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THE BIG INTERVIEW: Sarah Clarke-Kuehn, Group director- Care, Sanctuary Group

Sarah Clarke-Kuehn

Group director- Care at Sanctuary Group, Sarah Clarke-Kuehn, says the challenges of COVID-19 will make social care stronger and help forge a brighter future for the sector.

As head of one of the UK’s largest care home portfolios, Sarah told CHP she was “acutely aware” of the danger posed by COVID-19 when its potential threat first began to emerge in Europe in January.

Sarah said early, pre-emptive action had been key to minimising the impact of the deadly virus on Sanctuary’s homes. Just over half of the group’s 102 care homes have been impacted by the pandemic.

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“We were as prepared as we were able to be,” Sarah said. “We ensured we had the right supply chains in place for PPE. We made sure we had all our risk assessments in place. We made sure we renewed our infection control procedures and training.”

Taking decisive early action helped reassure anxious relatives and staff during the onset of the virus and throughout lockdown.

“It was really valuable for our staff because they felt supported and provided reassurance that we were on top of planning,” Sarah said.

Sanctuary took the “difficult decision” of ending care home visits to protect residents on 13 March.

At the same time, the care group stopped movement of internal staff between homes to reduce the risk of virus transmission.

“Our business model means we have dedicated operational staff for each individual home,” Sarah told CHP. “We don’t move staff around between homes. We have a number of internal staff, including internal quality auditors, regional managers and regional directors, who normally would move around homes but we stopped that as well on 13 March to minimise risk.”

Message to community at Nunthorpe Oaks during COVID-19

Sarah said staff absence rates rose at the height of the pandemic in early April to over 9% but had since dropped to just under 2%. The care director pointed out that Sanctuary’s historically low vacancy rate of 2% had helped offset the toll on staffing during the crisis.

Sanctuary was among the first leading operators to introduce full pay for self-isolating staff in early March.

“We took the decision because we didn’t want staff to feel financial pressure to take any risk with our residents,” Sarah explained.

“Our care home staff really pulled together in individual homes. They volunteered to carry out split shifts to cover absences and have gone above and beyond to support our residents.”

Staff at four of the group’s services made the ultimate sacrifice of leaving their homes and families to move in with residents for a period of weeks in order to shield them from the virus.

Sarah said Sanctuary had rewarded the heroic efforts of staff with increased overtime rates, which had also helped minimise agency usage.

The group recruited over 80 temporary wellbeing assistants at the start of the pandemic to provide activities and mealtime support, while also helping with social interaction with residents. The recruitment campaign targeted people who were customer focussed, and whose jobs were at risk in the hospitality sector, through the use of Facebook and jobs website, Indeed.

Staff pressures were further eased through the introduction of new technologies and a review of recruitment procedures.

These procedures, which included online telephone interviews, combined with the government’s streamlining of DBS regulations, helped Sanctuary induct and process new starters faster.

“We still have rigorous recruitment processes,” Sarah added. “It’s vital that we get high quality staff.”

The care provider’s in-house electronic care planning tool, kradle, has played a significant role in easing staff pressures by reducing time spent on administration and freeing up carers to spend more time with residents.

Sarah said Sanctuary was also rolling out the Atlas emar system across its homes, which will result in care planning and medication administration being accessible from the same device.

“Having developed our own platform for kradle allows us to link other bits of software to it in the longer term,” she explained.

Technology has also been key in supporting infection control procedures at Sanctuary’s homes throughout the pandemic.

The care group has installed light boxes in all its care homes to ensure staff wash their hands thoroughly. These have also been well used by the residents who have joined in training on their correct use.

Technology has also been key in terms of supporting residents’ mental wellbeing by connecting them with relatives and the wider community on social media.

“One of the first things we did before lockdown in mid-March was to send iPads to every care home so that residents could Skype, Zoom and facetime their families,” Sarah noted.

“We made sure staff had the available time to help. It was incredibly important that we had additional resources to help people keep in contact. Our managers wrote newsletters to families to make sure they were kept aware of what was happening. We also shared messages to loved ones in home windows. We did a lot of games and puzzles to make sure our residents stayed connected and had social interaction. We did whatever we knew worked for each individual resident.”

A two-month virtual cruise has proved a big hit with residents during lockdown
A two-month virtual cruise has proved a big hit with residents during lockdown

Sarah also noted how incredibly innovative and creative her staff had been in keeping residents’ stimulated and entertained during lockdown.

Staff teams have worked together to complete a two-month ‘virtual cruise’, which has proved a big hit with residents.

“We are having different themed days for different destinations and the families are getting really engaged in this,” Sarah said.

“We are really looking at how we do activities differently apart from inviting people in. We have some incredibly creative, talented staff. It really has galvanised everybody to work as a collective, whereas up until this point we have been collectively working on COVID.”

With Sanctuary having acted swiftly to close its doors to visitors at the onset of the virus, Sarah said the provider had made a point of resuming visits in a safe and controlled environment as soon
as possible.

Residents have been able to meet loved ones through a variety of means, including garden visits, drive-throughs and communicating through open windows, all at a safe 2m distance.

Video and traditional telephone calls have also been regularly used and the provider has ensured relatives have been kept informed of what is going on in the homes through virtual tours.

Speaking to us at the beginning of July, Sarah said Sanctuary had adopted “stringent guidelines” for its visiting policy and was awaiting government guidance before considering any form of indoor reunions for residents and families.

“We would want to understand how the government is proposing to allow that to happen while we work through our own risk assessments,” she explained.

“Every care home is shaped differently so we have to work out how that works for every individual home.”

