Safe and Strong Communities Select Committee QUALITY ASSURANCE OF ADULT CARE PROVIDERS Client Side Operations 1 Commissioning Delivery Hub
PROVIDER MARKET IN STAFFORDSHIRE The Quality Assurance (QA) Team provides assurance for 525 adult social care providers which is broken down as follows: • 296 Care Homes (residential and nursing) • 81 Dom Care agencies • 79 Supported Living services • 44 Day Opportunities • 14 Extra/Flexi Care Services 11 Other/3 rd Sector • These are mainly contracted providers and include Staffordshire County Council in- house provision, as well as SSOTP adult social care provider services. Currently we have over 2000 service users in receipt of direct payments. This poses a challenge in itself as contracts decrease and the direct payment market expands. 2
The Quality Assurance Team carries out on-site quality monitoring visits to adult social care services: Standard toolkits are used across the range of services which are consistent in approach but differ in detail dependent upon the service and/or contract in question. Unannounced visits are carried out where the contract allows. Currently we can do this with dom care, day opportunities and supported living 3
CURRENT PROCESS • Process of a quality monitoring visit – Pre-arrange date with provider (majority of visits) – Initial discussion with manager on day of the visit – Tour of the service (residential/supp living) – Review of documentation – Observation of practice – Feedback from staff, service users and relatives (where appropriate) – Verbal feedback given to provider on the day – Production of draft and final report to include action plan with timescales for completion • Follow up visit(s) • Quality Monitoring Officers will offer constructive advice and where necessary, signpost providers to other resources to assist in meeting recommendations raised during the visit. 4
• Quality Monitoring Officers make a ‘holistic’ judgment of a service. Some specific items may vary contract to contract, but generally the quality monitoring officer will assess (this list is not exhaustive): • Recruitment practices and DBS checks • Staff development, training and supervision • Quality of support planning processes • Risk assessment and management • Accident and Incident reporting, recording practices and trend analysis • Application of required policies and procedures • Complaints management and adherence to Multiagency adult protection policies and procedures • Provider's own internal Quality Assurance and customer feedback mechanisms • Medication • Food and Nutrition • Manual handling • Cleanliness and infection control 5
WHEN A PROVIDER FAILS OR DELIVERS POOR QUALITY Contract Management Adult Protection procedures (inc. Remedies LSI’s) Default/Suspension Termination Quality Monitoring Action Plan Trigger action with Reviews other agencies, Referral to e.g. SFRS, CQC Infection Control 6
QAT INCREASE IN PRODUCTIVITY Number of Monitoring Visits Completed Over the Last 3 Financial Years 7
On average the Quality Assurance Team has achieved a 30% year on year increase consistently over the last two financial years. This has been achieved without an increase in resources but through efficiencies made through streamlining processes. However, as the care market continues to expand, the teams ability to monitor services as we always have done is becoming increasingly difficult. Therefore we need to think about ‘doing things differently’ whilst still being in a position to offer the same level of assurance. 8
WHAT ARE WE ALREADY DOING DIFFERENTLY? •Improved information sharing with regulatory partners including SFRS, CQC etc. •Implementation of a provider database – central point for intelligence gathering from variety of sources including – NHS incidents – Healthwatch reports – Complaints – Infection Control – Adult Protection Data •Introduction of a risk register •Participation in Quality and Safeguarding Information Sharing Meeting (QSISM) 9
DIRECT SERVICE USER INSIGHT AND FEEDBACK MECHANISMS Reach Pilot Insight from SU’s with LD Focus Groups Dom Care Surveys Service Performance Feedback Forms (SPFF’s) Apr 13 – Mar 14 Top ten providers –9 520 forms across SSOTP is primary are dom care 138 providers referrer 10
WORKING WITH THE REGULATOR? Care Quality Commission (CQC) •Supply area profiles monthly – non compliance •Statutory notifications of Enforcement Action •SCC shares all QA reports with CQC •Regular attendance at QSISM •2014 SCC workshop with CQC Chief Inspector for Adult Social Care to investigate opportunities to improve joint working arrangements and bring greater continuity across respective responsibilities. Commissioning Delivery Hub - 11 People
CURRENT CHALLENGES •Market development opportunities with the challenging financial landscape. The sector’s ability to improve quality above ‘standard’ is wholly dependant on the rates paid for above ‘standard’ quality •Improvements in awareness of the pubic of the routes available to address poor quality means that there is an increase in demand to address potential concerns •Still disjointed operational activities between regulator and SCC, causing increased resource requirements on the sector and sometimes conflicting approaches •Who defines ‘quality’? 12
FUTURE PLANS •Current restructure of Client Side Operations within Commissioning Delivery Hub to improve productivity and effectiveness of quality assurance functions. •Plans under development to bring greater synergy across safeguarding, quality assurance and practice standards. •Work with regulator to improve operational arrangements and respective responsibilities to devise complimentary operating models. •Appointment of new Quality Management Lead in Client Side, working alongside new Commissioning Delivery Lead and Performance & Operational Intelligence Lead, and individual Relationship Managers (Older People, All Age Disability, Children’s, Learning & Skills, Public Health, Community Safety, etc) to bring greater accountability for commissioned arrangements (i.e. SSOTP, IF, FF, Entrust, etc). 13
MEMBER INVOLVEMENT •Periodic visits with QMO’s •Select Committee annual review of toolkits •Members ‘sponsorship’ of individual cases, ensuring direct Member accountability at any given point in time •Select Committee receive a quarterly QA report quarterly to keep up to speed with issues in the market •Others? 14
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