Appendix 3
Residential and Nursing Care Homes (Older People) Service Specification
Schedule 2: Part 1 – Overarching Specification
1. Introduction
all stakeholders including Health and Social Care Professionals, Commissioners, and managers to ensure Clients receive a coordinated approach to support. A positive relationship and open communication with NHS services must be maintained to prevent unnecessary attendances at A&E Departments and crisis admissions to acute or community hospitals. The Service Provider will be encouraged to work closely with Healthcare Professionals where they have been aligned to support the home to ensure optimum healthcare is provided to Residents.
1.13 The Council expects the Service Provider will use best endeavours to work towards a reduction
in energy bills and a cut in the carbon footprint of the business. Support to do this can be found
here: Green business – East Sussex County Council
1.14 The Provider will ensure that Care Workers are respected and valued as key members of the
health and social care workforce.
· Ensuring Care Workers feel supported, and that staff wellbeing continues to be a key priority of Service Providers
· Promote the role of Care Workers to health and social care partners and the local population and recognising their valued contribution to care
· Ensuring there are positive working relationships between Care Workers and other operational workforce groups across health and social care.
3.1 Individuals are eligible for the Services as follows:
3.1.1 Following an assessment of the individual’s needs by the Council under the Care Act 2014, the Council determines that the individual is in need of care and support not otherwise available to them in their own home.
3.1.2 The individual is eligible for the Council’s support based on Ordinary Residence rules; and
3.1.3 The individual is eligible to be accommodated under the terms of the Care Home’s Registration Certificate or in line with meeting people’s needs under the CQC Fundamental Standards.
4. Placements
4.1 Referrals
4.1.1 When a practitioner identifies that the Client’s needs can best be met in a residential or nursing care setting, they will liaise with the ASC Brokerage Team (“Brokerage”) or the Emergency Duty Service (“EDS”). Brokerage or EDS will then contact the most suitable Provider from the Approved Provider List to identify if they can take a placement. Further details of the referral process are set out in clause 5 of the Approved List Agreement.
4.2 Assessments
4.2.1 From the date of a formal referral is made by the Council to the Service Provider about a prospective Client, the Service Provider will ensure assessments are undertaken as soon as reasonably possible and within two working days where the Client is ready to be discharged from hospital or a maximum of five working days where in the community to avoid delay and, where the Client is currently in hospital, to avoid any delayed discharge.
4.3 Individual Service Agreements
4.3.1 For each Placement made under the Approved List, the Service Provider will enter into an Individual Service Agreement with the Council. The terms and conditions of the Individual Service Agreement are as set out in Schedule 3 of the Approved List Agreement (ISA Terms). For each Placement, the Council will issue an Individual Service Agreement Front Sheet (“ISA”), which sets out the details of the Client’s placement in the Care Home, for signing by the Service Provider. The ISA will, wherever possible, be available prior to the start of the placement.
4.3.2 The Individual Service Agreement between the Council and the Service Provider is formed of the following documents:
4.3.2.1 the ISA Terms (Schedule 3 of the Approved List Agreement).
4.3.2.2 this Specification (Schedule 2, Part 1 of the Approved List Agreement);
4.3.2.3 the ISA (Schedule 4 of the Approved List Agreement).
4.3.2.4 the Client’s Care & Support Plan.
4.3.2.5 Data Sharing Provisions (Schedule 8, Part 2 of the Approved List Agreement).
4.3.2.6 where relevant, TUPE Provisions (Schedule 9 of the Approved List Agreement).
4.4 Respite and Short Breaks (“Fixed Term Placements”)
4.4.1 Fixed Term Placements may be agreed in the following circumstances:
i) For Respite or short-term care to provide Client support.
ii) For the purpose of assessment prior to a long-term placement.
4.4.2 The expiry date of a Fixed Term Placement will be stated in the ISA. The Individual Service Agreement relating to a Fixed Term Placement will terminate automatically on the expiry date without the need for any notice to be issued.
4.4.3 The procedure for early termination of an Individual Service Agreement for a Fixed Term Placement (including the 12-week property disregard) will be the same as for long term Placements (as set out in clause 8 of the ISA Terms).
5. Personalisation
5.1 Client Care and Support Plans
5.1.1 The Care and Support Plan is the documentation containing the written social care assessment of the needs of the Client.
5.1.2 The Council will supply to the Service Provider and the Client (or where appropriate the Client’s representative) the Support Plan prior to the Placement or, in the case of an emergency Placement, as soon as reasonably practicable after the start of the Placement and within three working days.
· 5.1.3 The Service Provider will build on the details set out in the Support Plan by preparing a Client Care and Support Plan in consultation with the Client and/or their representative where appropriate. The Client Care and Support Plan will reflect the CQC requirements for person-centred care (Regulation 9), Safe care and treatment (Regulation 12) and Advance Care Planning[1]
.
· 5.1.4 The Client Care and Support Plan will be:
· based upon a pre-admission assessment undertaken by the Service Provider;
· completed as an initial document within twenty-four (24) hours of moving into the Care Home and be presented as a completed document within seven (7) days of moving into the Care Home. In the case of someone with nursing needs, it will include a contribution from a registered nurse;
· revised in light of the Client’s changing needs and kept up to date.
