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How does an Oxfordshire care home go from ‘Inadequate’ to ‘outstanding’?


3rd February 2020 |

By Editor

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How does a care home go from a CQC rating of inadequate to becoming the largest care home ever to receive a CQC Outstanding rating across all five inspected and assessed categories putting the home in the top 0.13% in the UK?

It takes a deep sense of responsibility, sweat, tears and hard work, but perhaps what you wouldn’t expect is, it took someone with no social care experience to do it!

Five years ago global hospitality high-flyer Sanjay Dhrona took a very fraught call detailing the trouble this once incredibly successful and much-respected care home was in, Sanjay was presented with the facts of the company’s failings and the proposition of no recovery.

Sanjay Dhrona, managing director of The Close Care Home says: “I did what anyone would do for their family in that situation. The home was in trouble, and we were concerned that residents weren’t being cared to a standard that we were happy with.  I literally walked away from my job and helped my father try and turn the business around knowing only to well I had no social care experience – I had to try.”

Leaving the world of corporate events and working with high profile clients such as the Royal Family, luxury car manufacturers, and pop stars, Sanjay was transported to the world of a ‘scare home’ – a message tattled by the media when referring to inadequate care homes.

“I can’t stress enough this was a leap, I had no idea if I would have a positive impact, never mind save the business. The truth was it needed radical thinking, the home had been allowed to be mismanaged, the staff team demotivated and the residents disregarded, the rot had set in”

“I realised really quickly that we had fantastic staff on the floor. Genuine people who really cared, they just didn’t have the right support. So on the first day I arrived the first room I came to was the laundry, and that ‘s where I started.”

Sanjay worked every department one after the other, he learnt the job, got to know the staff, listened to their opinions, and then went away, read the rules, and bit by bit made the necessary changes. From limited involvement, Sanjay was very quickly full-time running the business.

Working hand in hand with the CQC, Sanjay took his hospitality background and applied it to turning the business around. Making sure the business didn’t rely on any one person, he appointed two registered managers solely responsible for the clinical aspects of the business. In addition, a non-clinical manager was appointed to ensure the important role of the ancillary services ran smoothly.

“Keeping the two functions of running a home and delivering care was a no-brainer for me. We have 90 residents, but that isn’t the extent of our care and relationship management, each resident has family members and other care professionals involved their lives, such as social workers, NHS staff, doctors, district nurses and voluntary workers. That means we are caring and managing hundreds of individuals, how could one care home manager manage that and have time to consider whether portable electrical appliances have had a Pat Test?”

With this radical view on how to run a care home, the only thing left was to see if the CQC approved of the new innovative management style.

“The provider, registered managers and staff team were highly motivated and proud of the service they delivered to people. There were consistently high levels of engagement with people using the service, families and other professionals. There was a strong commitment to ensure the service was inclusive and that people had the opportunity to extend their lives in the community.” (Taken from the executive summary of the latest CQC report)*

The CQC report praises the care home and highlights many examples of high-quality, person-centred care. But the over-riding feedback picks up on the open and fair culture within the home that is fully supported through learning and innovation.

As part of the provider’s dementia strategy they had recognised that there was a need to adapt innovative methods to encourage those people living with dementia who got up in the night and slept longer during the day to maintain a well-balanced nutritional diet. Therefore, the provider and leadership team introduced a way of making their own microwavable TV dinners…

…after further consultation with people and relatives they put the TV dinners into production. This meant the service had identified people’s individual preferences and patterns of eating and drinking and was flexible to meet their needs.” (Taken from the CQC report. Is the service effective?)

Always finding ways to maintain dignity and inclusivity:

“The service had taken innovative steps to meet people’s information and communication needs over and above complying with the Accessible Information Standard. People used a variety of assistive communication aids to express themselves, which enabled staff to support people effectively to meet their needs. Examples included picture cards, assistive technology and personalised signs and gestures.” (Taken from the CQC report. Is the service responsive?)

Engaging and involving people:

“The systems and values within the service demonstrated their commitment to high standards of care for all people, this included challenging and supporting the wider community to care for and treat people with dignity. They did this through supporting and empowering established groups and organisations, and by creating new support networks. For example, the provider worked closely with the LGBT+ community and was involved in writing articles for a national magazine relating to care for people of the LGBT+ in later life. This meant The Close engaged constructively with staff, people and equality groups.”

“The provider had created strong links with local LGBT+ groups and we saw evidence of how members from these groups came to The Close to speak with people and staff about the barriers the LGBT+ community can face when accessing care. This demonstrated the provider’s commitment to high levels of engagement with staff and people who use services, to recognise the importance of equality.” 

(Taken from the CQC report. Is the service well-led?)

There are 15,282 CQC registered services in the UK, The Close joins 19 other services in the whole country with the full fleet of OUTSTANDING ratings across all five KLOE domains from the Care Quality Commission (CQC) of Safe, Effective, Caring, Responsive and Well-led. Responding to CQC’s report Sanjay had this to say:

“To say we are ecstatic with our CQC rating is an absolute understatement. It’s been a journey that’s been about focusing care on the needs of the person rather than the needs of the service.

“We did it, as a team, as a family! Everyone combined – staff, residents, stakeholders, visiting professionals, the works. Together we achieved the greatest feat known in adult social care. We are so proud of the amazing family we have built since to the development and implementation of the new business model in 2015 that really refocused the service to the core values that we hold so dear. We want to use this opportunity to promise that this is where The Close belongs and this is where it shall stay, we promise not to step off the gas pedal, not to become complacent or comfortable. We will commit publicly to continue to improve, continue to innovate and most importantly continue to care.

Sanjay concludes:  Not only was I on a mission to save my family’s legacy, but I was also on my own journey as an LGBT Asian man. The one thing this whole journey has taught me is that how can you expect people to respect you and work with you if you don’t know how to be yourself?

“You never realise the impact you have on someone’s life until you sit down and talk to them. From staff to the residents, we share our lives, I brought the whole person to work and they shared the whole person with me. I never thought I’d enjoy it, but I’ve never felt like I’m at work, it’s surprised me. I really wouldn’t want to be anywhere else!”

The Close Care Home is situated close to the historic city of Oxford and the picturesque market towns of Abingdon and Wallingford. The modern and purpose-built facility benefits from high levels of comfort and luxury inside and out with stunning terraces and grounds which lead to the River Thames.

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Tags: #featured, CQC, The Close Care Home

Category: Care Home inspection, Care Home News, Care home staff

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