Joint Residential & LD/DOM Care Forum - Held at Crossroads House Care Home on 31st January 2017
The meeting started with a presentation by Alison Maxwell from OLM, an IT company specialising in software for the Care sector. A copy of the presentation will hopefully be available here soon.
Eventide Care Home
Jennifer Nancarrow from Eventide Care Home in Liskeard took the floor to inform the meeting that following her CQC inspection last November, they has been awarded an outstanding rating.
As part of her speech, Jennifer highlighted that the home was in the fortunate position of not having to repay a mortgage on the premises which contributed hugely to allowing the not-for-profit business to invest any surplus into quality. It was highlighted that had they a reasonable mortgage, an outstanding would have been less likely.
Jennifer also took the opportunity to make providers aware of the Outstanding Managers Network meetings, a group which Jennifer has benefited from, and encouraged providers to send their managers where possible.
David Coleman (Senior Manager Business & Administration) spoke on the need for change at the Council, appreciating that change is needed and that it is happening, albeit at a slower pace than he would like.
David talked about Service Improvement, or Quality Assurance as it now
prefers to be called, and the role of inspection. David is keen for Quality
Assurance to modify their approach to ensure that onsite visits are used to speak
to staff and residents to obtain a more honest appraisal of what is happening
with that provider. Tasks such as reading policies, training records, etc can
be done by QA Officers remotely either prior to or after the site visit.
David is keen for providers to have an input in the future direction of the QA service and would like to shift the emphasis so that they concentrate more on areas and providers where they are needed rather than simply assessing every provider once per year.
Question: How does the Council assure and measure its own quality?
David outlined that the Council has its own internal audit process which is answerable to the elected members and the audit committee.
Question: Why are people on Direct Payments not getting the same increase
as Dom Care?
David acknowledged that such a discrepancy exists and that this is due to the decision made by the elected members to delay the increase for Direct Payments rather than link it with the increase for Dom Care. David was not sure of the reasoning behind the decision but will try to find out and feedback to Richard.
Question: For Service
Users waiting for financial assessments which were delayed or significantly
overdue, should these be logged with the Council as a complaint? The current
method is that providers have to chase individuals within the council which is
incredibly time consuming and hard to monitor progress.
David confirmed that ideally missed or overdue assessments and payments should be logged with the complaints team. David offered to provide Richard with the contact details of the complaints team.
Question: When Service Users on Direct Payments go to hospital, their
payments are still being made which seems unnecessary as they are being cared
for. Is there any way for the Council to reclaim this money?
David confirmed that the Council do have the authority and ability to reclaim this money, either when they are made aware that a Service User is in hospital or as part of their annual review. The Council are looking to move towards pre-payment cards which will allow for better monitoring, for example if a Service User does not use the card for a few days, it will flag up a possible issue).
Question: How can providers claim their funding when two statutory organisations are arguing over
who pays? Ultimately it is the provider who is punished until this is sorted.
David agreed that this is not fair on the providers and that the focus should be on getting paid. David suggested using the complaints team for initial queries, and offered to look at any individual cases.
Question: What is actually being done to achieve progress?
David indicated that it was hard to provide specifics, but that the Council are aware of some of the challenges and have increased staff in a number of areas that were under resourced which should start to alleviate some of the issues.
Question: What is happening with gross payments?
Despite the information that may have been shared with providers, there is no decision on this yet. The topic has been discussed privately within the council and has not yet progressed through the proper democratic process. David acknowledged that the Council are looking at this and that he will write a paper to recommend a move to gross payments. This should be presented in March with a view that by April some form of response should be available on what direction the Council will take on the matter.
Question: Why cant the Council rely on CQCs ratings?
David indicated that CQCs default is to inspect every two years and that much can change within that time frame. It was also indicated that the Council are accountable for anything they purchase and have to ensure processes are in place to justify quality.
Question: How is the quality
of the QA Officers monitored? A number of providers recounted instances
where Officers arrived having no idea what they were supposed to be looking at,
sometimes with very little knowledge of care.
David reported that all staff should have the skills to allow them to do their job and that they have all been through the Councils recruitment process. Please raise individual cases with David for them to be investigated
Question: Can the Council claw back funding from the Morleigh Group?
Whilst David was not able to comment on individual cases, he did confirm that the Council has the authority and ability to reclaim funding if they feel it is warranted.
Peter Tempest (Adult Transformation & Commissioning - Children, Families and Adults) arrived and started by talking about the meeting on the 25th January 2017 where the members had agreed on a transformation program paper as the way forward.
Peter also indicated that following Cllr Jim McKennas resignation, his role as Portfolio Holder for Adult Social Care will not be filled until after the elections in May as there is not enough time before the period of purdah starts. He remains a councillor, but not a Cabinet Member.
Peter highlighted that both the Scrutiny and Cabinet meetings are open meetings where any individual or business can attend or submit questions. Providers are encouraged to attend in order to provide feedback and comments to these groups as currently this does not happen.
Peter questioned the investment in the estate within Cornwall. The most
recently built care home was possibly
Cedar Grange, which was probably more than 10 years ago. In other areas,
several new care homes are being built each year.
It was suggested that the question to the Council should be are you prepared to invest in the Estate? Either to build and sell, build and lease, or build and operate.
The comment was made that this may encourage larger providers from out of county (like the Morleigh Group) to come to Cornwall for the cheap finance, which will push out smaller providers.
It was suggested by Peter that whilst there is no plan to bring multinationals to Cornwall, maybe there should be.
Question: What about investment in Dom Care?
Peter acknowledged that this was a fair point and that it is about changing mindsets within the Council and that there has to be a start somewhere. Most Cllrs do not have much understanding of Extra Care and the challenge is getting them to understand this, for example there is a plan for 1200 extra care units across Cornwall.
Peter reinforced that it is extremely unlikely that central government funding is going to suddenly increase so we have to work smarter with what we all have. This means the system has to get smarter and that includes the private sector, and such proposals created individually or as partnerships should be taken to the Council for consideration. For example, Mary proposed an extra care model whereby smaller (and less viable) independent care homes could de-register and the space sublet to Service Users, with care provided by local Dom Care agencies.
The final point made was that the fact that David and Peter attend meetings like this to listen to Providers concerns and comments is a very encouraging and refreshing sign and providers are appreciative of the dialogue.
David was not sure of the reasoning behind the decision [to delay uplift for Direct Payments] but will try to find out and feedback to Richard.
David offered to provide Richard with the contact details of the complaints team - Children, Families and Adults email address is : firstname.lastname@example.org