Service Specification for Specialist Residential - Care

SERVICE SPECIFICATION

FOR THE PURCHASE OF

Specialist Dementia Residential CareProvision of residential care on permanent or short stay basis (respite or transitional) for people with a diagnosis of severe or

moderate dementia

Dated: 1st Day Of July 2009

framework/demrescarespec/j1jul09/updated 1

ADULT HEALTH & COMMUNITY SERVICES DIRECTORATE

Adult Commissioning Unit

1.. HIGH LEVEL SERVICE OUTCOMES AND OBJECTIVES

1.1. Specialist Dementia Residential Care

The overall purpose of the specialist service is scheme is to provide safe and secure accommodation for Older People with a diagnosis of moderate or severe dementia in an environment that is homely and where people have control over their own life, personal space, privacy and security.

1.2. Service Provision that:

1. Promotes independence and delivers the ongoing care and supports the needs of its residents.2Contributes to supporting people to stay healthier and recover quicker from illness or accident, reduce the likelihood of admission to hospital or long term nursing care and facilitate timely hospital discharge.3. Enables through effective early care planning for a person to die with dignity, pain free and in a way that meets their identified spiritual, religious and cultural needs.

2 CARE SPECIFICATION

2.1 Philosophy and Core Principles

5 Principles that apply for mainstream care will also apply to dementia care and these are:

Person centred care: Care is to be provided in a manner that meets the identified needs of each individual resident. This is best achieved through an individual care plan, which recognises individual ethnic, religious, cultural and social needs and the characteristics of residents.

Choice and independence: Care should be provided in a manner that promotes and encourages residents’ independence and the enhancement of their individual rights. This includes choice about activities of daily living and access to activities that present reasonable risk.

Dignity and respect: Care is to be provided in a manner that offers privacy, respect and dignity to each individual resident both in life and in death.

Consultation: No decisions about the care provided to a resident should be made without their full participation and agreement, and where appropriate, the full participation and agreement of their family/carer/supporters. Where there is no family member/ supporter/carer, consideration should be given to an appropriate person from outside the home advocating on their behalf.


Participation: Residents should be encouraged to participate in activities of daily living and social activities within the home and the wider community in accordance with their interests and abilities.

2.2 Characteristics of good quality dementia care

In order to meet these principles of care, dementia care homes need to have in place a suitable set of conditions. These conditions will be supported by a local specific dementia strategy, which will form the basis of the homes management and care of people in their care. The strategy will be led by a senior member of staff and will, as key to its delivery, ensure that:

Staff have an appropriate level of understanding and training about dementia, effects of dementia and strategies and techniques to communicate with and provide care for people with dementia, this includes end of life care planning through advanced directives/advanced care planning.

Staff are supported in their care task by good leadership, staff management, staff training and development and person centred care planning.

The home reflects the type of environment that is appropriate for people who have dementia, has purposeful activities that relate to individual preferences rather than general entertainment, and establish strong links with and involvement in local communities.

Partnership working with voluntary and specialist agencies has been established to assist the home to cater for changing emotional, cognitive and physical health needs of its residents.

There is close working with family and/or informal carers to both understand the unique personality and life experience of the resident and what their care needs are and also to allow the family to continue to participate, if they wish, in the care of their loved one.

There is a nominated dementia Champion/leader who will take responsibility for improving quality and ensuring that people have access to a range of social activities that may involve their families.

There is a regular review at least every six months of the persons physical and mental health to ensure the care provided is appropriate.

There is a policy in place agreed with the commissioner on the use of anti-psychotic drugs, their review and the removal of those drugs when appropriate. Staffing and design should promote the avoidance of the use of anti psychotic drugs.


2.3.2. Outcomes and Key Performance Indicators (KPIs)

2.3.2.1. The Service outcomes are based on promoting independence, the delivery of ongoing care and support, avoidance of admission to hospital or nursing accommodation, and good quality well co-ordinated end of life care:

Service Level OutcomesA service that can:

1. Promote independence and deliver the ongoing care and support needs of its residents. 2. Contribute to supporting people to stay healthier and recover quicker from illness or accident, reduce the likelihood of admission to hospital or long term nursing care and facilitate timely hospital discharge.

