Call: 0300 421 8627
Email: CHST@glos-care.nhs.uk

We provide a wide range of education, training and hands on support to care home staff across Gloucestershire to enable care assistants, cooks, activity coordinators and nurses to provide the best possible care and quality of life to individual residents.

The Care Home Support Team is a multi-disciplinary team, currently made up of general nurses, mental health nurses, a dietician, occupational therapist and a medicines management technician.

The care home support team is jointly funded by Health and Social Care working in collaboration with the Gloucestershire County Council Quality Review Team. We also work closely with Gloucestershire Care Providers Association, the Care Quality Commission and Continuing Health Care as well as other organisations and departments.

Welcome to Home Managers

There are three main aims to the service we provide:

Training

The training we provide covers a range of subjects including Falls Awareness, MUST, Accountability and Documentation, Dignity in Care and Recognising the Sick and Deteriorating Resident. 

The training can include reflective discussions, team workshops and one to one training and takes into account best practice reflecting changes in regulation, national and local health and social care policies. This training is usually delivered at the Care Home itself.

We also hold CPD events throughout the year and have included such subjects as Tissue Viability, Nutrition and End of Life Care. These whole day events are really fantastic opportunities for Care Homes to network and gain knowledge of current evidence based practice.

Working with the Integrated Hospital Discharge Team (IDHT)

The Care Home Support Team RGNs support the Integrated Hospital Discharge Team (IHDT) to strengthen specific aspects of the ‘discharge planning process’. 

We can, if required by a Care Home manager, help undertake an assessment of an individual prior to discharge, so that the manager can make an informed decision with regards to them returning to their existing placement without experiencing any delays.

Following discharge we aim to work hand in hand with Care Homes to prevent unnecessary re-admissions by supporting Care Home Staff to develop robust Person Centred Plans that will meet the individuals care needs.

Lastly, we strive towards strengthening the channels of communication and working relationships between IHDT and Care Homes and where appropriate resolve difficulties which impact on the timely discharge of residents from the hospital back to the care home.

If a Care Home manager has any concerns about the discharge process, we welcome any comments, which we can feedback or escalate to the relevant person or parties.

Safeguarding and Performance Support

For some homes there are times when they may require some additional support. Our team work with all members of staff in order to encourage, educate and support them through the changes they need to make to improve care for residents.

Each Care Home is individual, so each interaction is unique to that home. After initial contact is made, there will be an honest and open discussion about how we can support your home.

Our team aims to be supportive, honest and above all, transparent in our interactions with you.

We may sometimes be required to work alongside the Safeguarding team to undertake some root cause analysis. This is an integral part of safeguarding and performance and is a structured process which is used to analyse information and also to review systems and processes. 

In the event that a Care Home is required to formulate an action plan in response to a monitoring visit by the Care Quality Commission (CQC) or Gloucestershire County Council Quality Review Team, the Care Home Support Team (CHST) can provide support/education to assist with meeting the requirements of the action plan.

The other aspects of supporting safeguarding and performance includes a multi-disciplinary team approach (MDT) to the support and education of Care Home staff sharing best practice and promoting safe effective care. 

Activity Provision

The Gloucestershire Meaningful Activity and Wellbeing Network information is available by pdfclicking here

The network's Facebook page is here

The initial Network newsletter is available here

The Spring 2017 Network newsletter is available here

NEW The Summer / Autumn Network newsletter is available here

A calendar of meetings for the Gloucestershire Meaningful Activity and Wellbeing Network is pdfavailable here

docxNICE guidelines for mental wellbeing

Activity Toolkit

An activities toolkit is available from the British Association of Occupational Therapists and College of Occupational Therapists. You can find their resources by following this link

Piloted in care homes across the UK, the Toolkit has been endorsed by the Care Inspectorate Scotland, English Community Care Association (ECCA), the National Association for Providers of Activities for Older People (NAPA), Skills for Care, Carers UK, Carers Trust, and the British Geriatrics Society.

Directory of Resources

This directory of resources is compiled by members of the Gloucestershire Activity co-ordinator network and contains information as used by Activity co-ordinators in homes throughout Gloucestershire.

This Directory of resources is hosted by Gloucestershire Care Services through the Care Home Support Team but does not represent the opinions or recommendations of Gloucestershire Care Services NHS Trust or its staff.

pdfDirectory of Resouces (November 2016)

pdfTwiddlemuff Challenge with Instructions

pdfThe Reader Organisation

Training sessions offered by the Care Home Support Team

We offer more than 30 different sessions for staff working in elderly care and nursing homes.

docxTraining available from the Care Home Support Team

Falls prevention and management

Gloucestershire Care Home Elderly Falls Forum aims to provide care home staff (or identified falls leads or champions) with advice, support and education in the area of falls management. 

