Vision, Mission & Philosophy
The background of the mission
In 2010 Mr Chaudhry met a transformational leader called Mrs Potgieter (whom we addressed as Mrs P) who decided to join Deen’s vision she then developed and implemented the mission, philosophy and culture of Ubuntu.
The Mission
To provide person-centred-care that is effective, caring, reliable, consistent, responsive and safe within a positive value-based service that is of outstanding quality through the empowerment of people.
We aim to form lasting relationships with our consumers and purchasers by involving them in making informed choices through sharing information in an open and transparent manner.
We will continuously strive to create an environment that people would choose to live in as an alternative lifestyle and support them to maintain or achieve their maximum potential for good health and well-being.
Mrs Cannon
Mrs. C was the Managing Director for Trust Care Management Ltd and Focus Care Supported Living Ltd, leading it to 35 (thirty-five) homes nationally before stepping back to Non-Executive Director in February 2021.
Mrs C studied and completed her nurse training in South Africa and relocated to the United Kingdom in 2001. Mrs P has 51 (fifty-one) years’ experience in the public and private sector of nursing this includes managing leading and teaching at various levels of her profession, and she’s received numerous awards academically.
Mrs. C is a credible leader who has completed her studies as a general nurse, mental health nurse, community health nurse, and midwife. She has delivered well over a thousand (1000) babies into this world.
Mrs. C received her Industrial Relations Diploma from Damelin Management College in South Africa. Upon arrival in the UK, she completed her RMA (Registered Managers Award).
She received a BA (Cur) in nursing education and a BA (Cur) in nursing administration at the university of South Africa and then commenced her Master of Arts in nursing sciences.
Mrs C still holds her pin with the NMC (Nursing Midwifery Council) she served on her local safeguarding board and participated in a development of the SAB (Safeguarding Adults Board) practice and procedures for Peterborough and Cambridgeshire. Mrs P is also a board member for the National Care Association influences national change for social care. So she is a transformational leader passionate about empowering us as her extended family.
Mr Graham
Mr Graham started with the company in 2018 as the quality and compliance manager, Mr Graham has a OTHM Level 7 Diploma in Health and Social Care Management specifically in working with children and adults living with a disability.
Mr Graham was hand-picked by Mrs C to step into the role of National Operations Director in March 2020.
Mr Graham has worked in a variety of roles, working his way up from a health care assistant, Mr Graham has worked in roles such as peripatetic manager, operations manager, registered manager and quality and compliance manager working with children and adults living with complex health needs. He has worked in disciplines that provide care in physical and learning disabilities inclusive of mental health and behaviours that challenge across residential, nursing and supported living.
Mr Grahams role is to provide inspirational leadership strategically to attain excellence in leading people to face the challenges, the risks and the prospects of what we could collectively achieve by empowering people’s lives continuously in delivering the highest standards of quality care and support.
Important
The Company’s Philosophy of Care aims to provide an outstanding quality of care in a homely environment.
We promote an ethos of respect for all people by treating them with dignity and ensuring that peoples’ rights to independence, choice, autonomy, privacy, safety and security are maintained.
The cornerstone of Trust Care Management Ltd is in establishing and maintaining an ongoing strong relationship between Residents and/ or service users, relatives, friends, and staff through enhancing empowerment, based upon the creation of a non-institutional regime, which enables individuals to lead a fulfilled life.
This is achieved by supporting people to reach their highest possible potential, physically, socially, emotionally and spiritually.
Our commitment is to ensure that by working together we can create a rewarding and positive environment for all.
We believe in various models and approaches within our companies, due to the differing skills levels i.e. from candidates that are novices to those with proficient attributes as care workers and nurses in the workforce from overseas. This has led to redefining roles in order to maximise the resources we have during the periods of staff shortages and of course during the pandemic.
For example, Health Care Assistants have been upskilled and empowered to train in certain nursing tasks (nurse delegated tasks) under the supervision of the nurse whether this is in the community (supported living) using support from community teams or in care homes with Nursing. We have promoted health care assistants to unit manager roles due to their leadership skills and general clinical skills too.
Several adaptations and combinations of the traditional models of service user care delivery have been used in our registered care homes and supported living services to accommodate the various levels of skill mix and numbers required within our services and according to the needs of our service users.
We have found that the hybrid model we use has demonstrated good quality of care, for example we use an adapted version of the Roper-Logan-Tierney Model of Nursing, in all our registered services i.e. care homes (nursing; residential; LD) and supported living services. Included in this model we adapt and adopt as required using a combination of the more traditional modes i.e. Functional, Team, Total service user Care, Primary Care models. The Functional nursing and Team nursing models are task-oriented and use a mix of personnel and the Total service user care and Primary nursing are patient-oriented and rely on nurses and skilled health care assistants and support workers to deliver the care.
We find that team nursing does present a better model for inexperienced staff to develop, a key aspect in our care homes and supported living services where skill mix and numbers or experience is diverse.
