INDEPENDENT SECTOR NURSING HOMES AGENDA ITEM 2.1 Report of Director of Nursing Paper prepared by Interim Nurse Lead Cardiff Locality Purpose of Paper Action/Decision required Link to Health Care Standards: Link to Health Board s Strategic Direction and Corporate Objectives Acronyms and abbreviations To provide the Quality and Safety Committee with an update about concerns with respect to the care provided by Burgess House and Sunrise Living Care Homes in Cardiff which were highlighted in reports to the previous LHB s Quality and Safety Committee and by verbal report to the UHB s committee in February 2010 The Quality and Safety Committee are requested to note the contents of the update paper and the ongoing actions being taken by the UHB to monitor and improve the standards of care within nursing homes in Cardiff. Standard 28 Clinical Governance Standard 17 Protection of Vulnerable Adults Fulfils Board s corporate responsibility for safeguarding vulnerable adults and ensuring safe and appropriate NHS funded placements UHB Cardiff and Vale University Health Board POVA Protection of Vulnerable Adults LA Local Authority JIMP Joint Interagency Monitoring Panel Nursing Home Report Page 1 of 6 Quality and Safety Committee
Executive Summary The LHB locality nurse assessor team work closely with Cardiff Local Authority to jointly monitor and review individuals for who both partners commission care in independent sector nursing homes. Where Protection of Vulnerable Adults (POVA) issues are raised the LHB and Local Authority in conjunction with the Care and Social Services Inspectorate for Wales consider and respond to individual and general concerns. Where individual POVA issues raise more general concerns a provider performance monitoring protocol is in place to consider and address commissioning concerns. Where there are escalating concerns not addressed by the above partners can also convene a Joint Interagency Monitoring Panel under the Escalating Concerns in Care Homes guidance published by the Welsh Assembly Government to consider how to either support homes or safeguard individuals for whom partners have a duty of care. Burgess House (Full Update Appendix 1) In February 2009 concerns were raised with respect to care standards in Burgess House Care Home under the joint provider performance monitoring protocol. Themes and concerns raised were related to: Dignity and Respect Continence Care Documentation Staff attitude and behavior Hygiene As a result of these concerns, Cardiff Council Adult Services and Cardiff Local Health Board imposed an embargo on new placements to the home and worked with the provider to develop an improvement action plan. Following the instigation of the embargo there was a high level of monitoring from both the UHB Nurse Assessor Team and the Local Authority Contracting Team to ensure the safety and wellbeing of residents. Nursing Home Report Page 2 of 6 Quality and Safety Committee
The LHB and Local Authority liaised closely with CSSIW throughout and they also monitored the home from a regulatory perspective. A provider action plan to address the concerns raised was produced and regular meetings were held with the provider to discuss the implementation of the action plan and to feedback with respect to the ongoing monitoring visits. In general the provider acknowledged fully the concerns of the statutory partners and responded positively in instigating a range of actions aimed at addressing concerns. Following a provider performance monitoring meeting on 9 April 2009 a decision was taken, following positive feedback from the monitoring teams and discussion with the provider, to lift the embargo on placements on the general nursing floor in the home. The embargo on placements was retained on the EMI nursing floor as there remained some concerns with respect to the progress of improvement actions in that area. In general the provider acknowledged fully the concerns of the statutory partners and responded positively in instigating a range of actions aimed at addressing concerns. Following further meetings with the provider the embargo on new placements within the home was lifted fully on 13 July 2009. The UHB nurse assessor team has continued to maintain a heightened level of monitoring to ensure that improvements are sustained and although there have been individual POVA issues in general improvements have been maintained. Sunrise Living Cardiff (Full Update Appendix 2) Sunrise Living Care Home is a residential care home in Cardiff which was originally registered and opened as a residential care home. Sunrise then subsequently registered to provide general and EMI nursing care. Following a number of concerns about the quality of service provision highlighted through the POVA process a Provider Performance Monitoring process was instigated in November 2009 to identify necessary improvements. Nursing Home Report Page 3 of 6 Quality and Safety Committee
Themes and concerns raised were related to: Communication within the home Management and leadership within the home Documentation, care planning and record keeping Ability to differentiate between individuals with residential and nursing care needs The capability and knowledge of the nursing team to meet and recognise the needs of individuals with complex health care needs including palliative care needs The suitability of the environment for individuals with care needs relating to dementia As a result of these concerns, Cardiff Council Adult Services and Cardiff Local Health Board imposed an embargo on new placements to the home with immediate effect. Following the instigation of the embargo there was a high level of monitoring from both the UHB Nurse Assessor Team and the Local Authority Contracting Team to ensure the safety and wellbeing of residents with the nurse assessor team visiting on a daily basis. In December 2009 a decision was taken by statutory partners to convene a Joint Interagency Monitoring Panel (JIMP) under the auspices of the Escalating Concerns in Care Homes Guidance. This decision was taken following: The continued receipt of VA1 referrals by the Local Authority Adult Protection Team relating to issues already highlighted for action and where no progress had been identified Continued demonstration of poor care records and a lack of comprehensive risk assessments or regular review of residents by the provider Continued evidence of failures of internal communication and a lack of communication with other professionals/agencies Issues relating to the internal investigation and the apparent failure to address clinical practice issues for one individual, which had been highlighted at a POVA Strategy meeting held on 04/11/09 Continued concerns from the UHB nurse assessors, CSSIW and the Local Authority contract monitoring team as to the ability of Sunrise of Cardiff to meet the needs and manage the risks for vulnerable residents with particular emphasis upon those receiving nursing care Nursing Home Report Page 4 of 6 Quality and Safety Committee
