Continuous Improvement drives Outstanding Care

CQC Outstanding is full of references to continuous improvement in services, but in my experience very few organisations are doing this well. Intentional processes for continuous improvement rarely look beyond compliance, and where they do they are often missing out key elements. I think this is an area with significant potential for care organsiations, and have made some suggestions below.


We tend to see two scenarios; either improvement is limited to a narrow domain of compliance, or where there is attention given to the wider business performance, improvement initiatives tend to be ad-hoc, and reliant on a small number of individuals in the service, often those in senior positions.

There is a third scenario that some of our client partners are creating. One where continuous improvement is driven by what the organisation wants to achieve, not just what it wants to fix. Where ideas and opportunities come from all quarters of the organisation and its community. Where a diverse group of people are involved in creative problem solving to work out the best solutions. And where all of this is managed in a consistent, replicable way that isn’t reliant on one ‘star’ individual making it happen. And of course, all of it is easily evidenced to CQC.

As ever in care organisations making the third scenario is complicated. It isn’t just about the processes, it is the wider culture and climate of the organisation, the leadership and skills of the people involved. Process is never a solution on its own, but it is an important part of the picture.

If you want to develop a more holistic approach to continuous improvement, than I suggest asking yourself some of the following questions:

How to identify improvement opportunities across the business?
How to ensure the teams our focused on the core purpose and values of the organisation?
How to involve everyone in identifying opportunities, generating and selecting ideas and implementing them?
How to ensure this is happing on a regular basis?
How to record and evidence what is happening?

Do you have effective continuous improvement processes in place? If you do please share them. If you don’t we’d love to help.

Creative Cat - Creativity is often really simple

In honour of national cat day this week. I want to share a tiny moment of creativity with you.

When I’m running creativity training, I always talk about creativity as anything that is new that makes a difference (more on that in my TEDx talk - Creating the care we all want), I ask groups to discuss examples of creativity in their own services. The other week when I was with WCS Care, one carer described a women she cared for who loved animals, and was now pretty isolated in her room. The example of creativity was that the carer decided to bring her cat from home in to the womans room, provoking a lot of joy and wellbeing. 

We all know that animals often make a difference to wellbeing. The point of this post though is the simple act of creativity from the carer. That the carer took a moment to use what she knew about the person she was supporting; thought widely about what she had access to that might make a difference, including things in her personal life; and took action.

We are all creative, and it is often as simple as this example. The difficult bit can be doing it, and developing a culture in our work environments and in our teams where we are regularly thinking about what's possible, and making it happen.

What can you do that is new and will make a difference to someone? Happy (belated) cat day.

Building Climate Literacy

Each year, Earth Day — April 22nd — marks the anniversary of the birth of the modern environmental movement in 1970. This event is global, having more than 192 participating countries and one billion participants it claims to be the largest civic observance in the world.

This year the Earth Day focus is on building a global citizenry fluent in the concepts of climate change and how to protect our environment.

Those working and living in care services know exactly how important the physical environment and emotional climate is to the enjoyment of daily life.

Both these ‘climates’ are extremely sensitive to small changes. e.g. window open + curtains closed = flat, chilly misery OR window closed + curtains open = sunny warmth and the possibility of noticing the birds building a nest in the tree. This is just one example of a small act making a big difference to the lived experience. Not complicated and easy to do when you choose ‘a living well’ attitude.

Extending our thoughts beyond our immediate world to consider the globe on which we all live, I am powerfully struck by this amazing photograph taken by Cory Richards. Cory is an American climber who takes on very tall mountains in the depths of winter. He also takes photos and in this one he epitomizes the effect of climate change in the Russian Arctic on a polar bear on Rudolph Island.

Photos Library.jpg

If like me this image touches you – this speaks to me to of an almost unbearable isolation, stuckness and deprivation due to circumstances way outside of the bear’s control, circumstances that might be influenced by you and me – then I invite you to choose your ‘living well’ attitude and make one small act in your immediate environment that affects the climate positively for those who are stuck where they are and can not now control the circumstances that put them there. I know you’ll think of something!

