The Care Home Consultation Forum

The Care Home Consultation Forum

Minutes from the meeting of Tuesday 3rd December 2013

The Hub, Shiners Way, South Normanton.

Present:Derbyshire Care Homes Association

Brian Rosenberg (BR)Ashgate Care Ltd

Barbara White (BW)Ashgate House

Pierre Falleth (PF)Milford Care

Michael Poxton(MP) Ashmere Care Group

David Poxton(DP) Ashmere Care Group

Brian Ballin(BB)Coxbench Hall

Olive Tomlinson (GW)Coxbench Hall

Josie Greveson(JG) Hill Care Ltd

Mandy Vernon (MV)Hill Care Ltd

Derbyshire County Council Adult Care

James Matthews (JM)DCC

Colin Selbie(CS)DCC

Debbie Fairholme (DF)DCC

Kathleen Winfield (KW)DCC

Derbyshire NHS

Georgina Greensmith (GG)NHS Derbyshire

Fiona Milner (FM) NHS Derbyshire

Nicola Smith(NS)NHS Derbyshire

Amanda Biggam (AB)NHS Derbyshire

Jill Badger (JB) NHS Derbyshire

Martin Shepherd (MS)NHS Derbyshire

Lisa Ruddle(LS) NHS Derbyshire

CQC

Geraldine Yates (GY)CQC

Apologies:

Janet McVeigh Four Seasons Healthcare

Debbie WiddowsonCQC

Ros JohnsonCQC

Sandra RileyDCC

Lorraine Chester NHS Derbyshire

Sharon Cooper NHS Derbyshire

1.0Minutes from the meeting of the 10th September 2013

1.1Accuracy

1.1.1Re. 1.2.2. PF advised that the minutes should have recorded the Association’s concern about the proposed removal of the Quality Premium.

1.1.2 It was agreed that, other than the notes above,the minutes were an accurate record of the meeting held on the 10th September 2013.

1.2 Matters Arising

1.2.1 Fees

1.2.1.1 CS thanked PF for his paper submitted on behalf of the Care Home Association, in response to the council’s initial proposals in respect of fee rates. CS stated this paper is being reviewed by the finance team. CS advised that the Strategic Director for Adult Care has enquired if the Care Home Providers would like to meet to discuss their paper and to hear the DCC response. BR advised that if the proposed meeting was just a re-statement of the DCC position then this would be declined and it would be better to proceed to a public consultation.However, a meeting would be useful if it included negotiations about the proposals.

1.2.1.2 CS advised he is hopeful decisions from the Cabinet will be concluded by March 2014.

1.2.2 Care Provider Forums.

1.2.2.1 CS advised the Autumn Care provider Meetings had all been completed and a summary of the outcomes would be made available. DF stated that the meetings were well supported by providers and she will prepare a paper for circulation. Action: DF

1.2.3 DCC Finance Payment system.

1.2.3.1More detailedinformation; cross related to clients, is requiredon DCC payment documents. JM advised he is in discussions with the Head of Finance. Unfortunately, the Council has been told by their Bank that they need to find another to manage all of the Council banking arrangements. When a new bank is in place, some changes to the payment documents available to providers can be considered whichmay offer more information.

1.2.3.2Timely delivery of Purchase orders.PF concerned that purchase orders are regularly late. PF is arranging for letters to be sent to each respective social worker expediting purchase orders. Given the delays in purchase orders, PF enquired if a process can be created where interim payments are sent to providers. CS asked that examples of late purchase orders be sent to DF and this will be reviewed in terms of which field workteam is causing the concern. Action:PF/DF

1.2.3.3 Funding communications when a client moves from private to DCC funded. DP advised delays in notifying a provider when a privately funded client becomes DCC funded. Problems arise because the purchase orders do not correlate to the actual date that the provider was notified. Therefore a funding difference can come about and there can be further delays as a consequence of protracted discussions with the social worker and DCC finance. CS asked that examples are sent to him and he will investigate.Action: DP/CS

To arrange for a representative from the Finance team to attend the next meeting.Action: CS

1.2.3.4 FNC purchase orders.

PF advised problems in getting FNC purchase orders. JB to advise on the CCG process on funding.Action: JB

1.2.3.5 Fieldwork team negotiations on fees.

CS confirmed in response to a query from BB, that field workofficers should assist clients and their family members in fee negotiations. CS will arrange for a field work representative to attend one of the meetings in 2014. Action: CS

1.2.4. CHC Claims - Backlog

JM in discussions with Sharon Cooper from Continuing Health Care Team about the backlog. CHC will be asked to attend a future meeting.