We have also included in this hybrid approach to care delivery within our services, especially supported living, the self-care deficit theory proposed by Dorothy Orem which is a combination of three theories, i.e. theory of self-care, theory of self-care deficit and the theory of nursing systems.
This theory speaks to activities that we find the people we support can perform independently to maintain life, health, and wellbeing. By using the basis of the nursing theories, we have found they influence our company culture and attitudes more positively placing the service user as the central figure /focus at all times – developing a more person-centred care approach.
Nursing theories have four concepts that are central to their metaparadigm: person, environment, health, and nursing.
we also use Florence Nightingale’s environmental theory which has one core principle: that nursing/care delivery is the act of utilizing the environment of the patient/service user in order to assist that patient/service user in their recovery. Her theory is simple and all our staff in all categories understand the importance of configuring their environment to best meet the service user’s needs, it assists in the healing process/makes service users feel comfortable – improving the quality-of-care delivery. Knowledge of this theory during the pandemic was of course invaluable.
When we use the phrase nursing care delivery, we think of our highly skilled health care assistants and support workers.
Ultimately, we recognise that despite the growing need for care to be more person-centred, there remains a gap between the theory and the application on the ground and therefore our in-house training and especially our induction, promotes our entire workforce to embrace and develop an understanding of our hybrid approach to care delivery.
By combining approaches and theories the person is placed at the centre of the service delivery and seen as an individual with unique circumstances. The focus is on the person and what their needs are, not their condition or disability. Care and support focusses on a holistic integrated comprehensive approach that motivates the individual to achieve their specific aspirations and the care delivery is tailored to the individuals’ unique needs.
The principles we focus on are enable/re-enable the individual to build and keep control of their own life. It is about respect, preferences and diversity.
- we believe the service user must be central to and involved in making decisions about their life
- we consider each person’s life experience, age, gender, culture, heritage, language, beliefs, identity and sexual orientation
- we promote a flexible service delivery to suit the individuals wishes and priorities
- we focus on the strengths of the individual rather than their specific challenges because they are the experts in their lives.
- we include the person’s support networks as partners as appropriate.
The company empower and promote the need for Ambassadors within our care homes and facilities, we are unique as a company, we believe that our staff demonstrate our company culture and are therefore champions within their everyday roles.
Ambassadors inspire and motivate people to understand more, about their chosen subject. They aim to improve the quality of life and support people in order that their voices are heard. Our ambassadors are passionate and therefore push for equality, diversity, outcomes and will challenge inequalities.
An Ambassador takes the lead on specific needs highlighted within our care homes and facilities. They play a significant role in increasing awareness about the importance of their responsible subject and promote best practice; ensuring that their responsible subject is implemented. Ambassadors should be unique to the need of the individual service:
- Continence Ambassador
- Data Protection Ambassador
- Safeguarding Ambassador
- MCA and DoLS Ambassador
- Hand Hygiene Ambassador
- Infection, Prevention and Control Ambassador
- Covid-19 Ambassador
- Communication Ambassador
- Restraint Reduction Ambassador and PBS (Positive Behaviour Support)
- End of Life Ambassador
- Dignity Ambassador
- Dementia Ambassador
- Employee well-being Ambassador
- Fire Safety Ambassador
- Wound Management Ambassador
- Equality and diversity Ambassador
- Culture Ambassador – Vision, Mission and Philosophy (UBUNTU – Family unity)
- Systems Ambassador
We believe with the growing diagnoses of mental health illnesses that we needed to make change through the pandemic to offer additional support to our staff team and service users. We employ a mental health first aider in the workplace is to be a point of contact for an employee who is experiencing a mental health issue or emotional distress. This interaction could range from having an initial conversation through to supporting the person to get appropriate help.
As well as in a crisis, Mental Health First Aiders are valuable in providing early intervention help for someone who may be developing a mental health issue reducing sickness and absence levels and promoting a positive work environment.
The company has invested in the Care Director, Mrs Elaine Cole to become the Companies Mental Health First Aider which she qualified through Mental Health First Aid England (MHFA).
It is demonstrable in the approach the company takes on nursing led care; we have a high volume of evidence and case studies that tells us we provide service users with the best care.
This is evidenced through the flat hierarchy structure and the model of care we choose to follow, Roper-Logan-Tierney’s Model For Nursing Based On A Model Of Living (ADL’s) the rationale behind using a scientific theory based model enable every person is treated equally and as an individual, treating the person that meets their needs rather than treating the illness or also known as the problem.
According to the model, there are five factors that influence the activities of living. The incorporation of these factors into the theory of nursing makes it a holistic model. If they aren’t considered, the resulting assessment is incomplete and flawed. The factors are used to determine the individual patient’s relative independence in regards to the activities of daily living.
