Hardwick Clinical Commissioning Group
Management of “Quality” in NHS Funded
Care Homes
Operational Policy for NHS Hardwick CCG staff
Contents
Context and Purpose
Page
Routine Contract Compliance and Clinical Quality Monitoring
Page
Assurance and Escalation Reporting
Page
Quality Visits
Page
Announced Quality Audit Visit
Page
Care Home Quality Monitoring Team & LA Announced Audit
Visit
Page
Unannounced/Concern visit (themed)
Page
Professional Observation Checklist
Page
Escalation Procedure for Level of Concern
Page
Suspension Procedure
Page
Unplanned Closure of Care Provision
Page
Unplanned Closure Activation Procedure
Page
CQC regulation
Page
Communications and Media
Page
Appendix One: Quality Monitoring/Escalation Process
Page
Appendix Two: Quality Monitoring letter template
Page
Appendix Three: Quality Monitoring Audit Action Plan
Page
Appendix Four: Derbyshire Care Home Provider - Professional
Observation Checklist
Page
Appendix Five: Care Provision Escalation Plan and
Accountability Framework - Summary
Page
Appendix Six: Derbyshire & Derby City Care Provision Closure
- Management Checklist
Page
Appendix seven: Derbyshire & Derby City Client Movement
Plan
Page
2
Context and Purpose
This operational guidance outlines the processes, actions and responsibilities of
NHS Hardwick Clinical Commissioning Group (HCCG) in the event of a care
provision concern within a Care Home in receipt of NHS Fully Funded Continuing
Healthcare, Funded Nursing Health or joint funded packages.
HCCG are the Lead NHS Commissioner for the quality of care provision in Care
Homes in Derbyshire and acts on behalf of the other NHS Clinical Commissioning
Groups (North Derbyshire CCG, Erewash CCG and Southern Derbyshire CCG).
A home may have individuals funded by both health and social care commissioners
and they therefore have a joint duty of care to ensure that the services
commissioned are of good quality, safe and effective.
The actions and responsibilities are identified at four ascending levels:
Level 1 Isolated/manageable Low level concern
Level 2 Persistent Low/medium Level concerns
Level 3 Serious/High Concern
Level 4 Persistent Serious/High or Significant Concerns
A Multi-Agency Concerns (MAC) meeting can be requested at any time during this
process and membership will reflect the level of concern. These meetings provide a
robust system of co-ordination of intelligence for all agencies including health, social
care, Care Quality Commission (CQC) and Police.
CQC, as a statutory regulator of care provision have their own independent alert
processes and can call a ‘Risk Summit’ meeting at any time if they have any serious
concerns.
The HCCG operational guidance is intrinsically linked to the NHS Standard Care
Home’s contract and safeguarding processes.
3
Routine Contract Compliance and Clinical Quality Monitoring
HCCG holds the Derbyshire and Derby City Nursing Care Provision Any Qualified
Provider (AQP) contract on behalf of all of the Derbyshire Clinical Commissioning
Groups and host the Care Home Quality Monitoring Team. The team consists of:
-
Registered Nurses x 3
-
Administration support
The team report to the HCCG Deputy Director of Quality and Safeguarding and are
accountable to the HCCG Chief Nurse.