1.2.5Living well through activity in care homes.

1.2.5.1AM stated there is a social activity co-ordinator network in Southern Derbyshire and the Care Home Advisory Service will be inviting providers in the area to attend meetings. This is currently a pilot scheme to commence in January 2014. Contact if you have not received an invitation.

2.0 Agenda

2.1.Further update on Medications at the point of Hospital Discharge. – Martin Shepherd, Head of Medicines Management, Chesterfield Royal Hospital.

2.1.1MS advised no feedback had been received from the members of the Care Home Consultation meeting, therefore he assumed everyone is in agreement with the draft Standard Operating Procedure for the supply of medicines to patients being discharged from hospital and who require social care support for the management of their medications.

2.1.2 MS noted there has been a decrease in concerns received from care homes and providers at the meeting acknowledged that there has been an improvement.

2.1.3 MS stated that Technicians are now working to a set standard and protocols. DP advised some of his homes are still not receiving discharge letters from the hospital. MS asked that if there are specific concerns to let him know, MS confirmed there should still be a paper copy for the home as well as electronic communications to the GP.

2.1.4 MS will now contact colleagues at Royal Derby hospital and share feedback from the Care Home Consultation Forum.

2.2. Medication Non Compliance themes. Geraldine Yates – Care Quality Commission Regional Pharmacy Manager – Central.

2.2.1 GY advised there are a number of common concern themes identified by CQC, e.g. Storage of medication, lack of/weak PRN protocols, Covert medication,Medication recording, Recording allergies.

Some of these themes were discussed in the meeting and are detailed below:-

2.2.2PRN protocols.

A Care plan is required because clients need PRN medication when they need them and administration should be delivered in a consistent way. How much information is contained in the care plan depends on the needs of the client. If the client has communication difficulties, the provider should include moreinformation as to how decisions are made, such as havinga pain chart in place. Where a client exhibits challenging behaviour, the provider should demonstrate there is a range of distraction techniques in place and that medication intervention is not a provider preferred first choice. The Care plan should be regularly reviewed to determine whether the medication and dosage is effective.

2.2.3 BW and GG advised there were concerns raised that there are inconsistencies in advice given from different CQC inspectors. GY stated there is a 197 page draft Medication guidance from NICEand there is good advice on PRN protocols. This should be available soon. BR advised there should be consistency nationally and not just in the East Midlands. GY advised that if a care home feels there are inconsistencies in advice from CQC inspectors, to raise their concern with D Widdowson and R Johnson.

2.2.4Drugs rounds.

Concern that there is insufficient dosage time between medication administration as the drugs rounds are sometimes taking so long to do and this is a national issue and not just Derbyshire. Draft NICE guidance will hopefullyalso address this. Providers should make sure client’s needs are met at appropriate dosage intervals and it could bea staffing issue if this is not achieved. CS noted that some of the clients are on complex medication and there appears to be reticence from providers to ask the GP’s to review the medication as if there are multiple medications for a client, then this makes the drugs round longer. If a client is asleep at the drug round, important to re-visit when they wake and administer meds.

2.2.5Community pharmacist and CQC pharmacist, discussion on seeking consistency in standards. CS advised hecan get a copy of a pharmacy review on a provider and use as a discussion with CQC in terms of correlation with the expected standards of CQC. Action: CS

2.2.6Staff competency

Providers must assess staff (including nurses) regularly to ensure they are competent to administer medication. General consensus of opinion was that annual competency assessments would be appropriate and a structured observation to be included. For providers to state that medication is discussed in staff supervisions is insufficient. For those people who are assessing staff competency, to evidence their qualifications and competency to do so.

2.2.7 Electronic medication records are acceptable, but providers to consider the skill sets of your current staff and their IT capability. Majorculturechange and recommends that the homemanagers are supporting the change.

