Agenda item

4.1       Hayley Marle, CQC Compliance Manager for Lambeth, Lewisham and Southwark, introduced the report and the following key points were noted:

·         The CQC Manager covers Lambeth, Lewisham and Southwark and manages a team of 10 Inspectors.

·         The CQC inspects a range of health and social care services.

·         There is a new CQC Strategy for 2013-2016, and this includes such objectives as:

o   Appointing a Chief Inspector of Hospitals, a Chief Inspector of Social Care and Support, and considering the appointment of a Chief Inspector of Primary and Integrated Care.

o   Developing new fundamental standards of care.

o   Making sure inspectors specialise in particular areas of care and lead teams that include clinical and other experts, and Experts by experience (people with experience of care).

·         The new Chief Executive of the CQC, David Behan, has been in place for over six months, and will look to implement  the 2013-2016 Strategy.

·         The purpose of the CQC is to ensure that social care services provide people with safe, effective, compassionate, high-quality care and they encourage care services to improve.

·         During inspections, the CQC will talk to staff, patients, family and friends, as well as inspecting the facilities and looking at appropriate documentation such as care plans and medicine records.

·         The five things that the CQC will look at when inspecting services are:

o   Are they safe?

o   Are they effective?

o   Are they caring?

o   Are they well led?

o   Are they responsive to people’s needs?

·         The CQC will be doing things differently in the future, and a couple of examples of this are:

o   The appointment of a Chief Inspector of Hospitals, and a Chief Inspector of Adult Social Care and Support and, potentially, the appointment of a chief inspector for primary and integrated care

o   NHS hospitals: national teams with expertise will be developed to carry out in-depth reviews of hospitals with significant problems

·         Lewisham has at present 202 locations registered with the CQC. Out of these, in the last year:

o   Lewisham Hospital has been inspected

o   All 103 social care services have been inspected

o   62% of independent healthcare providers have been inspected

o   26% of dental services have been inspected

·         CQC found on their inspections in social care that:

o   36 (35%)locations were found non compliance with one outcome or more

o   67 (65%) locations were found compliance with all five outcomes inspected

·         Some examples where good practice were found were:

o   Alexander Care Centre (report published 9 May 2013).

o   Aster House (report published 23 April 2013)

o   Jigsaw Project (report published 8 November 2012)

·         Some examples where improvement was found after initial non-compliance were:

o   Housing 21 – Cedar Court

o   Housing 21 –Cinnamon Court

o   Fieldside Care Home

4.2       In response to questions, the Committee were informed that:

·         Inspections are usually one-two days on site, with additional time to access documents and speak with family and friends of patients.

·         The CQC has a number of enforcement powers, including:

o   Warning Notices

o   Imposing restrictive conditions on a registered service

·         Those operating a regulated activity must be registered with the CQC. If an organisation is carrying out a regulated activity and not registered, the CQC has a registration team that will get in contact with that service, ascertain if they need to be registered and advise them to register if necessary.

·         The services that are registered with the CQC are published on their website. More public awareness is needed so that the public know that they can check whether a service is registered and whether it has recently been inspected and found to be compliant.

·         With inspections of larger care homes and hospitals, the CQC inspection teams can consist of ‘Experts-by-experience’ and practicing professionals. ‘Experts-by-experience’ are people who have experience of using similar services or care for people who have used similar services. Practicing professionals are currently employed in other health service or social care such as nurses.

·         The reviews and contract monitoring carried out by the Council also aid the inspection process.

·         The inspections cover not all of the financial management of the organisation, but specifically covers how it records and manages the money of the residents as part of safeguarding responsibilities.

·         In deciding what to inspect or what areas to focus specific inspections on, the CQC will look at a Quality Risk Profile and look to assess the areas it sees as most ‘at risk’.

·         The Compliance Manager would welcome sight of the reports from the Positive Ageing Council Lay Visitors.

4.3       Hayley Marle, CQC Compliance Manager for Lambeth, Lewisham and Southwark, introduced the report on the inspection of Lewisham Hospital, and the following key points were noted:

·         Lewisham Hospital was inspected in February 2013.

·         The inspection team included two practicing professionals

·         It was found to be non-complaint in the following areas:

o   Respecting and involving people who use

o   services

·         Non-compliance was seen to be of ‘minor impact’

·         Lewisham Healthcare Trust has submitted an Action Plan to the CQC.

·         The Trust hopes to be fully compliant by December 2013.

·         With the issues of the proposals surrounding the merger with Queen Elizabeth, proposals in respect of the A&E and the Francis Report implementation, this was deemed a reasonable time to aim for compliance.