If you and others are interested in joining the one billion people on Earth Day by having an event then why not find details and support at:

Jude Sweeting, Director of Quality & Enjoyment



On moveable feasts…. and dancing with ambiguity

Easter is a moveable feast – meaning that it occurs on a different day each year unlike many other religious feast days that occur on a fixed day every year.

The very idea of a moveable feast on a weekend full of spring conjures the possibility of moving your feast to wherever it will be most enjoyed, be it ‘al fresco’, on a formally decorated table or on your knees in front of the TV the point is to eat something a bit special. Easter has many feasting choices – its not all about chocolate (really???!) – and there are many tasty ways to celebrate the hope and fertility of spring.

My mum’s lemon meringue pie would certainly be on my menu for a springtime feast, indoors or out, come rain or shine. I have nothing but deeply appreciative memories about this fabulous pie as the very special treat after dinner on Easter Sunday – an absolutely scrumptious experience of creamy, lemony zestiness, rich short crust pastry all topped with ‘just right crunchy-chewy ‘ clouds of meringue heaven… my mum always got this just right!

Oddly, embracing correctness – wanting everything to be done the ‘right way’ or perfectly is not helpful in certain stages of the creative process.

Some even say that this kind of fixed mindset at the wrong time provides little room for creative thinking and imagination. Whilst there are times when nothing else will do other than the ‘right way’, as in the production of mum’s lemon meringue pie, or when administering a medical procedure safely, there are many times when the alternative and more creative mindset is one where ambiguity can be embraced in order to find something new and of value.

‘Embracing ambiguity’ means being able to accept two or more seemingly contradictory or odd ideas as being equally valid or able to co-exist.

If you are an explorer of the creative mindset it’s an interesting thing to notice about yourself - where and when you are good at embracing ambiguity and where it deserts you and ‘correctness’ gets the upper hand.

Here’s a small test – can you embrace the ambiguity of when Easter falls in 2018 – see below?  Try scoring yourself on a scale of 0-10 where 10 is ‘yes, I’m completely comfortable with this idea’ and 0 is ‘no, it just cannot be!’

It returns us to the notion of moveable feasts and the changing dates of Easter – did you know that Easter in 2018 is set to happen on April 1st or April Fool’s Day (ref Church of England web-site)?

How did you do?  I scored quite low on the embracing ambiguity test (for me) 5/10 - try it guys!

Happy ambiguities!

Jude Sweeting, Director of Quality & Enjoyment

How do you encourage creative thinking in your organisation?

Hmmmmmm… There’s no doubt that truly new and useful solutions to problems come from bumping ideas around together. And there are so many things that can stop this happening in care homes - or indeed anywhere else! Some of the critical aspects we notice are:

  • Lack of trust and openness 
  • Expressing ideas is given low value – little time is made and there are problems with collection and processing
  • Insufficient ideas generated – we don’t go far enough and stop too soon 
  • The belief that ‘my idea is not big enough or good enough to make things better’

Pondering on the key leadership messages to these seemingly insurmountable blocks – we suggest any of the following, if well landed, have the power to start unlocking everything at once:

  • We are all creative and together are able to think creatively
  • There is no such thing as a rubbish idea here – sharing always leads to something better, if you don’t have an idea ask a question
  • Are we asking the right question about this problem?

It is worth remembering that ideas require action or a response to have any power and that the creative process practically always transforms the first idea(s) to something else along the way. So small ideas, half-baked ideas and crazy ideas are the very, very welcome essence of change.

That’s how new and useful happens.

Nancy Brown, a woman concerned with keeping hearts alive in her role as CEO of the American Heart Foundation says it well:

‘One hundred percent of the ideas that we don’t share with others will lead to nothing.’

So if you do nothing else today other than lend a generous ear to someone else’s offered idea, then you will be encouraging creative thinking, creative confidence and the heart of creativity.

Here’s wishing you a world full of “wow – I’m amazed we came up with that!"

