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4.2 Care Governance Operational Policy

AMENDMENT

This chapter was updated in April 2016, in regard to information and an updated Appendix 1: Care Governance Flowchart.


Contents

  1. What do we mean by Care Governance and what does it cover?
  2. What is the Framework for the Operation of Care Governance?

    Appendix 1: Care Governance Flowchart

    Appendix 2: Service Provider Profile: Sources of Information

    Appendix 3: Suspending Placements in Social Care Services

    Appendix 4: Announced and Unannounced Audit Visits

    Appendix 5: Out Of City Placement Process For Under 65 Mental Health, Learning Disability, Older People And OPMH Care Homes Flowchart

    Appendix 6: Care Governance Board Terms of Reference

    Appendix 7: Service Improvement Panel Terms of Reference

    Appendix 8: Care Quality Improvement Group Terms of Reference


1. What do we mean by Care Governance and what does it cover?

A key goal of adult social care is to ensure that people receive good quality and safe services that deliver the outcomes they want. Care Governance provides a framework through which this can be assured and the delivery of good quality care supported.

Care Governance has been defined as 'a framework within which personal social services organisations are accountable for continuously improving the quality of their services and taking corporate responsibility for performance and for providing the highest standard of social care’ (Best Practice, Best Care 2002).

Care Governance is focused upon the quality and safety of services and runs alongside the Safeguarding Vulnerable Adults Framework that is in place. The Safeguarding Vulnerable Adults procedures are paramount and distinct from the Care Governance framework as described here. Where quality concerns regarding individual or groups of service users become a safeguarding matter then the safeguarding policies and procedures are followed and take precedence at all times. Information from Care Governance may well support any safeguarding investigation and the role of care governance will be important in relation to services once safeguarding investigations are completed. There maybe occasions within complex level 4 safeguarding investigations when investigations and improvement planning are running parallel with one another. This will need to be carefully managed through the Investigating Manager and Commissioning and Performance ‘Quality Lead’.

This policy is focused upon care governance in relation to the full range of social care services which people receive. Its key elements are:

  • Active promotion of good quality;
  • Robust and proportionate monitoring of service quality;
  • Timely and effective intervention when service quality is failing;
  • Clear framework of reporting and accountability.

This policy is not a high level overarching Care Governance Strategy across Adult Social Care. It is a practical and operational framework for the management of quality across all social care services on the ground.

This framework covers all adult social care services including both in house and externally contracted services. This includes social care services delivered within Section 75 arrangements and transitional care services.

This framework does not cover:

  • Non-adult social care services, for example services provided through the Children’s Services or the Supporting People team.

The framework has two key sections within it:

The section that deals with individual services (Section B: Monitoring and Intervention in Individual Services) has been divided into 5 sub sections:

  • Preventive / social support type services;
  • Regulated social care services (in city);
  • Direct Payments;
  • Out of city services;
  • Assessment services.

The divisions identified above and the different operational approach to care governance are linked to differences in the:

  • Needs of the people using services;
  • Level of involvement of social care assessment and contract teams;
  • Contractual arrangements;
  • Breadth and depth of information available regarding services;
  • Degree of choice and control people choose to exercise in the delivery of their care.


2. What is the Framework for the Operation of Care Governance?

The governance framework for social care services is set out visually in Appendix 1: Care Governance Flowchart. The text below seeks to explain how this framework operates in practice.

Section A: Promoting Quality in Social Care

The following three paragraphs simply highlight the importance of Commissioning, Work Force Planning and Provider Quality Assurance systems as underpinning the delivery of good quality care. The detailed programme on delivery of these sits outside of this document.

The Commissioning of care underpins the whole Care Governance framework. Promoting quality in care services needs to be grounded in:

  • Commissioning strategies and actions;
  • Procurement processes;
  • Contract documentation and management that actively promote and support the delivery of services that are of good and sustainable quality.

A skilled, trained workforce able to deliver care to standards is another cornerstone of quality provision. Workforce Planning, Learning and Development Programmes and individual development plans are key ingredients in the delivery of such a workforce.

It is essential that service providers themselves take responsibility for the quality of their service and have effective systems in place to assure themselves of quality and drive forward improvement.

