nottinghamshire county council adult social care and health welcome to the care home provider forum...
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Nottinghamshire County Council Adult Social Care and Health
Welcome to the Care Home Provider Forum 22nd May 2009
Linda Bayliss – Service Director, Strategic Service
Nottinghamshire County Council Adult Social Care and Health
COMPLAINTS PROCEDURE
2009Pati Colman
Service Manager – Customer Relations Service
The 2009 Complaints Procedure • 01.04.09 - A new Complaints Procedure was introduced nationally to cover Adult Social Care and NHS complaints.
• It is designed to be flexible
• It has no stages
• It has only 2 pre-set timescales.
The Four Cs
• Compliments
• Comments
• Concerns
• Complaints
ISPs
• Requirement under the new Regulations to deal
with:
• Care Standards complaints [Reg 10]
• Social Care Provider complaints [Reg 11]
• ISPs are still required to operate and publicise
their own internal complaints procedure.
Who can complain?
• Anyone who is funded wholly or in part by
ASC&H
• Representatives of the above:
• Where there is consent
• The person (user) lacks capacity
• The person (user) is dead.
What can they complain about?
• Any action, decision or omission made by the
Authority [ASC&H] or by an organisation
commissioned to act on behalf of the Authority.
• There are certain exemptions – where
procedures do not apply
Dealing with complaints
• Depends on where it is received:
• Locality (MEO/SO)
• CRS
• ISP
• Wherever, decide if it is a Compliment, Comment,
Concern or Complaint.
Compliments, Comments & Concerns
• If it’s received by either the Locality (MEO/SO)
or CRS it will be passed to the ISP to respond
by:
• Compliment: Informing the staff concerned
• Comment: Informing Proprietor/Policy-maker
• Concern: Deal with straight away
Complaints
• If it’s a complaint, no matter where it’s received, the process is:
• Take a record of complaints and desired outcomes (if not received in writing)
• Acknowledge (Model letter A)
• Send cc of record/desired outcome to complainant
• Email/send/fax it to CRS
What do CRS do?
• Check eligibility to complain
• Check if other procedures required (safeguarding / disciplinary)
• Make provisional assessment of seriousness to Complainant, Department, ISP
Response options • Written explanation
• Meeting
• Facilitated meeting
• Mediation
• Enquiry
• Independent Investigation
What if they aren’t satisfied
• There are no stages but there is nothing to
prevent other options being considered in addition
to the initial response.
• In discussion with the ISP and the Complainant
CRS will suggest alternative ways forward.
Adjudication / Response
• In most complaints the Unit Manager will be the person
responding to the complaint.
• Whatever is done (meeting / enquiry / investigation)
there must always be a written response.
• If there are notes / minutes / a report a copy must be
included.
Signing-off
• When either the matter is concluded to the satisfaction of the complainant or there is nothing further that can be done to resolve the matter it must be signed off.
• For all ISP complaints, depending on the seriousness of the complaint, it will be signed off by the manager of P&MM or a senior manager in ASC&H.
Ombudsman
• Once the complaint has been signed off (the
Department is clear that no further action can /
should be taken) the Complainant must be
informed of his/her right to go to the Ombudsman.
Joint complaints:
• Some complaints will have more than one focus. Typically they may involve the Department, The ISP and NHS.
• If you receive a complaint like this, you will take the usual 4-point action:• Record, • Acknowledge• Copy to complainant • Pass to CRS
Reporting
• The MEO/SO in the Locality will need to receive the following information from you:
• Compliments [area of service]
• Comments [Any practice / policy changes]
• Concerns [Numbers only]
• Complaints [Outcome and action taken to resolve for
both self-funders & funded]
Dementia in Care Homes
Mark Griffin
Community Mental Health Nurse
Long Term Conditions Team
1. How many people are said to be living with a dementia in England?
2. Name three different dementia’s3. Who first diagnosed Alzheimer’s
disease?4. How much is dementia said to cost
the UK each year?