Measurement Framework for Outcome One

Deliver the ongoing care and support needs of its residents through a localised dementia strategy for the home

Individual Outcome Measures Methodologya. Improved lives of

people residing in the home with a diagnosis of dementia

Development of dementia specific strategy for the management and care of people in the home to include key characteristics as listed at 2.2

Provider strategy and pathway measurement

Provider records, Customers filesConsultation with users and carer

Measurement Framework for Outcome Two

Promote independence and deliver the ongoing care and support needs of its residents through a defined dementia care pathwayIndividual Outcome Measures Methodologya. Ongoing

improvement, maintenance or minimised deterioration in ability to undertake daily living functions

% of Customers whose ability to undertake a daily living function has improved since receiving the Service.

% of Customers

Provider strategy and pathway measurement

Activities of Daily Living (ADL) assessment / assisted assessment via discussion


whose ability to undertake a daily living function has been maintained since receiving the Service.

Provider records, Customers files

b. Ongoing improvement, maintenance or minimised deterioration in ability to self care

% of Customers whose ability to self care has continued to improve since receiving the Service.

% of Customers whose ability to undertake self care has been maintained since receiving the Service.

ADL assessment / assisted assessment via discussion


c. Ongoing improvement, maintenance or minimised deterioration in mobility function

% of Customers whose mobility has continued to improve since receiving the Service.

% of Customers whose mobility has been maintained since receiving the Service.



d. Ongoing improvement, maintenance or minimised deterioration in confidence and independence

% of Customers whose wellbeing, confidence and independence has continued to improve since receiving the Service.




% of Customers whose wellbeing, confidence and independence has been maintained since receiving the Service.

e. Ongoing improvement, maintenance or minimised deterioration in health – both physical and mental health

% of Customers whose health – both physical and mental health has continued to improve since receiving the Service.

% of Customers whose health – both physical and mental health has been maintained since receiving the Service.



f. Continued involvement and support from family and Carers

% of family / Carers who undertake or contribute to the care of their family member who feel that they have been offered or given suitable support to care.

Self-assessment by Family/Carer / assisted assessment via discussion

Questionnaire/discussion

g. Reduced anxiety about ill health by

% of Customers who feel less anxious

Self-assessment / assisted assessment via


individual and their families

about their ill health.

% of family / Carers who feel that the Service has contributed to feeling less anxious about the ill health of their family member.

discussionQuestionnaire/discussion

Measurement Framework for Outcome ThreeEnsure people have good end of life care.

Individual Outcome Measures Methodologya. Management of Pain and distress

No. of Customers with advanced care plan or advance directiveNo. of supportive services available

Person is registered and reviewed by GP as Palliative care patient

Quantitative data collection

Discussion with family/supporter

Discussion with GP

Sight of palliative care reviews and register where appropriate.

b. Meeting a persons cultural, spiritual and religious needs

No. of Customers linked to their preferred cultural or religious services

Discussion with family/supporter

Discussion with GP


Service Specifications

This Service Specification sets out the commissioning requirements for Warwickshire County Council (WCC) when procuring residential care for people suffering from dementia and is set out as follows:

1. High Level Service Outcomes and Objectives

2. Care Specification

3. Service Description

4. Service Management

5. Service Delivery

6. Positive Interventions in Care Provision

7. Pre-admission and Discharge

8. Staff and Recruitment

9. Equipment, Facilities and Environment

10. Contract Monitoring

It is expected that all the criteria for the registration for the home will and are being met.


3. SERVICE DESCRIPTION

3.1The service will provide 24-hour specialist dementia care for people with a diagnosis of moderate or severe dementia. This includes Permanent and Short Stay Residential Care.

3.2The service will be provided in an environment that is homely and where people have control over their own life, personal space, privacy and security. The environment is expected to comply with dementia specific environmental standards.

3.3Customers will be helped to exercise choice and control over daily aspects of living such as food and clothing.

3.4Care Staff will regularly monitor and review the emotional, cognitive and physical health of the customer to ensure that appropriate care and services are provided.

3.5Customers should be able to have visitors at any reasonable time and if informal carers wish to be involved in personal care, this should be supported.

3.6All efforts should be made to understand and actively communicate with the service user, using good practice as appropriate. High importance will be given to communication and social interaction.

3.7The Customer will be helped to engage in everyday activities of daily living such as helping with gardening, laundry and domestic chores.

3.8Access to social activities outside the Home will be facilitated by the service provider.