In addition to the broad areas identified above there are some more specific activities which directly relate to the support and promotion of quality in care:

  • A training and development programme managed and funded through the Council to support the independent sector and carers. The in house services also benefit from an in house training and development programme;
  • A Dignity Group for all residential care services and home care services which promotes best practice in delivering the Dignity in Care agenda;
  • Themed sector wide quality improvement programmes identified and managed through the Care Governance process and specifically the Promoting Quality in Care Panel. Where sector / service wide issues are emerging regarding quality a specific programme is developed with the sector to support improvement;
  • Support to services in developing and delivering service improvement plans;
  • Participation in national opportunities to promote quality such as the My Home Life project in care homes and the programme in 2013 to support dementia friendly environments in the health and care sector.

Provider forums which meet with Commissioning and Performance Team officers are well established. It is recognised that strong and healthy partnership arrangements are essential if we are to work together to ensure good quality services.

Section B: Monitoring and Intervention in Individual Services

Preventive / Low Level Social Support Type Services

These services are characterised by:

  1. People who are using the services are often not assessed and reviewed by social services; they may not meet the eligibility criteria for social care provision;
  2. Services do not provide any form of personal care and are never regulated by the Care Quality Commission;
  3. There are no individual specific care / support plans for service users that form part of the contract;
  4. Services are typically focused on advice, information, low level support, community support, support re employment or training;
  5. Services are provided through a service specific contract or letter of agreement which will include activity, cost and performance measures. They are often provided through the voluntary sector.

The quality and performance of the service is monitored through contract reviews. These are held as specified in the contract. The reviews are informed by performance data which is provided by the service provider. Where appropriate service providers will be required to obtain the views of service users which will inform the contract review.

Any information outside of the contract monitoring in 2 above will be included in the monitoring of the service (e.g. any whistle blowing or any direct contact from service users etc).

The decisions about action and intervention in relation to the quality of the specific service rest with the immediate Commissioner of the service.

Commissioners will report any significant or thematic issues through to the Care Governance Board.

Regulated Care Service for People with Eligible Needs in the City (Contracted and In House Provision)

The characteristics of these services are that:

  • Service users will have higher levels of care needs and this may include personal care;
  • Where the Council is contracting or where the service is provided in house the service user will have been assessed by the social care team, they will have a clear care plan and this will be individually reviewed each year;
  • Service providers that provide residential, nursing home, supported accommodation (where personal care is provided), shared lives, home care services (where personal care is provided) will all be regulated by and registered with Care Quality Commission;
  • There is a breadth and depth to the information about service quality and outcomes in relation to service users who the council contracts for. See Appendix 2: Service Provider Profile: Sources of Information for a detailed breakdown of information;
  • These services may have people who purchase the service privately. Information about service quality is more limited for this group of users;
  • The impact of service failure is significant for individuals and the social care system.

The approach to care governance is more complex in these areas of service which reflects the levels of risk and vulnerability and the range of information to be processed.

2.1 Information

The process as identified in the diagram at Appendix 1: Care Governance Flowchart starts with information. We need to gather and analyse information that will inform judgements and actions about the quality and safety of services. Our approach to information is informed by the following:

  • This information should be balanced and the views of users and their family are of particular importance;
  • Information requirements need to be balanced against the impact and capacity on those providing the information;
  • Any information gathered needs to used and in a timely manner;
  • The information needs to be of value in supporting Care Governance, Commissioning and service improvement;
  • We want to be consistent across services to support fairness and equity but recognise there is some scope for variation within this;
  • The process needs to be proportionate;
  • The ask once use often principle should be applied.

2.2 Service Provider Profiles

Information about services must be collated and analysed to be of real value. Whilst a single discrete piece of information maybe sufficient to indicate concerns about quality, it is the triangulation of evidence from a range of sources that will often identify concerns, enable risks to be analysed and inform action. This is particularly important in supporting our approach of identifying any concerns early on and intervening as soon as possible to improve quality and averting more intensive interventions after incidents have occurred.

There are a large number of services providers within the city and a limited capacity within the Commissioning Support Unit for monitoring. The information analysis needs to inform a risk based approach to actual service interventions.

To support the above approach to information the Commissioning and Performance Team; Quality function has developed a Service Improvement Panel (SIP) through which information about services can be rag rated (Red/Amber/Green) and processed to analyse the risks identified. Monthly SIP meetings are held to discuss these ratings (issues of concerns).

