Devon County Council currently operates 23 care homes providing residential care for around 600 older people. The Council aims to provide its residents with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance.
Over the next three years, the Council is investing in an £11.2 million improvement programme to refurbish and remodel its residential care homes for older people. This includes creating up to ten dementia-specific Centres of Excellence.
Why is this investment taking place?
During 2007/8 a review of the service identified that a transfer of the current provision to the Independent Sector would provide greater opportunities to improve the quality of service and meet the demands of the local population. Despite our best efforts, attempts to attract potential interest have proved unsuccessful.
The provision of high quality residential care for those most vulnerable members of our community is a high priority for the Council. Therefore a decision was taken by Devon County Council’s Cabinet to support a major programme of refurbishment and remodelling of its residential care homes for older people, with an investment of £11.2 million between 2012 to 2015.
What is a Dementia Centre of Excellence?
We are at the early stages of planning, but we would want Dementia Centres of Excellence to provide a range of social care and health care services for people with dementia and their carers from a building which is well designed, decorated and furnished to maximise people’s independence. These Centres will include the provision of long term residential care, respite care and flexible day opportunities. They will include ‘inreach’ and ‘outreach’ services and support. We are working with partners to develop more detailed descriptions and proposals – including how we might work with local communities, health and the independent and voluntary sectors.
How will the Dementia Centres of Excellence be chosen?
We are carrying out feasibility and viability studies of all our care homes to identify which have the potential to become Dementia Centres of Excellence. Alongside this we are gathering population trend and needs information by area, as well as information about existing independent sector care home provision. We will use all this information to prioritise the development of Dementia Centres of Excellence.
When will these announcements be made?
We hope to be able to announce the first three homes to become dementia Centres of Excellence by September 2012. We will make decisions on future sites as soon as possible after this.
What happens to the homes that aren’t designated Dementia Centres of Excellence?
The future of all Devon County Council’s care homes is important and all will be subject to some form of redevelopment or refurbishment. We will keep residents, families, staff and others informed as decisions are made regarding individual homes.
How long will it take to complete this programme? And how long will the refurbishment of each home take?
This is a three year investment programme from 2012 to 2015. The timescales for the refurbishment of each home will depend on the extent of the works required. This will be planned in phases, with timescales agreed in advance with the building contractor. Residents, families, staff and others will be informed as decisions and plans are made.
Implementation of the Care Homes Development Programme:
Who is working with the County Council on the development programme?
We have appointed Midas Construction and the University of Stirling to work with us to design and deliver the Programme. Midas has significant experience in the construction and design of buildings used by older people and people with dementia, while the University of Stirling is nationally recognised for setting the standard for dementia-friendly buildings.
Will the work disturb residents and/or staff?
There will inevitably be some disturbance during the refurbishment programme. However, Midas has demonstrated a wide understanding of the sensitivities around this project and has a proven track record of working closely with managers, service users and their families to ensure works are carried out with minimum disruption. Residential Unit Managers will liaise closely with Midas over the works programme. They will be do all they can to minimise potential disruption in advance of any major works taking place, and be closely involved on a day to day basis as works progress. We will make sure residents, families, staff and neighbours are fully informed and involved.
Will any residents need to move while work is undertaken?
We will do our very best to minimise disruption. However, some homes will have bedrooms enlarged to facilitate wheelchairs and other equipment, and some will be extended to incorporate ensuite facilities. This will inevitably mean that some residents will need to move rooms within their home. We will work closely with them, their families and care managers to assess the potential impact of such moves and support residents sensitively so that any moves are made as easy as possible.
We do not plan to move residents out of their home. However, we will need to keep this under constant review as the development plans are progressed. Should there be any indication that a temporary move into another of our own care homes may be recommended, we will consult carefully with residents, their families, staff and care managers before any decisions are made.
Who will be responsible for health and safety during the works?
The Residential Unit Manager will be actively engaged with the Midas Operational Manager to ensure the health and safety of all residents, staff and visitors whilst the refurbishment is taking place.
Management of occupancy:
How will occupancy be managed during the refurbishment?
There will be a planned approach to reducing occupancy on a home by home basis prior to and during refurbishment. New placements will be suspended for a period of time before works are undertaken within individual homes and during it. Complex Care Teams and Care Direct Plus will be informed of these temporary admission suspension periods. This will assist in freeing up space for any moves required within the home.
We will contact care managers responsible for individuals who have pre-planned respite stays to make alternative arrangements where appropriate.
Who will assess the appropriateness of any new long stay or respite placements during refurbishment?
If any new placements are accepted by the Unit Manager because of exceptional circumstances, assessment visits will be undertaken in the usual way by Unit and Deputy Managers.
How will the individual needs of residents continue to be met appropriately?
It is the responsibility of the Unit Manager to ensure that the needs of each resident is assessed and met by the staff group of the home. Resident’s care plans are regularly reviewed with them to ensure that their service is appropriate. Where this proves no longer to be the case, a care management assessment is undertaken to determine the service and setting that is best able to provide care.
Will this programme affect residents’ choice?
We will work closely with residents and their families during this programme to ensure that individual choice and control remains at the forefront of all our planning and decisions.
Will all beds become long stay or will there still be respite?
The majority of beds will continue to be used for long stay purposes, but respite provision will be maintained to meet the needs of the locality.