3.9The provider should have effective mechanisms for liaising with other agencies to ensure that assessment of need and allocation of service provision results in the best achievable outcomes for the Customer.

The list of agencies can include:

Older People Community Mental Health Team Social Care Advocacy (Mental Health Act and Mental Capacity Act) Primary Health Care Teams Specialist Health Services Admiral Nurses Voluntary organisations such as Guidepost etc Mental Health Liaison Workers Spiritual, cultural and religious services


4. SERVICE MANAGEMENT

4.1 The service will be provided within a framework of:

Effective Leadership Quality Assurance Systems Staffing and role allocation Key Information and reporting

4.2 Effective leadership

4.2.1 The Manager of the Home will be a registered CQC manager within 6 months of their appointment with the company and will have both a management qualification and at least 2 years experience of managing dementia specific services.

4.2.2 Effective leadership should be demonstrated through:

Clear understanding of the principles and practice of a person-centred approach

Formal qualifications including accredited dementia specific qualifications

Adequate training to support procedure Robust operational procedures Effective development of policies that support service delivery

4.3 Quality Assurance Systems

Quality Assurance system should confirm that:

Policies are developed and disseminated to staff Policies and procedures are adhered to by staff Complaints are recorded and followed up Continuous improvement in service development and delivery take

place

4.4 Staffing and Role allocation

4.4.1 Registered Manager is responsible for ensuring that all contractual requirements are met, including:

Safeguarding key information and reporting (section 4.5) Care planning and quality of provision (sections 5 and 6) Procedures around pre-admission and discharge are adhered to

(section 7) Staff recruitment and training (section 8) Equipment, facilities and environment (section 9)


4.4.2 Staffing levels should adequately meet the level of need at any given time including Waking Night staff.

4.4.3 Each Customer should be assigned a key worker within the service who is responsible for both liaising and linking with family, completing a life storybook and ensuring that the care plan is met.

4.5 Key Information and reporting

4.5.1 Significant Event

Hospital Admission Temporary move or permanent discharge from contracted Home Serious illness/injury Death Lost or missing

These will be will be reported to the council’s contract monitoring team immediately by telephone (and followed up by written confirmation within 24hours). They will also be reported to the carer where one has been identified.

4.5.2 Safeguarding issues which include financial or physical abuse or

Deprivation of Liberty (DOLS) will in addition be reported to the safeguarding team. Where mental capacity is a concern, a mental capacity advocate will be contacted.

4.5.3 For both significant events and safeguarding issues, contact with relatives must be recorded including attempted contact. Details recorded will be

Time Date Name of relative spoken to Name of worker who made contact with relative

4.5.4 In the event of a major incident where the ongoing delivery of care to the Customers may be interrupted, the provider will notify the Council’s contract monitoring team within 24 hours. Major incidents include:

Fire Flood Disruption to power, heating and lighting Infection outbreak Major staffing disruptions Any loss of money or property Any circumstance where the Customer is in need of medical

attention but refuses to seek medical help.


4.5.5 The provider will notify the Council’s contract monitoring team within one month should the registered manager leave with details of interim arrangements. (See 4.2.1 for reporting appointment of new manager), any interim position must have accredited suitable dementia experience.

4.5.6 The Provider will ensure that all information including policies and procedures relating to the service is available to people who use services and Carers in a format that is acceptable and accessible to them. This may include policies relating to money-management, confidentiality, abuse if not included in other guidance.

4.5.7 The Care Home will make staff policies and procedures available for inspection by the County Council on request. This should include the following but can include others:

4.5.7.1 Medications policy which must comply with the standards set out by Care Quality Commission. Where appropriate every opportunity to access dementia specific medication should be sought. Excess medication should not be used to subdue or restrain individuals without the express permission of the Consultant and family. If anti psychotic medication is used it must only be with a consultants agreement, be reviewed within 6 weeks of prescribing and only be a drug recognised by NICE as suitable for Dementia patients.

The home should have a medication policy and all staff who administers medication should be adequately trained in both medication dispensing and dementia care clients, to do so

Appropriate medication should be administered for physical conditions and pain relief

Medication should not be used as a behaviour management method and where appropriate advice should be sought from informal carers and/or specialist agencies such as the Community Mental Health Team.

