Quality Assurance Policy

and Procedures London Borough of Barking and Dagenham

Adults’ Care and Support

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Contents

PART ONE: QUALITY ASSURANCE POLICY

Section Title Page No.

1. Introduction and overview 5

What is Quality Assurance? 6

Who is involved in Quality Assurance 7

Care and Support Hub 10

2. Understanding this policy 11

Purpose 11

Definitions 12

Scope 12

3. Core quality principles 13

4. Existing frameworks 14

Care Quality Commission (CQC) 14

East London Solutions (ELS) 15

5. Safeguarding 16

6. Sharing practice and collaborative working 18

Provider forums 19

Local Quality Surveillance Group

Commissioners’ Network

19

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Health Watch 19

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PART TWO: QUALITY ASSURANCE PROCEDURES

1. Monitoring and assessing risk to inform our

approach

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Monitoring visits 21

Monitoring reports 23

Complaints, Serious Incident Reviews and Safeguarding

Alerts

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Risk assessment 24

2. Improving quality 26

Safeguarding and Quality Group 27

Improvement and sustainability plans 28

Suspension of Placements 28

Provider failure 29

3. Our QA approach with specific provider groups 29

Residential and nursing care 30

Home (domiciliary) care 31

Supported accommodation 32

Other community based support and micro-providers 32

Personal Assistants 34

Appendix A Key definitions 35

Appendix B Safeguarding Concern Form 37

Appendix C Example questions from service user survey 46

Appendix D Supported Living/Nursing/Care Homes monitoring form 49

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Appendix E Dom/Home Care/Floating Support monitoring form 84

Appendix F Sheltered Housing monitoring form 97

Appendix G Monitoring Report Template 123

Appendix H Risk Assessment and Risk Thresholds 125

Appendix I Serious Incident form 130

Appendix J Improvement and sustainability plan 136

Appendix K

Appendix L

Example of suspension of placements letters

Provider Failure Policy

137

139

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PART ONE:

QUALITY ASSURANCE POLICY

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1. Introduction and overview

1.1 The Care Act1 (the Act) came into force on 1 April 2015. The Act represented the biggest change to adult social care in over 60 years and included a number of reforms to the law relating to the care and support of adults. The Act explicitly states that there is a duty placed upon the Council to promote an individual’s wellbeing. The Act also states that the Council has a duty to prevent the development of care and support needs and where these do develop the Council has a duty to carry out an assessment of needs. For the purpose of this policy in particular, it is also the responsibility of the Council to ensure there is a wide range of high quality care and support services available to residents as well as good information on these services for adults and carers to access. Under Section 5 of the Care Act the Council now has duties in relation to Market shaping which means the local authority collaborating closely with other relevant partners, including people with care and support needs, carers and families, to encourage and facilitate the whole market in its area for care, support and related services. This includes the design of strategies that meet local needs, engaging with providers and local communities, understanding and helping develop the market, ensuring an integrated approach with local partners, ensuring there are enough suppliers in the local market and ensuring quality through contracting. Where a provider is likely to fail the Council has a duty under the Care and Support (Business Failure) Regulations 20152 to meet needs for as long as the Council feels it is necessary.

1.2 This policy sets out the overarching principles and key processes that enable the London Borough of Barking and Dagenham (LBBD) to ensure that services offered to our residents are of the highest quality. We define high quality services as those that provide excellent care, tailored to the needs of each and every individual they serve. We are committed to making sure that residents receive the level of service that they deserve and need.

1.3 All Local Authorities have a statutory duty of Best Value, in addition to a duty to develop the local market in high quality services. LBBD are also required to ensure that value for money in the commissioning of services is achieved.

1.4 Central to the provision of high quality services in social care is the requirement of all services to have in place clear and robust safeguarding procedures as set out by the London Multi Agency Adult Safeguarding Policy and Procedure3 which the Council has adopted. Protecting adults at risk is the business of everybody in Barking and Dagenham, including all organisations that adults at risk of abuse or neglect may access and work with.

1.5 This policy is also an integral part of the response to the emphasis on choice and control for individuals over the services that they use, as explicitly set out in the Act.

1 For details of all the changes in the Care Act, please refer to the Department of Health’s factsheets on the

Care Act1, which provide an overview and information on the duties and powers of Local Authorities. 2 http://www.legislation.gov.uk/ukdsi/2014/9780111124161 3 http://londonadass.org.uk/wp-content/uploads/2015/02/LONDON-MULTI-AGENCY-ADULT-SAFEGUARDING-POLICY-AND-PROCEDURES.pdf

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This represents a major shift to personalisation in Adult Social Care services. This shift has brought about a different way of working in Adult Social Care. As the numbers of people receiving a self managed direct payment or personal budget and funding their own care increases, it is likely that more people will purchase services from organisations that have not been through a formal procurement or tender process with the Council. In response LBBD offers an accreditation scheme and inclusion on LBBD’s website of accredited providers for those who choose to be accredited. This framework for accreditation was developed in conjunction with other Boroughs in East London and has now been adopted by Barking and Dagenham. It also provides users of self managed Personal Budgets and people who self fund their care, assurance when purchasing these services.

What is Quality Assurance?

1.6 Quality Assurance (QA) provides the Council with information on the quality, performance and effectiveness of services delivered to our residents. Barking and Dagenham adopts a proactive approach to quality assurance through collecting data, speaking to frontline staff and, most importantly, listening to people who use services. We draw on this information to support and work with providers to improve and maintain high quality services.

Figure 1 - Quality Cycle

Figure 1, the Quality Cycle, shows the overarching process of quality assurance from planning to improvement.

Quality Assurance

Plan

Implement

Monitor

Improve

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Plan

1.8 Planning involves identifying what outcomes we wish to achieve. LBBD takes into account legislation such as the Care Act 2014, as well as local needs and demographics such as age, gender, ethnicity, propensity of disability/ill health within the community and level’s of deprivation. Once the desired outcomes have been identified, current provision is then measured against these outcomes to determine the levels of current service delivery. Where gaps are identified Commissioning can then define and set the new goals and objectives.

Implement

1.9 Implementation is where change takes place and new services or practices are begun.

Monitor

1.10 During the monitoring phase information is gathered for comparison, at this stage we determine whether we have achieved the planned goals and objectives and whether the service is performing to the standard that we expect.

Improve

1.11 Once the information has been analysed we can determine how well the changes have delivered our intended goals and objectives. We can also determine what else can be done to improve the process further. We can now begin to plan those new objectives.

Who is involved in Quality Assurance?

1.12 Quality assurance is dependent on a number of different functions working well together, namely Commissioning, the Quality Assurance team and social workers and other operational colleagues within Adults’ Care and Support (ACS). ACS front line staff support quality assurance by providing information to the Quality Assurance team on provider concerns, safeguards and reporting good practice. Quality Assurance use this information along with feedback from service users and carers, its own internal monitoring and that of other bodies such as CQC, to assure itself that standards are high and to take improvement action with providers where standards have dropped below an acceptable level (See Part 2 – Quality Assurance Procedures). Quality Assurance as well as ACS can alert Commissioning of provider concerns and commissioning can then hold providers to account through contractual arrangements (where they exist) between Barking and Dagenham and the provider. Commissioning also has a key function in developing and shaping the local care market which in turn enables ACS front line workers to support adults with care and support needs to choose from a range of high quality services at the support planning stage.

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Commissioners

1.13 It is the responsibility of Commissioning to design, shape and deliver a range of services that adults can choose from to meet their care and support needs. Commissioners look at levels of need both now and in the future, identify gaps in provision and develop and procure services in consultation with relevant professionals and adults with care and support needs. Much like the Quality Cycle above, Commissioners work to a Commissioning Cycle as outlined below in Figure 2. In terms of Quality Assurance, Commissioners ensure that quality assurance is performed throughout the Commissioning Cycle, particularly in the ‘Monitor’ stage. Commissioners will work closely with social workers and the Quality Assurance Team to monitor providers and work through issues of quality in the market.

1.14 Contractual arrangements will specify the quality assurance, outcomes and performance standards expected of a contract. The role of the Commissioner is to increasingly work with the market to respond to the needs of the adult and ensure services are available for them to purchase, rather than the traditional model of the Council being the buyer of services on their behalf.

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Figure 2 – The Commissioning Cycle

Figure 2, shows the Commissioning Cycle adopted by Commissioners in Barking and Dagenham

Social Workers and other operational colleagues

1.15 Social workers and other operational colleagues in Adults’ Care and Support (ACS) provides assessment and review services for people who may have care and support needs. Once eligibility has been determined, ACS will develop a support plan with the adult to identify how best to meet the adult’s needs. Adult’s can also choose a Direct Payment to purchase their own services. ACS will then carry out regular reviews to check whether the adult’s needs have changed and whether the support plan continues to meet those needs. LBBD has a statutory duty under the Care Act to ensure that adult’s with care and support needs are protected from abuse and neglect irrespective of whether they are in receipt of services. This is based on the fundamental principle that all adult’s with care and support needs have the right to live in safety, free from abuse and neglect. In LBBD the responsibility for investigating concerns of abuse or neglect lies with the ACS Teams.

1.16 Operational teams in Adults’ Care and Support and also the North East London NHS Foundation Trust (NELFT) have a great deal of contact with both service users and

Commissioning Cycle

Analyse

Review

PlanDo

Monitor

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providers and will work closely with Commissioners and the Quality Assurance team to share concerns regarding quality. Where safeguarding enquiries are taking place, ACS and NELFT teams will ensure that Quality Assurance and Commissioning are included where providers are involved.

Quality Assurance Team

1.17 LBBD has its own Quality Assurance Team whose service review officers carry out planned and unplanned monitoring visits of providers of care and support services in the borough. The QA team works closely with both the Commissioning units and the Adult’s Care and Support teams to ensure that all providers maintain standards and where there are concerns, that providers are supported to carry out the necessary changes to ensure high quality services to the local community. The team will also work with the Disability Service, Community Solutions and Healthy Lifestyles around quality assurance activity. This will evolve as the services are embedded in 2017.

Clinical Commissioning Group

1.18 The Clinical Commissioning Group (CCG) work closely with Quality Assurance, Commissioning and other colleagues where concerns are raised regarding the health elements of a provider’s service, for example the administration of medication or the performance of nursing services in a nursing home. Colleagues within the CCG will share intelligence with the local authority and will undertake joint planned and unplanned reviews of provider services with the Quality Assurance team. The CCG will also support providers to take necessary actions where improvements are identified.

Other

1.19 A range of other colleagues may also be involved in the Quality Assurance process, including:

• The Performance team, particularly in providing data and intelligence to support the quality assurance process;

• The Complaints team;

• Environmental Health.

Care and Support Hub

1.16 Once quality services are verified, either via registration through the CQC or via the local accreditation scheme, they are included on the Council’s Care and Support Hub4. The Care and Support Hub is an online Adult Social Care service directory, which offers the opportunity for residents to view a range of services available in Barking and Dagenham, with the knowledge that these services have gone through the Council’s accreditation process. The Hub aims to help residents to make better informed decisions about the care and support they want to purchase through their direct payment.

4 http://careandsupport.lbbd.gov.uk

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1.17 The Care and Support Hub acts as the front door to Adult Social Care Services in Barking and Dagenham and is central to the quality assurance process. Only providers that reach the Council’s clear standards for quality are included on the Hub. Inclusion on the Hub both promotes providers and provides a quality mark for their service delivery. To be included on the Hub, a provider must be either:

• a contracted provider;

• a CQC registered provider;

• a provider who has met the minimum standards of the Borough’s accreditation scheme (see Section 4 below); or

• a Personal Assistant (PA) who has been quality checked by the Local Authority PA Coordinator.

1.18 The Care and Support Hub also contains valuable information for both providers and professionals in the ‘Provider and Professional zone’5 as well as the information included in the advice pages and the rest of the service directory. Additionally, the BanD Together Routemaster website is a useful website for providers and professionals in terms of finding organisations that provide advice and support in the Borough6.

2. Understanding this policy

Purpose

2.1 This Policy outlines the approach that Adults’ Care and Support uses to ensure that all care and support service providers are delivering to a consistent and high standard of quality across the Borough.

2.2 The key aims of the policy are to:

• ensure transparency for providers and residents in our approach;

• give clear and accountable information on the processes and procedures used to quality assure, particularly in the context of personalisation where we no longer rely solely on contract monitoring to monitor performance;

• provide clarity on how the local quality assurance policy fits with existing quality assurance frameworks such as the Care Quality Commission (CQC) and the Borough’s accreditation scheme for providers (previously the East London Solution (ELS) framework); and

• clarify the relationship between Quality Assurance and Safeguarding.

