Compliance
the results have been thus far, no such documents or audits can be produced. A second key factor that can often undermine how well governed a care home is can stem from the varying interests of the major players at the home, namely: the staff, managers and directors. Although directors will have the interests of residents at heart when making decisions, ultimately, they have also got to be mindful of the purse strings and will have an acute understanding that there is not a bottomless budget, which means prioritising some areas or issues over others. Conversely, the carers are far more
involved with the day-to-day oversight and nursing of residents, meaning that their focus is largely going to be care- oriented, perhaps not appreciating that there are also commercials to manage. If these different groups of people are not communicating effectively and working in cohesion, the direction of the care home is going to be lost and mismanaged, highlighting the importance of minding the gap between the different stakeholders. Finally, many care homes do not
fully comprehend that implementing strategies and procedures to ensure that their establishment is well managed is going to be a gradual process. Any change involving people is going to take time, as old cultures need to be slowly overwritten; instead, many homes make the mistake of trying to rush change, which can lead to poor governance.
Ensuring your care home is well-led To prove that your care home is compliant with the CQC’s requirement that it is ‘well-led’, you will need to prove good governance, more commonly referred to as Regulation 17. This essentially asks care homes to implement strategies, ensure that they are constantly overseen and that this oversight informs decisions. That will require all those involved in
the care home to understand what the key objectives are for its improvement. Crucially, it is not enough simply to have a strategy in place; training, supervision and direction from the top down is going to be essential in ensuring that polices are being implemented on the ground. There also needs to be a key
system in place for understanding the repercussions of changes; the people in charge of monitoring the new system will need to understand how the strategies are affecting the commercials of the home, the services it provides, any risks that may be arising and – most importantly – the impact of the new procedures on the residents and whether they are receiving better care because of your decisions. In the collective experience of the
Fulcrum Care consultants, the best way to encapsulate this is not only from data, but also in talking to the individuals involved in the day-to-day running of the home, as well as discussing the residents’ experiences with them. It is also important to have written documentation
of all the feedback you receive, as well as regular board meetings where you discuss your findings and use them to inform future decisions. This will all help to demonstrate to the CQC that your care home is being well-led.
Equipping managers to implement policy decisions Most auditing of your home is likely to involve primarily the people at the top of your organisation’s structure, meaning that if they fail to communicate effectively with the lower ranks, ‘good governance’ will be undermined. One crucial way to ensure that your care home is compliant with being well run is through fostering strong links between your managers and your board of directors. When my team and I are working
on building cohesion between the different levels of personnel at the care homes we work with, our main aim is to foster effective communication that transcends these ranks. Managers are especially important for the board in promoting cohesion because they are their eyes and ears on the ground and should have great sway in influencing carers in favour of the directors’ decisions. To build strong relations with managers, it is important to get them involved in the decision-making process; of course, a care home is not a democracy, but including management in your board meeting will mean they understand why decisions are being made, making them more likely to be able to feed back to staff effectively the rationale behind new policies, ensuring they are met positively. It is also important to provide
your manager with the best way to communicate to staff, for example, you might want to encourage them to phrase a decision to carers or support teams in a certain way. Regardless, a new policy will not become embedded in the culture of the care home without the approval of your manager, and so it is important to get them involved from the start.
Getting ground level staff on board Convincing staff to get behind new policies is of the upmost importance as they will be the ones carrying out the decisions; without their complicity, you are not going to be able to demonstrate
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www.thecarehomeenvironment.com • October 2021
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