4.5.7.2 Complaints policy which stipulates that when a complaint is made against the provider, it will be recorded and investigated. If and when the complaint is escalated the provider must record every interaction with the complainant and or their advocate/family including telephone calls made and any verbal or written interactions. This information to be made available to the contract monitoring team on request.

4.5.7.3 Handling of money The provider must ensure that only minimal amounts of money is handled e.g. under £50 on behalf of the Customer. No staff member of associate must have Power of Attorney (POA)

4.5.8 Customers and Carers must be given written information onthe facilities and services in place in a format that is understandable and acceptable.


4.5.9 The provider will not offer advice on financial matters. A referral should be made to the Advocacy Service if no relative is appointee.

5. SERVICE DELIVERY

5.1 All care shall be person-centred and based around appropriate assessments and a tailored care plan. Care planning should reflect not only previous needs but those that might arise with increasing age and progression of the dementia.

5.2 Informal Carers or advocates will be involved in the assessment and planning process and should have access to all information available to enable them to make an informed choice about the placement.

5.3 All prospective customers at the point of referral will have a specialist Mental Health assessment. Where possible, this will be at the person’s own home and will cover:

Medication needs Mental Capacity Act assessment where appropriate Key professionals Frequency of reviews Cost of package Potential care needs Family involvement End of life Advanced directive where appropriate

5.4The Carer and Customer will be offered the opportunity to prepare the room allocated to the Customer in a way that will help the Customer to settle in and feel more at home using familiar and personal items belonging to the Customer.

5.5The provider may not transfer customers from a private room to a shared room without first consulting the social work team, Customer, their family and advocate or broker and getting agreement in written form.


5.6The Customer will have a detailed assessment of their needs within 1 (one) week of taking up service. This will be agreed with Customer and carer or appointed advocate and will include:

Goals of the service user based on what they can do not what they can’t.

Named key worker and personal contact (family carer or advocate)

The Care Plan to include: Self care capabilitiesNutritional screening Meaningful opportunities for engagement and activityNeed for aids and adaptations and Assistive Technology

Timetable for review and who involved Where the resident will live Management of risk End of Life care planning Family involvement in care

5.7 Implementation of care and services provided should be in accordance with needs outlined in the care plan. Where the Customer lacks capacity, a mental capacity advocate should be involved.

5.8Customers should be able to have visitors at any reasonable time and if informal cares wish to be involved in personal care, this should be supported and the care plan widened.

5.9Care staff will constantly monitor well and ill-being including pain, distress and other symptoms to ensure that Customers receive the care they need

5.10 Reviews of care plans should take place at agreed intervals and services adapted to take account of changing needs and risks. Carers should be involved where appropriate. These reviews will include medication reviews to ensure medication is appropriate. At no point will heavy medication be used without the permission of the family, or if no family, the relevant advocate.

5.11 All services provided should be in line with accepted best practice and the provider will keep up to date with development in this area through active research and attendance of training and events as appropriate.

6. POSITIVE INTERVENTIONS IN CARE PROVISION


6.1 Challenging Behaviour

6.1.1 The Manager and Care Staff must be aware of the contributory psychological and emotional factors that may initiate or perpetuate challenging behaviour and as such will:

provide the Customer and their family/carer/supporter with appropriate support, advice and encouragement in order to moderate or rectify any inappropriate or challenging behaviour

encourage and assist the Customer to communicate and express their choices and personal preferences and to take advantage of the opportunities which are available to them

encourage and support the Customer to remain or be more active in their own care and therefore less dependant on carers

seek help with behaviour that is likely to cause risk to others or put the placement at risk. Referrals should be made to CWPT older age psychology services for support and intervention

6.1.2 A risk assessment should be completed, and a written Support Plan will be formulated to manage inappropriate or challenging behaviour, liaising with other professionals as appropriate. The effectiveness of this should be measured not only around the reduction of challenging behaviour but also should include how people are engaged and how and who they spend their time with.

6.2 Nutrition

6.2.1 The home will encourage a positive mealtime experience for its Customers. Meals and drinks will be provided in accordance with preferences identified in the care plan.

6.2.2 Every effort will be made to ensure that a nutritious and balanced diet is provided through at least 2 (two) sit down hot meals a day.

6.2.3 Appropriate action will be taken to address any risks that may be present or highlighted in the nutritional screening e.g. ready availability of finger food and access to drinks throughout the day if appropriate to the nutritional needs of the Customer, and active monitoring of weight and hydration.

