Why And Support Training Is Important In Care Homes

Care home managers play a pivotal leadership role in whatever institution they work in. It is their role to administrate and maintain all of the most integral services that allow some of society’s most vulnerable people to live a happy, comfortable, and secure life. In order to ensure this, a care home manager must undergo the correct training and experience.

Why And Support Training Is Important In Care Homes

Entry Requirements of Potential Care Home Manager

If one wishes to become a care home manager, there are certain skills and qualifications that one should possess. You will need a qualification in a relevant course or degree relating to administration, and will need to have had experience as a manager.

There are apprenticeships in this field, and so one who feels like they are underprepared for this work should definitely enter one of these entry-level courses. A prospective home care manager will also need to have been cleared by the Disclosure and Barring Service.

 Possessing the Right Skills

The main task of a home manager is listening to the needs of your residents. What is lacking, what could be improved upon, and what is good enough. One will also need to be perceptive enough to notice the needs that go unsaid.

You will be looking after a whole group of people, but you will also need to adhere to the individual requirements of each person under your care. Taking the time to gain an intimate understanding of each patient’s needs is essential.

You should also have a moderate medical knowledge. The people living in care homes will more often than not be suffering from diseases or other medical conditions, and will require able and intelligent assistance.

Being a strong leader means the ability to maintain the legitimate national quality standards. This means being able to commandeer meetings with the relevant executives in order to secure the best possible investments for your home.

As a care home manager, you must be able to work with all manner of different people. While most care homes have a specific group of people that they look after, you should have the correct knowledge of the elderly, those with mental health issues, young children, as well as the terminally ill.

Being a care home manager means being a bit of a Jack of all trades. Your responsibilities will be very varied, and you need the versatile and comprehensive training to meet them. This is one of the most fulfilling jobs around, and knowing that you are ensuring the care and happiness of some of society’s most in-need people is a wonderful thing.

CQC Warning Notice

 

CQC annual report states that during 2014/15 they took 1,179 enforcement actions.

Warning notices can be regarded as the first stage of the cqc enforcement. They are issued in cases in which cqc believe there is a continuing failure to comply. When cqc issue a notice they must do this in writing. They will set a time table for the service to be compliant, however there is no legally-set timescale in the act for complying with a Warning Notice − CQC can set any reasonable timescale.

If you believe that they have made a mistake or you disagree with the basis of the notice you can make representation to cqc. However, there is no legal right of appeal against a Warning Notice. If you decide to appeal to cqc against the notice they only allow you 10 day form the day you received the notice. When making an appeal they encourage you to use the form that they provide with the notice. However they will consider notice made in writing using other written formats.

CQC state that once they receive representation they will try to respond with 5 days. However, they point out that they are not bound by the time scales in responding to the representation as they have no legal obligation to do so.

The action they state they will take on making a decision following your representation are as follows.

  • Withdraw the Warning Notice, or

  • Withdraw the Warning Notice and re-issue another one, or

  • Publish a summary of the Warning Notice and they may issue a press release.

 

Once you feel that you have complied with any identified failure you must inform cqc. They are likely to re inspect shortly after the time set for compliance. Failure to comply is likely to lead to an escalation in enforcement action. This may mean a cancellation of registration or and they may prosecute criminally in regards to the breach.

If you have received a warning notice contact MIT Consultancy, as we have many years of experience successfully assisting people in this situation.

