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Report to: |
Lead Member for Adult Social Care & Health |
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Date of meeting: |
22 March 2022 |
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By: |
Director of Adult Social Care |
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Title: |
Learning Disability Supported Living developments |
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Purpose: |
To seek approval to redevelop four existing learning disability services into high quality supported living services |
The Lead Member for Adult Social Care and Health is recommended to:
1) approve the proposals to redevelop the following existing services for adults with a learning disability into high quality supported living services, at a total estimated capital cost of £6,420,621:
· Beckley Close, St Leonards-on-sea, commencing in 2022/23
· Cregg Na Ba, Battle, commencing in 2022/23
· Jasmine Lodge, Northiam, commencing in 2023/24
· Grangemead Annex, Hailsham, commencing in 2023/24
2) delegate authority to the Director of Adult Social Care to take all actions necessary to give effect to the above recommendation; and
3) delegate authority to the Chief Operating Officer to take all necessary actions to ensure the appropriate lease property agreements are put in place.
1.1 Unlike residential care, supported living provides the people who live there with individual tenancies. This means that they have a home of their own and will benefit from a greater level of autonomy, as far as their environment is concerned. People in supported living are encouraged to maximise their independence and to engage in the indoor and outdoor activities that they enjoy. Any personal care is provided under separate contractual arrangements to those for the person’s housing.
1.2 The strategic direction of East Sussex County Council’s (ESCC) commissioned services for adults with a learning disability, is to increase supported living provision. The Council aims to provide high quality accommodation that is able to meet the current and future needs of existing East Sussex residents and support the cohort of younger people transitioning into Adult Services. This approach is in line with personalisation principles set out in ‘Building the Right Support’ (NHS England, Local Government Association, Association of Directors of Adult Social Services, 2015), ‘Registering the Right Support’ (Care Quality Commission, 2017) and Right Support, Right Care, Right Culture (CQC, updated 2021).
1.3 The supported living model is preferable to traditional residential care options for young people and working age adults as it provides the opportunity for more choice and control over how their accommodation, care and support needs are met, resulting in greater independence and autonomy over how they live their lives.
1.4 There is also a recognised need for more of this provision in the county to enable adults to live and be supported within East Sussex, thereby avoiding placing ESCC clients outside of the county. In the year to August 2021 there were 35 placements made out of county, where approximately 28 of these (80%) may have been possible to be made in-county had the services and vacancies been available at that time.
1.5 When compared to residential care options for adults with similar assessed levels of care and support needs, supported living is typically delivered at a lower unit cost to the council’s community care budget, as the accommodation and board costs are covered by rental charges in place with a housing provider, with most tenants eligible to claim housing benefit to cover this.
1.6 Placements at the two homes that are currently occupied (Beckley Close and Jasmine Lodge) cost approximately £1m per annum. Provisional estimates indicate that this cost could reduce to approximately £760,000 per annum following the introduction of a supported living model. Additionally, in supported living settings clients are provided with individually tailored packages of care that can decrease over time as areas of independence are increased, further reducing the cost of support and delivering best value.
1.7 Furthermore, the performance of East Sussex in relation to the national indicator for people with a Learning Disability living in settled accommodation is below the national average and these developments will contribute towards improved performance against this indicator.
Hastings and Rother Group Residential care homes
2.1 To meet the objectives and strategic direction of the council, a feasibility study has been undertaken relating to the re-development of two (of five) residential care homes forming part of a block care services residential care contract with the provider Affinity Trust. The aim is to improve the accommodation, increase personal space and ensuite bathroom facilities that can appropriately support current residents some of whom require hoisting equipment, and to make the services more attractive to future potential tenants.
2.2 The services support a range of adults with a learning disability and complex physical health needs, many being housed at these properties for several years. Affinity Trust have been the care and support provider since 2012 and have been successful in being awarded a new care services contract to commence from February 2022 following a recent competitive tender process. The terms of the new care services contract include provisions for change; specifically, the aim is to work with Affinity Trust to agree the most appropriate service or services that can be deregistered and reconfigured into a supported living model, moving away from outdated traditional residential care services. Where appropriate, the Council will grant leases and ancillary documents to Affinity Trustor, as nominated registered social landlord, that will be aligned with the supported living services to be provided.
2.3 Following the completion of a feasibility study, the two properties identified for redevelopment are Beckley Close in St Leonards-on-sea, and Jasmine Lodge in Northiam, near Rye.
2.4 Beckley Close is in a location offering good links to transport and local amenities. The plan is to reconfigure the building so that more of the six bedrooms have an ensuite bathroom, reducing shared facilities, and modernisation is undertaken to reflect a change from residential care to a person’s home with a tenancy agreement.
