Agenda item

The Director for Adult Social Care and Commissioning submits a report to the Commission to provide an update on progress against the manifesto pledge ‘Tackle Care Home Staff Ratio’s as part of their commitment to improve health & Care’.

The Commission is recommended to note the contents of the report and provide any comments or feedback to the Director for Adult Social Care and Commissioning.

The Director for Adult Social Care and Commissioning submitted a report to the Commission which provided an update on progress against the manifesto pledge ‘Tackle Care Home Staff Ratio’s as part of their commitment to improve Health & Care’. The Commission was recommended to note the contents of the report and provide any comments or feedback to the Director for Adult Social Care and Commissioning.

The Deputy City Mayor introduced the report and legislative framework of The Health and Social Care Act 2008 (Regulated Activities 2014: Regulation 18) around the deployment of staff to deliver care.

Annette Forbes, Group Manager, Contracts and Assurance, presented the report. The Commission was asked to note that the Council had no means of legally enforcing a staff-patient ratio in a care setting, legislation stated only that an organisation was required to deploy enough staff. The report also provided information on the number of measures available to the Council to ensure the needs of social care clients were being met, including  the fee setting process.

The report stated Leicester City Council compared well against the national average with regards to the numbers of nursing and residential homes which were graded by the Care Quality Commission (CQC) as ‘Outstanding’ or ‘Good’ overall. It was noted that whilst the Council could not enforce the numbers of staff deployed, the Department looked at intelligence from stakeholders, undertook checks on homes, and checked with individuals and family members to ensure the needs of individuals were being met.

It was noted when looking at the quality of services, the Contracts and Assurance Service (CaAS) undertook Quality Assurance Framework (QAF) assessments on a regular basis. Assessments usually could include a desk top exercise and observations, an auditing of alarm systems, Health and Safety inspections of homes, audit of fire safety, health and safety of workforce. Information gathered would form recommendations enforceable under contracts. A range of information was also received from stakeholders. Regular meetings were held with the CQC and information shared to get a rounded picture of services. Where a contracted provider was failing to meet its obligations a Multi-Agency Improvement Planning (MAIP) approach through a team would ensure deployment of enough staff to manage peoples’ needs and pressure times at homes, for example, mealtimes.

It was reported that fees had increased from April 2019 following a review of residential and nursing care banded structures, but additional needs allowances had also increased.

The commission was told that managers of care homes were informed on what support was available to them. It was noted that over the previous year, 18 care homes had required improvement following checks, three of which had been in relation to staffing levels.

Members questioned how a care homes performance was measured, and how many concerns had been raised over the past 12 months. Members were informed that a home could only be assessed on what officers could see on any specific day, for example, unanswered alarms ringing for a significant length of time, rushed staff, conversations with people and staff, questionnaires both to professional stakeholders and families. An ongoing alarm would be an indication for a care manager that there was a problem. It was further stated that a care home was required under the Care Act to work out a process to find out how many staff required were required, and assessments were evidence based on what officers saw when visiting a home.

The Commission was informed that homes would receive one announced visit, one unannounced visit, and responsive visits, for example, to check the sustainability of a placement. Reports to the CaAS could also come from district nursing, the CQC, and whistleblowing. For the three homes referred to previously, in two cases the managers had left, and new managers had changed the way they deployed people or increased the number of people employed there. It was acknowledged that situations changed on a day-to-day basis, and, for example, end of life care would require more one-to-one support from staff which would affect the staffing levels in a home.

It was reported that over 1000 Quality Referrals were received over the course of the last year. Officers would look at patterns in the reports and go out to assess a home if the information received warranted this approach. Basic training was also a mandatory requirement for staff, for example, in fire safety, and training to meet peoples’ specific needs. It was noted that good carers would seek out additional training to increase their qualifications.

Members asked for additional information on the scale of the issues over time, and further information on trend analysis. Members also referred to paragraph 4.24 in the report and asked for information on concerns raised. It was also noted that in addition to a telephone number those with concerns that an email address be provided which might capture non-urgent information.

The Deputy City Mayor suggested the Commission look at the requested information alongside the annual review at the last meeting which contained a significant amount of data.

The Chair recommended that a more detailed report about the scale of issues over time plus detail over the range of contacts which have been made, and what support role could be offered by Members to those that had raised concerns be placed on the Commission’s Work Programme for a future meeting.

The Chair asked that in relation to comparative groups Leicester City were doing quite well, but 23% of nursing homes overall required improvement, and that in looking at trends in performance of care and nursing homes, were they improving over time or at standstill? The Deputy City Mayor responded that care needed to be taken that when a home was described as ‘requires improvement’ through issues identified that it was not the same as ‘inadequate’ and did not mean it was failing, but could be moving forward and seeing an improvement.

The Chair asked if there was any scope to commission or contract differently with regards to ratios checks. The Deputy City Mayor believed it would increase costs, and as individuals needs changed from week to week, this would change the number of staff in a home required. For example, the ratio of staff needed around lunchtime would be higher than other times of the day or night.

The Chair thanked the officer for the report and stated that given the limited resources great work was being achieved by the team.

AGREED;

that:

1.    The Commission note the report.

2.    A detailed report about the scale of issues over time plus detail over the range of contacts which could be made, and what support role could be offered by Members to those that had raised concerns be placed on the Commission’s Work Programme for a future meeting.