Agenda item

The Committee was presented with the PAMMS Annual Report (Care Homes) for 2024-2025.  Introduced by the SBC Quality Assurance and Compliance (QuAC) 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.

·       Due to SBCs contractual commitment to the Framework Agreement, priorities for 2024-2025 were focused on homes that had a place on the ‘Older Persons Residential Framework Agreement 2024-2029’.  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 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, learning disabilities, and mental health) undertaken by the SBC Quality Assurance and Compliance (QuAC) Team throughout 2024-2025 showed that, of the 29 inspections carried out, one service (Park House Rest Home) was rated ‘Excellent’ overall, 22 services had received a ‘Good’ overall PAMMS rating, and six services had been graded ‘Requires Improvement’ overall.  None of the 16 learning disability-focused (14) or mental health-focused (2) services were assessed during 2024-2025.

Overall ratings following assessments published during both 2022-2023 and 2023-2024 were also included for comparison.  2024-2025 had seen a general improvement in ratings when set against the outcomes of inspections from the previous two years (2022-2023 results showed 14 services rated ‘Good’, and 14 receiving a ‘Requires Improvement’ judgement).  Accompanying graphs illustrated ratings levels for 2022-2025 across services with a nursing, residential, learning disability, and mental health focus.

·       Key themes from assessments that scored an ‘Excellent’ or ‘Good’ rating were listed, most of which echoed the content of previous Annual Reports – these included highly detailed and well-structured care plans, evidence of thorough and consistent monthly audits across all service areas, the operation of a robust Key Worker system, the safe and effective management of medication, strong recruitment procedures, the promotion of choice and independence, the quality and choice of resident meals, positive feedback from residents and their families, and a diverse and engaging programme of activities (tailored to meet individual and group needs).

·       Key themes arising from those assessments that scored ‘Requires Improvement’ were outlined, again reflecting those highlighted in previous Annual Reports.  However, the two overriding areas which impacted upon the quality of provision were the quality of management, and the management of medicines.  Whilst a range of other shortfalls continued to present issues (e.g. lack of person-centred detail in care plans, lack of / insufficient management audits and checks, staff recruitment records incomplete, limited engagement with service-uses / relatives / staff, infection prevention and control measures being inconsistent, home décor requiring attention), they were considered to pose a lower level of risk.

·       An additional section to the report highlighted the 2022-2025 co-ordinated approach with North England Commissioning Support (NECS) Medicines Optimisation Team to assist providers with the medication elements of the PAMMS assessments.  However, due to internal reorganisations of NHS England, the local Integrated Care Board (ICB) and NECS, it had been very recently confirmed that this joint working approach would no longer be able to continue (it was noted that NECS’ work to support the PAMMS inspections was an ‘extra’ as opposed to a requirement).  Assurance was given that the SBC QuAC Team had the competency to ask the right questions and ensure the relevant information was evidenced for future inspections.

·       The final element of the report (‘Next Steps’) documented what happened following a PAMMS inspection.  As well as the formulation of an Action Plan to address any identified concerns (monitored regularly by the responsible QuAC Officer), inspection outcomes were shared with the CQC and ICB (via NECS) to help inform their own intelligence-gathering.  Key themes were also communicated to the SBC Transformation Managers and Public Health so they could use the evidence to design projects and further interventions to support all care homes improve quality of care (a section summarising the work of the SBC Transformation Team during 2024-2025 was also included).  Additionally, PAMMS 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, and PAMMS summary briefing reports were also available on the Stockton Information Directory (SID) (linked from the Older Persons Care Home Ranked List) for families and potential residents to access.

With reference to the report’s concluding commentary, the Committee asked whether SBC or Catalyst (the co-ordinating organisation for the voluntary, community and social enterprise (VCSE) sector) was responsible for updating SID with PAMMS-related material – officers stated that it was the Council that did this.

Regarding the quality of management, Members drew attention to instances where some providers who owned multiple homes moved managers around in order to get an improved inspection rating at a setting which was experiencing challenges.  The Committee was informed that this was not common practice within the Borough, though there had been occasions where an existing manager was drafted in from another home a provider owned.  It was noted that, should this happen, the Council had previously increased monitoring of the service they had come from in case there was any deterioration in quality.

Focus turned to the developments involving NECS and the end of the joint approach to medication oversight, with the Committee questioning whether medicine processes were being led by pharmacists, and noting previous attempts to get a single GP linked to a care setting.  Members wondered if this was an area of follow-up for the local Health and Wellbeing Board – SBC officers agreed to liaise with relevant colleagues to seek assurances for the Committee around medication provision within services.

Continuing with medication matters, the Committee asked if the available medication training was specifically promoted to all services or just those who were deemed to require improvement.  Officers stated that those settings with medication shortfalls would have focused interventions, but that training support was open to all.  Similarly, the Council’s Well-Led Programme was accessible to all providers across the Borough.

Thanking the QuAC Team for another year of important and much valued work, the Committee welcomed the reduction in the number of services requiring improvement and the uptake of the Level 3 Medication Diploma.  Officers were encouraged to promote the latter, particularly to services with identified medication issues.

AGREED that the PAMMS Annual Report (Care Homes) – 2024-2025 be noted.