On December 17 following a JIMP the provider was issued with a corrective action plan aimed at addressing the above concerns and identifying clear actions and timescales for the provider to progress improvements. On 5 February 2010 Sunrise Living made a decision as a company to voluntarily deregister their nursing beds within the home. A proposal was submitted to CSSIW that following a transition period of 28 days they intended to no longer provide nursing care. Following this decision the UHB nurse assessor team and LA Contact and Review Team worked within the home and supported relatives and the provider as appropriate to identify and arrange transfer of all nursing residents to alternative nursing placements. The final resident was transferred on 11 March 2010 with Sunrise Living not being registered to provide nursing care after 12 March 2010. The LA contract monitoring team will continue to provide an enhanced level of monitoring within the home. All residents that have transferred to alternative facilities will be reviewed 4-6 weeks after transfer. The JIMP will be reconvened after a period of time to consider and reflect on the process with a view to identifying lessons learned. IMPACT ASSESSMENT Health Improvement Residents have now been transferred to placements which will be able to meet their identified needs. Workforce The intensive monitoring and support to care homes where escalating concerns are raised is provided by the Locality Nurse Assessor Team. (5.0 WTE). The workload associated with this has an attendant impact on the capacity of that team to undertake reviews and performance monitoring of individuals and general standards of care in other care homes within the Cardiff area. Nursing Home Report Page 5 of 6 Quality and Safety Committee
Financial Legal Equality Environmental The reduction of nursing registered beds in Cardiff will reduce spend on Funded Nursing Care this will be offset however by the opening of a new 100 bedded home in the near future. The response of CSSIW, local authorities and LHBs to either escalating concerns or home closures is shaped by their statutory functions, duties and roles as regulator or service provider/commissioner/contractor. N/A N/A RISK ASSESSMENT Clinical/Service Financial Reduction in risk to individual residents and attendant pressure of primary care services of a failing provider. No identified risk Reputational Reduction in risk to UHB of commissioning/contracting care which did not meet identified need CONSULTATION AND ENGAGEMENT N/A SOURCES OF INFORMATION & EVIDENCE Escalating Concerns in Care Homes Guidance South East Wales Protection of Vulnerable Adults Policy Nursing Home Report Page 6 of 6 Quality and Safety Committee
APPENDIX 1 BACKGROUND REPORT OF THE NURSE DIRECTOR UPDATE - BURGESS HOUSE CARE HOME, SOUTHERN CROSS Following a number of concerns about the quality of service provision at Southern Cross's Burges House Care Home, 77/85 Newport Road, Roath, Cardiff, CF24 0AE a Provider Performance Monitoring process was instigated in February 2009 to identify necessary improvements. Burgess House is a 100 bedded independent sector care home with residential EMI, general nursing and EMI nursing registered beds. An initial meeting with Southern Cross raised general concerns with respect to documentation and recording within the home and asked for the provider to provide an action plan as to how they intended to address the concerns raised. Themes and concerns raised were related to: Dignity and Respect Continence Care Documentation Staff attitude and behavior Hygiene As a result of these concerns, Cardiff Council Adult Services and Cardiff Local Health Board imposed an embargo on new placements to the home with immediate effect. UPDATE Following the instigation of the embargo there was a high level of monitoring from both the UHB Nurse Assessor Team and the Local Authority Contracting Team to ensure the safety and wellbeing of residents. The LHB and Local Authority liaised closely with CSSIW throughout and they also monitored the home from a regulatory perspective. Information was sent to all LHB and LA areas outside of Cardiff informing them on the embargo should they have had or intended to place service users within the home. A provider action plan to address the concerns raised was produced and regular meetings were held with the provider to discuss the implementation of the action plan and to feedback with respect to the ongoing monitoring visits. Following a provider performance monitoring meeting on 9 April 2009 a decision was taken, following positive feedback from the monitoring teams and discussion with the provider, to lift the embargo on placements on the general nursing floor in the home. The embargo on placements was retained on the EMI nursing floor as there remained some concerns with respect to the progress of improvement actions in that area. Care Home Page 1 of 2 CLINICAL GOVERNANCE & QUALITY COMMITTEE 4 AUGUST 2009