2.5 Jasmine Lodge has potential to be developed to enable all six bedrooms to have their own large ensuite bathroom, suitable for people with additional physical health needs, where hoists may be required. Whilst Jasmine Lodge is in a more rural location than Beckley Close, it still has access to local amenities for community participation, there is a bus route and a train station is approximately ½ mile away.
Cregg Na Ba, Battle
2.6 In addition to Beckley Close and Jasmine Lodge, a feasibility study has been undertaken in relation to Cregg Na Ba in Battle. Cregg Na Ba was originally part of the Affinity Trust residential care contract, until a steady increase in voids led to the service closing in 2018, with the clients supported to move into the remaining five Affinity Trust group homes. Property guardians have taken on the management of the property since this time, giving the ability to obtain vacant possession with one months’ notice.
2.7 The property is a single storey brick-built building providing six bedrooms and two bathrooms within the main accommodation. In order to accommodate six ensuite bathrooms of sufficient size to enable carer assistance a single storey extension of 60m2 is required to the rear (north-west) of the existing bedroom wing. The single storey extension would enable each bedroom to have an assisted bathroom with bath and shower providing sufficient space for a mechanical hoist to be accommodated.
Grangemead, Hailsham
2.8 The fourth property included for redevelopment is Grangemead, Hawthylands Road, Hailsham. This is an ESCC owned property and not subject to any NHS Capital Grant Agreement. The learning disability respite service at Grangemead was developed to re-locate the pervious provision from Sandbanks, also in Hailsham. The development utilised approximately 65% of the existing site with a whole wing left unoccupied. Several options for this have been considered and discounted leaving that part of the building empty.
2.9 The feasibility study has identified the potential to convert this wing into seven self-contained supported living flats for adults with a learning disability. The flats would have a separate entrance and potentially separate vehicle access.
3 Costs and funding
3.1 The feasibility studies have identified estimated total projected costs for each of the four redevelopments. If agreed, building specifications will be finalised for the individual projects and then go out to the market via the normal procurement route. To date, there has been detailed analysis of the feasibility studies but the formal tender process has not yet commenced. The project will deliver the number of units outlined in the table below:
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Development |
Units |
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Beckley Close |
6 |
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Jasmine Lodge |
6 |
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Cregg Na Ba |
6 |
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Grangemead |
7 |
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Total |
25 |
3.2 The Learning Disability Supported Living capital projects will be funded from within existing Adult Social Care reserves and ringfenced grant funding, which has been held in anticipation of eligible social care transformational investment. The overall provision includes contingency and other associated costs that reflect wider building construction pressures, including inflation too. The funding sources are set out in the table below:
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Social Care Capital Grant 2015/16 |
£1.4m |
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Disabled Facilities Grant 2020/21 |
£1.0m |
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COVID service reductions 2021/22 (one-off) |
£0.7m |
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Learning Disability Reform Grant 2011/12 |
£3.3m |
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Total |
£6.4m |
4 Impact on Learning Disability Settled Accommodation performance
4.1 The national performance measure for the proportion of adults with a learning disability living in settled accommodation covers all adults with a primary support reason of learning disability support who are known to the council, who are recorded as living in their own home or with their family and therefore excludes people living in registered residential care. Living on their own or with their family is intended to describe arrangements where the individual has security of tenure in their usual accommodation, for instance, because they own the residence or are part of a household whose head holds such security.
4.2 Historically the council’s performance against this indicator has remained in the lower quartile, due to the high proportion of adults with a learning disability currently supported in registered residential care. The learning disability cohort of clients does not change significantly each year, therefore, to increase performance sufficiently to move our comparative performance towards the lower middle quartile, supported living and shared lives developments need to be applied to clients already included in the measure who are currently in non-settled accommodation (ie: registered residential care).
4.3 It is not possible to achieve the desired performance improvement in one year, which is why this work is planned over the next three to four years, as it will require identification of approximately 69 people who are currently in non-settled accommodation settings who could be safely and appropriately moved to a supported living and shared lives settings following the development of more placements.
4.4 If all of the planned development activity occurs, alongside expected developments in the independent sector, performance will notably increase by 4.9% to a level close to the lower middle quartile by 2023/24 (75.6% against current threshold of 75.7%).
5 Potential Risks and mitigations
5.1 Risks inherent in the building projects will be captured in a buildings risk log. A summary of the key strategic risks is outlined below.
5.2 Approval required from NHS England
Cregg Na Ba, Beckley Close and Jasmine Lodge are subject to an NHS Capital Grant Agreement (CGA) dated 10 February 2011, as the group homes were part of a Valuing People Now portfolio transfer from Hastings Rother Primary Care Trust to East Sussex County Council. Any changes to the configuration of the buildings will require NHS England (NHSE) consent. In addition, any investment made from Council funds will be against properties with NHS charges, where a capital receipt would need to be repaid upon any sale or future change of use. Correspondence held with NHSE by the Learning Disability Commissioner, most recently on 10 January 2022, has confirmed that the development plans appear permissible and will deliver much improved accommodation and outcomes for the current occupants.