6.2.4 Positive encouragement to eat and taking action to address any factors that result in failure to meet nutritional needs such as physical inability to eat, depression, food presentation or because food is inadequate or unappetising, isolation/need for company.


7. PRE-ADMISSION AND DISCHARGE

7.1 Referral

7.1.1 Customers will either access the service directly through an agreed referral process or through a worker charged by Warwickshire County Council or other partner agency who organise support on a Customer’s behalf (this may be a broker, Personal Advisor or similar).

7.1.2 Admission to the permanent dementia placement unit will depend on Customers meeting the criteria for admission to residential care for older people with dementia. Minimum standards relating to timescales from referral to actual service delivery will be agreed with the authority

7.1.3 Short stay referrals will be made when the individual requires a short stay in residential care as a result of an emergency, or to provide respite to a family Carer or to enable assessment (and this could not be undertaken in their own home without serious risk to themselves or others).

7.1.4 For admission to the short stay dementia unit, Customers will have a diagnosis of dementia and needs that cannot be met in an ordinary residential care home with trained staff. The individual must not require the availability of qualified nursing staff on a 24-hour basis.

7.2 Trial period and Discharge

7.2.1 The purpose of the Trial Period shall be to ensure that the placement is satisfactory to all parties in meeting the needs of the Customer. Following completion of the Trial Period a decision will be made in conjunction with the Customer either to extend the Trial Period or to effect a permanent placement. During the Trial Period the Individual Placement Agreement (IPA) can be terminated on the giving of 1 (one) week’s notice by any party. The Council may in agreement with the Provider extend the Trial Period on behalf of the Customer after consultation with the Customer and their relative/advocate. For short term, short stay or respite care the Trial Period shall not be applicable.

7.2.2 Any referral of a Customer, which is not accepted by the Provider shall be explained by the Provider to the Council.

7.2.3 Any discharge will be part of a planned process (unless it is an emergency discharge to hospital) and measures will be put in place to ensure that the needs of the Customer are recognised and planned into the process.


8. STAFF AND RECRUITMENT

8.1 Management and recruitment

8.1.1 The Provider will demonstrate an efficient and appropriate use of staff and will seek to ensure that their employment practice and conditions of service are such that they maximise the retention of experienced staff and minimise unreasonable turnover of staff

8.1.2 Staffing levels must be such as to provide Customers with individual attention and enable the delivery of the Customers care plans. At no time should the staffing levels be allowed to fall below a level that is necessary to ensure the safety and wellbeing of the Customer.

8.1.3 Staffing levels should be prescribed by the manager and reviewed weekly and at times when there is a change in the needs of one or more Customer or other circumstance within the service.

8.1.4 Staff will be required to consistently demonstrate;

Willingness to listen and skills in all kinds of communication Understanding of how to problem solve, be creative, keep

people occupied and be person-centered in the ways in which they work with individuals who have dementia.

Highly developed abilities to read non-verbal signals, and to tune into emotional components of the words and actions of Customers

Ability to make sympathetic interpretations Special techniques for communicating with those who have little

speech Willingness to apply their communication and interpretation

skills to Customers and their relatives Skill in avoiding and managing conflict Interest in, and ability to complete and research and use, life

histories to support identity Knowledge of typical disabilities and experiences of people with

dementia.


8.1.5 Staff will require recognition that dementia care is emotionally demanding for staff and for managers and support needs should be recognised and addressed:

Recognition and appreciation for all positive aspects they bring to their work

Ongoing reassurance that holistic care is worthwhile Opportunities to reflect and review their ongoing performance Opportunities to discuss difficulties encountered during the

course of their work Management that is as interested in how they give personal

care as it is in speed and efficiency Opportunities to reflect upon their own needs for identity, sense

of control, hope and social confidence Leadership that demonstrates person-centred understanding

and skills. Peer support for new staff from more experienced dementia

trained staff to support skill development and confidence building.