One element following the SIP meetings will include audits and inspection type activity by the Commissioning and Performance Team (CPT). However there is not the capacity to audit and inspect all services every year. There is therefore a two-way process at play, with the SIP informing priorities for audit and inspection and the audits themselves informing the SIP.

We will continue to work with Care Quality Commission and the Clinical Governance Group (CCG) to support improvements in the exchange of information between the three organisations. The CPT access all CQC compliance reports, have a list of the lead inspector for each regulated service, make ad hoc contact as required, hold monthly telephone conferences and meet quarterly with CQC and CCG staff. Some audit visits are in conjunction with CCG colleagues e.g. Nursing Homes.

2.3 Service Intervention

The analysis and monitoring linked to the SIP will inform actions that are taken in relation to specific services. The menu of interventions will include:

  • Contract Termination;
  • Suspension of Placements (see Appendix 3: Suspending Placements in Social Care Services for protocol);
  • Removal from preferred / approved provider lists;
  • Dedicated Improvement Plans;
  • Audit, Inspection;
  • Enhanced Monitoring;
  • Individual reviews of all residents;
  • Meetings with senior managers from the organisation.

There is clearly an inter-play in respect of the interventions and more than one maybe happening at the same time. Some are focused on gathering more information and monitoring, some involve taking action to restrict the service and some are focused on improvement. The actual nature of intervention will vary in each case and will be led by the welfare and safety of those people using the service. Where we are successful in identifying concerns early then the focus is more likely to be upon gathering further information, monitoring and improvement. Where intervention follows the identification of more serious concerns then restrictive action in relation to the service (for example suspending placements) maybe an immediate consequence followed by improvement planning and monitoring.

A policy in relation to announced and unannounced visits was agreed at the Care Governance Panel in July 2013, see Appendix 4: Announced and Unannounced Audit Visits.

The focus here is upon service interventions; as noted in Section 1, What do we mean by Care Governance and what does it cover? any safeguarding matters whether individual or more systemic will be taken through the Safeguarding Vulnerable Adults Procedures.

2.4 Improvement Plans

The context for Improvement Plans is that all services should have robust and effective quality assurance systems in place so that they can assure themselves of the quality of their provision. This is a contractual requirement.

Where significant concerns have emerged regarding quality that cannot simply be left within the providers quality assurance system a dedicated service improvement plan will be required by the Commissioning and Performance Team (CPT).

These improvement plans will be approved, monitored and signed off by the CPT. The Service Improvement Panel (SIP) will oversee this element of the care governance process and report into the Care Governance Panel.

The approval of improvement plans will be linked to how effectively the plans cover the concerns, that resources have been identified to deliver the improvements and that an acceptable timescales are in place. Sign off will be based on evidence of improvements and that this improvement can be sustained.

The SIP group meets monthly chaired by the Quality Lead. It will receive reports from quality monitoring officers on all services currently subject to improvement plans. All service intervention actions identified above will be managed through the SIP. A manager for the Access Point will attend this meeting to support information exchange and managing the interface between care governance and safeguarding. (Action and communication outside of the SIP process will be required and interventions do not wait for the SIP; the meeting provides a monthly overview).

2.5 Out of City Placements

People are placed out of city in services either because that is their choice or because there is a lack of provision in the city.

A protocol is in place when it is proposed to place someone outside of the city (see Appendix 5: Out Of City Placement Process For Under 65 Mental Health, Learning Disability, Older People And OPMH Care Homes Flowchart).

People placed outside the city will nearly always be in residential care, supported accommodation or shared lives schemes. These services are all regulated by CQC.

These people will always have been assessed by social care teams and will be reviewed at least annually.

Some of these people will be in specialist provision.

The information and intelligence available is more limited in these services. The services are not in the city, we may well have only 1 or two people placed in the service and the strength of our working relationship with the host local authority will vary.

The key strands for assessing the quality of the service are:

  • Individual service reviews of people placed;
  • Information from the host authorities Contract Unit / SVA team;
  • CQC compliance reviews;
  • Information from websites such as the good care guide and Social Care Institute of Excellence.

Opportunities to work with the service to improve quality are limited, apart from through individual reviews, and we are more reliant on the host local authority.