The duties of the team are to:
-
Monitor the quality of care of AQP homes in conjunction with Local Authorities
(LA)
-
Provide regular activity and monitoring reports for CCG’s
Maintain a ‘live’ database of contracted AQP’s which will provide a single
point for recording ‘intelligence’ including ‘safe and well’ reports, audits and
concerns
-
Ensure that all AQP homes are visited at least once a year and audited once
every three years in conjunction with the LA when feasible. The visits will be
themed around a particular element of clinical care such as ‘End of Life’ or
Dementia. The reports and findings from these audits will be shared with LA
and individual AQP
-
Escalate and manage any issues or concerns raised during an audit or
‘whistleblowing’ in line with this operational guidance
-
Provide clinical support, in conjunction with the LA for all care provision to
ensure the delivery of high quality care for the population of Derbyshire,
including those that receive care out of area
-
Implement or assist with projects aimed at improving care provided
Assurance and Escalation Reporting
NHS HCCG Care Home Quality Monitoring Team meets on a fortnightly basis:
-
Review current suspensions
-
Share intelligence and identify potential concerns
-
Top three AQP and actions to address concerns from each area
-
Update business plan
4
-
Escalate concerns to the NHS HCCG Quality Committee
County and City LA Monitoring Teams meet on a monthly basis:
-
Membership includes representative from HCCG Care Home Quality
Monitoring Team
NHS HCCG Quality Committee meets on a monthly basis:
-
Escalation of concerns are reviewed by the membership
-
The quarterly care home report will be reviewed by the membership. Contents
will include intelligence from the AQP database, Derbyshire LA and Derby
City LA. The contents of the report are reliant upon the availability of
intelligence supplied by the LA’s. This should include:
-
CQC warning notices
-
Suspended Providers
-
New Safeguarding concerns
-
Prevention of Future Deaths (previously known as Rule 43’s)
-
Analysis of themes and trends from concerns
A copy of the report will be sent to the four respective CCG Chief Nurses in
Derbyshire.
NHS HCCG Governing Body meets on a monthly basis:
-
Chief Nurses report identifies any concerns and actions taken relating to
AQP’s
-
Concerns will be escalated to the Area Team Quality Surveillance Group
NHS HCCG Care Home Quality Group meets every two months:
-
Minutes are sent to the NHS HCCG Quality Assurance Committee for
information
-
Meeting is joint chaired by the LA and NHS HCCG
In addition there are a number of additional meetings associated with care provision
where concerns or intelligence may be discussed or escalated:
-
Care Provider Forums (County) held every six months
-
Greater East Midlands Commissioning Support Unit (GEM) quarterly meeting
-
Safeguarding Boards held quarterly
-
Care Provider Association meetings (City and County) held quarterly
5
Quality Visits
Members of the Care Home Quality Monitoring Team will use the following
guidelines for conducting announced and unannounced visits (appendix one).
However, there may be exceptional circumstances where the guidelines may be
circumnavigated in the interest of service users.
Announced Quality Audit Visit
The Care Home Quality Monitoring Team will give a minimum two week notification
of the quality audit visit. The care home manager will be informed verbally, followed
by written confirmation (appendix two). A copy of the quality audit tool will also be
sent to ensure relevant data is provided on the day of the visit.
Members of the Care Home Quality Monitoring Team will use the HCCG quality audit
tool during the audit.
All SOVA concerns identified during a visit will be reported and escalated using the
Derbyshire and Derby City Safeguarding Adults Policy, Procedures and Guidance
(http://www.saferderbyshire.gov.uk/what_we_do/safeguarding_adults/default.asp).
Concerns or issues identified during the visit will be recorded on the HCCG action
plan (appendix three). Any actions must have clear objectives with clear and realistic
timeframes. The severity of the concern/s will influence the grading level and
influence the required actions.
The care home manager will receive verbal feedback of the audit at the end of the
visit. Feedback will include positive elements and any remedial actions required (with
timescales). If required, a date for the action plan review meeting will be organised
with the care home manager. The relevant LA case manager will be informed of any
concerns.
The care home manager and LA case manager will receive a copy of the action plan
within 10 working days and a copy of the completed audit tool within 20 working
days.
The action plan review meeting will monitor implementation of the required
actions/improvements. Failure to achieve the required actions may result in
escalation of the concern level or contractual levers.
6
Care Home Quality Monitoring Team & LA Announced audit Visit
The Care Home Quality Monitoring Team and Local Authority will normally conduct
joint audit visits to facilitate joint working and sharing of intelligence. Both parties will
agree a lead for each audit visit to avoid duplication.
The nominated lead will give a minimum two week notification of the quality audit
visit. The care home manager will be informed verbally, followed by written
confirmation. A copy of the quality audit tool will also be sent to ensure relevant data
is provided on the day of the visit.
Members of the Care Home Quality Monitoring Team will use the HCCG quality audit
tool during the audit.