2.2.8Warfarin

Blood tests are not being undertaken on time and therefore the right dose not given. There needs to be a structured process and if the district nurse does not turn up or does not want to do it, then what action is be taken. Sometimes a client may resist a blood test and a nurse in a nursing home may not often take blood tests and therefore they rely on the DN to assist. There appears to be a reluctance from District Nurses to attend a nursing client in a nursing home. Provider concerns on the support given by DN’s should be directed to Jill Badger and she will take the matter up.Action: JB

2.2.9 MP has asked JB for a document with expectations on services from District Nurses and JB confirmed she would arrange. Action: JB

2.2.10Providers should use the body map for recording where patches are attached to the body, when they were removed and to rotate the sites where the patch is applied.

2.2.11CQC Pharmacist resource

They go in when there is a referral from the CQC inspector. They react to specific CCG concerns, Whistle blow concerns, Warning Notice on Medication concerns.

2.3 NHS New Quality Monitoring tool.

2.3.1 The Icare tool is now been further developed and will be piloted in January 2014. In due course, the new tool template will be circulated.

2.3.2 A recent audit of all the Continuing Healthcare (CHC) Any Qualified provider (AQP) Care Homes in Derbyshire has identified a number of themes which contribute to poor care and a copy of the paper was circulated.

These themes include:-

• Staffing
• Care Planning
• End of Life Care
• Access to the Wider NHS
• Medicines Management
• Management and Leadership

2.3.3 JB stated that a trend was observed, that where a care home had a Manager vacancy, the themes above are particularly noticeable and her team will visit these homes more often to offer support.

.

2.4 Care Home Statistics

1st April 2013 – 14th November 2013

65+ admitted to permanent nursing or residential care:

525
Starters in fin yr / ..
Purchasing Team Area / LA residential / Indep Residential / Nursing
Amber Valley / 20 / 48 / 24
Bolsover / 10 / 24 / 26
Chesterfield / 13 / 50 / 22
Derbyshire Dales / 6 / 21 / 6
Erewash / 21 / 32 / 18
High Peak / 10 / 24 / 20
Mental Health / 2
North East Derbyshire / 3 / 60 / 18
South Derbyshire / 6 / 27 / 14
Total / 89 / 288 / 148

Bed Vacancies – DCC Web Site 2n December 2013

Amber Valley / Bolsover / Chesterfield / High Peak / Derbys Dales / Erewash / North east / South Derbys / Total
Nursing
4 / 16 / 8 / 11 / 13 / 17 / 7 / 7 / 83
Residential
22 / 19 / 12 / 32 / 19 / 22 / 19 / 12 / 157

Suspensions 2ndDecember 2013

Care Homes Older People 5 suspended from receiving new placements

Nursing Homes Older People4 suspended from receiving new placements

1 voluntary suspension

Care homes – People with Learning Disabilities2 suspended

Home Care3 suspended

1 voluntary

2.5 Any Other Business.

2.5.1 Problems recruiting nurses.JB to discuss with CCG management team and feedback.Action: JB

2.5.2 NHS Dentist resource. DP stated there is a 6 month waiting list for a dentist to visit a client. If the matter is urgent, the home is required to arrange for the client to visit the dentist surgery. JB to review CCG contract arrangements and feedback.Action: JB

2.5.3. Social workers and clientMCA assessments prior to admission..

DP stated that Social workers are not undertaking MCA assessments prior to admission. It was not clear if this was a County Wide problem CS asked for examples so that they could be sharedwith fieldwork colleagues and feedback. Action:CS

2.5.4 Mediquip equipment. DP stated dependency levels of clients is ever increasing and there is a regular, almost standard, demand for profiling beds. DP stated the providers cannot finance these beds which, historically, were only required occasionally.

CS stated the equipment contract is due for re-tender and in the meantime, he will ask the Contract Lead officer to contact DP on specific current concerns. Action:CS

2.6Next meeting dates:

• Wednesday 12th March 2014. 10.00am – Noon. Venue: - Lea Green Centre, Main Road, Lea, Nr. Matlock DE4 5GJ
• Wednesday 4th June 2014. 10.00am – Noon. Venue: - Room 3 TheHub, Shiners Way, Off the Market St, South Normanton Derbyshire DE55 2AA

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