Draft Service Specification - Leeds City Council Consultations by wuzhenguang

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									SG RSH 4/1/2012




             Residential and Nursing
                  Service Specification


                  Care and Support in a
              Residential Care Home
                   Draft v10 5/1/2012




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SG RSH 4/1/2012


   Contents
      1. National and Local Policy Context            2

      2. Statement of Requirements                    3

      3. Intended Individual Resident Outcomes         4

      4. Needs Assessment and Start up Arrangements    8

      5. Care and Support Plans                       10

      6. Capacity to Meet Needs                       12

      7. End of Life Care                             12

      8. Autonomy, Independence, Rights and Choice    12

      9. Communications                               14

      10. Dietary Needs and Healthy Eating            15

      11. Religious, Cultural and Spiritual           15

      12. Staff Requirements                          16

      13. Staff Recruitment                           16

      14. Staff: Development and Training             18

      15. Organisational Policies and Procedures      20

      16. Safeguarding                                21

      17. Medication                                  22

      18. Resident and Relative Involvement           22

      19. Resident Data                               23

      20. Quality Assurance and Monitoring            23

      21. Contract Management and Performance         25

      22. Appendices                                  27




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SG RSH 4/1/2012

  To note and remember that any Council Procedure or guidance referred
  to in this specification must be provided or the provider must be
  informed where to find it

  National and Local Policy Context

  The provision of residential and nursing care is influenced by health and social care
  policy relevant to older people, carers, and the management of long-term health
  conditions. This includes mental health conditions which may affect older people,
  especially dementia, depression and anxiety.

  Older people in the Leeds City Council area need services which achieve good
  outcomes, offer good quality and provide care with safety and dignity. Performance
  of services will increasingly be judged according to the experience of people who
  use services, with transparent sharing of information so that people needing
  services can make informed choices, including the knowledge of what other people
  think of services. The Law Commission has proposed a new legal framework for
  adult social care, which starts with the principle that the well-being of the vulnerable
  person is paramount.

  Prevention, early intervention and promoting independence is often thought of in
  terms of avoiding admission to care homes. However, care homes remain a key
  service for older people who need a lot of care and support, and this specification
  requires care home providers to ensure that older people can access the right
  health care and treatment, stay as well as possible, and can live well with long-term
  conditions and care needs. People must be enabled to do as much as possible
  independently, both to promote well-being and to support dignity.

  Care homes are expected to offer meaningful choice and control to people, with
  daily routines suiting the individual rather than the institution, with older people
  generally expressing a preference for consistency and familiarity of staff support,
  and being able to choose and/or make a preference who is their keyworker and who
  provides care.

  Family members, friends and, where applicable, advocates, must be respected as
  expert partners in a person’s care, and to have the opportunity to be involved in
  planning, decision-making, and sharing in the provision of care. When there is
  apparent conflict of interest between a person and family members, or perceived
  risks to safety and well-being, these must be managed within the legal framework
  and local policy regarding safeguarding, mental capacity, and decision-making.

  The National Dementia Strategy emphasis the priority of living well with dementia in
  care homes, with a workforce who are aware of the condition, and skilled & trained
  in working with people with dementia. The use of anti-psychotic medication is
  generally recognised as being too high and prolonged for many people with
  dementia, causing
  harmful side-effects and increased risks to well-being where it is wrongly used to
  manage behaviour, or its use is not kept under proper review. Care home staff


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SG RSH 4/1/2012

  must work in partnership with specialist dementia services to offer the best quality of
  care.

  Once a person moves to live in a care home, it is generally the place where it is
  right for the person to remain until death. The health and care needs associated
  with end of life do give rise to risks of further moves of accommodation and / or
  admission to hospital, which may mean that a person experiences death without
  familiar people. Therefore this specification requires care home staff to have
  awareness of and competence with care needs at the end of life, and to work with
  specialist palliative care services to achieve the best outcomes with and for the
  person.

  Statement of Requirements
  The service must be provided at all times in accordance with the values
  stated in this specification.

  The service shall be delivered with the aim of promoting personalisation and
  enhancing quality of life for residents. The service will ensure residents retain and
  enjoy maximum independence compatible with such limitations as may be imposed
  on them by reason of any physical, learning and/or sensory impairment. In
  particular, residents shall receive skilled and sensitive support whist at the same
  time maintaining and developing abilities, skills and motivation. The support will be
  delivered with respect and dignity and their individuality respected to ensure a
  positive experience of care and support. Residents will be enabled to lead as
  independent a life as possible so that their ability to exercise choice and achieve
  personal fulfilment is maximised.

  Services will be provided in a way that is not based on the provider’s assumption
  but which acknowledges, involves and listens to residents. Such an approach will
  enable the provider to fully understand the situation and make the maximum use of
  residents’ knowledge, expertise and preferences. An enabling approach to
  delivering care and support will be adopted to help prevent deterioration, delay
  dependency and support recovery. Staff will be accountable for the delivery of good
  quality services and set clear standards for all aspects of service delivery

  Older people with mental health needs, including dementia, will have access to all
  activities and support outlined in this service specification. Early detection and
  identification of the onset of mental health problems, including dementia, will be an
  intrinsic part of the role of the service provider. Staff will be trained to communicate
  with people with dementia and signage and the environment appropriate to people
  with dementia.

  The service provided will include a single room (unless residents wish to share), full
  board, day care activities and personal care provision on a 24 hour basis.

  The location and layout of the home will be suitable for its stated purpose: it will be
  accessible, safe and well maintained; meets the residents individual and collective
  needs in a comfortable and homely way and designed with reference to relevant
  guidance

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SG RSH 4/1/2012


  Services and the atmosphere in which they are provided must take full account of
  the personalities, interests and lifestyle, and physical, sensory and mental health
  needs of each resident. Within the overall constraints of the care setting and the
  requirements of a resident’s care plan, each resident’s age, gender, ethnic origin,
  language, culture, religion, spirituality, sexuality and disability will be taken into
  account. Services will be designed to to address the needs of individual residents to
  ensure outcomes in the care and support plans are met. The needs and
  preferences of minority ethnic communities, social/cultural or religious groups
  catered for are respected, understood and met in full.

  ASC has adopted the Social Model of Disability. The Disability Equality Perspective
  states that disability is the social oppression experienced by people who have
  physical or sensory impairments, learning difficulties and/or mental/emotional
  distress. The problem resides, not with disabled people, but with a society that
  discriminates by denying them the full rights and facilities available to non-disabled
  people.

  All work required by the resident's care plan must be carried out in a manner which
  respects their privacy, wishes, and feelings of the resident (and carer where this is
  appropriate). Residents will be encouraged to assume control, whenever possible,
  over the delivery of their care plan. Residents should expect that their privacy is
  strictly respected by all support workers, and that nothing concerning them is
  discussed or passed to other parties other than in circumstances set out in this
  Service Specification. Residents and their families should feel confident that they
  are protected from avoidable harm in a safe environment.