All SOVA concerns identified during a visit will be reported and escalated using the
Derbyshire and Derby City Safeguarding Adults Policy, Procedures and Guidance
(http://www.saferderbyshire.gov.uk/what_we_do/safeguarding_adults/default.asp).
Health related concerns or issues identified during the visit will be recorded on the
HCCG action plan (appendix three). Any actions must have clear objectives with
clear and realistic timeframes. The severity of the concern/s will influence the
grading level and influence the required actions.
The care home manager will receive verbal feedback of the audit at the end of the
visit in conjunction with the LA contract manager. Feedback will include positive
elements and any remedial actions required (with timescales). The nominated lead
will specify a date for the action plan review meeting with the care home manager.
The care home manager and LA case manager will receive a copy of the action plan
within 10 working days and a copy of the completed audit tool within 20 working
days.
The action plan review meeting will monitor implementation of the required
actions/improvements. Failure to achieve the required actions may result in
escalation of the concern level or contractual levers.
7
Unannounced/Concern visit (themed)
The Care Home Quality Monitoring Team will carry out unannounced visits following
receipt of intelligence which may indicate health related concerns/issues.
Unannounced visits may be jointly conducted with the relevant LA contract manager
but this may not always be relevant or possible and will be dependent upon the
concern raised and timescales.
Although not exhaustive, the triggers for an unannounced visit may include:
 Safeguarding concerns
 Whistleblowing
 CQC inspection outcomes
 Concerns raised by family or Healthcare Professionals
Prior to an unannounced visit, the Care Home Quality Monitoring Team will contact
relevant agencies if required to gain any further intelligence.
All SOVA concerns identified during a visit will be reported and escalated using the
Derbyshire and Derby City Safeguarding Adults Policy, Procedures and Guidance
(http://www.saferderbyshire.gov.uk/what_we_do/safeguarding_adults/default.asp).
Health related concerns or issues identified during the visit will be recorded on the
HCCG action plan (appendix three). Any actions must have clear objectives with
clear and realistic timeframes. The severity of the concern/s will influence the
grading level and influence the required actions.
The care home manager will receive verbal feedback of the audit at the end of the
visit in conjunction with the LA contract manager if applicable. Feedback will include
positive elements and any remedial actions required (with timescales). The
nominated lead will specify a date for the action plan review meeting with the care
home manager.
The care home manager and LA case manager will receive a copy of the action plan
within 10 working days.
The action plan review meeting will monitor implementation of the required
actions/improvements. Failure to achieve the required actions may result in
escalation of the concern level or contractual levers.
8
Professional Observation Checklist
In addition to announced and unannounced visits care homes have regular contact
with a wide range of Healthcare professionals. Hardwick CCG has developed a
Professional Observation Checklist (appendix four) which can be used to capture
and record any observations during a visit to a care home.
A copy of the checklist is available on the HCCG website and completed forms can
be submitted to a dedicated email address (insert email address). Concerns/issues
will be captured and recorded on the care home database.
Escalation Procedure for Level of Concern
Escalation of concern is categorised into four levels with a corresponding MultiAgency Concern (MAC) meeting (appendix five). However, this is not a linear
process and any level of MAC can be requested at any time by any organisation on
a case by case basis. CQC can request a Risk Summit meeting at any time for all
organisations.
Level 1 Isolated/manageable Low level concern: day to day business and/or low
level concerns to address care provider.
Predominantly raised at the regular Multi Agency Information Sharing Meeting (MAC
1) that is attended by senior representatives of:
-
CQC (Chair)
-
NHS HCCG Care Home Quality Team
-
Derbyshire Care Home Contracting and Compliance Team
-
Derby City Service Quality Team
-
Continuing Health Care Team
-
Adult Safeguarding
Level 2 Persistent Low/medium Level concerns: concerns continue and need
some formal action including SOVA.