Jude Sweeting, Director of Quality & Enjoyment

Highly Commended Evidence of Outstanding Activities Competition Entry Acknowledgment

Each quarter, we receive many detailed and considered entries to our Evidence of Outstanding Activities Competition. Whilst the cold realities of the competition allow for only one ‘winner’, in instances where another Home or Activities Coordinator has demonstrated exceptional transformation, connection or inspiration, we like to further acknowledge this by awarding certificates of High Commendation. For our winter round, we awarded one of these acknowledgments and certificates to…

…Gemma Smith (The Grange, Forest Healthcare). Her entry was Highly Commended for involving colleagues and building the home community. Her submission wonderfully demonstrated her skilful ability to build curiosity and anticipation, to inspire and enable participation - both planned and spontaneous - and her foresight and capacity for considered follow-up.

She used specific Rebel box dress-items to pique interest: the tattoo sleeves being used and worn by resident Teresa causing such joyful laughter that ‘everyone who happened to be in the area at the time was dragged into the action.’ Staff dressed up and posed for pictures with residents, which really ‘helped them to see the value of the boxes,’ with residents taking on ‘new personalities’ and feeling ‘young, vibrant and involved.’ Following this successful interaction, the home developed their own mobile photo booth and created a photo album, which now welcomingly greets visitors at reception. Family members can also use the album to request copies of photos of their loved ones.  

A great outcome and a clear demonstration of how materials can be adapted to evolve and extend an activity and interaction.

Great work guys!

Elliott Grigg - Administrator & Project Officer

A Game is not just for Christmas ……

Jude Sweeting, Director of Quality & Enjoyment

‘The room was filled with laughter and everybody embraced the project so now we’re going to do something like this every month!’

It’s great this month to hear the new possibilities emerging from the senior team at Halliwell, in Tunbridge Wells.  They had a go at exploring playfulness by playing a game together. At Ladder to the Moon games are not just for Christmas and not just for children either. A game is something where people invest their time fully together in a process of ‘doing’ without – for once – being concerned about the outcome.

They allow for some ‘messing about’ by creating false purpose. Messing about is not just a great pastime it allows people to ‘re-create’ themselves as individuals and we strongly recommend it.

So why might all this be particularly important in a care? Well we notice, and people tell us, that actions and conversations in homes tend very often to focus on the achievement of specific outcomes.

While these conversations can still be creative in nature the outcome focus can constrain the thinking to doing the things that we know will work. Nothing wrong with that but often there is no newness, inspiration is missing and there is no space for discovery.

As part of the support we give to companies developing their culture of creativity, we ask leaders in homes to try out new approaches with their teams that open up playfulness. We ask people to try out some ‘games’ together because ‘games’ provide fresh opportunity to build openness, acceptance and relationships.

Games allow a world where the outcome doesn’t really matter – even though we may feel the edge of competitiveness in the playing.  We have found that to improve relationships and trust the most productive games are often those that have the most impossible outcomes to achieve. And they usually cause the most laughter, which allows for openness and connection.

Such was the case at Halliwell when the Heads of Department, who meet every month, were split in to 3 groups and asked to build the tallest tower in 30 minutes, out of sellotape, marshmallows, string and spaghetti (uncooked!).

Each team member was assigned a role e.g. time-keeper. They discovered their ingenuity more as the materials ran out, in the case of the sellotape, or simply didn’t comply as when spaghetti snapped and marshmallows melted.

I am told that the results rival the famous towers of Blackpool and Paris – and the leaning tower in Pisa and the team were talking about their efforts for days afterwards.

Congratulations Halliwell for bold creative leadership and encouraging the heart of the senior team!


How watching TV ‘soaps’ can encourage the heart of care ....

It’s always worth noticing what kindles the seed of an idea to flourish into a vision worth pursuing ….

‘Holby City’ was the inspiration for a Home Manager I spoke to recently. She had watched an episode in which a dying man had expressed a wish to feel the sun on his face. She easily made the creative connection between this heartfelt request and the situation that people at the end of their life in her home might find themselves in.

