Views Voyage Care Voice – S2E9: High quality care in our residential care homes.
After a successful pilot season of Voyage Care’s first ever podcast, we are excited to share our second season with everyone! Relaunching as Voyage Care Voice, our podcast will be showcasing real people with real insights.
In our final episode of season two, we’re joined by Keith, Service Manager at one of our residential services in West Yorkshire and Mariza, Team leader at one of our residential services in Southampton. They’ll be discussing ways in which they ensure high-quality care is at the centre of everything we do.
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Read the transcript of the podcast below.
Grace:
Welcome back to season two of Voyage Care Voice. This season, we are focusing on the importance of high-quality care and support. Joining us for our last episode of this season is, Keith, Service Manager at Three Sisters, one of our residential care homes in the north and Mariza from West Road. One of our residential care homes in the south. They’ll be chatting about how they ensure high-quality care and support in both of their services.
Keith:
Hi everyone. Thanks for joining us today on the Voyage Care Voice, today we’ll be talking about quality in our residential care services. My name is Keith Moran. I’m a Service Manager for Voyage at Three Sisters, residential care home up in Haworth in West Yorkshire. We look after 10 people with learning disabilities and challenging behaviors. I’m joined today by Mariza who works at West Road.
Mariza:
Hello, my name is Mariza. I work at West Road in Southampton. I’m a team leader and we support people with learning disabilities and autism. I work at Voyage Care for around six years. I’ve been recently promoted to team leader, I’m from Portugal and this was my first job in care, which I enjoy doing.
Keith:
Is your service down in Southampton?
Mariza:
Yes, it’s in Southampton, in Hedge End, we normally support three of them, with two members of staff, which feels like more of a family environment. What does high-quality care and support mean to you?
Keith:
Very good question, Mariza. I think for me, it’s seeing the people we support in my service having a happy, fulfilled life and going about their day to day business happy and engaged, from a manager’s point of view, doing all the audits and the checks and managing the staff team, you know, good quality care for me is making sure that when I’m doing those, they’re coming, coming out with positive outcomes and if something isn’t coming out as a positive outcome, then it’s rectifying that immediately to bring it up to be a positive outcome. So, yeah, that’s my opinion of good quality care in my service. What about yourself Mariza?
Mariza:
So I think all of you say is true and applies to my service as well. Also, I think diversity is a very important topic in high-quality care. We must treat everyone the same and equal like here at West Road. We always try to involve our guys in our different cultures. I will tell you an example, we have some of our staff team from Portugal. We have some staff team from Poland and the Philippines. So, we have this day on the menu, which is Friday. We always do food from around the world. So, this is like a way to show our guys different types of culture. We also go on holidays with them, which improves a lot, they enjoy doing this. So, when we go on holiday, we always go abroad for them to know other cultures and other food and other places different than home. We also had our friend’s picnic, which was a huge success. They really enjoyed this, they understood that love is love and it doesn’t matter the sex, the age, you know, we must love each other the same way.
Keith:
So Mariza, how do you know that that high-quality care is there then?
Mariza:
I think it’s here because our service is safe. It’s effective, person-centered, efficient, delivered by a good staff team and good management. And, you know, our guys are happy. They feel good, safe, worth it and loved, which is very important. What about you Keith?
Keith:
Knowing it’s at that high-quality level, it’s not just my own opinion, as to how I feel it’s going, because I’m overseeing everything so I can see all the data coming in and how people are reacting, but it’s also from external people coming into the service, you’ve got your quality checkers, you’ve got your quality team, you’ve got CQC, you’ve got your Ops Manager coming in and doing audits. And you’ve also got family members who are coming in and they’re feeding back to you how they’re finding the service. So all externally as well as internally, they’re the key indicators as to how well you’re performing as a service and also through, you know, if you ever get any complaints, then you know, something’s wrong and you can work around it and try and implement it just to make things better. Compliments as well, I think it’s key that you get feedback from external people all the time. We recently had the quality team, they came and did a fresh eyes visit, which was good for the staff team to talk to the quality team and for the quality team to see how the staff were interacting with the people we support, it was a positive experience. I’m glad they came because gave us some feedback as to whether they were happy with how people were interacting. So yeah, those opinions count too.