8.1.6 The Home will ensure that its’ recruitment policy takes into account all current legislation, including Equal Opportunity legislation. The policy will establish the competencies and qualifications of all staff and will cover (but is not limited to);

Advertising Job Descriptions Person Specification Application forms Interview Written References Criminal Records Bureau Checks Medical Clearance

8.2 Staff training

8.2.1 The Home will have a registered manager qualified to a minimum of NVQ4 standard or equivalent. The manager will in addition have a minimum of two years relevant experience of working with people with moderate to advanced dementia. The Home will have an appropriate number of care staff, qualified to at least NVQ2 level or equivalent. Accredited Dementia qualifications will be essential for the manager and Key Workers. The provider will need to ensure that the dementia skills and knowledge of all care staff are sufficient to meet the needs of Customers.

8.2.2 The Provider will keep appropriate records relating to recruitment, supervision and training


8.2.3 The Home will provide all staff with an induction and training programme to comply with current regulations covering a probationary period to ensure all recruited staff have (but are not limited to);

A good understanding of the needs of people with dementia Suitable experience and qualifications The appropriate attitude to deliver the required service

8.2.4 The Provider will provide all staff with

An accredited dementia training programme Ongoing dementia specific training relevant to the skills needed

to deliver the service. This will involve all staff, irrespective or status that may at some point come in contact with Customers, e.g. cleaners, kitchen staff etc.

Written information on their employment status A job description and the general Social Care Council (GSCC)

Codes of Practice Standards, Policies and Procedures including Health and Safety Performance appraisal arrangements which might involve

people who use the services

8.2.5 The Care Home will ensure that management supervision is provided to all staff on at least a quarterly basis. The aim of supervision is to promote the highest standards of care and the provider will ensure that written arrangements exist and records kept relating to the management and support for all staff and subsequent good practices achieved.

8.2.6 The use of volunteers should be positively encouraged and they should be trained in both working with individuals with dementia, communication and support with eating where appropriate and encouraging interaction and social participation of Customers.

9. EQUIPMENT, FACILITIES AND ENVIRONMENT

9.1The provider will ensure that a robust approach to cleaning is in operation at the home, which facilitates a safe and clean environment. Providers should deliver the service in-line with the DH publication of infection in Residential and Nursing Homes 2006

9.2The Home will provide all equipment necessary to support a Customer, including hoists and other specialist equipment within the contracted price for the service.

9.3The Provider must ensure that any transitional and permanent beds are in two discreet units, which are in areas separate from other service provision.


9.4 The Home shall have designated areas for eating, social activities and private areas and every effort should be made to identify and delineate these areas, using signage, and appropriate use of furniture so that Customers and staff can easily find their way around.

9.5 Entrances to social areas should be well lit and welcoming. The development of materials and objects as cues for following or ‘sensing’ a route is recommended.

9.6 As and where possible, the Home should adapt the interior design to meet the needs of people who have dementia. For example:

Creation of a therapeutic ambience Avoidance of contrasting patterns in flooring and walls Level flooring, avoiding contrasting interface between 2 rooms Minimal use of reflective surfaces, recognising the potential effects that

reflective surfaces and mirrors may have on some service users High contrast in toilet seat and doors to aid recognition and orientation Appropriate use of ‘cues’ and stimulus to help orientate people such as

pictures, lighting and shelf displays

10. CONTRACT MONITORING

10.1 Care homes to make available at request a copy information relating to CQC assessment.

10.2 An annual questionnaire relating to the capacity of each provider

should also be completed by the provider and returned to the contract monitoring team as requested to enable county wide mapping of provider capacity

Current best practice/Legislation/Initiatives

In addition to the legislation, strategies and current initiatives identified in this specification and contract also apply:

NHS & Community Care Act 1990 Mental Health Act 1983, Mental Capacity Act 2005 Deprivation of Liberty Safeguards 2008 Transforming the Quality of Dementia Care DoH 2008 Care Standards Act 2000 Safeguarding Adults CSCI Regulations National Dementia Strategy Equality and Diversity legislation and policies


Monitoring for Dementia Care for Residential Homes (Draft)

Section 1: About the Care HomeWe need you to give us the details of your home, its capacity and registration to CQC.

Name of Home:

Name of Home Manager:

Name of Contract Monitoring Officer:

Date of visit:

1. THE HOME

1a. Are you the Registered Manager with CQC?

If no what is the Name of the Registered Manager:

1b.Has the Fit Person Interview taken place?

?