Supreme Court Judgement on Mental Capacity and Deprivation of Liberty

A recent judgement by P v Cheshire West and Chester Council and P&Q v Surrey County Council changed the landscape in the  way deprivation of liberty can be viewed for  people that lack capacity. It was previously believed that residents that did not object to being confined or under continuous monitoring were not being deprived of their liberty as constructed under article 5 of the human rights act.
The facts: P (otherwise known as MIG) and Q (otherwise known as MEG) v Surrey County Council
MIG and MEG are sisters who first became the subject of care proceedings under the Children Act 1989 in 2007, when they were aged respectively 16 and 15. MIG has a learning disability at the lower end of the moderate range or the upper end of the severe range. Until 2007 they lived with their mother and from 1997 also with their step-father. They were ill-treated and neglected there.
MIG was moved to foster mother who was devoted to her she was very well supported. MIG never attempted to leave her door was never locked and she required no medication. However, if she had attempted to leave her foster mother would restrain her.
MEG was moved from foster mother who was unable to control her aggressive outburst. She was placed in a secure residential home for learning disabled adolescents with complex needs. She sometimes required physical restraint and received tranquillising medication for the purpose of controlling her anxiety. She attended college and went on outings.
The Supreme Court majority judgement of four to three held that these arrangements in P & Q amounted to deprivations of liberty.
The west Cheshire case involved P, an adult with cerebral palsy and Down’s syndrome. P required a great of care on a 24 hour basis. P was 38 at the time of the Court of Protection hearing. He had lived with his mother up to the age of 37. His mother health had deteriorated and she was no longer able cope with her sons needs. He was moved into a bungalow -Z House with 2 other residents and lived close to his mother. He also required prompting and help with all the activities of daily living, getting about, eating, personal hygiene and continence. He wore continence pads. Because of his history of pulling at these and putting pieces in his mouth, he wore a “body suit” of all-in-one underwear which prevented him getting at the pads. Intervention was also needed to cope with other challenging behaviours which he could exhibit. But he was not on any tranquillising medication.
By the time of the final hearing before Baker J in April 2011, the principal issue was whether these arrangements amounted to a deprivation of liberty. Baker J held that P was completely under the control of the staff at Z House, that he could not “go anywhere, or do anything, without their support and assistance” Further, “the steps required to deal with his challenging behaviour lead to a clear conclusion that, looked at overall, P is being deprived of his liberty” .Nevertheless it was in his best interests for those arrangements to continue.
The Court of Appeal substituted a declaration that the arrangements did not involve a deprivation of liberty: The appeal was allowed in this case.
Lady Hale stated in judgement
“In my view, it is axiomatic that people with disabilities, both mental and physical, have the same human rights as the rest of the human race. It may be that those rights have sometimes to be limited or restricted because of their disabilities, but the starting point should be the same as that for everyone else. This flows inexorably from the universal character of human rights, founded on the inherent dignity of all human beings, and is confirmed in the United Nations Convention on the Rights of Persons with Disabilities.  Far from disability entitling the state to deny such people human rights: rather it places upon the state (and upon others) the duty to make reasonable accommodation to cater for the special needs of those with disabilities.”

The Department of health has given advice to local and care providers that they should “take steps to review existing care and treatment plans for individuals lacking capacity to determine if there is a deprivation of liberty” in the light of the ruling.
Where people are deprived of their liberty – and this is judged to be in their best interests – this must be authorised, said the DH.
It therefore essential that care home and hospital providers ensure that they re-examine all their residents and where necessary make application for appropriate authorisation.
In a related matter CQC have been criticised by the house lords scrutiny committee examining the mental capacity act and deprivation of liberty safeguards.
The report makes a number of recommendations, however in regard to the role of CQC the report states
It is clear that the CQC has not used its existing powers to best effect to ensure that the requirements of the Mental Capacity Act are met in practice.
We welcome the recognition by the CQC that a new focus on the Act is required in the way it regulates and inspects services.   We recommend that the standards against which the CQC inspects should explicitly incorporate compliance with the Mental Capacity Act, as a core requirement that must be met by all health and care providers. Meeting the requirements of the empowering ethos of the Act, and especially in terms of actively enabling supported decision-making, must be given equal status with the appropriate use of the deprivation of liberty safeguards, or their replacement provisions.
The recommendation make clear that all future inspections by CQC will have a large element devoted to ensuring that hospitals and care home are meeting their obligations in regards to Provisions of the mental capacity act and deprivation of liberty safeguard regulations.
If you require training and support in mental capacity and deprivation of liberty call or email info@mitconsultancy.co.uk

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The Emergence of the Fundamental standards

The new Fundamental standards have come about as a result of the failings in both the health and social care. The health social care act 2008 had for the first time combined the function of the regulator for health care and social care into one. This was presumably for economic reasons. The regulator Care quality commission set about re registering all services and at the same time it let go of a number of experienced inspectors and replaced them with generalist. Following the abuse of winterbourne view care home and The Mid Staffordshire NHS Foundation Trust abuse. The government set up any enquiry led by Robert Francis.
Francis in his summary wrote:

The system of regulation which the Health care commission (HCC ) was given to run failed to prevent or detect over three-quarters of its lifetime what has been described as the biggest scandal in NHS history.

