Agenda item

(To receive a report from Andrew Appleyard, Inspection Manager Lincolnshire, which provides the Committee with a position statement on the progress and themes coming out of the Care Quality Commission's (CQC) inspections of Adult Social Care services in Lincolnshire)

Consideration was given to a report by the Inspection Manager Lincolnshire from the Care Quality Commission (CQC) which provided the Committee with a position statement on the progress and themes coming out of the CQC's inspections of Adult Social Care services in Lincolnshire.

The Inspection Manager reported that he had been in post for five months, and managed a team of nine inspectors for Lincolnshire.  It was highlighted that the role of the CQC was to monitor, inspect and regulate all health and social care services in England and ensure that they met fundamental standards of quality and safety within the framework of the Health and Social Care Act 2008.  Members were advised that there were 422 locations registered in Lincolnshire for the provision of adult social care and the CQC had inspected and published ratings on 385 of these 422 services.

Members were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and some of the points raised during discussion included the following:

·         It was queried if a service had been rated as good by the CQC and through council monitoring it was found to be not doing as well, was the Council able to contact the CQC to request a visit.  Members were advised that the contract officers were in regular contact with the CQC, and if concerns were raised about a provider, then either the Council would carry out a visit, or the CQC could bring forward an inspection. It was noted that the Council had the ability to go into a provider more regularly than the CQC.

·         It was noted that having a consistent Registered Manager in post had a positive influence.  There were currently 25 locations in Lincolnshire without a registered manager.  Members were advised that where a registered manager had left one establishment and moved to another, this would generate a visit.  It would be possible to check how quickly a provider improved if they got a new registered manager.

·         In terms of small, unregistered providers, it was queried how they were engaged with, as if financial risk was recognised, there was the potential for people to be exploited.  It was highlighted that registration was not due to the size of the organisation, but whether it was providing a regulated activity.

·         In terms of Registered Managers, it was queried whether there was the possibility of having affiliated managers where they covered, for example, 3 smaller homes, and it was confirmed that this was possible.

·         It was noted that organisations would have a registered manager and there were registered providers.  GP surgeries may also have a registered person.  It was highlighted that the registered manager was someone that was accountable for the delivery of the regulated activity.

·         It was commented that elderly people would advertise for people to help them, including live in help, which could include a friendship element.  However, there was no requirement for people responding to these adverts to be CRB checked.  It was noted that where help included assistance with washing/dressing or helping with medication, this would then become a regulated activity.

·         In terms of the powers that the CQC held, it was noted that it could carry out targeted and focused inspections, as well as issuing warning notices.  The CQC could also hold registered managers and providers accountable for both civil and criminal matters.  It worked closely with the Police and the UK Border Agency.

·         Members were advised that the Council had seen a huge increase in compliance with contracts.  Over the last 18 months improvements had been seen where providers had gone from 'Requires Improvement' to 'Good'.  It was noted that targeted support and intervention had made a significant difference.

·         It was confirmed that visits by the CQC to providers were not announced, but inspections would generally take place within set timescales.  How the Commission asked for provider information returns had recently changed, and they were now requested on an annual basis.  However, small providers may be given 24 hours' notice to ensure that there were staff available.

·         It was queried whether the CQC had any powers of intervention with non-registered services.  Members were advised that there was scrutiny from the Council and officers would be looking for assurance that the provider was compliant with the contract.  If a safeguarding risk was identified then it would be referred to the safeguarding team.  The Council was working with the CQC and police in terms of criminal prosecutions.  If there were concerns, the Council could contact the CQC.

·         It was reported that the CQC did have a non-regulated services team, who could take action against non-registered providers who were delivering regulated services.

·         Members were advised that the CQC did not use 'mystery shoppers' to check on services.  However, there were assistant inspectors, and conversations were taking place around their roles, and the carrying out of welfare visits.  There may be a change to the way that reports were written.  It was also noted that the Council's contracts officers could visit providers and would observe practices.  Sometimes, feedback would also be received from utilities companies, and a lot of information was also received from the general public.

·         One member commented that they had visited a number of care homes and had noticed how things had improved in recent years, and were moving in the right direction.

·         It was queried what percentage of the elderly population went into residential care.  However, it was noted that the trend for the past 10 – 20 years had been to help people to stay in their own homes.  There was however, still a large number of working age people with disabilities entering residential care settings.  The availability of suitable housing was currently a big topic, and it was important that closer working with district colleagues continued in order to address this. 

·         It was highlighted that as people stayed in their homes for longer, the care that was being delivered changed and it was likely they would need more complex care, and most of this care was being delivered by family members.

·         It was suggested that there could be increased demand for non-regulated services such as shopping/cleaning as peoples care needs changed.  Members were advised that where these services were part of someone's care package, they would be commissioned by the Council who would have oversight of how they were delivered.

·         If a new registered manager was appointed to a provider, it would be between six months and a year before the CQC would visit to take account of any notice period they may have to serve at their previous provider and also to allow time to complete their induction period.  The CQC would try to be flexible with these circumstances and seek to understand the whole situation.

·         It was queried whether there was a career path for registered managers, and it was noted that there was a lot of development of staff within the industry, which was important.  It was noted that the CQC had been to Boston College to speak to a group of registered managers who were holding a day of training.

RESOLVED

            That the information presented be noted.