Currently the information identified in the bullet points above is only pulled together routinely and collectively at the point of placement. Any further analysis would be reactive, triggered by an individual service review, information from the host Council or a CQC compliance review.

Opportunities for a more structured protocol with our CPT colleagues in neighbouring Sussex authorities is being pursued. In the interim the CPT is identifying where the Council has significant number of placements in East and West Sussex Providers (currently 5+) and advising the review team of this with a view to collating responses from reviews and using this to engage in discussions with neighbouring Commissioning, Quality and Contracts Teams.

2.6 Direct Payments

The purchase of services through Direct Payments is a key element within the personalisation programme. Through direct payments people can exercise greater choice and control about the care they receive. The self reported outcomes for people who have elected to have their needs met through direct payments are more positive than those people who receive services through a more traditional route.

People using direct payments will have similar levels of need to those people who use care services through more traditional routes. However they will be purchasing services more flexibly and creatively; services that may not be regulated and may not be part of any contractual framework overseen by the Council. They maybe provided by individuals employed specifically by the service user, possibly friends or relations of the service user who will fulfil the role of Personal Assistant, others will be micro businesses.

The empowering of people to manage directly their own care needs also means a significant shift in the management of the quality of that care. The immediate ‘governance’ of quality rests with the individuals themselves. They will make decisions about whether the care is of an acceptable quality and they will have the authority to shift to another provider of care if they are not satisfied. They may do this without reference to the Council.

However the Council still retains a level of accountability regarding the quality of care provided through direct payments and does support an infrastructure to promote good quality in this sector of the care market.

To support good quality care in the Direct Payments sector of the market the council:

  • Has implemented a risk assessment policy and related processes to ensure that the decision to approve people accessing direct payments has been fully risk assessed;
  • Ensures that people receiving direct payments receive individual reviews of their care needs and the outcomes from their support plan through the Councils assessment team;
  • Funded a support service through a local voluntary agency for people using direct payments and who will be employing their own staff;
  • Supports a Peer Support Group for people who use direct payments;
  • Introduced the Support with Confidence scheme; this is an accreditation scheme that is a joint development between Adult Social Care and Trading Standards. It is based on the Trading Standards ‘Buy with Confidence’ scheme, which is currently in operation both locally and nationally. The aim of Support with Confidence is to give a degree of protection to individuals when they purchase non regulated care. In Brighton it will focus initially on Personal Assistants and it aims to grow the market and minimise risk to individuals who purchase their own support;
  • A Personal Assistant Noticeboard (the FED) is now available on the Federation of Disabled People’s website to enable employers to advertise their vacancies and personal assistants to list their details and availability to work. A launch event was held in October 2010 to promote this service;
  • Monitors Direct Payments users experience through the Annual Survey of service users;
  • Previously worked with the LINK to undertake a more qualitative survey of the experiences of people who use Direct payments;
  • The Care Governance Board has commissioned in 2011/12 an overarching report regarding Direct Payments which collated and analysed the available information;
  • In 2012 the Council invited a Peer Review to focus upon people who use direct payments from a safeguarding / care governance perspective. The outcomes from this review have been incorporated into the Safeguarding Board Action Plan for 2013.

2.7 Assessment Services

The governance of the quality of these services is managed directly through a performance compact between the Director of Adult Social Services and the Head of the Delivery Unit.

2.8 Provider Services

Regulated services, see Regulated Care Service for People with Eligible Needs in the City (Contracted and In House Provision).

Non regulated services are managed directly through a performance compact between the Director of Adult Social Services and the Head of the Delivery Unit. (This will also include regulated services).

2.9 Self Funders / Private payers

Some people will be assessed and receive care services but following financial assessment they will be paying the full cost of the service (self funders). Some people will purchase services direct without any direct contact with the Council and will pay for these services direct to the provider (private payers).

Information regarding the quality of care for people who paying privately for services that they have arranged themselves is more limited.

Private payers and self funders will receive the same service as council funded service users in relation to the safeguarding concerns. Where concerns about the quality of a service emerge then self funders and private payers will also benefit from any improvement action in relation to that service. Equally any broad sector wide programme or initiative aimed improving quality will benefit these groups of service users.

Where services are regulated the role of CQC will be no different whether services are publically or privately funded.

