Top 10 Mistakes in Care Home Refurbishment Projects

Refurbishing a care home is harder than it appears. Residents remain living within the home during refurbishment. Care workers continue to provide their services; CQC inspectors could walk into the home tomorrow. All decisions made by the home will affect its ability to ensure the health, well-being, and dignity of its residents, maintain regulatory compliance, and continue providing care without interruption.

We commonly observe the same mistakes repeatedly occurring throughout all phases of the refurbishment process. These errors cause owners financial loss, decrease CQC rating scores, create frustration among employees, and disrupt the lives of residents. With proper planning and the right people involved in the project, these common mistakes can be easily avoided.

Below are ten of the most frequent errors we see in this industry, along with recommended alternatives:

1. Considering the refurbishment solely as a decorating endeavour rather than a clinical upgrade

Most refurbishments begin with painting, replacing carpeting, installing new soft furnishings, etc., and end with those activities. While many refurbished facilities may appear visually appealing, none of the improvements to date has contributed to improved compliance, reduced infection rates, or enhanced care delivery.
CQC Regulation 15 states that "premises shall be suitable for the intended purpose" and "shall be properly maintained." CQC inspectors do not review colour schemes; however, they review whether surface materials can withstand clinical-grade cleaning, whether surface finish materials are non-porous, and whether the design/layout supports the safe delivery of care.

Alternative Action: Plan the refurbishment as a clinical upgrade first, then focus on enhancing the space's aesthetics. Antimicrobial coatings, coved skirting (reduces dirt buildup), wipeable wall protection for high-traffic areas, and floors that meet standards for healthcare environments are examples to include in your specification. When completed, both performance and appearance will improve.

2. Lack of a phased schedule - attempting to accomplish too much in a single phase

Attempting to close down a live care facility and complete a full-scale refurbishment rarely results in success. There is no way to remove 50+ residents from a care home simultaneously. Closing a care facility completely results in lost revenue for several months. Despite these realities, some care providers attempt to order contractors to complete the entire scope of work as rapidly as possible so they can "get it done quickly."
Reality: Residents are displaced, care provider employees become overwhelmed with caring for the remaining residents while the contractors are completing the rehabilitation, multiple contractors interfere with each other, and ultimately spend far more time and resources than originally anticipated.

Recommended Alternative: Schedule the renovation according to a phased approach. Rehabilitate one wing or one floor at a time. Relocate small numbers of residents at a time. Communicate clearly regarding the relocation of residents. Maintain operations in the remainder of the facility. By utilising this method, you will help preserve income streams, minimise the number of vacant beds (and thus minimise the decline in occupancy), and minimise disruptions to current residents who cannot relocate due to medical or personal reasons.

Phase renovations are becoming the normative approach to renovating a long-term care facility. Phase renovations help preserve cash flow and prevent significant declines in occupancy, which may adversely affect operating costs and profitability.

3. Downplaying dust and infection control

Dust is generated during construction. Dust is not merely a nuisance in a care facility; it presents a risk for patients/residents. Fine particulate matter may contain pathogens. Patients/residents who suffer from respiratory disease, dementia or have compromised immune systems are significantly more susceptible to contracting illness due to airborne pathogens.

Many generic construction companies treat dust management as an afterthought. They install plastic sheeting (polyethene) and believe they have met their obligations under IPC regulations.

Recommended Alternative: Utilise proper zoned separation using rigid hygienic barriers/partitions, M-Class HEPA dust removal equipment and establish procedures for transporting/dispensing materials/waste through resident-occupied areas. The contractor should treat IPC protocols as fundamental elements of the project -- not mere "check-off" boxes.

4. Sending a Generalist Contractor

A majority of problems in construction projects occur before actual construction activities begin. A general construction company may excel at constructing residential dwellings or commercial office buildings; however, care facilities present entirely different challenges. Care facilities require specialised knowledge related to HBN-HTM guidelines. Contractors have a limited understanding of what CQC inspectors seek to verify during inspections of care facilities. Care facilities represent unique operational environments involving vulnerable populations.

Consequently, Contractors miss critical compliance issues; use improper materials; design spaces that impede staff workflow; and cause unnecessary disruptions that could have been avoided.

Recommended Alternative: Use a contractor specialising in care facility renovations. The cost associated with hiring a specialised contractor represents a fraction of the costs required to rectify substandard rehabilitation work (or worse yet, being cited during your next CQC inspection).

5. A complete lack of consideration for the potential impact on residents’ well-being

There are several factors to consider when undertaking refurbishment works in a care home setting. These include compliance with relevant health and safety regulations, ensuring that any service disruption is kept to a minimum, and avoiding unnecessary stress or anxiety for residents and their families.

The above points notwithstanding, there has been an increasing trend towards prioritising aesthetic considerations in care homes, such as making the environment "look nice" rather than addressing the very real needs of residents. This approach can result in significant adverse consequences for both residents and the service providers.

In particular, this approach may result in:

• Residents are becoming withdrawn or isolated due to a perceived loss of independence.
• Residents experiencing increased levels of anxiety or stress, particularly if they are unable to understand what is occurring.
• Increased levels of dissatisfaction among both residents and their families regarding the quality of the service being provided.
• In extreme cases, this may lead to regulatory action against the service provider.

Therefore, while aesthetics are undoubtedly important, they cannot be allowed to override residents' needs and rights.