4.4       Joy Ellery, Director of Knowledge, Governance and Communications, Lewisham Healthcare NHS Trust introduced the Action Plan for Lewisham Healthcare NHS Trust in response to the inspection report, and the following key points were noted:

·         The Action Plan has been considered by the Lewisham Healthcare Trust Board.

·         The Trust could have completed the compliance quicker, but there a number of changes taking place that made it more prudent to set the deadline at December 2013.

4.5       In response to questions, the Committee were informed that:

·         A symbol was used to indicate when a patient had specialist communication needs, such as dementia or a learning disability to remind staff to give additional consideration as to how to effectively communication with the patient where appropriate.

·         The ‘Communications Passport’ is developed with a patient’s carer. There has been positive feedback from patients with learning disabilities who have used these. More communication is needed to ensure that patients and their family understand what they are for and what they entail.

·         The ‘Communications Passport’ for patients with learning disabilities would be circulated to members at the next meeting.

4.6       Hayley Marle, CQC Compliance Manager for Lambeth, Lewisham and Southwark, introduced the report on the inspection of Mental Health Adult Placement Scheme and the following key points were noted:

·         The Mental Health Adult Placement Scheme was inspected in March 2013.

·         It was found to be non-compliant in the following areas:

o   Supporting workers

o   Assessing and monitoring the quality of service provision

·         An Action Plan has been submitted to the CQC.

4.7       Dee Carlin, Head of Joint Commissioning, presented the Action Plan report to the Committee, and the following key points were noted:

·         The Mental Health Adult Placement Scheme provides accommodation and support to people recovering from mental illness enabling them to live independently in the community.  

·         Currently 28 service users are supported through the scheme; ten are placed in the homes of individual carers and 18 are supported in shared accommodation. 

·         Adult Placement Scheme Staff are employed by the Council and for the purpose of CQC registration, the Council is the Registered Provider. The service is managed by SLaM under a management agreement.   The carers who provide the support to service users are remunerated through the Council’s Supporting People budget. 

4.8       In response to questions, the Committee were informed that:

·         The scheme is on track to be compliant by July 2013.

·         There will be updates on the progress to compliance in both May and June.

·         A manager has been recruited to cover the implementation of the Action Plan.

4.9       Hayley Marle, CQC Compliance Manager for Lambeth, Lewisham and Southwark, and Joan Hutton, Interim Head of Adult Social Care, introduced the report on the inspection of Hamilton Lodge and the following key points were noted:

·         Hamilton Lodge has had numerous managers over the past 12-18 months, and lack of stable management is a key issue in its performance.

·         There have been 4 CQC Inspections in 2012-2013.

·         The last inspection was 22 February 2013, and the report was published in April 2013.

·         Enforcement action has been taken:

o   Two Warning Notices were issued on the management of medicines and assessing and monitoring the quality of the service provision

o   Hamilton Lodge is not allowed to admit any residents unless with the CQC’s prior agreement

·         Hamilton Lodge has the capacity for 40 beds, but at present only 20 of the beds are occupied.

·         Inspectors went back on 9 April 2013 and found that it was non-compliant on Outcome 7 (safeguarding patients who use services from abuse).

·         The Council is working closely with Hamilton Lodge and the CQC to help them implement the Action Plan.

·         There is no issue in relation to the care of the residents who are in the home at present, and the limited numbers will give the provider the opportunity to improve.

·         A new permanent manager has been appointed and this has led to some improvement, and there is less reliance on agency staff.

·         There have also been less ‘safeguarding alerts’ in the past four months, showing signs of improvement.

4.10    In response to questions, the Committee were informed that:

·         The service at Hamilton Lodge is commissioned on a block contract. There are also users there who are supported by other boroughs.

·         It was felt that it was prudent to not allow additional patients until the service was to improve.

·         If the service does not improve as required by the CQC, the option is available to move residents and close Hamilton Lodge. That decision would be taken with all the parties involved.

·         It was felt that the non-compliance issues would not put residents at risk at present and the residents were happy with the care that they received at Hamilton Lodge.

·         The report on Hamilton Lodge is in the public domain. A link to the report would be sent to the Members.

4.11    RESOLVED: that

a)    the Committee thanks the CQC Compliance Manager for her attendance.

b)    the Committee would invite to the CQC Compliance Manager to future meetings when appropriate.

c)    the Chair and Vice-Chair would meet with the CQC Compliance Manager when appropriate.

d)    the Committee note the report.

e)    Hamilton Lodge be kept under review by the Committee.