Louise Spencer Associate Director Quality and Nursing July 2018 Care Homes Louise Spencer Associate Director Quality and Nursing July 2018

Mr A Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

South Eastern Hampshire Our Area Total Nursing, Residential and Learning Disability homes 199 Fareham and Gosport 91 South Eastern Hampshire 108 (CQC Care Directory as of 23.08.2018)

Partners Continuing HealthCare (CHC) Care Quality Commission CCGs SHFT Community Nursing Teams Hampshire County Council Safeguarding Boards Care Quality Commission SHFT Enhanced Care home team Local GPs The homes themselves Continuing HealthCare (CHC) Funded nursing care Public Health and IPC teams LD & MH teams

Care Quality Commission (CQC)

Care Quality Commission (CQC)

Quality Improvement Quality Assurance Collaboration, alignment and streaming resources Clinical Commissioning Groups including quality, commissioning, safeguarding, GP and primary care teams Hampshire County Council (the Local Authority: LA) Continuing Health care (CHC), Funded Nursing Care and Learning Disability (LD) teams Southern Health Foundation Trust (SHFT) enhanced care home team and community care teams Quarterly Care Home Forum run by the CCG and the SHFT Enhanced care home team Proactive Providing advice and guidance supported by the identification of trends through Quasar Visits to homes including quality visits, review of care packages and any requests for support Proactive and reactive Responding to quality concerns and safeguarding alerts Reactive Continual relationship building Monitoring quality through the LA Quality Outcomes Contract meeting (QOCM)process Monitoring safeguarding events in homes through the LA Large Scale Enquiry (LSE) process

Innovations Hydrate Care planning workshop MCA workshop- scenarios and best interest proforma Behaviour care planning Plans for roll out of NEWs2 and Restore projects Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

Choking prevention Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

Challenges Some people not receiving optimal care due to: Significant shortages in registered nursing workforce Quality of nursing leadership resulting in skill mix challenges Ability to adhere to CQC registration requirements potentially resulting in CQC actions and decisions to close Several nursing homes in the process of de-registering to residential as they cannot recruit qualified staff and one de-registered 25% of 44 homes surveyed in December 2017 reported more than two registered nurse vacancies Unqualified worker availability identified as an issue with 55% of homes having significant carer vacancies Local increase in safeguarding alerts- analysis underway Limited capacity in care home team and CCG quality team for care homes Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

Opportunities - Going Further Closer working with the Local Authority (CQC System Inspection Plan) Already join up through Hampshire Community Health LCP Delivery work stream with Portsmouth and South East Hampshire CCGs and Providers Quality system group Compliment the LA care home training packages – fill any gaps Up-skill homes to take higher acuity patients- ensuring adequate skill mix encourage peer review Joint brokerage arrangements for care with Hampshire County Council Implement the NEWs2 and Restore programmes Possible care home Leadership programme Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.

Questions welcome Mr A lives in a residential home and had some safeguarding concerns raised by his wife. This was investigated by the CCG and the Local Authority under the statutory safeguarding function. The investigation found that Mr A had been falling multiple times over 15 times in the past year. The home were recording these events; however it appeared they were finding it difficult to safely manage this gentleman’s care. There were also multiple ambulance call outs to assist with Mr A. The majority of the Mr A’s falls were without injury however for 3 of the falls Mr A experienced injuries, from skin lacerations to bruising. Mr A has a medical history of vascular dementia, is on complex medication and is partially sighted As a result of dementia he is often unable to recognise limitations and forgets to use his walking frame. The CCG quality and safeguarding team worked with the Care home manager and Mr A’s family to identify risk management strategies to prevent Mr A falling including: Improved care planning and documentation around Mr A’s potential for falling, including recognition of increased risk if Mr A shows signs of developing an infection Improved communication with Mr A and recognising signs of agitation Offering visits around the grounds for recreational activity in his wheelchair A 1:1 carer between 17:00 and 08:00 hrs Development of an improved falls policy and roll-out to staff through training As a result Mr A’s falls reduced and his quality of life has improved. The care home has more confidence in the proactive risk management of complex residents. Ambulance call outs have been reduced significantly.