The care director said Sanctuary has also been able to draw on the invaluable support and shared experience of fellow not-for-profit providers throughout the crisis.

“We followed government advice and learnt a lot from each other by working with other not for profits,” Sarah explained. “We have developed a much stronger bond between us as a result of the crisis.”

While the pandemic has thrown the spotlight on integration, or sometimes lack of it, between care stakeholders, Sarah said Sanctuary had worked “incredibly well” with its 41 primary local authority partners.

The care director said Sanctuary had also found the NHS to have been “incredibly supportive” during the outbreak, adding that the care group’s rigorous infection control procedures had helped prevent the spread of infection within homes from patients discharged from hospital.

“We risk assess every new resident,” Sarah explained. “We ensure that the residents we take in are those we are able to care for and meet their needs. We have gone through our risk assessment processes and we are very comfortable that they are robust and appropriate. Every resident that joined us isolated for 14 days. We are ensuring that all our staff know exactly what those procedures are.

“I write a weekly bulletin on our website that shares additional things we are doing and how we are progressing with staff and resident testing. Every care home writes a residents’ newsletter where we share what we are doing.”

Sarah said Sanctuary had ensured it was part of the government’s whole home testing programme and welcomed the launch of regular testing for residents and staff.

“We are fully tested in England and in the majority of homes in Scotland,” Sarah shared.

“We really look forward to saliva testing if that becomes available. I believe it would be the least intrusive. Swab testing is a challenging experience for some people.”

The care director said the group had also adopted thorough cleaning and deep cleansing regimes in its homes and ensured staff were equipped with the most up-to-date infection control training and had sufficient PPE.

“We are prepared as much as we can possibly be for a second wave,” she said.

“We are currently reviewing all our processes. We are as confident as we can be. We have worked incredibly well as a sector in sharing best practice and coped incredibly well with the unique challenges that we have all faced.”

Reunited: Iris Gilpin with Claire and Freddie Macaskill at Furzehatt Residential and Nursing Home

Despite the challenging times the sector has experienced and still faces, Sarah remains optimistic about the future.

“We have seen our occupancy levels fall but we have begun to see an increase in the number of enquiries in the last few weeks and our occupancy is stable now,” she noted.

With a recent IPPR poll having found that a third of people were less likely to seek residential care as a result of COVID-19, Sarah noted it was essential for care home operators to provide reassurance on preparations for a second wave and procedures on local lockdowns.

While observing she had “seen a few shoots of growth” in occupancy, Sarah admitted people remained concerned over the government and Public Health England recommendation that new admissions self-isolate for 14 days.

Recognising this concern, Sanctuary offers an alternative option where new admissions can self-isolate in the comfort of their own home for 11 days before moving into a care home where they will be tested for COVID-19 and then self-isolate for a further three days whilst awaiting the test outcome.

Sarah explained that uncertainty over the incubation period of the virus meant it was not possible for new residents to be immediately tested in order to avoid isolation when being admitted.

“Fourteen days of isolation is the current government and PHE recommendation and, therefore, we are following that in order to keep all current residents and our staff as safe as we possibly can,” Sarah said.

Sarah conceded it would be some time before occupancy levels fully recovered, however, predicting they would not return to pre-COVID levels until between June and October 2022.

“It is going to be a slow increase in numbers but a care home is a vibrant, lively, enriching place to be,” she said.

Sharing her wish-list for the sector, Sarah said the onus was now on the government to provide a long-term funding solution for social care so that its workforce could be suitably recognised for their enormous contribution over the last five months.

“We have enriched lives for 22 years in Sanctuary Care,” Sarah observed. “We want to continue delivering high-quality care services and ensure that care is seen as a career and that people understand that they can come into care and develop and grow as a person and actually be rewarded and recognised.

“We want to make sure that the skills and experience of our staff are fully recognised. They have such a positive impact on the day-to-day lives of our residents.”

Sarah also called for further investment in Skills for Care so that it could build on its “outstanding” work to date and provide more support for the continued upskilling and development of care staff across the sector.

She also highlighted the need for a social care register similar to that in Scotland, Northern Ireland and Wales, to ensure staff were suitably qualified and their experience was recognised.

“I would also love to see more of the assistant practitioner and nursing associate programmes but we have got to make sure they are affordable to providers because that grows our role and gives us the skills we need in the sector,” she added.

The care director said Sanctuary was well placed to withstand the financial impact of the pandemic through being part of the wider Sanctuary Group organisation and a not-for-profit housing association.

“The group structure allows us to draw on additional finances that other providers may not have access to,” Sarah noted. “We remain fully committed to growing our care operation. We want to ensure there are enough high-quality care homes that can support our elderly population.

“As part of a wider not-for-profit organisation, we have the financial strength to support our growth strategy. That will be about building new care homes through our own development programme and also looking at acquisitions that will dovetail within our current operation and geographical footprint.”

The care director stressed there were positives to take from the sector’s most challenging of times.

“Adult social care is now seen on a par with the NHS,” she noted. “Care is a people business and I have been bowled over by our staff. I already knew they were amazing but I have been truly humbled by how amazing they have been and can genuinely only say thank you from the bottom of my heart.

“Our residents have had to live through scary times but our care homes have been really lively and engaging places that have been provided for by totally committed staff teams that have gone above and beyond, and developed new ideas that have become part of our new ways of working.

“We have got a really great opportunity to move forward. I feel real traction on a long-term social care model and what long-term funding for adult social care will be. We have also seen a coming together of the sector and amazing support from the National Care Forum who have brought together finance, HR and senior operational people to really galvanise the sector.”

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