2.3 The document outlines the guiding principles for quality assurance in Barking and Dagenham, how we monitor quality with providers and the processes that we use to improve quality. This includes information on the different quality assurance

5 http://careandsupport.lbbd.gov.uk/kb5/barkingdagenham/asch/site.page?id=BPLgNW9ZDlQ 6 http://bandtogether.co.uk

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frameworks, risk management, safeguarding and what action will be taken if a service is failing to deliver.

2.4 It is intended that this document will be used by commissioners, providers, residents and Local Authority staff (including social care staff) to understand the expectations and processes used to quality assure.

Definitions

2.5 A comprehensive list of definitions of terms relating to Adult Social Care can be found at the following link: http://www.thinklocalactpersonal.org.uk/Browse/Informationandadvice/CareandSupportJargonBuster/

2.6 Key definitions specific to this policy are given at Appendix A.

Scope

2.7 Adults’ Care and Support services include services for adults aged 18+ who have care and support needs that require extra support to meet their needs. These needs could include people living with learning disabilities, mental health needs, physical and sensory disabilities, and older people. The types of services available for these individuals and included in the scope of this policy are:

• Residential and nursing care (including our in-Borough homes);

• Respite;

• Home (domiciliary) care;

• Supported accommodation;

• Personal Assistants;

• Micro-providers;

• Payroll providers;

• Day opportunities; and

• Floating support.

2.8 Each of these areas will be discussed in turn in Part Two: Quality Assurance Procedures.

2.9 The above list is not exhaustive, and as new types of services or providers enter into the market, we will need to develop our quality assurance approach. For example, the Borough is currently looking at increasing opportunities around ‘shared lives’ schemes and we will need to think about how we quality assure this type of support in the future.

2.10 The different types of services that are available for service users and included in the scope of this document include:

• Contracts tendered through the Council;

• Services provided by the Council (in-house);

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• Services spot-purchased by the Council;

• CQC regulated services;

• The Personal Assistant market; and

• Other community based services and micro-providers that could be purchased via a direct payment or managed personal budget.

2.11 There is some variation in the way that we quality assure different types of services. However, the overarching principles and key procedures detailed in this Policy apply across the board.

2.12 It should be noted that the Quality Assurance Policy and Procedures apply to providers who operate in the Borough of Barking and Dagenham. Providers used by Barking and Dagenham residents who operate in other Boroughs are subject to the quality assurance policy and procedures of the Borough in which the provider operates. Where concerns regarding any Out of Borough Providers are brought to the attention of Barking and Dagenham workers, for example through social work reviews, we will alert the appropriate Borough to the concerns, and participate in the appropriate quality assurance activity. Additionally, where Boroughs alert us to their quality assurance concerns, we will participate in any appropriate quality assurance activity and we will review our service users to ensure that our residents are receiving a quality, and safe, service.

3. Core quality principles

3.1 There are a number of core principles that guide how we assess quality. These principles should underpin the delivery of all adult social care services and are integral to ensuring residents receive high quality care and support.

3.2 The core quality principles are:

• Assessing service quality should be based on an evidence based outcome-focused approach;

• Services must demonstrate a measurable positive contribution to the health and wellbeing of their service users;

• Customer experience is at the heart of quality services – service users and carers will be involved in defining standards expected of services and in how the quality of services are monitored in a meaningful way. Where adults with care and support needs have substantial difficulty in participating in the process, lack capacity or there are safeguarding concerns, advocacy will be available to support them to take part in the process and/or to participate in the process of best interest decision making;

• Service users must have choice regarding service provision and be provided with information that enables them to make an informed choice;

• Quality services recognise diversity, are inclusive of all, and promote equality;

• Staff training and development is central to maintaining and improving quality;

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• Confidentiality, security and commercial sensitivity will be maintained at all times in line with freedom of information and data protection legislation; and

• Providers are always responsible for the quality of the work that they do.

3.3 LBBD have signed up to Unison’s Ethical Care Charter 7 and expect homecare providers to adhere to this to ensure the work force receive fair conditions of employment.

3.4 We work to these principles alongside key national standards such as the Care Quality Commission Fundamental Standards8, which give clear guidance on the expectations a customer should have of a service. Standards include:

• Person-centred care: You must have care or treatment that is tailored to you and meets your needs and preferences.

• Dignity and respect: You must be treated with dignity and respect at all times while you're receiving care and treatment.

• Consent: You (or anybody legally acting on your behalf) must give your consent before any care or treatment is given to you.

• Safety: You must not be given unsafe care or treatment or be put at risk of harm that could be avoided.

• Safeguarding from abuse: You must not suffer any form of abuse or improper treatment while receiving care.

4. Existing frameworks

4.1 There are two existing quality assurance frameworks that feed into the local quality assurance policy, as detailed below.

Care Quality Commission (CQC)

The CQC9 are responsible for inspecting all health and social care providers that fall under their regulatory remit. This does not include all Adult Social Care Services, but does include:

• Personal care provided by organisations;

• Accommodation for persons who require nursing or personal care;

• Accommodation for persons who require treatment for substance misuse;

• Assessment or medical treatment for persons detained under the Mental Health Act 1983; and

• Nursing care.

7 https://www.unison.org.uk/content/uploads/2013/11/On-line-Catalogue220142.pdf 8 http://www.cqc.org.uk/content/fundamental-standards 9 http://www.cqc.org.uk/

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4.2 In October 2014, CQC introduced a new ratings regime to make the outcomes of inspections easier to understand for both consumers and providers. The new ratings ask five key questions of the services that CQC inspect:

• Are they safe?

• Are they effective?

• Are they caring?

• Are they responsive to people's needs?

• Are they well-led?

4.3 CQC regulated services are also subject to the LBBD local quality assurance processes as detailed in this policy, however the two frameworks are complementary. There is a close working relationship between the Council and the CQC. The results of CQC inspections are used by LBBD to shape its own approach to quality assuring care and support services and, vice-versa; the CQC use our information to inform their approach to inspections.

4.4 The rating given to a provider by the CQC, feeds into the Council’s monitoring procedures and informs intervention with a provider as detailed in Part Two: Quality Assurance Procedures.

Our local Accreditation Framework

4.5 The East London Solutions (ELS) Quality Assurance Framework10 was introduced in 2015 to monitor services in 6 East London Boroughs that do not have a contract with the local authority and are not regulated by the CQC. Specifically, it is for providers who wish to offer services to individuals who manage their own care and support arrangements via a Direct Payment or cash Personal Budget. In 2016 the local authority adopted the ELS framework as our own local accreditation framework.

4.6 The Accreditation Framework seeks to:

• Make sure that we have everything in place to positively manage risk and give people the tools to make informed decisions;

• Encourage the social care market so that it grows to meet service user’s needs;

• Tell service providers what is important to service users and professionals in terms of quality and to give guidance to meet these standards; and

• Support smaller organisations so that service users have a good variety of choice.

4.7 Types of providers/services covered by the Accreditation Framework include:

10 http://careandsupport.lbbd.gov.uk/kb5/barkingdagenham/ACSh/advice.page?id=3zxUa7XzXh4

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• Micro-providers11;

• Payroll providers;

• Day opportunities;

• Floating Support; and

• Supported Accommodation not covered by CQC regulations or have a contract with the local authority.

4.8 The Framework has been implemented across six East London boroughs; Barking and Dagenham, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest. Once a provider is accredited in one borough, they are also accredited in the five remaining boroughs and will be included on the LBBD Care and Support Hub.

4.9 In order for a provider to gain accreditation from the framework there are a number of steps they must take, starting with a questionnaire. This information can be found on the LBBD Accreditation Framework page on the Care and Support Hub12.

4.10 Being accredited means that a provider’s information is shared with service users, carers, social workers and support brokers via the Care and Support Hub. This increases their potential to attract business and enables them to formally evidence their quality.

4.11 The Accreditation Framework is market led and providers that are accredited will not go through the same regular monitoring processes that apply to contracted and spot-purchased providers detailed in Part Two: Quality Assurance Procedures. However, as they are providing services in the Borough, the Council retains the right to quality assure and conduct announced and unannounced monitoring visits to check quality and will undertake an annual service review as a minimum.

4.12 Additionally, these providers must follow the London Multi Agency Safeguarding Adults Policy and Procedures, which include having a Safeguarding lead in post. Complaints, serious incidents and safeguarding alerts will be handled via the escalation process in the Procedures in Part Two, as is the case for contracted and spot-purchased providers.

5. Safeguarding

5.1 Safeguarding is separate to quality assurance; however, the two are very closely linked and have a clear relationship as is shown in Figure 3. Quality Assurance

11 Micro-providers have five or fewer paid staff and are based within the communities they serve. Due to their

size, micro services are often able to offer very diverse, personalised and flexible support to service users and can be purchased via a personal budget or through a service user’s own funds

12 http://careandsupport.lbbd.gov.uk/kb5/barkingdagenham/asch/advice.page?id=3zxUa7XzXh4

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information is likely to be used in any Safeguarding investigations that take place and information from these investigations will feed into future monitoring.

Figure 3 - Safeguarding and Quality Assurance

5.2 All providers must have a Safeguarding policy as well as adhering to the London Multi Agency Adult Safeguarding Policy and Procedures 13. In brief, ‘safeguarding’ means identifying and preventing risks, and includes:

• Having a ‘zero tolerance’ policy towards all forms of abuse or neglect;

• Responding to and investigating any suspected instances of abuse or neglect;

13 http://londonadass.org.uk/wp-content/uploads/2015/02/LONDON-MULTI-AGENCY-ADULT-SAFEGUARDING-POLICY-AND-PROCEDURES.pdf

Safeguarding and Quality Assurance

Regular Quality

Assurance (QA)

Safeguarding info continually

passed to CQC, Care and Support

and Commissioner

Safeguarding concern raised - QA provides background

information for investigation

Outcomes of investigation

informs future monitoring and actions

with Provider

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• Supporting adults at risk to report any concerns while also empowering them to safeguard themselves from harm;

• Supporting adults at risk to stop abuse or neglect and to access the services they need, such as advocacy and victim support;

• Ensuring that quality commissioned, regulated and accredited services are provided by staff with appropriate training to meet the needs of adults at risk;

• Improving access to justice and the criminal justice system;

• Promoting dignity and respect; and;

• Engaging with the local community to promote and inform about safeguarding issues.

5.3 Providers are expected to comply with all elements of the London Multi Agency Adult Safeguarding Policy and Procedure and to actively participate in safeguarding enquiries. This includes the provision of all requested information to assist the Enquiry Officer in carrying out their safeguarding function under the Act.

5.4 The standard safeguarding concern form used in LBBD and which all providers are expected to use is given at Appendix B.

6. Sharing practice and collaborative working

6.1 One of the key forums in which performance and intelligence is shared within Barking and Dagenham is at the multi-agency Safeguarding and Quality Assurance meetings held monthly and hosted by the local authority. These meetings will be discussed in Part Two (Procedures) due to their integral function to the assessment of risk which forms the basis of our quality assurance procedure. However, there are a number of other forums which enable collaborative working and the sharing of good practice and intelligence in the Borough which shape our approach to quality assurance.

Provider Forums

6.2 The local authority coordinates a number of provider forums to enable sharing of best practice and learning, and for providers to raise any issues or feedback as a collective. Additionally, the local authority and the CCG work with the provider forums to share information and procedures with providers, as well as collective trends and issues that result from quality assurance activity. These forums are held regularly and actively contribute to the improvement of service quality. Figure 4 shows the provider forums that currently exist.

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Figure 4 - Provider forum structure

Local Quality Surveillance Group

6.3 The Local Quality Surveillance Group is a multi-agency, cross-borough forum coordinated by NHS England, which meets quarterly to discuss quality and delivery of health and social care providers. This group consists of representatives from BHRUT (Barking Havering & Redbridge University Trust which includes both Queens and King George hospitals) Barking and Dagenham, Havering, Redbridge, Healthwatch, the CQC, the Clinical Commissioning Group (CCG) and the London Ambulance Service. The Group enables the sharing of intelligence about quality, as well as good practice and learning. The key headlines from the meeting also feed up into the North, Central and East London Quality Surveillance Group meeting that takes place quarterly.

Commissioners’ Network

6.4 The Commissioners’ Network is a quarterly meeting of all London Commissioners in which Boroughs come together to discuss commissioning challenges and the state of the provider market, and share best practice. The Care Quality Commission attend these meetings periodically to give updates on their workplan and quality assurance approaches and methodologies are regularly discussed at the meetings.

Health Watch

6.5 Healthwatch has statutory powers14 to carry out Enter and View visits to publicly funded health and social care services in the borough, such as hospitals, GP practices, care homes and dental surgeries, to observe how a service is being run and make any necessary recommendations for improvement. Enter and View visits are carried out by the Healthwatch team alongside trained volunteers and the visits can be planned or can be unannounced. The reports are written up by the Healthwatch team and are published on their website as well as being circulated to the people on their mailing list15.