They are:
- Biological
- Psychological
- Sociocultural
- Environmental
- Politico economic
The biological factor addresses the impact of the overall health, of current injury and illness, and the scope of the patient’s anatomy and physiology. The psychological factor addresses the impact of emotion, cognition, spiritual beliefs, and the ability to understand. According to Roper, this is about “knowing, thinking, hoping, feeling and believing.”
This theory is not only success for a nursing setting, we as a company have successfully used this model in all our care settings to upskill and empower our HCA and support workers to write and manage the ADL’s successfully ensuring the service users receive the best care.
To strengthen this further, the company are committed to developing all staff in their learning and training, specialisms offered to strengthen skills based, we celebrate ambassadors and host support groups, for example, LGBTQ+
With all of this activity in place, we can demonstrate high skills at nurse task level that HCA and support workers carry out ensuring we reduce hospital admissions.
Promoting choice is top of the company’s agenda of care. We respect each individual’s dignity and lifestyle choices. It’s what makes our care homes and services such warm and welcoming place to live and work.
It’s our ambition to be the best and become the leader for equality and inclusion in the health and social care sector and we have been doing this since we first opened the company. With solid foundations in place, we’re taking steps to broaden our culture of dignity and respect to include people of all backgrounds, sexual orientation and gender identity.
This role is exciting and innovative for the company, this additional ambassador role will enhance and create our LGBTQ+ strategy to ensure we meet the needs of all LGBTQ+ people who live or work at our company.
With more and more people openly living their lives as LGBTQ+, the population from this community entering care homes is rising. Research found that older LGBTQ+ people are worried about accessing care home services and how this will affect them in later life. They fear having to hide their sexuality or live in a place where they won’t be accepted or respected for who they are.
It’s time for the health and social care sector to catch up with our company and show that we welcome diversity and make sure people of any sexual orientation feel comfortable in our care or to provide care and support as an employee.
Our strategy has always set out our commitment to LGBTQ+ equality and encourage discussion amongst staff and the people we support.
All staff receive training on ‘sexuality and relationship’ supported by easy read documents and a policy on how to approach and care for older people from the LGBTQ+ community. This will help everyone to understand the barriers they face and encourage more open conversations between staff and LGBTQ+ residents. Staff will also receive guidance on how to talk about LGBTQ+ issues in a non-judgemental way.
We’ll also be adding events to celebrate diversity, such as Pride month, to our social calendar.
It’s important that staff have someone they can talk to other than their manager if they encounter bullying or harassment. The diversity champions network will be a support system that acts in solidarity with members of the LGBTQ+ community.
Training & Development
The company holds high expectations on training and development for every person in the company, all staff hold a positive attitude and behaviour towards learning and demonstrate that they enjoy learning and understand quickly that this company expect everyone to have an integral part of their own CPD.
Types of training the company offer are interactive, visual, supportive and easy to use. There are layers of learning and different ways to monitor and observe competence and enhance skills.
- Induction
- Onboarding
- E-LFY
- Face to face training
- Observations
- Shadowing
- Competencies
Open and transparent with the flat line structure encourages all staff to positively challenge and question all senior management team with confidence to ensure HCAs and support workers feel empowered to stand up for service user rights and make positive differences. Lessons are learnt and quality is improved.
We believe the opportunity to enhance skills and knowledge encourages everyone to engage in training and learning. Additional training access courses beside all statutory and mandatory training is available to everyone, some training we provide is listed below;
1) ROLE OF CLINICAL LEAD AND TRAINING DIRETCOR
We teach our team their role in protecting data security within the organisation, Implement GDPR compliant processes, Apply the GDPR rights of data subjects, we teach our staff their responsibilities in order to comply with the new General Data Protection Regulations (GDPR). We also have two Data Protection Officers (DPO) within the company that train and guide the teams in the services.
Discover the structure and function of the brain recognise the impact of an acquired brain injury. This course will help staff to understand the structure and function of the brain, including its anatomy, whilst also being able to recognise the impact of an acquired brain injury.
This course will be of use to individuals who are involved in the refurbishment, maintenance, and upkeep of buildings and who may foreseeably disturb the fabric of any building that was built or refurbished before the year 2000.
This course is a combination of both theoretical knowledge and interactive activities, which have been designed to help our staff learn, and practice, appraisal skills whether an employer or employee. They Identify the appraisal process and recognise how to conduct an effective appraisal.
This course introduces the spectrum of autism and how autism affects people in different ways. It has been developed with subject matter experts from our company: a specialist, outcome-focused provider of support for people with mental health needs, learning disabilities, autism and acquired brain injuries.
