The report of the Care Quality Commission (Document “AH”) provides an update from each of the inspection directorates.

Recommended –

That the report be noted.

                                                                                    (Sarah Drew – 0300 0616161)

The Inspection Manager, Adult Social Care, Care Quality Commission, presented a report (Document “AH”) which provided an update from each of the inspection directorate within the Care Quality Commission (CQC).  It was noted that there were 213 active Social Care organisation locations in Bradford, 50 nursing homes that provided 2129 beds and 88 residential homes with 2336 beds.  The Assistant Director, Operational Services, informed Members that the Council met with the CQC on a regular basis and contracts were monitored alongside safeguarding.  It was noted that last year more providers had required improvement and work had been undertaken with the sector in order to reduce those on a warning down to ten.

Members then raised the following points:

·         In 2016 changes around payments were made, was there any association in relation to the number of organisations that closed?

·         62% of the active locations ‘required improvement’.  What percentage related to safety?

·         What were the inspection timescales and were they linked to previous inspections?

·         How were people informed of standards within homes?  How did they find out if the location was just within the ‘requires improvement’ category?

·         Was the standard based on points?

·         Would the public understand why the rating had been given?

·         Were there any statutory requirements for care workers and managers?

·         What qualifications were required for managers and providers?  Were there any minimum requirements?  Did they have to be from the medical profession?

·         A company could be established and owners had to be registered and prove that they could manage a home.  They were not required to be a registered nurse, unless they were managing nurses.  The majority of managers were qualified to NVQ Level 5 and it was very important to have good leadership in homes.  The staff needed to have a care certificate and the CQC looked for this along with training and development.  Clear pathways were required for carers in order for them to progress to higher levels.  A key part of an inspection would be to identify the training provision and robust processes.

·         Were the 65 locations that required improvement mentored?

·         Were the compliance actions related to the overall ratings?

·         Would the prioritisation process be used for all locations or just where serious incidents had taken place?

·         How would a change in the rating from ‘good’ be identified?

·         If a location was ‘inadequate’ how could it continue to operate?  How long would it take before it was closed down?

·         How would the judgement call be made?

·         There was a general trend towards improvement.

·         The information in relation to hospital inspections required further investigation.     

In response it was confirmed that:

·         Some organisations had closed as the new standards were higher and some providers could not afford to make the required changes.  Other companies had changed owners and if a provider went out of business it caused problems for the Council.

·         The locations were observed in terms of issues.  There were varying levels of ‘requiring improvement’ and advice was provided on what action was required.  The levels had been raised and standards were much harder to attain now.  ‘Experts by Experience’ Inspectors were used and they spent a great deal of time with carers.  As part of the inspection, documents would be requested and feedback provided.  Evidence could be submitted following the inspection and the provider had ten days to submit feedback in relation to points of accuracy.  Locations were immediately informed of areas of risk.

·         Inspections would be scheduled within timescales, where possible, although the CQC could visit at any point.

·         A report summary was provided and information was available on the CQC website.

·         The standard was based on the overall rating for the location.

·         It should state within the main body of the report why the location had been given the rating.

·         All managers had to be registered with the CQC.  Proof of qualifications had to be submitted and interviews were undertaken to ascertain their skills.

·         Mentoring was not provided as such, however, Action Plans would be requested and there was a vast amount of information available on the CQC website.

·         The CQC worked more closely with those locations that required improvement.  The serious concerns procedure could be triggered and the Council would work with NHS partners to resolve issues.

·         Incidents up to one year old could be investigated and it would depend on the rating given after the return visit whether the process would be undertaken.  Locations were constantly being reviewed and the CQC could visit at anytime.

·         The information submitted was reviewed and professional judgement was used to ascertain whether a location should be revisited.  Management review systems were also in place.

·         An embargo would be placed on the location and no new people would be admitted until the issues had been resolved.  A serious concerns procedure would be put in place immediately.

·         There were varying levels of inadequacy and the Council would make the judgement as to whether people were moved, which was a requirement of the Care Act.  The action taken would be based upon the best interests of the residents.  The CQC had closure and urgency powers that could be used if required and liaison would be undertaken with Local Authorities and Clinical Commissioning Groups prior to their implementation.

·         The ratings had improved and there was a commitment within the Council to progress and drive quality upwards.  

·         A report on the hospital inspections would be presented to a future meeting.   

Resolved –

That a further update report be presented to the Committee in 12 months.

Action:  Inspection Manager, Adult Social Care, Care Quality Commission