Agenda item

To provide an update on the most recent commissioning and quality assurance activity carried out in the care sector by the Council and on inspections in the care sector by the Care Quality Commission (CQC).

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:

• 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.
• 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.
• 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.
• 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.
• 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:

• 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.
• 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)
• 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.
• 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)
• 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)
• 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.
• 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.