Ascertain how to reduce risks and appropriate bed rail set up. Follow safety guidelines as per company policy and procedures
To provide the learner with a basic understanding of the knowledge behind the techniques used in emergency first aid situations. Primary Survey Cardio Pulmonary Resuscitation, (AED) Automated External Defibrillator, Secondary Survey Recovery Position, Choking and Anaphylaxis
The learner will have an understanding of the 15 (fifteen) standards:
- Understand their role
- Their personal development
- Duty of care
- Equality and Diversity
- Work in a person-centred way
- Communication
- Privacy and dignity
- Fluids and nutrition
- Dementia and cognitive issues
- Safeguarding adults Safeguarding children
- Basic life support
- Health & safety
- Handling information Infection prevention & control
The learner will have an understanding of the 15 standards within a supported role to care.
This is a systematic approach to maintaining and improving the quality of service user care within social care, including different settings such as supported living and the nursing home inclusive of hospital settings. The training places a new duty of quality on health organisations in the UK. This is potentially a powerful mechanism for ensuring that high standards of clinical care are maintained throughout the country, and that the quality of the NHS and social care services is continually improving. Staff will gain an understanding of this and be able to demonstrate best skills in a care home settings.
To ensure that our staff have the knowledge and understanding to be able to communicate with their clients through a range of different methods. Total communication is vitally important and this is the basis for further training including Makaton.
Describe substances in the workplace that are hazardous to health Identify the current legislation regarding. To raise awareness of substances hazardous to health in the workplace. This course explains the need to risk assess chemicals in the workplace.
Establish the characteristics of positive and negative customer service and discover how to deliver outstanding customer service. Select a personal approach to create a good first impression for our company. Discover good listening techniques Identify the key skills required to deal with customer complaints. To provide those working with customers with the information and skills needed to deliver a consistently high level of customer service within their daily activity and workplace
Define what dementia is, explain how dementia affects people in different ways. Clarify that quality dementia care focuses on what a person can still do. To provide the learner with an understanding of how teamwork and support leads to better care for people with dementia.
- Describe how diabetes develops
- Explain the types of diabetes
- Describe the symptoms associated with the condition
- Identify the management of the two main types of diabetes
- Describe how to prevent complications associated with diabetes
- To provide the learner with an overview of diabetes, the symptoms, management and complications that can arise.
To ensure our staff are able to complete all required documentation within care so that it complies with both legal and organisational requirements. Explain the purpose of care records Clarify the types of records that you are required to complete Explain the legislation and guidance behind this Define your accountability in this process, linking this to confidentiality, it explains how to complete care records, avoiding the common errors.
The professional duty of candour refers to a healthcare professional working in an honest and transparent manner at all times. The publication in 2013 of the ‘Francis Report’ heralded many changes within the health and social care sector. The drive to improve transparency and openness became key performance indicators. The need to provide assurance for our service users, that everything that can be done to keep them safe in our care was being done, became a fundamental requirement of day-to-day practice. Our staff will understand: The difference between statutory and individual duty of candour Recognising a ‘notifiable safety incident’ Various levels of harm and associated actions The disclosure process for notifiable safety incidents’ Good practice when carrying out duty of candour and correct terminology
Identify the types of texture modification and fluid thickness relating to the IDDSI framework. Recognise how to care for someone with dysphagia Identify key health professionals who may be involved in caring for an individual with dysphagia.
To raise the profile of dysphagia to prevent serious choking incidents or malnourishment.
Be aware of the individual’s wishes for their end of life care and understand advanced care planning. Have a knowledge of the supporting health care standards and legislation.
Identify a person entering the last stages of their life.
Have a basic knowledge of symptom management and pain assessments
Provide an individualised care plan for their end of life care.
To ensure our staff are able to deliver the right person-centred care to a high quality for individuals approaching the end of their life with compassion, competency and respect.
Discover epilepsy and what can trigger it correctly order the steps for the recovery position Recognise how to provide individual support to someone with epilepsy Aims: To give anyone caring for a person with epilepsy a good understanding of the condition and how to care for them in the event of a seizure.
Understand the importance of equality and inclusion Work in an inclusive way Access information, advice and support about diversity, equality and inclusion Aims: The purpose of this learning is to increase our teams awareness and to ensure that our team have the knowledge and understanding to be able to work to best practice, or no where to go to get the right information. The organisation has an open culture to LGBTQ+ and employs an ambassador in this area to support both staff and service users. We empower our minority groups to be leaders and we teach our staff to be open to learning about new cultures, spirituality, sexuality, religion etc
We have a zero tolerance to falls, a root cause analyses is triggered by the SMT should this increase in any home or facility we teach our staff to describe the effects and implications of falls Recognise causes of falls Understand how falls can be reduced or prevented Describe the falls risk assessment process Aims: This course is intended to provide an overview of the implications of falls in older people, both for the individual concerned and the care organisations; and how these falls may be prevented and reduced through risk assessment.
State the causes of fire in the workplace Identify the different classes of fire Explain what is meant by the Fire Triangle Describe the different types of extinguisher and on what types of fire they can be used to describe the actions to be taken in the event of a fire Describe the importance of a fire risk assessment Aims: To raise awareness of the importance of fire safety in the workplace for all staff.
