or 3rd position. Our Chairman, David Spruzen, handed out the personally engraved awards and everyone was treated to a 3 course meal and disco. It really was a great evening.

Staff awards web

If you would like to see a list of all the categories and finalists, please contact sue.pym@cmg.co.uk.

On a slightly less positive note, I’ve noticed occasionally on my visits to services recently a reduction in meaningful activity for the people we support. Michael Fullerton and I have therefore put together a ‘Social Inclusion Audit Tool’ which outlines 10 core activities which the people we support should be engaged in. These core activities are:

Active Support
Employment
Regular use of community facilities
Independence training
Promoting sport and physical health
Promoting emotional wellbeing
Maintaining contact with friends
Sensory stimulation
Use of public transport
Involvement with clubs and societies

When I visit services each week I will be scoring them on a scale of 0 – 3 as to how well they are achieving social inclusion against each activity for the people they support.

Black History Celebrations and valuing our staff

28th October 2016

We held another of our fantastic annual events this week, our Black History Celebrations. It was such a great day, packed full of activities to celebrate and embrace the great diversity we have in CMG. It is basically one big party with singing and dancing competitions, a fashion show, face painting, henna tattoos and foods from around the world! It was good to see staff and people we support having so much fun and I think the photo below demonstrates this well. My thanks to Pam Kujeke and her team for cooking and preparing all the fantastic food, to the resource centre in Sutton for organising some amazing artworks that decorated the room and to Sue, Emeka, Harissing, Pam Hirsh, Dan and many others for making it such a successful day.

At our Registered Managers Conference last week we held a workshop on how we can continue to improve valuing our staff. We had some great feedback from our managers and have subsequently put together an action plan to carry forward some of their ideas. This includes improving recruitment processes for example, by having continuous recruitment to reflect turnover rather than recruiting to specific vacancies. Also where staff may not be suitable for one service, we share them with another to avoid losing them. We will also be developing a good practice guide to improve the culture in services. Suggestions included having more fun team meetings, implementing house awards, saying thank you more often and encouraging positivity through a ‘wall of positivity’ with comments and positive staff feedback.

As well as our Employee of the Month Scheme we will also introduce a quarterly Team of The Month Award where the winner will receive a visit from myself, along with a hamper of goodies for the team!

187

Three great events in CMG’s calendar!

19th October 2016

It’s been a very busy couple of weeks but the highlight has definitely been some fantastic CMG events. Last week we held our fourth Driving Up Quality Roadshow, this time in Hampshire. These events are proving to be really successful with some fantastic pledges being made by people we support in one or more of the following five areas:

Relationships
Being Out and About
Being Healthy
Coping with Emotions
Gaining Employment

Our Deaf services from the New Forest attended this event and they made a collective pledge for more social clubs/events for Deaf people to attend. In these services both the tenants and staff are D/deaf and all communicate using BSL. We are going to look at ways in which we can help them achieve their pledge.

????????????????????????????????????

Last week we also held our 20th Anniversary celebrations for our Welsh services (we held our celebrations for our English services back in July). Staff, people we support and their families and professionals from across South Wales joined the festivities at Islwyn Indoor Bowls Club in Blackwood. Guests were greeted by Claire Pritchard our Operations Director for Wales who gave a welcoming speech in both Welsh and English, before the celebrations got under way.

There was a full programme of music and arts focused events including a ‘Welsh Factor’ singing competition, art therapy workshops, poetry, photography and even Zumba classes and a baking competition. We were also treated to an amazing performance by the Blaenavon Male Voice Choir. Well done to all involved for a fantastic day.

Yesterday we held our annual Registered Manager’s Conference attended by all managers across CMG. This is an annual gathering and it’s always great to see all our managers and give them the opportunity to network with one another. The day’s programme included a mix of key note speakers as well as workshops where everyone has the chance to discuss various topics. This year the workshops focussed on: End of Life Plans; Leadership and Culture in Teams; Managing Stressed Staff Teams and Retaining and Valuing our Staff. Former Olympian, Derek Redmond also gave us a truly inspirational presentation on achieving success and the importance of working as a team to achieve that success. A really successful day and I’d like to thank all our managers for taking the time to attend.

Members of