Agenda item

Consideration was given to the latest quarterly summary regarding Care Quality Commission (CQC) inspections for services operating within the Borough (Appendix 1).  15 inspection reports were published during this period (January to March 2023 (inclusive)), with attention drawn to the following:

Providers rated ‘Good’ overall (7)

• Oxbridge House, Roseville Care Centre and Real Life Options – Darlington Road had all been upgraded from a previous overall rating of ‘Requires Improvement’.

• Royal Mencap Society – 71 Middleton Avenue and Real Life Options – 2 Frederick Street had maintained their grading following a previous overall rating of ‘Good’.

Providers rated ‘Requires Improvement’ overall (7)

• Cherry Tree Care Centre and Chestnut Lodge Nursing Home had breaches in relation to safe care / treatment and good governance which led to the services being downgraded from their previous overall rating of ‘Good’.

• Mandale Care Home had breaches in relation to safeguarding and good governance (as well as a breach of CQC regulations regarding the failure to notify the CQC of important incidents) which led to the service being downgraded from the previous overall rating of ‘Good’.

• Churchview Nursing and Residential Home had breaches in relation to the need for consent and good governance, and Piper Court had breaches in relation to good governance – no change in grading following a previous overall rating of ‘Requires Improvement’.

• North East Ambulance Service NHS Foundation Trust were served with a notice under Section 29A of the Health and Social Care Act 2008 and told to make significant improvements to governance systems, seeking and acting upon staff feedback, incident reporting / investigating / monitoring of actions, and medicines management.  It was noted that the Trust would be responding to the outcomes of this inspection at the next Tees Valley Joint Health Scrutiny Committee meeting on 28 July 2023.

Providers rated ‘Inadequate’ overall (1):

• Ashwood Lodge Care Home had breaches in relation safe care / treatment and good governance which led to the service being downgraded from the previous overall rating of ‘Good’.  The home had since closed, with the last resident being moved out on 12 February 2023.

The Quality Assurance and Compliance (QuAC) Manager presenting the report noted that most CQC inspections now tended to be focused on the ‘Safe’ and ‘Well-Led’ domains, though can be opened up to include the other three previously established domains (‘Effective’, ‘Caring’ and ‘Responsive’) should issues be found during a focused inspection.

Regarding the now closed Ashwood Lodge Care Home, Members praised the QuAC Team for flagging-up issues prior to the CQCs subsequent visit, and were also reassured by the speed of the action taken in relation to residents once concerns had been identified.

With specific reference to Piper Court, the Committee asked for clarification of the CQC timescales around re-inspections should a provider be graded either ‘Requires Improvement’ or ‘Inadequate’.  Officers stated that services were usually re-visited within six months if they were rated below ‘Good’, though the new CQC monitoring framework had made this less clear.  The CQC would therefore be approached to confirm the present arrangements.

Attention was then turned to the section on Provider Assessment and Market Management Solutions (PAMMS) reports (Appendix 2).  17 reports were published during this period (January to March 2023 (inclusive)), with attention drawn to the following:

Providers rated ‘Good’ overall (10)

• Windsor Court Residential Home had been upgraded from their previous overall rating of ‘Requires Improvement’.

• Hadrian Park, Ayresome Court, Teesdale Lodge Nursing Home, Green Lodge, The Hollies Residential Care Home, Reuben Manor, Piper Court, Roseworth Lodge Care Home and Edwardian had maintained their grading following a previous overall rating of ‘Good’.

Providers rated ‘Requires Improvement’ overall (6)

• Ingleby Care Home had been downgraded from their previous overall rating of ‘Good’ following concerns identified in relation to the environment and infection prevention control, recruitment and retention of housekeeping staff, and medication management.

• Churchview Nursing and Residential Home had no change in grading following a previous overall rating of ‘Requires Improvement’.  Issues were identified in relation to care plans, staff checks / supervision / training, and provider engagement with service-users / families and its staff.

• Cherry Tree Care Centre had been downgraded from their previous overall rating of ‘Good’ following concerns identified in relation to care plans and the sharing of feedback on the quality of service.

• Woodside Grange Care Home (older people’s service only) had been downgraded from their previous overall rating of ‘Good’ following concerns identified in relation to the consistency of care plan quality, risk assessment, medication management / administration, and the home environment.

• The Maple Care Home had no change in grading following a previous overall rating of ‘Requires Improvement’.  Issues were identified in relation to the consistency of Mental Capacity Assessments and Best Interests decisions, medication administration / storage, and staff supervision.

• Allison House Care Home had been downgraded from their previous overall rating of ‘Good’ following concerns identified in relation to medication administration, staff training, and quality assurance systems.

Providers rated ‘Poor’ overall (1)

• Ashwood Lodge Care Home had been downgraded from their previous overall rating of ‘Requires Improvement’ following concerns identified in relation to care plans, staff supervision, recruitment, and training.

The Committee queried how Roseworth Lodge Care Home could receive a PAMMS grading of ‘Good’ in March 2023 when the CQC had published its report only three months earlier (December 2022) which rated the provider ‘Inadequate’.  Officers stated that the specific elements of each report would need to be checked, but that significant improvements can be made in a relatively short space of time.

With reference to Allison House Care Home, the Committee asked if concerns raised during a PAMMS inspection can lead to a subsequent visit by the CQC.  Members were reminded that the CQC has its own inspection regime, but that SBC has meetings with CQC representatives every six weeks which are used to feed-in PAMMS outcomes and determine future action.

In order to address any emerging issues as quickly as possible, Members queried what was in place to allow providers to flag problems (i.e. early warning systems).  Officers responded by outlining the existing contract management of providers by the QuAC Team that puts an onus on services to raise concerns (duty of candour), a process which works more effectively now than in the past due to the mechanisms in place for regular contact / feedback.  Local services are RAG-rated as part of an ‘intelligence’ dashboard, and Provider Forums, Leadership and Activity Co-ordinator Networks are offered on a regular basis.  SBC Transformation Managers also engage with providers and encourage networking.

The Committee once again praised officers for the content and detail of the PAMMS reports (echoed by the SBC Cabinet Member for Adult Social Care) which, in contrast to many of the CQC published outcomes, always reflected inspections which looked at all of the established domains.  Concerns were also raised about the CQC seeking assurance about provider practice via telephone as opposed to in-person visits – ensuring robust oversight around the safeguarding of vulnerable residents was paramount.

To assist the Committee, officers proposed the submission of a briefing on the number of care providers currently operating across the Borough – this would be forwarded to the Scrutiny Officer for circulation to Members.  The benefits of going to visit services was also noted, something which may help Members further understand the existing offer and any issues / concerns.

AGREED that the Care Quality Commission (CQC) Inspection Results – Quarterly Summary (Q4 2022-2023) report be noted.