The Care Home Quality Team will investigate the nature of concern and implement
the following actions:
-
Document and inform the AQP of the actions required and set realistic
timescales
-
Increase monitoring levels
9
-
Inform LA contracts team, Greater East Midlands Commissioning Support
Unit (GEM) and Continuing Healthcare (CHC) and record on concerns
register/AQP database
-
Use monthly meetings to share intelligence and agree joint monitoring
requirements
-
Liaise with affected General Practitioner
-
Liaise with GEM to consider issuing a contract query or performance notice
-
Arrange a Multi-Agency Concerns meeting (MAC 2)
Level 3 Serious/High Concern: Significant and/or sustained concerns that require
enforcement action, including planned suspension of contract.
The Care Home Quality Team will investigate the nature of concern and implement
the following actions:
-
Meet with the provider to review concerns
-
Establish an action plan with defined timescales and outcomes
-
Consider issuing a performance notice or warning notice
-
Communicate any suspension notice to monitoring managers across LA, CHC
CQC, CQC, field workers and relevant GP/community staff
-
Inform GEM
-
Consider need for Multi-Agency Concerns meeting (MAC 3) for contract
termination with senior managers
-
Specify areas of concern, risk assess, mitigating action and agree increased
levels of monitoring
-
Formal reporting into CCGs, LA contract managers and CQC
Senior managers may take an active role in the action. Consider meeting with
residents/clients and representatives and agree communication strategy.
Level 4 Persistent Serious/High or Significant Concerns: Care provision at risk of
urgent closure.
The Care Home Quality Team will implement the following actions:
-
Report through the Multi-Agency Concerns (MAC) meeting as per procedure
for risk of urgent closure
-
Liaise with other authorities including LA contact teams/senior managers
10
-
Inform GEM
-
Clinical lead will have responsibility for overall monitoring of the service and
response to the action plan requirements
Senior managers will organise Multi-Agency Concerns (MAC 4) meeting and
agree lead responsibility and assign responsibilities for various components.
Suspension Procedure
Suspension of new placements with providers is only an option where evidence is
recorded or information received where the safety of clients could potentially
compromised (Level 3 or 4 concerns). Prior to any suspension there must be
evidence of positive support with the care provider to enable them to continue their
business. Suspensions in all care homes with nursing care must be carried out in
partnership with the LA.
The whole process of monitoring visits, visits to address concerns and action plans
all contribute towards informing the suspension process. All monitoring visits are
logged and documented to provide evidence to support suspensions. Action plans
should be proportionate and time limited.
A default notice may be issued where a provider repeatedly fails to meet actions
specified in the action plan. This may be the first stage to suspension and gives a 10
day response period.
Suspensions can be put in place without the need of a default notice if there are
serious concerns about the quality of care and support i.e. ongoing concerns
regarding staffing, drug administration or clinical care. Where there are serious
concerns and a clear breach of the registration standards then CQC may decide to
take enforcement action. This could ultimately remove the provider’s registration
which may mean temporary or final cessation of business and closure.
The decision to suspend a care provider is taken by Director or senior manager
level, they review the evidence including the provider’s attempts to address the
concerns and where appropriate seek legal advice. Any decision to suspend will be
documented.
11
Unplanned Closure of Care Provision
Unplanned care provision closures can present particular challenges in that
intervention would be required immediately and the assessment and transfer of
residents to alternative care facilities may take place within a very short time frame.
Derbyshire and Derby City LA escalation plan defines an unplanned closure as one
that occurs during a period of 1-60 days.
Unplanned closure may be as a result of:
-
Notice of proposal to remove registration by CQC
-
Decommissioning of care by commissioners
-
Provider no longer financially viable
-
An emergency situation e.g. infection control, flooding, fire
The closure of a single care provider imposes stress on a local market, whereas the
closure of a large corporate provider involving several care provisions in the same
area at the same time will present challenges that may require the involvement of a
number of neighbouring CCG’s and Local Authorities to identify alternative capacity.
The LA may implement local emergency planning procedures and care provider
business continuity plans.
It is recognised that every situation is different and it is up to the Care Home Quality
Team and HCCG senior managers to decide the best approach for the situation
presenting at the time.
The transfer of resident/clients to alternative care facilities is dependent on the
assessed needs of the resident and availability of spare capacity in the local market.
The re-location process will normally be led by GEM and CHC, supported by LA field
workers.
