Health and Social Care Committee
Inquiry into residential care for older people
RC70 – Cardiff Council
The process by which older people enter residential care and the availability and accessibility of alternative community-based services, including reablement services and domiciliary care.
In Cardiff we have the following three initiatives which support people at key stages in the care cycle, with the aim to maintain/regain independence, and minimise escalation of need and admission to NHS or residential care.
Our Short Term Assessment and Response Team (START) provide 6 weeks of intensive support for people upon leaving hospital, with a strong ‘re-ablement’ focus. Admission to the service is via the Contact & Assessment team, hospital ward staff or a hospital social work department. An assessment is required, and the service is free for up to six weeks after which normal charging applies. On average [in 2009-10] only 30% of START clients are referred for ongoing care at the end of the 6 week program, and the service receives excellent feedback via its Customer Satisfaction program to which all users are asked to contribute.
Our Elderly Care and Assessment Scheme (ECAS) operates from Rookwood Hospital, and receives referrals from the GP services for vulnerable older people who require urgent but not immediate assessment and investigation. Without the option of ECAS intervention, the GP would usually admit the patient to hospital. The service provides Medical, Physiotherapy, OT and Social Work intervention with a view to keeping older people in their own homes, the aim of the Social Work support being to provide a long-term care package via a care agency, within 5 days of Short Term Intervention Home Care putting in a service. Again, this service receives consistently excellent feedback via the Customer Satisfaction program that supports it.
The Cardiff East Locality Team (CELT) is a pilot scheme funded by the Welsh Government and developed collectively by Cardiff Adult Services and the Cardiff Local Health Board, who take the lead on the project. The service aims to prevent avoidable hospital admission though multi-agency intervention, including occupational therapy and social work as well as substantial Health input. Access is via referral from frontline GP and district nursing services in particular, typically responding within one working day or the same day where urgently needed. Within the evaluation period approximately 75% of referrals were from service-users in their own homes, and 25% were for those needing supported hospital discharges.
Work has now begun on developing locality-based teams for the rest of Cardiff, and the Vale.
The capacity of the residential care sector to meet the demand for services from older people in terms of staffing resources (including the skills mix of staff and their access to training) and the number of places, facilities andresource levels.
Cardiff has a mixed market of residential care providers who are currently absorbing the demand for residential care for older people leaving some capacity in the market for growth.
We hold a quarterly Residential and Nursing Provider Forum to share best practice and development opportunities within the market. Attendance at the Forum is voluntary and is reflective of a core group of providers, including the Chair of the Cardiff Care Homes Association.
In addition, we work closely with providers through our Social Care Workforce Development Program (SCWDP) to provide access to training and resources wherever available.
Access to training and qualifications through SCWDP is available to support all providers who are in a contractual relationship with Cardiff; engagement is voluntary in that many independent sector providers have their own provision for training in house or for the purchase of training from private sector training companies. One key element of the training programme is the need for basic skills training which underpins an individual’s ability to attain National Minimum Standards within the established training targets for care staff. A further issue impacting staff resourcing is the turnover rate of care staff in a number of establishments.
SCWDP has a varied suite of training methods accessible to support providers and aims to be responsive to areas of identified need.
The quality of residential care services and the experiences of service users and their families; the effectiveness of services at meeting the diversity of need amongst older people; and the management of care home closures.
In 2009 and 2010 we undertook Customer Satisfaction surveys of our Cae Glas and Ty Mawr homes, targeting primarily the family/friends of residents but also professionals who had cause to visit the homes. Response rates and levels of satisfaction were particularly high and any criticisms that arose were all investigated and resolved.
Service users who receive care in an independent sector residential setting in Cardiff are also regularly surveyed to assess their levels of satisfaction and again the responses received have shown particularly high levels of satisfaction with the services they receive.
The authority also grant funds Age Concern to provide a placement advocacy service across the residential and nursing home sector to underpin our quality assurance processes.
The care homes providing residential care to older people through the Councils internal provision and the independent sector have proved to be very effective in their ability to meet the needs of the diverse population of older people in Cardiff.
The Council recently completed an “Enhanced Dementia Care (EDC) Project which took place between 2008 and 2011. The project was funded by the Welsh Government’s ‘Promoting Independence and Well Being Grant Scheme’. Its aims were to contribute to improving the quality of dementia care in Cardiff by working in partnership to reduce inappropriate admissions to care homes and to enhance dementia care knowledge, skills and understanding in care homes and support the delivery of person centred care (Copy of the draft report attached).
Over the next 12 months the Council has planned to close its 2 remaining residential homes and has mapped a path for the closure following a formal decommissioning process, communicating and involving residents their families and carers throughout the ongoing process.
The Council undertakes monitoring of the residential care in Cardiff through the Adult Services Contracts & Service Development Team who work in conjunction with other organisations. Joint investigations with Care and Social Services Inspectorate for Wales, Health and the Independent and Voluntary Sector Agencies are regularly undertaken to improve the quality of services delivered to the people in residential care.
The Council has a dedicated safeguarding team, which adheres to the policy and procedures as outlined in the "All Wales Adult Protection Policy and Procedures" and the principals as outlined in the document "In Safe Hands".
The team endeavours to protect vulnerable adults from abuse (including Physical/sexual/emotional/Financial abuse and neglect) and investigate allegations of abuse together with other professional and partner agencies.
The team are contactable by any person(s) but in particular by the service user, family member or service provider, including staff under the whistle blowing guidelines and advocacy agencies including Age Concern.
Under the guidelines various types of meetings e.g. strategy meetings/case conferences, whole home enquiries, provider performance, escalating concerns meetings, Joint Inter Agency Monitoring Protocol meetings and serious case reviews are convened as and when appropriate to assess and manage the safety of vulnerable persons who may be at risk and also to assess systemic and organisational concerns such as poor care and practice.
Where appropriate and under the terms of the policy and procedures, service users, family members and advocates are involved in the meetings
In recent times the safeguarding team have been conducting assurance visits to residential homes where issues have been raised. These have been both announced and unannounced and have proved productive in gleaning first hand information, evidence of concerns, monitoring homes and safeguarding vulnerable persons.
The effectiveness of the regulation and inspection arrangements for residential care, including the scope for increased scrutiny of service providers’ financial viability.
Cardiff Council has an excellent relationship with the Care and Social Services Inspectorate for Wales (CSSIW) and has worked closely with them to ensure that residential care services for older people are provided at a high quality and in a safe environment. This has included the coordination of CSSIW inspections and Contract Performance Monitoring visits as well as a number of joint initiatives.
The Council would welcome the scope for the CSSIW to have the ability to increase the scrutiny of service providers’ financial viability in the interest of safeguarding the care provided to its citizens.
The Council will continue to work closely with the CSSIW in order to ensure a robust response is delivered to those providers where poor performance has been identified. Where necessary this happens in the residential care sector with the close cooperation of the providers.
New and emerging models of care provision
Over the last 4 years the Council has developed 3 Extracare schemes in Cardiff and is interested in developing and adopting potential new models for the delivery of residential care to older people.
The balance of public and independent sector provision, and alternative funding, management and ownership models, such as those offered by the cooperative, mutual sector and third sector, and Registered Social Landlords.
Cardiff Council welcomes the opportunity to take part in this inquiry into residential care provision for older people and would be interested in further exploring the possibility of alternative funding arrangements, management and ownership models such as those offered through alternative provision by cooperatives, the mutual and third sector and Registered Social Landlords.