In general the provider acknowledged fully the concerns of the statutory partners and responded positively in instigating a range of actions aimed at addressing concerns. In June 2009, following concerns expressed about the need to strengthen leadership within the home, a project manager who was an experienced home manager from another establishment within the Southern Cross group was seconded to support the home manager in achieving sustained change. As a result of the above and following further meetings with the provider the embargo on new placements within the home was lifted fully on 13 July 2009. The UHB nurse assessor team has continued to maintain a heightened level of monitoring to ensure that improvements are sustained and although there have been individual POVA issues in general improvements have been maintained. RECOMMENDATIONS The Quality and Safety Committee are requested to note the contents of the update paper and the ongoing actions being taken by the LHB to monitor and improve the standards of care within nursing homes in Cardiff. Care Home Page 2 of 2 CLINICAL GOVERNANCE & QUALITY COMMITTEE 4 AUGUST 2009
APPENDIX 2 UPDATE SUNRISE LIVING CARE HOME BACKGROUND Sunrise Living Care Home is a residential care home in Cardiff which was originally registered and opened as a residential care home. Sunrise then subsequently registered to provide general and EMI nursing care. Following a number of concerns about the quality of service provision highlighted through the POVA process a Provider Performance Monitoring process was instigated in November 2009 to identify necessary improvements. An initial meeting with Sunrise Living and a previous meeting held in July 2009 raised general concerns with respect to the ability of the provider to deliver safe nursing care, documentation and recording within the home and asked for the provider to provide an action plan as to how they intended to address the concerns raised. Themes and concerns raised were related to: Communication within the home Management and leadership within the home Documentation, care planning and record keeping Ability to differentiate between individuals with residential and nursing care needs The capability and knowledge of the nursing team to meet and recognise the needs of individuals with complex health care needs including palliative care needs The suitability of the environment for individuals with care needs relating to dementia As a result of these concerns, Cardiff Council Adult Services and Cardiff Local Health Board imposed an embargo on new placements to the home with immediate effect. UPDATE Following the instigation of the embargo there was a high level of monitoring from both the UHB Nurse Assessor Team and the Local Authority Contracting Team to ensure the safety and wellbeing of residents with the nurse assessor team visiting on a daily basis Monday to Friday. The LHB and Local Authority liaised closely with CSSIW throughout and they also monitored the home from a regulatory perspective. Information was sent to all LHB and LA areas outside of Cardiff informing them on the embargo should they have had or intended to place service users within the home. A provider action plan to address the concerns raised was produced and meetings were held with the provider to discuss the implementation of the action plan and to feedback with respect to the ongoing monitoring visits. In December 2009 a decision was taken by statutory partners to convene a Joint Interagency Monitoring Panel (JIMP) under the auspices of the Escalating Concerns in Care Homes Guidance. This decision was taken following:
The continued receipt of VA1 referrals by the Local Authority Adult Protection Team relating to issues already highlighted for action and where no progress had been identified Continued demonstration of poor care records and a lack of comprehensive risk assessments or regular review of residents by the provider Continued evidence of failures of internal communication and a lack of communication with other professionals/agencies Issues relating to the internal investigation and the apparent failure to address clinical practice issues for one individual, which had been highlighted at a POVA Strategy meeting held on 04/11/09 Continued concerns from the UHB nurse assessors, CSSIW and the Local Authrotiy contract monitoring team as to the ability of Sunrise of Cardiff to meet the needs and manage the risks for vulnerable residents with particular emphasis upon those receiving nursing care On December 17 following a JIMP the provider was issued with a corrective action plan aimed at addressing the above concerns and identifying clear actions and timescales for the provider to progress improvements. Further meetings were held with the provider in January 2010 to discuss required improvement actions and intensive monitoring of the home and residents continued. Concerns at lack of progress continued and discussions were held as to the requirements to move residents to alternative facilities On 5 February 2010 Sunrise Living made a decision as a company to voluntarily deregister their nursing beds within the home. A proposal was submitted to CSSIW that following a transition period of 28 days they intended to no longer provide nursing care. This proposal was accepted by CSSIW. This decision does not preclude CSSIW taking regulatriy action against the provider. Following this decision the UHB nurse assessor team and LA Contact and Review Team worked within the home and supported relatives and the provider as appropriate to identify and arrange transfer of all nursing residents to alternative nursing placements. The final resident was transferred on 11 March 2010 with Sunrise Living not being registered to provide nursing care after 12 March 2010. The LA contract monitoring team will continue to provide an enhanced level of monitoring within the home. The sector community nursing service has also been briefed and directed as to the appropriate route for raising any future concerns with respect to residential care residents. All residents that have transferred to alternative facilities will be reviewed 4-6 weeks after transfer. The JIMP will be reconvened after a period of time to consider and reflect on the process with a view to identifying lessons learned. RECOMMENDATIONS The Quality and Safety Committee are requested to note the contents of the update paper and the ongoing actions being taken by the LHB to monitor and improve the standards of care within nursing homes in Cardiff.