Be aware of the principles of hydration, nutrition and basic food safety Know how to support individuals with fluid intake Understand how to support individuals with informed food choices to receive the right nutrition Know how to support people when eating. We provide our staff with the knowledge required to support people with eating well and maintaining fluid intake to promote their well-being.
We teach our staff the importance of food safety and legal obligations to Identify the risks of food contamination and how to keep food safe List the importance of maintaining high standards of personal hygiene and cleaning in a catering environment.
Classify the main health and safety responsibilities of yourself, your employer and others in the work setting Identify reasons why we comply with health and safety legislation and assess risks, Select health and safety tasks that shouldn’t be carried out without specialised training. Identify hazards and assess the risks posed Identify how and when to report health and safety risks.
Know the principles of infection prevention and control Identify responsibilities in the prevention of avoidable infection, Understand the chain of infection and how to interrupt it. To raise our staffs knowledge and awareness of infections common to the health and social care sector, and the ways to minimise the risk of infection in the workplace.
We aim to raise the profile of learning disabilities. Recognise how someone may feel if they have a learning disability. Discover how positive attitudes towards those with learning disabilities will improve the care and support they receive Identify adjustments that might need to be made to the way care and support is provided if someone has a learning disability Discover how to support individuals with learning disabilities in accessing healthcare
Gain knowledge and understanding of Legionella bacteria and how it develops Understand the effects to health (Legionnaires Disease) Know how to control exposure and minimise risk
To provide the learner with the knowledge and skill to comply with the legal requirements under the Health and Safety at Work Act 1974 Section 2 (1) and Section 3 – Lone Working. Describe what the term ‘lone working’ means Identify lone working within the workplace Explain how to identify suitable control measures in order to reduce risks Understand the law and legislation behind lone working, and the requirements of the law to document and keep records
Define ‘capacity’ and explain the key principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards Describe how these may be relevant to service users and how they may impact on our staffs own practice Provide a basic description of the assessment process required for assessing both mental capacity and the authorisation for deprivation of liberty Describe the supporting framework and roles of others specific to these Aims: To provide an overview of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and the implications they have for the service user and service provider.
State the legislation that underpins medication administration, Explain the process to go through from ordering of medication to administration, and the disposal of medicine, Identify the different routes for administration of medication and the possible drugs for each.
Recognise how someone may feel if they have a mental health condition, such as: psychosis, depression or anxiety Discover how positive attitudes towards those with a mental health condition will improve the care and support they receive Identify adjustments that might need to be made to the way care and support is provided, if someone has a mental health condition, such as: psychosis, depression or anxiety.
Explain the key pieces of legislation relating to moving and handling. Describe the structure of the spine Understand the potential risks associated with poor moving and handling Conduct a basic moving and handling risk assessment using the acronym TILE (Task, Individual, Load and Environment). Describe the principles of moving and
Identify the principles of the skin healing process, Outline best practice in skin management, Spot the difference between pressure ulcers and moisture lesions and complete a skin integrity assessment to Identify pressure-relieving tools.
Understand the term ‘person-centred care’ Understand how a person-centred approach supports individuals to engage in active and fulfilling lives Understand the importance of putting people and their families at the centre of decisions about their health and social care.
This course covers the requirements relevant to anybody involved in the recruitment of people who work with children, young people or vulnerable adults. To enhance your learning we recommend you complete our Conducting Effective Interviews course. Safer Recruitment Identify the indicators of different types of child abuse List the actions to take in response to safeguarding concerns Outline the support required following a safeguarding referral Identify the risks and possible consequences for children and young people of being online
Define the different types of abuse and the recognition features of each one and describe how to deal with the disclosure of abuse and the process to follow State the legislation they may need to be aware of with regards to an abusive situation Identify the support available following disclosure
Safeguarding & Protection of Adults Recognise the signs of someone vulnerable to extremism Discover how to safeguard against extremism Identify when it is appropriate to raise concerns
Types and Causes Define continence and incontinence Describe the incidence and prevalence of urinary incontinence today Recognise the anatomy and physiology of the urinary system Understand the impact of urinary incontinence on a person’s quality of life Understand the importance of respecting the dignity and privacy of a person with urinary incontinence in a care setting.
We teach our staff how topical medication is applied to a particular place on or in the body.
Identify what constitutes sexual harassment Recognise sexual harassment Outline steps to take if you experience or witness sexual harassment
To refresh and develop learners knowledge of the wound healing process, dressings, appropriate surgical interventions and any other factors that may compromise wound healing. Assess and treat wounds in a care environment Understand the factors affecting wound healing. Differentiate between acute and chronic wounds. Classify and categorise types of wounds. Understand the importance of wound care assessment and documentation. Understand the rationale for wound dressing choice
The company also provides bespoke training for specific individuals, tailored to the person and not the diagnoses. This is empowering and enhancing the quality of care received and positive outcomes because training is unique it makes the learner truly engage in the subject matter being taught.
