Agenda Item No. 4
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 16th April, 2018
Report of the Director of Social Services
Response to the Older People's Commissioner for Wales - Follow-up to Care Home Review
Purpose of the Report
- To provide Scrutiny Committee with oversight of the Directorate's response to the Older People's Commissioner for Wales following her follow-up to publication A Place to Call Home; Care Home Review.
- That the Scrutiny Committee notes the role of the Commissioner.
- That Scrutiny Committee notes the Vale of Glamorgan Council's response to Reviews undertaken by the Commissioner.
Reasons for the Recommendations
- To ensure that Members continue to exercise effective oversight of important functions undertaken by the Social Services Directorate.
- To brief Members about the action points raised by the Commissioner in her report "A Place to Call Home? - A Review into the Quality of Life and Care of Older People living in Care Homes in Wales", published in November 2014, and follow-up A Place to Call Home; Impact and Analysis published in January 2018, and the Council's response.
- The Older People's Commissioner for Wales, Sarah Rochira, is an independent voice and champion for older people across Wales. The Commissioner has legal powers to review the adequacy and effectiveness of law, policy and strategy affecting the interests of older people in Wales.
- The Commissioner's role and statutory powers are defined by the Commissioner for Older People (Wales) Act 2006 and accompanying Regulations. The Commissioner must ensure that:
- Older people in Wales are made aware of the existence and functions of the Commissioner's office.
- Older people in Wales are made aware of the location of the Commissioner's office or offices and the ways in which they may communicate with the Commissioner and her staff.
- Older people are encouraged to communicate with the Commissioner and her staff.
- The views of older people are sought as to how the Commissioner should exercise her functions and as to the content of the Commissioner's annual work programme.
- The Commissioner and her staff make themselves available to such older people in the older person's locality.
Relevant Issues and Options
- Using her powers under the Act, the Commissioner undertook a formal review into the quality of life and care of older people in residential care in Wales. The Report, "A Place to Call Home? - A Review into the Quality of Life and Care of Older People living in Care Homes in Wales" was published in November 2014. She concluded that: "Too many older people living in care homes in Wales have an unacceptable quality of life". The key findings were grouped under four headings: day-to-day life; health and wellbeing; people and leadership; and commissioning, regulation and inspection.
- The Commissioner wrote to all Local Authorities in Wales, outlining requirements for action. The letter to the Vale of Glamorgan included cross-cutting themes and also specific observations relating to the Council's own Part 3 care homes. The Council prepared two responses for the Commissioner's consideration and these are attached at Appendices 1 and 2 (January 2015 and May 2015). The Commissioner responded to our proposed action plan, stating:
"Your response clearly demonstrates a commitment to delivering the change required that I outlined in my Care Home Review and clearly details action you have in place or will take to deliver the intended outcomes. Your organisation has proposed the proactive development of new services or processes which have the potential to progress as best practice. I am therefore satisfied that your organisation is already complying with the majority of my Requirements of Action or is committed to taking the action necessary to deliver the required change".
- The Older People's Commissioner wrote to the Council requesting a progress report in January 2017, and a follow-up report was provided outlining evidence in March 2017 responding to the areas she required evidence of progress. This response is at Appendix 3 for context.
- Further correspondence was then received in January 2018, when the Commissioner wrote to the Managing Director (Appendix 4) commenting on the evidence provided last year, and sharing a publication: A Place to call Home: Impact and Analysis, a copy of which is attached at Appendix 5. She advised that of four Requirements for Action she made the following observations referenced at Appendix 6, with our responses also highlighted in the report:
Requirement for Action 2.2 - Older People in Care homes have access to specialist services and, where appropriate, multidisciplinary care that is designed to support rehabilitation after a period of ill-health- Borderline.
Requirement for Action 3.2 - All care home employees undertake basic dementia training as part of their induction and all care staff and Care Home Managers undertake further dementia training on an ongoing basis as part of their skills and competency development, with this a specific element of supervision and performance assessment - Sufficient
Requirement for Action 3.3 - Active steps should be taken to encourage the use of befriending schemes within care homes, including intergenerational projects, and support residents to retain existing friendships. This must include ensuring continued access to faith based support and to specific cultural communities - Insufficient.
Requirement for Action 6.2 - Care home providers, commissioners and CSSIW, should develop informal and systematic ways in which to ensure they better understand the quality of life of older people, through listening to them directly (outside of formal complaints) and ensuring issues they raise are acted upon - Insufficient.
Annual reporting should be undertaken of how on-going feedback from older people has been used to drive continuous improvement. - Sufficient.
- We believe we have been able to evidence progress against the Commissioner's areas of concern, demonstrating that we have continued to deliver quality services despite the challenges related to cost pressures and increasing complexity of the residents supported within residential care homes, both council run and also within the independent sector. This is highlighted in our response at Appendix 6 which outlines the current position following a significant journey with the Older People's Commissioner in relation to her aim to improve the quality of life and care of older people living in care home in Wales.
- The Vale Community Resource Service (VCRS) continues to support care homes through falls prevention and ongoing dialogue to support residential care staff in the care of their residents who may require therapeutic input.
- The reablement unit, 'The Bay' accommodated within Ty Dyfan residential home continues to be a valued service. We provide ongoing promotion of the service to ward staff to support people in their endeavours to regain their independence following a period of ill health. The aim is for people to return to their own home within a six week period with either no ongoing care or minimal care support.
