By Debbie le Quesne

Archive for the ‘CQC ratings’ Category

ADASS fact-finding budget a worrying snapshot

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The latest document on monies and adult social care was never going to be happy reading.

Produced by the Association of Directors of Adult Social Services (ADASS), it gives a harrowing insight of what could be the future for care providers and their clients.

After reading and digesting a plethora of graphs and words in the ADASS Budget Survey 2015 I need a drink – well, at least a proper coffee.

The annual ADASS Budget digest is promoted as “an authoritative analysis of the state of adult social care finances” and indeed does provide in-depth intelligence on how adult social care is responding to the challenges of meeting increased demand and managing reducing resources.

The survey, with some 147 of the 155 local authorities in England responding, is a snapshot – albeit a very complex one – of the current state of play.

We all know that more people are living longer with more complex needs that require vital care, support and protection from adult social care in councils.

But this year (2015/16) councils are running out of “efficiencies”, warns the report and “will make service reductions of £420 million to people needing that care and support and their carers.”

The figure is eye-watering for a social care market that is creaking.

Note this well: There have been five years of funding reductions totalling £4.6 billion and representing 31 per cent of real terms net budgets. This year, adult social care budgets will reduce by a further £0.5 billion in cash terms.

Taking the growth in numbers of older and disabled people into account, this means that an additional £1.1 billion would be needed to provide the same level of service as last year, the report says.

There are more than 400,000 fewer people receiving social care services since 2009-10, and of those who are still supported, a significant number will get less care. Most directors expect that still fewer people will get access to services over the next two years.

We’re a creative thinking bunch – those who manage in the care sector – but every one is now struggling to carve more costs away and not least, local authorities.

Listen to this: The proportion of savings secured through efficiency has fallen from 80 per cent in 2014/15 to 75 per cent in 2015/16 and at the same time savings from income has increased from 4 per cent to 6 per cent, and from service reductions from 16 per cent to 18 per cent over the same period. Simply put, it means fewer savings are proportionately being made from efficiencies and more from charges and reducing frontline services.

There is so much material in this non-political document, I’m proposing to post a number of blogs on what I believe are the salient points.

Where’s the chocolate . . . I need sweet tea or may be a stiff coffee. Now!

Inadequate ratings – how does a business ever come good again?

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Right at the start of this month three Hartlepool care homes were rated inadequate by CQC.

During unannounced inspections at all of the homes in January and February 2015, inspectors found that they were “failing to provide care which was safe, effective, responsive or well led.”

Under CQC’s new programme of inspections, all adult social care services are being given a rating to help people choose care – outstanding, good, adequate and requires improvement. The signposting could be a big help for the general public in assessing how good firms are at compliance exercises, but what effect does such branding have on the care providers who have fallen foul of the new Standards criteria?

My concern is that some with less than ‘outstanding’ ratings could still deliver good care, while being poor at some compliance exercise. What’s more, I fear that a ‘requires improvement’ result could ultimately spell disaster as the need to improve grows against less capacity to generate funds to make them happen.

According to the CQC website the purpose of such measures are to:

  • Ensure that providers found to be providing inadequate care do not continue to do so.
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to cancel their registration.

Okay, I understand. But a question asked of me continues to haunt me: How does a home, when rated inadequate, improve? The pressure is racked up considerably for such providers as failure to improve initiates a special measures process.

It seems to me that perhaps we should be taking a lesson from education where additional resources are made available to failing schools.

Not so it seems with social care. In this scenario special measures could potentially involve multiple agencies all making their separate demands. For example, as well as the CQC rigour, there could be additional issues with Health and Safety, Infection Control and, of course, the local authority inspectorate. Each could legally demand their own response, while no doubt referrals from authority commissioners would be frozen.

The question which was put to me is a valid one and deserves more than a ‘should do better’ answer.

With potentially less income, a planned raft of reforms essentially drafted as directives by CQC, and inevitable low morale, there appears to be only one miserable conclusion unless extra funding is magically spirited out of the ether. Fact: Investment is needed to improve and perhaps the reason for failure has been the inability to do just that.

Of course, in some rare cases, the scenario could be very different, but my professional experience tells me that money troubles are generally the precursor to falling standards.

Support for schools that fail comes in various forms and in some cases a new management committee is drafted in. Resources for recovery are by the bucketful.

