Behind the Scenes

On Monday this week we had our fire alarm service, this had been delayed a few months, but I felt it was critical it took place.  It was planned with military precision, the engineer had a precise time he had to arrive, I was with him at all times cleaning behind him (he was in full PPE), the residents were shielded away from him.  The residents were moved into the garden for his arrival. When he had left I went into the garden, to find a calm oasis of smiling faces, which turned into an impromptu dancing event.  Clapping, cheering, laughing.  The birds were singing, the flowers were in bloom.    Later on we had a story telling game, all the residents adding bits to the story.  In the other lounge the residents were watching family videos of great grandchildren racing around and singing.    The residents are fine, happy and safely cocooned, we continue to keep smiling behind the masks and do everything in our power to keep everyone safe.

Last week I had a week away from LTC.    Anyone who knows me knows that switching off is not something I am very good at.  During the pandemic I have been encouraging all staff to take time off, there is a tendency to just keep on working.  All of our staff have cancelled holidays and would prefer to carry forward holiday, but not only would this cause issues later in the year or early next year with everyone wanting time off at the same time, but it is important for staff to have time away from the home and the residents.

For social care staff and healthcare workers we have not had the lockdown time to tidy cupboards / do Joe wicks workout / homeschool.  It has been been a stressful time, pressured, confusing, scary, but equally we have all had a purpose, a goal, and LTC has been our safe little bubble, keeping our residents and each other safe.

So actually switching off is hard for everyone.  I used the time to just hang out with my family and be there if my teenage children did need me.... rather than be at the care home, taking an urgent call from the home / families, PHE, Dept of Health etc etc.  But I used that time away from the care home to also speak to other care homes, chat about best practice and share ideas.

On Tuesday last week I had a very distressing call.  It was with a care home that had lost more than 30% of their residents to Covid 19.  It is not my story to tell but suffice to say it was a heartbreaking story.  The manager of the home was so open and keen to share her experience.  She had decades of nursing experience and it was very clear that this was an impressive nursing home, they had done everything right but very early on in the pandemic, Covid 19 entered the building.  She directed me to this programme which was aired on newsnight in June.  I urge everyone to watch it.

https://www.youtube.com/watch?v=bS-6_phuWFQ

I reflected on that conversation and it made it crystal clear to me that despite pushback that I may receive, minimising the risk of transmission of Covid 19 into the home must continue to be my main focus.  At times decisions I take may not be popular.  Anyone who has read my previous blog entries knows that I have expressed concerns about some of our residents wellbeing due to staff wearing facemasks all day long, for a few residents this negative impact continues, but the use of facemasks is a critical step to reduce the risk of asymptomatic transmission and ensuring our residents safety is paramount.  Guidelines changed yesterday to say that facemarks must be worn by all and this includes everyone in the care home at all times - whether cleaning or cooking, or just servicing a boiler.  

Guidelines also changed about visitors yesterday, recommending that visitors should be limited to a single constant visitor (socially distanced wearing PPE).  In recent weeks there has been much in the news and on social media about residents in care homes (particularly those with dementia) suffering without visitors.  Quotes are made about residents wellbeing being so negatively impacted without visitors.   I am certain that in the majority of care homes residents wellbeing is being focused on at all times, and residents are happy, loved and settled, even without visitors.   Whereas it is awful having to limit family visits, these visits continue to represent an additional real risk to our residents.  I have individual risk assessments in place for all residents to understand the risk of external visitors - because for every single resident their circumstances are different.   I am hugely grateful to the families or our residents who have been so supportive of my decisions regarding visiting their loved ones.

I will continue to hold firm and do everything that I believe is the right way to minimise the risk with the best interests of the residents and staff, even if those decisions are not always popular.

Regular Testing of staff and residents will begin shortly.  We did receive the test kits, but these were recalled earlier this week due to safety issues and we have been advised that there will be a few weeks delay until we received the new test kits.   Staff are tired, PPE is uncomfortable, guidelines change often weekly, sometimes more often.  But I know that together, as a team, we continue to do everything we possibly can to protect our residents and each other.  