  All staff will be fully conversant with the service philosophy and subscribe to its
  requirements and receive regular and ongoing training as necessary to ensure its
  delivery.

  Effective multi agency working with all stakeholders will be undertaken to ensure
  residents receive a coordinated approach to support. A positive relationship and
  open communication with NHS services will be maintained to prevent unnecessary
  crisis admissions to hospital or A&E Department.

  Mention End of Life Care here

  Intended Individual Resident Outcomes
  In line with Government agenda and good practice, ASC is committed to moving
  towards the provision of outcome based services that will meet a resident’s needs
  and enable the resident’s involvement in when and how care is provided. The
  provision of outcome based services require changes to working practices and all
  providers are therefore expected to work with ASC when required to develop new
  methods of providing outcome focused services

  ASC expects that as a result of receiving the service, residents can experience the
  following:


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SG RSH 4/1/2012

  Resident Outcome 1 – Improving and maintaining health and emotional well-
  being
  Residents report improved physical mental and emotional health

  Resident Outcome 2 – Improved quality of life
  Residents have the best quality of life, including life with family members supported
  in a caring role.

  Resident Outcome 3 – Making a positive contribution
  Residents can participate in their community as equal members
  Residents where possible, are involved in planning and decision making about the
  direction of their support and in the design a delivery of the services they receive.

  Resident Outcome 4 – Increased choice and control
  Residents are assisted in determining for his/herself how they are supported, how
  they spend their day, able to receive reliable information and advice which is
  available in accessible formats.

  Residents have increased access to equipment/assistive technology and fair and
  equitable complaints systems.

  Resident Outcome 5 – Freedom from discrimination or harassment
  Residents feel safe and free from discrimination or harassment.

  Resident Outcome 6- Economic well-being
  Residents have improved access to full financial information and are supported to
  manage their money

  Resident Outcome 7 – Maintaining personal dignity and respect
  Residents feel listened to, respected have a sense of worth and are valued by
  others with appropriate levels of confidentiality


  Should the table of tasks below be an appendix?


  (Needs to include more detail on mobility i.e. use of equipment; NMSt 8.8
  Prevention of Falls Katie Cunningham to have input



            Personal Care of the Resident
   Residents will be helped and prompted with intimate physical care and treatment
   sensitively, discreetly and in a way that maintains their dignity. All care and
   support will be provided in the least intrusive way at all times.
   Assisting the resident to get up or go to bed in accordance with the residents
   preferences on daily routines
   Assisting the resident in moving and transferring as required e.g. moving to a
   sitting position in bed, transferring from bed to wheelchair, transferring from bed to
   commode/toilet, transferring from chair to bed.

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SG RSH 4/1/2012

    Moving with or without a mechanical hoist and taking into account Health and
   Safety legislation. Appropriate equipment should be provided. Do we provide or
   the home? Katie Cunningham
   Washing, bathing, hair care, denture and mouth care and shaving with an electric
   shaver. Care staff maintain the personal and oral hygiene of each service user
   and, wherever possible, support the resident’s own capacity for self-care.

   Washing as a result of incontinence, cleaning and safe disposal of waste.
   Can we include the washing element in the general topic on personal care above.
   Appropriate waste management can then be added into environmental health and
   Infection control section specifically?

   Assistance with dressing and undressing, ensuring residents wear their own
   clothing at all times.
    Assessment of residents by a trained professional to identify those residents who
   have developed or are at risk of developing pressure sores. Skin care but not
   tending to broken or inflamed skin unless directed by a Clinician.

   Different requirements will apply to care homes with nursing                                Formatted: Highlight
                                                                                               Formatted: Indent: First line: 0"
   Assistance with putting on appliances (e.g. leg callipers, special boots and
   artificial limbs) after instruction from Health staff.
   Assisting residents in emptying and changing catheter bags and colostomy bags.
    Replacing, emptying, fFlushing and re –catheterisation are all the responsibility of
   the District Nursing Servicee for care homes without nursing.

    Care Homes with nursing will be responsible for provision of all elements of               Formatted: Highlight
   catheter and stoma care described above – to discuss more specifically in relation          Formatted: Highlight
   to nursing spec as other elements will apply e.g. skin integrity at stoma sites,            Formatted: Highlight
   appropriate onward referral to specialist continence services for complex issues,

   Assisting the resident to go to the toilet, taking into account Health and Safety
   legislation.
   The registered person ensures that appropriate professional advice about the
   management of incontinence and promotion of continence is sought and acted
   upon.

   Assisting and encouraging the resident with implementation of a plan developed
   by the GP, District Nursing Service, and/or Community Urology and Colorectal
   Service (CUCS)

   Continence supplies: for care homes without nursing aids & equipment accessed               Formatted: Highlight
   via referral to GP or district nursing service                                              Formatted: Indent: First line: 0"


   Care homes with nursing are responsible for the provision of continence supplies            Formatted: Indent: First line: 0"
   and equipment, with the exception of supplies and equipment provided through                Formatted: Font color: Auto, Highlight
   prescription (i.e. catheter & stoma supplies)                                               Formatted: Highlight
                                                                                               Formatted: Font color: Auto
   Contributing to rehabilitation prescribed by professionals.


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SG RSH 4/1/2012

    Preparation for attendance at appointments (day services, hospital etc).
   Assisting and encouraging the resident with implementation of a plan developed
   by an Incontinence Nurse. Registered nursing homes to take responsibility for
   providing all the incontinence care Health to confirm – Brain Ladd?
    Washing as a result of incontinence, cleaning and safe disposal of waste. The
   registered person ensures that professional advice about the promotion of
   continence is sought and acted upon and any aids and equipment required is
   provided.
    Orientation, prompting, encouragement and assistance which are needed to
   improve a resident’s mental impairment if necessary. The service user’s
   psychological health is monitored regularly and preventive and restorative care
   provided.
    Assisting with Resident's health needs
   Assisting resident’s handling of medication, ear or eye drops.
   Verbal prompting of the resident to take medication which has been prescribed
   and dispensed into individual doses taking due regard to any local policy and
   procedures which Adult Social Care has notified to the provider.
    Preventive application of non-prescribed creams/ointments in accordance with
   the manufacturer’s instructions if asked to do so by the resident.
    Monitoring prescriptions, overseeing collection of medicines.
   Work with primary and secondary care services to develop non-pharmacological
   responses to behavioural disorders.
   Ensure the appropriate use of antipsychotic medication in line with NICE/SCIE
   guidelines
    Assisting resident’s with dressings etc.
    Monitoring general safety and welfare of the resident.
    Orientation, prompting, encouragement and assistance which are needed to
   improve a resident’s mental health
   Physically assisting a resident to take medication e.g. by placing in on the tongue.
   This requires:
         An explicit account of the procedure in the resident’s care plan and
        provider’s service delivery plan
         A proper training of the staff concerned as required by Essential Quality
        Standards
         The informed consent of the resident or advocate if the resident is unable
        to give consent recorded in the provider’s records.
   The Residential Care setting will not undertake primary health care functions
   such as:
         Administration of drugs by injection
         Application of dressings
         Care of wounds
         Treatment of pressure sores
         Supervision of specialist medical treatment
         Removal or insertion of suppositories or pessaries
         Colostomy care
    The above tasks will be undertaken within a Nursing Home setting
    Awareness of Resident's health needs

