The Committee considered a report of the Director of Adults and Communities which provided an overview of quality for care homes in Leicestershire and described how the local authority supported care home providers to sustain safe care, and to develop the quality of care. A copy of the report marked ‘Agenda Item 9’, is filed with these minutes.
Arising from discussion the following points were raised:
(i) In reference to the numbers of adult social care providers in Leicestershire prior to the Covid-19 pandemic, it was clarified that these related to services registered with the Care Quality Commission (CQC) and the reasons why registered care homes could be non-operational usually reflected provider position e.g. resulting from a business change.
(ii) In response to a question raised, the Director confirmed that as part of its mobilisation work, the Department was reaching out to care home providers to confirm their position on Covid-19 vaccinations for staff to ensure readiness for when the Regulations, requiring everyone working in care homes to be fully vaccinated, came into effect.
(iii) Concern was raised that the regulations requiring everyone working in care homes to be fully vaccinated against Covid-19 would put additional stress on care homes at an already very difficult time. It was queried how a potential reduction in staffing levels as a result of people choosing not to be vaccinated would be managed. The Director advised that Leicestershire’s position was generally positive with high levels of vaccine uptake from residents and County Council staff. However, inevitably there would be a proportion of staff who would choose not to get vaccinated and therefore be required to make choices about their future employment. Assurance was provided that the Department was doing all it could to support care home providers and working with them on their plans to mitigate the risks. A risk rating had been given to each care home to identify where specific support was needed. The regulations also affected other organisations such as the NHS that deployed staff into care homes, so the Department was also working closely with its partner organisations across Leicester, Leicestershire and Rutland to encourage staff across the health and social care sector to get vaccinated. The last date for care home workers to get their first dose of the vaccine was 16 September, so it was expected the local picture would become clearer once this milestone had been reached.
(iv) The Director clarified that the quality position of adult social care providers in Leicestershire as referenced in the report provided details of the current position only and so was subject to change if CQC ratings changed in future. Members requested that periodic updates be provided to keep them informed of the situation and any impact on care market sustainability as the Director considered appropriate. Members noted that during the Covid-19 pandemic, the CQC had not been able to carry out inspections of care providers in the usual way so this would have caused a number of new providers to be graded as ‘unrated’ for a period of time.
(v) All new providers joining the new Home Care for Leicestershire Framework had been required to demonstrate they were registered with the CQC and specific elements had been built into the Framework to ensure that the providers signing up were in an acceptable position where quality was concerned.
(vi) Members noted that whilst the increased cost pressures of £14m during the current financial year had reduced to £13m, greater savings still needed to be made. The Director reported that an Action Plan had been put in place to understand the reasons for and to manage the increased cost pressures. Members were pleased to hear that regular Departmental meetings were taking place to review and monitor actions and adapt the Plan as necessary to keep costs under control so far as possible. It was expected that pre-pandemic spending levels would not return for some time, but the situation was expected to become more balanced in the medium-term.
(vii) A Member who represented electoral divisions in the Hinckley area commented that whilst the percentage of care homes in Leicestershire rated by the CQC as inadequate was positively low, unfortunately a care home in Hinckley had recently fallen into this category. The support being given to this home to avoid closure was questioned. The Director provided assurance that a triangulation of work was being undertaken between the Council, the service provider and the CQC to help improve the rating. It was noted that the provider had a responsibility to put in place a quality improvement plan to set out the ways it planned to address the issues identified by the CQC. The situation would be monitored and kept under review until the rating improved. Members noted that the Council’s Quality and Contracts Team also worked closely with the CQC to address particular concerns with care homes. The risk ratings the Council attributed to the care homes were also helpful in identifying the correct level of oversight and intervention that needed to be given.
(viii) The CQC’s new strategy was expected to change the way the Council was required to give assurance of its own processes and practices in a whole range of areas including commissioning. Details of the CQC’s approach to implementation were still in development making it difficult for the Department to plan with much certainty, but testing was expected to be carried out by the CQC over the course of this year prior to the Strategy becoming fully operational. It was anticipated that elements of the Strategy may also affect certain work being undertaken regionally. For example, Commissioning was an area that had been identified as requiring a much greater level of focus and a situation the Department would be monitoring over time with CQC involvement.
That the update on Care Home Quality, be welcomed, and the recommendation to undertake a review of care home fees for implementation in April 2023, be supported.