Six things you should know about ‘Excellent’ rated care homes.

There are more than 24,000 care homes in the UK and only 13% have been awarded an ‘Excellent’ 3 star rating.

Six things you should know about ‘excellent’ 3 star care homes:

1. What are star ratings?

2. Star rating categories.

3. How are star ratings decided?

4. What makes an ‘excellent’ care home?

5. How many care homes are rated ‘excellent’?

6. How often are care homes inspected?



1. What are star ratings? Star ratings work in a similar way to the hotel rating system. They aim to differentiate between the level of service and facilities offered in a care home. The star ratings do not reflect the price being charged by the care home.

2. Star rating categories. Care homes are categorised from 0 to 3 stars, with 3 stars being the highest. 0 = poor, 1 = adequate, 2 = good and 3 = excellent.

3. How are star ratings decided? Until April 2009 inspections of care homes were carried out by the Commission for Social Care Inspectorate (CSCI). This has now been taken over by the Care Quality Commission (CQC). The inspection includes; interviews and surveys of residents, families and staff, an Annual Quality Assurance Assessment (AQAA) and the inspectors observations.

To ensure that ratings are consistent across the country the inspectors follow the Key Lines of Regulatory Assessment (KLORA). The CQC is introducing new regulations that will be implemented after April 2010 and will affect all care homes in England.

4. What makes an ‘excellent’ care home? The national minimum standards for care address 7 categories within care homes; choice of home, health and personal care, daily life and social activities, complaints and protection, environment, staffing and management and administration.

An ‘excellent’ rating will be awarded if at least half of these areas are rated ‘good’ or ‘excellent’ and no area is rated as poor.

5. How many care homes are rated ‘excellent’? There are over 24,000 care homes in the UK and 13% have been rated ‘excellent’ – approximately 2,600.

6. How often are care homes inspected? A 3 star care home at the present time would expect to be assessed every 3 years. The homes that do not perform to this standard will be assessed more frequently to help them to improve. However, the new regulations which will be enforced in 2010 have not yet outlined if this procedure will alter.

As with any governing body the rating system is not infallible and it is important to personally visit and make your own judgment about any care home you are considering.

In addition to this, any personal recommendations from the residents, relatives or visitors to the home will be an invaluable source of information.

http://www.best-care-home.co.uk/ is an online register that only lists 3 star 'excellent' rated care homes.  It also publishes personal recommendations from the residents, relatives and visitors of those homes to help you identify the home that will most suit your needs.

Moving to a care home – 10 ways to get it right.

Moving into a care home can be as traumatic as bereavement –it is a life changing experience and its impact should not be underestimated.

Here are 10 ways to help you make the right decisions.

1. Most importantly - do you really need a care home or could you manage at home? Contact Social Services and get an assessment, this is free and everybody is entitled to one. You will get a professional opinion on whether staying at home is an option and if not, whether a residential or nursing home would be more appropriate. Carers are also entitled to an assessment.

2. How are you going to pay for the care? This is worth considering early on as quite simply it could affect which care home you are able to live in. If your assets are in excess of £23,250, including your home (unless you leave behind a spouse or dependent under 16) then you are classified as a ‘self funder’ and will need some financial advice to work out what level of fees you can afford and what allowances you may be entitled to.

3. Now you are ready to start looking for a care home that most suits your needs. Care homes are rated by the Care Quality Commission, the independent advisor for Social Care. They are rated by stars, 0 -3, with 3stars being the highest rating. The rating does not reflect the price of the care home but the standard of care being offered and I would recommend you start with the 3 star care homes.

4. Take a list of questions to ask the care home and visit as many as you can that cater for your needs. There is a lot to be said for instinct and how the home immediately makes you feel – a welcoming smile and fresh smell are good starting points.

5. Preparing for the move is an important task, both for the prospective resident and their relatives. Be aware that a move into residential care changes your identity from ‘householder’ to ‘resident’ and removes you from your usual day to day activities. If you are looking on behalf of somebody else, make sure you include them in as many decisions as possible so that they feel in control of their situation.

6. When you have chosen the home that most suits your needs it might be useful to spend a little bit of time getting used to it before you move in. If circumstances permit go for lunch a few times in order to orientate yourself and meet the residents and staff.