He went on to highlight the CQC internal environment as part of the causes of its failure:

While it is clear that the CQC aspires to be an organisation which welcomes constructive comment, the Inquiry has seen evidence of a defensive institutional instinct to attack those who criticise it, however honestly and reasonably those criticisms are made. A healthcare regulator needs to be a model of openness and therefore welcome constructive criticism.

He stated that the regulator should not be responsible for ensuring improvement but rather to ensure compliance with fundamental standards. He stated that the role of the regulator CQC should be to ensure compliance in regards to governance and financial sustainability.

Fundamental standards according to Robert Francis should be clear and be able to be understood and accepted by providers, patients and the public. While he understood that they required government approval in the form of regulations. He states that they should not be imposed as top down standards but through consultations to ensure that staff that work with residents have full confidence in them such as nurses and doctors. Previously guidance and regulations were not always well synchronized and it was not clear from the guidance if breaches of the regulations had occurred. The new guidance will seek to improve this by focusing the regulations more closely on outcomes, rather than on the steps that must be taken to achieve that outcome, and by clearly specifying the offences.[i]
Robert Francis stipulated that as the fundamental standards and their associated regulations will be simple and easily understood and without ambiguity, failure to comply would lead to harsher penalties for the provider.
Francis proposed that CQC as a regulator will be given powers to act immediately without notification if it is in the patient interest even while investigating. Noncompliance with the fundamental standards that potentially seriously endangers patient’s health CQC will be given powers to prosecute as criminal offence.

New inspection methodology
From this has emerges a new methodology for inspection. Inspection are to concentrate not as much on breach of regulation but rather on these specific questions.

• Is it safe?
• Is it effective?
• Is it responsive?
• Is it caring?
• Is it well-led?

The approach that CQC took to establish areas that required examination of a service when using the five questions   were from an earlier consultation. A number of questions were put forward and consulted upon. From the question asked a number of areas were seen as relevant and fit to be included in the fundamental standards and these included the following.

• I will be cared for in a clean environment.
• I will be protected from abuse and discrimination.
• I will be protected from harm during my care and treatment.
• I will be given pain relief or other prescribed medication when I need it.
• When I am discharged, my on-going care will have been organised properly first.
• I will be helped to use the toilet and to wash when I need it.
• I will be given enough food and drink and helped to eat and drink if I need it.
• If I complain about my care, I will be listened to and not victimised as a result.
• I will not be held against my will, coerced or denied care and treatment without my consent or the proper legal authority.

Guidance

CQC have legal obligation to publish and disseminate information about the regulations Health social care Act 2008 under section 23. However, from examination of the current guidance there appears to be little change in the style and description of the way CQC provide guidance. There remains a great deal of ambiguity and subjectivity in regards to the interpretation of the regulations. There still time for improvement as the regulations are unlikely to come in to force until the April 2015

Duty of Candour regulation 20

It has been felt that poor care has been known in a number of services and there has been a failure to report this to the authorities. Parliamentary select committee -After Francis: making a difference – Health Committee stated[ii]:

The Committee believes that Trusts and other care providers have a fundamental duty to establish an environment where concerns about patient safety and care quality raised by clinicians or managers are addressed openly and directly.

The regulation impose a duty on the provider to be honest and open and to notify the relevant body of any incident with all the facts. CQC state this includes providing a truthful account of the incident, providing an explanation in writing about the enquiries and investigations that will be undertaken and offering an apology in writing.  If CQC believe that the provider has not been fully truthful and transparent in regards to an incident or has not made and appropriate apology, then CQC can prosecute, without issuing a warning notice

Enforcement Powers of CQC

The first major change is that CQC will be given powers to prosecute without first issuing a warning notice. Secondly and perhaps more ominous CQC can use its enforcement powers to hold certain individuals within providers to account. Those individuals are any director, manager or secretary of a body corporate (or a person purporting to act in that capacity), or an officer of an unincorporated association or member of its governing body. Under section 5 of the new regulations it makes it clear that individuals who have authority in organisations that deliver care are responsible for the overall quality and safety of that care can be held accountable. The regulation and guidance from CQC states that the provider must ensure that its directors have the necessary authority and are fit for the role (See regulation 19 Fit and proper workers employed). While currently CQC cannot directly prosecute under this regulation they can related breaches in other areas and related to regulation 5.
The regulation that CQC can prosecute without first serving a warning notice are as those in italics:

