Service Specificationfor Learning Disability

Schedule 2

East of England

Service Specificationfor Learning Disability,

(Care Homes & Accommodation based Services - June 2013)

East of England

Service Specification Care Homes & Accommodation Services

1.Introduction

1.1The Services shall be those services to be provided by the Provider, as set out below, and performed in accordance with the Contract (the ‘Services’).

1.2Providers must recognise the role they play in ensuring that people with learning disabilities experience the good health and wellbeing necessary to live a meaningful life. Providers should be aware that there are higher incidences of long term conditions, and other health problems, experienced by people with learning disabilities, and prioritises preventative and palliative services and support to minimise potential impacts to Individuals. As such staff must have sufficient and appropriate training and skills to effectively engage people with learning disabilities in health promotion.

1.3The consistent principles that run throughout this document and should remain at the core of the support and services provided are:

• all services are commissioned on a person centred basis and are required to be responsive to the personal needs and preferences of each individual;
• given the right support, people with learning disabilities can live well and maintain their health with varying levels of independence;
• That the good health and wellbeing of the people for whom these services are commissioned is ‘everyone’s business’ and not influenced by the type of organisation providing the service (i.e. social care services)

2.General Requirements (of regulated providers)

2.1In providing the Services the Provider is required to be registered with the Care Quality Commission (CQC) and to maintain that registration throughout the Contract Period. All Providers must meet the ‘Essential Standards of Quality and Safety’ as set out in the Health & Social Care Act 2008 (Regulated Activities) Regulations 2009 and the Care Quality Commission (Registration) Regulations 2009. Each Service Provider must be registered with the Care Quality Commission (CQC) and will be inspected as required by the CQC.

2.2In addition to meeting the requirements of the Essential Standards of Quality and Safety as set out above, the Provider is required to meet the specific Contract Standards, as set out inthe East of England Service Outcomes and Standards of Care, section 12 belowbelow.

2.3Each Provider must ensure that it has the ability to provide the necessary service with sufficient numbers of trained and competent staff necessary to provide care for each Individual. The Service Provider must ensure that each person responsible for the delivery of care is fully aware of the requirements of the Contract Standards as well as the Essential Standards of Quality and Safety and be able to demonstrate a commitment to maintaining and delivering high quality Services for adults with a variety of needs and/or conditions and provide a service where all aspects of a person's care are met.

2.4The Provider will provide services that meet the needs of the individual and are provided by competent staff in a way that supports the safety and security of the Individual. The services shall be responsive, reliable and maintain a persons dignity and respect at all times. The Services shall be accessible and delivered with understanding and without discrimination.

3Maximising Health and Wellbeing

Staff members will have the specific knowledge and skills to work with Individuals to achieve optimal wellbeing. Members of staff will be expected to demonstrate to the Council their understanding of health promotion and how they work with Individuals to maintain health and wellbeing.

3.1The Provider will ensure that staff have access to learning and development opportunities that includes public health messages and an understanding of the services that can support them. Delivery of training courses should include self advocates and family carers.

3.2Any organisational learning needs analysis will include consideration of staff understanding of how to maintain good health; local health services and initiatives, and an overview of common health conditions and health risks for people with a learning disability. Providers should consider how their local Community Learning Disability Service can support this.

3.3As part of the Contract the Provider will recognise the importance of supporting annual health checks for the Individual and where this has been arranged, support and prioritise attendance over social activities. The provider will provide appropriate staff to support the Individual in attending their annual health check and will ensure that information available from annual health checks is used effectively to plan for, and respond to, the health needs of Individuals as part of the person’s care and support plan. This includes plans for access to healthcare and medical intervention, including hospital admissions (if this requires changes to the person’s support plan, the provider will contact the care manager for agreement to the change).

3.4Any staff member supporting a Individual to attend a health appointment of any type should have permission from the individual; have a good understanding of any health conditions; be able to advocate on behalf of the person and be prepared to support the individual to feed relevant information back to others. Prior to a health appointment, the staff member should meet with the individual to agree the purpose of the appointment and the Individuals’ expectations regarding how they wish to be supported.

3.5Where possible services must always be provided in a way that enables the Individual to maximise their independence, health and wellbeing and supports their social, spiritual, emotional and healthcare needs.

3.6The provider will also demonstrate a commitment to preventative care as a means of reducing the number of emergency admissions and understands the specific service requirements of people with a learning disability. They will be aware that certain conditions, such as constipation and conditions related to dysphagia or swallowing (such as chest infections, pneumonia and gastro-oesophageal reflux disease) have been identified as in the top five reasons for hospital admissions for people with learning disabilities (IHaL) and as such will invest in appropriate support and training, to help reduce admissions from these conditions.