7. Make a list of items that need to be taken into the home; clothes, toiletries, radio, TV, favourite chair, photos – the list is endless and of course depends upon the size of the room – make sure you know how much space you have before packing. If you are helping somebody else ensure that you talk to them to find out exactly what they would like to take in with them. Look at where they usually sit and on bedside tables, the items that are positioned nearby may well be the items that would be most missed if not taken to a new home.

8. When moving in try and introduce yourself to the other residents. It is also useful to work out, if you have been unable to do this prior to your move, where all of the facilities are and what time lunch and supper starts. Make sure you have a watch or clock that you can read to ensure you don’t worry in the early days that you are missing a meal or event.

9. When your relatives visit you encourage them to get to know other relatives and residents – sharing experiences or concerns, or simply having another face to chat to all work towards a more positive experience.

10. Finally, embrace your new home. Make the most of the activities and new friends. The success of your new home will be reflected in your attitude towards it.

Debbie Harris is a Dignity Champion who owns www.best-care-home.co.uk an online register of 3 star care homes, including information on Questions to ask a care home, Preparing for the move, Are you sure you need a care home? Her site also publishes personal recommendations of the homes.

The dilemma about dentists and opticians in care homes.

How many care homes have access to dentists and opticians for their residents? There are no statistics that will answer this question, but when was the last time you heard of a resident having their teeth or eyes checked?
This is what you should know if it was longer than 12 months ago;
Dental Health.
i. Dental health is often an indicator of underlying health problems.
ii. Untreated dental health can lead to complications including heart and respiratory problems.
iii. Elderly people are more susceptible to oral disease.
iv. If your false teeth are loose not only is it difficult to eat - it’s really embarrassing.
Optical Health.
i. The NHS entitlement scheme means everybody over the age of 60 is entitled to regular free eye tests.
ii. The elderly require regular eye exams as their vision becomes increasingly important as other senses deteriorate.
iii. The elderly are more at risk of eye conditions like glaucoma, age-related muscular degeneration and cataracts.
iv. These conditions can be detected through early eye exams and treated with little or no loss of vision.
v. Untreated optical conditions can lead to loss of sight.
vi. Wearing the wrong prescription restricts an already limited environment.
Regulations.
The Care Plan that is put into place after an assessment will gauge the needs of the service user for; sight and hearing, oral health and foot care. Should the needs of the service user change over time then re-assessments should pick this up.
In reality it requires the conscientious approach of a vigilant care home to spot any of the tell-tale signs of deterioration and the need to see a specialist.
In addition to this, mobile dentists and opticians are not widely available or easy to access for care homes.
Having a correctly fitting pair of dentures that enable you to eat properly, or glasses that actually help you to see are surely fundamental rights in this age - and allow for a dignified existence.
If you know somebody who is unable to access these services independently and need some assistance – be their Dignity Champion.
If you know of any mobile dentists or opticians, or have any other suggestions on how to overcome this problem I would love to hear from you.

Are you making the most of the internet?

During this time of change in health and social care public spending is likely to be reduced leading to cuts in funding. This leaves care homes trying to attract service users who are self funders and who currently number approximately 30% of those in care, although this figure is likely to rise.

At the present time there is very little information about how self funders find care. However, during 2007 90% of people in Britain, with access to the internet, searched for information about a product or service online - with a marked increase in the percentage of people searching for information relating to health.

Who makes the initial enquiry about care is often dictated by the type of care required, but if that enquiry is made by somebody of working age, 81% of whom have access to the internet, then statistically they are highly likely to have sourced their information online.

In addition to this, the more affluent the enquirer, the more likely it is that internet access is available at home.

There is therefore a clear link between self funders, their internet use and how they may search for care. A care home that does not have an online presence could easily be overlooked by this group of people.

Online directories and web sites offer easily accessible information and are rapidly taking the place of expensive paper brochures. The online directories in particular also allow independent homes to stand shoulder to shoulder with the larger care providers.

An impartial online register that has a personal approach is likely to attract the readers attention and create a level of trust in the information provided, such as linking to the CQC reports. Other additional benefits, such as Personal Recommendations can prove to be particularly helpful when making a shortlist of care homes to visit.

