Margaret Lynes, Inspection Manager at the Care Quality
Commission (London Region), provided an overview of inspection work
in Haringey Borough. There were 81 registered locations in
Haringey, 32 of which were residential homes and 49 of which were
community-based services. The Covid-19 pandemic had caused a
dramatic impact on the number of inspections that could be carried
out and so any on-site visits were carried out in response to risk.
The number of these that were necessary in Haringey was low
compared to some other areas.
The
general approach during the early stages of the pandemic was a
supportive one with service providers being contacted to ascertain
how they were managing and flagging any particular concerns such as
a lack of PPE. An Emergency Support Framework (ESF) was introduced
to enable the targeting of local advice, guidance and support to
providers and care staff.
After
the initial support phase, a Transitional Monitoring Approach (TMA)
was introduced, enabling more inspections to take place but doing
so remotely where possible and limiting the physical presence of
inspectors at premises. This was a more detailed approach than the
ESF with more data required from providers and more intelligence
gathered in order to more accurately assess risk.
An
Infection Prevention and Control (IPC) methodology was developed to
enable targeted inspections of practices relating to infection
prevention and control in care homes. This was used to identify
both good practice which could be shared and providers where
services required improvement and could be given additional support
and guidance. Around 500-700 of these inspections were being
carried out per month and the IPC methodology continued to be
included as part of care home inspections.
Margaret Lynes then responded to questions from the
Panel:
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Asked by
Cllr Connor what difference the changes in practice had made to the
public reports following inspections, Margaret Lynes said that the
purpose of the ESF was not to produce reports but instead to
identify issues and provide advice and support where necessary.
Reports that had been produced through physical inspections did not
have as much service user voice as they would like due to the need
to avoid close contact with residents. Inspectors also took
additional precautions when visiting care homes including the use
of PPE, weekly covid tests and a lateral flow test prior to the
visit. As the methodology had developed, service user voice was
being obtained through the use of ‘Experts by
Experience’ and by contacting relatives’
representatives of service users.
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Asked by
Cllr Connor about the guidance for visiting care homes, Margaret
Lynes said that the CQC position was that service providers should
follow government guidelines. The CQC had established that some
providers had chosen to go beyond the government guidance and so
the CQC had firmly said that providers should follow the government
guidance unless there were very good reasons why they
shouldn’t. She was not aware of any care homes in Haringey
that had imposed their own restrictions.
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Cllr da
Costa asked whether the limitations on visits would cause a backlog
when inspections resume. Margaret Lynes said that the transitional
arrangements had allowed every service to be looked at and put into
different risk bands which would enable the CQC to make judgments
on services that should be prioritised for inspections in
future.
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Asked by
Cllr Demir asked whether the CQC would be going back to inspect
certain service providers, she said that premises rated as
‘Inadequate’ would be prioritised for further visits
with others prioritised on the basis on risk.
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Cllr Connor
noted that, according to the Council report to the Panel, only 5
CQC inspection reports had been carried out between June 2020 and
June 2021 and asked whether, in such circumstances, risk was being
accurately assessed. Margaret Lynes said that she was confident
that the methodology would identify risk but noted that risk was a
changing landscape. She acknowledged that there had been a
relatively low number of inspections in Haringey, mainly because
risk was identified elsewhere. However, risk data was analysed and
reviewed on a monthly basis which would identify any changes that
would require an inspection.
Charlotte Pomery, Assistant Director for Commissioning, added that
regular communication had taken place throughout the pandemic
between the CQC, the Quality Assurance teams at the Council and the
CCG and care providers so inspections alone were not relied upon as
the only way of identifying issues. Margaret Lynes agreed that
these communication channels had proved valuable and noted that the
Adults department at the Council had been very responsive to the
CQC during this pandemic.
Charlotte Pomery then introduced the Council’s report on
the provider market in Haringey, which included a table of
providers that the Council was working with due to an identified
need for intervention. As an example, the first on the list had
been rated as ‘Good’ by the CQC but an establishment
concern process had still been initiated due to other
concerns.
Of the
5 CQC inspection reports produced between June 2020 and June 2021,
one had been rated ‘Good’, two rated ‘Requires
Improvement’ and two rated ‘Inadequate’. A number
of closures had also taken place but this was largely due to
business decisions rather than care quality issues.
Section 7 of the report outlined the response to Covid-19 including
the vaccination programme for residents and staff, infection
control, testing, use of PPE and communications work. Additional
government funding for infection control had just been announced.
These measures were expected to be necessary for quite some time to
come.
Charlotte Pomery then responded to questions from the
Panel:
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In response
to a question from Cllr Demir about services that had been rated
‘Inadequate’, Charlotte Pomery said the Council
immediately looks at areas highlighted in the CQC report, looks at
the improvement plan drafted by the provider, takes a risk based
approach suspending any new placements and, if necessary, reviews
individual care packages. Service users may want to move to an
alternative placement, though this is often a big decision for care
home residents for example and some individuals may want to
remain.
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Asked by
Cllr Demir about what had happened to services user at Burghley
Road after the closure of services there, Charlotte Pomery said
that she would provide details to the Panel in writing.
(ACTION)
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Asked by
Cllr Blake about cost comparisons and value for money, Charlotte
Pomery said that the Council currently paid the London Living Wage
for home care. An hourly rate of £18.00-£18.50 was
required to enable this to be paid. For supported living, the
Council benchmarks with other local authorities and there were
different rates for different care groups and this was monitored
closely. For nursing/residential care the Council worked closely
with partner authorities across north central London so that there
was a detailed idea of benchmarking rates. Asked by Cllr Demir
whether provider costs had risen during the pandemic, she said that
there had been some additional costs caused by PPE, the need for
social distancing and staff sickness but the government funding
provided, including through the Infection Control Fund, had helped
to cover this. There could be implications from longer-term trends,
such as the initial decline in care placements as families were
concerned about Covid risk, and these trends would need to be
monitored over time.
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Asked by
Cllr da Costa about the CQC ratings of the 6 new providers outlined
in paragraph 6.4 of the report, Charlotte Pomery said that she
would be able to provide details of these to the Panel in writing.
(ACTION)
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Asked by
Cllr Connor about addressing the concerns raised on certain
providers, as outlined in paragraph 6.1 of the report, Charlotte
Pomery said that a lot of improvement support could be provided
through online communications though there had also been some
direct visits, prioritised based on assessed risk. Timescales for
change would vary depending on the nature of the issues. Cllr
Connor asked for a more detailed timeframe for dealing with the
issues to be provided to the Panel. (ACTION)
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In response
to a query from Cllr Connor about the vaccination programme for
residents and staff, as set out in paragraph 7.2 of the report,
Charlotte Pomery said that there were now targets for vaccinations
in care home settings and a huge amount of work was being done to
encourage and support residents and staff to get fully vaccinated.
This included an offer of a choice of vaccine, easier access to
vaccines and briefings from practitioners and clinicians. There
were a core of residents and staff who were either unwilling or
unable to receive the vaccine and it was possible that the
government would make it mandatory for care home staff to be
vaccinated.
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Asked by
Cllr Connor about the short notice given for relocation of
residents from the Mary Feilding Guild, Charlotte Pomery said that
the Council had no residents placed there so there were no
commissioning issues. From a safeguarding point of view, it was a
challenging process and there were clearly issues with the building
and other factors such as a change of ownership. There was a
concerted effort by the Council to support residents, working
closely with the provider and carrying out assessments of the needs
of individual residents. All residents were moved to alternative
accommodation before the deadline, though the legislative framework
in this area would have protected residents in any
event.