Operations Director Elaine Farrer shares south coast, private pay focused provider Colten Care’s recipe for ‘outstanding’ care.
With four of its 20 care homes rated ‘outstanding’ and the rest rated ‘good’, Colten Care has established itself as a leading private-pay focused provider of premium quality care.
The south coast provider’s record is even more impressive given the context that all of its homes specialise in nursing care, an area where achieving the CQC’s top rating has proved to be more challenging because of the complex nature of the care being delivered. So how does Colten Care do it?
“For me it’s about collective brilliance, and a One Team approach,” Elaine told CHP.
“It’s about our two strategic goals – being the provider and employer of choice in the south coast – being our ultimate focus. If we are doing things that don’t impact on our residents then we shouldn’t be doing them. All About Me – is our philosophy of care where the resident is at the heart of all that we do.”
Elaine highlighted the importance of staff and senior management living the Colten Care values of: ‘friendly’, ‘kind’, ‘individual’, ‘reassuring’ and ‘honest’.
“We roll out our company values from the top,” Elaine noted.
“We are a very visible Board. We spend a lot of time in the homes talking to residents and relatives and getting to know our staff.
“Our values came from our relatives and staff. It’s all about making sure that we deliver on them.”
As part of its responsive approach to care, Colten Care asks residents for their ratings on how well its values are role modelled.
“95% of our residents tick all five of those values,” Elaine said.
The operations director added these values were also key when hiring new staff.
“We recruit on a values basis,” Elaine said.
“This isn’t about having a wealth of experience within the care sector. It’s about taking somebody who has got the right attitude and the right aptitude for life who can identify with those values. You can teach people how to use a hoist but attitude and appreciating what are values are has to come from within.”
Colten’s family business model and values-based approach has helped it develop a stable, committed and motivated workforce.
Agency use at the provider is low, at around 4% of worked hours, although Elaine stressed that Colten was always striving to do better.
The operations director said agency use was driven by affluence in the south coast and competition with local hotel and hospitality operators.
“We want staff who want to be here and want to be part of the team,” Elaine stressed.
“Agency for us is awkward and doesn’t fit well with our values. We have some great agency staff but it’s not the same as having your own committed team.”
Given providers’ tight operational margins, Elaine said Colten had to look for other ways to attract staff and nurses, in particular.
“Care homes for nurses, in particular, still have a stigma,” Elaine said.
“We have done a lot of raising the profile of nurses in care homes. We are like all providers of nursing care, very aware of the challenges in recruiting registered nurses.”
Career development for nurses is encouraged. Colten Care has created a career structure within the nursing teams and employs a Nurse Learning and Development Manager who supports nurses, especially those new to care homes.
“We also run Clinical Excellence days where at the last event almost 70 of our registered nurses joined us for a day of practice development with guest speakers relevant to the older persons sector and with trade stands to visit,” Elaine said.
“98% of nurses who attended rated the day as exceeding their expectations.”
Around 40 of the provider’s nurses have taken on mentoring responsibilities as practice assessors, supporting student nurses through a partnership with Bournemouth University. Nine carers are also being supported, having signed on to a two-year trainee nursing associate programme at Solent University.
Ongoing learning is promoted. A clinical manager who recently completed the Older Persons Fellowship at Kings College London achieved a Postgraduate Certificate in Advanced Practice. A 37% reduction in falls in one pilot nursing home was observed during her quality improvement project, which is now being rolled out across the business with some very positive results.
Colten also employs three Admiral Nurses. The team of three is led by a Consultant Admiral Nurse. They lead on delivering the dementia strategy and dementia promise “supporting you to overcome the challenges associated with dementia”, across Colten’s 20 homes and provide support to the local community. The business also holds an annual Dementia Utopia day for staff from its dedicated dementia homes to share best practice.
Colten’s close links with the community are further embedded through contact with primary schools, nurseries and junior schools, and its participation in the Duke of Edinburgh scheme, which sees young people come into its homes to befriend residents.
While justifiably proud of the recognition of its care excellence by the CQC, Elaine is quick to point out that gaining a CQC ‘outstanding’ is not an end in itself.
“It’s important that we just don’t do things for the sake of CQC,” Elaine said.
“As an organisation we are anything but complacent. Whilst it’s an amazing achievement to get outstanding, it’s then about what we now need to do to demonstrate the impactfulness of what we do with our residents. It has got to be in order that our residents can live well and we are looking at different ways that we can take a service from outstanding to outstanding plus.”
As part of its ethos of continuous improvement, the provider adopts a ‘stretch audit’ for homes that are outstanding or approaching outstanding.
“The audits measure parameters at a higher level so that we can really demonstrate that our residents are looked after well and that they have maximum opportunity to be involved in the running of the home and have a say in what happens, and we make that all the more of a focus in our outstanding homes,” Elaine told us.