Mariza:
Yeah, that’s great. Because sometimes staff see the quality outlets as a bad thing or CQC inspection, I don’t think that’s the case. I don’t know if your staff team does?
Keith:
I think you’re right, Mariza, I think staff teams sometimes worry about CQC and I always say to them, you should never be worried about quality coming in, CQC, coming in the Ops Manager coming in because everything is good and you are, they’re coming in to, to look at all the good things that you are doing. So if everything’s good, then everything’s great. And you want to share that with everyone and show them.
Mariza:
Yeah, I totally agree with you.
Keith:
Mariza, you say that this is your first job in care. How have you found quality since starting in your care role?
Mariza:
Well, I found it very important to make sure the people we support have choice and control over their lives. I also find it very good the relationship between the staff, the people we support, the families, the professionals. It’s very rewarding to see them happy as well, the people we support, which means they feel good and worth it and safe. What about you Keith? How long have you been working for Voyage Care?
Keith:
I’ve been working for Voyage Care for a number of years now since 2004 actually but I’ve done various roles in the organisation from support worker and I was an Operations Manager for a period of time. I left Voyage to try something new and then decided to come back and since I’ve come back, I’ve been a Service Manager at Three Sisters and I’ve absolutely loved it. The quality side of it is, is just so important. Everything that we do in the service is all about quality. Everything from infection control right down to serving the people we support and them doing activities. It’s all quality led and it’s so important. I think sometimes your staff team doesn’t realise why you ask them to do things and check this and check that, which is all important stuff that they need to do to ensure that everyone’s safe and well protected. And the house is clean and it’s unbelievable how many things we have to do as a Service Manager and yourself as a Team Leader but it’s all vital and important things to make people safe.
Mariza:
Yeah, I agree.
Keith:
Yeah and being Service Manager, when I go out into the service and see what people are up to, there’s nothing that pleases me more when I go through and the house is just empty and there’s nobody there. That makes me smile, then I think, that’s brilliant because everybody’s going out. People are not just sitting there. Twiddling their thumbs wondering what to do. The staff team are using their initiative and going out on activities, based on the areas that the people we support want to do and we do all sorts of things, in listening to what the people we support do as well. We, I’m sure you are very similar down at your service, but we use, annual service reviews, house meetings, key worker meetings. We have a suggestion box, just general chats day to day and I also have an open-door policy where the people we support can come in and ask me questions if they need to and ask for things. Do you do similar things at West Road?
Mariza:
Oh yeah. I really like the idea of a suggestion box. Can you tell me more about that? It’s quite interesting.
Keith:
Yeah, it’s just the box that’s in the dining room and basically when people have ideas, what they do is it can be from the staff team, team leaders, people we support and any ideas will go into the suggestion box. Sometimes they’re not always good suggestions. They might be, you know, maybe two suggestions to help improve the service somehow but then when, when it comes to the team meetings, the people who live in the house open up the suggestion box and see what’s there and we discuss it. Any actions taken from that we will work on and that’s a good way because we’ve had all sorts added to the suggestion box at our place. We had a pool table so we got a pool table. We’ve had things added onto the menu, taken off the menu, decorations, things like that and it’s helped the service become a person-centered service, which is nice.
Mariza:
Help them make their own choices as well.
Keith:
Yeah, definitely. I think it’s really important that the people we support are listened to and that underpins all the quality aspects in the service.