As this is known to the wider sector as specialist training this has been addressed here, however the company has a set expectation that everyone is to attend all the training that is available to them to ensure there awareness and abilities are improved to empower everyone and encourage a better quality of life for all our Residents and/ or service users;
Included in the Non-Executive Directors induction video, includes a child signing Makaton on video relaying the induction speech, who teaches Makaton to staff. We believe that communication is the starting point to enable people we support to have choice and control over the support they receive. We have invested in a member of staff becoming a Makaton trainer for the people we support and staff to learn together. We also produce easy read documentation and policies about important topics such as sexuality and relationships. By facilitating people’s communication, we are able to involve them in all decisions that affect their choice and control. We support people to be involved in the initial assessment before we start supporting them to be aware of their expectations, wants and needs; this is to ensure that we are the right provider and that we can offer the support that the individual wants. As stated previously people are involved where possible in planning their transitions in to their new homes and being involved in choosing décor and furniture etc.
Individuals will also be invited to be involved in interviewing the staff that will be supporting them. We then work with individuals to develop their support plans. Pictures are used to make support plans and activity plans accessible. People use pictures to sequence and plan their day. Pictures are used to help people choose their meals and other personal items. Photos and videos are used, with consent, to support people to tell others such as family members and care managers what they have been achieving. This also builds people confidence and supports them to take part in review meetings to direct their support. We have worked with a young man and a behaviour specialist to develop his own pictorial behaviour support plan and this has empowered him to be involved and helped him to understand his own behaviour and the impact it has on himself and others. He has also been involved in debriefs after incidents of challenging behaviour so that he and his staff team learn together to identify the triggers and how to avoid these; identify what helps and what doesn’t help.
He has been able to manage his own behaviour and express himself in other ways; significantly reducing the number of incidents of challenging behaviour. For people who need more support to be able to communicate their choices we seek support from advocates and family where appropriate. All staff are trained in the Mental Capacity Act and how to follow the legal framework for supporting decision making and best interest decisions. All day to day decisions regarding care and support are documented in daily progress notes and Mental Capacity documentation demonstrating how decisions were made and who was involved. We also use social stories to prepare people for events that they may find difficult to understand such as preparing someone for a blood test. Previously they had always refused but with preparation from a social story explaining the process a successful blood sample was taken. The Expert by Experience meets with people we support during quality audit visits and asks people to share their experiences of what is working and what is not working for them. This information is used to make positive changes to peoples support.
Other
We have 10-years’ experience successfully supporting individuals with a range of complex social/behavioural difficulties with managing their behaviour effectively. We adhere to NICE guidance and recommendations for ‘Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities whose Behaviour Challenges’. Our approach emphasises Positive Behavioural Support (PBS).
‘Behaviours that are considered challenging/concerning’ is not a diagnosis, although it may challenge services, family or others, it serves a purpose for the individual such as producing sensory stimulation, attracting attention, avoiding demands and communicating. We undertake thorough assessments of the person, their environment and any biological predispositions to understand triggers and behaviours, and how we can adapt support to improve the person’s overall quality of life. This Bio-Psycho-Social model ensures a well-rounded and holistic approach to looking behaviours’ functions and motivations, and supports the development of strategies/interventions to mould more socially appropriate behaviours.
Functional assessments identify the purpose behaviours serve for individuals. We can then put in place interventions that enable people’s needs to be met without presenting such behaviours. From point of placement, our Assessment will seek to understand the history of any presenting behaviours through a systematic assessment of when, where, how and why an individual displays such behaviour. The primary outcomes of this assessment are a description of behaviours; identification of events, times and situations where/when behaviours occur; identification of its function; summary of the behaviour and direct observations that indicate the onset of behaviour. From this we can identify:
- Proactive Strategies
- Early-Warning Signs
- Reactive Strategies
- Post-Incident Strategies
Risk Management Plans are put into place with guidelines developed for the Team to ensure a consistent approach to PBS with proactive strategies being preferred to reactive strategies. Consideration is taken of mental capacity difficulties alongside any support which may include restrictive practices or indeed a deprivation of liberty. If a Service User is deemed not to have capacity, we will use a best interests approach to decide what we can/can’t do. This includes working with the individual’s family, advocate, healthcare professionals, the Local Authority and the Court of Protection to decide how to approach interventions and strategies for managing challenging behaviour. In any event, our level of intervention is directly proportionate to the risk that is being presented. Any physical restriction that is used (and only when this is to protect the safety of the individual and others) is to be done so for the shortest possible duration and with minimum force, sitting or standing only).