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SG RSH 4/1/2012

   Constantly monitoring health condition and circumstances of user including using
   assistive technology.
   Awareness of health condition and circumstances of the resident.
   Recognise need to summons GP or Nurse / alert Manager.
   Co-operation with carers/relatives/district nurse/health visitor/ occupational
   therapist/social worker.
   Night Cover
   Responding to emergency and alarm calls including alerts from assistive
   technology and providing personal and/or nursing care when required or as
   detailed in care plans
   Food and Nutrition
   Assistance with the preparation of food and drinks as required.
   Dealing with dietary needs, including health related needs (e.g. diabetes and
   swallowing difficulties). Nutritional screening is undertaken on admission and
   subsequently on a periodic
   basis, a record maintained of nutrition, including weight gain or loss, and
   appropriate action taken.
   Assistance with feeding or drinking.
   Encouraging residents to have input into the menu planning and offered a menu
   choice
   Provide an environment where the resident can enjoy their meal
    Domestic Services
    Bed making including cleaning after incontinence.
    The provision of adequate warm, clean bedding in the wardrobe
    Emptying and cleaning commode.
    General tidying and cleaning to meet standards imposed by the Infection Control
   team and Environmental Health Refer to DOH guidance- copy of infection
   control specification from CHC contract is available for reference
    Washing up.
    Laundry.
    Managing central and other heating systems.
    Dealing with household refuse and medical waste, Sharps etc
    Disposal of incontinence pads through Health Authority collection systems.
    Assisting residents to care for pets.
    Assisting with personal correspondence.
   Safety Issues
   Assisting residents to manage food hygiene.
   Monitoring general safety and welfare of the resident including use of assistive
   technology.
   Bringing to the attention of the resident health and safety issues (e.g. safety of
   household equipment, furnishings etc)
   Social and Recreational Activities
   Supporting the resident in maintaining and strengthening links and networks with
   family and people in the surrounding community.

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SG RSH 4/1/2012

   Ensure that there is a regular, scheduled programme of meaningful activities in
   order to stimulate and engage people with dementia according to individual
   needs, wishes and lifestyle.
   Assisting the resident to pursue opportunities for friendship leisure activities,
   intellectual stimulus and to access mainstream services such as library, learning
   and leisure services.
   Assisting the resident to access daytime activities and opportunities (e.g.
   luncheon clubs, social clubs) including the planning of a weekly programme of
   weekly activities.
   Rehabilitation
   Assistance in developing the resident's skills in the above areas to re-establish
   independence.

  Needs Assessment and Start up Arrangements
  The Home has a written and accessible Statement of Purpose and Resident Guide
  which prospective and current residents can refer to about the care provided at the
  Home and make an informed choice about where to live. The resident guide should
  give full information about the service and be fully discussed with the resident and
  their carers/advocates, including any implications of any future costs to the resident
  and/or carer.

  As well as the CHISA and contract put in place by Adult Social Care, each service
  user has a written contract/statement of terms and conditions with the home which
  is written in an accessible way. The statement of terms and conditions should
  include:
   rooms to be occupied;
   decoration and fixture and fittings maintenance arrangements
   overall care and services (including food) covered by fee;
   fees payable and by whom (service user, local or health authority, relative or
  another);
   additional services (including food and equipment) to be paid for over and
  above those included in the fees, for example chiropody, hairdressing and outings.
   rights and obligations of the service user and registered provider and who is
  liable if there is a breach of contract;
   terms and conditions of occupancy, including period of notice (e.g. short/long
  term intermediate care/respite).

  An assessment of the needs of new residents is undertaken by the provider, prior to
  the provision of a care and support service, by people who are trained to do so,
  using appropriate methods of communication so that the residents and their
  representatives are fully involved, treated with due respect and not experience any
  form of discrimination.

  In the case of emergency placements, a service may be provided without an
  assessment or contract subject to prior agreement between the care manager and
  Home. The Home will undertake a full assessment and provide all the relevant
  information referred to above to the resident with five working days. The Care
  Manager will review the placement within 7 working days

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SG RSH 4/1/2012


  When an emergency admission is made, the registered person undertakes to inform
  the service user within 48 hours about key aspects, rules and routines of the service
  and to meet all other admission criteria within five working days.

  The registered person ensures that prospective service users have the opportunity
  to visit the home and to move in on a trial basis, before they and/or their
  representatives make a decision to stay; unplanned admissions are avoided where
  possible.

  For individuals referred through care management arrangements, the provider will
  also obtain a summary of the assessment and copy of the resident’s care plan.

  At the end of the 4 week trial period, a review meeting will be held to confirm the
  placement is appropriate and finalise the individual care plan. Within this 4 week
  period notice isn’t required to cease the service.


  Adult Social will undertake an annual review of the placement which may take the
  form of a live face to face review or the Home will be required to undertake provider
  led reviews which will be validated by Adult Social Care. The Provider will notify
  ASC of any changes to the residents care needs with the aim of triggering an
  unscheduled review

  short term placements e.g. transitional beds etc – ??




  Care and Support Plans
  Each resident and respite user will have an individual support plan agreed
  between them and the provider which is designed to meet their aspirations,
  needs and goals. Where the resident has been referred through the care
  management process, residents also need to achieve the outcomes stated
  within their care plan.

   ASC will establish the resident’s eligibility under Fair Access to Care Service
  (FACS) and undertake an assessment of needs. On this basis a care plan will be
  prepared and used by the provider to develop a support plan.

  Inclusion/exclusion criteria? Exclude for clients awarded Continuing Healthcare         Formatted: Highlight
  Funding, exclude out of area, and any other agreements in place through ASC such        Formatted: Highlight
  as LD etc?

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SG RSH 4/1/2012


  The Home will draw up an individual care plan which will be reviewed monthly by
  the Home as and when circumstances change. A formal review with the resident,
  their carer and any other professional (as appropriate) should happen at least
  annually or as and when circumstances significantly change. All staff are made
  aware and can meet the needs set out in the plan and ensure that staff spend time
  getting to know the person with dementia by using life story work. The care plans
  will reflect an individualised approach to maintaining well – being.

  This care plan will include: Do we need to be so prescriptive as below ?