Prevalence of Dementia
Currently 700,000 people said to be living with dementia
Projected to increase by 1 Million by 2040
Suggested that there are 244,000 people in care homes with dementia - Daily Mail 27/11/2007
Prevalence of Dementia
Up to 75% of residents in non-specialist care homes have dementia Transforming the Quality of Dementia Care – DOH - 2008
The prevalence rises to between 90% and 95% in homes for the elderly mentally infirm Transforming the Quality of Dementia Care – DOH – 2008
64% of people living within care homes have a dementia – Alzheimer’s society 2008
Prevalence In Nottinghamshire
People with dementia
0
2000
4000
6000
8000
10000
30 -64
65 -74
75+ Total
Age
Nu
mb
ers Nottinghamshire
City
Notts County
National Dementia Strategy
“Health and social care services for dementia should enable access to good-quality care at home, in hospital or in a care home – provided by people with an understanding of dementia (“they need to know how dementia changes things”) – Transforming the Quality of Dementia Care – DOH - 2008
National Dementia Strategy – Recommendation 11
Improved dementia care in care homes Outcome – Quality of care in care
homes to be improved for people with dementia
National Dementia Strategy Recommendation 11-
Care homes developing a policy for good quality care for people with dementia; the appointment of a senior member of staff to lead the development and delivery of the policy; the policy being monitored and its provision being part of the contracting process. Transforming the Quality of Dementia Care – DOH – 2008
National dementia Strategy – Recommendation 12
Improved dementia care in care homes
Outcome – Quality of care in care homes to be improved for people with dementia
National dementia Strategy – Recommendation 12
Introduction of registration procedures requiring ALL care homes to demonstrate that they can provide good quality care for people with dementia, unless there are specific reasons for exemption
Managing care homes for people with dementia Ensuring staff and management had specific knowledge, skills
and commitment for dementia care;- having staffing levels which provided residents with individual attention;- recognising that dementia care is emotionally demanding for staff, and for managers, and responding to their needs for support;- involving relatives and residents with dementia in influencing individual care and the management of the home;- maintaining good links with local health and social care services, community groups and other local resources
http://www.jrf.org.uk/knowledge/findings/socialcare/312.asp
What staffing levels are required? Staffing levels were appropriate for meeting
residents' needs. The most common care staff/resident ratio was approximately 1:4. In homes with poorer staff/resident ratios, care staff felt under more pressure to get on with tasks rather than spend time with residents. Induction arrangements provided the support that new staff needed and imbued them
with the culture of the home.
Care staff felt valued as individuals, supported and appropriately rewarded; working with people with dementia is very demanding of staff.
All staff had good foundation training in dementia care as well as access to broader training and development opportunities.
Staff management (for example shift patterns, cover arrangements) provided residents with consistency of care.
Any staff working in respite or day care facilities had skills appropriate to that setting
http://www.jrf.org.uk/knowledge/findings/socialcare/312.asp
So what is needed for effective dementia care in
residential/nursing homes ? Staff Training :-
Basic awareness of what dementia is
How to deal with aggressive behaviours
Different types of dementia
Respecting a persons dignity and privacy
So what is needed for effective dementia care in
residential/nursing homes ?
Diet and nutrition
Personal care
Activities
Diversional Techniques
Life history
Communication
So where can you access the training?
Alzheimer’s Society Community Mental Health Team
Independent companies In - house training
Nottinghamshire County Council Adult Social Care and Health
Alice Gregson & Halima WilsonWorkforce Planning Team
Pathway for End of Life Pathway for End of Life CareCare
Nottinghamshire Care Homes Nottinghamshire Care Homes ForumForum
Helen Scott, Health Improvement Helen Scott, Health Improvement PrincipalPrincipal
Nottinghamshire County tPCTNottinghamshire County tPCTFebruary 2009February 2009
What is the End of Life Care What is the End of Life Care Pathway?Pathway?
Guidance for the management of Guidance for the management of care given in all settingscare given in all settings
in the last year(s) of life, and after in the last year(s) of life, and after deathdeath
to support patients and carersto support patients and carers
How was the pathway How was the pathway developed?developed?
National guidance (NICE, NHS EoLC National guidance (NICE, NHS EoLC programme, National Service programme, National Service Frameworks, CSCI)Frameworks, CSCI)
Consultation with individuals and Consultation with individuals and small groupssmall groups
Workshop June 2008Workshop June 2008
PATIENT
Advance Care Plan
Gold Standards Framework
DS1500 Report
Anticipatory Prescribing
Continuing Care Fast-Track
Liverpool Care Pathway
CARER
Bereavement Care
Respite Care
PROGNOSIS< 1 YEAR
PROGNOSIS< 6 MONTHS
PROGNOSIS“FEW
WEEKS”
PROGNOSIS< 1 WEEK
Carers Needs Assessment
AFTER DEATH
CRITERIA FOR ENTRYIdentification of patient in the last year of life using Gold Standards Framework prognostic indicators
in primary care, secondary care, hospice, care home.
