The Chair is invited to make any announcements as they see fit.
Minutes:
The Chair highlighted that Members may have seen recent news articles about the safety of care for vulnerable city residents, particularly some poor standards in care homes and a care agency and sought assurance about the situation in the city.
The Director of Adult Social Care & Commissioning acknowledged the concerns raised following recent news articles and reassured the commission that this is not a systemic issue and that measures continue to be in place manage quality assurance in the external market and ensure residents receive the best possible care. It was further noted that:
· There are 95 care homes in the city currently, of which 50 support older people and the remainder supporting individuals with a learning disability or mental health condition. Current data indicates 1 care home is rated outstanding and 60 good. There are 28 care homes that require improvement ,and 1 inadequate, of which 7 have not been reinspected by the CQC for over 2 years, and therefore not able to demonstrate improvements that may have been made to support an improved rating. A further 5 care homes have not yet been inspected by the CQC and therefore correlates with concerns about the confidence in the CQC to regulate standards.
· There are around 150 regulated registered providers in the city providing domiciliary care to people in their homes. The Council hold a contract with 32 of those providers and statistics from June indicated 75% inspected by the CQC were good or outstanding. Following the recommendation by the Commission regarding the retendering of the home care contract, a requirement of the forthcoming contract is that providers have to have a CQC rating of good or above, demonstrating our commitment to high standards and performance.
The Chair noted concerns around the sustainability of the CQC and therefore sought further details to inform the Commission of the local quality and assurance measures, in which it was noted that:
· The Council have a contract specification with providers which includes standards to be met for residents drawing on support and funded by the Council. The contract will include terms and conditions associated to pay and expectations as well as actions if there is a failure in the contract provision. The contract specification, quality assurance framework and regulation of CQC inspections collectively promote the expected standards.
· The Council can undertake announced and unaccounted visits to assess providers. Generally, announced visits will focus on paperwork compliance whereas an unannounced visit will observe the day-to-day practice to get a sense of the culture and atmosphere to ensure the care being provided is inclusive and dignified. Officers will usually ask the manager who the most complex person funded by the Council is within their care and will observe to review against their care plan to ensure the care is being provided as expected.
· Providers will be assessed against many standards to determine compliance. Where a provider is deemed to be non-compliant this will be categorised as major if there is an immediate impact to the health and safety of residents, moderate where there could be an impact, and minor where there is likely to be an issue with a recording process. If a provider is considered to be majorly non-compliant, then officers will revisit within 28days to determine whether any new placements should be suspended to enable the provider to improve.
· The Council has the ability to suspend activity through a notice to remedy a breach which is a formal letter to the provider which indicates where they have been observed not to be meeting the contract terms or the needs of residents being cared for on behalf of the Council. It will include timescales for the breach to be remedied and a formal meeting with the provider and relevant professionals to discuss concerns and agree an action plan.
In response to questions and comments from Members, it was noted that:
· Prior to the pandemic, local assessment would often complement and correlate with CQC inspections. However, since the pandemic, the CQC have dramatically altered the approach and inspections have been focussed where issues are suspected, but the Council continue to assess all providers. If the CQC undertake an inspection and find issues the contract and assurance team will visit to also assess and ensure there is an action plan to address the concerns. The team have worked with providers inspected by the CQC and rated requires improvement to ensure they meet the contract terms and meeting standards to deliver safe care but are awaiting the CQC to re-visit.
· Where an individual has self-funded their care and available savings have been utilised to become below the threshold for entitlement to Council support, an assessment would need to be undertaken. This would ensure the placement is assessed for suitability and financial viability to meet the needs of the individual, which can sometimes require changes in the care package.
· Providers often charge self-funders more than costs negotiated by the Council and in circumstances where the required care cannot be provided within the financial assessment, consideration to relocate to a new provider will be carefully assessed against the impact of a move to the individual. If there is a requirement to relocate, due to a change in need, the choice of an individual and/or their family or where homes close, skilled officers will navigate this accordingly with the family.
The Chair invited the Healthwatch representative to participate in the discussion in which it was noted in response to comments and a question that the deferred payment scheme is available and used in Leicester, for example to enable care to commence whilst a house sale is proceeding.
The Chair agreed that further discussion around care funding and proposed white papers on the future of funding for adult social care be added to the work programme.