       The resident’s wishes and how they are to be addressed and met
       A ‘pen picture’ of the resident i.e. personal history, daily routine, appearance
        preferences i.e. hygiene, washing, grooming, hobbies and              interests
       The resident’s desired preferences and outcomes; what the resident will
        be able to do as a result of the service provided
       What actions will be taken, by when and by whom, to ensure the outcomes
        are achieved
       The date when the care and support plan will be reviewed by the provider
        with the resident.
       How health needs will be met including but not limited to (nutrition,
        mobility, continence, tissue viability, wound care)
       How social needs will be met
       How intimate physical care will be provided and by whom
       How cultural and spiritual needs will be met
       How emotional and mental well being will be addressed
       How social and community engagement needs will be facilitated
        Any specialist equipment needed
       How special communication needs will be met
       Arrangements for taking medication
       How any special dietary needs/preferences will be met
       The next of kin and emergency contact numbers and what participation
        in reviews and decision making they hold
       Advocacy needs
        A risk assessment The resident’s named key worker
       Who should be involved in care reviews.
       Input from other professionals;
       Advanced Care Planning – (End of Life care)
       Advanced Care Directive
       Power of Attorney/Welfare if appropriate

  The Provider will enable residents to have access to specialist medical,
  nursing, dental, pharmaceutical, chiropody and therapeutic services and care from
  hospitals and community health services according to need.

  The service will facilitate and support access to mainstream services and support
  that will enhance or sustain a person’s life opportunities when requested.



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SG RSH 4/1/2012

  The provider will ensure that the care and support service which is provided is
  compatible with the resident’s care plan produced by ASC.

  Information from the assessment of need, ASC’s care plan and the individual’s own
  support plan will be made available to support workers so that they are aware of
  any special needs, the activities they are required to undertake, the purpose of the
  activities, the frequency and duration agreed, the outcomes to be achieved and any
  applicable time frames.

  The provider will have in place a means of recording action taken to meet objectives
  and outcomes and staff will record the acquisition of new skills and the achievement
  of goals by the resident.

  Care and support plans will be signed by the resident, or carer where the resident is
  unable to sign, and a copy will be held by the resident, (unless there are clear and
  recorded reasons not to do so). They will be available in a language and format
  chosen by the resident that the resident can easily understood and accessible to
  care staff at all times.

  Where the Provider identifies that the resident’s needs have changed , they should
  alert Adult Social Care who will undertake a review of the resident’s needs. Where a
  reassessment by ASC indicates that needs have increased or decreased the Care
  Manager may increase, decrease or withdraw services by advising the provider of
  the required change.

  The plans will be managed by skilled staff, with the participation of family carers,
  advocates and circles of support where appropriate.

  Any limitations on a person’s wishes or chosen lifestyle, for the purposes of
  preventing self-harm or self neglect or abuse or harm to others must be consistent
  with the agencies responsibilities in law under the deprivation of liberty standards
  and the Mental Health Capacity Act. Risk assessment, actions and rationale for
  those actions must be clearly evidenced.




  Capacity to Meet Needs
  The resident is confident that the provider is able to meet their needs as
  stated in his/her care plan.

  The provider will have the capacity to provide services designed to meet
  requirements and specified outcomes as stated in ASC’s care plans and the support
  plans of individual residents. There will be sufficient competent staff to ensure that
  the individual needs are met and that 24 hour cover is maintained.


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SG RSH 4/1/2012

  All specialist services offered are based on current good practice and reflect
  relevant specialist and clinical guidance.

  Staff have the necessary skills and experience and knowledge to deliver the
  services. Staff are trained to communicate appropriately with people with dementia
  and that they are treated with dignity and respect at all times.

  The communication needs of individual residents and preferred method of
  communication are understood by staff. Effective communication to ensure choice,
  control and participation by all residents takes place.

  End of Life Care
  To facilitate early discussion about preferences at the end of life providers will offer
  an advance care plan to all residents within 3 months of admission, using a
  recognised care planning tool. Advance care plans should be reviewed at least
  annually, and upon any significant change in the resident’s condition.
  Propose this is an appendix –Brian Ladd                                                     Formatted: Font color: Auto
  Care Home providers will have formal processes for appropriate onward referral to
  the GP or district nursing services following the identification of significant changes
  or deterioration in a resident’s health condition.

  Care Homes with nursing will follow a pathway approach to end of life care, using a
  formal and recognised end of life care pathway, which will include anticipatory care
  planning, use of a palliative and supportive care register, protocols for onward
  referral for specialist advice and reflective practice following the death of a resident.
                                                                                              Formatted: Font: Not Italic, Font color: Auto
  Care Homes have processes in place to identify and address the training needs of            Formatted: Font: 12 pt
  all workers (registered & unregistered) with regard to end of life care, including          Formatted: Justified, Indent: Left: 0.2", Line
  communication skills, assessment & care planning, advance care planning, and                spacing: single
  symptom management.                                                                         Formatted: Font: 12 pt
                                                                                              Formatted: Font: 12 pt
  Palliative care meds/syringe driver?                                                        Formatted: Font: 12 pt
                                                                                              Formatted: Font color: Red
  Attendance at practice GSF meetings?
                                                                                              Formatted: Font color: Red

  establishing links with specialist palliative care services?                                Formatted: Font color: Red
                                                                                              Formatted: Font color: Red
                                                                                              Formatted: Font: 12 pt, Font color: Red
  Autonomy, Independence, Rights and Choice                                                   Formatted: Font: Not Italic


  Residents have control over decisions about their life and the services they
  receive; they have access to resources to help carry out their decisions and
  meet the outcomes agreed in their individual care plan and support plan. They
  are fully supported to exercise control over their lives in all aspects of the
  service. Services are responsive to individual needs and preferences.

  Service users are entitled to bring personal possessions with them, the extent of
  which will be agreed prior to admission. The resident should not be moved to a


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SG RSH 4/1/2012

  different room without his/her consent unless there are exceptional circumstances in
  which case Homes should consult Contracts prior to any move.

  Service users handle their own financial affairs for as long as they wish to and as
  long as
  they are able and have the capacity to do so.

  Residents can confirm that they are able to make decisions in relation to their own
  lives, and those that have a say in:

      Who supports them
      What they are supported to do
      Who they want to have relationships with

  Homes should be as flexible as possible and residents have the opportunity to
  discuss their preferences with regard to:

      leisure and social activities and cultural interests;
      food, meals and mealtimes;
      routines of daily living;
      personal and social relationships;
      religious observance.
      requirement that residents have input into the running of the home.

  Residents can confirm that they are encouraged, enabled and empowered to
  control their personal finances, unless prevented from doing so by severe mental
  incapacity or disability. Residents will have access to a locked drawer/cupboard if
  they so wish.

  Staff and residents can confirm that wherever possible care and support workers
  carry out tasks with the resident, not for them, minimising the intervention and
  supporting residents to take risks, as set out in the resident plan, and not
  endangering health and safety.

  Residents and their relatives and representatives can confirm that they are kept fully
  informed about the service they receive and are provided with information in an
  appropriate format.

  Residents can confirm that staff communicate with residents in their first or, where
  agreed, their preferred, method of communication.

  Residents or their relatives or representatives (with permission of the resident) can
  confirm that they are able to see their personal files kept on the premises of the
  service provider agency, in accordance with the Data Protection Act 1998, and that
  they have been informed in writing that these files may be reviewed as part of the
  inspection and regulation process.