5.1.5 The Service Provider will ensure that all care staff are familiar with the content of the Client Plan and any subsequent amendments, and that care logs reflect that the Client Plan has been followed.
5.1.6 Where the Client’s care needs have changed significantly including to a level whereby the Service Provider believes it can no longer meet the Client’s needs appropriately or the Client no longer requires the level of care provided, a review can be requested by the Provider. Reviews will be undertaken within 28 days wherever possible. Any changes in funding agreed by both parties will be backdated to the twenty eighth day after which the review request was received by the Council or the date of the review, whichever is earlier.
5.17 Where a review is needed as described in 5.1.6 Service Providers will: Contact Adult Social Care and Health | East Sussex County Council
5.2 Civil and Democratic Rights
5.2.1 The Service Provider will ensure the Client is able to be involved in democratic processes if they choose to be.
5.2.2 The Service Provider will ensure that the Client can choose to exercise their rights of citizenship in voting, and in receiving electoral communications and personal calls by canvassers.
5.3 Personal Possessions (inventory/insurance)
5.3.1 The Service Providers will ensure Client is treated with dignity and respect and this will extend to the client’s personal possessions and clothing To support this the service provider will compile an inventory of the Client’s belongings when they first move into the home. A copy should be given to the client and/or their family/carer/representative and on the client’s records file.
5.3.2 The Service Provider must take due care with the Client’s possessions and provide its staff with guidelines for ensuring the safety of the Client’s possessions. The Service Provider will make good any loss suffered or incurred by the Client that is caused by the negligence of the Service Provider or its staff.
5.3.4 The Service Provider will provide the Client with a means of locking personal possessions within their bedroom (e.g. a lockable cupboard).
5.3.5 The Service Provider must make a clear statement of its insurance arrangements for cover, and limitations of cover, for Clients’ personal possessions in the Care Home’s ‘Service User Guide’.
5.3.6 The Service Provider will ensure that the labelling of Clients’ possessions is kept to a minimum and that clothes labels are used sensitively and discreetly to preserve dignity. The Service Provider will ensure that each Client has their own toiletries and will facilitate the Client supplying and using own their towels where appropriate.
5.3.7 The Service Provider will ensure that Clients always wear their own clothes, of their choice (within socially acceptable limits), and that the Service Provider’s staff do not provide a Client with clothes from any other Client at any time.
5.4 Care of People who are Dying
5.4.1 The Service Provider will meet the care needs of people who are dying, ensuring that Clients have a comfortable and peaceful period leading up to their death, and their wishes regarding their own death/funeral arrangements are respected during this period and after they have died (see Appendix 3).
5.4.2 The Service Provider must notify the Council within one Working Day of the death or discharge of any Client via the Provider Portal | East Sussex County Council
6. Families, Carers and Legal Representatives
6.2 The Service Provider will report incidents to the Client’s family, carers and / or legal representatives (as applicable to the Client), share appropriate information and keep them updated with the permission of the Client, where they have capacity. The Service Provider will enable flexible visiting times to meet the needs of the Client’s family/friends living at a distance/working etc, taking account of the needs and wishes of other clients in the home, reflecting the availability of staff support and any infection control or other national guidance.
7. Safety
7.1 The Service Provider must inspect the premises regularly and records of safety inspections must be kept. Any faults must be recorded together with details of actions to isolate equipment or rectify the fault and the date of completion of the action.
7.2 All hazardous materials used for cleaning or gardening must be stored in a locked cupboard in accordance with Control of Substances Hazardous to Health (COSHH) and they must not be left unattended when in use.
7.4 Fire Safety
7.4.1 The Service Provider will:
· comply with the Regulatory Reform (Fire Safety) Order 2005 or any replacement provisions.
· have sufficient and suitable risk assessment carried out by competent person;[2]
· follow relevant guidance as listed below.[3]
8. Safeguarding
8.1 The Service Provider must ensure that the Client is free from abuse and that appropriate action is taken where abuse is suspected. When a safeguarding concern is identified and the Client is in immediate danger or has been the subject of crime, the Service Provider must contact the emergency services on 999. In all other cases where a safeguarding concern is identified, the Service Provider must contact Adult Social Care and Health | East Sussex County Council
9. Deprivation of Liberty Safeguards (DoLS) and Liberty Protection Safeguards (LPS)
Liberty Protection Safeguards (LPS)
10.1 When meeting the needs of Clients in residential settings who have dementia the Service Provider will refer to the guidance in Appendix 1 and:
· ensure that early requests for clinical input are made to manage Clients’ needs and prevent
escalation;
11. Behaviour
12. Medication
12.1 Medication is only to be administered as per a qualified medical practitioner prescription, with
dosages checked and recorded in accordance with General Medical Council, NICE guidance[6]
and CQC regulations. (See section 17, recording and information sharing, for ordering processes
and recording)
13. Equipment
14. Control of Infectious Diseases
· keeping the Care Home clean and decontaminated as per infection control policies and procedures, this includes items of equipment which may need to undergo specialist decontamination; and
14.2 The Service Provider must be able to demonstrate that it has an effective procedure to
prevent the spread of infectious diseases and all Care Staff are adequately trained and
comply with that procedure.