Please see the following documents for more information:

Falls Forum letter to managers

Falls Forum Terms of Reference

pdfFalls Forum invite 2016

For guidance from the National Institute for Health and Care Excellence (NICE) please follow this link

Additional documents

F1 Falls Toolkit Front Page
F2 Falls info
F3 Falls flowchart
F4 Meds that can cause falls
F5 Environmental audit
F6 Top Tips
F7 Falls risk ax tool
F8 History of most recent fall
F9 Falls Action Plan
F10 Falls care plan
F11 Individual falls audit
F12 Whole Home falls audit
F13 Falls Incident Reporting help sheet
F14 Falls Care Pathway
F14a Falls Protocol
F15 Useful contacts

How to safely get up from the floor

Getting to Grips with Hoisting (HSE)

Infection Control

An information pack with guidance on preventing infection and controlling their spread is available here

A poster with specific guidance on Influenza outbreaks is available here

Mental Health in Care Homes

Mental Health in Care Homes

Our team primarily focuses on the topic of dementia and person centred care in care homes. To that end, there are various training packages available to the care homes, to support their practice. In addition, we have documents to support good practice in care homes available for download below.

Frequently Asked Questions

How do I refer a resident to the mental health services?

There are two routes to our community mental health nurses.

  • Firstly, you can refer your resident via the G.P. This will be sent to the local team, who wil visit and assess the needs of that resident. They may then formulate an action plan or a care plan for treatment.
  • Secondly, our team are able to visit informally to provide support, suggestions and advice. If this is insufficient, then a formal referral would be advised. Access is via the team's single point of access - see details on the contact us page.

What do I do if I think my resident has a memory problem?

In this case, please consider referring to the team to gain support, advice and suggestions. You can refer formally or informally. Please see the information above. You can also contact the Alzeimers Society for advice, support and guidance.

It is important to know that not all memory problems mean your resident has dementia. Please read through the leaflet below.

Management of Non Alzheimer Dementia

What do I do if my resident's behaviour changes?

It is important to exclude physical causes of behaviour changes prior to involvement of the mental health team. These include:

 Urinary Tract Infections
 Constipation
 Chest Infection
 Pain
 Dehydration

In addition, a GP visit is important, as he or she can exclude any other causes. After these are excluded, it is possible to access the team for advice as above. It may be helpful to have the above information to hand when the team visits to discuss this. You can also download an ABC chart to track behaviour changes and triggers during the course of each day.

ABC Chart

ABC Incident Analysis form
Use this to monitor the triggers for certain behaviours with residents.

My resident has no relatives, friend or advanced directive, and we don't know if they have the capacity to make a decision. What should I do?

You can contact the IMCA services who will let you know if it is appropriate for them to come out and help your resident to make a decision.

Alternatively, you can contact your community mental health team, via a formal referral who may visit and assess for capacity.

The IMCA referral form is available for download below.
If your resident wants to make decisions for the future, in the event that they do lose capacity, please see the information on Lasting Power of Attorney below.

IMCA Referral Form

Lasting Power of Attorney Information

What circumstances does the Deprivation of Liberty Safeguards apply?

The circumstances are varied and individual to each resident and situation. However consider:

 1. Are the restrictive practices necessary to prevent harm?

 2. Are the restrictions proportionate to the degree of harm to the person?

 If no:
 Check care plan and change restrictive practices for less restrictive options.

 If yes:
 Check care plan and apply for DoL Authorisation to the Supervisory Body.

 Restriction does not need an authorisation. For example, A resident who wants to go out but needs to be escorted is restricted but not deprived. A resident who is not allowed to go out under any circumstances is deprived.

Deprivation of liberty safeguards - Code of practice

How do I make a best interests decision for my resident?

Residents are able to make decisions, however unwise, if they have capacity to do so. If they lack the capacity and you are making a best interests decision on their behalf, you must consider the following points:

 1. Giving equal consideration and non-discrimination.

 2. Considering all relevant circumstances.

 3. Regaining capacity.

 4. Permitting and encouraging participation.

 5. Special considerations for life-sustaining treatment.

 6. The person's wishes and feelings, beliefs and values.

 7. The views of other people.

Code of practice for MCA

For MCA and DOLs documentation please also look on our Medicines Management page.

What do I do if we really can't cope with our resident's behaviour?

Rarely, the intervention does not work and the resident's behaviour is not managable within the care home.

In this case, your first port of call should be the mental health team, if known to them, or the G.P. if the mental health team is not involved with this resident. They will be able to advise further action.

What do I do if my resident is sexually disinhibited?