  (Are the following 2 paragraphs covered by Deprivation of Liberty sections in the
  terms and conditions?)


                                                                                        14
SG RSH 4/1/2012

  Evidence exists that any limitations on the chosen lifestyle or human rights, to
  prevent self-harm or self-neglect or abuse or harm to others, have been made only
  in the resident’s best interests, consistent with the agency’s responsibilities in the
  law.

  The limitations have been recorded in full within the risk assessment and plan for
  managing the risks (and entered into the resident’s care plan). The resident can
  confirm that this has been explained to them, and that they have had involvement in
  these decisions.

  Residents and their relatives or other representatives can confirm that they have
  been informed about independent advocates who will act on their behalf and about
  self-advocacy schemes.

  Residents, carers and family can confirm that they are supported to understand all
  of their rights and responsibilities.

  Where service users lack capacity, the registered person facilitates access to
  available advocacy services.

  Service users’ rights to participate in the political process are upheld, for example,
  by enabling them to vote in elections.

  Communications
  Residents are not marginalised in any aspect of the service because of
  communication needs as defined in their individual care plan and support
  plan.

  Staff are aware of the preferred communication methods of residents and
  communicate in the method and language of the resident’s choice; they are
  appropriately trained and knowledgeable with the necessary communication skills.

  The provider will ensure all the services’ aids and equipment are available to assist
  residents’ communication as identified in their care and support plan.

  Residents will be supported to access and use specialist individual communication
  aids as prescribed.

  Residents’ care and support plans will contain a record of any communication
  assistance needed and this will be regularly reviewed and updated.

  Residents will be supported to communicate at the speed and in the style they wish.

  Residents will be supported to prepare for important events, (e.g. a review), and
  have time to communicate their feelings, views and answers.

  Residents will be able to ask family, friends or others to help staff in listening and
  understanding their views.


                                                                                       15
SG RSH 4/1/2012

  Staff should seek to use language and expressions that are readily understandable
  and appropriate to residents.

  Residents shall have access to a friend, relation or adviser of his/her own choice to
  act as and ‘advocate’ and have the facility to pursue matters on their behalf. (This
  may include the involvement of the advocate in resident Care or Support Plan
  reviews). The provider will co-operate with the appointment of an advocate and
  assist the advocate in providing a service to the resident.

  Access to interpreters should also be available to those who would benefit from this
  facility, including profoundly deaf people and this should be considered at times of
  assessment and review.


  Dietary Needs and Healthy Eating
  Residents will have healthy, nutritious meals and refreshments that meet their
  dietary and cultural requirements and personal choice

  Residents should be encouraged to assist in the preparations if they wish e.g. laying
  tables etc wherever practical/possible.

  Residents’ dietary requirements and preferences will be discussed and recorded in
  their care and support plan where appropriate.

  Food preparation e.g. all food and drink will be prepared and served in line with
  current food hygiene standards and practice

  Staff will have full knowledge of individuals’ dietary requirements i.e. swallowing
  difficulties, allergies, nutritional risks. Staff are trained and ready to offer assistance
  with eating and drinking where necessary. Support will be offered discreetly,
  sensitively and individually in a manner that respects the residents’ dignity and
  wishes. Advice will be sought from the Speech and Language Team (SALT) where
  appropriate.

  Residents will be offered assistance in monitoring intake of food or drink if required
  and appropriate recording procedures will be in place.


  Religious, Cultural and Spiritual
  Residents are confident that their religious, cultural and spiritual needs are
  respected and supported by the service.

  Staff will be properly informed about the implications of cultural and religious beliefs
  or faiths. Staff will support residents to take part in religious, cultural and spiritual
  activities, and to keep in touch with their faith communities.

  Arrangements will be made for dietary and personal care needs in keeping with
  religious/cultural beliefs and practices.

                                                                                          16
SG RSH 4/1/2012


  The needs of residents from black and minority ethnic communities are understood
  and catered for.




  Staff Requirements
  Residents are satisfied that there are sufficient staff to meet competently their
  daily and development requirement.

  Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the
  assessed needs of the service users, the size, layout and purpose of the home, at
  all times.                                                                                Formatted: Font color: Light Blue


  A recorded staff rota showing which staff are on duty at any time during the day and
  night and in what capacity is kept.

  Communication systems, including verbal and written                hand-over,    ensure
  consistency of approach to provide care and support.

  Additional staff are on duty at peak times of activity during the day.

  There are waking night staff on duty in numbers that reflect the numbers and needs
  of service users and the layout of the home. In care homes providing nursing this
  includes registered nurse(s).

  Staff providing personal care to service users are at least aged 18; staff left in
  charge of the home are at least aged 21.

  Domestic staff are employed in sufficient numbers to ensure that standards relating
  to food, meals and nutrition are fully met, and that the home is maintained in a clean
  and hygienic state, free from dirt and unpleasant odours.

  There will be no cross-over of carer/domestic roles during any one shift.


  Staff Recruitment
  The well being, health and security of residents is protected by the provider’s
  policies and procedures on recruitment and selection of staff



                                                                                       17
SG RSH 4/1/2012

  There will be a rigorous recruitment and selection procedure which comply with the
  requirements of equalities legislation and in particular the Equalities Act 2010 and
  any subsequent amendments.

  Any staff, employees or volunteers working with residents must undergo checks
  made through the POVA list (where appropriate), and the Criminal Records Bureau
  at the appropriate level. The provider must complete these checks for all new staff
  and volunteers joining their organisation to include the following:

              Checks required for staff, bank staff and volunteers
              Verification of identity
      Enhanced CRB
      Independent Safeguarding Authority checks
      Protection of Vulnerable Adults list
      Work permit (if appropriate)
      Driving licence (if appropriate)
      Certificates of training and qualifications claimed
      Declaration of physical and mental fitness
      Confirmation service check (if holding a nursing, midwifery or health visitor
       qualification)
      Sex offenders register – Does the CRB check include this?
      Other relevant professional registers
       Verification of identity to comply with the Asylum and Immigration Act 1996
        (birth certificates or passport) shall be conducted before the applicant takes
       up post.
      Appropriate references including the last employer for candidates are sought
       and checked.

  The service provider shall not employ staff without first obtaining ASC’s consent
  (not to be unreasonably withheld) in circumstances where they:

      have a conviction for an offence involving dishonesty or violence;
      have previously resigned or been dismissed from employment due to acts (or
       alleged acts) of dishonesty or violence;
      are unable to provide a satisfactory reference from their last employer.

  The employer must be mindful of their overarching responsibilities for the
  safeguarding and welfare of the people who use their services, and the guidance
  issued by CQC on safe recruitment practices. When recruiting an employee failure
  to comply with these procedures ASC reserves the right to require the employee to
  be withdrawn and an acceptable person substituted.