The larger care providers have for some time recognised the importance of an online presence and it is vital that independent homes, in order to compete in this changing market, promote themselves through online registers and make the most of the internet.

If you would like to take advantage of a free online website contact www.best-care-home.co.uk , submissions can be either online or by post.

Checklist: what to take when you move into a care home.

The first thing you need to know is that everything needs to be labelled - absolutely everything. Losing clothes or somebody else wearing your relatives clothes can be a big problem.

-Underwear.
Most care homes suggest you take in enough underwear for several weeks, bear in mind space will be limited. A word about tights, they are difficult to get on and off if you are a little unsteady on your feet, consider pop socks.

-Everyday clothing.
Again think about how much space is available, the type of clothes your relative would normally wear and feel comfortable in and the general style of the other residents. Being over or under dressed can be embarrassing and make it difficult to fit in.
Care homes tend to be warm for us, but chilly if you are sitting for long periods, consider layers of various thicknesses - cardigans are always useful and easy to get on and off, enabling your relative to do dress without having to ask for help.

-Accessories.
Shoes should be comfortable as they are likely to be worn most of the time when your relative is not in their room. Outdoor shoes and boots are unlikely to be used and take up a lot of space - perhaps store them on your relatives behalf. Other accessories, for example scarves should also be considered if they tend to form part of your relatives usual dressing habits.

- Jewellery.
Precious items for your relative should be taken into the home. However, valuable items may need to be considered separately. Have a word with the Matron or Manager and see what their policy is.

-Toiletries.
Clearly this is a personal issue, but you will need to take in all of the normal day to day toiletries. It is probably worth having a look in your relatives bathroom to make sure you know what brands they like - when you have been using Colgate toothpaste all of your life it's a bit much to be asked to switch to Macleans! It is also likely that you will be buying replacement toiletries, so it's quite useful to know what the brands are.

Keep an eye on how much space there is for potions and lotions and consider a wash bag that you can hang next to the sink with everything in it.

-Towels and Robes.
If you want your relative to use their own towels then its time to sew on more labels. Dressing gowns and slippers are a must.

-Furniture.
How big the room is will be the governing factor here. Familiar items of furniture, tables, favourite chairs and cushions and paintings are all really important and will help your relative to feel at home. Do not underestimate the importance of photos as their link with the past and the present reinforce who we are and our sense of identity.

-Television.
If space permits and I hope it does, then a TV in your room can be a godsend - you will need a TV licence though, this can be transferred from the old house, but don't forget to keep an eye on when it runs out.

-Radio.
A radio or music centre might be important to your relative, particularly if they have failing eyesight. Ask how they would normally spend their evenings and try to recreate that.

-Clock.
Knowing when somebody is going to call or it is time to go to lunch can be worrying if you don't know what the time is. Make sure the clock is large enough to tell the time - particularly if the numerals on a wrist watch are too small.

-Telephone.
Keeping in touch without having to go via the Managers office can be important. Mobile phones are often either too small or too technological to be of use. Sometimes there is a telephone point in the room in which case you can use a land line. However, there is a new phone that has been developed that takes a sim card, looks like a normal phone, doesn't need any wiring and most importantly, if the handset isn't replaced it recognises that nobody is talking and hangs up for you - enabling the next call to get through, it's new so email me at debbie.harris@best-care-home.co.uk if you would like more information.

-Books.
Check your relatives bedside table for any current books they are reading and do bear in mind that books are like old friends, there may be others that they would wish to take - however many times they have read them. Don't forget newspapers.

-Calendar.
Keeping track of time and marking birthdays and special events on a calendar, along with perhaps a supply of cards and stamps might be useful. Ask the Manager or Matron what the postal arrangements are.

-Phone numbers.
Don't forget the address book with all of the telephone numbers of friends.

-Paperwork.
Decide where the paperwork will be kept, either with your relative in a secure cupboard or depending upon their level of awareness with a relative.

Look around your relatives home - in particular the places where they spend a lot of time; their favourite chair, in bed, on the porch - what items surround them, it is these that are most likely to be missed. Try and take as many into their new home as your can.

