Agenda item

The Committee was presented with the PAMMS Annual Report (Care Homes) for 2023-2024.  Led by the SBC Service Manager – Quality Assurance & Brokerage (who began by acknowledging the efforts of the SBC Quality Assurance and Compliance (QuAC) Manager in producing the report), 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.

·       Priorities for 2023-2024 were focused on homes on the ‘Older Persons Care Home Ranked List’ that had received an overall rating of ‘Requires Improvement’ and Learning Disabilities (LD) homes that had not received a PAMMS assessment in 2022-2023.  Assessments were planned around priority of support / level of risk, taking into account factors including date and rating of last CQC / PAMMS assessment, outcomes from the most recent CQC / PAMMS assessment report, other intelligence and data that increased the risk of service quality deterioration, and the number of PAMMS assessments that could be completed within current team resources.

·       A summary table of assessments for contracted care homes (covering nursing, residential, LD, and mental health) undertaken by the SBC Quality Assurance and Compliance (QuAC) Team throughout 2023-2024 showed that, of the 28 inspections carried out, two services were rated ‘Excellent’ overall (both LD settings), 16 services had received a ‘Good’ overall PAMMS rating, and 10 services had been graded ‘Requires Improvement’ overall.  17 services were not assessed during 2023-2024.

Overall ratings following assessments published during both 2021-2022 and 2022-2023 were also included for comparison.  2023-2024 had seen a general drop in ratings when set against the outcomes of inspections from the previous two years, most likely as a result of the impact of a strengthened approach towards medicines management (working closer with the North of England Commissioning Support (NECS) Unit to implement more robust medication audits).

·       In response to past Committee discussions around challenges within different categories of care home provision, graphs were included illustrating ratings levels for 2021-2024 across services with a nursing, residential, LD, and mental health focus.

·       Key themes from assessments that scored an ‘Excellent’ or ‘Good’ rating were again listed.  In addition to those elements identified in last year’s Annual Report (i.e. comprehensive, clear and concise care plans with personalised detail; well-managed medication; robust processes around safe staff recruitment; the promotion of choice and independence to residents by staff; offering residents a choice of meals; evidence of a varied activity programme, tailored to the needs of the individual as well as groups), the completion of monthly audits by the registered manager on all aspects of the service that were robust, consistent and used to critically review the offer (supported by well-managed Action Plans to improve any shortfalls in provision) was also noted, as were the benefits of an effective key worker system (with service-users being aware of who their key worker was and how the system operated).

·       Key themes arising from those assessments that scored ‘Requires Improvement’ were highlighted, many of which were also recorded in last year’s Annual Report (i.e. 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; issues regarding the management of medication; an absence of infection, prevention and control (ICP) procedures; tired décor of some homes; lack of contractual compliance around staff induction, supervision and training).  Further identified themes included a lack of / inconsistent management audits and checks, and little evidence of a range of regular, organised meetings where service-users, relatives and staff could provide feedback (or, if they did, that this was listened to, or acted upon appropriately, with people not kept informed of the outcome).

·       The report concluded with a reminder of the next steps following a PAMMS inspection, with an Action Plan developed (and subsequently monitored regularly by the responsible QuAC Officer) highlighting those areas that needed an improvement in quality / compliance to ensure they were being delivered to a ‘Good’ standard.  Assessment outcomes were shared with the Care Quality Commission (CQC) and North East and North Cumbria Integrated Care Board (NENC ICB) to help inform their own intelligence-gathering, whilst key themes were relayed to SBC Transformation Managers and SBC Public Health (to aid the design of projects and further interventions to support all care homes improve quality of care, a number of examples of which were documented in relation to the former), whilst ratings were provided to social workers who could share with families searching for a care home so they could access up-to-date information about the Council’s view of quality.

Reflecting upon the development of this Annual Report over the last three years, the Committee welcomed the continued inclusion of overall outcomes from previous assessments in addition to the latest rating – this enabled the identification of trends / potential issues within the different categories of care.

The Committee contrasted the significant confidence that the PAMMS programme gave Members in comparison to the decreasing CQC output and commended the SBC QuAC Team for its efforts during the last year.  The recent ‘Excellent’ rating for two of the LD care homes was very encouraging, as was the current status of the Borough’s two mental health-focused care homes (particularly given the greater complexity being seen in patients requiring mental health support), though it was felt that inspections of these latter providers should be prioritised given neither were assessed during 2023-2024.  Members also highlighted the need for the Council to push medication training / courses as medicines management issues remained prevalent.

Continuing with the theme of those services which were not inspected in the last year, Members asked why The Maple had not been visited given it had been rated ‘Requires Improvement’ following assessments in both 2022-2023 and 2021-2022 – the Committee was informed that this service had changed provider recently and SBC officers had conducted an inspection last week (the report would be circulated in the near future).  Members also requested clarity on the lack of an assessment of Park House Rest Home in the last three years, and heard that this service had previously chosen not to be on the old framework but were on the new one (and will therefore receive an inspection).

Bringing this item to a close, the SBC Service Manager – Quality Assurance & Brokerage drew attention to the need for the Council to conduct a bed sufficiency assessment next year on all older people’s residential care contracted providers – this meant that PAMMS assessments must be completed on all these providers which would bring challenges for the SBC QuAC Team given existing resource levels.  The Committee looked forward to learning of the outcomes of these assessments once completed, particularly to understand ongoing and future costs to the Council and the ability to bring those individuals placed out-of-area back to the Borough.

AGREED that the PAMMS Annual Report (Care Homes) – 2023-2024 be noted.