Group Director – Care Mark McCarthy says Sanctuary Care’s success has been built on its ability to draw upon the diverse array of skills and resources held by Sanctuary Group.
CHP caught up with Mark at Sanctuary Grove in Worcester, a £22m state of the art care complex launched in June 2015.
Sanctuary Grove is the embodiment of the diverse array of care resources and services provided by Sanctuary Group.
Offering a window on the future, the complex provides extra care, retirement living, supported living and care from one site.
Developed in partnership with the Homes and Communities Agency, University of Worcester, the City and County Council and UW Wrenbridge LLP, funded by the Sanctuary Group and the Homes and Communities Agency, and built by Stepnell, the complex is a fine example of Sanctuary’s ability to execute major schemes offering multiple care types.
“This is a flagship development for us,” Mark observed. “It’s the first time we have purposely built everything in one location.”
The site not only shares the full range of Sanctuary’s services but also links to a neighbouring GP surgery. More recently it has also provided short-term placements for NHS and University students.
A sense of community is fostered through events hosted at the site’s restaurant and the service even boasts a minibus to help bring people in for activities from other sites.
“There’s a nice range of activities for all members of our community,” Mark noted.
It’s an impressive formula for providing the full range of elderly care but Mark notes that it can only be made possible when the conditions are right.
Offering multiple services is a high cost proposition requiring considerable land and support resources. Local authority support is also required for extra care tenancies.
“It helps if there is the right blend of private leaseholders who want to move into extra care,” Mark said. “It also depends on the local need for specialist services. It’s something we do well. It’s been our first and has been a success – it is something we can do elsewhere.”
Sanctuary Group’s business plan envisages 30,000 further accommodation units covering housing, market rent, elderly care and other specialist services.
Sanctuary also offers a telecare service to support housing tenants and private leasehold properties.
Mark has managed the rapid growth of Sanctuary Care since he joined the business in the late 90s from just two care homes in 1998 to 104 currently.
Having bought a number of independent homes in the south west and having begun to develop its own services, the business more than tripled in size with the acquisition of 36 homes from Shaftesbury in 2006.
“We had 14 care homes and were quite comfortable with running those,” Mark told me.
“However, we wanted to be bigger and wanted our geographical spread to be developed by acquisition rather than just build because that would have taken many years.
“The biggest challenge was ensuring we remained consistent because we were merging a number of companies we had bought and we were still bedding those in with our own ideals and with Shaftesbury we were then taking on something that was bigger and more established than us.
“We had to make sure we got the policies and the management structure and culture right. It helped us deliver a bigger and better culture by merging with the cultures we had acquired.
“I love making things more efficient and delivering quality. Good is never good enough for me.
“You can’t rest on your laurels in the care home business because you can get caught out quite quickly.
“Quality is the most important thing for us as a business and never accepting what you do is good enough.”
Being part of the Sanctuary Group provides Sanctuary Care with access to the significant capital required to fund growth.
The Group acquired Embrace Care last year and is looking at further growth opportunities throughout the UK with three new care homes opening this year.
Given the rapid growth of the provider, CHP asked Mark if there was an optimum size for the business, given the dangers of possible overstretch as highlighted by ongoing quality issues at Bupa and Four Seasons.
“I don’t think there’s an absolute maximum with the right systems, process and management,” Mark said.
“To have assurances over quality you need to set some goals. Within our current three-year strategy we are looking at expansion to 140 homes but since we have bought Embrace Care that number could double because we have a greater geographical spread.
“The number needs to be right in terms of ensuring you can have your mission, your values, consistency and your quality right. Having said that, I think we could come close to 200 homes quite easily because you can have that level of assurance.
“If you are a visible tangible leader I think people work that little bit harder because your staff see that you care and value their commitment,” he told me.
“We need to strike the right balance,” Mark said. “You can’t deliver a service if it doesn’t pay for itself. We are able to do more things than more commercially focused providers are but we won’t put ourselves in a position where we struggle financially.”
The provider is also talking to a number of NHS Trusts and CCGs about offering support where there are local hospital bed blocking issues, with Sanctuary Care looking to expand this support service throughout its national wide nursing homes.
“There’s definitely enough capacity in the care home market to offer intermediate care,” Mark said.
“It’s one of our strategic aims to work with the NHS and CCGs to provide accommodation where we can.”
Around 50 beds are under contract with the NHS for the service but Mark intends to scale this up in the coming years.
“We have 24 nursing homes so we if we offered 10 beds in each one we could provide 240 beds,” Mark said.
“There are further opportunities at the 29 homes offering nursing care through our acquisition of Embrace Care, which offer opportunities across the north of the country.”
Occupancy is high at Sanctuary Care at about 95%. The homes acquired through Embrace average around 88%.
Sanctuary has spare capacity with 186 beds becoming available at three brand new homes opening this year in the Wirral, Nantwich and Devizes, Wiltshire.
“I think we can create opportunities as we have a really good ability to adapt,” Mark said.
“Because of the way we build our care homes you can adapt the level of care quite easily. The room sizes are good so they can take nursing care and other specialist care if we need it, giving us the ability to switch when the market changes.”
Mark is particularly proud of a project Sanctuary delivered with the Group’s care and maintenance businesses working together to offer intermediate care at the George Eliot Hospital.
“The Trust came to us a number of years ago because they had a focus on bed blocking and had a derelict ward on site,” Mark said.
Under the project, Sanctuary Maintenance carried out refitting and rebuilding work at the site to convert a 20 bed hospital ward into a CQC registered 16 bed care home run by Sanctuary Care.