I welcome any suggestions that will improve this checklist.

Are you sure you need a care home?

EIGHT WAYS TO HELP YOU MAKE THE RIGHT DECISION.


Moving into residential care is a big decision and sometimes it is clear that it is the best decision you can make, if this is the case visit preparing for residential care and discover how to make it a positive move.

Looking after somebody who is unable to care for themselves is exhausting, emotionally draining and isolating. Here are eight suggestions that might make life a little easier and help you, or the relative you are caring for to stay at home.

1. Get an assessment from Social Services.

Whether you qualify for financial help from Social Services or not, this assessment is free. The assessment will help you to recognise what your needs are and who might be able to help you.

The carer can also have their own needs assessed and may be eligible for help.

2. Home Improvement Agencies.

Concern about maintaining your house can be a great worry – poorly maintained homes can also create hazards; cold is a killer for the elderly.

Foundations is a government appointed national body of ‘home improvement agencies’. They will offer advice on keeping your home warm and safe and the types of equipment available to help you stay in your own home. They will also advise you on any grants that you may be able to apply for.

STEP 3. Help at Home.

Home help is called ‘Domiciliary Care’ and if you are relying on this to get out of bed, bathing, dressing or your meals you need to make sure that the agency is reliable and that you like your carers. This can be tricky if you are funded by Social Services.

Alternatives are Direct Payments, where money is paid directly into your bank account and you employ your own help.

Private or voluntary agencies also provide domiciliary care. All agencies need to be registered with the Care Quality Commission (CQC), have a look on their website for a list – my advice would be to start with the agencies that have the highest rating – 3 stars.

STEP 4. Food.

Keeping well depends upon eating well. Everybody has heard of Meals on Wheels, well they still exist so get in touch. Alternatively there are many companies that are local to you that deliver high quality food, find one that offers the food that you like with reliable drivers.

STEP 5. Pets.

Having a pet can be enormously rewarding, especially if you life alone. However, it can also be very worrying – who will look after him if I am ill, how will I get food in? The ‘Cinnamon Trust’ is a national charity that holds hands with owners to provide care for their pets – if your pet needs it, they will do it.

STEP 6. Disability Register.

The disability register is a not for profit organisation and provides details of new and second hand equipment that may make life a little easier. Items are bought and sold on a direct one-to-one basis, no middle men or commission involved.

STEP 7. Day centres.

Day care centres provide the opportunity to spend time with other people, as well as offering a range of activities – they also give the carer a break and some time to themselves. Run by the local authorities and local voluntary groups a national register doesn’t exist, but your local Age Concern will have a list of day centres.

STEP 8. Loneliness.

Being lonely can be a big problem when you are trying to remain independent in your own home. ‘Contact the Elderly’ is a volunteer organisation that organises regular Sunday afternoon tea parties for people over 75, who live alone with little or no social support.

If you decide that a care home is the right option for you, make sure you know what to ask when you visit your short list of homes, Questions to ask a care home gives you a list of questions that you can print off and take with you.

Where are the Dignity Champions?

I became a Dignity Champion about a year ago and recently attended a meeting at the Department of Health about their Dignity in Care Campaign. Among the 15 or so who attended there was only one other person, other than myself, who did not actually work in a care environment.

I must say they were all articulate and passionate about trying to make their care environment more dignified - but I couldn't help thinking, where are the members of the public?

Surely it is the public who wants to safeguard the dignity of their relatives when they are in a residential or nursing home? It is also the public who often witnesses undignified or unacceptable behaviour by health care workers.

Being treated with dignity is in my view a basic human right and never more so than when the individual concerned is vulnerable. So why aren't the public getting involved in the Dignity Campaign?

I think the answer to that is quite simple - they don't know about it!

So I am on a mission to inform members of the public that they can become dignity champions and help to influence how their relatives are treated within care homes and any other care environment. I have even got my mum and dad involved as they are the reason I feel so passionately about this - check out http://www.best-care-home.co.uk/dignity.php if you would like to meet mum and dad and see how I am trying to encourage people to become Dignity Champions. Are you one?