The public sector does seem to have an unfair advantage over private care business in this respect even though both are dealing with public ‘consumers’.

My answer to the question is typically political as I pose another: How is anyone supposed to do much more as potential for generating extra revenue is diminished?

Care providers are an ever-resourceful, creative and inventive breed.

My organisation is there to advise those who find themselves needing help and while we can’t predict winning Lottery numbers, please remember we have access to a huge pool of wisdom and professional advice from our membership and those agencies with which we work.

Bring on the coffee and cheering chocolate now please . . .

Failings report: The other news behind the headlines

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The BBC has picked up on a media release from the Care Quality Commission, reporting that nine sites have been rated inadequate across the north of England.

Some 41 visits in that region had taken place at the time of the newsbreak (April7).

It all makes depressing reading with incidents of faeces on a sofa and a window sill, walls and furniture stained, damp dining chairs and sliding bolts found on the outside of doors. What!

You may think that this news (see www.bbc.co.uk/news/uk-england-32204389 ) is CQC flexing its muscles to sends out a very clear message to those homes where standards are not so good.

Perhaps, that in part, is true – frankly, neither myself or the West Midlands Care Association which I head would ever condone substandard care – but the cases highlight for me another issue and probably a bigger one.

For too many years care providers delivering residential packages have been deprived by local authorities of realistic rates for beds.

Some councils have pegged fees, some have offered minor increments, a few in more affluent areas of the UK have dispensed better deals, while others have been challenged in the courts over chronically poor payments.

This financial deprivation has effectively forced the hand of many providers to keep their quality mark at a safe level, but not at the excellence that many would wish. Safe, indeed, not exemplary . . . it’s what’s being paid for, and has been paid for even in the years of plenty when LAs saw fit to spend budgets on other items they deemed more important tan caring.

With fiscal restraint continuing to look bleak even post-General Election, there appears to be no money left for the poor care provider who must continue to maintain safe care with no extra resource.

Of course, I’m not defending the failing homes, but I would like to think the Commission really did understand the root cause of many of the problems that its enthusiastic diligence will disclose.

I wonder too just how many homes will fall at the new CQC hurdles because of bad paperwork and poor audit trails. Ironic, isn’t it, that this Government body is fast uncovering the results of its own master’s policies.

Add to this the top-heavy procedures of implementing DoLS and safeguarding, we have a growing pool of homes where ratings are bound to plummet.

I’m not surprised with the emerging outcomes, especially when the standard required to achieve ‘good’ has significantly shifted upwards.

Like most things in life, you get what you pay for.

Here’s a snapshot of the West Midlands picture:

Good  Requires        Inadequate


Dudley Care Homes                         3               8                             2

Sandwell Care Homes                    12              10                           0

Wolverhampton Care Homes        4                   5                            1

Walsall Care Homes                        2                 3                            0

Birmingham Care Homes                35            17                             2

Worcester Care Homes                  13              5                              0

Totals                                              69            48                              5

lease note well: Worcestershire, with its better figures, pays better than the other Midlands authorities and there are also more privately funded service users in that region to subsidise those whose care is paid for by the local authority.

Ratings posters edict seems heavy-handed

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With downloadable options for rating posters now on the CQC website, this is a gentle reminder not to forget the obligation to display inspection ratings.

Under requirements to display, these posters must be “conspicuous” at premises and websites.

Breaches of this regulation can move directly to prosecution – there’s the big stick – without a warning notice being served.

For split or multi-site providers, the posters must also be displayed “from each and every premises where a regulated activity is being delivered.”

Okay, I know people need to know the ratings, there’d be no point in having them if they were secretly squirreled away from public gaze, but no warning prosecution!

The feedback I’m getting is that for such a minor ‘offence’ – remember this nothing to do with the wellbeing of those receiving care – it’s heavy-handed.

It’s worth noting that providers will be able to defend themselves against such wrongs where they are able to show they took all reasonable steps and acted with all due diligence.

One element of the new enforcement policy does offer a glimmer of hope to providers as the CQC’s aim to take only action that it deems to be “proportionate”.

Granted, we have heard this before and providers on the receiving end of such action are unlikely to agree that the Commission is a proportionate regulator. However, in the light of appeals representations, this assurance should be at least a guide to the central pillar of evidence.

Written by debbielq

April 23, 2015 at 10:17 am