However information about the quality of care in relation to private payers is more limited and this will impact on the Care Governance of services which are primarily utilised by private payers.

In 2012 the Care Governance Board commissioned an internal report on care governance in relation to self funders.

The Care Bill is likely to place additional responsibilities on Councils in relation to self funders / private payers and these will need to be considered within the implementation plan for the legislation.

2.10 Reporting Framework Care Governance Board

The Care Governance Board will:

  • Oversee the overall Care Governance framework;
  • Set priorities and identify resources to deliver these;
  • Approve all new or revised policy and procedures that relate to Care Governance;
  • Receive quarterly reports from:
    • Service Improvement Panel (Care Governance report);
    • Care Quality Improvement Group.
  • Terms of Reference are in Appendix 6: Care Governance Board Terms of Reference.

The Care Governance Board will meet three monthly.

The Care Governance Board will be chaired by the DASS and membership will include, Executive Councillor for Adult Social Care, Heads of Commissioning, Heads of Commissioning and Performance Team Quality Lead, Head of Assessment Delivery Arm, Head of Safeguarding, Healthwatch rep, Director of Quality CCG Brighton & Hove, Head of Workforce Planning.

The Care Governance Board will provide reports into Cabinet Members Meetings, Joint Commissioning Board, Scrutiny Committee and Safeguarding Board as required.

The DASS also chairs the Multi-Agency Safeguarding Vulnerable Adults Board and this provides an important connectivity between the two Boards.

2.11 Service Improvement Panel

The Panel will oversee the monitoring of all individual services, service interventions, improvement plans and the Service Improvement Panel.

It will feed key themes in relation to quality into the CGB and the Care Quality Improvement Group.

It will report into the CGB regarding activity, improvement plans and service interventions.

The SIP will meet monthly. It will be chaired by the Head of Commissioning and Performance Team and key membership will be staff directly involved in monitoring and service intervention plus an operational manager from the Access Point. CCG officers have an open invitation linked to the agenda.

The Terms of Reference are in Appendix 7: Service Improvement Panel Terms of Reference.

2.12 Care Quality Improvement Group

This panel will oversee and co-ordinate all activity across the care sector which is focused upon the active promotion of service quality.

The panel will report into the CGB.

The panel will be chaired by the Care Standards Officer.

Terms of Reference and member ship are in Appendix 8: Care Quality Improvement Group Terms of Reference.


Appendix 1: Care Governance Flowchart

Click here to view the Care Governance Flowchart


Appendix 2: Service Provider Profile: Sources of Information

  1. Care Quality Commission:
    1. We will continue to use CQC Inspection Reports and judgements for as long as these are deemed to have validity;
    2. CQC Compliance Reports;
    3. Ad hoc contact with CQC Inspectors;
    4. Quarterly meetings with CQC and CCG (also telephone calls monthly);
    5. Ratings scheme which is being considered as part of the Care Bill.
  2. Service User / Carers Feedback:
    1. Request copies of annual user surveys from providers and action taken;
    2. Reports from Impetus interviews with service users; currently only covers homecare and community meals;
    3. Develop current arrangements for facilitating feedback from relatives;
    4. Annual ASCOF Surveys;
    5. Interviews with services users and their families as part of any audit work undertaken.
  3. Reviewing Officers:
    1. Reviewing Officers are encouraged to provide structured feedback on service quality aggregated up from individual service users reviews.
  4. Complaints / Plaudits:
    1. Monitoring of providers complaints process and log as part of Audit;
    2. Reports from Corporate Standards and Complaints Unit re complaints that have come in through council route;
    3. Information from Ombudsman’s Office re any involvement.
  5. Health and Safety:
    1. Fire Safety Reports;
    2. CHAS Reports;
    3. Incident Reporting;
    4. Food Hygiene.
  6. Clinical Review Nurse (Nursing Homes only):
    1. Structured audits and reports on clinical standards and progress against improvement plans.
  7. Safeguarding Vulnerable Alerts:
    1. Number of alerts;
    2. Level of alerts;
    3. Resolution / outcomes from alerts.
  8. Information from Healthwatch;
  9. Feedback from relatives and friends.