What I am most proud of

It is Friday evening, and I am reflecting on what has been a challenging week.

Challenging in terms of guidance, PPE issues, testing.  But after a longish walk I have reflected on what is really important and what I am proud of about our home.

Anyone who has read my blog up until now will, I hope, understand my frustrations about inconsistent guidelines which have been produced for care homes with a lack of understanding of the challenges.  I will continue to try to educate and ensure that care home residents, staff, and their families have a voice.

But this entry is all about what I am proud of in our care home.

1.  I am obviously proud that we have kept our residents and staff safe and that we have remained Covid free.
2.  I am proud that every day I go to the home it is filled with smiles and laughter -both residents and staff.
3.  I am proud that our residents have been protected from every challenge that the "outside world" has experienced in the last three months - they have eaten like kings and queens, never wanted for anything and their life have continued unchanged (apart from visitors).
4.  Our activities have kept everyone busy and energised, from flower arranging to visits to the farm to see robotic feeders, from VE zoom to Tik-Tok routines, from horses to chicks visiting, from online singing lessons to zoom bingo.
5.  I am proud to be part of the most wonderful community who have shown masses of support and love, from parcels from Tesco staff to free visors, letters and messages from school children, fancy dress visits twice a week.
6.  I am proud of the wonderful team who smile, laugh and have kept going and adapting to the ever changing process.
7.  I am proud of our amazing 700 year old home and beautiful garden... even when bits keep falling off.
8.  I am proud of my DIY skills - particularly with a power drill due to a lack of maintenance visitors
9.  I am proud that I have a job that I love and that my family extends to 17 residents and 25 staff.

And finally, a picture tells a thousand words, so this is just a taster of what the last 13 weeks have looked like.

OUTRAGEOUS - Facemasks - Now recalled....

I have written a lot about facemasks and particularly the impact of them on those living with Dementia.

Today I have different concerns, I don't know my next steps in this regard.  But I need to write this down somewhere.

At the start of the pandemic everyone is aware that there were issues with  PPE supply chains.  The "National Supply Disruption Resolution team" which, I believe, came under the NHS dispatched 300 Type 11R fluid repellant facemasks.  We were encouraged to buy future supplies from Government approved suppliers.  I bought over 1800 additional masks from Countrywide Health - an approved supplier.

At the end of April we noticed that the nasal strip on the facemasks was failing and particles were getting up our nose and in our mouth.  On close inspection, ALL of the boxes had a sticker over the best before date extended the 2016 expiry date to 2021.

On 3rd May I called the CCG and NHS PPE team, expressing concern about the extended expiry dates and the masks failing. I also emailed them.  They called me back and said to keep using them as they were better than nothing.

PHE also referred me to the HSE following my email to them.

On 4th May I called the National Supply Disruption Resolution Team - they told me to call NHS England as they "didn't deal with issues of expiry dates"  They told me they "thought" they were re-evaluated.  I asked for the certification of this.  They told me to call the "CPC" but could not tell me who the CPC were or what the telephone number was.  I called Countrywide, they told me the Department of Health told them they were ok to sell and that the Department of Health had the certification relating to the extended expiry dates.

On 7th May I emailed the HSE with details about my concerns about the masks failing and the extended best before dates.

On 20th May HSE sent my email to MHRA - regulator of medical devices.  They asked for more details which I sent that day.

On 2 June MHRA replied and said that they were looking into this.

TODAY an email was sent from the Local Authority Resilience Team that reads as follows;

We understand that the following masks have been recalled from the NHS supply chain. We believe these have only been issued through the NHS supply chain and therefore it is unlikely that you will have any in your setting. However, as a precaution please review the attached document which provides further details and check that have not been supplied with any of these masks.

What does this mean?
1.  We have been using facemasks which have not been fit for purpose.
2.  It has taken eight weeks for my concerns to be dealt with - is this an acceptable timeframe, in relation to PPE?

I literally have my head in my hands.  I had to write this down to share this.  How on earth has this been allowed to happen?

Luckily I have some other facemasks which we are using (as of 30 minutes ago).