Care Campaign for the Vulnerable is learning of the pressures faced by conscientious led Care Providers striving to offer a caring and safe environment to both service users and staff. Safety monitoring is proving to be a invaluable care assist tool - bringing a more open and transparent culture into care homes as well as saving valuable resources within the care home sector and the NHS
Safety Monitoring In Communal Areas in Care Homes.
We are an advocate of Safety Monitoring and have been since 2012.
My first inspiration was during a meeting with my Manager when the topic of discussion was ‘unwitnessed falls’ around the care home. The care home would get spates of falls only to ebb off for a while and later return as different Residents’ would arrive. On closer examination it was very much dependant on the Resident themselves and not the environment around them. The amount of Residents we would get that were prone to falling were becoming more and more and although we tried to limit the risk during their stay with us it was impossible to monitor unless we provided a one on one care service.
It was a reflection on my 10 years Police Service that inspired me next. It was always said that one could not walk from one end of Portsmouth City to the other without being followed the whole way by Safety Monitoring.
With Safety Monitoring we could monitor the falls closer and even better watch the lead up to the fall to see if there was a trigger and also see the seriousness of the fall to give the paramedics the exact story of what had happened so the right treatment could be administered. We could also monitor reaction times and how the incident was dealt with by our own staff.
A few weeks went by with thoughts on the day and how it could help at Shedfield Lodge Care Home.
The first problem was the cost implication and authority to install in a Care Home.
The cost would be a direct hit on the bottom line and the return would be lengthy with a return on the hardware over years rather than months.
I found a local installer and after briefing them on what I wanted they suggested to help with cash flow to install a few cameras at a time and add further cameras when the funds became available.
The cost of each camera worked out at around£60.00 each and the DVR recorder £250.00 plus the cost of the install and cable. The TV monitors were at first second hand at a cost of £60.00 each. These are optional as one can get the images on the office computer for free.
A total cost for 3 cameras installed worked out to be less than £1000.00.
Before I took the plunge I had to then think of Policies and Procedures and authorities. This proved easier than I thought and before long had a full Policy and Procedure folder put together from our Employment Law Consultants free of charge.
I then put it out to all family members, staff, advocates and Residents themselves that I was going to install Safety Monitoring in communal areas and Imet little resistance.
The only concerns raised were by staff thinking it was going to be like ‘Big Brother’ watching them. Once I assured them it was to protect them and the Residents, they were appeased.
The whole team identified that by having Safety Monitoring, it would be beneficial for all and would be an invaluable care tool moving forward.
Another main reason for the Safety Monitoringwould be Peace of Mind for the Provider and Management team. In this I mean that the right care is being provided at the right time with factual evidence being given to professionals. The management team could log on to the cameras 24 hours a day from the convenience of either the office or at home and witness live, all that was going on in the home. I know I would sleep better as a Provider knowing that if anything happened it would be recorded, protecting both my staff and the Residents.
The install of three cameras was then carried out withthree monitors placed around the home for staff to view all the cameras in situe. One monitor was placed in the manager’s office, one in the kitchen on the ground floor and one in the smoking area whereby staff could monitor what was going on in the home whilst on their break. We initially covered the main lounge, stairs and front door with the cameras.
It was not long after the install that we had a visit from the CQC for their regular 18 month inspection.
I met with much resistance from them and was informed to take the Safety Monitoring down as it was not appropriate and breached their regulationsand privacy laws.
I apposed this and stood my ground and showed the Policies and Procedures I had put together and the authorities I had from the families and this seemed to change their minds and they remained in situe. I was a little concerned the Inspection report would come back negative but it did not so they obviously were happy for me to continue.
Seven years later into having Safety Monitoring we now have 21 cameras covering ALL communal areas, exits and outside areas.
During the time we have had Safety Monitoring there have been numerous occasions that we have all benefitted from their presence. Here are a few examples:
• There was one occasion whereby a Resident was seen on the floor picking up crumbs having put themselves on the floor. As soon as a staff member approached they were seen to lay down. Without Safety Monitoring an ambulance would have been called as it would have been recorded as an unwitnessed fall. As a result of the Safety Monitoring we were able to establish an ambulance was not needed and it was dealt with in house. This in turn saved so much time for my staff who would have had to stay with the Resident until the ambulance arrived, sometimes hours on previous history and obviously the time of the ambulance service and not to mention the stress to the Resident who may have had to go to hospital as they would not have known if they had hit their head.
Normal protocol for the ambulance service for an unwitnessed fall that had potential for a head injury would be to take the Resident to A and E for a check up. This would, depending on the time of day need a member of our staff to go in the ambulance with the Resident. A further cost to the care home.
• Another example was when a Resident was found half way down the stairs on a landing in a seated position. This was noticed by a staff member just after the fall, however at the time the staff member had no idea how the incident happened.
The Resident stated that he was pushed down the stairs.
When the incident was reviewed it was established that he had lost his footing and not pushed by anyone. We informed the family immediately and when they came to see him the next day the Resident informed them that he had been pushed down the stairs.