Unplanned Closure Activation Procedure
The decision to de-register a location is invoked by the CQC. The decision to
decommission care which may lead to care provider closure is taken jointly by LA
and HCCG. The decision to activate this plan will come from the lead personnel with
the lines of accountability for activation (HCCG Chief Nurse and the LA Corporate
Director of Health and Adult Services). The expectation is that the LA, HCCG and
CQC will agree activation jointly and work in partnership.
12
As soon as closure notification is received or potential closure identified, the HCCG
Care Home Quality Team must be notified immediately by telephone with
confirmation in writing (email). Staff passing information to and from the Care Home
Quality Team must ensure that it has been received.
If the closure is linked in any way to the safeguarding of vulnerable adults (SOVA),
the Safeguarding Adults Team should be notified immediately.
HCCG, LA or CQC will arrange a Multi-Agency Concerns meeting (MAC 4) if
possible on the same working day, or if not, the next working day, to agree a plan of
action. In order to ensure timely involvement of all key parties including CQC, this
may necessitate ‘virtual’ meetings such as through teleconference.
At the initial MAC 4 meeting the Lead Officer will be nominated and will:
-
Have responsibility for ensuring that all decisions are made and implemented
in a timely manner
-
Ensure minutes are taken of each meeting with agreed actions and circulated
to team members and heads of service
-
Agree a password to protect documents
-
Decide on the frequency of meetings, agree a core group of members who
are kept informed and responsible for cascade of information in their own area
-
Ensure that the meeting will also discuss, if deemed appropriate, potential
measures to prevent or delay closure (e.g. short term additional funding or
assistance from HCCG or LSs).
The impact of urgent relocation upon residents and their relatives and carers should
be managed in the best way possible by working to the agreed guidance documents,
to minimise disruption and distress:
- Provision Closure Management Checklist (appendix six)
- Resident Movement Plan (appendix seven)
CQC regulation
Registration requirements are the responsibility of the CQC and are measured
against the CQC Essential Standards of Quality and Safety. CQC provide relevant
regulatory information concerning care provision to partner organisations and
support the overall messages of quality at local level.
13
In cases of serious breach of regulations CQC may instigate enforcement action with
the provider, which could mean possible home closure.
CQC hold Critical Summit Meetings with commissioners to share information and to
advise of concerns and actions they are taking with individual providers that are
giving concern.
The Care Quality Commission may issue Warning Notices when the Provider’s care
falls below the requirements in the essential standards of quality and safety. A press
release summarising each Warning Notice is issued by CQC on their website, which
the press may then choose to publish. Assurances will be needed about what
actions will be put in place and improvements made.
Required Actions by the Provider:
 A letter should be sent out to all clients and/or their families (within a
maximum of 5 days of notification) that clearly sets out the following:

That a Warning Notice has been issued and what it is about

What the Provider has done to remedy the concerns

The name of an individual (s) and contact details the client and/or family
member can contact at the Provider Organisation if they have any queries.
Where concerns are very serious and where more than one Warning Notice has
been issued it is recommended that a client and relatives meeting is held to give
assurances. The Provider shall, send a copy of the letter to the Council, Health and
CQC.
Consideration will be given to sharing information relating to the Warning Notice with
clients and their families, especially if the Provider fails to do so. Commissioners will
liaise with the Provider and other Stakeholders about the impact of the Warning
Notice and what action might be required for example action plan put in place and
temporary suspension of contracts for new placements whilst improvements are
made.
Good practice would be for the Provider to advise clients/families when the Notice(s)
has been lifted.
14
Communications and Media
The communications lead, hosted by GEM, is contacted with the details. This person
will work in partnership with the LA communications lead and will usually issue a joint
statement
15
Appendix One: Quality Monitoring/Escalation Process
CHQT announced
quality audit visit
Unannounced/Concern visit
CHQT & LA joint
announced audit visit
(themed)
Verbal notification/written notification
(minimum 2 week notice)
Conduct visit
No
Concerns identified
Verbal Feedback on the
Day
Yes
No
Written Feedback within
20 working days
SOVA
concerns
identified
Report as per
Derbyshire and Derby
City Safeguarding
Adults Policy
Verbal Feedback with
remedial actions required (with
timescales)
Normal quality monitoring
Yes
Written Feedback, including
copy of action plan within 10
working days.