Her home is deep in the Gloucestershire countryside and has great outdoor space with many mature trees. Residents already have great social times and relaxation in the garden but often these do not include those who are the most frail. But thanks to Holby City two thoughts combined afresh (the feel of the sun and the thought of her home’s beautiful garden) to produce a new and compassionate possibility.

The manager has set a goal for next year, which is to have a summerhouse – ‘a place where many things can happen and where people at the end of life, if they wish it, can come out in a protected chair to “feel the sun on their face”.

3 tips on Inspiration:

·      It often comes from unexpected places

·      It makes you want to act to change something

·      It will wear off so best get started!


Jude Sweeting, Director of Quality & Enjoyment 

The Outstanding Activities Competition Winter Winner is ….. [drum roll] ........

Amy Roberts – Maidstone Care Centre (Ranc Care)

Amy’s entry impressed the selection panel, specifically for:

  • Leadership and openness – showing a responsive approach to the icons Photo Shoot box
  • Noticing further potential and her ability to deliver impact - personalising her approach in responding to residents
  • Transforming crises into opportunities 
  • Embedding her practice

The Evidence:

During the home’s first session using the evocative Icons Photo Shoot activities box, a resident began to discuss his time in the army and the different uniforms worn. Seeing the opportunity present in this engagement, Amy and the activities team decided to extend the ‘dressing up’ aspect of the box. They sourced additional armed forces uniforms – both Navy and Army – from the local theatre’s wardrobe department and gave residents another opportunity to not only ‘dress up and have their pictures taken’, but also, invaluably, another opportunity to connect.

Amy elicited interest and aroused curiosity in the uniforms and event by donning first the Red Cap uniform and then the Wren’s uniform and enjoyed her own multiple ‘tours of duty’ around the home.

Residents were both surprised and amazed, with some commenting that the event was ‘better than Christmas’, with the original resident whose memories sparked this new opportunity thoroughly enjoying dressing up as an army officer. He had his picture taken and has it framed and proudly on show in his bedroom.

To further broaden the impact of the activity, Amy wrote a report, replete with photos, and disseminated it amongst interested parties: staff, relatives and visitors. And perfectly summarised the moving impact the occasion had on the activities staff with the heart-warming quote: ‘None of us were quite prepared for the reaction of some of our residents…and the emotion in their eyes that left us all with a lump in our throats.’

Congratulations Amy and well done to all the staff and residents of Maidstone Care Centre!

Elliott Grigg, Project Officer



The home that moved Christmas .......

What a joy to be on a Centre for Creativity & Innovation in Care webinar recently with a home manager from Harrogate.  2016 had not been the greatest of years for this manager, who had experienced a CQC inspection just a few months after coming into post and before the home had fully realised the benefits of all her work for change.

The inspection report had been hard to embrace and had left the home team low.  Further bad news arrived with the cold December winds when nasty infectious viruses forced the home to close to visitors right across the Christmas period. So Christmas became a moderate affair unshared by residents with their loved ones.

The manager chose her attitude. Having dealt with the ‘crisis’ she looked for the ‘breakthrough opportunity’ hidden in the ‘breakdown’. She and the team decided to ‘redo’ Christmas. So on January 11th the home was doing all its rituals for Christmas eve. January 12th, Christmas Day, saw the post man come in especially to wish the residents a happy Christmas, the staff wore their Christmas jumpers and Christmas dinner and games were enjoyed by families and staff in great spirits.

Finally, January 13th was confidently declared Boxing Day by one and all and the buzz has lived on well into February.

Crisis? What crisis?


Jude Sweeting, Director of Quality & Enjoyment


Post inspection blues – and outstanding habits ....

Jude Sweeting, Director of Quality & Enjoyment 

It is disheartening for homes to hear post inspection that they are at the upper end of Good when they have spent months of personal investment to achieve Outstanding. And of course it is joyful to achieve an Outstanding rating where, in the exposure of an inspection, nothing seems guaranteed. In both cases however there is the aftermath of the inspection and some kind of rallying and refocusing.