Over time our team develop close therapeutic relationships that form the foundation for trust and understanding. staff are able to discuss and practise coping and tolerance techniques with the individual, ensuring these strategies are tailored to the individual’s abilities, long-term needs/condition, preferences and communication type. To mitigate the escalation of anxiety, obsession or challenging behaviour, staff/Service Users are encouraged to regularly revisit these coping techniques with individuals, offering prompts and reminders when signs of escalation are spotted. They will also highlight and reward ‘right’ decisions made by the individual during difficult situations, such as leaving the room to prevent conflict escalating, thereby reinforcing positive behaviour.
Incidences of de-escalation are logged in the Service User’s Support Plan offering tangible evidence and reassurance of the abilities to remain self-aware and implement coping strategies successfully. In this way, we can seek to identify additional triggers that may have developed over time, or as a result of new pressures in the individual’s environment. By recording information in this way, we can have a clearer understanding of behaviour patterns, triggers for escalation for each person we support. We understand that as people grow and develop the effectiveness of coping strategies and interventions might change also, it is therefore of great importance that these needs are regularly reviewed. We closely monitor support provision to ensure consistency across the team, between shifts and at all times of the day where support is provided.
The company has a strong clinical and non-clinical leadership team within the management team, the company employs a General Nurse and a Learning Disability Nurse as Clinical Lead and Training Directors. Their roles have enriched the quality of nursing (we see the terminology of nursing skills, as health care assistants and support worker) skill bases within our teams across the nursing, residential, LD and supported living services.
We believe that a diagnoses does not define someone, rather we believe in our differences and we acknowledge, respect and embrace them. This allows us to provide bespoke training, to the person and not generic training on a illness or particular diagnoses. We look at how a condition effects a person and deliver bespoke training tailored to that person.
The Clinical Lead and Training Directors design our policies with support from Quality and Compliance and Human Resources, competencies, training and induction by empowering our employee engagement steering committee and our service user steering committee (people with lived experience, that we support and care for) guided by our clinical team to shape the future development for the company. This has supported in the development of the below nurse delegated tasks;
Trust Care Management Ltd use is a physical deterioration and escalation tool for care settings called RESTOR2, We carry out route cause analysis and identified that the RESTORE2 tool supports Health Care Assistants and Support Workers in the community and in care settings to monitor and observe a Resident and/ or service users health alongside being a communication and escalation pathway to get the right help early.
It is designed to support our staff to:
- Recognise when someone may be deteriorating or at risk of physical deterioration
- Act appropriately according to the service users care plan to protect and manage the service user
- Obtain a complete set of physical observations to inform escalation and conversations with health professionals
- Speak with the most appropriate health professional in a timely way to get the right support
- Provide a concise escalation history to health professionals to support their professional decision making
All Health Care Assistants and Support workers are instructed to comply with NICE guidelines as a non-clinical administrator of medicine. They receive theory based training, practical training by a competent and qualified person and then receive competencies for all stages of managing medication:
- Prepare
- Safe environment
- Knowledge of individual
- Clean and tidy work area
- Correct MAR charts, protocols, stock count
- Communication books and handovers
- Wash hands
- How to administer
- Safety of handling medication
- Observing communication with service user
- Before administering checking the 6 R’s
Evidence is captured through monthly evaluations of all care needs inclusive of monthly trends (analytical data) and quality audits, this is then presented by senior management team (regional Operations Director, Quality and compliance manager, Clinical Lead and Training Directors to the National Operations Director and stakeholders for thematic review, what we found is that the company as a whole have had 1% medication errors in the past 6 (six) months, against a National average of 8-25% demonstrating the success of the companies high training and governance within the organisation. We also found that the omissions in medication errors were around recording errors rather than drug errors which evidences a level of open and transparentness which is one of our core values and behaviours.
All of our health care assistants and support workers are trained in the administration of medication, even in nursing settings.
All Health Care Assistants and Support Workers are trained and supported to ensure that they work at the highest standards and are empowered to observe, monitor and respond efficiently to wound care. We train our health care assistants to be able to treat wounds, and the clinical governance behind reporting with the regulators. We have a zero tolerance to acquired wounds in the home and have a proven track record of nursing wound / pressure ulcers back to health, where the NHS had assessed and confirm that the limb required amputation, in social care we do not accept that and we treated the wound and this person drove out of one of our nursing facilities driving a sportscar.
We strive to be the best and with this vision, the culture is enriched with education and to drive transformational leadership within our services – this is the success behind the high quality care and outcomes our service users receive.
The structure within the company highlights it success, we train our health care assistants and support workers to complete nurse delegated tasks, this has clearly demonstrated empowerment through (Continuous Professional Development) and that our leadership style and methodology to care is effective.
Our ‘non clinical team’ in the community ‘supported living, and our residential and learning disability home that are not nursing are able to successfully and with the highest regard complete the following nurse delegated tasks.
⦁ Administer rescue medication through the buccal cavity.
⦁ Administer rectal rescue therapies
⦁ Administer Suppositories
⦁ support people living with Percutaneous Endoscopic Gastrostomy (PEG)
⦁ Insulin administration and monitoring including rapid response
⦁ Controlled drugs – regulation, storage, administration, ordering and disposal
⦁ Phlebotomy – taking blood from the vein with a needle
⦁ Wound management inclusive of grading and vacuum therapy.