  (What about safeguarding cases where the staff member has an allegation made
  against them: proposal they are not worked unsupervised, non care activities; they
  don’t work with LCC residents?) Check with Mark/Tim and Legal

  Full records of recruitment and selection forms shall be retained and available for
  inspection.


                                                                                   18
SG RSH 4/1/2012

  The recruitment policy shall address resident involvement in the staff selection
  process.

  Anyone involved in the recruitment and selection process will have received training
  in the organisation’s policies and procedures.

  Each appointment should be subject to successful completion of a probationary
  period.




  Staff: Development and Training
  Staff will be trained to an agreed standard at an appropriate level to meet the
  identified needs, objectives and outcomes of the service.

  All managers will ensure that resources for training and development are made
  available through a planned approach and staff have a learning and development
  plan in place from the point of induction.

  All managers of the service will be suitably experienced and/or qualified in order to
  run the service effectively. It is expected that the Registered Manager responsible
  for overall day to day management of the service will hold either
   NVQ Level 4 Registered Managers Award
   NVQ Level 4 M and NVQ Level 4 in Health and Social Care or registration with
       a professional body
   QCF Level 5 in Leadership in health and Social Care and Children’s and Young
       People’s Services

  Staff will have the necessary training, skills, competencies, personal qualities and
  caring attitudes to enable them to meet the needs of individual residents supported
  by the provider. ?Insert requirement that Care homes with nursing offering              Formatted: Font color: Red
  EMI/dementia care should have RMN on staff                                              Formatted: Font color: Red


  Staff must respect the privacy of residents. Nothing concerning the resident must
  be discussed with anyone other than the Manager, and on a need to know basis
  others in the staff team, ASC, the residents’s health care professionals, and police
  in the case of a pertinent enquiry. This must be done with the express permission of
  the resident or their advocate if the resident is unable to express an opinion.

  Volunteers will be recruited according to the skills and ability they have to perform
  the required tasks; will receive a full induction to the service and training will be
  offered to address any skills shortfall.

  The provider will ensure provision of a structured induction process, which is linked
  to National Standards (e.g. Skills for Care Common Induction Standards), is
  completed by all new staff and a basic training programme for staff or volunteers
  appropriate to the needs of the resident group, within an agreed period of taking up
  appointment. Training needs will continue betond basic induction and it should be

                                                                                    19
SG RSH 4/1/2012

  acknowledged that individuals will have their own unique developmental needs and
  aspirations.

  The provider will undertake training needs analysis for each new member of staff
  and this will be incorporated into the staff training and development plan.

  The service provider will have a clear training and development programme for staff
  and managers that feeds into a monitored organisational training and development
  strategy and identifies when refresher training is required. This programme will
  enable a flexible response to individual learning needs.

  Training content will be validated and provided by a suitably qualified individual /
  organisation A record of participation and competency from inductions and training
  shall be maintained for each staff member and will be available on request to ASC.

  Staff will receive regular training to carry out all aspects of their role which should
  include :

   Mandatory Training                                              Refresher
   Induction and Foundation Training
   Moving and Handling
   Safeguarding Adults                                             2 years (3 years ?)
   Health and Safety
   Cleanliness and Infection Control
   Management of Medicines
   Meeting Nutritional Needs
   Food Hygiene                                                    3 years
   Equality and Diversity
   Management of Medicines
   QCF Diplomas appropriate to role of worker

  The provider will enable staff to take part in learning and development that is
  relevant and appropriate so that they can carry out their role effectively.
  Development plans should be reviewed and adjusted to meet the changing needs of
  the people who use the service. Where specialist skills are required within the
  service these are identified to ensure staff working in the service remain competent
  for their role and provide an effective service to each individual.


   Recommended Non- Mandatory Training
   Mental Capacity Act (MCA)
   Deprivation of Liberty Safeguards (Dols)
   Care with Dignity
   Dementia Awareness
   End of Life Care
   Introduction to Parkinson’s Disease
   Person Centred Thinking
   Stroke Awareness
   Communication Skills

                                                                                      20
SG RSH 4/1/2012

   Confidentiality and Data Protection
   First Aid
   Risk Assessment and Management
   Recording and Reporting
   Personal Care
   De Escalation Techniques (dealing with violence and aggression)

  The above list is the minimum requirement. Providers are expected to be pro-active
  in identifying further training as and when required
  In services where qualified nurses are employed registration must be renewed            Formatted: Highlight
  annually by following the registers body requirements this will include producing
  evidence of 5 days continuous professional development and a registration fee.          Comment [CD1]: we may be able to shorten
                                                                                          this to a requirement that all nurses maintain
                                                                                          their registrations and that providers carry out
  The service must ensure that the service is of a high quality in turn delivers high     appropriate checks at recruitment and at regular
                                                                                          intervals thereafter.
  quality outcomes for customers. Training and development of staff at all levels is an
  important part of quality assurance. All staff should be provided with training and     Formatted: Highlight

  development which will equip them with the skills to fulfil their responsibilities.

  Supervision should be provided to all staff members as per the providers’
   supervision policy. Insert minimum requirement for 3 monthly formal 1:1                Formatted: Highlight
supervision, documented in employee’s record?

  Organisational Policies and Procedures
  Residents’ rights, health and best interests are safeguarded by robust
  policies and procedures implemented consistently by the provider.

  The service provider will provide and implement the following:

      Statement of purpose: aims and objectives of the organisation
      Conditions of engagement including travel expenses, insurance
      Contract and job description
      Range of activities undertaken – and limits of responsibility
      Personal safety whilst at work
      Lone working
      Standards for quality assurance
      Confidentiality of information
      Provision of non-discriminatory practice
      Equal opportunities, sexual, racial and disability harassment
      Health and safety – refer to Essential Standards Quality and Safety
       Information appendix?
      Moving and handling
      Dealing with accidents and emergencies
      Safeguarding adults and children
      Date protection and subject access
      Assisting with medication
      Handling money and financial matters on behalf of a resident
      Record keeping
      The giving and/or receiving of gifts/hospitality
                                                                                    21
SG RSH 4/1/2012

      Dealing with violence and aggression
      Complaints and compliments policy
      Discipline and grievance
      Training, supervision and staff development
      Recruitment and Induction?                                                          Formatted: Bullets and Numbering

      DoLS                                                                                Formatted: Font color: Red
      Infection Control Policy – refer to DoH publication The Code of Practice for
       Health and Adult Social Care Prevention of infections and related guidance.
       Appendix?
      Appropriate professional boundaries/relationships

  Safeguarding Adults
  Children and Adults are protected from abuse, neglect or self harm.

  The provider must have a policy and systems in place to ensure full compliance with
  safe employment practice, including the requirements of the Independent
  Safeguarding Authority (ISA) and Criminal Record Bureau (CRB). This will include
  making referrals to the ISA Vetting and Barring Scheme where the referral criteria
  has been met.

  The provider must have an identified lead professional for safeguarding, who is
  sufficiently senior to influence and manage organisational change where required.