The family then raised a complaint which was immediately resolved by showing them the Safety Monitoring.
It was clear on the Safety Monitoring that seconds before the fall another Resident turned off the light on the stairs before he went to bed. The camera was able to pick this up even in the dark.
Also as a result of this we had our maintenance team adjust the stairway lights so they could not be switched off and are now permanently on.
Had we not have had the benefit of the Safety Monitoring we would have had a complaint on our hands to deal with regarding a Service User being pushed. We would have had to notifySafeguarding and CQC which all takes time and an ambulance at the time of the fall.
The cost element in all of the above without Safety Monitoring would be in the £1000’s just on that incident.
• Not so long ago we had a situation whereby a Resident was on the floor in a corridor with 2 other male Residents stood over him. A member of staff was passing and saw the situation having missed what had happened.
The staff member notified the management team to look at the Safety Monitoring to see what had happened and in doing so saw that the male on the floor tripped after stepping backwards and fell to the ground. Seconds later 2 Residentswere walking down the corridor and came across the male. There was no injury seen by staff and he was assisted to his feet.
Without Safety Monitoring we would have had to call the ambulance as it was an unwitnessed fall and we would not have known if he hit his head. We would also have had to notify Safeguarding as the situation looked like he had been pushed to the floor by two other Residents. The call to the families would not have been a good one either.
Again another saving for the NHS whereby we did not have to call the emergency services.
• There are also other ways in which Safety Monitoring can assist the care home and an example here is when I had a member of staff whistle blow on another staff member having assaulted a Resident by kicking them.
Safety Monitoring was viewed and it was seen that a staff member was handing out a drink to a Resident in the foyet next to the stairs. The Resident was sat on a couch with 2 other Residents.
This resident did not want her drink and so the staff member was seen to point at her whilst standing over her. The Resident then kicked the staff member lightly on the shin. The staff member’s reaction was to kick back immediately and then walk off. The whistle blower only saw the staff member kicking out and not the lead up, which was obviously later seen by management.
Without Safety Monitoring it would have been one staff member’s word against the other as during the initial enquiry they denied the incident happeneduntil we showed them the Safety Monitoring.
It was as a result of the Safety Monitoring that we managed to dismiss the staff member immediately and eventually had them put on the POVA list never to work in care again.
Other benefits Safety Monitoring has are the remote access. This means that the management team can view the Safety Monitoring from any location in the world providing they have access to internet.
There are other benefits including staff training. We often use the cameras after there has been an incidentso we can sit the staff member down in front of the cameras and go through with them how they reacted to the incident and the treatment given. We can praise good work or learn from possible mistakes by using it as a training tool.
As an add on to the Safety Monitoring, we identified an area in the home that had potential for an accident as the door opened out to a hallway and did not have a window to see who or what was on the other side. We have now managed to put a camera on one side and a monitor on the other so before the door is opened one can see the other side on the monitortaking out the chance of opening the door onto a Resident or other person.
We currently have 21 cameras, however as a result of expanding I have had to purchase a new DVR in order to accept the cameras at a cost of £500.00. Over time I have also changed the cameras to HD zoom lenses so staff get a better clearer picture. These new cameras come at a cost of £90.00.
Overall as a result of Safety Monitoring we can reduce the calling of the ambulance, saving the NHS tens of thousands of pounds every year. Also reducing the distress caused to an individual whom without Safety Monitoring would have had to have waited, without being moved, sometimes for many hours, for an ambulance, then to be taken to A and E, waited to be seen, treated and released, which can also have taken many hours. All this would have been with an escort, therefore taking a valuable member of staff from the home, creating extra pressure on remaining staff or having the cost of an extra staff member to cover.
We have as a result of Safety monitoring been able to sign off Safeguarding in days rather than dragging out for sometimes weeks and months. It has also stopped the Safeguarding teams coming out to the home which used to take hours of time from the management team. They are now happy for the Safety Monitoring to be sent to them for them to view before making a decision on whether further evidence is needed.
We have searched the internet for a cost breakdown into call outs as a result of a 999 call.
£7.00 To answer a 999 call.
£180.00 Dispatch an Ambulance.
£233.00 Take a patient to hospital.
Taken from the Independent.co.uk 16/4/2018.
Then you have the costs of the hospital staff with possible X rays, scans etc and more importantly the distress of the patient/resident going into hospital, waiting around for hours on end and then being discharged in the early hours of the morning on occasions.
Additional costs to this on occasions would be your own staff, as on many occasions the ambulance crew have requested an escort. This in turn reduces the staffing levels in the home and forces the hands of the care home to get an extra member of staff into the home to cover.
My Brother, CEO of English Oak Care Homes has 3 Care homes specialising in Dementia on the south coast and as a 4 care home unit we can get better figures on how Safety monitoring assists not only the home but the NHS as a whole.