14 Section 221 of the Local Government and Public Involvement in Health Act 2007 15 http://www.healthwatchbarkinganddagenham.co.uk/enter-and-view

Learning

Disability

Provider

Forum

Homecare

Provider

Forum

Residential

Provider

Forum

Mental

Health

Provider

Forum

Advocacy

Steering

Group

Carers

Network

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PART TWO:

QUALITY ASSURANCE PROCEDURES

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1. Monitoring and assessing risk to inform our approach to quality assurance

Monitoring

1.1 Monitoring of services is central to ensuring delivery is of a high quality and quality is sustained. We monitor in a number of ways and monitoring is always risk management led with the wellbeing and safety of the service users as the primary concern.

1.2 Section 3 of these procedures details the specific monitoring that is undertaken with each of the different types of providers. However, generally the key methods of regular monitoring are:

• Announced Monitoring visits – the provider is given a minimum of 5 working days’ notice in advance of these visits and paperwork is sent to the provider in advance in order that the provider is aware of what will be looked at in the visit;

• Unannounced monitoring visits;

• Service user feedback questionnaire (example questions given at Appendix C);

• Feedback collected from social workers carrying out assessment and reviews around provider concerns.

1.3 It should be noted that monitoring visits could be undertaken jointly with colleagues in the Clinical Commissioning Group (CCG) and North East London NHS Foundation Trust (NELFT) where there are relevant concerns to these organisations.

1.4 In addition to the information gathered via the regular processes, data and intelligence is also gathered to inform monitoring and our approach to quality assurance. This includes:

• CQC inspections

• Safeguarding reviews;

• Serious incident reviews;

• Performance information (e.g. pressure sores, falls etc.);

• Complaints.

1.5 Combined, this information enables us to identify risks and ongoing areas for improvement as soon as LBBD is made aware of them.

Monitoring visits

1.6 Monitoring visits are the primary method of checking the quality of a provider. Monitoring visits are normally conducted by Service Review Officers and may be in conjunction with Commissioning and/or Social Workers, depending on the type of provider.

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1.7 How regular both announced and unannounced visits are carried out is dependent on a number of factors which can be found in the ‘risk assessment’ section below. As a minimum, an announced visit will be undertaken on an annual basis as part of an annual review.

1.8 When conducting an annual monitoring visit, an officer will use a standard tool to check different elements of service delivery. Examples of monitoring checklists for different types of providers can be found in Appendix D, E and F. These will be discussed in more detail in Section 3 of the Procedures below.

1.9 As part of a visit, an officer will investigate a number of areas. This includes:

• Speaking to service users;

• Speaking to carers and advocates where required;

• Reviewing complaints and compliments;

• Speaking to management and staff;

• Observing practice;

• Looking at case files;

• Looking at staff files and rotas;

• Inspecting premises and checking infection control and food hygiene standards;

• Looking at training records;

• Reviewing relevant financial records to ensure the financial stability and sustainability of the provider and to ensure that staff are being paid appropriately according to legislation;

• Looking through provider procedures such as safeguarding procedures, business continuity plans, complaints procedure, equality, health and safety procedures; and

• Asking staff to explain their understanding of the above procedures.

1.10 Providers are expected to be open and transparent as part of an announced or unannounced visit and that they make available all files and other documentation including payroll as requested by the QA team and other Officers of the Council. Providers are also expected to have a ‘no locked doors’ approach to visits to ensure that QA and other colleagues can fully assure themselves of the safety and quality of services.

1.11 Adults who access care and support services have expert knowledge in the quality of those services. Consequently, LBBD is committed to ensuring that users of services and the organisations that support them are part of the quality monitoring process.

1.12 From 1 April 2017, the Commissioning and Quality Assurance teams will be undertaking an ‘experts by experience’ programme in which service users and other lay representatives will form a key part of annual service reviews. The experts will receive training and pay for their important work as part of these reviews.

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Monitoring Report

1.13 After each monitoring visit, the officer who conducted the review will produce a monitoring report within 15 working days. This report will include key observations made, areas for improvement and any significant concerns. An example of a monitoring report is given at Appendix G. Providers are then given 15 working days to make any representations about the report and the quality of the review. Where the Council accepts the changes, the report will be rewritten and resent. Where the Council does not accept the providers representations these will be attached to the unchanged report and filed.

1.14 The monitoring report is sent to the Provider, the Commissioner, Adults’ Care and Support teams, Clinical Commissioning Groups and other relevant partners.

Complaints, Serious Incident Reviews and Safeguarding Alerts

1.15 It is important to acknowledge that issues in Adults’ Care and Support services may happen outside of regular monitoring processes and certain issues will require an immediate response. There are a number of existing mechanisms that ensure these issues are raised with the Council and other Authorities as they happen so that they can be swiftly addressed. These mechanisms, as detailed above, also feed into quality assurance monitoring.

1.16 Complaints about a provider can be raised via the Local Authority’s Complaints Department. In the first instance, we would advise complainants to raise the complaint directly with the provider through the providers own complaints procedure. If the complainant continues to be dissatisfied with their response, they may then access the Council’s complaints process16. All complaints made are recorded and contribute to monitoring information about a provider.

1.17 Serious Incidents should be reported to the CQC (if a CQC regulated provider) and the Local Authority within three working days (72 hours) of them taking place. A Serious Incident Form and where to send it is given at Appendix H. We understand that the nature of Adult Social Care services mean that Serious Incidents are likely to happen. It is in the interest of providers to ensure the Local Authority is informed of these incidents to protect vulnerable adults, to enable transparency and trust and to make sure support is provided where required. As with complaints, Serious Incidents are recorded and will contribute to quality assurance monitoring. Quality Assurance and Commissioning will lead on all Serious Incident investigations.

1.18 Safeguarding concerns also contribute to quality assurance, however safeguarding follows the London Multi Agency Adult Safeguarding Policy and Procedures, which must be adhered to - more detail on this is given in the Safeguarding section in Part

16 https://www.lbbd.gov.uk/council/complaints-and-feedback/complaints-about-council-services/how-to-complain/

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One above. Operational Adults’ Care and Support colleagues will lead on all Safeguarding Concerns and Enquiries.

Assessing risk

1.19 To inform the frequency of our monitoring and our approach to Quality Assurance, each provider has a risk assessment which determines the level of risk to the Council should the provider leave the market for any reason. The risk assessment is informed by the outcome of provider meetings, monitoring visits, feedback from operational teams, as well as data and intelligence around financial security, volumes and degree of difficulty to the Council in finding an alternative provider. In addition, we look at information from the CQC, complaints, serious incidents and safeguarding concerns. The provider failure risk assessment is made primarily by Commissioning and Quality Assurance colleagues and is reviewed on a quarterly basis, or more quickly when risks change or arise. The risk assessment is guided by the factors set out in Appendix I. The risk rating will also feed into the Quality Assurance & Safeguarding Panel.

1.20 Serious concerns will be dealt with through the escalation process detailed in Section 2 – ‘improving quality’, with the most ‘risky’ providers discussed at the monthly Safeguarding and Quality Assurance meetings.

1.21 The risk assessment helps inform the Safeguarding and Quality Assurance meetings decision on the frequency of the monitoring that needs to be undertaken and Figure 5 sets out the frequency of monitoring for each level of risk.

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Figure 5 - Risk Rating Definitions and Frequency of Monitoring

Level of Risk Impact on People Using the Service

Indicative frequency of monitoring

Black (major)

People who use the service are not protected from unsafe or inappropriate care. The provision of care does not meet quality & safety standards.

See escalation process (Figure 6)

Following suspension, a formal meeting will be undertaken with the provider and an improvement plan put in place. Frequent monitoring will be undertaken in the form of announced and unannounced visits and service user/carer feedback will be regularly sought.

Red (moderate)

People who use the service are generally safe, but there is a risk to their health and wellbeing. Provision of care is inconsistent and may not always meet quality & safety standards.

See escalation process (Figure 6) Commissioning and the Quality Assurance team will put in place a formal improvement plan with the provider. A heightened level of monitoring, announced and unannounced visits will be undertaken and placements/work given to the provider will be made ‘with caution’. Service user/carer feedback will be sought before the provider is reduced to an ‘amber’ or ‘green’ rating.

Amber (minor)

People who use the service are safe, but care provision may not always meet safety and quality standards.

Commissioning and Quality Assurance will undertake a monitoring visit to the provider and will formally meet with the provider to discuss concerns and agree an improvement plan. Improvements will be monitored thereon until the provider receives a Green ranking. If a ‘block contracted’ provider, this may be through the contract monitoring meetings.

Green (no concern)

Provider is meeting relevant standards – no concern.

Spot purchased providers or community-based providers via our local Accreditation Framework will receive an annual monitoring visit. Block contracted providers with the Council, will receive an annual monitoring visit and will also be subject to contract monitoring meetings.

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2. Improving quality

2.1 Improving quality of services is the overarching aim of quality assurance processes. Under the Care Act (2014), Local Authorities have a responsibility for ensuring that services are of a high quality and to work with providers in the market to support them to improve where there are concerns. This should be seen as a collaboration between the Local Authority and the provider, working together to reduce risk and to enhance wellbeing for residents.

2.2 However, it must also be understood that the provider has the primary responsibility for ensuring the safety and wellbeing of residents and if they fail to do this, serious sanctions must be imposed.

Escalation process

2.3 LBBD has a clear process for the escalation of issues and the implementation of improvement plans. Where working together has not led to the required service improvement, further action should be taken. Figure 6 shows the basic process by which issues are raised to the relevant authorities and steps are taken to address and improve performance and quality. 17

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*Association of Directors of Adult Social Services

Safeguarding and Quality Assurance Group

2.4 The Safeguarding and Quality Assurance Group is made up of Local Authority Directors and Managers who have a direct role in the commissioning and Quality Assurance of providers in the Borough. The membership includes:

• Operational Director, Adults’ Care and Support;

• Quality Assurance and Safeguarding Adults Board Manager;

• Group Manager for Intensive Support;

• Group Manager for Integrated Care;

• Principal Commissioning Manager; and

• Relevant Commissioning Managers and Service Review Officers dependent on provider.

Monitoring – progress fed back

to Safeguarding and Quality

Group who reassess RAG rating

Green

Bla

ck

Am

ber

or

Red

Information

gathered from

regular monitoring

and ad-hoc

Complaints,

Safeguarding Alerts

and Serious

Incidents

Safeguarding and

Quality Assurance

Group

(meets monthly but

can meet at any time

to respond to

immediate risks or

concerns).

Providers discussed

and risk rating

confirmed (BLACK,

Improvement and

sustainability plan to

be implemented –

timescales set and

frequency of monitoring

increased to ensure

improvements are made

SUSPENSION

No further placements

made for a specified

period – other

Authorities informed via

ADASS*, review whether

to move existing service

users

Figure 6 - Escalation process

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2.5 It should also be noted that relevant Officers from the Clinical Commissioning Group (CCG) and North East London NHS Foundation Trust (NELFT) are also invited to the meetings to discuss relevant providers.

2.6 The Safeguarding and Quality Group oversees all providers, but primarily the ones that pose the most risk in the provider market. They meet monthly; however, they can also be called together if there is a serious and immediate concern raised that requires an immediate response (via a Safeguarding concern for example). The focus of the discussion is on those providers where issues have been identified in regular monitoring, where the risk assessment is largely RED or BLACK, where there are high levels of incidents, safeguarding alerts and/or complaints, and where there have been ongoing issues (i.e. they have previously been rated BLACK, RED or AMBER and are currently implementing an improvement plan).

2.7 The group will agree the risk rating for the provider and will advise on actions and next steps, particularly where providers are agreed as RED or BLACK.

2.8 As well as responding to serious issues, the Group also analyses the information provided, particularly the risk assessment, to anticipate possible future issues for providers. If possible the Group will then put measures in place to prevent future issues occurring.

Improvement and sustainability plans

2.9 Any provider rated BLACK, RED or Amber will be asked to develop an improvement and sustainability plan with support from QA/Commissioning. The Safeguarding and Monitoring Group will either agree the plan or request alterations to ensure it is fit for purpose. The implementation of the plan will then be monitored by the Commissioning Manager and Service Review Officers. The Safeguarding and Monitoring Group may change the BRAG rating based on whether improvements have been made or not.

The improvement and sustainability plan template is given at Appendix J and will include the key actions that a provider must take to improve the quality of the service and to sustain this improvement. The provider will need to evidence that they are actively making improvements to avoid further sanctions. The frequency of monitoring visits will be increased in order to support providers in making these improvements as per Figure 5.

