Agenda item

Further to Minute No. 135 of the Cabinet Meeting held on 15^th April, 2019, Nathan Atkinson, Assistant Director, Adult Care, Housing and Public Health, supported by Councillor Roche, Cabinet Member, gave an update on the recommendations and corresponding actions arising from the Scrutiny Review of Residential and Nursing Care Homes for Adults aged over 65. 

The purpose of the review was to consider progress in bringing about improvements to safety, quality and effectiveness in the sector as well an opportunity to explore the impact of the Care Homes Support Service as the care home sector was one of the transformation initiatives under the Rotherham Integrated Health and Social Care Place Plan.

The Commission was advised that the Service had not closed any care homes, but three private care homes had closed so in two of these cases people placed by the Council had been withdrawn.  One home was re-opening shortly under a new provider but people would not be placed there unless it complied with the Council’s standards. 

The Council’s powers with private care homes were very limited.  However, they were monitored under contract compliance and residents removed if there were issues about their care especially with regard to safeguarding.  There were also close links with CQC and G.P.’s as every care home had a G.P. linked to them.  Wherever possible, good relationships with private care homes were maintained.

In comparison to the rest of Yorkshire, Rotherham did not have a single failing care home, which was an improvement.  Work was still taking place to improve the direction of travel towards outstanding and it was pleasing to report that the Cabinet agreed to the recommendations which endorsed current and planned work in this area.  Scrutiny were thanked for their work on this review. 

All the recommendations were now in place and in recent weeks emails had been circulated to relevant Ward Members to update them on  Care Quality Commission (CQC) ratings for homes in their Wards. Detailed briefings were also provided if there were any concerns or if the CQC had been in. 

Discussion ensued with the following issues being raised and clarified:-

·           Training for staff - how was this being monitored, were there any issues and how was it implemented?

       Of the two care homes that were run by the Council, training was provided and monitored.  However, in terms of private homes, it was made clear what the requirements were and what steps would be taken if they were not compliant.  However, in terms of training, the Council could only suggest, cajole and recommend.

       The Council had maintained the training offer for the independent sector. It also had its own services and needed to make sure these were of requisite standard with staff access to training and refreshers.  Much was also open to the independent sector but the onus was on organisations to take up that offer.  Part of the contract monitoring was to look at where staff were in regard to annual refresher training and any areas for additional training were welcomed or if there were issues identified.

       Contract compliance required registered providers to carry out an annual self-assessment that related to the Council’s contract, including policies and procedures, staffing and training.  Validation work examined the annual training matrix and this was cross referenced against staff records.  The Council found that when training had been booked staff had not attended and this was addressed to ensure the non-attenders were charged. 

       There was regular communication between Contract Compliance Officers and the training team who were available to be contacted for advice, guidance and support.  Any issues were addressed to the home manager and a six week period improvement plan put in place to address issues. 

       The Service annually produced a training programme in consultation with care providers and commissioned on need.  There was always an element of flexibility in the programme as not all staff could attend on the dates organised and the trainers did reschedule to get value for money if numbers were low.  Attendance at training was booked through Directions internally and all information was made available to providers direct.  Training provided externally to the Council had to be ratified and identified through Skills for Care.

       Work with the Care Homes Support Service had gone well and the Clinical Quality Advisor undertook a range of audits and the Service then  targeted any additional training around the themes where issues have been found.  It was confirmed that contractually providers were obliged to pay staff to attend training.  Training and Development colleagues would be able to answer questions with regard to the use of Directions.

·           Had there been any progress to increase the number of nursing beds within the local provision?

       The closure of some nursing homes had seen the reduction in nursing beds, but Greasbrough nursing home would be re-opening shortly with  some provision.  This was a challenge nationally for the sector in securing nursing staff when competing for agency nurses and driving costs up.  There were also challenges around standards as nursing homes tended to have lower CQC ratings than residential.  It was the aim with all new providers to steer towards nursing care as there was still substantial over capacity on the residential side.

       Pay remained an issue in care homes and some providers had gone bankrupt due to rising costs.

·           Training pathways for young people in partnership with local college had been discussed previously.

       The Council was involved in work taking place with the Health Education England Skills for Care to develop these.  The trainee Nurse Associate course was attracting more people to make a career in nursing.  Other work would take place with regard to the new Home Care Service to make careers in the Service a more attractive proposition for younger people.

·           Under-provision of nursing care had been mentioned.  Were there waiting lists given that there was an excess of residential care?

       There were no waiting lists per se but capacity in the system was limited and, for example, as part of the Winter Plan, block buying of nursing beds was often done by Health colleagues.  There had never been a situation that did not have a solution within the Borough but there was more provision of residential than nursing beds but much depended upon location.  Choice was part of the assessment. 

       The first choice was always to return a person home, but there could be delays if adaptations were required.  There was a redefined pathway for intermediate care and enablement under the principles of Home First to get people back home independently and for them to continue to live in their community.

·           What were the current vacancy rates?

       There were 1,686 beds across the Borough with a 31.6% vacancy factor, which equated to 84 residential, 92 residential EMI beds, 36 nursing beds and 18 EMI beds.

·           With vulnerable children and adults there was the environment for potential abuse and neglect especially when people were not properly trained or paid enough.  Was the Council sufficiently confident to spot neglect and abuse at an early stage for families in residential care to ensure issues were picked up quickly.

       In terms of older people, there were thirty-four homes in the Borough, of which two were Council-owned. There was regular monitoring from the Local Authority, which was very frequent, along with health professionals who were also going into the care homes, so the eyes and ears were good.  Rotherham did not have any inadequate homes as the sector had been proactive in dealing with issues.  The number one priority was to work with providers to address some of the concerns and raise standards and there were excellent working relationships with the CQC with joint working and sharing of intelligence to ensure joint visits were effective. 

       There were often concerns about the potential for abuse in people’s own homes and some of the smaller establishments for people under 65 were monitored closely.  There were 111 smaller establishments in the Borough and all were monitored. 

       The CQC did a recent league table relating to quality ratings and Rotherham was third out of fifteen in the Yorkshire and Humber.  Everyone was doing their best and, whilst there would still be challenges, the aim was to be a proactive Borough and remain passionate about quality.

·           Was anyone talking to residents?

       Performance colleagues were resourced to carry out this work and ensure the Service user was heard.  There was also free independent advocacy for people which they were encouraged to use and the Service worked closely with Healthwatch Rotherham but did want to get more Service user voice.

·           Were there any plans to have a “trip adviser” type review for care homes?

       An older people care home guide identified homes available in Rotherham and another explained what a family or resident should be looking for in a care home in order to make the best choice.

·           Recognising that work was being developed on Service user voice, could the Select Commission contact Healthwatch Rotherham to ascertain how they captured the Service user voice?

·           How was the work of the Quality Board progressing, including the Quality Matters initiative and the Leadership Academy?

       Work on the Quality Board was in progress.  Plans were in place to expand membership to wider health partners.  Quality matters and principles of good contract monitoring were in the Service Plan working on a quality strategy.  It was recognised there were real challenges, but progress was on an upward trend and the workforce, availability of quality and adoption of the key principles remained a priority.

·           The issue of choice and whether to go back into the home required lots of professionals to work together and evidence showed that was being successful.

Resolved:-  (1)  That the response to the recommendations of the Scrutiny Review of Residential and Nursing Care Homes for Adults aged over 65 be noted.

(2)  That consideration be given to inviting Healthwatch Rotherham to submit a response to the meeting should they be unable to attend.