Agenda item

Carers and recipients of domiciliary care have been invited to tell the Commission of their experiences of domiciliary care.  The Commission is recommended to receive this evidence and comment as appropriate.

Members are advised that some of this evidence will be presented verbally at the meeting, but some is attached at Appendix B.

The Chair reminded the Commission of the rationale of the review and advised that carers and recipients of care had been invited to give evidence of their experience of domiciliary care.

It was reported that two care managers invited to give evidence had indicated that they were unable to attend and had their apologies for absence noted.

The Chair referred to the written evidence provided arising from an informal meeting and discussions held with carers at Danbury Gardens, with managers from a private care provider, and following a visit to meet and observe care workers.  It was noted that the husband of the lady receiving care at that home visit was in attendance to give his own evidence.  Copies of the Chair’s notes were circulated for the Commission’s attention.

A carer (now retired), and an individual in recipient of care for his wife, were in attendance.

The Chair invited the individual in receipt of care to give evidence of his experiences of the domiciliary care service.

He advised the Commission of the care required for his wife and the decision made by the family to take up a direct payment, so they could choose the domiciliary care provider themselves to deliver the care package.

It was reported that a converted room had allowed for proper implementation of the care plan, although difficulties with some care providers had been experienced, particularly with the turn-over of carers visiting his wife. The relationship between staff was also considered important when working together and having handovers. The Commission noted the requirement for care providers to ensure, as much as possible, that consistency was maintained in the carers being sent to individuals.  The Chair referred to her notes of the visit which emphasised this requirement.  It was considered that if changes were necessary, prior notice should be given.

He stated that the greatest difficulty he faced was in accessing the service and it was only because he knew people in the service that he knew the correct avenues to follow to ensure that his wife received the correct level of care.

The Chair expressed her thanks for the evidence submitted and referred to the model of care which had been demonstrated to be satisfactory, subject to adequate controls being in place, including suitable advocacy arrangements and commitment from the care managers.

The Chair asked Commission members to note the written evidence submitted, following a media appeal and clarified the two case studies listed had been raised on BBC Radio Leicester.

The Chair then invited a carer, (who had retired in 2011), to present written evidence of her experiences in domiciliary care. She highlighted particular issues including poor training and support, little travel time which  was unpaid, not enough information provided about clients, an unreliable logging system which did not record hours fully and a bullying culture by companies on their staff.

Asked why she had found it necessary to leave the service, she stated that largely it was due to the daily pressures. She considered that during her work she had felt that there had been too much room for major error, and also she personally was not being given enough hours to remain in the profession.

In debate, concern was expressed that the agency she had worked for was contracted with the Council, although it was noted that the carer’s experience had been within the county. It was confirmed that this organisation was contracted by Leicester City Council, but it was emphasised there had been a rigorous Quality Assurance Framework (QAF) in place to monitor all providers since the new contracts were awarded in October 2013.

In response to a question from a Commission member it was reported that the UNISON Ethical Care Charter, which had previously been cited as a possible helpful benchmark, could be made available

The carer was asked if she knew of processes to ‘whistle-blow’ was and she reported that she felt that the opportunity had not been evident and it was difficult to identify who any complaint or report would be forwarded to in the first instance.  At this point, officers circulated cards with details of how to report any problems in the service.  The commission was informed that these were circulated to all contracted organisations for distribution to carers and service users in February 2014, as a means of enabling people to raise concerns with the Council, the Care Quality Commission, or the NHS.

It was also noted with concern that a large amount of the problems experienced by the carer had been due to a lack of appropriate training, and that a shadowing arrangement had been considered sufficient.  The requirement to ensure adequate monitoring of care providers was expressed, particularly given the apparent assurances needed in respect of training.

The Chair expressed her thanks for the evidence submitted and referred to the contrasting models demonstrated by comparison with the first witness’s evidence.

The Chair referred to her written submission following her interview with two middle managers from a private provider.  She commented on the reports which had described some alarming incidents and also stated that a visit with another provider had been cancelled within an hour of its start time.

It was also considered that care providers should be given information about any potential difficult clients by the Council, to prevent problems resulting from staff being sent to difficult  situations.  It was accepted that an increase in the information available to them could prevent problems for carers, leading to better staff retention.  The Director for Care Services and Commissioning confirmed that a copy of the care plan was now sent to providers, so they now had the relevant information, including risk assessments, so they understood the needs of a client before providing care. It was requested that the data concerning the turnover of staff be researched and reported to the Commission in due course.

Commission members asked on progress of the removal of 15 minute visits. It was confirmed that these are being screened out through reassessments with providers.

Commission members asked about progress of the removal of 15 minute visits. It was confirmed that these are being screened out through reviews of clients.

The Director of Care Services and Commissioning referred to the new contracts that had been in place since October 2013 and the requirements of the QAF as the mechanism to monitor contracts with providers.  It was reported that customer satisfaction surveys and regular audits were undertaken to ensure adequate levels of training, care and safeguarding. Copies of the training matrix, staff supervisions files and evidence of certification were all checked via the QAF process.  In the future, providers would be asked to provide information relating to the turn-over of their staff.

It was considered that systems to identify the results of those audits should be established to ensure that qualitative data is available to the Commission.

It was confirmed that all providers would be undertaking the QAF audit by the end of the calendar year and that resultant data and comparisons could be submitted to a future meeting.  The requirement to ensure that information on the levels of care being given, as received from the carers themselves, was reiterated as an important part of that process.

The ABC assessment rating was explained, where level A showed they were striving to be leaders in their field, at level B they were performing at the good level and at C they were meeting the contractual obligations.  The ladder of intervention policy would be implemented if a provider fell below level C was described, including relevant timescales for revisits and evidence.  It was confirmed that, should a provider still fall below the minimum level C, suspension and termination from the framework could result.   The Director for Care Services and Commissioning confirmed that the A, B, and C results for providers could be supplied to Commission members.

RESOLVED:

i)             that a draft report of the review be submitted to the next meeting of the Commission to be held on 15 May 2014, to include an overview of the process to date and the circulation of the UNISON Ethical Care Charter; and

ii)            that the audit information is reported back to the commission at a future meeting of the commission.

The meeting was adjourned at 7.35 pm and was reconvened at 7.45 pm