Suspension of New Placements (BLACK RATING)

2.10 If a provider is rated BLACK on the BRAG rating, which may be due to a number of serious concerns, the Local Authority will immediately suspend placements to the provider. This decision will be taken by the Commissioning Director, Adults’ Care and Support in discussion with the Operational Director of Adults’ Care and Support. The relevant Commissioning Manager will send the provider a letter stating that we will no longer place new admissions with their service and will review existing

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placements to decide whether service users should be moved to alternative arrangements. These reviews will be undertaken by operational colleagues in Adults’ Care and Support. An example of this letter is given at Appendix K. In addition to this, a letter will be sent via the Association of Directors of Adult Social Services (ADASS) to all other Local Authorities informing them of the suspension of placements and advising Local Authorities to review service users with this provider. It is highly likely that other authorities will also cease to place with the provider. The length of the suspension depends on the circumstances and the improvements made. Once letters have been sent, a formal meeting will also be scheduled with the provider to discuss the requirements of the improvement plan.

2.11 The Council acknowledges the serious impact a suspension of placements can have on a provider’s business and aims to support providers to avoid this situation occurring.

2.12 A suspension will only be lifted where the provider has demonstrated that all areas of the improvement and sustainability plan have been substantively met. The lifting of a suspension will be confirmed in writing to the provider, CQC and to all other Local Authorities via the Association of Directors of Adult Social Services.

Provider failure

2.13 In the rare situation that a provider fails and is no longer able to deliver safely despite attempts at improvement, the Local Authority (under the Care Act) has a responsibility to ensure that residents continue to receive the care that they require.

2.14 In Barking and Dagenham, we have a provider failure guidance document should a provider fail (Appendix L). This will be followed to ensure that individuals receive continuity of service with the minimum of disruption.

2.15 It needs to be acknowledged that our approach to provider failure will depend on the circumstances of the failure and our approach will be based on ensuring the safety of service users and continuity in service.

2.16 In addition, providers are expected to have Business Continuity Plans and these are examined as part of the quality assurance process. The Business Continuity Plans should clearly outline the contingencies for if the provider is no longer able to deliver services.

3. Our approach to quality assurance with specific provider groups

3.1 Section 1 and Section 2 of the Quality Assurance procedures sets out our general approach to quality assurance and improvement for all providers in Barking and Dagenham. This section sets out specific quality assurance procedural issues relating to the following provider categories:

• Residential and Nursing Care;

• Home care agencies;

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• Supported accommodation;

• Other community-based support and micro-providers;

• Personal Assistants.

Residential and Nursing Care

3.2 Residential and Nursing homes fall under the definition of Regulated activities18 and as such fall under the CQC inspection regime outlined in Part One: Quality Assurance Policy.

3.3 The Council work closely with CQC and can raise concerns with them directly regarding any regulated provider. The trigger for reporting a concern to CQC would be where the Council felt that the standards had fallen below that required by CQC’s Fundamental Standards19. This can include any safeguarding concerns being raised by the provider.

3.4 We work closely with the Clinical Commissioning Group in undertaking monitoring and quality assurance activity and announced and unannounced visits may be taken jointly, and a joint improvement plan may be developed where there are concerns.

3.5 The spread of infection in care homes poses a significant risk to people who use the service, as well as staff and visitors who may have contact. It is the responsibility of the providers to have robust systems in place to minimise the risk of spreading.

3.6 It is also the responsibility of the providers to report any outbreaks of infections such as Noro Virus – Diarrhoea, vomiting (DV), Scabies, bed bug infestation and MRSA to Public Health England and the local authority Environmental Health team immediately.

3.7 As per the procedures outlined in Section 1 and Section 2 above, providers are assessed on risk and therefore the frequency of monitoring and the implementation of improvement plans is dependent on the level of risk. As a minimum, each residential care and nursing home will receive a monitoring visit as part of an annual service review. The monitoring checklist that will be used at residential and nursing care monitoring visits can be found at Appendix D. In reviewing respite arrangements, the same monitoring checklist and approach will be undertaken as for residential and nursing care.

3.8 Service users in residential care will have their views and experiences taken during monitoring visits, as well as via the service user statutory survey.

3.9 It should be noted that the Borough’s in-house schemes are subject to the same monitoring processes and quality assurance processes as external providers in the Borough.

18 Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 19http://www.cqc.org.uk/content/fundamental-standards

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Home Care (Domiciliary Care) Agencies

3.10 Home care agencies fall under the definition of Regulated activities20 and as such fall under the CQC inspection regime outlined in Part One: Quality Assurance Policy. As per paragraph 3.3 above, the Council works closely with the CQC regarding home care agencies and will report concerns when standards fall below the CQC’s Fundamental Standards.

3.11 In 2016, the Council tendered for an approved list of home care agencies. In total, 14 home care agencies were successful in being a part of the approved list.

3.12 Where service users have a managed personal budget, the majority of home care packages are delivered by the agencies on the approved list. We also ensure that service users with a direct payment are aware of our approved list of providers, although the choice of the home care agency is down to the service user and service users can pick an agency that is not on the approved list.

3.13 All of the home care agencies on the approved list are monitored through contract monitoring information provided by the providers. All of the home care agencies have regular monitoring meetings with the Service Review Officers and the Commissioning Manager. The Council also conducts spot check visits and phone calls to service users to check the quality of the service that they receive.

3.14 As per the procedures in Sections 1 and 2, home care agencies on the approved list are assessed on risk and therefore the frequency of monitoring visits is dependent on this. However, as a minimum, each of the 14 home care agencies will receive an annual monitoring visit from the QA team. The monitoring checklist that will be used at home care agency monitoring visits can be found at Appendix E.

3.15 For other home care agencies who operate in the Borough and are used by Barking and Dagenham service users (either via a managed personal budget or a direct payment), the Quality Assurance policy and procedures still apply and each provider will be given a risk assessment. As a minimum, all home care agencies will receive an annual monitoring visit but may be more frequent depending on the outcome of the risk assessment.

Supported Accommodation

3.16 Supported accommodation may be subject to the Care Quality Commission regulated activities, dependent upon the nature of the service that is being delivered in the supported accommodation scheme.

3.17 In Barking and Dagenham, supported accommodation providers are both ‘block contracted’ and ‘spot contracted’ for people with learning disabilities, people with mental health needs and older people.

20 Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

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3.18 For block contracted supported accommodation providers, providers are monitored through contract monitoring meetings. All of these supported accommodation schemes have regular monitoring meetings with the Service Review Officers and the Commissioning Manager.

3.19 Service users in supported living will have their views and experiences taken during monitoring visits, as well as via the service user statutory survey.

3.20 As per the procedures outlined in Section 1 and Section 2 above, providers are assessed on risk and therefore the frequency of monitoring visits to these block contracted providers is dependent on the level of risk. As a minimum, each scheme will receive a monitoring visit as part of an annual service review. The monitoring checklist that will be used at supported living visits can be found at Appendix D.

3.21 For ‘spot contracted’ supported living schemes, or for any other supported accommodation scheme that operates in the Borough, the Quality Assurance policy and procedures still apply and each provider will be given a risk assessment. As a minimum, all supported accommodation providers will receive an annual monitoring visit as part of an annual service review and the monitoring of these agencies may be more frequent depending on the outcome of the risk assessment.

Other community-based support and micro-providers

3.22 Some of the providers that provide support to service users in the Borough with their care and support needs do not neatly fit into the categories defined above. Some examples of these providers may be:

• Floating support – Providers who provide tenancy sustainment and signposting support. This is a preventative service to individuals who have care and support needs or are vulnerable and may not meet Care Act eligibility criteria. This service is currently ‘block contracted’ by the Council but could also be purchased through a direct payment or managed personal budget. For floating support providers, the same monitoring checklist for homecare/domiciliary agencies is used (Appendix E)

• Micro-providers – Providers of less than five full-time employees who provide care and support services to individuals. These services are purchased by service users via their direct payment or managed personal budget. These providers are subject to the Accreditation Framework discussed in Part One: Quality Assurance Policy.

• Payroll providers – These providers support service users to undertake the payroll related duties that come with employing a service or PA via a direct payment. These providers are paid via the service user’s direct payment. They are subject to the Accreditation Framework as discussed in Part One: Quality Assurance Policy.

• Other community providers, including day services - The local authority also block contracts a number of other providers who provide vital support to individuals with care and support needs, such as advocacy services and support to carers.

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3.23 The quality assurance processes followed for these providers is dependent again on whether they are block contracted or are part of the Accreditation Framework.

3.24 For block contracted providers, providers are monitored through contract monitoring information provided by the providers. All of these providers have a minimum of an announced QA monitoring visit with the Service Review Officers.

3.25 Service users will have their views and experiences taken during monitoring visits, as well as via the service user statutory survey.

3.26 As per the procedures outlined in Section 1 and Section 2 above, providers are assessed on risk and therefore the frequency of monitoring visits to these block contracted providers is dependent on the level of risk. As a minimum, each provider will receive a monitoring visit as part of an annual service review. The monitoring checklist that will be used for these providers will be dependent on the terms of the contract, but for floating support, the checklist at Appendix E will be used.

3.27 For micro-providers and payroll providers, all providers would need to have submitted evidence as part of an accreditation questionnaire as part of the Accreditation Framework (either for micro-providers or for payroll providers). The questionnaire asks providers to provide evidence of the way that they conduct their service to assure the local authority that they have all of the appropriate procedures and policies in place e.g. Safeguarding policy. The questionnaires are reviewed by a panel from Quality Assurance and Adults’ Care and Support and once approved, they are placed on the Borough’s Care and Support Hub website.

3.28 Once the providers are approved, they are subject to the Quality Assurance Policy and Procedures. As a minimum, all payroll or micro-providers will receive an annual monitoring visit as part of an annual service review and will be monitored against the Accreditation Framework to ensure that they are still compliant and risk assessed as per the usual QA procedures. The monitoring of these providers may be more frequent depending on the outcome of the risk assessment.

3.29 Service users using these providers will have their views and experiences taken during monitoring visits, as well as via the service user statutory survey

Personal Assistants

3.30 Personal Assistants, also known as PAs, are employed by people who need social care, either because of their age or disability, to enable them to live as independently as possible. PAs are employed via a direct payment or managed personal budget by service users in Barking and Dagenham and are not employed by the Council.

3.31 London Borough of Barking and Dagenham supports a scheme called ‘Personal Assistants for Barking and Dagenham’ in which accredited PAs are put on the Council’s PA register and online PA Finder – http://careandsupport.lbbd.gov.uk/kb5/barkingdagenham/asch/pa_home.page

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3.32 All of the PAs accredited by London Borough of Barking and Dagenham must go through a number of checks, including a Disclosure and Barring Service (DBS) check provided free of charge by the Council and a reference check.

3.33 PAs are also required to sign up to a Code of Conduct with the Council to ensure that they meet the Council’s standards of care, including the promotion of rights and independence, confidentiality, safeguarding, and risk.

3.34 In return, the Council will promote accredited PAs through our PA register and online PA Finder and also offer free training to accredited PAs.

3.35 The local authority may not know about all of the PAs within the Borough, because an individual may choose not to select a PA from the Borough’s accredited PA register. However, all PAs on the list are subject to quality assurance processes arranged by London Borough of Barking and Dagenham. Adults’ Care and Support, Quality Assurance and Commissioners work together regarding quality assurance issues and through the Personal Assistant scheme, monitoring visits and discussions with PAs, service users and their carers will take place where issues arise and will put in place improvement actions where required.

3.36 Additionally, the Council also conducts spot check visits and phone calls to service users to check the quality of the service that they receive from their PA.

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Appendix A – Key definitions

Adult Care and Support - Care and support for adult’s who need extra help to manage their lives and be independent - including older people, people with a disability or long-term illness, people with mental health problems, and carers. The Local Authority has a dedicated Adult Social Care Team which oversees the delivery of this work.

Adult – Under the Care Act 2014 an Adult is defined as a person who has care and support needs irrespective of whether these needs are actually being met by the LA.

Best Value – LBBD has a general Duty of Best Value to secure continuous improvement in the way in which its functions are exercised, having regard to a combination of economy, efficiency and effectiveness. Authorities should consider overall value, including economic, environmental and social value, when reviewing service provision. Carer – Under the Care Act 2014 a Carer is defined as somebody who does not charge for the provision of care and support to an adult and who may as a result have support needs.

Commissioner – an individual or organisation that plans the services that are needed by the people who live in an area, and ensures that services are available. Sometimes the commissioner pays for these services, but not always. The Local Authority is the commissioner for adult social care in Barking and Dagenham.

Contract – a formal agreement between two parties – in this instance the Council and the provider of services. Contracts are in place for all Adult Social Care services that the Council funds.

Local Authority/Council – the governing body for a particular area – in this case, the Local Authority is the London Borough of Barking and Dagenham. The Local Authority may also be referred to as the Council and is responsible for ensuring there are sufficient and high quality social care services for residents in the Borough. The Local Authority is run by elected Councillors who represent the community and make key decisions and paid Council Officers deliver the work.