  The provider must maintain a safeguarding log which details allegations and
  incidents of abuse (if any) that have occurred, actions taken including, when and
  how it was reported, and outcomes.

  The provider must ensure that, through its governance systems, that safeguarding
  concerns, patterns and trends are reviewed annually and any actions required to
  minimise the risk of abuse or neglect are acted upon. Such reviews and actions
  should be documented.

  The provider must have a policy in place that meets the requirements of the Public
  Interest Disclosure Act 1998.

  The provider must ensure there is a policy in relation to the requirements and
  provisions of the Mental Capacity Act 2005, and that practice is compliant with
  legislation.

  The provider must ensure there is a policy in relation to the requirements and
  provisions of the Deprivation of Liberty Safeguards (DoLS) , and that practice is
  compliant with legislation.

  The provider must have a safeguarding adults procedure that provide staff with
  clear guidance as to how to respond to possible abuse or neglect. The provider’s
  procedure must be consistent with the Leeds Safeguarding Adults Partnership Multi
  Agency procedures. The policy should reflect the nature of the organisation, its
  structure and the kinds of services it provides.

                                                                                      22
SG RSH 4/1/2012

  The policy should include, as a minimum:

  a clear statement that safeguarding is a responsibility of all staff members (and
  volunteers); and that abuse in any of its forms will not be tolerated by the
  organisation.
  types of abuse
  clear step by step guidance to staff on how to fulfil the Alert and Referral stages of
  the Leeds Safeguarding Adult Partnership Multi Agency procedures,
  who within the organisation will fulfil key roles, such as who would be responsible
  for making a safeguarding referral (including where applicable, how such roles will
  be fulfilled ‘out of hours’)
    detail recording arrangements
    include details of how to make a safeguarding referral, and responsibilities to notify
    the commissioner/regulator
    how issues of consent and mental capacity will be managed
    a review date, of no more than every 2 years.

   The provider must have a child safeguarding procedure that provides staff with
   clear guidance as to how to respond to possible abuse or neglect. The provider’s
   procedure must be consistent with the Leeds Safeguarding Children’s Board
   procedures and their published guidance.

   All staff (and volunteers) should have read and have access to the safeguarding
   procedures. Staff should be able to describe their role and responsibilities in
   relation to safeguarding.

   The service provider should make information available to residents and their
   families as appropriate, as to how they can raise concerns or seek advice in
   relation to abuse or possible abuse.

   The provider will ensure that safeguarding responsibilities and procedures are
   covered within induction and fully understood by staff.

   Training on safeguarding adults is given to all staff within six months of
   employment and is updated every two years.

   The provider and its staff or volunteers are expected to participate fully within
   investigations carried out within the Leeds Safeguarding Adult Partnership Multi
   Agency Procedures. This will also involve the provider undertaking Type 1
   investigations as defined within the Leeds Safeguarding Adult Partnership Multi
   Agency Procedures, where required by the safeguarding coordinator. It will also
   include attendance at and participation within strategy meetings/discussions and
   case conference meetings.


   Medication
   Appendix

   Resident and Relative Involvement
                                                                                       23
SG RSH 4/1/2012




   Residents and relatives are given the opportunity to participate in and
   influence the running and development of the service

   It should be clear that residents’ views have been fully sought in all aspects of
   service provision and care planning. These issues will include:

       Participating in the choice of new staff
       Planning activities
       Monitoring the quality of care
       Influencing change within the organisation’s policies and procedures
        developing plans for future services

   There should be evidence through the use of a variety of communication methods
   that all residents have been consulted in a manner that is consistent with the
   person’s own communication method and understanding. This may be through
   speech, or a variety of augmentative communication aids i.e. picture boards,
   computerised talk boards, use of BSL or Makaton.

   It should be clearly evidenced how residents have been consulted and how
   residents’ views have been used to guide the general ethos of the service.

   Relatives will be invited to be involved in any consultation exercise that has   an
   impact on the service delivered by the home.

   Residents, their carers and advocates are treated with courtesy at all times.

   Resident Data
   Do we need this section? Isn’t most of it covered in the DPA Act? Terms and
   Conditions ??
   The provider will maintain all the records required for the protection of residents
   and the efficient running of the service for the requisite length of time.

   All records will be secure, up to date and in good order and will be constructed,
   maintained and used in accordance with the Data Protection Act 1998, other
   statutory requirements and the Leeds Adult Learning Disabilities Service
   Information Sharing Protocol and will be kept for the requisite length of time.

   Personal data may also be required to be supplied to the Council’s information
   management staff for analysis purposes in order for the Council to fulfil its
   statutory duties and statistical reporting requirements. The supply of this
   information by the provider and its staff falls within one or more proper purposes in
   schedule 2 (and schedule 3) of the Data Protection Act 1998.
   Checking the above with ITC Lawyer, Zoe Cooke

   Quality Assurance and Monitoring

                                                                                         24
SG RSH 4/1/2012

   Residents will receive high quality services that meet their needs, aims and
   objectives.

   ASC will expect services to be provided in accordance with the registration
   requirements of the Care Quality Commission and any organisation that may
   replace them. Reports, assessments, statutory notices and quality ratings issues
   by the regulator or other body will be shared with ASC and will be taken into
   account for monitoring and compliance purposes.

   ASC will measure individual outcomes for residents as well as measuring the
   organisation’s outputs against this general service specification. We propose to do
   this by sampling evidence of the support service provider’s success in enabling the
   resident to achieve positive outcomes identified in their individual care and support
   plans under the following headings: Check headings are commensurate with
   Quality Assurance group work

      Improved quality of life
      Health and well being
      Stay safe
      Make a positive contribution
      Exercise of choice and control
      Freedom from discrimination and harassment
      Personal dignity.

   The performance of the provider will be reviewed against the Service Specification
   and ASC’s contract. ASC will also take into account any reports, investigations or
   requirements made by any regulatory authority. The provider will allow access for
   service reviews or inspection by officers designated by ASC. Relevant financial
   information will be supplied by the provider as requested by ASC.

   The provider will have a system to identify and put in place sustainable
   improvements in the quality of the service and provide Commissioners and other
   relevant professionals with information requested. The provider will work with
   Commissioners and regulatory bodies to ensure a high quality service and
   implement agreed action plans as and when required.

   The provider will operate a process and a procedure for regularly consulting with
   residents and their carers about the service and assuring quality and monitoring
   performance. Outcomes arising from the consultation will be acted upon.
   Outcomes from the quality assurance and monitoring process including changes
   made as a result of feedback, will be made available to residents, carers and all
   stakeholders including ASC.

   The provider will maintain an effective system for quality assurance based on the
   outcomes for residents, in which standards and indicators to be achieved are
   clearly defined and regularly monitored. The provider will have responsibility for
   day-to-day monitoring of the service and maintain sufficient records for this
   purpose.