3.7People with a learning disability often having poorer oral hygiene than the rest of the population. Providers understand that poor oral hygiene can lead to a number of serious health conditions including heart disease. They will be aware that pain as a result of toothache can also cause behaviour that challenges services and ensure that this is not overlooked when providing care services and support. The provider will ensure that staff are working with Individuals to understand and maintain good oral hygiene and are accessing the dentist at least annually.

3.8TheServices should also achieve the outcomes for Individuals in accordance with the White Paper, ‘Our Health, Our Care, Our Say’, namely:

• Exercising Choice and Control
• Improved Health and Emotional Well-being
• Personal Dignity and Respect
• Quality of Life
• Freedom from Discrimination and Harassment
• Making a Positive Contribution
• Economic Well-being

3.9When providing care and support, providers should also be mindful of the following national policy and guidance:

• Death by Indifference (2007); Healthcare For All (2008); and Six Lives (2009)
• Confidential Inquiry into the Premature Deaths of Adults with Learning Disabilities (2013)
• Health Equalities Framework for People with a Learning Disability (2013)
• Public Health Outcomes Framework 2013 – 16
• Adult Social Care Outcomes Framework 2013 – 14
• NHS Outcomes Framework 2013 – 14

3.10The Provider ensures that its Staff have regard for the Individuals equality and diversity and upholdspeoples human rights (in line with the guidance outlined in the Equality and Human Rights Commission inquiry) and does not discriminateagainst people for any reason. Its policies will incorporate respect for both Staff and Individuals.

3.11The provider ensures that all staff work in an enabling way that allows individuals to increase or maintain their level of independence, develop self caring and move to a reduction in home care support, where appropriate.

3.12 The Providers practice, culture and values mirror the objectives set out in the Dignity Campaign 2006 updated in Jan 2012 – Appendices 6.

4.The Service: Residential Care

4.1 The Services provided in the Care Home should include a single room (unless Individuals wish to share), toilet and bathing facilities, full board, personal care, [add nursing care where appropriate] staffing on a 24 hour basis, and day time and evening social activities. Exceptions can be made where recorded on the Individual’s Care Plan as prepared or agreed by the Individual’s Care Manager and the Individual or their representative.

4.2As well as personal care tasks, Providers should make it a clear and expected aspect of the work of their Staff that part of their role is for Staff to spend time talking to, relating with, and understanding the lives of Individuals and supporting them with appropriate activities.

4.3 The Care Home shall arrange and pay for (unless paid for by the local

Clinical Commissioning Group) any health equipment and materials, (for

example, to relieve pressure, aid continence, ensure safe handling or to

provide bariatric care) required by Individuals and work in accordance

with the Eastern Region Guidance for the Provision of Community

Equipment in Care Homes -Appendices 10.

5 Dementia

5.1 The provider will ensure that all care staff receive dementia training in

line with with the Alzheimers Home for Home Report.

6.Volume of Service

6.1The Provider will provide places for individual Referrals as agreed from time to time and as set out in the [individual service commission / individual service contract].

7.Accessing the Service & Assessments

7.1The Council has a statutory responsibility, within its eligibility criteria, to ensure the provision of certain statutory services in order to meet individual assessed needs.

7.2The needs of each Individual will be identified through an assessment completed by a Care Manager from the Council. If the Individual is eligible for the Services, the Care Manager will produce a personalised and outcome focused Care Plan and a Risk Assessment, with input from the Individual and / or their representative, to identify how their needs will be met and the outcomes to be achieved.

7.3The Brokerage Team shall have authority to refer Individuals to the Services on behalf of the Council.

7.4The Provider shall nominate those persons with authority to accept referrals and shall inform the Authorised Officer of their names, addresses and telephone numbers from time to time.

7.5Referrals may be made by telephone or in writing. The Referral and the agreed start date shall be confirmed in writing within 5 Business Days of the Referral being made by email, by post or facsimile transmission. A copy of the Care & Support Plan and Risk Assessment will also be sent to the Provider.

7.6 The Provider is expected to completed their own pre assessment within 48 hours of the Individual moving into the home.

7.7 The Provider is expected to develop a support plan with the Service User with personalised outcomes/aims and clear objectives.

7.8 The Council expects that moving forward more individuals will purchase services using a Personal Budget or Individual Service Fund and the Provider will be responsive to the changes.

7.9 The Contract will allow for the provision of an Individual Service Fund (ISF) wherby a Personal budget will be allocated to an individual and held by the Provider on the basis that it will be spent according to the Individuals approved Care and Support Plan or Care Programme Approach (CPA) that are relevant for this service.

7.9.1The Provider shall provide the Services for the named Individual from the start date, until the Services are cancelled, suspended or varied in accordance with the Contract.

7.9.2The individuals assessed needs and risk assessment will determine if a trial period is appropriate. This will be agreed at the time of referral and will not exceed 28 days unless the parties agree otherwise in writing.