1c. Name of Deputy Manager:

1d. CQC Registration Category: With nursing Learning disability

Dementia (EMI) Old age only

Mental Health Physical disability

1e. Date of last CQC Inspection Report:

1f. Confirmation of Rating


1g. What areas of improvement have been identified since the last CQC inspection report and what has been done to address these?

1h. Number of beds:

Double En suite Single En suite Twin En suite


Section 2: Framework to monitor quality and outcomes

Key area Indicator Possible sources of evidence

CommentsStaff awareness?

Evidence of outcomes

Management frameworkGood leadership and defined dementia pathway

Named person to lead on dementia strategy in place

Strategy and pathway

Policy and procedures

Dementia Champion to monitor and improve practice

Training attended

Training cascaded

Improvement Measures put in place

Training schedule in place and adhered to

Provider records

Communication Information available about: service

policies in place

other key services

Provider records

Policies

Customer records

Observation and questioning

Questionnaire to carers

Awareness of key reporting requirements

Provider records

Policies

Customer records

Observation and questioning

Involvement of Family/carer Customer records


family/carer in assessment and care

have continued involvement and can support customer:

Observation

Policies

Questionnaire to carer

Carers have been informed of any significant changes

Customer records


Carers feel the service has contributed to them feeling less anxious about the health and wellbeing of their family member

Self-assessment/assisted assessment via discussion

Questionnaire/discussion

Safeguarding Safeguarding issues are recognised by staff and policy in place

Provider recordsTraining records

questioning

Training

Capacity assessments in assessment and review

Customer records

Awareness of role of IMCA and how and when to contact


Policies

Awareness of DOLS


Policies

Complaints policy in place and understood by staff, customers and carers:

Provider recordsPolicy/. Complaints logtraining

leaflet

questionnaire to carer


Independence outcomes

Care planning that focuses on retaining independence based on the abilities of customer

ADL assessments

Discussions with carers/supporters

Recording of improvement, maintenance or deterioration in ability to self care, undertake daily living functions, mobility etc

ADL assessments

Discussions with carer

Staff aware of abilities and interests of individual customers

Questioning

Observation

Interaction with service user time spent with each individual daily

Customer records

Person centred record

Range of activities

Customer /Carer consultation

Links with range of activity providers who visit home or are visited by customer

Provider records

Questioning

Observation


Customers appear secure and undertaking tasks, activities, personal interaction

Questioning

Observation

Health outcomes Physical and Customer records


mental health is recorded and reviewed on regular basis to include health screening and dental checks


Anti psychotic drug prescriptions are noted and reviewed 6 weekly

Customer records

Medicine records

Good quality of nursing care to ensure health of patient and prevent deterioration for example, wound care , catertirasion, pressure sores, food intake.

Customer recordsCarer discussionsNo of infectionsLevel 4 or 5 sacral wounds

Customer is supported to stay healthier and recover quicker.

Reduce likelihood of admission to hospital or long term nursing care

Links with General Practitioner, CMHT or allied health professional who can respond to emerging customer needs

Provider records

Customer records

Questioning


Facilitate timely discharge

Links with hospital liaison as necessary to respond to emerging needs to include pre admission and discharge planning

Provider records

Discussion

View of plans

End of Life care Good Provider records:


management of pain and distress

Numbers of Advanced care plan or advance directivesNumber of support services available

Customer records:Person is registered by General Practitioner as Palliative Care patient-Palliative care reviews where appropriate

Questionnaire to carerMeeting cultural, spiritual and religious needs

Provider records;Number of cultural or faith based support services available

Customer records:No of customers linked to their preferred cultural or religious service


EnvironmentLayout and ambience of home

Designated areas for eating, social activities with appropriate cues and stimulus to help people sense a route and recognise where they are

Things to look for include:

Appropriate use of furniture

Well lit doorways

Doors contrasting colour with walls

Use of signs

Pictures and shelf displays convey purpose of room

ambience Rooms should be:

Warm and welcoming

Neutral colour of walls and flooring


Not too noisy or crowded

Choice of private or group area

Appropriate décor and signage

Avoidance of contrasting patterns in flooring and walls

Level flooring, avoiding contrasting interface between 2 rooms

Minimal use of reflective surfaces and mirrors

High contrast in toilet seat and doors to aid recognition and orientation

Appropriate signage on front doors of customers to enable easy identification of their own room


Service Specification for Specialist Residential - Care

Documents

Transcript of Service Specification for Specialist Residential - Care