Copy of completed audit tool
within 20 working days.
Follow up quality visit
No
Yes
Ongoing Quality Concerns
Default notice issued
Yes
Concerns addressed
Follow up quality visit
Normal quality
monitoring
No
Suspension of new
placements/Contract
16
Appendix Two: Audit Letter Template
Scarsdale
Nightingale Close
Newbold
Chesterfield
Derbyshire
S41 7PF
Care Home Manager Name
Address
Date: Insert
Telephone: Insert
Dear Insert
Re: Quality Monitoring – Independent Sector Residential/Nursing Contract
As part of our commissioning responsibilities Hardwick Clinical Commissioning
Group and Derbyshire County / Derby City Council contract / quality monitoring in
independent sector care homes. For this purpose I have arranged to visit your home
along with insert name from the Local Authority on date to conduct an audit. We will
arrive at approx. time.
The visit may take up to a full day. This will not involve your time directly for the
whole of this period, but we would be grateful for some time with you at the start of
the day and then again at the end, so that we can give you feedback from the visit.
The visit will include an examination of files and documentation, a tour of the home
and may include discussions with staff and any visitors that may be present. Please
find attached a copy of the audit template so that you can prepare for this visit.
As employees of the CCG we are bound by confidentiality and have undergone DBS
checks as appropriate to our role.
Please do not hesitate to contact me if you have any queries.
Yours sincerely
Insert
17
Appendix Three
Hardwick Clinical Commissioning Group
QUALITY MONITORING AUDIT ACTION PLAN
Type of Inspection …………………………………… Date of audit/visit ................................................
Care Home.........................................................
Manager………………………………………
Undertaken by...........................................................Accompanied by..................................................Overall Score..............................
Section
Problem Identified
Recommended action Time Frame
Action taken / date
.
.
Compiled by......................................
Designation.......................................... NH Manager signature…………………………………
Please retain a copy of this action plan with the audit results.
Appendix Four
Derbyshire Care Home Provider - Professional Observation Checklist
Name of Care Home provider:
Name and title of Observer
Date of visit:
Purpose of visit:
Please complete this form after every visit and return to: email box to be set up
Prompts
Environment
Did the home smell pleasant?
Was the home tidy and in good order?
Did the home/equipment appear to be clean?
Did you see a good standard of food & drinks?
Resident(s)
Did you see the resident you are reviewing?
Was the resident(s) dressed appropriately and
in clean clothing?
Did the resident(s) appear well cared for e.g.
hair combed, clean finger nails, positioned
comfortably?
Resident’s own room
Was the identified equipment (from care plans)
in place i.e. profile bed, mattress, sensors, call
bell, hoist?
Was the room ‘clean’ and tidy?
Staff
Did there appear to be enough staff on duty?
Were the staff polite and courteous?
Did the staff treat the residents with dignity
and respect?
Were the staff professional in their attitude and
approach towards each other, residents and
visitors?
Did you see evidence of good infection
control, health and safety, use of equipment?
Care plans/ Support plans
Were the care files up to date and
information easy to access?
Do you have any medication concerns?
If ‘No’ to any questions did you inform the
manager of the service?
Did you agree any actions and if so ‘what’
and by ‘when’?
Any other comments;
Yes No
Not
obs
Comments
Appendix Five: Care Provision Escalation Plan and Accountability Framework - Summary
Guidance Notes
a) Potential media involvement must be considered on a case by case basis.
NHS Quality
Monitoring
NHS & LA Operational Staff
Example
Continuing
Health Care
Assessors
LA Field
Workers
Primary and
Community
Staff
LA & Health
Safeguarding
Team
NHS Hardwick
CCG Care Provider
Quality Team
LA Contract & Compliance
Monitoring
Senior Managers /
Directors
Derbyshire
County
Council
NHS Hardwick
CCG, Derbyshire
County and Derby
City Councils
Derby
City
Council
Care Quality
Commission
North Derbyshire
and Derby City &
South Derbyshire
Level 1 - Concerns (day to day business, low level concerns to address care provider)
CHC Assessor
will assess
resident/client
and liaise with
care provider
staff.