Appendix 3: Suspending Placements in Social Care Services

  1. The decision to suspend new placements in any service will always have the safety and welfare of people who use services at its heart and this will be paramount in all decision making;
  2. The decision to suspend is delegated to the Head of Commissioning and Performance Team (Adult Social Care) who will consult with the Head of the Assessment Delivery Arm. In their absence the Head of CPT or the Director of Adult Social Care will take the decision;
  3. The decision making on this matter will be undertaken on a level playing field across all services including in house provision and block contracts;
  4. The decision to suspend placements will be made on a case by case basis and will always be a matter of judgement;
  5. The following are some of the factors that will influence decision making (always acknowledging point 1 above):
    1. The outcome of CQC Compliance Reviews in services that are regulated. Particular weight will be given to circumstances where the CQC have identified 3 or more major concerns as part of their compliance monitoring and which have a direct impact on the safety and wellbeing of service users;
    2. A Safeguarding Case Conference identifies suspension as an important element of a protection plan;
    3. The Clinical Quality Review Nurse rates a Nursing Home to be poor in relation to clinical care;
    4. The cumulative weight of evidence that is gathered over time through the Care Governance Process linked to the severity and pattern and trend of concerns;
    5. The level of confidence in the service provider to deliver timely and sustained improvements;
    6. Serious concerns about the financial viability of the service provider such that further placements may place potential residents at serious risk of uncertainty and change in the provision of care.
  6. Where appropriate the suspension of placements maybe limited in its scope to some certain types of placement;
  7. Evidence regarding poor quality in care will be communicated with service providers at all times as early and as fully as possible. This should support providers taking early action in relation to concerns and avert the level of concern escalating to the point where new placements are suspended. Where the intention is to suspend from making new placements the evidence behind this will be shared as fully as possible with providers. However there maybe occasions particularly in relation to complex safeguarding investigations where the Council cannot share all the information it has to hand at the point of suspension;
  8. The decision to suspend from making new placements will be formally communicated to providers in writing;
  9. Service providers will be requested to produce an improvement plan which will be approved by, and monitored by the Commissioning and Performance Team; Quality function and through the Care Governance Framework. The suspension will be lifted once sustainable improvements are evidenced such that the quality of care and safety of residents can be assured. The care and safety of existing service users will be a key focus in relation to improvement planning;
  10. Where service providers are having difficulties in sustaining service quality this should be communicated to service users and their families alongside plans for improvement;
  11. The Council recognises the impact on providers when new placements are suspended particularly if this becomes prolonged. The Council will complete any outstanding investigations and monitor improvement plans in a timely manner. The Council will seek to support providers in developing improvement plans, linking them into training and quality assurance opportunities and highlight best practice examples where possible;
  12. There will be a right of appeal for providers and this will be to the Director of Adult Social Care, or in their absence the Head of Commissioning and Performance Team;
  13. The decision to suspend new placements and the lifting of this decision will be communicated to:
    1. The Head of Delivery (Assessment) so they can consider action in relation to those people currently using the service;
    2. The Head of Delivery (Provider) if this involves an in house service;
    3. Relevant Commissioners so they are aware of the issues and this intelligence informs their commissioning plans;
    4. The Care Matching Team;
    5. The Care Quality Commission in the context of the protocol on information between Councils and the CQC;
    6. The senior on call manager;
    7. Other Councils who are using the service;
    8. The public through public information sites;
    9. Access Point.