Two weeks ago I had my first coaching call of the year with a home which achieved a CQC rating of Outstanding late last year. I left the call even more convinced that Outstanding is a leadership mindset, which produces behaviours that once ‘turned on’ become as natural as breathing.

The CQC rating is an important validation with powerful business consequences and we all need to understand what is needed to achieve this. There is much learning to be done as we seek to share an understanding of creativity and innovation in care services.

Arguably, authentically outstanding homes won’t need to ‘bounce back’ post inspection. They won’t need to spend lots of time ‘managing’ being unsuccessful or successful (after the final result and even if it seems unfair) as they already have a higher investment in the process of innovation and creativity than the outcomes these produce.  They just will continue to be innovative in their behaviors because they have lots of evidence that pleasing outcomes will follow in abundance. Stretching is not just for inspections (or even Christmas) it is a habit of success.

Where there is a post inspection sense of‘returning to business as usual’ or even ‘its now time to refocus’ it is important to get back to ‘clean slate’ thinking.

So what was it about the post inspection Outstanding home on this call with their home manager and activity leader that gladdened my heart? It was a sense of unstoppable creative confidence with tangible indications that innovative behaviours are routinely automatic:

  • Natural future focus: ‘yes we had the (CQC) celebration party before Xmas, it was lovely, but that was ages ago’


  • Noticing impact and feedback:  ‘our new electronic care records mean that I had 4 staff attending an afternoon social event last week – that is unheard of!’


  • Willingness to learn, exploit, hoan, combine and build: ‘I’m seeing that if we do more work matching staff with residents we can use the ‘new’ time for more outings and ‘in home special times’.”


  • Commitment to relationship building using the whole team: ‘we used the tool you sent us and 20 of the staff have done their relationship circles – I’ve been really amazed that some of the residents who I had on my outer circle (less energizing relationships) were in the centre circle for a number of staff – there’s a lot we can use here’


  • Inclusion and curiosity underpin investment in enquiring: ‘I will complete the tool with all the staff so we can see it all’


  • Risk–taking and working to be leader proof: ‘we had to resuscitate a resident recently and I stood back to allow other staff to put their learning into practice. Often the home manager is expected to do the CPR. I’m doing this to encourage staff problem solving too by saying‘I haven’t got time – come back and tell me what you have done’


  • Playfulness that encourages the heart of positive relationships: ‘I asked staff to share a proud achievement in their lives and created a game for the residents to guess which member of staff had done this thing. They loved it – when the residents weren’t sure who we were talking about I re-introduced the member of staff to them’


To the Moon!!

Ladder to the Moon's - No. 1 Tip for Christmas and beyond - settle back and find some Hygge ....

December 20th 2016

For those of you well on the path to Christmas you may have noticed that books about ‘Hygge’ (pronounced hue – gah) the Danish word for a feeling that most of us know but find hard to define, have been ‘the thing’ this year. If you work in a care home its still worth putting them on your Xmas wish list to Santa, or spending your Christmas present book vouchers on as they have many hints and tips applicable to boosting well-being for those living in care homes. And they will be thought provoking about the meaning of home, chores and the mundane in your own life too.

Hygge is variously defined as a quality of presence, an experience of togetherness and it’s a feeling of being warm safe comforted and sheltered. It’s about feelings of relatedness and contentment, that the self and belonging to the moment matters – and that these things are worth our regular attention in every day life.

The Danes as a nation score very highly for national well-being and so a book on Hygge will likely give you plenty of ideas of how to create inclusion and comfort for individuals and for groups of people. At its heart Hygge is usually about savouring a very simple sensual experience of ordinary life, often shared with others, and where something is enjoyed for the comfort and/or connection it brings.

The winter season abounds with such opportunities. Real fires and candlelight feature very strongly for Danes throughout the long months winter and although these are usually not do-able things in nursing homes there are plenty of other simple offers where Hygge moments can be created and shared e.g. a warming hot chocolate served in a favourite mug and in a peaceful corner, a special cosy blanket, a plate of mince pies specially presented in subdued lighting to share with a friend or in a small group, perhaps with a glass of sherry.