Mariza:
Yeah, here at West Road, we do the key worker for things. And normally is the key worker who discuss with the people we support their activities. We use both with images or research online, like we have the people we support said he wants to go swimming. So yeah, his key worker just sat down with him, talked about this, check the risk assessments, check if it’s possible. We talked with the family, they were okay. He really enjoyed swimming. So yeah, the key worker just sat down with a person with support and just try to search for a good venue to go and swim, schedules and equipment and he’s going, and he’s very happy with it at the moment. And then we have the house meetings, we discuss like the new activities with all the staff and all the people we support to see if there’s another person that would like to do the same thing. Like for example, swimming. And then we will just find out how we manage with the staff support and the timetable if it’s possible. So, two of the guys can enjoy the same activity.
Keith:
It just adds value to their week. Doesn’t it? When they’re doing all those interesting activities that they want to do? I think we’ve had, we’ve had a couple of people where they’ve actually said they wanted to do a job, so we’ve kind of worked with them and, and we’ve worked with the community as well. We have some volunteer services and we’ve worked with them and we’ve managed to get someone at present working in a local charity shop twice a week and she loves it and we’ve had two people actually, historically who have worked in, a shop and have helped out there. And it’s been a paid employment as well, and they’ve enjoyed it. Um, and it’s great to see them when they come home after they’ve done their duties in their roles and they come home and they have a cup of tea and tell us all about what their day’s been like. It’s good to listen to. We’re a challenging behavior service. And for people who live with us, to be able to, do those sorts of, tasks is quite amazing considering how the individuals were when they came to live with us because they were particularly challenging. But over time they’ve become settled. From working with the staff team, they like where they’re living and they feel confident enough to then go out into the community. And for me, that’s a really big part of our role as a staff team to make them feel as confident as they can to do that.
Mariza:
Yeah. And that’ll help us to be prepared for CQC inspections as well and also internal audits, right?
Keith:
Oh yeah. Internal audits. Wow. Do you get involved with that, as a team leader? Mariza, do you do internal audits?
Mariza:
Yes, I do. Yes.
Keith:
Oh, that’s good. Do you enjoy doing them?
Mariza:
I don’t mind. It’s just, you know, everything normally is fine. It’s just some updating to do and some care plans to review.
Keith:
Well, I think they’re really important because it helps you pick up things that you may have missed, or you need to review or do. And so it’s like continuous improvement in your service. So if you didn’t have the audits, then there’d be so much stuff that, you know, as a, as a manager, you just, you can’t keep it all in your head all the time. So, the audits kind of help remind you that things might need to be done, and you can put them on an action plan list and then, and then you consolidate to action plan list, and then go back and review it and share with your team, to get them to do some of the tasks for you and help you out. Because as a service manager, I can’t do everything. And, and it’s really important that you delegate to your staff team so that they learn new things and can help you.
Mariza:
I remember being on shift when was CQC inspector came into the house. And yeah it was quite nice because all the staff are well trained. They know what they’re doing, you know, we, we have all the records, updated and the policies and procedures. We also have, I dunno if you have in your service, but you should have, you should have an album from 2020, you know, the year that COVID happened, you should have an album with pictures to show to CQC what we were doing when the pandemic hit. I don’t know if you have that, but we have, and it’s quite good. It’s a good way to show, the good outcomes that came from the pandemic. We have pictures of our guys having picnics outside, enjoying the sun, eating lots of food, enjoying baking, cooking, playing mini-golf, all those things. We painted the rainbow and everything.
Keith:
That’s a good thing to evidence when CQC does come to the service. Yeah, absolutely. I once did a blog called it was ‘outstanding logs’. You should check it out. It’s good. It’s about a thing we implemented at the service where, any good thing that you do in the service like you mentioned all those activities during COVID times and you log them on the outstanding log and you put it into a different category, like safe, effective, responsive, and well-led. And then put it in a folder it’s called an outstanding folder. I think every service has got one it’s called an outstanding folder. And so every time something good happens in the service. Like for instance, when I mentioned earlier where the individual goes to the charity shop for her work placement, we’ve put that on the log. And every single thing that we can think of to put in there, goes in there. So when CQC comes, they can open that. You know, if for instance, I’m not there and they’re waiting in the office, we’ll put that folder in front of them to read, and then they can look through all the good stuff that’s happened throughout the year. And we’d done a lot of work on that before COVID hit. I picked it back up again about a month ago and thought, do you know what, I know COVID has happened, but we’ve done so much during COVID. It’s not like we sat at this service and have not done anything. So I went through all the good stuff that we’d done through COVID and how we’d responded to that pandemic and our staff worked so well in thinking on their feet and putting in place loads of different activities in the service, outside the service. And it was just, it was so good. We kind of doubled the folder just by things we’ve done in COVID, which was fantastic. Did you struggle with family contact?