- Our response (Appendix 6) also highlights some joint events that have happened across all residential homes within the Vale of Glamorgan. This includes a Tea Dance in July, 2017, a Christmas event and current planning for an Easter event. Additionally, residents at College Fields Care Home were supported to access and enjoy skating at Winter Wonderland in Cardiff over the festive period.
- The response to the four requirements for action has been returned to the Commissioner on 16th March outlining the actions taken by the Vale of Glamorgan Council. Details of our response are located at Appendix 6, with the corresponding evidence that supported our claims at Appendices 6a, 6b, 6c, 6d and 6e. We await further correspondence from her in relation to this.
- As a Region we have been clear regarding our collective commitment to ongoing improvement of care within our care homes. The Regional Safeguarding Adult Board (RSAB) has requested sight of each of the statutory partners' responses to the Commissioner's review - Cardiff Council, Cardiff and Vale UHB and Vale of Glamorgan Council. Each organisation's response is due to be presented at the next full Board, scheduled for 15th May, 2018. Following this we will be clear as to any Regional actions required. We have proposed to the Commissioner that we will prepare a Regional Action Plan to be monitored through the RSAB if Board members feel that this is required and appropriate.
Resource Implications (Financial and Employment)
- There are no direct resource implications as a consequence of this report. However, there are significant cost pressures for the Council associated with demographic factors and changes in government policies, including the introduction of the new National Living Wage. This will have an impact upon the rates for care services that the Council will need to set as a commissioner of independent care provision.
- In recognition of the need to further develop our services, we have submitted bids to the Integrated Care Fund capital programme to complete work on two of our homes (Southway and Ty Dewi Sant) to ensure that they are dementia friendly in their décor and layout. We hope to find out the conclusion of this bid by the end of April. A further component of the capital bid is to develop a three bed unit within our Southway home in Cowbridge to support people to remain in the home during a period of assessment, negating the need for hospital admission for assessment and lessening the impact by not disturbing them from familiar surroundings and continuity of staffing. We hope that we will be successful in a revenue bid in the future to staff this unit as we would need access to health staff to support this function as it would be above the remit of social care.
Sustainability and Climate Change Implications
- Effective delivery of commissioning responsibilities helps to ensure that the Council's assets are managed efficiently and effectively. It also helps to ensure that best use is made of the resources available for social care services, establishing sustainable models of assistance and support as well as contributing to the most appropriate ways of meeting the needs of vulnerable people.
- There are no climate change implications as a direct result of this Report.
Legal Implications (to Include Human Rights Implications)
- The Regulation and Inspection of Social Care (Wales) Act 2016 received Royal Assent in January 2016. Implementation will have a considerable impact upon the provision and commissioning of care services, especially when new areas of the social care workforce such as residential and domiciliary care staff become regulated.
- Part 1 of the "Commissioning Framework and Good Practice guidance" is issued under Section 7(1) of the Local Authority Social Services Act 1970 and it provides standards with which Local Authorities are expected to comply. Commissioning practice should not place constraints on people's statutory rights to have their need for social care met by the services which the Council makes available under the relevant legislation. Legal Services are consulted in respect of issues in respect of commissioning and/or de-commissioning decisions.
- The Commissioner for Older People (Wales) Act 2006 and the Commissioner for Older People in Wales Regulations outline the role and remit of the Commissioner. The Act outlines the action that the Commissioner is able to take to ensure that the interests of older people are safeguarded and promoted when public bodies discharge their functions and also the assistance that the Commissioner may provide directly to older people in certain situations.
Crime and Disorder Implications
- There are no direct crime and disorder implications as the result of this report. However, should there be issues identified in reviewing care homes, both within Council run homes and the independent sector, the necessary actions to consider any potential criminal offences would be considered in conjunction with South Wales Police, in line with the Protection of Vulnerable Adults procedures.
Equal Opportunities Implications (to include Welsh Language issues)
- Commissioning of care services has to ensure that they are accessible to all those eligible to receive them and this will require Equalities Impact Assessments to be carried out, where appropriate.
- Under Section 7 of Social Services and Well-being (Wales) Act 2014, a person exercising functions under this Act in relation to an adult falling within section 6(1)(a) or (b) must have due regard to the United Nations Principles for Older Persons adopted by the General Assembly of the United Nations on 16 December 1991.
- The work outlined in this report addresses the following corporate objectives outlined in the Corporate Plan 2016-2020:
Wellbeing Outcome 1: An Inclusive and Safer Vale
Objective 2: Providing decent homes and safe communities
Provide appropriate accommodation and support services for particular vulnerable groups.
Wellbeing Outcome 2: An environmentally responsible and prosperous Vale
Objective 4: Promoting sustainable development and protect our environment
Improve access to public transport for people aged 60+ by promoting and increasing take up of Welsh Government Concessionary Travel Schemes.
Wellbeing Outcome 4: An Active and Healthy Vale
Objective 8: Safeguarding those who are vulnerable and promote independent living.
Policy Framework and Budget
- This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
- The issue relates to all areas supported by the Vale of Glamorgan Council and so there has been no individual ward consultation in relation to this matter.
Relevant Scrutiny Committee
- Healthy Living and Social Care.
Scrutiny Committee 13th June 2016 - Older People's Commissioner for Wales - Introduction
Suzanne Clifton, Head of Adults Services
Corporate Management Team
Lance Carver, Director of Social Services