In a time when many care home operators are focusing exclusively on the luxury private market, CEO Maria Ball says not for profit provider Quantum Care remains steadfast in its commitment to local authority fee payers.
CHP caught up with Maria at Anson Court in Welwyn Garden City, Quantum Care’s newest care home which has been built as part of its 25-year partnership with Hertfordshire County Council (HCC).
Since its foundation as a care transfer organisation for HCC, providing a service for LA fee payers has been a core part of Quantum Care’s service. Today, LA fee payers make up 50% of residents, however, their failure to keep up with the cost of care has forced Quantum Care to pass on the growing differential to its private fee payers.
As a result, private fee payers pay are being asked to pay more than £1,000 a week in fees at Anson Court, for example. While across the business, the differential between LA and private fee payers averages 40%. However, this cross-subsidisation has failed to shake Maria’s belief in providing the same high quality service for everyone.
“We still believe everybody gets the same care,” Maria told me.
“Everybody is in the same part of the building. Everybody has the same access to everything we do.”
With high end care home providers increasingly targeting the South East, Maria sees it as part of Quantum Care’s mission to make sure LA fee payers are not left with nowhere to go.
Nursing care is another area where Quantum Care is boldly going against the current grain for many other providers.
Maria plans to reintroduce nursing care at Anson Court from April despite the current recruitment and retention challenges, which have seen many, including fellow not for profit provider Anchor, leave the market.
“We have done small care nursing in the past before we too had to leave the market,” Maria said.
So what has now changed to make nursing once again a viable option for Quantum?
“We learnt a lot the first time,” Maria said.
“We believe we can do it again. We feel we should. Many of our residents will get very frail. Around 100 of our people leave our homes each year to go to nursing care. We would love to be able to provide nursing for them.
“We will run a different model of nursing. We run very much a residential model with nurses in it. We have learnt how to retain nurses. They have to feel part of a clinical team. We currently have a core nursing team with two nurses. We have someone who is developing nursing care for us who is a nurse and many of our other staff have nursing experience, so we have a clinical support core.”
While up for the challenge of re-entering nursing care, Maria admits to not having a ‘magic answer’ to recruitment problems in nursing recruitment but is confident Quantum’s caring culture can attract good quality staff.
“We have a nice way of working,” Maria said. “It’s a very different way of working from in an A&E and other high pressure environments.”
“We can offer a career opportunity and progression and development. Our links with Hertfordshire also offer learning and development opportunities.”
Maria is also looking at a slightly different model of nursing, including offering variations on district nursing.
“We are going to go into it in a very creative and innovative way,” Maria said.
“I think it would be good for nursing nationally to promote care as part of a career. I think it’s a really good opportunity for people.”
While nursing represents a development of Quantum’s care offering going forward, dementia care will remain the provider’s core specialism.
“The main thing I think we have done over the last 12 years is grow our expertise as dementia specialists,” Maria said.
Around three-quarters of Quantum’s current residents have some form of dementia.
“We are well-known for our dementia training,” Maria said.
“We do a lot more than the basic required. We have training programmes at different levels all the way up to our home managers. We have also leadership award levels in dementia.”
Quantum’s Rhythm of Life programme provides a framework for its dementia care.
“It’s about engaging people. We have areas that create calming atmospheres for people,” Maria commented.
Quantum has also adopted the use of dementia doll and pet therapy throughout its homes.
As part of its broad care offering, Quantum is also carrying out research into end of life care with Hertfordshire University.
“People have got frailer in care homes over the years as they come into care towards the end of their life, so it’s a really important part of care,” Maria told CHP.
Quantum Care specialises in Namaste Care, which is about providing people with very individually focused care such as hand therapy and relaxation in order to make end of life as comfortable as possible.
“It’s about taking care and comfort to people who may be confined to their beds,” Maria said.
Quantum’s partnership with HCC has enabled it to set up enablement and intermediate care when they were very new services.
Currently, Quantum provides intermediate care with two CCGs in Hertfordshire.
“You need to provide the range of care but some work needs to be done on what the models should be,” Maria said.
The not for profit provider has been in one of the pilots for NHS Net so it will be part of the NHS email system which provides security for safe document transfer for clinical care and is looking at using the Information Governance Toolkit with CCGs ahead of the introduction of the GDPR.
Quantum also offers a significant respite and day care service.
