Nottinghamshire County Council Adult Social Care and Health

1. Nottinghamshire County CouncilAdult Social Care and Health Welcome to the Care Home Provider Forum 22nd May 2009

2. Nottinghamshire County Council Adult Social Care and Health Linda Bayliss – Service Director, Strategic Service

3. COMPLAINTS PROCEDURE2009 Pati Colman Service Manager – Customer Relations Service

4. 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.

5. The Four Cs Compliments Comments Concerns Complaints

6. 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.

7. 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.

8. What can they complain about? Any action, decision or omissionmade 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

9. 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.

10. 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

11. 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

12. What do CRS do? Check eligibility to complain Check if other procedures required (safeguarding / disciplinary) Make provisional assessment of seriousness to Complainant, Department, ISP

13. Written explanation Meeting Facilitated meeting Mediation Enquiry Independent Investigation Response options

14. 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.

15. 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.

16. 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.

17. 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.

18. 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

19. 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]

20. CRS Details • Phone: 0115 977 2788 • Fax: 0115 977 2787 • customer-relations-service@nottscc.gov.uk

21. Dementia in Care Homes Mark Griffin Community Mental Health Nurse Long Term Conditions Team

22. How many people are said to be living with a dementia in England? Name three different dementia’s Who first diagnosed Alzheimer’s disease? How much is dementia said to cost the UK each year?

23. 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

24. 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

25. Prevalence In Nottinghamshire

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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.

33. 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.

34. 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

35. 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

36. So what is needed for effective dementia care in residential/nursing homes ? Diet and nutrition Personal care Activities Diversional Techniques Life history Communication

37. So where can you access the training? Alzheimer’s Society Community Mental Health Team Independent companies In - house training

38. Nottinghamshire County CouncilAdult Social Care and Health Alice Gregson & Halima Wilson Workforce Planning Team

39. Pathway for End of Life Care Nottinghamshire Care Homes Forum Helen Scott, Health Improvement Principal Nottinghamshire County tPCT February 2009

40. What is the End of Life Care Pathway? • Guidance for the management of care given in all settings • in the last year(s) of life, and after death • to support patients and carers

41. How was the pathway developed? • National guidance (NICE, NHS EoLC programme, National Service Frameworks, CSCI) • Consultation with individuals and small groups • Workshop June 2008

42. CRITERIA FOR ENTRY Identification of patient in the last year of life using Gold Standards Framework prognostic indicators in primary care, secondary care, hospice, care home. PATIENT CARER Advance Care Plan Gold Standards Framework PROGNOSIS < 1 YEAR Carers Needs Assessment PROGNOSIS < 6 MONTHS DS1500 Report Respite Care Physical Care Training Anticipatory Prescribing Continuing Care Fast-Track PROGNOSIS “FEW WEEKS” Liverpool Care Pathway PROGNOSIS < 1 WEEK Bereavement Care AFTER DEATH

43. Criteria for entry • Gold Standards Framework indicators: • www.goldstandardsframework.nhs.uk

44. Pathway stages • Status:

45. Prognosis < 6 months Prognosis< 1 year

46. Prognosis “a few weeks” Prognosis < 1 week

47. After death 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 support Self-help and support services Respite care Equipment Spiritual support

48. CRITERIA FOR ENTRY Identification of patient in the last year of life using Gold Standards Framework prognostic indicators in primary care, secondary care, hospice, care home. PATIENT CARER Advance Care Plan Gold Standards Framework PROGNOSIS < 1 YEAR Carers Needs Assessment PROGNOSIS < 6 MONTHS DS1500 Report Respite Care Physical Care Training Anticipatory Prescribing Continuing Care Fast-Track PROGNOSIS “FEW WEEKS” Liverpool Care Pathway PROGNOSIS < 1 WEEK Bereavement Care AFTER DEATH

49. ADVANCE CARE PLANNING Elise Adam Steph Pindor Rob Smith END OF LIFE CARE TRAINERS

50. 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