Is my job at risk?
No. There will be changes to the focus of work as our service changes to reflect the growing needs of older people with dementia. There may also be changes to the numbers of residents within each of our homes. There are no plans to make staff redundant as a result of this development programme.
How will staff be supported through change?
Our managers, team leaders and front line staff – including care workers, housekeepers, cooks and handypersons support residents and their families on a day-to-day basis. They will be informed and involved as investment decisions are taken and improvements or changes are proposed for their care homes. This will support staff to communicate effectively with residents and families as part of their day to day work.
We will also provide support from HR, Learning and Development and other corporate services as appropriate to ensure staff have the right skills to fulfil their future roles – especially if they are changing to meet the needs of dementia specialist care homes.
What happens to staff if a home changes focus from caring for older physically frail people to those with dementia?
The prevalence of people with dementia requiring intensive levels of support is increasing, which is why we are developing Dementia Centres of Excellence. However, all our homes will continue to meet the increasing needs of older people with dementia – as they do now. For homes that change to become Dementia Centres of Excellence, staff will experience a change of focus within their roles. We will support managers and staff through an assessment of their individual learning and development needs. This Development Programme is designed to bring about a staffing profile and skill mix that is well supported to provide specialist dementia care.
Will staff have dementia training?
Four of our homes already provide specialist dementia care with highly skilled staff, and some have specialist dementia units. We need to ensure all our staff are skilled to respond to the needs of individuals with dementia and their carers. Good training is key to ensuring we provide excellent services. We are developing our training programme now so that we can continue to meet the assessed learning needs of managers and staff.
Training will also continue to be provided in other areas of service delivery where we are requiring increased skills, responsibility and knowledge from staff.
What if staff don’t want to work with people who have dementia?
Our homes provide care for older people, and therefore include a growing number of people with dementia. All our staff will be trained and supported to understand and meet the needs of residents with dementia, and their families. All our care homes will respond to the needs of older people with dementia – whether or not they become Dementia Centres of Excellence.
Will staffing levels be affected?
Our staffing levels will continue to be regularly reviewed during the implementation of the Programme. Staffing levels will reflect the needs of residents and our regulatory requirement to achieve the standards of care set out by the Care Quality Commission. The Care Quality Commission does not specify or determine staffing levels in care homes, but they inspect us annually to ensure that our staffing is adequate to meet the assessed needs of all residents.
Will additional staff be needed if the needs of service users change?
It is the responsibility of the Unit Manager to ensure that the needs of each service user can be met by the staff group of the home. Unit Managers will continue to be responsible for taking the appropriate actions that are currently in place to secure additional staffing if this is required.
Will staff be required to change location?
At this stage, we do not anticipate permanent changes of staff location, but there may be a need to relocate some staff temporarily as the programme is implemented. We will keep this under constant review and any proposed temporary or permanent changes in work location as a result of this Programme will be looked at on an individual basis, taking into account individual circumstances and organisational requirements. There will be an appropriate consultation process with staff members if such changes are proposed, and Trade Unions will be fully involved and consulted.
Will staffing rotas be changed?
Rotas, including start and finish times, are designed to meet the needs of residents and there are no plans to change them as part of this programme.
Will staff hours of work change during the refurbishment?
Staff will be required to work flexibly during the refurbishment to ensure that the needs of residents are fully met. Any changes to hours will be undertaken through negotiation on a group or individual basis as appropriate, with the full involvement of Trade Unions.
Communication and involvement:
How will residents and their families know what’s happening?
Residents and their families will be kept informed as investment decisions are made about individual homes, and as work progresses. We will use a range of methods to communicate so that individuals can choose how they want to be involved. Care home managers and their staff will decide how best to engage individual residents and their families, and we will support them to do this effectively in the way that best suits the home.
How will staff know what’s happening?
We will meet with staff to ensure they are fully informed. In addition, the care home managers will ensure their staff are kept fully informed and involved as decisions are made and the work progresses. Trade Unions will be involved and invited to attend formal staff information meetings.
Will residents and staff have a say on changes to the homes?
We are keen to involve residents (where possible), families and staff in decisions around the remodelling and redecorating of homes and they will be fully informed and involved as the work progresses.
Are Trade Unions being kept informed?
Trade Union representatives are being kept fully informed of progress within the Programme. This is through a standing agenda item at the monthly operational Joint Consultative Committee meetings, copies of minutes and any communication to staff. They will also be invited to any staff meetings.
Has the Care Quality Commission been informed?
The Care Quality Commission is being fully informed of progress within the Programme through regular meetings with a CQC representative, copies of minutes and communication to staff. They will be kept fully informed of progress throughout the implementation phase.
Are Complex Care Teams and Care Direct Staff being informed?
Senior managers are informed and updated about progress through our attendance at their regular meetings. Managers are sent copies of minutes so that they can communicate progress with their staff.
How will other stakeholders be kept informed?
Effective and timely communication is key to the success of the programme. Engaging with a range of stakeholders who have diverse interests in the future of care homes, some of a personal and emotional nature, is vital to ensuring the aims of the Programme are understood and that all stakeholders feel included as it progresses, particularly as key decisions are made.
An engagement plan has been developed which deals primarily with stakeholder engagement throughout the life of the Programme, while highlighting additional issues such as media engagement.
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