This behaviour can be linked to particular illness and, in those cases, is to be managed as part of those illnesses.

Otherwise, it would need to be managed on an individual basis. Advice can be sought from the Care Home Support Team, via the Single Point of Contact.

Nutrition

Nutrition

Our Dietician can offer training, information and advice for patients, family members and professionals about Nutrition within Care Homes in Gloucestershire.

Taken from the British Dietetic Association (www.bda.uk.com)

What is a Dietician?

Registered Dieticians (RDs) are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public health level.  They work with both healthy and sick people.  Uniquely, dieticians use the most up-to-date public health and scientific research on food health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.


What does a dietician do?

They often work as integral members of multi-disciplinary teams to treat complex clinical conditions such as diabetes, food allergy and intolerance, IBS syndrome, eating disorders, chronic fatigue, malnutrition, kidney failure and bowel disorders.  They provide advice to caterers to ensure the nutritional care of all clients in the NHS and other care settings such as nursing homes, they also plan and implement public health programmes to promote health and prevent nutrition related diseases.  A key role of a dietician is to train and education other health and social care workers.

How does the Care Home Support Team Dietician work?

The Care Home Support Team Dietician will mainly focus on the training of Care Home staff to enable them to identify residents who may be at risk of malnutrition an appropriate ways to treat this.  The Dietician may also see some residents on an individual basis.

Referrals

The referral form is available here. 

Please email your completed form tol CHST@glos-care.nhs.uk

Malnutrition

Malnutrition is a serious condition that occurs when a person’s diet does not contain enough nutrients to meet the demands of their body.  You could be at risk of malnutrition if you are underweight and/or have unintentionally lost 5-10% of your body weight over 6 months or less.

Identifying malnutrition using ‘MUST’ (Malnutrition Universal Screening Tool)

All Care Homes have access to ‘MUST’ training from the Care Home Support Team that will enable them to identify residents who are at risk of malnutrition and provide guidance on how to treat them accordingly.

The following links are the resources needed to complete ‘MUST’ scores for residents.

MUST tool
• 1. Nutrition Tool Document
• 2. Reference Tools
• 3. Nutrition Assessment Record 
• 4. Managment Guidelines 
• 5. Nutrition Care Plan
• 6. Food and Fluid chart
• 7. Copy of carehome must calculator

How can we help residents who are at risk of malnutrition or not eating and drinking well?

Swallowing

If a resident has difficulties with swallowing then please refer them to Speech and Language Therapy. You may find the following information on providing different textured diets helpful.

 • Modified Diets

Food Fortification

Food fortification is the process of adding high calorie/high protein ingredients to every day food and drinks to make them higher in energy. This means that the resident will get more energy without having to actually eat more. Some examples of this are found in the link below;

• Foodfirst

Dietary Supplements

Sometimes it might be necessary to consider providing additional calories/protein in the form of dietary supplements. This should only be considered after food fortification has been thoroughly trialled and the resident has been shown to still be at risk of malnutrition. The NHS Gloucestershire guide on prescribing supplements can be found here;

Glouc_CCG_Sip_Feeds_Guidance_Oct_2013.doc

Speech and Language Therapy

What does a Speech and Language Therapist do?

A Speech and Language Therapist can help people who are experiencing problems with:

  • speaking
  • understanding
  • reading or writing
  • swallowing
  • voice

They do this by;

  • formal and informal assessment
  • diagnosing the difficulty
  • giving therapy- both specific to the identified problem and to increase functionality
  • providing and training in the use of communication aids (if appropriate)
  • using counselling skills
  • educating and supporting family and carers regarding the difficulty and how to help
  • giving training sessions 
  • working with other professionals

How do I access Speech and Language Therapy?

For swallowing issues, you need to ask your resident's GP to make a formal referral to the service. This can only be done by a doctor.

For communication issues, anyone can refer to the service. You do this by contacting Speech and Language Therapy Team, on 0300 422 8105 

Where will I receive Speech and Language Therapy?

The Speech and language therapist will initially visit you at your home. If the problem is with swallowing we will need a referral from a Doctor to see you. If the problem is with communication the person, their family, friends or support workers can refer them. You may be invited for further therapy at out-patient clinics or you may be reviewed at home, depending on your needs.

If you are admitted to hospital the Speech and Language Therapist will see you in hospital and help to get you home as soon as possible.

What do I do if I am unhappy about the service I am receiving?

If your concern is about the service you are receiving from the Speech and Language Therapy Service, you can discuss this with your Speech and Language Therapist or contact the Manager of the Speech and Language Therapy Department at 0300 422 81055.

 

After this, if you still feel you need to discuss it further, you can contact our service experience team on 0300 421 8313.