Combining these small ideas with another aspect of Hygge which is to enjoy contrasts, like hot and cold, dark and light means that small chunks of time can be quickly upgraded from mundane to special. None of this is rocket science but the important rule of Hygge is that people are mindful about creating enjoying simple moments together and everyone in the group works hard to have others be accepted, included and supported to be themselves. And that a ‘comforting home’ is an act of creation wherever you are.

Seasons greetings one and all!

Jude Sweeting, Director of Quality & Enjoyment

Wait a minute Mr Postman ……

Ashley Gardens recently took delivery of a creative resource box from Ladder to the Moon called “The Post Box” this is the story of what happened next ….

They got creative of course!

The first step – who do we want to get in touch with and why? The outcome of this thinking has not only resulted in strengthening connections with the local community, but also an international flurry of contact, which has brought delight and a few surprises to everyone involved.

Postcards have been sent to residents’ friends and family in Russia, Greece, Italy and France, to funeral directors, local schools, the WI, other local care homes and …… they are beginning to receive replies!

This amazing and otherwise untapped level of contact and connection, sparked off the idea to create a visual journey for the home – they now have a large wall map of the UK and another of the World – every postcard received is displayed on the wall with a piece of cord running from the postcard to its location on one of the two maps.

Resident Penny Jones has been nominated “post lady” - she dons the post cap every morning and goes to check the Post Box made by residents for any new arrivals.

 Penny Jones collects the post at Ashley Gardens

Penny Jones collects the post at Ashley Gardens


Ladder to the Moon supports WCS Care Achieve Outstanding Overall - 5 Outstanding overall

"The work we embarked on with Ladder to the Moon helped us to understand the journey we were on which was to develop creative practice and creative leadership" - Christine Asbury - CEO WCS Care

National Care Forum Executive Director Vic Rayner interviews WCS Care Chief Executive Christine Asbury about the Warwickshire-based care home provider's fifth 'Outstanding' from the Care Quality Commission.

Christine, also a Founder Member of the Centre for Creativity & Innovation in Care - -  speaks about the role Ladder to the Moon has played in supporting their success.

Ladder to the Moon has, over the last 18 months, supported 3 providers and a total of 9 care homes to achieve Outstanding Overall .... 9 homes and counting!

On capturing imps and scribbles (and why post-its were invented)

Mary Oliver in her essay on ‘Power and Time’ writes about how creativity sometimes needs concentration without interruptions ‘– a place apart – to pace, to chew pencils, to scribble and erase and scribble again’.

She talks too of how easy it is for your mind to distract you with some other seemingly more pressing issue like phoning the dentist or buying mustard. And how we always react and when we return ‘the imps of the ideas have fled back into the mist’……..

Jude Sweeting - Director of Quality & Enjoyment

“My father is a new man”: Vibrant Communities causes an increase in pride and openness

“Have I told you about what happened at Turnberry?” Chloe Burrows, Activities Officer, Notting Hill Housing asks me. “One of our resident's daughters came up to me and thanked me for giving her her daddy back!”. Chloe then went on to tell me about the transformation of a resident, "Paul", which began during one of Ladder to the Moon's film shoots. (The persons name has been changed to protect his privacy).

At the start of our Vibrant Communities programme, we recognised "Paul" as being one of the more isolated people in the extra-care scheme. Spending all his time in his flat, no longer interested in his appearance or spending time with others in the scheme, he just wanted to drink.

Staff decided to try again with "Paul" and invited him to be part of their "Some Like it Hot" film shoot. "Paul" agreed to come along and see what it was all about. Encouraged by the playfulness of the staff, he joined in, donning a wig and contributing to our chorus number. To acknowledge the humour and playfulness he bought, and to recognise how much we appreciated him joining us he was awarded an Oscar. Both the involvement and acknowledgement caused a huge shift in "Paul’s" wellbeing.