The service has been running for two years moving more than 200 residents onto different forms of accommodation. Negotiations are underway on the future development of the contract.
Technology is another area where being part of a larger group has created opportunities for Sanctuary Care.
The provider has created its own electronic care plan system in collaboration with care home staff, the Group IS team and an external software developer.
The ‘kradle’ electronic system has been rolled out at three homes with plans for all Sanctuary Care homes to have the system in place by January 2019.
“kradle has been delivered and designed in house by a dedicated team,” Mark said.
“I thought about this five years ago and my main driver was to improve resident wellbeing and create capacity for our care and nursing staff to form great bonds with the residents they care for. I also wanted the system to be owned by our care home staff so they had to be at the forefront at the creation and delivery stage.
“We previously went out to pilot with a systems provider about three years ago but it didn’t quite fit with what we wanted because we had an ideal of what we wanted to deliver.”
The process has been led by a former care home manager and a senior carer in the business.
“We have people from our care homes designing this,” Mark said. “They also work with people who have technical expertise from an IS system background so we have a perfect team.”
Sanctuary Care has employed a team of people to roll out the system over the next 12 months.
“We’ve had a lot of success in our three trial homes,” Mark said.
“It gives us that additional professionalism and provides even more assurance to families and residents. The staff are happier and the system is intuitive – reducing the capacity for human error.
“We have designed it from the view of how we think we should deliver care and what records we need to keep which link in with CQC’s fundamental standards.”
Mark said the move from paper to electronic would facilitate Sanctuary Care’s growth plans by ensuring better quality assurance.
“Our staff have really bought into this and want to be first on the national roll out,” Mark said.
“We would not have been able to afford to do this ourselves but being part of Sanctuary Group we can afford to do it because we can account for it over a longer period of time. We would also not have been able to implement the system quite so quickly on our own so we may have lost the impetus or created something with different systems in place.
“We could have created a break in our culture where people at the end of the process may have thought they were not as important as those at the start. However, because we can do it with Sanctuary’s backing we can get it into every home within a year.”
Sanctuary has also begun talks with a digital medical administration provider and aims to implement a system following its roll-out of the electronic care planning system.
It is also researching the use of ambient lighting, to help improve resident well-being, as well as using acoustic monitoring systems to provide less intrusive night-time care.
“We have been looking at WCS Care’s acoustic monitoring system and plan to go and talk to their staff and residents about it,” Mark said.
Mark stressed the importance of learning from best practice at other providers. Sanctuary Care is also able to do this through its membership of the National Care Forum.
Sanctuary Care also enjoys the benefit of access to Sanctuary Group’s SAP systems, which maximise efficiency across the business.
“Sanctuary want to invest in the future and ensure that we have a scalable platform and bring additional consistency and quality to what we do,” Mark noted.
“Sanctuary has some of the best credit industry ratings which means we are financially strong and viable and have a good solid business plan and although we are diversifying there is ultimate confidence we can deliver what we are doing.
“With the different backgrounds of staff across the Group, we can assess things fully so we don’t take adverse risks.
“By owning almost all of our homes we are in complete control of our own destiny from a financial perspective.
“Our priority is delivering the right quality of service with the right balance of staff and the right sustainable return which goes into developing our own care homes.
“We have great asset management support. We employ asset management surveyors who are linked to Sanctuary Care and employed by the Group.
“We have a good PR and marketing team to make sure that the brand is pushed out there and good financial support from the Group finance teams. We have a Skills for Care endorsed learning and development team ensuring our staff training is top notch and also have a Group L&D team to ensure we meet our expectations in terms of management training.”
Sanctuary Care has produced its own management development training programme to provide its leaders of the future.
The provider has created its own career pathway that links almost any role in its care homes to an aspirational role or gives people the right training and support if they are happy where they are so that they can keep developing so they will stay with the provider and ensure consistency of care for residents.
“We have got a track record of training and investing in our staff and supporting them to do other things,” Mark said.
“I want deputy managers in our care homes to have aspirations to become a home manager. I want nurses to become regional managers if they want to and I want to be able to attract and keep our nurses. Care homes are really rewarding places to work because you get to know the person you are caring for.”
Despite the challenges in the workforce marketplace, Sanctuary remains committed to providing nursing care.
“Our main priority is to continue to offer a stable, professional and caring nursing provision,” Mark said.
In the last couple of years the provider has reintroduced nurse recruitment from the Philippines and Africa. It has offered around 200 roles to overseas nurses who are training to meet the required English language and NHS entry criteria.
“Our current OSCE success rate is 56%, which is above the sector average of 49% and we are continuously striving to build on this,” Mark said.
Sanctuary Care’s focus on non-EU citizens means it is less exposed to the risks of Brexit than others, plus its experience from recruiting internationally has provided better retention rates compared to EU recruitment.
A new Nursing Academy was also launched by the provider in January 2018, which is led by an experienced nurse who has also managed one of its successful care homes and held previous roles as regional manager and clinical lead for over 17 years.
“We are hoping to see some real benefits from that this year,” Mark said.
“We are linking with universities and colleges in this country to look at how we can support nurse development through offering trainee nurse programmes and improved nurse engagement on the job clinical training,” Mark said.
This includes the creation of a nursing support assistant role, which involves giving senior care staff nurse specific training to support and work alongside nurses on medication and minor nursing duties.
The move is designed to help reduce agency hours and provide staff with a different skill while offering the financial support required to help them become a nurse.
The not for profit provider is intending to maximise the apprentice levy to pay for nurses to go to university.
“We are constantly striving to be innovative on how we attract and retain nurses,” Mark said.