14.3Service Providers must comply with the latest local and national guidelines in relation
to infection prevention and control.
15 Home Closure
15.3 The Service Provider will pay due regard to good practice guidance in the event of a Home
Closure: Quick guide: Managing Care Home Closures (www.nhs.uk)
16. Finance
16.1 The Client’s Personal Finances:
16.1.1 The Service Provider must ensure that self-funding residents are advised of the potential implications of moving to Adult Social Care funding should their Capital drop below the Threshold where the Client is required to meet the full costs of their care. The Provider must advise residents or their Representatives that they should contact the Council six months before their Capital will drop below the Threshold.
16.1.2 The Service Provider will clearly explain to the Client any charges it makes for Additional Services not covered by the Council’s Agreed Fee prior to delivering those services to the Client.
16.1.3 The Service Provider will account to the Client or their Representative or Carer (as applicable), for any of the Client’s money handled by the Service Provider. Simple itemised records are to be kept by the Service Provider for the handling of the Client’s money. Such records are to be made available by the Service Provider for external scrutiny, including by the Council upon request. The Client and their Representative or Carer (as applicable) must be informed of how often itemised bills are to be provided by the Service Provider. The Service Provider must ensure that details of bank accounts and total balances are made available for external scrutiny (including by the Council upon request), where appropriate.
16.1.4 The Service Provider will support the Client to take care of their own financial affairs as far as possible in relation to the Client’s physical and mental ability.
16.1.5 With the agreement of the Client or their Representative or Carer, the Registered Manager of the Care Home may hold information on where a Client’s will is lodged and may keep a record of the Client’s wishes regarding funeral arrangements.
16.1.6 The Service Provider must not advise on the Client’s will, act as trustee for the Client, nor (apart from in exceptional circumstances and with the Council’s approval) assume power of attorney on behalf of the Client. The Service Provider will also not act as an agent for funeral directors in promoting the pre-purchase of a funeral service.
16.1.7 The Service Provider must not take financial advantage of its relationship with the Client.
16.1.8 The Service Provider shall be responsible for collecting the Client Contribution directly from the Client.
16.1.9 Guidance on Non-Payment of Client Contribution and Management of Debt is set out in Schedule 5.
17. Record keeping, Information Sharing and Digital Technology.
17.3 The Service provider will ensure that there is adequate Internet access available for Clients to
help them stay connected, reducing any impact of loneliness and isolation and to support
independence.
17.6 It is expected that care homes will have secure email to enable the secure transfer of confidential information. The recommended route is via NHS email which requires completion of the NHS Data Security and Protection Toolkit (DSPT). DSPT completion is required for Proxy Ordering of Medication and Proxy access to NHS records (see
Appendix 9.
Improving the Availability of Health and Social Care Data:
17.7 The Service Provider should provide the required data for the NHS Capacity Tracker or
similar to understand capacity and risk in the system (both local authority and
privately funded care) and any future data capture requirements.
17.8 The Council continues to promote digital ways of working where appropriate in order to
streamline business processes and support efficient and effective service delivery. Service
Providers may be asked to engage with the Council digitally where this is requested. This may
include (but is not limited to) using digital tools and systems to view, process and contribute
to e.g. client support plans, assessments, reviews and to provide returns, invoices / activity
reports.
17.9 The Council will use electronically submitted information from agreed systems to pay
Service Providers, charge Clients and monitor performance (as requested or
appropriate).
18. Complaints and Compliments
18.1 Clients should feel confident they can complain about their care and concerns are handled well with a resolution focus. The Service Provider will ensure a clear, well-publicised and accessible process is in place.
18.2 The Service Provider will be expected to investigate any complaints thoroughly and take action if problems are identified. The Service Provider must be able to evidence how they ensure learning from complaints improves the quality of their services.
18.3 The Service Provider’s complaints and compliments process must also refer to the Regulator, Local Government Ombudsman and Social Care Ombudsman (LGSCO) and the Council’s Complaints and Feedback Team if the complaint requires an alternative signposting route.
[2] A Fire Risk Assessor can be found via the Institution of Fire Engineers – www.ife.org.uk/fire-risk
[3] Regulatory Reform (Fire Safety) Order 2005
https://www.london-fire.gov.uk/safety/the-workplace/fire-safety-law-explained/
http://www.legislation.gov.uk/uksi/2005/1541/contents/made
Fire safety risk assessment: residential care premises:
https://www.gov.uk/government/publications/fire-safety-risk-assessment-residential-care-premises
East Sussex Fire and Rescue:
https://www.esfrs.org/business-safety/5-key-stages-to-risk-assessment/
[4] https://www.eastsussexsab.org.uk/information-resources/guidance-on-raising-concerns-about-abuse-and-neglect/