Mariza:
Yeah it was a tough times for our guys because they were not able to see their families and call but it’s not the same thing. One of our guys, we bought like a tablet for him to see his family on Skype which helped him because he used to see his family twice a week, at least, and it was from that to nothing. So yeah, but apart from that, they did quite well because they knew what was happening. We showed them the easy reads about the COVID and the virus and they understood something was happening. Yeah, I think it was well managed.
Keith:
Yeah, absolutely. That was one of the most horrible parts of the COVID, I mean being inside and stuck indoors all the time was, was all okay. But it’s the family, they missed the family. A lot of our people like to go home at weekends and go on holidays with their family. And it all of a sudden just stopped overnight. And people with autism really struggle, you know, they like their routines and the structure. And when that, all of a sudden stops it’s difficult to manage but do you know what, I thought during COVID we were gonna get loads of behaviors, absolutely loads of behaviors, but it was the opposite for us. It was as if they weren’t rushing about all day doing all these different activities, which, you know, they do enjoy, but it was just like, it was all calm and there was no rushing about, so the actual behaviors in the service reduced massively. I think that’s a lesson to learn that people don’t always need to be rushing around and busy all day and getting up at six o’clock to make sure they’re at the day service at eight o’clock, you know, people we need to learn from that.
Mariza:
Yeah. I think that’s an interesting point. I think lots of houses were now just reviewing the activity plans.
Keith:
Absolutely and a lot of people we support go to the day service and they’ve been there for the last 15 years or whatever. And, you know, do they get any value from going there all the time? Wouldn’t it be better to do a varied range of activities rather than the same day service all the time. So again, we’ve tried to try to look at that a little bit.
Mariza:
I think that will improve the quality of care.
Keith:
Right in the middle of the pandemic, we had a referral for a new person we support who was particularly challenging in the hospital. And we agreed to work with the provider and the local authority and admit the person. But he was really challenging, but we did so well working with him, within the staff team and working with all the other professionals worked really well. That was right in the middle of the whole pandemic. It was really difficult at the time cause we had to go to the hospital where he was staying, and we had to do the transition and right then we were limited about how many staff could go in there. How many, you know, we had to wear all the PPE. It was such a difficult transition for such a complex person. But working with all the professionals and the staff team, it just went really well. And then he moved into the service, put everything in place. We used all our infection control procedures and all used PPE and it ended up being a really smooth transition and his behaviors were absolutely through the roof. But since then, and, and this is a year ago now he moved in September 2020 and his behaviors now, there’s barely any a week. We’re talking several a day when he first moved in, it was very physically challenging, but now there’s less than a couple a week. And then, and we don’t have to use physical restraint with him anymore. It’s always there as an option because there’s a risk there that it could happen, but you know, he’s so familiar with the staff team and loves the service and his family now come visit, which was a big factor in his unsettled state when he first moved in. And yeah, just working with all the professionals made it work so well, even through COVID.
Mariza:
How is this person with support now, is he happy?
Keith:
Do you know what? Before he came, he was in the hospital, a secure hospital and he wasn’t able to access the community, he was able to walk around their car park, which had like a 10 foot fence and he wasn’t able to go anywhere. Um, and he’s moved, moved in with us and we’ve gradually built up his activities now. And, he’s even going down to the local shop to buy a drink and a packet of crisps and stuff. That’s the first step in him going down to buy his toiletries and shopping. So he’s done amazingly well, really, really well.
