Operational Review and Long-Term Management Assignment for a Specialist Provider Group

 

HCMS were approached by a registered provider with 5 specialist services in the south of England following a downturn in the Group’s commercial performance, initially to undertake an operational review of the services.

These homes had historically traded well and had achieved inspection ratings of ‘Good’ however 2 of the 5 services had dropped to ‘Inadequate’ with 1 issued with a warning notice to improve safety and governance.

Despite the appointment of an experienced Operations Director, the Group’s required outcomes were not being delivered internally and a decision was taken to transfer all the homes into HCMS’ full management including taking over the NI role.

As part of the brief, the Group’s Board, who were considering their long-term strategic direction and future development opportunities, needed an independent and objective report on how effectively the business was leading and operating its care services in terms of quality and commercial management, along with recommendations for improvements.

HCMS completed the detailed review of the services and provided a ‘Red-Amber-Green’ assessment of the level of risk identified along with a detailed schedule of corrective actions required at each service. The financial element of the review identified significant cost savings for the Group through improvements in staffing and other overhead cost reductions.

Under HCMS’ management, all services were rated as ‘Good’ and strong sustainable relationships with commissioners were created. Each service had a settled Home Manager and a new Operations Director was appointed by the Group.

Confidential review of a portfolio of homes

Our client wished to carry out the covert review of a medium sized portfolio of services with a view to possible acquisition however formal access was not possible.

HCMS mystery shopped all services using highly  qualified managers with years of experience of care home operation. Being able to assess the quality of a service, identify CAPEX requirements and Health and Safety risks and compare staff performance with other services, we were able to determine how badly or how well services were performing and, with reference to available financial information produce forecasts of future performance.

Being able to gain comfort as the worst, likely and best case future trading outcomes the client was able to assess the performance of current management and to estimate the potential upside in the portfolio.

Review of a Large Portfolio of Care Homes for an Overseas Investor

 

HCMS were invited to provider an operator’s perspective on information generated by other outside agencies on trading and values. Over an intensive 4 week period information on over a hundred services was reviewed and discussed and the output taken to a roll-up meeting at the client’s overseas offices.

Whilst the generation of information from publicly available information and mystery shopping exercises provided invaluable data, as operators HCMS understand the reality of what is achievable and, due to the large number of services that the HCMS have involvement in, very relevant and very current knowledge can be applied, providing genuine value to any due diligence process.

Interim Management of 13 Non-Core Care Homes in England and Wales for an Administrator Pending Individual Sales

Healthcare Solutions (HCMS) was invited by a major national insolvency firm to tender for the Management in Administration of 13 care homes with a wide geographical spread.

The group had been struggling financially for some time and as a consequence the homes were suffering from irregular supplies, under-investment in the fabric of the buildings, poor relationships with the Care Quality Commission (“CQC”) and Local Authority contracting departments (“LA’s”) and, in certain cases, admissions embargoes were in force.

On appointment, HCMS mobilised it’s team of Regional managers and their field based teams to attend each home and the group’s head office.

Day 1

HCMS staff contacted the CQC and LA’s to advise of the Administration and open channels of communication. Basic information relating to each home was collated regarding staff, clients, and supplies. Suppliers were contacted and arrangements made for new accounts to be opened for each home.
Home managers were briefed and staff meetings were arranged. Staff were advised of the situation thus helping to alleviate concerns. An initial review of each home was carried out to ensure that there were no immediate Health and Safety, Safeguarding or physical risks to clients.

Staffing levels were reviewed and rotas checked to ensure that adequate staffing levels were maintained.

HCMS staff met with the Administrator’s representatives at the group’s head office. It was established that not all information was readily available and there were doubts as to the accuracy of that found.

Week 1

A full health & Safety audit was carried out identifying any potential risks. As part of this exercise, a number of surveys were commissioned – including fire, electrical testing, Legionella testing, PAT (portable electrical appliances) and LOLER (lifts and hoists).

Staff files were reviewed to ensure the legality of employment of staff and, in particular, overseas workers. As a result, a number of staff were immediately suspended pending establishment of their legal right to work.

Client files were reviewed to ensure that care plans are properly prepared, accurate, current and relevant to the individuals. Where necessary risk assessments were carried out.

Optimum staffing levels were determined and changes implemented within the homes.

Financial information was reviewed and financial forecasts prepared in conjunction with the revised staffing levels.

Without accurate and up to date financial information it was difficult to determine with confidence the financial performance of the homes on Appointment. What could be determined was that the homes were in a poor physical condition, there were serious issues with the regulator and with the contractors, management at the homes was patchy and largely unsupported and unsupervised, record keeping was poor and basic supplies hard to obtain.

HCMS continued to operate the homes, improving both the standards of care and financial performance. Two homes that had been poorly rated and on embargo were successfully regraded and the admissions blocks lifted.

From the start and all the way through the assignment, close professional links were developed with the CQC and LA contracting teams. Quality was improved across all sites and embargoes were lifted.

A Series of Audits of Individual Care Homes to Identify Any “Red-Flag” Items and to Develop a Risk Management Profile for Newly Appointed Administrator

 

A partner at a major national insolvency practice was appointed Administrator to various small care homes in the South of England. It was felt that, although on the face of it there were no major causes for concern, both he and the bank would be reassured by an audit carried out by HCMS.

With just 48 hours notice a senior member of the HCMS team attended site at each location and carried out an audit of all major areas of each business including:

  • Environment (including Health & Safety risk profile and plan)
  • Staffing (including a current and proposed staffing model)
  • Medication: storage, administration recording and audit
  • Quality system
  • Client care
  • Staff training
  • Contractual concerns of the Local Authority
  • Risk Management
  • Accidents and Complaints
  • Catering

HCMS were able to provide a verbal update regarding the key findings the following day and this was supported by an email summary within two working days.

A full written report was submitted within the week addressing each area. The report highlighted a number of areas of risk and included suggestions for minimizing exposure.