Inclusivity, transparency and responsiveness are key to the Colten recipe for achieving the highest care standards.
The provider takes annual feedback from its residents which is combined with the findings of an independent survey as part of its ‘You Said, We Did’ programme.
“94% of our residents rate our quality of care as good and outstanding,” Elaine noted.
“Where we don’t score 100%, we discuss that with residents to find out what we need to get to a 100%.”
The provider asks its residents for their feedback on a quarterly basis.
“It’s a very visible, responsive, ongoing practice,” Elaine said.
“It’s embedded in the homes philosophy.”
Colten is equally open when dealing with complaints, which are handled through its Are We Meeting Your Expectations? programme.
All concerns are categorised into the four main areas of: ‘care’, ‘food’, ‘attitude’ and ‘communication’.
“We can then see whether it’s a training issue or a misunderstanding,” Elaine added.
“If we have got it wrong, we want to understand why. We want raising concerns to be part of our culture.
“It’s disappointing for any care provider to feel that complaints can’t be raised in an open way.”
A Significant Event Analysis is carried out on the occasion that the provider gets something wrong with its results being shared with the team so lessons can be learned. This way of working has been complimented on by CQC, Elaine noted.
“If it’s something to do with a care issue, then one of my clinical managers will go into the home and review how we got to that situation,” Elaine said.
“We will then take that complaint apart and talk to the members of staff involved in a positive way and look at learnings.
“It’s one of our ways of sharing we are learning as we go because we are human beings and don’t get it right all of the time.”
The provider takes the same open and candid approach to end of life care and, via a working group of home managers, carers and nurses, has developed its own end of life care strategy. Colten actively promotes the concept that we only have ‘one chance to get it right’.
To support this aim, Colten embraces the need to talk with all residents and their relatives about advance care planning at the earliest opportunity during the pre-admission process, and by completing ‘after death analysis’ for every death, share best practice, or if things did not go well, identify clearly what can be learnt and shared, always striving to achieve outstanding care. One measure of the quality of care provided is that, in the last six months, 93% of all end of life care was provided in the nursing homes with no need to transfer for hospital.
Transparency is also key for Colten when dealing with the sometimes complex area of care home fees.
“We are very transparent about our fees,” Elaine said.
“We are all inclusive. We do not charge any upfront fee, including maintenance or pre-assessment. We clearly show families what the fee is composed of.”
The operations director said that fees were dependent on a resident’s category of care and, in the event that this is changed, a meeting is held with them and their relatives to explain why it is happening.
“We give the family the opportunity to discuss those changes and then write to confirm when a care need change has been agreed and give them 28 days’ notice of the change,” she said.
Regarding after death fees, which have been a main focus of the CMA’s investigation into the sector, Elaine said these would only be charged until the resident’s room had been cleared.
While culturally innovative in its approach to care, Elaine admitted Colten was not the most progressive in terms of its adoption of technology.
While having had great success with its eMAR trials, which it is looking to roll out to other homes, the provider retains paper care plans.
“Technology has a place but I am still waiting to be convinced that it’s the right thing for us to be doing especially with electronic care planning,” Elaine noted.
“In general we don’t have great issues with our care documentation.”
In terms of other technology, the provider has seen a huge reduction in individual resident falls through the use of Rambleguards Assistive technology sensor pads, which are attached to a call bell system.
The release of any pressure off the pad provides an alert to staff through the call bell system so they can attend to the resident quickly before a fall may occur.
Elaine said improved reporting, via online data capture as an incident happens, had enabled her team to monitor information on falls and other incidents much more responsively rather than relying on monthly reporting.
“Clinical and quality managers now see this picture building much earlier and can take a more proactive approach to helping and supporting residents and can get into the homes offering support,” Elaine noted.
The provider runs a clinical governance risk report to look at what is going on in the homes from a benchmarking point of view across a number of clinical matrices. The system has been designed to highlight clinical risk. It actively encourages an open culture of reporting, with the aim of supporting home managers and clinical leads demonstrating clearly and transparently how they manage clinical risk responsively and effectively.
“We will look at a number of clinical parameters that we consider to be important in our nursing homes,” Elaine commented.
“The monitoring of these clinical risk areas allows us to benchmark similar homes with each other, look at trends and identify both issues and best practice in a timely way,” Elaine said.
“It helps us drive our goods to outstandings and keeps our outstandings where they are.”
The provider’s in-house IT support team has played a significant part in developing this system, working closely with its clinical managers to continually review and look for ways to further improve the ease of information capture and how this data is presented and used for the benefit of each resident.
Colten takes the same in-house approach to its design, adapting furnishings and designing new homes on the basis of resident feedback through its specialist teams.
The Colten in-house, uniquely, bespoke care model is clearly an effective recipe for outstanding care as evidenced by its glowing reports from both service users, carehome.co.uk ratings where the group has an overall 9.8 score, and the CQC.