Field Worker
will assess
resident/client
and liaise with
care provider
staff. May
send contract
monitoring
form.
GP / DN /
Pharmacist /
Paramedic
will note in
case records
and liaise as
appropriate
with Care
Manager
May not have
a role at this
stage
Clinical and
contracting
officers
Review quality and
contract monitoring
Routine
contract
monitoring
Service
Quality
Team log
concern on
database and
follow up for
action
No role
CQC Inspectors will
advise Care Manager
accordingly during
regulatory visits and
when information of
concern is received by
the CQC office
21
22
23
Appendix Six: Derbyshire & Derby City Care Provision Closure - Management Checklist
The following checklist provides a framework for managing a Care Home closure (or potential closure). Please note that this list is
not exhaustive. It is up to the Joint Incident Steering Group to determine actions as necessary based on individual circumstances.
Date:
Name of Care Home:
Steering group members:
Responsibility
(to be completed by the Joint Steering Group)
Action
Joint Incident Steering Group
For group membership – see section 8
1.1
Assemble team and plan the work
1.2
Appoint team leader
Initial work/clarification
2.1
Establish timescales for closure
2.2
Establish number of residents/clients affected and user category
and who funds them
2.3
Seek an up to date list of Care Home vacancies (liaise with CQC as
necessary)
2.4
Consult adjacent local authority offices as necessary
2.5
Establish tasks and timescales and allocate them
2.6
Allocate lead workers, (preferably based on site) equipment and
management support requirements
2.7
Consider equipment issues: mattresses, furniture, hoists, packing
boxes etc
2.8
Arrange a meeting with Home Owners/others
HCCG
LA
Care Home
24
2.9
2.10
Clarify if the Home has a business continuity plan in place as part of
the contractual arrangements that can be used
Agree when and how users are informed and by whom
2.11
Check that the Home Owner allows free and open access by
professionals to the Home over the relocation period
Action
2.12
Agree the ‘need to know’ information that should be shared with
other parties e.g. care professionals; GP; CCG urgent care lead;
potential care providers
2.13
At the time of a potential closure, investigate the potential of Care
Home staff or voluntary groups to facilitate residents/carers visiting
other Care Homes
2.14
Identify key Care Home Management staff to be involved
2.15
Contact details of Home Owner/Manager
2.16
Identify site (s) for offsite meetings for management team/Care
Home staff if required
2.17
Other agencies to be involved?
2.18
Follow Serious Incident (formerly known as Serious Untoward
Incident) procedure and in addition, consideration to be given
through the Safeguarding Vulnerable Adults Board as to whether a
Serious Case Review would be commissioned
Residents/clients
3.1
Assemble an accurate list of all residents, and their needs – and
confirm numbers with Care Home. Also any special factors
3.2
Agree responsibility for assessing any self-funding or out of county
residents
3.3
Check current Registration category
3.4
Assess residents to identify possible change of category
3.5
Check if any very frail people need exceptional arrangements
3.6
Identify residents wishing to move sooner rather than later
HCCG
LA
Care Home
25
3.7
Identify residents who should be assessed early in the project work
due to their predisposition to stress, anxiety or complexity or for
other factors
3.8
Assessment of Residents/client’s capacity to make decisions
3.9
Identify user advocacy including IMCA where required
Financial responsibilities
4.1
Any Out of County funded residents/clients? Make aware of
situation and confirm whether they wish the steering group to act on
their behalf to relocate Residents/clients
Action
4.2
Identify LA funded residents
4.3
Identify HCCG funded residents
4.4
Identify whether there are any private funded Residents/clients and
who will take responsibility for their care
4.5
Identify any Residents/clients who are funded by the Department of
Work and Pensions or have Preserved Rights
4.6
Check current fee level being paid
4.7
Investigate cost of potential new placements
4.8
Take a legal view and response, on the period of contract
payment/termination issues etc.