Mariza:
That’s really nice. So Keith, how, how did you manage to reduce those behaviors, you and your staff team through the quality care?
Keith:
That’s a really good question actually. I think the key was looking at the person, what was he having the behaviours for, which is a million-dollar question for this person but we worked it out. We worked as a team, worked with the professionals who already knew him, but were also still learning because he’d come from a family home all of a sudden. And we found out what he liked and what he didn’t like. So we expanded upon that and we found that he had a lot of sensory needs, so he needed to be kept busy. He needed to be out every day. He needed to be on a swing all the time. He needed to be on a trampoline or a bike. So, we used all those elements to kind of keep his day busy and that worked to treat. We looked at the local area, we’re in a stunning area up in the Yorkshire Dale and there are so many walks that we can undertake. Even in a radius of about five miles, there’s hundreds of walks we can do. We planned 10 walks that we could do in the area that are all different and varied and we put those in place in his activity plan and since then we haven’t looked back and even incorporated the shopping trips, he goes swimming now to the local pool. He goes to a trampoline arena, a bouncy castle arena, cause he just likes to bounce and jump up and down and again, use it for that sensory stimulation. But we worked all that out by working as a team, listening to parents as well. You know, their views were really important, understanding what they knew of him from when he was at home and the occupational therapists, the school, language therapists, behavioural therapists from Voyage as well, were all instrumental in ensuring that he had a happy life. And, that just shows now in his behaviours, we can tell, we know that he’s happy, he’s got a smile on his face and he’s not attacking the staff because he’s settled and that’s really pleasing for us. And it just shows that we’ve done our job in the service. We are not at the end of the job, obviously because there’s still a lot more work to do there and building his activities, but we get in there. That’s good.
Mariza:
In our service, I also have an example. We have a guy who was prescribed psychotropic medication and he’s been taking this for years. Like, more than 15 years. He was referred to the learning disability team in Southampton. We had a couple of appointments with the doctor and then he decided to come to the house to do a proper assessment. So he did the assessment. He said, okay, this person doesn’t need to be on such a high of psychotropic medication. He decided to cut like a hundred grams of this medication and then COVID happened. So, this person was reducing the psychotropic medication in such a difficult time, without seeing his family, without doing his normal activities. We thought this would be an issue and that we’d have lots of behaviors, a lot of side effects from the medication. But actually he was completely fine. There were no issues, no side effects. He was perfectly fine. He was attending his activities like the walks, he would just want to go for fresh air. He was really happy. There were no issues regarding this medication and then he just kept going. We just kept reducing the medication until completely stopped. So we managed to get him out of this psychotropic medication in COVID times. And he’s so much happier now without it.
Keith:
Absolutely amazing that, because sometimes when people have been on, on medications like that, you don’t know if it’s gonna go the other way, do you because you want them to be as settled as they can be. By using the support guidelines and reviewing the medications with the professionals, you’ve got to try haven’t you sometimes to reduce, you don’t want people on psychotropic medications if they don’t need to be and it’s really good that it’s worked out for you on that one.
Mariza:
Yeah. Especially in such difficult times, which we, really thought all the staff and the family, his family, we thought that, okay, this will not go well, something will happen. His behaviors will just escalate, but he was just completely fine and now he’s out of medication completely.
Keith:
Wow. That’s amazing. Thanks everyone for listening to this edition of Voyage Care Voice, with myself, Keith Moran, and Mariza it’s been a pleasure learning about your service and the people you support down there, so thank you as well.
Mariza:
Yes. Thank you as well. Keith it was really good to know some stuff about your service and share some of mine as well.
Keith:
Brilliant. And I hope I can come down to Southampton and see your service. And perhaps you can come up here as well. One day. It’s a bit far mind but it’d be good to meet you. If anybody wishes to get any more information about Voyage Care, please visit the website at www.voyagecare.com. Thank you.
Mariza:
Thanks for listening. If you’d like to learn more about our high-quality care and support, please visit our website. Stay tuned for a brand-new season of Voyage Care Voice in the new year.
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