Personal Budget/Managed Personal Budget – a personal budget is money that is allocated to an individual by the Local Authority to pay for care or support to meet assessed needs. The money comes solely from adult social care. This money may be paid directly to the individual for them to spend. Or, an individual can choose to have a Managed Personal Budget in which the Local Authority will arrange services for them.

Policy – a set of principles and actions that are agreed by the Local Authority and partners, and provide the process for work in a particular area (in this case, quality assuring adult social care services).

Quality – a degree or standard of excellence. The level to which a good service is being delivered and is achieving positive outcomes.

Quality Assurance – the process through which quality is measured, monitored, evaluated and improved.

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Risk – a situation in which harm, danger or another negative impact is possible. When a service user is deemed at risk, there are concerns about their safety when using a service.

Service User – the term used under older legislation for an individual who accesses an adult social care service. For example, a resident of a care home or someone who has a carer at home. (Please also see ‘Adult’ definition above)

Spot-purchase – the process through which the Local Authority pays for services as they are needed.

Suspension in placements – the process through the Local Authority prevents a provider from accepting any new service users. A suspension will be placed if there are serious concerns about the safety of the service being delivered and is designed to protect residents until improvements are made.

Tender – the process through which the Local Authority commissions a provider to deliver

services where the value of the contract is £50,000 or more. This process involves

advertising the contract to providers and accepting applications. This is followed by a panel

of experienced professionals from across agencies choosing the best provider to award the

contract to, based on a number of criteria.

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Appendix B – Safeguarding Concern Form

CONFIDENTIAL

SAFEGUARDING ADULTS CONCERN FORM

NB* Please type or use block capitals only when completing this form

SECTION 1: PRELIMINARY DETAILSs

1.1 Adult at risk reference number, if known.

AIS / Swift

RIO

NHS Number

1.2 Date of the alleged incident

1..3 Date Safeguarding concern form completed

1.4 Is the adult at risk aware you are making this referral? The adult should be told wherever possible unless to discuss so would leave them at greater risk or they lack mental capacity to understand.

Yes No

SECTION 2: DETAILS OF THE ADULT AT RISK

2.1 Title

First name

Last name

Male or female

Age

Address line 1

Address line 2

Town

Postcode

Telephone numbers

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Ethnicity

Religion

Sexuality

2.2 GP or Doctors surgery name

GP or Doctors surgery address

Contact number

2.3 Details of any recent hospital admissions

2.4 Does the adult at risk have any specific communication needs?

2.5 Does the adult at risk have any special contact preferences, or persons they wish to be contacted?

2.6 Adults at risk should be presumed to have capacity and should be fully involved in the safeguarding process. Is it your assessment that the adult at risk may lack the capacity to make their own decisions about their personal safety or protection?

Yes No

Please explain why you believe the adult may lack capacity

2.7 Details of any other involved agencies (e.g. homecare, support workers, sitting service)

2.8 What are the usual living arrangements for the adult at risk (tick all that apply)

Lives alone

Lives with spouse/partner

Lives with family/carer

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Lives in care/nursing home

Lives with children under 18 years

Lives within Supported Living

Lives in temporary accommodation

Other e.g. homeless (please specify)

2.9 Vulnerability factors for the adult at risk (tick all that apply)

Older people (age 65 and over)

Learning disability

Mental health (age 18 – 64)

Mental health (age 65 and over)

Physical and sensory disability

Substance misuse

Other (please specify)

SECTION 3: DETAILS OF THE PERSON COMPLETING THE FORM

3.1 Title (Mr Mrs Ms Dr)

First name

Last name Address line 1

Address line 2

Town

County

Postcode

Telephone numbers

Relationship to adult at risk

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3.2 Has the person raising the concern reported the incident to the

police? If yes, please specify the following

Yes No

CAD number

Crime reference number

3.3 If the police have not been informed; please provide reasons

3.4 If reported to the police is the adult aware that the police may

contact them directly?

Yes No

SECTION 4: PERSON ALLEGED TO BE CAUSING THE HARM (PACH):

If this person is employed in a position of trust, please include the name and telephone number/s for

their employer below

4.1 Full Name of employer

Address and postcode of (PACH) (Or

Organisation details if applicable)

Postcode

Telephone number

4.2 Is the person alleged to be causing the harm known to the Adult at risk?

Yes No

4.3 What is the person’s relationship to the adult at risk?

4.4 Is this person the adult at risk’s partner

or former partner?

Yes No

4.5 Is the person alleged to be causing the

harm (PACH) also an adult with care and

support needs?

Yes No

4.6 What if any are the vulnerability factors for the person (adult or child) alleged to have caused the

abuse or neglect (tick all that apply)

Older people (65 and over)

Learning disability

Mental Health (18-64)

Mental health (65 and over)

Physical and sensory disability (18-64)

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Substance misuse

Other (please specify)

SECTION 5: INCIDENT

5.1 Setting where the alleged abuse or neglect took place (please tick all that apply)

Own home

Public place

Care or nursing home

Hospital

Day care

Property of the person causing harm

Mental health inpatient setting

Supported accommodation

Training/education/workplace

Other (please specify)

5.2 Did anyone else witness the alleged abuse or neglect?

Yes No

If yes, please provide contact details for witness

5.3 Has the Adult made an allegation of an offence?

Yes No

What offence is being alleged by the Adult at risk?

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If no offence is being alleged by the Adult at risk, what offence is being alleged by the person raising the concern?

How often do you think the alleged abuse or neglect happens and when was the most recent episode?

5.4 If you are not the original recipient of this information please detail the source of the information

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If yes you must now alert the Child Protection Team (please use the link below) http://lbbd/childrens-services/multi-agency-referral-form.htm

5.8 Please describe your concerns in more detail below. Be specific about what has happened and why you are concerned about the possible abuse or neglect of the adult at risk. Please include where possible the impact this has on the adult at risk. A body map diagram is below so that you may accurately record any injuries. Please also explain what you or your organisation have done to reduce or stop the abuse or neglect now.

5.5 Nature of the alleged abuse or neglect (tick all that apply)

Discriminatory and social

Physical

Sexual

Domestic Abuse

Psychological

Financial

Modern Slavery

Neglect & Acts of Omission

Self Neglect

Professional

Organisational

5.6 Do you believe that other adults at risk may be in danger from this alleged person causing the harm? If so please raise a separate safeguard and cross reference to this one.

Yes No

5.7 Are children also at risk? Yes No

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5.9 Making Safeguarding Personal What outcomes does the adult at risk want?

We all have different preferences, histories, circumstances and lifestyles, it is important to

ask the adult at risk of abuse or neglect and record where safe to do so their desired

outcomes.

If you have not talked to them about their desired outcomes please state reasons why.

SECTION 6: REQUIRED ACTIONS CHECKLIST

• Consider and take any immediate action required to ensure safety.

• Out of Hours contact the LBBD Emergency Duty Team on adult.edt@nhs.net 0300 555 1249.

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• If a criminal act is alleged / suspected alert the Police in an emergency calling 999 or 0300 123 1212 (non-emergency), or report in person at the front desk of ANY police station or report online at https://online.met.police.uk/.

• Consider how to preserve potential evidence and secure your records.

• Inform your Line Manager. (Where it is appropriate and safe to do so).

• If a Care Home, Nursing Home, or Acute Hospital is involved alert the regulatory body. (Care Quality Commission) 0845 0150 120 enquiries@cqc.org.uk.

• If children are thought to be at risk alert Child Protection on 020 8227 3852 / 82 / 60. Childrens@lbbd.gov.uk.

• The concern MUST be raised immediately with the Safeguarding Adults Team if the person remains at risk or within 24 hours for all other cases:

Secure e-mail: SafeguardingAdults@lbbd.gcsx.gov.uk Telephone number: 020 8227 2915 (Please do not post alert forms as this may lead to delays).

• If you suspect that domestic abuse has taken place or you wish to seek advice on domestic abuse, please contact the local domestic abuse service on 020 8591 3498.

• The Council has signed up to the London Multi Agency Adult Safeguarding Policy and Procedures which can be found at: http://londonadass.org.uk/wp-content/uploads/2015/02/Pan-London-Updated-August-

2016.pdf

Body Map

46

Appendix C – Example questions from service user survey

Quality Assurance Questionnaire -

`

Date ……………………………….

Name of service user: ……………………………………………. Care Agency/PA

…………………

Name of reviewer: ………………………………………

Good morning/afternoon. My name is _____________ and I work for the London Borough

of Barking and Dagenham.

Is Mr/Mrs/Ms _______________ or their family member/friend/advocate available to

answer a few questions about the quality of the care funded/arranged by LBBD that

you/they receive from

Name and relationship of person answering questions if not the service user

……………………………………………………………………………………………………..

1. Are you or a member of your family involved in the planning of your care and support?

Yes No

2. a Do you have a regular carer?

Yes No

b. If no, how many care workers have you seen in the last 4 weeks?

________________________________

47

3. Are your carers friendly?

Yes No

4. Are you satisfied with the timekeeping of the care workers?

Yes No

5. Are you told if there is a last-minute change to your carers call times?

Yes No Sometimes

6. How many care calls do you get each day?

………………………………………………………………………………………………………

…

7. How long is each visit? (duration of call time)

………………………………………………………………………………………………………….

.

8. Do the care workers treat you with respect and dignity and ensure you have privacy?

Yes No Sometimes

9. Are the carers aware of your cultural and religious needs?

Yes No Not sure

10. Do you know how to make a complaint if you are not happy with the care you receive?

Yes No

48

11. Are you contacted by the care agency to check you are happy with the service you

receive from them? (Do not ask for PA services)

Yes No N/A

12. Overall how happy are you with the support you receive at home?

Very happy Happy Unhappy Very unhappy

Why do you say this?

………………………………………………………………………………………………………

…………

………………………………………………………………………………………………………

…………

13. Do you have any other comments about the support you receive?

……………………………………………………………………………………………………

…………

……………………………………………………………………………………………………

…………

Thank you for taking the time to answer these questions. This information will help the

Council to monitor the quality of the care you receive from your carers so that all

people get the support and care that they need in a way that they want.

Where you have raised complaints/concerns are you happy to raise these with the

provider yourself or do you want me to do it following this conversation. (If they want

you to do it are they happy for you to name them or do they want you to raise it

anonymously (but there care may not improve because the care provider doesn’t

know)

Raise themselves Worker raises them Concerns to be raised

anonymously

49

Appendix D – Monitoring checklist

Supported Living

Nursing/Care Home (Please circle one of the above)

Quality Assurance

MONITORING FORM

Name of Service:

Address:

Number of registered places:

Number of vacancies:

Date of last CQC inspection: Rating:

No. of LBBD Placements:

List of other placing boroughs:

Date of Visit:

50

Monitoring visit details

Registered Manager:

Has there been any

change since the last

visit

Name of Officer(s)

carrying out Monitoring:

Type of Monitoring Visit Annual Full, 6 Monthly

____ Monthly

Announced /

Unannounced please

circle

Names of other people

present and involved in

the visit:

Provider details Categories of Care Offered in the Home number of

beds in each category

Physical/Sensory

Disability Mental Health

Other Please State

Adult Nursing – YPD` Learning

Disability

Rehabilitation End of Life

Care

Respite

General Impressions

Looking to deliver

outcomes Yes No N/A Comments / Observations

Was the service

welcoming?

Institutional?

Homely?

Was there a visitor /

signing in book?

Was the service free

from unpleasant

odours?

Was the condition of

decoration satisfactory?

51

Registration / Inspection

Details Yes No N/A Comments / Observations

Was the Registered

Managers Certificate

on display

Was the home CQC

Certificate on display

Has the home attained

the Gold Standard

Framework?

Is Certificate on Display

Were relevant

insurance certificates on

display?

Registration / Inspection

Details (cont) Yes No N/A

Was the home

Statement of Purpose

on display?

Is Quality Audit (QA) up

to date?

Are all permanent

residents issued with a

service

agreement/Tenancy?

If tenancy do the

tenants have capacity to

sign or has it been

signed on their behalf

under PoA

Are all residents issued

with a welcome pack?

Does this include a

copy of the complaint’s

procedure

Has there been a

change in ownership

since the last monitoring

visit? If yes Obtain

details of new owner(s),

date change became

effective

52

Does the service have

any planned

developments for the

next 12 months?

Obtain copy of plans

Is staff interaction with

service users

satisfactory?

Health and Safety Comments

Who is your service

allocated Health and

Safety Officer?

Please supply proof of

their competency to

undertake this task i.e.

Certificates

Is the Health and Safety

Certificate on display?

Does the service have

an incident / accident

book? Evidence?

Yes No

Does the service have

evidence of COSHH

assessment? E.g. date

of visit

Does the company that

owns this service carry

out regular Health and

Safety checks?