Physical Care Training
Criteria for entryCriteria for entry
Gold Standards Framework indicators:Gold Standards Framework indicators:
www.goldstandardsframework.nhs.ukwww.goldstandardsframework.nhs.uk
Pathway stagesPathway stages
Status:Status:
Gold Standards Framework initiated
Single assessment of needs completed
Carer needs assessment fast-tracked
Patient-held record issued
Prognosis communicated
Keyworker nominated
Discussion of Advance Care Plan inc. Advance Decisions to Refuse Treatment, Preferred Priorities for Care initiated
Information prescriptions issued for patient and carer
DS1500 completed
Do Not Attempt to Resuscitate status reviewed and communicated
Out Of Hours, NHS Direct, East Midlands Ambulance Service informed of Advance Care Plan via Special Patient Note / EMAS End of Life decision registration form
Respite care arranged if appropriate
Blue Badge application fast-tracked if applicable
PrognosisPrognosis < 1 year
PrognosisPrognosis < 6 months
PrognosisPrognosis < 1 week
ACP inc. ADRT, PPC reviewed
Information prescriptions updated
Fast track to Continuing Care completed if additional service funding required
Anticipatory medications supplied
Carer needs reviewed
Support arranged for provision of terminal care in setting of patient’s choice e.g. Hospice at Home
Liverpool Care Pathway initiated
Out Of Hours, NHS Direct, EMAS updated on patient’s condition via Special Patient Note / EMAS End of Life decision registration form
PrognosisPrognosis “a few weeks”
After deathAfter death
Verification of death
Liverpool Care Pathway section 3 Care After Death completed
Special Patient Note / EMAS EoL registration form cancelled
Bereavement support needs assessed and agreed. Referral made for further support if appropriate
Audit of pathway completed
Learning reviewed in Multidisciplinary Team
The following will be provided at the appropriate time according to individual patient and carer needs:Specialist care (condition-specific and/or palliative)Specialist psychological supportSelf-help and support services Respite careEquipmentSpiritual support
24 hour access to advice and co-ordination of care underpin the pathway
PATIENT
Advance Care Plan
Gold Standards Framework
DS1500 Report
Anticipatory Prescribing
Continuing Care Fast-Track
Liverpool Care Pathway
CARER
Bereavement Care
Respite Care
PROGNOSIS< 1 YEAR
PROGNOSIS< 6 MONTHS
PROGNOSIS“FEW
WEEKS”
PROGNOSIS< 1 WEEK
Carers Needs Assessment
AFTER DEATH
CRITERIA FOR ENTRYIdentification of patient in the last year of life using Gold Standards Framework prognostic indicators
in primary care, secondary care, hospice, care home.
Physical Care Training
ADVANCE CARE PLANNING
Elise Adam Steph Pindor
Rob SmithEND OF LIFE CARE TRAINERS
WHAT IS ADVANCE CARE PLANNING?
• Advance Care Planning (ACP) is a voluntary process of discussion between an individual and their care providers irrespective of discipline.
• Advance Care Planning (ACP) is an “umbrella” term which may include;
LASTING POWER OF ATTORNEY ADVANCE DESCISION TO REFUSE TREATMENT PREFERRED PRIORITIES FOR CARE
WHY IS IT IMPORTANT?
• Enables people to make their own choices.
• Respects individuals “autonomy”.
• Creates a “forum” for open discussions re future care/concerns between patient/carer and health care professionals.
• Increases likelihood of actually achieving future wishes/preferences.
• Enables opportunity to audit care outcomes.
WHO IS RESPONSIBLE
• Any discussion must be determined by the individual concerned.
• All health and social care professionals should be open to any discussion, however :
Require appropriate training. Understanding of legal and ethical issues involved. Only initiate if the (ACP) is likely to benefit the care
of the individual. The discussion should be introduced sensitively.
USE OF ACP: TIMING AND CONTEXT
• Holistic assessment of individuals need.
• Admission to care home.
• Multiple hospital admissions.
• In conjunction with prognostic indicators; All diseases, i.e. dementia, frailty, COPD, heart disease.
• Life changing event.
• Following a new diagnosis of life limiting condition where appropriate.
Links to End of Life Care Pathway
• Prognosis < 1 year : Initiate discussion of ACP – possibly include ADRT , PPC .
• Prognosis < 6 months : DNAR status reviewed and communicated .
• Prognosis “few weeks” : ACP inc. ADRT , PPC reviewed .