Person-centred care

Dignity and respect

Need for consent*

Safe care and treatment*

Safeguarding service users from abuse*

Meeting nutritional needs*

Cleanliness, safety and suitability of premises and equipment*

Receiving and acting on complaints

Good governance

Staffing

Fit and proper persons employed

Duty of candour*

CQC have the powers to impose through civil action in noncompliance of regulations that cannot be prosecuted by imposing conditions such suspending or cancelling registration
CQC have cautioned providers in their guidance [iii] that serious failure to meet some of those requirements which are not offences, such as person-centred care and dignity and respect, would be likely to result in a breach of other requirements which are offences, such as abuse or safe care and treatment, and could therefore result in a prosecution via that route.
[i] Introducing Fundamental Standards Consultation on proposals to change CQC registration regulations. DEPT of Health. January 2014
[ii] After FrancisHealth comitteehttp://www.publications.parliament.uk/pa/cm201314/cmselect/cmhealth/657/65705.htm
[iii]http://www.cqc.org.uk/sites/default/files/20140725_fundamental_standards_and_enforcement_consultation_final.pdf – p20

CQC and Local authority forced to change the way they examine case of deprivation liberty following Supreme Court ruling

Despite our fears and trepidations most CQC inspectors, inspect fairly and appropriately. Most reports are generally well balanced and reflect the state of the home at the time of the inspection.
There are however, a few reports that that are not well balanced, or have factual inaccuracies.  If this is the case you have 10 days to respond before the report is published. This has been reduced from 28 days. You have the right to make representation, and in most cases your argument will be taken into account prior to publication. There is no automatic right to appeal against the publication, however unfair you may think it may be. This does not mean that you should not attempt to persuade your inspector to see the outcome from your perspective.
The fact that time frame has been reduced to 10 days implies that CQC are confident that the findings of their inspections are accurate and without errors.
The time frame for submitting action plans remains unchanged at 28 days.
In one case a part time inspector wrote her report based on information provided by a visiting relative. She failed to investigate the allegation and hearsay by the relative; which led the home to have a number warning notices in at least 5 outcomes. Despite the protestation of the providers and evidence that contradicted the report, the report was published and the warning notices stood. It took a further inspection by the senior cqc manager and two other inspectors to vindicate the providers. Although no apology was provided a glowing report was subsequently published.
It is important that you establish a dialogue with your inspector and ensure that you have detail feedback at the end of the inspection. While it is understandable that at the end of the inspection day you are likely to ‘wind down’ it is crucial that you pay attention and write down feedback that is being provided. Ask question and correct any errors or misunderstanding. It is much easier to correct issues before the report is written.
While we have heard that the culture within CQC is changing we are all aware that it takes time to change attitudes.
In Francis report on Mid Staffordshire NHS Foundation Trust Summary states

The evidence received by this Inquiry does not suggest that the CQC is a happy environment to work in. The massive upheaval that has taken place in its creation has led at least some elements of staff, from the frontline to the Board, to express concerns and to believe they have not received an adequate response. While it is clear that the CQC aspires to be an organisation which welcomes constructive comment, the Inquiry has seen evidence of defensive institutional instinct to attack those who criticise it, however honestly and reasonably those criticisms are made. A healthcare regulator needs to be a model of openness and therefore welcome constructive criticism

Once a report has been published and you find yourself non-compliant it is important that you set about addressing the issues of noncompliance. Depending of the nature and depth of the noncompliance you will be requested to be complaint within a very short period of time.  A further inspection will check for compliance, if you are still not compliant you are likely to face enforcement action. You may face enforcement from your initial inspection depending the finding of the inspector.
If you believe that you have been judged unfairly and that the report is unduly skewed against you. MIT Consultancy can support you to challenge the inspection report by CQC.

If you are unsure how to be compliant contact MIT Consultancy we have many years of experience supporting clients with challenging inspection reports right through to first tier tribunals.