To avoid these issues, consideration should always be given to the potential impact of proposed refurbishment works on residents' well-being. Where possible, consultation with residents should occur prior to commencing refurbishment works.

6. Failure to engage with the local community

When planning for major redevelopment work, it is essential to consider how the local community will perceive the project. Care homes provide vital services to older adults, including elderly nursing care and assisted living. However, when the physical appearance of a care home is altered dramatically, members of the local community may raise concerns.

Some examples of concerns that may arise include:

• Noise disturbance associated with demolition and construction activities.
• Disruption caused to public highways or footpaths used by pedestrians.
• Potential environmental hazards created by waste disposal practices.
• Concerns regarding fire safety and emergency access during construction periods.

Engaging with the local community can help alleviate these concerns. To achieve this, regular meetings should be held with key stakeholders throughout the development phase. Providing regular updates on progress will help maintain positive relationships among all parties involved.

7. No thought is being given to how the refurbishment may affect staff

Refurbishments in care homes are not simply concerned with improving facilities for the residents. Many aspects of the workplace are affected by refurbishment work. Examples include narrow doorways that restrict the movement of equipment (such as hoists), confined spaces (including sluices) that present challenges for staff accessing them, and limited storage capacity that results in cluttered corridors.
Examples of poor practice in refurbishments include:
• Installing wide doorway handles and narrow handrails that prevent easy use for carers who are carrying equipment.
• Fitting small shower cubicles so that they do not allow sufficient clearance for a hoist or wheelchair.
• Removing sluice rooms and replacing them with lounge areas.
• Creating tight corner spaces where hoists become stuck or create obstacles for moving around.
It is therefore crucial to incorporate staff input early in the decision-making process to ensure adequate measures are taken to improve working conditions for employees.

8. Ignoring how technology affects people

Technology plays an ever-increasing role in our lives and, as such, we must develop our understanding of its effects upon individuals. There are several studies demonstrating how technology negatively impacts people's mental wellbeing. Some of the negative effects identified include:
• Addiction to screens leading to decreased social interaction.
• Reduced attention span due to constant notifications.
• Poor sleep quality resulting from exposure to blue light emitted by electronic devices.
However, technology can also have beneficial effects on mental wellbeing, such as providing instant access to mental health resources and reducing feelings of loneliness.

To determine whether technology positively or negatively affects an individual's mental wellbeing, researchers conducted interviews with participants and asked questions about their experiences using digital technologies. When analysing responses, researchers found that nearly 60 per cent reported feeling lonely after spending time online, compared with offline interactions.

9. Cutting Corners On Bathrooms & En-Suites

When it comes to refurbishing, bathrooms and en-suites are often where a renovation will add significant value or simply fail to impress. Additionally, this is an area where many operators cut costs by maintaining original fixtures, repairing or patching tilework, and/or delaying conversion of wet rooms.
A poorly refurbished bathroom is likely one of the main reasons why potential clients decline an offer to view a care home. A poor-quality bathroom can also lead to "Requires Improvement" ratings from inspectors evaluating the dignity and infection control aspects of a care home. Modern-day wet room standards are becoming the minimum expected standard when admitting new residents.

Instead of cutting corners in the bathroom, please ensure that all bathrooms meet current industry standards during a full-scale renovation. This includes level-access wet rooms, slip-resistant flooring, contrasting sanitary ware, non-institutional-looking grab rails, sufficient lighting, and proper ventilation. Wet rooms provide some of the greatest returns on investment when renovating a care home.

10. No Plan For Post-Refurbishment

You have completed the renovation, and the contractors have left. Your facility now looks fantastic. However, six months later, the walls are scratched, paint is chipping off, new flooring is already showing signs of wear in areas you did not expect, and the beautiful community lounge is beginning to look worn out.
So what happened? Unfortunately, nobody had plans for the post-refurbishment phase. There is no planned maintenance program. There is no reserve fund established. No contact information is available for suppliers of replacement parts. There is no defined time frame for addressing defects.
Instead of cutting corners during the rehabilitation process, create a comprehensive operations and maintenance manual before releasing the contractor from their contract responsibilities. Also, identify replacement material requirements for each component of the rehabilitation project. Establish a planned inspection program to occur six months after completion and again twelve months after completion. By establishing this type of program, you can identify issues while the contractor is still responsible for making any necessary repairs.

The Pattern Behind Most Of These Mistakes

In order to understand the pattern behind most of the mistakes listed above, consider the three causes below:
• Rushing through the planning process
• Hiring unqualified personnel to manage the rehabilitation process
• Treating a rehabilitation project as strictly cosmetic
By addressing these three issues first, most of the other issues mentioned above should fall in line. You will develop a well-thought-out plan. You will develop specifications that accurately reflect your client base's needs. You will establish effective communication. Ultimately, you will produce a better living environment for both the residents and employees of your organisation.

Better Than Just Looking Newer

The best care home renovations are those that are developed with the interests of three parties in mind: the residents who call the renovated home home, the employees who provide care within it, and, finally, the inspector who may visit at any time.
Care Home Renovation Specialists
Care Home Builders specialises in rehabilitating occupied care environments. We recognise how to segment rehabilitation projects into phases. We recognise how to minimise disruptions to residents. We recognise how to maintain compliance with CQC regulations. We know how to complete a rehabilitation project which produces a high-quality, long-lasting final product.
We would like to assist you with your upcoming rehabilitation project – whether it is replacing a single bathroom or a total renovation across multiple floors.