Please give details

Yes No Comments / Observations

Please supply a copy of

your current Health and

Safety guidelines

53

Emergency

Procedure

Please state what your

current procedure is

when an ambulance is

called for one of your

service users

Contractual and

Regulatory

Information

Yes No N/A Comments / Observations

Has the proprietor of

the service agreed to

a pre-placement

contract agreement?

Which local

authority?

Date signed

Do all rooms have

en-suite facilities?

Are there any shared

rooms?

Does the provider

have any issues

around service

user(s) care needs?

If Yes has local

authority been

notified?

54

Are social workers’

reviews up to date?

If No how many

outstanding

Contractual and

Regulatory

Information (cont)

Yes No N/A Comments / Observations

Does the home

inform care managers

when residents

refuse provision on

services?

Is the Local Authority

Informed about

serious incidents,

illnesses, RIDDOR

using the serious

incident form?

Have safeguarding

concerns been raised

in the last 12 months.

Substantiated –

Unsubstantiated –

Outcome awaited -

Have there been any

other issues since the

last visit?

55

Does the home have

a complaints /

compliments log

book?

How many

complaints have been

recorded in the last 6

months

How many

compliments have

been recorded in the

last 6 months

Contractual and

Regulatory

Information (cont)

Name

Comment

Who is responsible

for carrying out the

service quality audit

(QA)? Please provide

evidence

If No - What Quality

Assurance Systems

is in place

Staffing Details

No. of staff on duty

during the monitoring

-

56

How many staff does

the service employ?

Give breakdown if

appropriate 21

Day

Night Other

Perm Tem

p

Per

m

Tem

p

Per

m Temp

Management

Nurses

Senior Carers

Carers

Household staff

Admin /

secretarial

Provide details of

how the service

covers sick and

annual leave e.g

overtime/agency/ban

k

Provide details of

staff rotas, including

shift patterns etc.

Provide evidence of

DBS, references,

PIN, staff are legal to

work in the UK.

21 If only aggregated total please delete as appropriate. Temp refers to agency or bank staff employed

57

Provide details of

staff meetings are

held and their

frequency for all staff

e.g. Management,

Nursing & Carers

Housekeeping &

Admin

Provide details of

formal staff

supervision? Who

gives supervision,

Frequency etc.

Provide details of key

worker system

Provide details of

staff training?

Evidence details of

competency and

skills

Care Details Yes No N/A Comments

Does the service

receive any chiropody

services? NHS,

Private (Charges)

NHS

Private (Charges)

58

Does the service

provide escorts to

residents for hospitals

/ GP visits? Are any

charges made?

Are customers

charged for any

services: dentist /

GP?

How does the home

determine access to

free dental

treatment?

Is this recorded in the

service user’s

agreement?

Does the service

employ a Handy

Person?

Is the service able to

care for minority

service users

Activity Details Yes No N/A Comments

59

Does the service

provide social,

educational,

recreational and leisure

activities?

Is there a list of daily

activities on display or

available?

Are residents consulted

about activities?

Evidence seen

Are the activities

suitable for the

individual

needs/interests?

Does the home have

hairdressing facilities?

Provide details of

opening times and

charges

60

Has evidence been

seen that activities and

trips have taken place?

Check group and

individual activity

planner against

individual activity

records i.e. daily logs,

diaries to check

planned activity and

actual activity are the

same/similar. If not

advise provider are

highlight as area for

improvement.

61

Accommodation /

Personal Yes No N/A Comments

62

Are customers able to

personalise their

rooms? Bring furniture,

hang pictures

Is there evidence of

customers right to

privacy? Describe

Is there evidence of

lockable storage space

in the customers’

bedroom?

Are there arrangements

for the safe keeping of

customers’ money and

valuables? Describe

Resident files / care

plans Yes No N/A Comments

Does each service user

have an individual file?

Are these files easy for

all staff to access?

Resident files / care

plans Yes No N/A Comments

63

Were service users’

care plans seen?

Are files kept in a

secure place?

Are residents and

relatives involved when

drawing up the care

plan?

Are relatives / council

officers informed of any

changes to the care

plans?

Is there evidence of

resident’s reviews and

risk assessments?

Customers finance Yes No N/A Comments

64

Are service user (s)

receiving correct

personal allowance and

is this being paid via

the next of kin or does

the home hold personal

allowance?

Is there evidence of

fully accounted records

of any financial

transactions on behalf

of the residents?

How many residents

paying top ups/client

contribution

Please state how much

Are there any financial

issues?

Catering Yes No N/A Comments

Are staff

trained on

Food

Hygiene?

Are fridge /

freezer

temperatures

recorded?

65

Catering Yes No N/A Comments

Are there

adequate food

stocks?

Is there

evidence of

stock rotation?

Does the

kitchen and

food

preparation

area have

evidence of a

cleaning

schedule?

Are dietary

requirements

being met?

Gluten free,

Kosher, Halal,

Soft diet, thick

& easy,

diabetic diet

etc

66

Are residents

issued with a

daily or weekly

menu? How

do they chose

their meals

Is the menu on

display in the

home? Obtain

a copy and

attach to this

form

Catering Yes No N/A Comments

Do flexible

arrangements

exist for meal

provision? If

residents

choose their

own meal

times

Are residents

involved in

meal planning

/ choice of

meals?

67

Can residents

choose where

they have their

meals?

Are residents

able to eat the

meal

hygienically,

safely and with

dignity? This

may involve

cutting up the

food or feeding

the resident

Catering (cont) Yes No N/A Comments

Are staff

aware of the

importance of

cultural, social

and religious

practices

relating to

meals and

mealtimes for

each resident

in their care?

68

Are there meal

provisions for

residents who

have a

lunchtime

hospital

appointment?

What are the

timings for

meals in the

home?

Is the home

meeting the

nutritional and

hydration

needs of the

residents?

General Yes No N/A

Is resident

consent to

care, photos in

place?

69

No. of care

plan/risk

assessment

checked

No. of care

plan/risk

assessment

reviews up to

date

No. of care

plan/risk

assessment

person centred

Is the provider

compliance

with duty of

candour?

Does the

home notify

the local

authority of

when a

resident is

admitted to

hospital?

Nursing Number

Comment

70

No. of

residents

receiving End

of Life Care

No. of

residents on

syringe driver.

Subcutaneous

(SC) drug

infusion

No. of nurses

training to use

syringe driver

No. of

DNACPR in

place

No. of

residents on

CD on each

unit

No. of

residents on

Insulin

No. of

pressure

ulcers

71

No. of

Percutaneous

endoscopic

gastrostomy

(PEG) feed

No. of

Nasogastric

(NG) tube

No. of

residents on

tracheostomy

No. of nurses

trained on

tracheostomy

care and

evidence of

training

No. of nurses

trained to draw

blood from

residents

72

Evidence of

Phlebotomy

training

No. of

residents with

Methicillin-

resistant

Staphylococcu

s aureus

(MRSA)

No. of

residents with

Clostridium

difficile

(C.Diff)

No. of

residents with

diarrhoea and

vomiting –

Norovirus

Infection

73

No. of days

the home is

closed due to

outbreak

Infection

Control

management

in place

Policies and Procedures

Does the home have the following policies and procedures? Yes – seen; No – Not seen or unavailable

List of policies

and

procedures

Yes No Comments

Confidentiality

of information

Financial

procedures

Equal

opportunities,

diversity,

sexual or

racial

harassment

74

Health and

Safety, Moving

and Handling

Medication

administration

Dealing with

accidents and

emergencies

Acceptance of

gifts (Probity)

Missing

Resident

Procedure

List of policies

and

procedures

Yes No Comments

End of

life/Dignity and

care

Safeguarding

Vulnerable

Adults

Business

Continuity

Plan

Management

of challenging

behaviour

75

Event of death

Admissions

procedure

Hospital

admission

Smoking

Training and

Development

Whistle

blowing

Complaints

and

compliments

List of policies

and

procedures

Yes No Comments

Deprivation of

Liberty

State number

of referrals for

assessments

made to date?

The Service

General

Policies/Procedures

Yes No

Comments

76

Does the home have

effective system for

disposing clinical

waste?

Are any rooms in need

of renovation?

Are door locks

satisfactory?

Do all bathrooms /

toilets have necessary

toiletries / equipment?

Soap, toilet paper,

drying facilities

Are there adequate

storage facilities

Are the home grounds /

garden tidy and

accessible? Is the

garden regularly used

by residents

Does the home allow

smoking? If yes, give

details

Are the lifts working

and does the home

have a certificate for

servicing?

77

Are fire and emergency

doors clear of

obstruction and working

correctly?

Has a legion Ella test

ever been carried out

on the water system?

Does the home have a

pest control contract in

place?

Are fire alarms tested

and fire drills conducted

on a regular basis?

Is there a security

system on the front

door?

Is there a laundry

system

Other Comments or questions/staff comments

Safe

78

Other Comments or questions/staff comments

Effective

Caring

Responsive

79

Other Comments or questions/staff comments

Well- led

Actions

Deadline

80

Other Comments or questions/staff comments

Service Review/Commissioning

Officer/Manager Name:

Signature:

Date:

81

Further Comments

82

Further Comments

83

Further Comments

84

Appendix E Monitoring Form Checklist Domiciliary and Floating Support

Dom/Home Care

Floating Support

(Please circle one of the above)

Quality Assurance

MONITORING FORM

Name of Service:

Address:

Number of registered places:

Number of vacancies:

Date of last CQC inspection: Rating:

No. of LBBD Placements:

List of other placing boroughs:

Date of Visit:

85

QA Monitoring - Checklist

Check

Compliant Y/N Action to be taken

Staff files in order

Staff files contain

copy of passport or

right to work

documents & photo

ID

Staff training up to

date – all relevant

training has taken

place (see p7)

86

Refresher training is

scheduled

Staff supervision and

appraisals up to date

Check

Compliant Y/N Action to be taken

Staff DBS checks up

to date

87

Staff development

plans in place

Service users files up

to date & indexed

Service User support

plan in file &

reviewed 6 monthly

Risk Assessments in

file & reviewed 6

monthly

88

Copy of the social

workers support plan

in file

Check

Compliant Y/N Action to be taken

Do both plans

achieve the same

outcome?

Complaints

procedure in place

89

Staff, service users

and family members

are aware of

providers complaints

process – evidence

(leaflets given?)

Number of

complaints risen

since last QA visit?

Proven

Unfounded

Ongoing

Safeguarding and

Serious Incident

issues log checked

90

Check

Compliant Y/N Action to be taken

Serious incidents

have been logged

with Council and

CQC – evidence to

be seen

Emergency cover

plan in place

Weekend cover plan

in place

91

General appearance

of the office space

Carers have ID on

display when

attending visits

Check

Compliant Y/N Action to be taken

92

Carers are wearing

suitable

clothing/uniform on

visits

IT systems in place

and recording is up

to date

Premises complies

with Health and

Safety

Fire Certificate in

place and up to date

Insurance Certificate

in place and up to

date

93

Staff have Managers

emergency numbers

Sickness procedure

in place and plan for

cover

Management helpful

willingness to assist

with QA visit?

Medication

information

QA – Office use only

Date Comments

Risk assessment updated

94

Report completed

Frequency of monitoring

changed?

Monitoring spreadsheets

updated if appropriate

Issues escalated if

appropriate?

Date of next visit

95

QA Monitoring: Training Checklist for homecare providers

Date of Monitoring ………………..

Recommended training for carers working in the homecare sector

Provider……………………………………………………………………. No of carers

…………………

Carers audited

Name ………………………….. (carer A)

Name…………………………… (carer B)

Name…………………………… (carer C)

Training Relevant

to role

No of

carers

completed

No of

carers not

completed

No of

carers

booked

for

training

Action

date for

completion

of training

Compliance

Y/N

Handling

information

(data

protection –

handling

sensitive

personal

information

All

Safeguarding

Adults

All

Safeguarding

Children

All

Dignity All

Health &

Safety

Awareness

All

96

Assisting and

moving

All

Lifting and

manual

handling

(equipment

training)

All

First Aid

including

basic life

support

All & role

specific

Fire Safety All

Infection,

prevention

and control

All

Medication Role

specific

Fluids and

Nutrition

All

Mental

Capacity Act

Training

All

Dementia

Care

All

End of Life

Care

All

Learning

Disabilities

All

Diabetes All

Sources for training recommendations to comply with CQC requirements can be found on

the Skills for Care website including information regarding the Care Certificate:

http://www.skillsforcare.org.uk/Standards/Care-Quality-Commission-

regulations/Recommendations-for-CQC-providers-guide.aspx

97

Appendix F Sheltered Housing

Sheltered Housing

Quality Assurance

MONITORING FORM

Name of Service:

Address:

Number of flats:

Number of vacancies:

No. of LBBD Placements:

List of other placing boroughs:

Date of Visit:

98

Monitoring visit details

Name of Manager:

Has there been any change

since the last visit

Name of Officer(s) carrying out

Monitoring:

Type of Monitoring Visit Annual Full 6 Monthly Monthly

Announced / Unannounced please circle

Name of other people present

and involved in the visit:

Provider details

Categories of resident support needs – list number of residents in each category

Physical/Sensory

Disability Mental Health

Other Please State

Rehabilitation Learning Disability

Respite End of Life Care

99

General Impressions

Looking to deliver outcomes Yes No N/A Comments / Observations

Was the service welcoming?