                                                                                     25
SG RSH 4/1/2012

   The provider will have a policy that covers all aspects of receiving/handling and
   responding to all complaints and is accessible to all. Appendix

   ASC will only request information where it is required to enable effective
   monitoring and compliance with the contract and requirements of the service
   specification.

   Suitable accounting and financial procedures are adopted to demonstrate current
   financial viability and to ensure there is effective and efficient management of the
   business.

   Insurance cover is put in place against loss or damage to the assets of the
   business. The level of cover should reflect the full replacement value of buildings,
   fixture, fittings and equipment.

   Insurance cover is provided for business interruption costs (including loss of
   earnings), as well as costs to the operator of meeting its contract liabilities which
   includes £10 million employment liability cover and £5 million public liability cover

   Records are kept of all transactions entered into by the registered person.
   There is a business and financial plan for the establishment, open to inspection
   and reviewed annually

   Business Continuity Plans

   Contract Management and Performance
   ASC will monitor and manage this process. The contract management process will
   enable both parties to meet their obligations and deliver the contract objectives.
   The contract management process commences immediately after the award of
   contract and will continue during the life of the contract. It will involve the following:

      Monitoring and tracking performance against the service specification and
       method statements
      Ensuring compliance with the contract’s terms and conditions.

   The contract management process will ensure that the service delivers:

      The required outcomes for service users through a person-centred support
       planning process.
      the required quality standards and continual improvement
      the required performance levels and continual improvement
      Best value for money is maintained for commissioners and service users.


   The below information to be discussed and decided.

   Performance Reporting Requirements
   The service provider will be required to submit the following performance
   information in relation to each service as follows:
                                                                                          26
SG RSH 4/1/2012


   Annual Service Review Information (Written Annual Report)
   Annual meetings will be agreed to review the service in accordance with residents,
   carers and stakeholders.

   Services provided will be evaluated by gaining the views of residents, carers and
   other stakeholders.


    Information                  Frequency                    To whom
    Performance monitoring       Quarterly                    ASC
    Service cost analysis        Six monthly                  ASC

        Service levels and performance (including complaints, comments and
         compliments), making use of ASC procedure
        Positive outcomes for residents
        Spend against budget for the service
        Annual accounts
        Staffing, recruitment & retention


   Compliance with:
      Legislation (i.e., Health and Safety, Equal Opportunities
      Insurance requirements
      Inspections for Care Standards by the Care Quality Commission
      Public and employment liability
      Continuous Improvement
      Efficiency gains or savings.




                                                                                  27
SG RSH 4/1/2012




   APPENDIX ONE

   REFERRAL PATHWAY

   Care management to confirm content


                          Referral to Adult Social Care



            Adult Social Care carries out comprehensive assessment



                                                                         Identifies
                                  Appropriate                 No
                                                                     alternative service
                                    service?

                                        Yes

                           Refer to service provider



                     Service provider carries out needs and
                                risk assessment




                                                                      Refers back to
                                  Appropriate                 No
                                                                     Adult Social Care
                                    service?

                                        Yes

                                 Place offered



                                                                                28
SG RSH 4/1/2012



                              Support service commences




-for nursing providers it would be useful to add in a step in the pathway re: referral for     Formatted: Highlight
FNC assessment
     In relation to Health and Safety section
     Appendix – Essential Standards of Quality and Safety Outcome 10

    The following prompts relate to all registered providers except where care,
    treatment and support is delivered in a person’s own home.

    Ensure the premises are adequate

    People who use services and others who work in or visit the premises
    can be confident that in relation to design and layout, the provider:

        Ensures the premises are suitable for the regulated activity.
        Takes account of identified risks.
        Meets the requirements of the Health and Safety at Work Act 1974 and
        associated regulations and the Regulatory Reform (Fire Safety) Order 2005
        and other relevant legislation.
        Ensures the premises protect people’s rights to privacy, dignity, choice,
        autonomy and safety.
        Ensures the premises have space, heating, lighting and ventilation that
        conform to relevant and recognised standards.
    10
    Part 2: Guidance

    Care Quality Commission: Guidance about compliance Essential standards of
    quality and safety March 2010

        Ensures the premises are accessible to people who need to enter the
        premises and meet the appropriate requirements of the Disability
        Discrimination Act 1995.
        Ensures the premises are free from preventable offensive odours.
        Ensures the premises are designed and operated in a way that takes
        account of guidance from expert bodies in relation to specific needs.
        Takes account of the safety needs of people who enter or use the premises,
        including the safety of children and other vulnerable people where they are
        permitted to enter.
        Ensures there is space for a relative, carer or friend to be able to be with a
        child who uses services.
        Ensures that all safety precautions are in place and tested with regard to all
        specialist equipment and engineering systems that are physically fixed to
        the premises.

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SG RSH 4/1/2012

      Ensures care is taken to maintain a suitable and comfortable environment
      for treatment having regard to the impact from equipment in use.
      Ensures the premises reflect Department of Health published guidance.




   Lead effectively to manage risk about the premises

   People who work, visit or use services can be confident that,
   in relation to design and layout:

      Medical gas cylinders and pipe lines are properly installed and maintained
      in accordance with manufacturers’ instructions and patient safety
      communications relating to these are followed.
      There are arrangements and licences in place for the safe collection,
      classification, segregation, storage, handling, transport, treatment and
      disposal of clinical waste in line with current waste legislation.
      Arrangements are in place to meet the Control of Substances Hazardous to
      Health Regulations 2002 as amended.
      Where premises are altered or their use is changed, the continued safety
      and suitability of the premises is assessed.

   Outcome 10: Safety and suitability of premises
   Care Quality Commission: Guidance about compliance Essential standards of
   quality and safety March 2010 113

   10C People who work, visit or use services can be confident that,
   in relation to security of premises and grounds:

      There is a risk assessment of unauthorised access relevant to the type of
      premises, the services provided and the nature of people who use those
      services, and they implement and review procedures to take account of the
      risk assessment.
      Security arrangements are in place to protect people who use services and
      others who have access to the premises and any associated grounds.
      Measures are in place to protect the personal possessions of people who
      use services.
      People who work, visit or use services can be confident that,
      in relation to maintenance of premises and grounds, renewal
      and service continuity:

   There are clear procedures, followed in practice, monitored and reviewed,
   which cover:

      how the premises are maintained
      the identification, assessment, management and review of risks
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SG RSH 4/1/2012

      where necessary the prevention, collection, storage, handling, transport,
      treatment and disposal of waste.
      Plans are developed and implemented for the adaptation of the premises in
      response to changes in:
      the needs of people who use services
      design, technical and operational guidance issued by appropriate expert
      bodies
      how the service intends to provide regulated activities
      relevant legislation.
      Appropriate risk assessments are undertaken regarding the safety and
      suitability of the premises, when the provider is not responsible for the
      premises in which the care, treatment and support is delivered.


   Relevant guidance is taken into account, including that from the Care
   Quality Commission’s Schedule of Applicable Publications (see appendix B).
   People who use services, and staff understand:
   What to do in the event of an emergency.




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