The figures below are based on 3 of the 4 homes as the fourth home has only been in the English Oak group for a couple of months. This home on takeover had no Safety monitoring but within weeks of the takeover there are now 22 cameras in communal areas.
Based on the 3 care homes since January 2019 to present day there have been 119 unwitnessed falls of which 3 of those 119 resulted in 999 calls. That is 116 times as a result of safety monitoring our homes have not had to call 999 and has saved not only the Emergency Services responding but more importantly saving the Service User going into hospital, waiting around in A and E, being checked out and released more times than not in the early hours of them morning.
The figures above based on the 2018 statistics for costs involved on a 999 callout show that the individual cost per call from dialling 999 to getting to A and E is £420.00. This does not include treatment.
£420 x 116 unwitnessed falls that as a result of safety monitoring did not need the services of the NHS = a saving of £48’720 we have saved the NHS so far this year.
This off course is worst case scenario whereby we are assuming the patient will be taken to A and E. On some occasions the Paramedics will assess on site and request the staff to monitor over a period of time rather than them going to hospital. This will require a member of staff to carry out observations for the period dictated to by the Paramedics, which can add unnecessary stress to the Service User.
The minimum cost every time and the figure we are 100% saving the NHS would be the dial up and callout of the initial Paramedics.
This figure would be £187 x 116 = £21’692.00 per year for three care homes.
The average of these two figures is a saving of £35’206.
We truly believe that having Safety Monitoring assists us greatly in providing a safer environment for our residents to live in, a safer environment for our staff to work in and all those who visit the home. Safety Monitoring enables us to respond quicker to incidents and in a vast majority of cases gives us the opportunity to act before a potential incident can occur, therefore affording us the ability to proactively reduce potential risks.
Just on a conclusion it is only since late 2018 the paramedics upon arrival to the care home on an emergency call out are now requesting to see the Safety Monitoring footage as part of their protocol so they can make the right judgement call and give the correct treatment.
Care Campaign For The Vulnerable Statement
We are not at all surprised by these findings. Factual and anecdotal evidence from care providers using safety and monitoring systems support the assertions made by the Shedfield operators. Indeed some are reporting a number of notable outcomes in addition to the decline in hospital admissions. One care provider has confirmed that safeguarding events have not only reduced quite considerably but that the remaining actual events have - as a result of the visual evidence being available - compressed the investigatory time period, with the resulting cost benefit to the multiple agencies involved in the usual long drawn out review. If that were to be a repeated outcome for all care homes, (assuming they all had safety and monitoring systems)anticipated cost efficiencies would surely be measured in millions of pounds.
Currently a material safeguarding event usually consumes the time of up to 15-20 people over a period of weeks. That group is generally made up of social workers, funding commissioners, local authority investigators, CQC regulators, families and care provider representatives. If a crime is suspected, it will also include the police. Co-ordinating all of those stakeholders to consider a set of investigation outcomes - that may consist of unwitnessed event details and therefore determined upon the basis of probability - becomes tortuous, expensive, elongated and time consuming. An eventual outcome might only be determined after very many months, constant visits to the home, countless statements being taken etc and multi agency involvement. It was actually only the power of visual evidence that enabled the recent Whorlton Hall Panorama expose to be escalated to a criminal enquiry. No need existed to initiate a wide ranging investigation as the visual images told the complete story. Much like Winterbourne View and very many other historical care home abuses. It was the use of camera technology that exposed serious issues and enabled a direct course of action to be taken immediately. No long drawn out investigation pulling in hundreds of man hours.
It is for those reasons CCFTV supports widespread use of safety and monitor systems in all care homes. Every single week CCFTV continues to receive very distressing images. Whilst we have no doubt that many care providers are diligent in seeking to deliver excellent services, the fact is too many ‘unexplained injuries’ occur that not only negatively impact resident welfare and create trauma for families but also have a much wider ripple effect. That means very high taxpayer costs are incurred to investigate with any outcomes (in the absence of safety monitoring) generally being determined on the basis of ‘probability’. That potentially allows poor care to continue, or a staff member to be erroneously disciplined, or an inaccurate conclusion to be reached about a care provider or an incident. It also means vital local authority resources including police time may be spent trying to assess the nature of an incident.
It seems ludicrous when safety and monitoring systems are available today, to enable doubt to be removed, for resources to be deployed efficiently and immediately and to act on the basis of visual evidence. That is a win for the taxpayer, the care provider, the resident and family and all of the associated healthcare professionals.
Thank you to SHEDFIELD LODGE RESIDENTAL CARE HOME IN HAMPSHIRE and Andrew Geach CEO at our presentation Alzheimer's Show London Olympia talking about safeguarding of our most vulnerable and dedicated carers as well as the cost effectiveness to care homes and the NHS by having safety monitoring installed in communal areas
"The evidence from Providers who have installed CCTV seems to me to merit careful attention and to be quite persuasive"
Just some of the Care Providers who support our CCTV Safety Monitoring in Care Homes
Download their 'Safety Monitoring In Communal Areas in Care Homes' document
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