‘He’s a completely different man since the experience’ - Sara, daughter

Turnberry organised a premier of the film and "Paul" was invited as a VIP/Oscar-winner. "Paul", who had previously not even wanted to shave, was now demanding a suit from his family. He felt he needed to look the part. He now has a photograph of himself at the Premier in his room as a constant reminder. Even more importantly, this shift has lasted, and "Paul" is now taking more pride in his appearance on a daily basis.

This is symbolic of a greater sense of pride. His daughter spoke abouthow he had recently discovered a recording he had made with one of his band's and said, “Oh I must let Chloe hear this”, which she feels would never have happened before the shoot. He is also spending less time in his room and more time with other people living at the scheme. He sees he has a role in events organised by Chloe and wants to be there to support her.

His daughter Sara asked Ladder to the Moon if we could do the programme monthly!

‘I saw so many residents uplifted by it. People who thought “I can’t” now think, “I have and I can!”’ - Sara, daughter

It takes time to grow a marrow / Outstanding Activities gave a seed to Forest Healthcare and their glorious harvest continues to improve quality of life!

It’s been my pleasure recently to hear some wonderful examples of the enduring impact of change in services working with Ladder to the Moon’s Outstanding Activities programme. As our company name suggests, you can’t get to the Moon in a single step. Change takes time. It takes effort and it takes intentionality. I’d like to share a recent story of success in one of our participating services and look at the steps that were taken to create such good news.

For those of you who don’t know, our Outstanding Activities programme develops and supports participants to become leaders of outstanding social engagement in their services. The programme supports a whole service approach to life enrichment, using creative approaches to improve the quality of life for people working and living in care.

Every month, participating services receive a creative resources box. Earlier this year one such box was the Bird Box Bonanza! Forest Healthcare’s The Grange recently won our Evidence of Outstanding Activities Competition with an entry in which use of this box led to the creation of a vegetable patch in the back garden.

Since then, a Gardening Club has been established, run by the Maintenance team, which led to a meal using a stuffed marrow grown on the premises - a resident chose the meal, grew the marrow in the garden and the kitchen cooked it!

This wonderful example of whole service approach and personalisation has led to menus being based on what the residents want - they've chosen the entire list.  And a Cookery club is about to start.

What fantastic developments! If a home grown food and cookery club sounds like quite a step from a creative resource box called ‘Bird Box Bonanza!’ you’d be right. It’s many more than one step - you can’t get to the moon in a single step - but the steps are linked. And every idea has a seed.

Let’s have a look at the steps:

  1. The Bird Box Bonanza box arrives at the Grange (a seed is offered!)
  2. Inspired by the box, bird feeders are made by residents and staff
  3. The residents pick a place in the rear of the garden for the bird feeders that could be seen from the lounge
  4. “The residents loved doing this activity so much that they asked to use the rest of the garden at the back for a vegetable patch”
  5. “Betty and Dorothy had been observers at the making of the bird feeders as they did not want to get involved but decided to join us when we placed them in the garden - they led the discussion about the vegetable patch and they are now keeping this going and watering it regularly and keeping an eye on its progress”
  6. A weekly Gardening club is established, run by the Maintenance team
  7. A stuffed marrow recipe is requested and a marrow is grown by the Gardening Club.
  8. Kitchen staff are enrolled and the stuffed marrow recipe is cooked
  9. The stuffed marrow is eaten
  10. Residents are offered greater choice over menus

By way of disclaimer, I ought to point out that there are many more steps here not illustrated. Not least the fact that The Grange began participating in the Outstanding Activities programme some four months before they received the Bird Box Bonanza! box. Every step also has the potential to be a first step on a different line of development.

Outstanding Activities participant Naomi Mead observed “The vegetable patch seemed to just happen as a result of the bird feeder activity and it was a surprise to us all when this activity grew in to something different.”

The staff at The Grange were open to this surprise and responsive to letting these steps develop. They protected new ideas and gave them the space to grow and develop. Residents were involved at every step. You can’t get to the Moon in a single step. You can’t grow a marrow in a day. But, given a seed, amazing results are possible in time!