Mitigation: There are no current plans to sell or change the use of the buildings when reconfigured to offer supported living accommodation to adults with a learning disability in East Sussex. Furthermore, NHSE have confirmed that a revised CGA can be put in place to reflect the total ESCC investment following the completion of any redevelopment works.
5.3 Use of Cregg Na Ba
If ESCC do not utilise the Cregg Na Ba asset for the benefit of people with a Learning Disability in East Sussex, NHSE will assume there is no further need for resources in order to develop supported accommodation in the county and will request the property is disposed of in order to gain the capital receipt for future NHSE investments and developments.
Mitigation: Development of Cregg Na Ba into supported living is an option to be considered for adults with a learning disability as outlined in section 2.6.
5.4 Identification of potential Tenants
The anticipated impact on Learning Disability Settled accommodation performance is contingent on tenancies being provided to adults already included in the measure, and within non-settled accommodation. This could be challenging to achieve for all placements dependent upon the priority placement need of new referrals received by the specialist brokerage team.
Mitigation: A targeted project alongside the Community Learning Disability and Transitions Teams to identify clients that would both benefit from supporting living placements and have a positive impact as far as possible on the Key Performance Indicator for settled accommodation, will be initiated.
5.5 Impact on existing residents
There will be disruption caused to current residents within Beckley Close and Jasmine Lodge, as temporary moves will be required whilst building works are carried out.
Mitigation: It is proposed that Beckley Close is the first home to be reconfigured in financial year 2022-23, with one void in this service and therefore only five residents would be affected rather than six. Full consultation with residents and their families will be undertaken, involving the Community Learning Disability Team, to ensure disruption is minimised as far as possible. Furthermore, the improvement works being made will enable current residents to continue being supported in their original home when the works are complete (if that is their and/or their representatives’ wishes), and Affinity Trust have prior experience of supporting residents to transfer between services when Cregg Na Ba closed in 2018.
5.6 Care Quality Commission De-Registration
The Care Quality Commission (CQC) will need to agree to a change of registration from residential care to supported living, in line with principles set out in Registering the Right Support (CQC, 2017), and Right Support, Right Care, Right Culture (CQC, updated 2021), therefore there is a risk that CQC may not approve this request.
Mitigation: The plans have considered increasing personalised areas by increasing the ensuite facilities, and Affinity Trust have previous experience of successfully deregistering services. Furthermore, the care and support model will be personalised, and tenancy agreements will be separate to care arrangements.
6 Equality Impact Assessment
6.1 A business case has been developed which includes reference to an initial Equality Impact Assessment (EqIA), completed with involvement from the care provider and from the Community Learning Disability Team. The initial analysis in the EqIA has indicated that, if the project progresses as expected, there is unlikely to be a long-term detrimental impact relating to people’s protected characteristics as a result of any service model changes. A further, more detailed, equality assessment will be undertaken once the project has been agreed.
6.2 The ten people supported at the two homes that are occupied (Beckley Close and Jasmine Lodge), and their families, have been kept up to date regarding the proposals, with reassurance offered that people can move back to these services when development works are complete. However, detailed engagement with service users and families at this early stage is not appropriate, as it may cause unnecessary anxiety and concern for those involved, given their complex communication needs.
7 Conclusion and reason for recommendations
7.1 There is a need to ensure that a wide range of high quality supported living options are available to adults with a learning disability in East Sussex, alongside improving our relative performance in respect of the proportion of people with a Learning Disability in Settled Accommodation and achieving best value when developing and commissioning services for this cohort.
7.2 The proposed supported living developments will offer greater choice, control and flexibility for adults with a learning disability, ensuring that personalised support tailored to individual need is provided. This will support better outcomes being achieved for people and their families, maximising independence and offering security of tenure. The approach to care and support is well suited to driving forward the key priority areas in the Council Plan, of helping people to help themselves, as well as making best use of resources with tailored packages of care and support that can reduced over time as areas of independence are increased.
MARK
STAINTON
Director of
Adult Social Care
Contact
Officer: Fraser Cooper, Strategic Commissioning Manager (Learning
Disability)
Email: fraser.cooper@eastsussex.gov.uk
LOCAL MEMBERS:
Councillor Phil Scott (Beckley Close); Councillor Paul Redstone (Jasmine Lodge), Councillor Kathryn Field (Cregg Na Ba), Councillor Steve Murphy (Grangemead)