“Day care is very much about helping people stay in the community and helps alleviate loneliness,” Maria said.
Going forward, she sees Anson Court as a care centre operating as a community hub.
The home will host regular Age UK and Mind meetings and is fostering strong links with schools and community groups.
The not for profit provider is opening its cafes and day rooms up for community use for lunch groups and coffee mornings and invites people into its homes for their Christmas dinners.
Quantum Care’s Willow Court in Harpenden boasts an a la carte restaurant which can be used by the local community as well as residents and their families.
The provider has also been part of the national Vanguard work in developing care best practice. Work has been looking at ways of dealing with increasing frailty and clinical needs, and the growing complexity of care.
“There’s been very good learning in those schemes which we hope to adopt,” Maria said.
She said maintaining Quantum’s tight geographic focus had been crucial to the provider’s success.
“We believe being able to visit our homes on a regular basis is very important,” she said.
“I pop into the homes all the time. I will probably drive past half a dozen every day. We are very much in our homes and I think that’s crucial.
“People need to see that you are supporting your staff and engaging with them on things such as training and development.”
Looking ahead, Maria said there was potential for Quantum’s expansion provided that it maintained its geographical focus.
“We would want to add new homes but we would be quite careful about where we did it,” she added. “We are looking at other options.”
Quantum Care is a founder member of the National Care Forum (NCF) and Maria has recently become chair of the not for profit body.
Maria said being a NCF member gave Quantum Care the opportunity to share best practice with other providers in ways that are not seen in the corporate world.
“For me it’s a privilege being a chief exec of a not for profit,” Maria said.
“I think it’s the most interesting place to be. It’s not always easy. Sometimes you have to balance money and quality but I haven’t got shareholders looking over my shoulder and I haven’t got to make huge returns on large loans and debts and financing and that allows us to put money into training and innovation and our buildings. We make a small surplus after investment.
“We try and give staff as much as we can each year and do a lot of recognition of our staff such as award and certificates.”
In terms of innovation, Quantum is looking to develop software Apps to compliment its care.
The provider is looking at piloting the adoption of tele medication through the use of tablets at its homes in partnership with HCC and the local care providers association.
Maria said Quantum was yet to take the plunge and adopt a digital care planning system, however.
“I think they have improved over the last few years and we are just starting to relook at them,” Maria said.
“By next year we will have some e-care plans,” she added.
“I think it will make a difference to the standard of some of our care reporting.
“There’s so much of it. Making sure it is all in one place at one time is a challenge.”
3D virtual reality therapy is an area of innovation where Quantum has been more active.
The provider has developed a range of tailored virtual experiences with local business Tribemix which it is rolling out across its homes.
“It’s very personalised,” Maria said.
“We can make the experiences relevant to our residents by talking with them about their lives and interests.
“The great thing is that it is being driven and organised by our care staff. They have developed a process to assess whether it has an effect. There’s no point in doing it unless it really works for our residents.
“We look at how contented people are, whether they are sleeping or eating better and how it has affected their behaviours if they are challenging. The important thing is how we can use it to improve the quality of people’s lives. It works with some people but not with others.”
Looking forward, Maria said Quantum Care will be seeking to expand its offering into assisted living.
“Our new Director of Operations Stewart Mynott has come from supported living housing. I believe we will be working with extra care in a different way in terms of supporting and providing care.”
The not for profit provider is looking at potential shared sites.
“We are considering a close care model where you run it from a home as a hub,” Maria said.
“We are looking with the local authority at the potential of whether people can come into our home and take part in our activities and use our services and facilities as part of their daily homecare package.
“HCC commissions day care with us so we can perhaps work on home care at the same time. We are also talking with a couple of local housing associations that run supported housing.”
Maria said maintaining quality amidst increasing financial pressures would be the main challenges for Quantum going ahead.
As the provider celebrates its 25th anniversary one of its main ambitions is to gain its first overall Outstanding home.
All of its homes apart from one are Good with several having Outstanding for individual categories.
“CQC has generally improved quality standards in care and the consistency of those standards,” Maria said.
“I think it has improved hugely. The challenge for me is the definition of what is Outstanding. It seems to be quite rare. It would be good to recognise progress better because that does reward improvements and that’s what we are all trying to do. Perhaps Outstanding needs to be broader than it is.”