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

2. 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.

3. 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 )

4. 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

5. Care Quality Commission (CQC)

6. Care Quality Commission (CQC)

7. 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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.