• Prognosis 1 week : OOHs , NHS Direct , EMAS updated/review existing forms .
ADVANCE DECISION TO REFUSE TREATMENT
• An Advance Decision To Refuse Treatment (ADRT) is part of Advance Care Planning (ACP).
• It can only be completed by an adult over 18 years who has “capacity”.
• Only comes into effect once they have lost capacity.• Whilst they have capacity it may be withdrawn or altered at any
time.• It can only be used to REFUSE treatment related to specific
circumstances.• NB The ADRT form is not the same as the “Registration Of the End
of Life Care Decision Form” which is completed and used by Out of Hours and EMAS (East Midlands Ambulance Service),
Five Key Principles of Capacity
1. A person must be assumed to have capacity to make their own choices
2. A person is not to be treated as unable to make their own decision
3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
4. Any action for a person must be in a persons Best Interest
5. Any action on behalf of a person must cause as little restriction as possible
KEY PRINCIPLES OF ADVANCE CARE PLANNING
• The process is voluntary and should be determined by the individual.
• All health and social care professionals should be appropriately trained to undertake discussion.
• Should an individual wish to make a formal decision to refuse treatment (ADRT) this should be documented.
• Confidentiality should be respected at all times.
• Professionals need to be aware when they have reached the limits of their knowledge and competence and know when to seek advice.
USEFUL WEBSITES
• www.adrtnhs.co.uk
• www.goldstandardsframework.nhs.uk/advanced_care.php
• www.endoflifecareforadults.nhs.uk/eolc
Sarah Clarkson
balance the Food and Nutrition Service
Telephone 0779 318 7741
CORE BUSINESS
Food safety and hygiene
Preparation, cooking and food service for care settings
Nutrition for health and well being
Hydration
Food and Diet for Care
The Care Standards Act stresses diet as one of the most important factors in determining a resident’s quality of life.
Individuals food preferences and cultural or religious preferences must always be observed.
Standard 15 – ensure that service users receive a varied appealing wholesome and nutritious diet.
Food and Care Planning
Meal times can be “the highlight of the day” for people living in residential care
Concern has been focused on food and nutritional values
Food must meet individuals needs and preferences to reduce the risk of malnutrition and dehydration
Promote good communications and understanding between cooks and care
staff
Food and Nutrition Services
Sarah Clarkson General Manager Gavin Shelley Team Manager Garry NewburyCaroline BunningCatherine MarshNicky Parsons Stef Farrimond
•
Nutrition Checklist to ensure that the menu is nutritionally adequate, provide at least
2 portions per day meat fish ,cheese, eggs, pulses
Dairy foods 1/2 pint of milk daily
Fruit and vegetables1/3 pint of fruit juice and 4 portions of fruit or vegetables
Bread, cereals potatoes, rice, pasta one helping with each meal
Spreading and cooking fats fortified with vitamin D and E
•
Nutrition Checklist to ensure that the menu is nutritionally adequate, offer these foods at least once a week
Dried fruit such as apricots, currants raisins sultanas
Oily fish – mackerel, sardines, kippers, fresh tuna
Green leafy vegetables
Offal – kidney, liver, oxtail, liver sausage, pate
•
Promoting Nutrition Checklist
Ensure that menus include meals that residents are familiar with and enjoy
Provide a pleasant eating environment and assist with meal selection and eating where appropriate
Extra helpings and snacks should be available to residents with increased energy needs
Meals should be cooked as near to serving times as possible and kept hot for the minimum time possible
Residents are encouraged to go out of doors as much as possible in the
summer months
•
Nutrition Checklist
What would you recommend to ensure that this menu improves the nutritional status of residents?
Changes to the menu?
How food is served?
How well are cultural and dietary needs identified ?
How would you ensure personal choices are reflected?
HydrationDo you feel thirsty?Fatigue?Headache?Dizziness?Weakness?Our bodies are estimated to be 60-70% water
6-8 glasses of water daily is recommended
Hydration
Choose a water poster to display in your unit. Tell the people on your table how you will use it to promote health
Consider the water and health good practice and add your own suggestions to encourage water consumption
Nutritional screening
Malnutrition Universal Screening ToolHeight and weight, BMI Weight loss?IllnessLevel of risk – monitoring or seek advice
Six out of ten older people are at risk of becoming malnourished Age Concern Seven steps to end malnutrition
Listen to older people
Staff must become food aware
Staff must follow professional codes
People should be assessed for signs of malnutrition
Protected meal times Red trays
Use volunteers