⦁ Support people living with a syringe driver
⦁ Verify a death (VoD)
⦁ Catheterisation – male and female
⦁ Stoma care
⦁ Tracheostomy care
⦁ ENT Training (Ears, Nose and Throat) nebulisers, ear drops, eye drops etc
⦁ Anticipatory Medication
⦁ Injection
2) OVERSEAS RECRUITMENT AND OSCE (OBJECTIVE STRUCTURAL CLINICAL EXAMINATION)
Trust Care Management successfully launched and recruited Nurses from overseas to work in two nursing homes, January 2020 – August 2020.
The calibre of nurses readily available in England has been questionable, leading the company to empower and upskill our health care assistants and support workers to complete nurse delegated tasks.
Since the overseas nurses were recruited they have successfully complete their OSCE training via the Companies internal training and development department and clinical team.
The induction was written independently by the clinical team meeting the learning criteria:
- All overseas Nurses had a 30 (thirty) day induction plan to prepare them for their exam.
- 15 (fifteen) OSCE Nurses successfully ⦁ 93% successfully passed on first attempt passed.
- 7% success pass on second attempt
The candidates were required to complete six stations. Therefore, we covered the following nursing skills as per OSCE guidelines:
- APIE – Assessment, Planning, Implementation and Evaluation (hospital setting & community setting)
- The seven steps of hand hygiene
- Wound care
- Catheter Care
- Urinary Catheter removal procedure
- Collecting CSU, MSU sample
- Urinalysis
- Intramuscular and Subcutaneous Injections
- Recording Vital Signs to include the National Early Warning Score (NEWs)
- Neurological Assessment
- Recording and Interpreting Peak Flow
- Basic Life Support
- MUST Score Calculation
- Administration of medication to include drug calculation
- Administration of inhaled Medication (AIM)
We also ensure our non-clinical managers and directors are supported through the OSCE as part of their induction to the company through our internal training and development department.
We have also upskilled 2 (two) of our oversea nurses, 1 (one) of them has successful gone through an internal management and leadership training course and is awaiting registration with the regulator to become a registered manager with CQC and another one is successfully managing a 2 (twenty-two) dementia nursing unit in a nursing home.
2) PRECEPTORSHIP
A preceptorship programme is implemented by the company to support newly qualified nurses and students by way of ensuring the organisations qualified nurses get the best start to their nursing careers. We empower a solid foundation of clinical practice as the nurse starts their journey as a qualified nurse.
Our approach recognises that where preceptorship is firmly established as part of the organisational culture, there are significant benefits for the newly qualified nurses, staff and the organisation in terms of recruitment, retention, values and culture.
The transition from student to registered nurse is pivotal to every newly qualified nurse. Therefore, Preceptorship was introduced as part of Project 2000 reforms where evidence shows that the transitioning period is a window of opportunity to learn as you start your career as a register nurse.
Health Education England 2015 and 2016, published preceptorship standards for organisations to clarify the requirements of preceptorship as part of the Shape of Caring Review which highlights areas of best practice and included 14 required elements. Furthermore, the findings from Odelius et al (2017) suggest that the majority of preceptees benefit from increased competence and confidence through a preceptorship programme.
The NMC (Nursing and Midwifery Council) state that new registrants on a preceptorship programme should have protected learning time in their first year of qualified practice and access to a preceptor with whom regular meetings are held. Furthermore, it is also recommended that all new registrants should have a formal period of preceptorship of about four months but this may vary according to the need of the individual.
The company encourages and welcomes newly qualified nurses who are looking at completing their a preceptorship here with us. We believe that our programme is more effective in terms of our nursing model, leadership style and total communication.
We provide a conducive learning environment by facilitating the transition from student to registered nurse. Apply and encourage learning to foster during the preceptorship period.
Responsibilities:
- Take ownership of the role as a preceptor.
- Possess good understanding of the preceptor framework requirements.
- Communicate these to the newly registered nurse clearly and concisely.
- Ensure induction has been completed and check that the nurse is fully aware of local ways of working and appropriate policies and standards are adhered to at all times.
- Promote effective working relationships with all staff to include members of the MDT (Multidisciplinary team).
- Set achievable goals with regular and confidential supervisions and competency with the nurse.
- Encourage learning through signposting resources and actively planning learning opportunities for clinical, professional and personal growth of the preceptee.
- Use coaching skills to enable the newly registered nurse develop both clinical and professionally and build on confidence.
- Give timely and constructive feedback, set action plans and review in a timely manner to aid further development and growth.
- Act as an advocate and be a critical friend while maintaining professional standards at all time.
- Liaise with the RM when monitoring progress and address areas of concern through objective setting. Seek advice from the training department as necessary.