Herefordshire Care Homes owner and CEO Karen Rogers boasts the enviable record of having five out of her six care homes rated ‘outstanding’ by the CQC with the sixth rated ‘good’. CHP spoke to Karen to find out her recipe for success.
Karen is no stranger to inspections having managed a team of inspectors when the regulatory role was in the hands of the local authority.
She came into care with the acquisition of her first home in Herefordshire 20 years ago.
Since then Karen has grown the business through the purchase of five more existing properties.
“They were all trading as care homes with some quite old fashioned practices and quite institutionalised models of care,” Karen told CHP.
Part of the transformation of the homes was upgrading them to provide a more welcoming and spacious environment.
Karen added 17 en-suite rooms to her first acquisition as well as remodelling the existing property, this expansion and redevelopment was replicated in each of the other homes.
“They were all tired care homes that were struggling and providing a model of care that was quite outdated,” Karen noted.
“I think it’s really important that nobody’s standard of living falls when they move into a care home. It’s important for me that people live in a really nice environment.
“Changing the culture was the biggest challenge in order to get to providing the level of care we are now.”
The CEO achieved this turnaround through a combination of training existing staff and bringing in key people who share a vision of well-being.
One of the many innovations Karen employs to achieve staff buy-in to her values is getting managers to live in the care home as a resident for a day.
“They have to rely on staff for everything – for their nutrition, hydration and social interaction,” she said.
Following the day, a feedback sessions is held with the management team to discuss how it feels to be in a home and how disempowering it can be.
“We look to continue to keep pushing the boundaries,” Karen noted.
“We have developed a model of care that is appropriate for the times we live in.
“We have developed a model that is really just about people changing their address. We want our residents to choose to live in a care home because they can continue to live well.
“It’s a different model of care. It’s not task led at all. People are really busy living their lives no matter how frail they are. Even the frailest are out living their life and functioning really well. We’ve seen so many people whose frailty has been reversed due to a model that focuses on good health.”
All six homes are located in rural locations, which can pose problems in terms of workforce access.
“It should pose a challenge but thankfully it doesn’t,” Karen reflected.
“Staff like working in a model of care that reflects the way they would like to live themselves. It really motivates them to help people do the things they would like to do themselves.
“We talk about empathy all the time and you can really see that they are so proud of what they do. They just absolutely love making sure people have a great life.”
Staff are further motivated through a range of incentives, including annual awards.
Lead responsibilities are provided to staff in every home in areas such as infection control, nutrition and hydration, and tissue viability.
The homes also have advanced practitioner staff and Karen is about to launch a nursing associate training programme.
Staff turnover, as a result, is very low with the provider adopting a no agency policy.
Technology used to support carers includes Person Centred Software’s evidence based Mobile Care Monitoring digital care planning system, as well as laser beams and fall/movement sensors.
“We have adapted the digital care plans as we have gone along and they work for us,” Karen noted.
“They have the potential to really save time and input accurate, real time information.”
Karen has also completely changed the way activities are provided in her homes.
“We don’t have standard activities providers coming into the homes anymore,” Karen said.
Herefordshire Care enables residents to choose their own entertainment, such as house concerts, and invite their relatives and friends along to experience it with them.
The homes also invite guest chefs to come in to provide special cuisine nights at pop-up restaurants.
“There are no routines that fit in with the shift patterns of the people who are working – people are engaged in a whole range of things such as yoga, swimming, theatre groups and outdoor activities such as gardening or participating in a walking group. Each evening people choose how they spend their time, from watching films with a glass of wine or just socialising with others,” Karen said.
A real priority is keeping people out of hospital whenever possible.
Staff carry out an assessment on each resident when they come into a home to predict the likelihood of a hospital admission, based on their GP summary.
“We then put measures in place to do everything we can to prevent that happening,” Karen said.
“We have seen a drastic fall in admissions and a real improvement in increasing people’s mobility.”
Every resident has a nutritional assessment and is provided with a range of foods that provide good health, with their nutritional and hydration intake monitored closely.
Each home employs a physiotherapist who works with residents on a daily basis on improving their core stability and strength.
Karen’s homes have also taken on the ‘red to green’ initiative which has been adopted in the NHS, where ‘red’ is a day of no value and ‘green’ is a day of value.
“Every day starts off as a red day and we have to convert that to a green day,” Karen said.
“The most important thing for us is ensuring that every single day is a day of value to the resident.
“A week in bed equates to 10 years of muscle ageing so we have a real emphasis on people being up and active and dressed.
“Everything we do is about people living really well and being active and improving people’s mobility.
“We have seen a 40% reduction in the number of falls over the last two years. They are very few and far between.”
Karen and her team have achieved a sector leading level of care quality across the organisation through regularly sharing best practice. Management teams meet every month to share learnings.
The provider has also replicated a recent CQC ‘learning from incidents’ initiative.
Herefordshire Care’s exemplary CQC ratings are also partly the result of preparing thoroughly for inspections.
“We continually prepare for inspections, ensuring we gather the evidence to support the characteristics of an outstanding service,” Karen said.
“Our focus is all about outcomes and the impact of our actions. We particularly look at gathering evidence to show how the things that we do have an impact on people’s lives.
“The level of governance we have across the organisation is fairly robust. We have a huge range
“We work very closely with the residents in our homes to make sure they are involved in recruitment.”
While Karen has made the highest possible standards of care the norm throughout her organisation she highlighted that this would not be possible on local authority fees.
“We do have some people who are local authority funded with a third party contribution but the majority are privately funded,” Karen said.
The CEO said that being a small, independent business was fundamental to the quality of care she provided.
“I am in touch with the homes every day and I know all the staff, all the families and all the residents,” Karen highlighted.
“Obviously the larger you get the more difficult that is and that is why I practice in just the one area. I strongly believe in supporting my managers particularly with the level of frailty people now have.”
While comfortable with her size as a provider, the CEO said she was hoping to expand the group a little more, however, with one acquisition pending in the coming weeks.
Watch this space.