7.9.3 In circumstances where an Individual requires emergency medical attention the Council expects the home to ensure the individuals safety is paramount. Where an individual requires transferring to hospital the Provider must assess if a staff escort is required and at the point they reach hospital if it is safe to leave the individual. It is expected that any judgement would be based on an individual risk assessment

7.9.4 In cases of emergency treatment and/or medical intervention

theHomeis expected to contact the next of kin and any Individual

holding power of attorney; in accordance with prior arrangements made with the family, to provide a summary of treatment and needs

7.9.5 In circumstances where the Individual is discharged from hospital the

Council expects the home to be able to facilitate the return of the

resident up to 7pm daily seven days a week.In the case of new

admissions this should be no later than 4pm seven days a week,unless

agreed otherwise by the home and hospital.

8. Care & Support Reviews / Changes in Service

8.1The Provider must inform the Council of the need to review the Care and Support Plan if there is a material change in the Individual's needs, or in the way that a Individual would prefer to have their Services provided.

8.2A care management review will be held as often as the Care Manager considers necessary, or as requested by the Individual and / or their representative, or by the Service Provider but at least annually.

8.3The care management review will involve the Individual and/or their representative, the Care Manager or their representative, and where appropriate, the Provider or designated representative. Consideration will be given to ensure convenience and adequate notice for all participants wherever possible.

8.4The care management review will consider the extent to which the outcomes set out in the Care and Support Plan are being met and will identify future objectives.

8.5The Individual’s individual service contract will be amended as appropriate following the review.

9.Temporary suspension of individual places in the Services

9.1In the event of the Individual’s admission to hospital the Provider shall maintain appropriate contact with the Individual, their representative, Contract Finance and relevant Care Management and Assessment officer(s) unless explicitly requested otherwise and in accordance with the timescales set out in 12.1below

9.2The payment arrangements that apply for temporary suspension of places in the Services are set out in Schedule 4 (Contract Price).

10.Termination of individual places in the Services

10.1Payment for the individual Service shall be terminated 3 days after the death of the Individual.

10.2The Council may terminate an individual place in the Services on giving not less than 28 day’s notice to the Provider unless mutually agreed on a case by case basis

10.3The Provider may terminate an individual place in the Services on giving not less than 28 day’s notice to the appropriate Care Manager and to the Authorised Officer unless mutually agreed on a case by case basis.

10.4At any time during the trial period of occupation of the Home by the Individual (or at any time for a Short Term Individual) the Individual, The Provider, or The Council, shall have the right to terminate the occupation by the Individual by giving 7 day’s notice in writing. Notice by the Individual should be given to both The Provider and The Council. Notice by The Provider shall be given to both The Council and the Individual. Notice by The Council shall be given to both The Provider and the Individual. In the event of an emergency a Individual may terminate his/her occupation without notice.

11How and what we will monitor

11.1The Council is responsible for monitoring the quality of the Service provided and for reviewing the individual needs of Individuals.

11.2As part of this Contract the Council will periodically monitor the Service delivery to ensure compliance with the Contract Standards, The East of England Service Outcomes and Standards of Care, its Terms and Conditions as well as the Contract Schedules, and to assess the quality and performance of the service being delivered to Individuals in relation to meeting their outcomes.

11.3To do this the Council will use a variety of methods. Assessment will include (but not be limited to) the following:

• By feedback from Individuals and/or their carers on the standards of Services being provided;
• By feedback from Council officers reviewing whether or not the Service is meeting the Individual's assessed needs and meeting their outcomes in the best possible way;
• By systematic monitoring of the Service Provider by the Council, in order to evaluate and record the Service delivered against the Specification;
• By consulting with Individuals and/or their representatives;
• By the investigation of complaints and / or safeguarding instances- Appendices 5 & 9 respectively;
• By Provider Performance Monitoring Forms;
• By reviewing written procedures and records for both Individuals and Staff;
• By the Service Provider, submitting to the Council an annual report detailing the outcome of quality assurance processes, including its service improvement plans;
• Through external compliance reports from CQC;
• Through the ADASS monitoring toolkit.

11.4 The Provider is required to notify the Council of any CQC inspection and share the draft report at the earliest opportunity.Non compliance will automatically trigger the Councils formal Escalation Policy – Appendices7.

11.5 The Council is mindful of the need to apply a proportionate approach in respect to the monitoring of Services.

11.6 The Council has risk based approach to monitoring Services and this determines the frequency and scope of the visit however the minimum standard is that a full service review will be completed annually.The Provider will be notified 1 week in advance by email to the Registered Manager.Following the visit the Purchasing & Quality Assurance team will forward a full report of its findings within 10 working days.Any Provider scoring POOR overall will automatically escalate to Provider Performance under the Councils Esclatation Policy.