Appendix 4: Announced and Unannounced Audit Visits

CPT Policy

  1. Audit visits take place within the broader Care Governance Framework which has the following key elements:
    • Active promotion of good quality;
    • Robust and proportionate monitoring of service quality;
    • Timely and effective intervention when service quality is failing;
    • Clear framework of reporting and accountability.
  2. The purpose of these audits is to provide assurance about the quality, safety and contractual compliance of care services. The audits are informed by a range of intelligence that is collated on each provider and this will determine the extent and the focus of the audit;
  3. Audits are planned within a risk based programme but will also take place in response to immediate concerns outside of a planned programme;
  4. The contract in place with service providers for care homes and homecare enables the council to undertake both announced and unannounced audit visits. Historically the vast majority of visits are undertaken on an announced basis. This is replicated when in house provision is audited. In contrast the inspections undertaken by CQC are unannounced;
  5. This policy outlines the factors which would influence whether visits are announced or not;
  6. Announced visits:
    • Pros:
      • Ensures that managers and key staff can be on site;
      • Enables the service to plan its day so that service users / relatives are not inconvenienced and supported to participate;
      • Promote a partnership rather than an inspectorial one;
      • Enable the service to have evidence readily accessible;
      • Enable a more efficient use of everyone’s time;
      • Avoid abortive visits e.g. because most of the service users are out that day with staff;
      • Can be planned to ensure that within the visit the people, systems, care plans etc that are central to the audit are selected by the auditor themselves.
    • Cons:
      • Could enable a covert approach to audit from the service provider such that poor quality is not evident on the day of the visit
  7. Unannounced visits
    • Pros:
      • Do not allow the services to prepare for the visit in a covert manner;
      • Encourage services to ensure consistent quality on the basis an auditor could turn up at any time.
    • Cons:
      • Can be disruptive for people using the services;
      • May not allow full examination of available evidence;
      • Does not promote a partnership approach.
  8. A further option is to undertake audits at short notice, similar to Ofsted’s approach to school inspections. Owners are advised that an audit will take place but with only 1 or 2 days notice or within a given period of time, for example a 1 week window;
  9. In planning audit visits CSU staff will take account of all the factors in deciding whether it is more appropriate to visit announced or unannounced including the options identified in 8 above. This will include:
    • Nature and level of concern;
    • The providers past history of working with the CPT and commitment to improvement;
    • The likely benefits of undertaking an announced or unannounced visit in relation to assurance provided.


Appendix 5: Out Of City Placement Process For Under 65 Mental Health, Learning Disability, Older People And OPMH Care Homes Flowchart

Click here to view the Out Of City Placement Process For Under 65 Mental Health, Learning Disability, Older People And OPMH Care Homes Flowchart


Appendix 6: Care Governance Board Terms of Reference

  1. To provide strategic leadership across the Care Governance system;
  2. To ensure that clear arrangements are in place regarding accountability, monitoring and action in relation to service quality;
  3. To ensure that the resources available to promote good quality in care are co-ordinated, targeted and the outcomes measured;
  4. To promote the principles of care governance as core organisational values;
  5. To set priorities and target resources within the Care Governance system;
  6. To receive regular reports from the Service Improvement Panel and Promoting Quality in Care Panel;
  7. To inform the Safeguarding Adults Prevention Strategy.


Appendix 7: Service Improvement Panel Terms of Reference

  1. To co-ordinate and review the information available regarding the quality of social care services;
  2. To identify services where concerns regarding quality are evidenced and take appropriate action at the earliest opportunity;
  3. To ensure robust improvement planning and that these plans are delivered in a timely manner;
  4. To support the delivery of improvement plans by linking providers into local programmes that support quality improvement;
  5. To recommend enforcement action in relation to contracted services as appropriate;
  6. To establish priorities in relation to available capacity;
  7. To report emerging themes re service quality into the broader Care Governance process;
  8. To report into the Care Governance Board;
  9. The Services covered by the SIP are as identified in the Care Governance Guidance.


Appendix 8: Care Quality Improvement Group Terms of Reference

The overall aim of the group is to improve care quality across Brighton & Hove, by working out what the quality issues are and what to do about them.

The group aim to make a real difference to peoples experiences of care in a positive way, help providers of services where they are struggling and reduce the number of quality and safeguarding concerns which arise.

The group will:

  1. Share intelligence about quality issues from a variety of sources;
  2. Identify themes needing improvement;
  3. Identify areas where more than one service is struggling and help decide what may be needed to assist quality in that area;
  4. It will co-ordinate and prioritise improvement activity relating to the themes;
  5. Review progress in improvement areas;
  6. Inform the Commissioning of Services;
  7. Inform Workforce and workforce development strategy;
  8. Agree best practice;
  9. Group to consider all social care services, including assessment, and services for self funders, and users with direct payments, as necessary;
  10. The group needs to be able to engage, stimulate and utilise providers own motivation towards achieving best practice and quality;
  11. Blocks to achieving best practice to be referred up to the Care Governance Board;
  12. Group to link into the contractual processes via contract Managers;
  13. Issues with individual services will not be discussed in detail at this group;
  14. Individual issues will be addressed outside this group but recurring themes across services will be considered;
  15. Report back to the main Care Governance Board;
  16. Agreed to report and receive regular feedback from each existing provider forums.

End