Personal recommendations about care homes are rarer than hen's teeth and yet it seems to be that most people rely on the views of others when they choose a care home. I have even seen statistics that suggest one third of people only see one care home when making their choice - presumably through lack of information about the others.

If you don't have access to unbiased information it is easy to see how the first one you see could become the ultimate destination.

My ethos as I explained in my first blog, is that if you have a problem with an area of care try and find a solution. So I have set up www.best-care-home.co.uk. Initially I simply wanted to provide an online register of the best care homes, with a lot more information that simply a name, address and telephone number - so I encouraged lots of photos, links to CQC reports, videos (more of that later). Anything that will really give a prospective resident and their family a realistic and valuable insight into the home, before they visit it; and I made this free to the care home so that there were no barriers to providing information.

I also encouraged personal recommendations of the homes; and if I believed everything I read in the newspapers, I wasn't expecting to receive very many - how wrong could I be. I have received hundreds in a few months and they are moving and genuine and would really encourage me to visit that home.

So congratulations to the homes and the staff that have received these pesonal recommendations and thank you to the members of the public, residents, health visitors and everybody else that wanted to share their positive experiences with others.

A study led by the University of London's school of pharmacy has shown that 70% of care homes, incorrectly administer drugs. In some cases the prescribed drugs were not given at all. The consequences of these mistakes could obviously be severe. Newspaper articles that once again lay the blame (within their headlines at least) at the feet of the care home, complain of the situation but does not suggest a remedy.

Norman Lamb, Liberal Democrat health spokesman said

' This shocking number of mistakes cannot be tolerated...The NHS should be made to declare when staff mistakes injure or kill patients so that improvements to standards can be made'.

A case of shutting the stable door after the horse has bolted in my view. A Department of Health spokesman said;

'We will work with the Care Quality Commission (CQC) and others to take forward the important issues raised by this study'

Frankly that does not reassure me. The residents within care homes are our relatives and as such we have a responsibility to improve conditions and procedures - simply pushing this responsibility onto the CQC is not going to get the situation improved.

What can we do about medication that is incorrectly given, or forgotten entirely?

At the Care Show at Olympia last week I saw a company that provided weekly medication - for use within care homes or private homes, in what I can only describe as a large blister pack. It can dispense pills and liquids, is labelled with the drug and when it should be taken. In addition and perhaps most importantly, it has the name of the resident and their photo on it.

I will have a word with the company and see if they would like to tell you more about it.

I was reading The Times last week and they were talking about private schools and the power of parents within the parent teachers association. It occured to me, that as far as I know we don't have an equivalent 'voice' within care homes.

I emailed the Residents and Relatives Association and asked them their view. The bottom line is that according to them, there is no requirement within the existing Care Quality Commission (CQC) regulations that stipulates or even suggests the existance of a 'relative carers association'. They went on to say that they thought the poorer care homes would avoid this avenue at all costs - I am sure they would.

So, if it works for schools, why wouldn't it work for care homes? I think one of the reasons schools get more support from parents is that they meet in the playground and become friends etc. and obviously this doesn't happen in a care home. But if the care home set up an online association for the relatives or residents to participate in, what a voice. Sharing problems, concerns and praise could benefit everybody involved - the residents, relatives and the staff.

If the care home won't or can't establish an online association what is to stop the residents creating their own? I don't see this as a vehicle for being negative about a care home, but as a drive towards improving what is wrong, praising what is going right and sharing information.

I am going to suggest this to some care homes and some relatives to see what the response is - I will let you know.

My first blog.

Welcome to my first blog.

Care and share is about the people we care for; how we care for them and the information we can share to help each other. By sharing information we can join together in improving care for the elderly and vulnerable people in our society.

The care industry is massive and in the main receives pretty awful publicity - but I don't think we can only blame the care homes for this level of care. We should assume some responsibility for the poor care received in some residential environments because we don't do anything about it - and before you go ballistic; when you have read in the newspaper about baby P, or abuse in a nursing home, what have you actually done about it?

You have probably done the same as me, nothing. Until now. I invite comments from anybody that has an opinion on care homes in any form, let me know what you think - but if you have a complaint, suggest a remedy. Between us we might be able to come up with some answers and let's face it we won't know until we try and you never know where this blog might lead us.