Transcript County Provider Forum Presentations

Nottinghamshire County Council
Adult Social Care and Health
Welcome to the Care Home Provider
Forum 22nd May 2009
Nottinghamshire County Council
Adult Social Care and Health
Linda Bayliss – Service Director,
Strategic Service
COMPLAINTS
PROCEDURE
2009
Pati Colman
Service Manager – Customer Relations Service
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.
The Four Cs
•
Compliments
•
Comments
•
Concerns
•
Complaints
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.
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.
What can they complain
about?
• Any action, decision or omission made 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
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.
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
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
What do CRS do?
• Check eligibility to complain
• Check if other procedures required (safeguarding /
disciplinary)
• Make provisional assessment of seriousness to
Complainant, Department, ISP
Response options
• Written explanation
• Meeting
• Facilitated meeting
• Mediation
• Enquiry
• Independent Investigation
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.
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.
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.
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.
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
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]
CRS Details
• Phone: 0115 977 2788
• Fax: 0115 977 2787
• [email protected]
Dementia in Care Homes
Mark Griffin
Community Mental Health Nurse
Long Term Conditions Team
1.
2.
3.
4.
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?
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
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
Prevalence In Nottinghamshire
People with dementia
Numbers
10000
8000
6000
Nottinghamshire
City
4000
Notts County
2000
0
30 - 65 - 75+ Total
64
74
Age
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
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
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
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
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
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
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.


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.



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/31
2.asp
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
So what is needed for effective
dementia care in
residential/nursing homes ?
Diet and nutrition
Personal care
Activities
Diversional Techniques
Life history
Communication
So where can you access the
training?
Alzheimer’s Society
Community Mental Health Team
 Independent companies
 In - house training


Nottinghamshire County Council
Adult Social Care and Health
Alice Gregson & Halima Wilson
Workforce Planning Team
Pathway for End of Life Care
Nottinghamshire Care Homes Forum
Helen Scott, Health Improvement Principal
Nottinghamshire County tPCT
February 2009
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
How was the pathway developed?



National guidance (NICE, NHS EoLC
programme, National Service Frameworks,
CSCI)
Consultation with individuals and small
groups
Workshop June 2008
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
DS1500 Report
PROGNOSIS
< 6 MONTHS
Anticipatory
Prescribing
Continuing Care
Fast-Track
Liverpool Care
Pathway
Carers Needs
Assessment
Respite Care
Physical Care
Training
PROGNOSIS
“FEW
WEEKS”
PROGNOSIS
< 1 WEEK
AFTER
DEATH
Bereavement
Care
Criteria for entry

Gold Standards Framework indicators:

www.goldstandardsframework.nhs.uk
Pathway stages

Status:
Prognosis < 1
year
Prognosis < 6
months
Gold Standards Framework initiated
DS1500 completed
Single assessment of needs completed
Do Not Attempt to Resuscitate status
reviewed and communicated
Carer needs assessment fast-tracked
Patient-held record issued
Prognosis communicated
Keyworker nominated
Discussion of Advance Care Plan inc. Advance
Decisions to Refuse Treatment, Preferred
Priorities for Care initiated
Information prescriptions issued for patient and
carer
Out Of Hours, NHS Direct, East Midlands
Ambulance Service informed of Advance
Care Plan via Special Patient Note / EMAS
End of Life decision registration form
Respite care arranged if appropriate
Blue Badge application fast-tracked if
applicable
Prognosis “a few
weeks”
Prognosis < 1 week
ACP inc. ADRT, PPC reviewed
Liverpool Care Pathway initiated
Information prescriptions updated
Out Of Hours, NHS Direct, EMAS updated on
patient’s condition via Special Patient Note /
EMAS End of Life decision registration form
Fast track to Continuing Care completed if
additional service funding required
Anticipatory medications supplied
Carer needs reviewed
Support arranged for provision of terminal care
in setting of patient’s choice e.g. Hospice at
Home
After death
Verification of death
Liverpool Care Pathway section
3 Care After Death completed
Special Patient Note / EMAS EoL
registration form cancelled
Bereavement support needs
assessed and agreed. Referral
made for further support if
appropriate
Audit of pathway completed
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
Learning reviewed in
Multidisciplinary Team
24 hour access to advice and co-ordination of care underpin the pathway
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
DS1500 Report
PROGNOSIS
< 6 MONTHS
Anticipatory
Prescribing
Continuing Care
Fast-Track
Liverpool Care
Pathway
Carers Needs
Assessment
Respite Care
Physical Care
Training
PROGNOSIS
“FEW
WEEKS”
PROGNOSIS
< 1 WEEK
AFTER
DEATH
Bereavement
Care
ADVANCE CARE PLANNING
Elise Adam
Steph Pindor
Rob Smith
END OF LIFE CARE TRAINERS
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
WHY IS IT IMPORTANT?
• Enables people to make their own choices.
• Respects individuals “autonomy”.
• Creates a “forum” for open discussions re future
care/concerns between patient/carer and health care
professionals.
• Increases likelihood of actually achieving future
wishes/preferences.
• Enables opportunity to audit care outcomes.
WHO IS RESPONSIBLE
• Any discussion must be determined by the individual concerned.
• All health and social care professionals should be open to any
discussion, however :
 Require appropriate training.
 Understanding of legal and ethical issues involved.
 Only initiate if the (ACP) is likely to benefit the care
of the individual.
 The discussion should be introduced sensitively.
USE OF ACP: TIMING AND CONTEXT
• Holistic assessment of individuals need.
• Admission to care home.
• Multiple hospital admissions.
• In conjunction with prognostic indicators;
 All diseases, i.e. dementia, frailty, COPD, heart disease.
• Life changing event.
• Following a new diagnosis of life limiting condition where
appropriate.
Links to End of Life Care Pathway
• Prognosis < 1 year : Initiate discussion of
ACP – possibly include ADRT , PPC .
• Prognosis < 6 months : DNAR status
reviewed and communicated .
• Prognosis “few weeks” : ACP inc. ADRT ,
PPC reviewed .
• Prognosis 1 week : OOHs , NHS Direct ,
EMAS updated/review existing forms .
ADVANCE DECISION TO REFUSE
TREATMENT
• An Advance Decision To Refuse Treatment (ADRT) is part of
Advance Care Planning (ACP).
• It can only be completed by an adult over 18 years who has
“capacity”.
• Only comes into effect once they have lost capacity.
• Whilst they have capacity it may be withdrawn or altered at any
time.
• It can only be used to REFUSE treatment related to specific
circumstances.
• NB The ADRT form is not the same as the “Registration Of the
End of Life Care Decision Form” which is completed and used by
Out of Hours and EMAS (East Midlands Ambulance Service),
Five Key Principles of Capacity
1.
A person must be assumed to have capacity to make
their own choices
2.
A person is not to be treated as unable to make their own
decision
3.
A person is not to be treated as unable to make a
decision merely because he makes an unwise decision.
4.
Any action for a person must be in a persons Best
Interest
5.
Any action on behalf of a person must cause as little
restriction as possible
KEY PRINCIPLES OF ADVANCE
CARE PLANNING
•
The process is voluntary and should be determined by the individual.
•
All health and social care professionals should be appropriately trained to
undertake discussion.
•
Should an individual wish to make a formal decision to refuse treatment
(ADRT) this should be documented.
•
Confidentiality should be respected at all times.
•
Professionals need to be aware when they have reached the limits of their
knowledge and competence and know when to seek advice.
USEFUL WEBSITES
• www.adrtnhs.co.uk
• www.goldstandardsframework.nhs.uk/adv
anced_care.php
• www.endoflifecareforadults.nhs.uk/eolc
Sarah Clarkson
balance
the Food and Nutrition Service
Telephone 0779 318 7741
CORE BUSINESS
Food safety and hygiene
Preparation, cooking and food service for care
settings
Nutrition for health and well being
Hydration
Food and Diet for Care
The Care Standards Act stresses diet as one of the most
important factors in determining a resident’s quality of life.
Individuals food preferences and cultural or religious
preferences must always be observed.
Standard 15 – ensure that service users receive a varied
appealing wholesome and nutritious diet.
Food and Care Planning
Meal times can be “the highlight of the day” for people living in residential care
Concern has been focused on food and nutritional values
Food must meet individuals needs and preferences to reduce the risk of
malnutrition and dehydration
Promote good communications and understanding between cooks and care
staff
Food and Nutrition Services
Sarah Clarkson General Manager
Gavin Shelley Team Manager
Garry Newbury
Caroline Bunning
Catherine Marsh
Nicky Parsons
Stef Farrimond
Nutrition Checklist
to ensure that the menu is nutritionally adequate, provide at least
2 portions per day meat fish ,cheese, eggs, pulses
Dairy foods 1/2 pint of milk daily
Fruit and vegetables1/3 pint of fruit juice and 4 portions of fruit or vegetables
Bread, cereals potatoes, rice, pasta one helping with each meal
Spreading and cooking fats fortified with vitamin D and E
•
Nutrition Checklist
to ensure that the menu is nutritionally adequate, offer these foods at least once a week
Dried fruit such as apricots, currants raisins sultanas
Oily fish – mackerel, sardines, kippers, fresh tuna
Green leafy vegetables
Offal – kidney, liver, oxtail, liver sausage, pate
Promoting Nutrition Checklist
Ensure that menus include meals that residents are familiar with and enjoy
Provide a pleasant eating environment and assist with meal selection and
eating where appropriate
Extra helpings and snacks should be available to residents with increased
energy needs
Meals should be cooked as near to serving times as possible and kept hot for
the minimum time possible
Residents are encouraged to go out of doors as much as possible in the
summer months
Nutrition Checklist
What would you recommend to ensure that this menu improves the
nutritional status of residents?
Changes to the menu?
How food is served?
How well are cultural and dietary needs identified ?
How would you ensure personal choices are reflected?
Hydration
Do you feel thirsty?
Fatigue?
Headache?
Dizziness?
Weakness?
Our bodies are estimated to be 60-70% water
6-8 glasses of water daily is recommended
Hydration
Choose a water poster to display in your
unit. Tell the people on your table how you
will use it to promote health
Consider the water and health good practice
and add your own suggestions to encourage
water consumption
Nutritional screening
Malnutrition Universal Screening Tool
Height and weight, BMI
Weight loss?
Illness
Level of risk – monitoring or seek
advice
Six out of ten older people are at risk of becoming malnourished
Age Concern Seven steps to end malnutrition
Listen to older people
Staff must become food aware
Staff must follow professional codes
People should be assessed for signs of malnutrition
Protected meal times
Red trays
Use volunteers