Institutional?

Homely?

Was there a visitor / signing in

book?

Was the service free from

unpleasant odours?

Was the condition of decoration

satisfactory?

Registration / Inspection Details Yes No N/A Comments / Observations

Was there a Registered

Manager Certificate on display

Has the home attained the Gold

Standard Framework?

Is Certificate on Display

Were relevant insurance

certificates on display?

Was the home Statement of

Purpose on display?

100

Is Quality Audit (QA) up to

date?

Are all permanent residents

issued with a Tenancy?

Do the tenants have capacity to

sign or has it been signed on

their behalf under PoA

Are all residents issued with a

welcome pack?

Does this include a copy of the

complaints procedure?

Has there been a change in

ownership since the last

monitoring visit? If yes Obtain

details of new owner(s), date

change became effective

Does the service have any

planned developments for the

next 12 months?

Obtain copy of plans

Is staff interaction with service

users satisfactory?

Health and Safety Comments

Who is your service allocated

Health and Safety Officer?

Please supply proof of their

competency to undertake this

task i.e. Certificates

101

Is the Health and Safety

Certificate on display?

Does the service have an

incident / accident book?

Evidence?

Yes No

Does the service have evidence

of COSHH assessment? E.g.

date of visit

Does the company that owns

this service carry out regular

Health and Safety checks?

Please give details

Yes No Comments / Observations

Please supply a copy of your

current Health and Safety

guidelines

Emergency Procedure

Please state your current

procedure when an

ambulance is called for one

of your residents

Contractual and Regulatory

Information Yes No N/A Comments / Observations

102

Has the proprietor of the

service agreed to a pre-

placement contract

agreement? Which local

authority?

Date signed

Do are all flats self-

contained?

Are there any shared flats?

Does the provider have any

issues around resident’s

care needs?

If Yes has local authority

been notified?

Are social workers’ reviews

up to date? If No how

many outstanding

Contractual and Regulatory

Information (cont.) Yes No N/A Comments / Observations

Does the housing provider

inform care managers when

residents refuse provision of

services?

Is the Local Authority

Informed about serious

incidents, illnesses,

RIDDOR using the serious

incident form?

103

Have safeguarding

concerns been raised in the

last 12 months?

Substantiated –

Unsubstantiated –

Outcome awaited -

Have there been any other

issues since the last visit?

Does the site have a

complaints / compliments

log book?

How many complaints have

been recorded in the last 6

months

How many compliments

have been recorded in the

last 6 months

Have these been logged

with the Local Authority?

Contractual and Regulatory

Information (cont.)

Name

Comment

104

Who is responsible for

carrying out the service

quality audit (QA)? Please

provide evidence

If No - What Quality

Assurance System is in

place

Staffing Details

No. of staff on duty during the monitoring -

How many staff does the

service employ?

Give breakdown if

appropriate 22

Day = Night = Other =

Perm Temp

Perm Temp Perm Temp

Management

Support staff

Admin / secretarial

105

Provide details of how the

service covers sick and

annual leave e.g

overtime/agency/bank

Provide details of staff

rotas, including shift

patterns etc.

Provide evidence of DBS,

references, staff are legal to

work in the UK.

Provide details of staff

meetings are held and their

frequency for all staff e.g.

Management, support staff

& Admin

Provide details of formal

staff supervision? Who

gives supervision,

Frequency etc.

Provide details of key

worker system if applicable

106

Provide details of staff

training? Evidence details of

competency and skills

Care Details Yes No N/A Comments

Does the service receive

any chiropody services?

NHS, Private (Charges)

NHS

Private (Charges)

Does the service provide

escorts to residents for

hospitals / GP visits? Are

any charges made?

Are customers charged for

any services: dentist / GP?

How does the service

determine access to free

dental treatment?

Is this recorded in the

service user’s agreement?

Does the service employ a

Handy Person?

Is the service able to care

for minority service users

Activity Details Yes No N/A Comments

107

Does the service provide

social, educational,

recreational and leisure

activities?

Is there a list of daily

activities on display or

available?

Are residents consulted

about activities? Evidence

seen

Are the activities suitable for

the individual

needs/interests?

Does the home have

hairdressing facilities?

Provide details of opening

times and charges

108

Has evidence been seen

that activities and trips have

taken place?

Check group and individual

activity planner against

individual activity records

i.e. daily logs, diaries to

check planned activity and

actual activity are they the

same/similar.

109

Accommodation / Personal Yes No N/A Comments

110

Is there evidence of

customers right to privacy?

Describe

Is there evidence of

lockable storage space in

the customers’ bedroom?

Are there arrangements for

the safe keeping of

customers’ money and

valuables? Describe

Resident files / care plans Yes No N/A Comments

Does each customer have

an individual file?

Are these files easy for all

staff to access?

Resident files / care plans Yes No N/A Comments

Were service users’ care

plans seen?

Are files kept in a secure

place?

111

Are residents and relatives

involved when drawing up

the care plan?

Are relatives / council

officers informed of any

changes to the care plans?

Is there evidence of

resident’s reviews and risk

assessments?

Customers finance Yes No N/A Comments

Are service user (s)

receiving correct personal

allowance and is this being

paid via the next of kin or

does the site hold personal

allowance?

Is there evidence of fully

accounted records of any

financial transactions on

behalf of the residents?

How many residents paying

top ups/client contribution

Please state how much

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Are there any financial

issues?

Catering Yes No N/A Comments

Are staff trained on

Food Hygiene?

Are fridge / freezer

temperatures

recorded?

Catering Yes No N/A Comments

Are there adequate

food stocks?

Is there evidence of

stock rotation?

Does the kitchen and

food preparation

area have evidence

of a cleaning

schedule?

Are dietary

requirements being

met? Gluten free,

Kosher, Halal, Soft

diet, thick & easy,

diabetic diet etc.

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Are residents issued

with a daily or

weekly menu? How

do they chose their

meals

Is the menu on

display in the home?

Obtain a copy and

attach to this form

Catering Yes No N/A Comments

Do flexible

arrangements exist

for meal provision? If

residents choose

their own meal times

Are residents

involved in meal

planning / choice of

meals?

Can residents

choose where they

have their meals?

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Are residents able to

eat the meal

hygienically, safely

and with dignity?

This may involve

cutting up the food or

feeding the resident

Catering (cont) Yes No N/A Comments

Are staff aware of

the importance of

cultural, social and

religious practices

relating to meals and

mealtimes for each

resident in their

care?

Are there meal

provisions for

residents who have

a lunchtime hospital

appointment?

What are the timings

for meals?

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Does the food meet

the nutritional and

hydration needs of

the residents?

General Yes No N/A

Is resident consent

to care, photos in

place?

No. of care plan/risk

assessment checked

No. of care plan/risk

assessment reviews

up to date

No. of care plan/risk

assessment person

centred

Is the provider

compliant with duty

of candour?

116

Does the

organization notify

the local authority

when a resident is

admitted to hospital?

Nursing Number

Comment

No. of residents

receiving End of Life

Care

Infection Control

management in

place

Policies and Procedures

Does the home have the following policies and procedures? Yes – seen; No – Not seen or unavailable

List of policies and

procedures Yes No Comments

Confidentiality of

information

Financial procedures

Equal opportunities,

diversity, sexual or

racial harassment

Health and Safety,

Moving and Handling

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Medication

administration

Dealing with

accidents and

emergencies

Acceptance of gifts

(Probity)

Missing Resident

Procedure

List of policies and

procedures Yes No Comments

End of life/Dignity

and care

Safeguarding

Vulnerable Adults

Business Continuity

Plan

Management of

challenging

behaviour

Event of death

Admissions

procedure

Hospital admission

Smoking

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Training and

Development

Whistle blowing

Complaints and

compliments

List of policies and

procedures Yes No Comments

Deprivation of

Liberty

State number of

referrals for

assessments made

to date?

The Service

General

Policies/Procedures

Yes No

Comments

Does the site have effective

system for disposing clinical

waste?

Are any rooms in need of

renovation?

Are door locks satisfactory?

Do all bathrooms / toilets

have necessary toiletries /

equipment? Soap, toilet

paper, drying facilities

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Are there adequate storage

facilities

Are the home grounds /

garden tidy and accessible?

Is the garden regularly used

by residents

The Service

General

Policies/Procedures

Yes No

Does the home allow

smoking? If yes, give details

Are the lifts working and

does the home have a

certificate for servicing?

Are fire and emergency

doors clear of obstruction

and working correctly?

Has a Legionella test ever

been carried out on the

water system?

Does the home have a pest

control contract in place?

Are fire alarms tested and

fire drills conducted on a

regular basis?

Do people have Personal

Emergency Evacuation

Plans where needed?

120

Is there a security system

on the front door?

Is there a laundry system

Other Comments or questions/staff comments

121

Other Comments or questions/staff comments

Actions Deadline

122

Other Comments or questions/staff comments

Service Review/Commissioning

Officer/Manager Name:

Signature:

Date:

123

Appendix G – Review Report Template

London Borough of Barking and Dagenham

Adult and Community Services

Draft - Quality Assurance Monitoring Report

Provider

Type of Service

Date of Monitoring Visit

Type of visit

Annual

Full

Other please

state

Carried out by

Date of Report

Date of last visit

Provider staff present

Background - To include previous reviews by CQC and QA

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Evidence Gathered - To include all the records care plans finance, staff rotas, training service

users care plans discussions etc observations and discussions with staff and service users.

This info to be anonymised on the report but identifiable on the saved reviewing form.

Recommendations / Improvement Actions - where the provider is rated Amber, Red or

Black an improvement plan must be devised with the provider.

Report to be sent to: Service Provider Manager - Commissioning Manager - Quality Assurance Manager- (others may be cc’d if appropriate)

Copy to be saved to provider folder by report author

Signature:

Date:

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Appendix H – Serious Incident form

Adult Commissioning

Serious Incident Reporting Procedure

Revised – 18-07-2017

For: Service providers commissioned and/or contract monitored by the Adult

Commissioning Group

Safeguarding –

If the incident involves an adult with care and support needs is suffering or has suffered abuse and/or neglect or may be at risk of abuse and or neglect then this is a safeguard and an immediate safeguard concern must be raised by phoning the Intake Team or completing the Safeguard Concern form and emailing it to the Intake Team: e-mail: safeguardingadults@lbbd.gov.uk

Secure e-mail: SafeguardingAdults@lbbd.gcsx.gov.uk

Tel: 020 8227 2915 For incidents involving Child Protection please contact 020 8227 3811

If the person is at immediate risk call the police on 999.

• All medication errors must be raised as a safeguard.

•

A copy of the London Multi Agency Safeguarding Adult Policy and Procedure23 plus

any local policies should be held on site at each service.

Any other concern that is not a safeguard is a Serious Incident and is covered

by this form.

Serious Incident Reporting Procedure: - Serious Incidents need to be reported to

the contract monitoring section. This applies regardless of you having internal

reporting procedures, requirements to report to other regulatory bodies or to

statutory service areas such as social work teams.

Please provide a brief description of what happened using the attached form. It is a

contractual obligation to report these incidents. If you are uncertain whether an

incident should be reported, contact the Adult Commissioning Group to discuss it.

23 http://londonadass.org.uk/safeguarding/review-of-the-pan-london-policy-and-procedures/

126

Serious Incidents will be monitored by LBBD and will be reviewed at contract

meetings.

1. You must notify Adult Commissioning within three working days.

• Email this form to adultcommissioning@lbbd.gov.uk

Definition of serious incident: -

1. CQC reportable incidents • All CQC reportable incidents should be reported. This can be done by sending

the CQC documentation to the above email. With the exception of; o Deaths in Nursing and Residential homes which are reported to

commissioning separately, these do not need to be raised through this process.

2. Death or serious injury

• Death – Suicide / Accidental / Murder / neglect (not age related natural causes in Sheltered Accommodation). (See 1 above for exceptions). Serious injury as the result of an accident on the premises. (Serious =

Requiring medical treatment, e.g. burns, broken arms / legs / ribs)

consider whether this needs to be a safeguard. Single grade 2 pressure

sores. (Multiple grade 2 and all grade 3 and 4 pressure sores should be

reported as a safeguard).

3. Serious crime or violence affecting staff or members of the public

• Use of weapons by / against anybody other than a service user or associated person (partner / friend / family member).

