As part of our Enter and View programme in 2018/19, we visited 16 Care Homes in Milton Keynes to hear about residents’ experiences, particularly regarding social engagement and activities. This year, we have begun the process of getting in touch with these Care Homes to find out what has changed since our report and whether our recommendations have been put into action.
It has been ten months since our visit to Burlington Hall Care Home, at which time six Recommendations were made and a low-level safeguarding concern was raised. We were pleased to be invited back by the manager, who was keen to for us to see the positive changes at the Home following our Recommendations. We made an unannounced return visit to Burlington Hall on 19th September and were welcomed by the Manager, shown around the Home and introduced to the residents.
During this follow-up visit, two Authorised Representatives (ARs) spoke with eight residents. Many of the people we spoke to had limited capacity for detailed conversation, due to their dementia, but there was an overall vibe of calm and positivity and residents seemed happy.
It is worth highlighting the comments from a particular resident who, after we explained the purpose of our visit, told us:
“It’s better now, thank you for sorting it out. I get noticed now. They have good hearts.”
And, whilst the topic of food was not prompted by us, another resident was very keen to tell us how good the food was. The manager explained that, since our original visit, the Home no longer outsources catering and they now have a Chef preparing all meals on site.
We said: “Ensure processes are in place (and all staff are trained) to recognise the signs of loneliness or isolation and to introduce action plans to address them.”
They did: Burlington Hall told us they have reinforced with staff the importance of spending quality time with residents and staff are now encouraged to complete paperwork in the communal areas to remain open to resident engagement. Of the eight residents we spoke to at the follow-up visit, five told us they did not feel lonely and it was evident to see many had formed meaningful friendships. One resident said they did not leave their room much but had a “steady flow of people” coming in to talk to them.
We said:“Review processes and daily routines to increase individual choice and empowerment.”
They did: The Manager told us that processes have been reviewed to ensure resident choice is at the forefront of decisions surrounding personal care and that residents are encouraged to have a full shower at least once a week. None of the eight residents we spoke to raised any concerns about personal care or showering. Comments included:
“Would be nice if more regular but I can get a good wash in my room.”
“I shower myself. Someone comes and helps me with my socks.”
We said: “Consider the introduction of a Key Worker system to improve continuity of care and even better relationships.”
They did: Since the report, management told us they have reviewed the system that was already in place, to ensure continuity of care. At our follow-up visit, we asked residents who their key worker was. Of the eight residents we spoke to, only one could name their Key Worker. However, many of the residents suffered from varying stages of dementia and, whilst most could not remember, all felt well cared for by all staff.
“I feel like they care about me.”
“I think I have a key worker, but I don’t know who it is.”
“I don’t really know [who key worker is], but all of them take notice.”
Furthermore, during the follow-up visit, ARs observed many instances of natural, caring and tactile interactions between staff and residents. The manager appeared to know the residents very well and it was evident to see a strong rapport between them.
We said:“Consider introducing some evening social opportunities such as film nights, card games or Scrabble, to reduce feelings of boredom or loneliness.”
They did: The Home introduced evening activities on both the Residential and Dementia Care units. The extended activities were well received in the Dementia Care unit and resident feedback showed that they enjoyed the new programme. However, residents in the Residential unit said they preferred not to partake in evening social activities and chose instead to relax in their rooms after dinner. The Home decided not to continue with evening activities on the Residential unit for this reason, but have made residents aware that anyone can join the activities on the Dementia Care unit if they wish. Comments from the residents we spoke to at the follow-up visit were reflective of this:
“Cooking isn’t one of my things – but I like the eating!” [when asked about the baking activity]
“I prefer to sit and watch my TV”
We said:“Review laundry processes to reduce the number of items lost or misdelivered.”
They did: Following our Recommendation, management introduced a new laundry process which involved labelling all items of clothing and a photographic inventory of belongings for each resident, kept within their notes. At the follow-up visit, the manager and residents told us that, since the introduction of this new process, there have been no issues with laundry:
“A bit of a hiccup with new staff but usually very good.”
“No problems at all.”
“Ladies in the laundry are very good. Only lost one shirt but that was a long time ago.”
“[The laundry is] all sorted.”
We said:“Continue to monitor the delivery of care, to ensure every resident is treated with dignity and respect.”
They did: Following the visit, the management told us they continue to regularly monitor the delivery of care and audit their processes, as well as holding regular staff meetings. At our follow-up visit, we asked eight residents whether they felt well looked after and all the participants told us, or indicated, that they did:
“We’re very lucky, everything is good and everybody is well looked after.”