4.9
Consider issues such as petty cash etc.
Carers
5.1
Ascertain the list of names, addresses and telephone numbers
5.2
Identify carers who may have special factors to consider – own
health, out of county etc.
5.3
Seek fullest involvement of relatives in relocation process
5.4
Contact advocacy groups to support carers
Consultations/information management
6.1
To ensure the process runs smoothly it is essential that all groups
are consulted:
Residents/clients
HCCG
LA
Care Home
26
Care Home Staff
Families/representatives
Public/press via communications lead
Appropriate internal staff all agencies
Relocation (if decision is made to close)
7.1
Re-assessment of residents and adequate resource requirements to
complete
7.2
Check choice (s) of area/Homes available that are compatible with
residents/client category with resident/carer
7.3
Maximise resident/carer ability to make an informed choice about
compatible area/Homes available
7.4
Are there friendships between residents that need to be
maintained?
7.5
Offer opportunity for resident/carer to view/visit/trial visit Care
Homes
7.6
Seek Care Home staff help to inform/visit potential Homes with
resident where applicable
Action
7.7
Decision by resident/carer on new Home and date to move
7.8
Help of Care Staff to take or escort residents to potential new
Homes on placement?
7.9
Arrange schedule transport to new Homes, in and out of county e.g.
car/minibus/ambulance – identify cost and who pays
7.10
Ensure residents are accompanied by someone familiar on the day
of the move, including carers if possible
7.11
Use current Care Home staff to the fullest; passing on their
knowledge of residents to new Homes, escorting, transporting etc
7.12
Staff handover to new Homes – verbal and written. Care
summaries, including care plan that details health and social care
needs
7.13
Respect Care Home staff friendships with residents and likely
HCCG
LA
Care Home
27
concerns for their future welfare. Find opportunities for current Care
Staff to verbally discuss residents care needs summary with
received Home Care Staff, where appropriate to do so
7.14
Maintain a log of decisions and movement of residents
7.15
Move residents at their own pace/convenience as far as possible
and contact within 48hrs to ensure the resident is ok.
7.16
Programme Social Worker/nursing reviews at 4 weeks and as
necessary thereafter
7.17
Resident medications and treatment details to go with residents
7.18
Particular attention to be made to ensure correct identification of
relocated residents
7.19
Change of GP and new Home recorded
7.20
Placements made Out of County should be notified to the receiving
CCG/Local Authority
7.21
Homes Residents/client information/case files/summaries/transfer
with Residents/clients
7.22
Consider how many family members/friends might visit the resident
in the new Care Home, can we assist them to do so
7.23
Notify Department of Work and Pensions of change of Home
7.24
Liaise closely with the LA Commissioning Team (new contracts
need to be issued, old contracts terminated)
Action
7.25
Consider whether moves should be arranged to coincide with the
moving of other residents or spread over more than a week (if time
is available)
7.26
Consider the desirability of temporary/second moves
Quality assurance
8.1
Ensure Care Home is Registered for the category of care required
8.2
Liaise with CQC, HCCG, LA staff to ensure there are no concerns
about the Care Home
8.3
Conduct a debrief after every incident to identify good practice,
HCCG
LA
Care Home
28
lessons identified and further actions to be taken
8.4
Incident follow up through with the use of the Serious Case Review
process if instigated
Record keeping
9.1
Maintain a record of meetings, decisions made
9.2
Designate an administrative lead to collate all records
9.3
Conduct a debrief involving all staff involved to evaluate the closure
process and produce report including any recommendations
9.4
Residents/client outcomes should be recorded, particularly with
regard to their health
Additional Notes:
29
Appendix Seven: Derbyshire & Derby City Client Movement Plan
New provider
identified,
Surname
Forename
Care First
ID/NHS No.
Cat
Funding
source
NOK
Professional
contact
Name of
current Care
Provider
date of intended
move and actual
completion
Individual needs
eg mobility,
diversity
Does the client
have the mental
capacity to
agree to a
move?
30