• Any form of abuse or sexual offence against anybody other than a service user. (The Commissioning Team do not require the intimate details but there is a need to know the type of incident and that the correct action has been taken)

• Drug dealing from the premises.

4. Serious threats

• Threats to kill or seriously injure made by a service user.

5. Emergency or compulsory Attendance or Admission to Hospital

• Incidents in connection with admission to psychiatric units, especially ones that may have caused substantial disturbance to neighbours.

• Serious injury requiring hospital attendance or admission.

6. Fire, flood or other serious issues relating to buildings

• Fire or flood, etc causing substantial damage to the property.

• Any incident of Arson

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7. Any temporary suspension of service.

8. Any other incidents or situations that would involve a serious risk to service users, staff, visitors or service viability.

9. Any other incident that gives rise to serious concerns

• Incidents that attract adverse public attention.

• Incidents that attract media attention.

London Borough of Barking & Dagenham

Adult Commissioning Group

Serious Incident Reporting Procedure for Service Providers

Provider name & service

name:

Provider Address:

Name and job title of

person making this

report:

Contact Details: Telephone:

Email:

I.D. Number

1. Name of Client/Staff Member Involved:

2. Address of Incident

128

3. Date of Incident

4. Description of the incident

(attach a copy of your

organisations incident

report form if

appropriate)

5. Actions taken by staff ( This includes any support offered or risk assessment carried out)

Actions taken by

staff (cont).

6. Actions agreed to manage the situation going forwards

7. Are there any risks outstanding that cannot be managed by the above?

8. Any change to process or procedures as a result (if applicable)

Please Return to:

• adultcommissioning@lbbd.gov.uk

129

2. You must submit a written report to the team within 3 working days.

Please mark all correspondence ‘private and confidential’ and return it to: -

Adult Commissioning,

London Borough of Barking & Dagenham Room 218

Barking Town Hall 1 Town Centre Barking IG117LU

130

Appendix I

Provider Failure Risk Assessment RAG rating.

London Borough of Barking and Dagenham

Commissioning, Adults Care and Support

Provider Failure Risk Assessment RAG rating.

Risk assessment is the process of assessing the potential for harm posed by a

service. The level of risk will depend on the likelihood of the outcome happening and

the severity of the impact on individuals or the Council if the outcome were to

happen. We assess four categories which are explained in the attached appendix

and this should be referred to when completing the risk rating.

Only the final category, Management, should feed into the Quality Assurance and

Safeguarding Call Over BRAG rating. The other three categories are additional

information to determine the response by the Council in the event of service failure.

Service Name

Contract or Spot

purchase

Duration of

Contract

Type of service

Service user group

Capacity

Contract Value & %

Overall BRAG:

131

Date Assessed at Call Over:

Date of last QA review

Registered with CQC?

Date of last CQC Inspection report

CQC Rating

Safe

Effective

Caring

Responsive

Well led

Overall Rating

Finance (not to be included in Safeguarding and QA Call Over BRAG rating)

Financial Stability:

Red Amber Green

Scale:

Red Amber Green

Service Users (not to be included in Safeguarding and QA Call Over BRAG

rating)

Dependence:

Red Amber Green

132

Management Issues (To be included in Safeguarding and QA Call Over BRAG

rating)

Track record of delivery:

Red Amber Green

Responsiveness:

Red Amber Green

Safeguards:

Red Amber Green

Environment:

Red Amber Green

Performance:

Red Amber Green

Risk Analysis Thresholds

The overall focus is on the risks to the Council of a provider leaving the market

through choice, failure or termination of the contract by the Council.

Risk Explanation Examples

Finance

133

Financial

Stability

Based on

Published

Accounts

Provider

Meetings

Intelligence

RED:

High risk of financial

failure in the next 12

months.

AMBER:

Medium risk of

financial failure

in the next 12

months.

GREEN:

Low risk of

financial failure in

the next 12

months.

Scale

Ease of

sourcing

alternative

provision

RED:

Alternative volumes

would be difficult to

find at short notice.

AMBER:

Alternative

volumes could

be sourced with

some difficulty.

GREEN:

Alternative

volumes can be

sourced easily.

Service Users

Dependence Extent to

which the

service users

are

dependent on

this service

for their daily

wellbeing

RED:

Service users must

receive the service

at all times.

AMBER:

Service users or

a large

percentage can

survive without

the service for

up to 48 hours.

GREEN:

Service users or

a large

percentage can

survive without

the service for up

to 72 hours.

Management

Track record of

delivery

Quality of

delivery over

the life of the

contract.

RED:

A long history of

concerns or a new

contract not yet

‘proved’.

AMBER:

Periods of

concern over

the life of the

contract

documented

through contract

processes.

GREEN:

Well managed,

good history of

delivery and

responding to

issues.

Responsivenes

s

Response of

the contractor

to

commissioner

concerns,

RED:

Poor, defensive,

non-collaborative,

AMBER:

Some concerns

about the

quality and

timeliness of

GREEN:

Prompt response

when

issues/concerns

are raised,

134

complaints,

safeguarding

unresponsive, lack

of robust plans

responses

when issues are

raised

encouraging

feedback, good

planning

Safeguarding/

Serious

Incidents

Current

ongoing

concerns,

safeguarding

serious

incidents.

RED:

Substantial current

issues, including

investigations,

outstanding

complaints, lack of

action by provider.

AMBER:

Some issues to

be addressed,

with responses

being worked

through

GREEN:

No immediate

concerns

Environment –

Physical and

Emotional.

Quality of

physical build

and

decoration.

Service

welcoming/

nurturing

Service feels

threatening.

RED:

Substantial risk to

service user or

public safety, or

critical impact on

care for a number of

service users

AMBER:

Environmental?

emotional

issues have an

impact on

service user

outcomes but

do not

compromise

safety

GREEN:

Service is of a

good physical

and

psychological

standard.

Performance

Is the service

delivering

against the

service

specification?

National

standards?

RED:

Substantial deviation

and unlikely to meet

targets at the end of

the year.

AMBER:

Some concerns

in some areas

but generally

delivering as

required.

GREEN:

Sound delivery

against

specification,

only minor or no

concerns.

The wide range of care services supplying the Council means we cannot have a

prescriptive scoring system; it requires judgement. Risk rating should take place

continuously particularly when there is change to a service providers circumstances.

135

The rating should be based on evidence collected by both Commissioning in their

management of the contracts with individual providers and the evidence collected

and reported by the Quality Assurance Team.

136

Appendix J – Improvement Plan

Service Name Service Improvement Plan

Locality: Barking & Dagenham

Teams:

Start Date : Completion Date:

Issue Related CQC Regulation & Actions Required

By Whom Deadline Evidence Required

Outcome/Update R A G

Rating:

Commenced but not on target

Commenced and on target

Completed

Not Yet Commenced

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Appendix K

Dear ,

Suspension of placements to be imposed on ____________Ltd

As you are aware, the Quality Assurance team have carried out visits to ________ on

the ________ and the _________ as part of our inspection and review duties. These

were in response to concerns raised in two safeguarding alerts and further concerns

raised by social workers undertaking the safeguarding enquires. I have summarised

the concerns that have been reported to me by the Quality Assurance team below:

Concern A

Concern B

Concern C

Consequently, the Council is not assured of the safety of the services being provided

by ____________ to adults with care and support needs that it supports.

Next steps – suspension of placements

In view of the risks posed to service users in your care that are outlined above, and

acting in consultation with the Operational Director, Adults’ Care & Support, I have

agreed that an immediate suspension of placements to _______ Ltd is an appropriate

step whilst improvements are put in place.

Provider Name and Address

Integration & Commissioning Adults’ Care and Support Barking Town Hall, Room 218 Barking Essex IG11 7LU 020 8227 2619 Date:

138

We are also required to notify other London authorities of our concerns through the

London Branch of the Association of Directors’ of Adult Social Services, together

with the Care Quality Commission.

This decision has not been taken lightly and is representative of the level of concern

that we have about _________. Officers will be in contact with you to agree a plan of

improvement based on what has been outlined above, and to establish the standards

that need to be met.

If you wish to discuss the details of this letter in any further detail, please contact

Quality Assurance Manager on Tel ________or by email at _____.gov.uk

Yours sincerely

Commissioning Director, Adults' Care & Support

Cc

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Appendix L Provider Failure

Policy

Managing Provider Failure

Introduction

1.1 Interruptions to care and support services cause uncertainty and anxiety for

people receiving services, their carers, family and friends. Local authorities

have powers and duties when services are at risk of interruption and, in

particular, when the interruption is because a provider’s business has failed.

1.2 Not all instances of provider failure will trigger local authority intervention. If

service provision remains uninterrupted and the needs of the people using that service are still met, there is no need for local authority intervention. Should provider failure lead to a temporary or permanent service interruption however, the Council has a temporary duty to intervene.

1.3.1 Business failure24 happens when:

• a receiver or an administrative receiver is appointed

• a winding up order is made

• an application for bankruptcy is submitted • the charity trustees of the provider become unable to pay their debts

The full list can be found in the Regulations25

The Temporary Duty on Local Authorities

2.1 The Care Act 201426 outlines a specific set of duties that local authorities

should exercise in the event of provider failure. The duties on local authorities

apply under relevant legislation in England, Wales, Scotland and Northern

Ireland.

2.2 The duty on local authorities to meet needs continues for as long as the local

authority considers it necessary.

• It applies regardless of whether a person is ordinarily resident in the

authority’s area.

• It applies from the moment the local authority becomes aware of the

business failure.

• Actions taken by local authorities depend on the circumstances and

may include provision of information.

24 The Care and Support (Business Failure) Regulations 2014 25 http://www.legislation.gov.uk/uksi/2015/301/pdfs/uksi_20150301_en.pdf 26 http://www.legislation.gov.uk/ukpga/2014/23/part/1/crossheading/provider-failure/enacted

140

• Local authorities have discretion over how to meet needs during

business failure.

It does not matter:

• whether or not the local authority has contracts with that provider.

• if all the people affected are self-funders.

• which local authority (if any) made the arrangements to provide

services.

2.3 Where there is provider failure the Council will intervene to ensure the needs of the individuals affected continue to be met.

2.4 The Council will seek to minimise the disruption to the people receiving care.

The Council will aim to provide as similar a service as is possible, whist recognising that the Council has discretion about how those needs will be met and it may not be possible or necessary to arrange for the exact same combination of services that were previously supplied.

2.5 In deciding how an individual’s needs will be met, the Council will involve the

person concerned, and carer that the person has, or anyone the person asks the authority to involve. If the individual lacks capacity to do that, the Council will involve anyone who appears to have an interest in the person’s welfare.

2.6 Where the provider is subject to the Care Quality Commission (CQC)

oversight regime, the Council will work with the CQC to prepare to develop a remedial action plan in preparation for exercising this temporary duty.

2.7 In the event of service disruptions occurring that are not triggered by business

failure, the Council may still choose to exercise these temporary duties if the disruption is likely to cause urgent needs of the individuals receiving that service.

Charging in the Event of Provider Failure 3.1 Care and support services are not always provided free, and charging for

some services is vital to ensure affordability. 3.2 The Care Act 2014 Section 48 (5-7)27 states that a local authority may charge

for the costs of arranging alternative services, where the individual concerned is funding the costs of their own care. The Council will only seek to recover costs incurred in arranging the alternative care to ensure this service is cost neutral to the local tax payer.

3.3 In the event that the service was arranged by another local authority, the Care

Act 2014 allows the cost of arranging alternative services to be recharged to the placing authority.

27 http://www.legislation.gov.uk/ukpga/2014/23/part/1/crossheading/provider-failure/enacted

141

3.4 This charging mechanism does not apply to people who are receiving care

that is paid partially or fully by the Council. 3.5 The Council will not charge for the provision of information and advice to the

person as a result of provider failure. Service Failure 4.1 Service Failure happens where services are interrupted, for example when

there are quality failings with a provider or there is a risk of an emergency closure but business failure is not the cause.

4.2 Where the provider's business has not failed, it remains the provider's primary

responsibility to meet the needs of individuals receiving care and support in accordance with their contractual liabilities.

4.3 Where the continued provision of care and support is in imminent jeopardy and there is no likelihood of returning to business as usual, The Council will exercise its discretionary power to meet urgent needs. This power is not limited to regulated providers and may be extended to unregistered providers, i.e. unregulated providers of a social care activity.

4.4 Before exercising this discretionary power a risk assessment will be

completed to determine whether the needs are urgent. Every service interruption will be considered on its facts and the circumstances.

Continuing Health Care 5.1 The Council will not be able to meet NHS Continuing Healthcare needs in

provider failure cases. This is because the duty to provide NHS Continuing Healthcare falls on the NHS and The Council is not permitted to provide it. The NHS duties are outside the scope of this policy. However, the relevant clinical commissioning group will be treated as a relevant partner that the Council will co-operate with in reaching an agreement about how to meet needs.

142