Four Signs Your Care Home is Failing Before it Actually Fails
Key Contact: Jenny Wilde
Acuity Law and Cornerstone Care Solutions join forces
When a care home is failing, the financial signs are obvious. If you’re measuring your financial KPIs, you’ll be in no doubt when the ship starts to steer off course. But what many care homes miss are the signs of a failing home that begin to emerge in non-financial ways. Financial KPIs tell one side of the story, but embedding quality assurance KPIs can give you more nuanced clues that the business could be in trouble before they show up in the financials – and before it’s too late to turn things around.
Falling average weekly fees, occupancy and staff-to-income ratio are all signs of financial trouble. So, what are the signs of falling quality standards that foreshadow the figures turning red?
Mayday!
- Quality of financial information
Before looking at the care and staffing at the home itself, it’s worth spending some time on the quality of the financials themselves. If the financial oversight is lacking – for example, KPIs are not monitored and there is no (or late) management information being produced – these all signs that a business is not being managed in an optimal way. Trouble could be on the horizon.
- Leadership engagement
If there’s no captain, who is steering the ship? A warning sign that a care home is not performing as it should is often disengaged, ineffective leadership lacking in visibility and credibility with sector stakeholders such as the CQC, the local authority and patients’ next of kin. When leadership is not present, performance and compliance oversight suffer, and a culture of blame can creep in when standards drop. The business might lose sight of cost control and without strategic input for turnaround, the business can become lost at sea.
A common theme in services experiencing regulatory difficulty is a lack of proactive and involved leadership. A senior team that “walks the floor” and performs detailed and thorough audits is much better at identifying and resolving issues before they become a problem or are picked up for the first time during an inspection. The regulator will see unaddressed issues as an example of poor leadership and a lack of oversight. These matters can quickly spiral out of control or snowball into significant regulatory enforcement action. It is common for issues investigated by the CQC to be precipitated by staff discontentment or a breakdown in relationship between the staff team and the Registered Manager.
- Staffing
It goes without saying that an effective workforce should be present, and that high levels of sickness and absenteeism are a red flag, not least if they are a prelude to disciplinary actions, HR activity and legal sped, in the event of employment claims.
A happy workforce will generally provide better quality care and encourage consistent attendance and engagement at work. Employees who feel that their managers are approachable and receptive to feedback will be more inclined to raise concerns or thoughts about a service and this, in turn, will allow managers to resolve issues personally, rather than staff feeling that they have no choice but to report them to the regulator in the first instance.
But as well as being there, staff should be engaged and bought into the success of the business. A high reliance on agency staff can be a warning that all is not as it should be, as is a workforce with high turnover. No or low training spend is a sign of a business that does not invest in the skills and career development of its staff, with potential know-on implications in workforce satisfaction and performance. Negative CQC comments can be both an indicator and a consequence of a people management style that is lacking.
- Poor quality care provision
If the standard of your provision is below par, it won’t be long before this is reflected on the figures. Reduced capital expenditure can be a vicious circle: an inferior environment with inadequate resident facilities and a lack of stimulating activities for residents makes for a further diluted care provision. If standards are low, compliance is likely to fall, and CQC action points will follow.
Negative findings unearthed during CQC inspections can very quickly snowball, resulting in adverse ratings, a perceived breach of regulation and low-level enforcement action (such as the issuing of a Warning Notice). If not properly remedied, this kind of activity can very quickly escalate with providers being subject to a notice of proposal to cancel a registration, remove a location or apply conditions to a registration using CQC’s urgent powers under Section 31 of the Health and Social Care Act 2008.
What can the business do?
If your business displays any of these warning signs, there are quick wins that can be made with little or no financial outlay.
Problem #1: Quality of financial information
Solutions:
- Develop a comprehensive understanding of resident funding sources
- Produce management information
- Implement KPIs
- Conduct a needs assessment to ensure correct staffing and fee levels
- Review all costs and utilities and ensure suppliers provide the best value for money
Problem #2: Leadership engagement
Solutions:
- The leader becomes a positive, visible presence with all local authorities, next of kin, the CQC and other local stakeholders
- The leader promotes a positive culture
- The leader works to engage staff in business performance
Problem #3: Staffing
Solutions:
- Staff and the Registered Manager outline their expectation to the business
- The workforce meets regularly to share best practices and lessons learned
- Issues relating to the workforce are resolved in a timely manner
- Staff are allowed to work flexibly
For more on this topic and practical solutions for spotting and averting impending difficulties with your care home, look out for our upcoming breakfast seminar this autumn – details to follow soon.
For more on ensuring your practice is compliant with regulations or for regulatory advice, contact our Acuity Law Health & Social Care team.
