Agenda item

The Committee was presented with the PAMMS Annual Report (Care Homes) for 2022-2023.  Led by the SBC Quality Assurance and Compliance Manager, key content was relayed as follows:

• The Provider Assessment and Market Management Solutions (PAMMS) is an online assessment tool developed in collaboration with Association of Directors of Adult Social Services (ADASS) East and regional Local Authorities.  It was designed to assist users in assessing the quality of care delivered by providers.  The assessment was a requirement of the Framework Agreement (the Contract) with providers, and they were contractually obliged to engage with the process.

• A summary of assessments for contracted care homes undertaken by the SBC Quality Assurance and Compliance (QuAC) Team throughout 2022-2023 showed that 17 services had received a ‘Good’ overall PAMMS rating, 14 services had been graded ‘Requires Improvement’ overall, and one service was deemed ‘Poor’ (a home which had since closed).

2021-2022 overall ratings were also included for comparison – this indicated that 28 services were previously considered ‘Good’ (11 more than in 2022-2023), four services were previously graded ‘Requires Improvement’ (10 less than in 2022-2023), and no services were previously deemed ‘Poor’ (one less than in 2022-2023).  Windsor Court’s upgrading from ‘Requires Improvement’ in 2021-2022 to ‘Good’ in 2022-2023 was well deserved given the efforts made by the provider.

• Key themes from assessments that scored a ‘Good’ rating were listed – these included comprehensive, clear and concise care plans with personalised detail (evidencing people’s preferences and routines), well-managed medication (including checking consent prior to administering), robust processes around safe staff recruitment, and the promotion of choice and independence to residents by staff.  Offering residents a choice of meals and evidence of a varied activity programme, tailored to the needs of the individual as well as groups, were also key.

• Key themes arising from those assessments that scored ‘Requires Improvement’ or ‘Poor’ showed shortfalls in the completion of staff recruitment records (including gaps in previous employment and DBS checks), inconsistencies in relation to the quality and content of care plans, and issues regarding the management of medication.  Other concerns surrounded infection, prevention and control (ICP) procedures, the décor of some homes, and a lack of contractual compliance around staff induction, supervision and training.

• In an attempt to improve the quality / robustness of providers’ medication management / processes, SBC undertook a co-ordinated support approach in conjunction with the NECS Medicines Optimisation Team around the medicine elements of the PAMMS tool throughout 2022-2023.

• As per established practice, following a PAMMS inspection, an Action Plan is developed highlighting those areas that need an improvement in quality / compliance to ensure they are being delivered to a ‘Good’ standard.  The Action Plans are monitored regularly by the responsible QuAC Officer for progress, and will be only signed off as compliant and complete when all identified areas demonstrate and evidence the required level of quality and service delivery.  Key themes regarding PAMMS outcomes are also shared with the Care Quality Commission (CQC) as well SBC Transformation Managers and SBC Public Health, whilst ratings are provided to social workers who can share with families searching for a care home so they can access up-to-date information about the Council’s view of quality.

Committee questions focused on the key themes arising from those services which were rated ‘Requires Improvement’ or ‘Poor’.  Members expressed alarm at the identified lack of DBS checks, though it was explained that this usually pertained to supplementary staff going into a setting to provide an additional service (as opposed to the core workforce) or an issue around the renewal of previous documentation.  It was confirmed that anyone providing ‘personal’ care on a 1:1 basis must have a valid DBS check.  As for IPC shortcoming, this often related to a lack of understanding / apathy (e.g. lack of mask-wearing / hand-washing) about the required procedures, though it was acknowledged that guidance can quickly and repeatedly change.

Several concerns were raised on the reported shortfalls in the management and administration of medication, something which Members considered to be a fundamental element of care.  The Committee heard that medicines processes could be very complex and involved requirements often unique to an individual, as well as factors such as consent and storage.  The use of agency staff (as a result of recruitment challenges) who have less knowledge about the setting and its residents may cause issue, though it was emphasised that care home managers had a responsibility to ensure any worker was properly inducted.  The Committee subsequently requested details on the uptake of the Level 3 medications management training.

Noting that providers were usually private businesses who can and do make profits in this sector, Members asked if there was any point where the Council would refuse to place individuals within a service if there were identified concerns.  In response, the Responding to and Addressing Serious Concerns (RASC) multi-agency process was highlighted which prohibits admissions when a provider becomes too risky – this remains in place until sufficient improvement can be evidenced.

Reflecting on the report as a whole, the Committee was perturbed about the downward trend in overall ratings which was likely to be echoed within any forthcoming CQC inspections.  Getting medicines and IPC processes right was crucial in ensuring safe care, and the Council was again encouraged to promote the Well-Led Programme to those services that had been deemed ‘Requires Improvement’.

AGREED that…

1)    the PAMMS Annual Report (Care Homes) – 2022-2023 be noted.

2) information on the uptake of the Level 3 medications management training be provided.