Poor Risk Management and Safeguarding Issues Lead to CQC Registration Being Cancelled

The CQC has cancelled Viewpark Care Home’s registration following multiple breaches of the regulations, and ongoing and serious concerns in relation to the provision of safe care and treatment.

There were repeated breaches in relation to:

  • The Mental Capacity Act,
  • assessing and mitigating risks to people’s health and wellbeing,
  • the safe management of medicines,
  • safeguarding procedures,
  • supervision of staff,
  • consent,
  • deprivation of liberty safeguards,
  • good governance
  • and acting openly and transparently.

In addition:

  • Staff were not following the advice of a professional and were providing food
    and drinks of an incorrect consistency.
  • There were ongoing issues in relation to the safe management of medicines. Staff did not always monitor the temperatures that medicines were stored. When temperatures had been monitored, there was a lack of evidence to show the appropriate actions had been taken if temperatures had exceeded manufacturers
    recommendations. This meant there was a risk these medicines might not work as effectively.
  • The administration of medicines was not always accurately reflected on the medication administration records (MARs).
  • There were shortfalls in actions taken to ensure the safety of the premises.
  • The provider had not obtained a required safety check of the passenger lift.
  • There were no robust procedures in place to ensure staff employed were of suitable character.
  • Staff were not following the home’s financial procedures and people were at increased risk of financial abuse as a result.
  • There were missed opportunities for staff to engage with people and to set up activities.
  • People were not aware of having been given the opportunity to be involved in developing or reviewing their care plans, and there was no documentary evidence of such involvement.

There had been multiple whistleblowers to CQC, issues raised included:

  • concerns about the registered manager’s treatment of staff.
  • staff within the service had not always acted openly and transparently in relation to issues arising in the service.
  • The systems in place to monitor and improve the quality and safety of the service were not effective.

Debbie Westhead, CQC’s Deputy Chief Inspector for Adult Social Care said “The provider was given every chance to improve the service and provide high-quality consistent care. On serval occasions we found the home putting people at risk by not taking the advice from healthcare professionals. We also had serious concerns over the management and leadership of the service.

“Taking enforcement action of this nature is not something we take lightly, nevertheless the safe care and treatment of people using services is our highest priority and they deserve safe, effective high-quality care.”

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Have Your Say Over the CQC’s Proposed Changes to Regulatory Fees

The Care Quality Commission (CQC) has published its consultation on provider fees for 2019/20.

Proposed changes will affect:

  • community social care (including domiciliary care)
  • dental services
  • residential social care

The Proposals

The CQC’s proposals will see an increase in fees for the community social care sector and the dental sector, and a decrease in fees for the residential social care sector.

  • An average community social care provider will see an increase in fees of £290.
  • Dental services with one location will see an increase of between £69 and £149 (depending on the number of dental chairs on site).
  • Dental services with multiple locations will see an increase of between £183 and £6871 (depending on the number of locations).
  • An average social care provider will see a decrease in fees of £64.

How to give your views

You can view the CQC consultation documents online (click here) and have your say using the online feedback form.

This consultation closes at noon on Thursday 17 January 2019.

What Happens Next

The CQC will analyse the feedback from this consultation to prepare a response and a final fees scheme to recommend to the Secretary of State, whose consent is required to implement the scheme from 1 April 2019.

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Graduate Unemployment Rate Has Fallen to Its Lowest Since 1979!

The unemployment rate for graduates six months after leaving university fell to 5.1% this year – the lowest since the 1979 survey when it was 4.9%.

Prospects’ What do graduates do? 2018 report shows a robust graduate labour market.

Employment increased from 74.2% to 76.6% (184,295) as 4,540 more graduates found jobs compared to last year. The proportion of employed graduates in professional-level roles also increased, from 71.4% to 73.9%.

Skills shortages across many industries appear to have helped job prospects with increases in those entering professional jobs across all degree subjects. More graduates qualified in high demand subjects, such as IT, engineering, accountancy and marketing, went into their vocationally linked roles as a result.

Changes to the balance of occupations could also be indicative of skills shortages with maths graduates working in IT and engineering over the more typical business services roles. There were also more physics graduates working in IT, and the marketing industry proved much more popular this year among geography and English graduates.

The skills shortage also appears to have impacted salaries as the average starting salary for graduates increased from £21,776 to £22,399 this year. All regions saw a rise, with the Midlands, East of England and Northern Ireland seeing the largest percentage increases.

Charlie Ball, head of higher education intelligence at Prospects, said: ‘Skills shortages have been a feature of the graduate labour market since the recovery from the last recession. There are signs that this may have helped to fuel a modest rise in salaries as well as job prospects.’

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Networking, Workforce Management Software and Productive Team Meetings Contribute to CQC Outstanding Rating

Carefound Home Care (Wilsmlow) a care agency in Wilmslow Cheshire has received an overall rating of Outstanding following an inspection in August 2018 by the Care Quality Commission.

Inspectors rated the service Outstanding for being safe, effective, caring responsive and well-led.

Carefound Home Care (Wilsmlow) is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection there were a total of 21 people using the service.

Key Findings:

  • Inspectors found the service had exceptional and distinctive methods to ensure people were cared for by staff they could connect well with.
  • They actively recruited staff who had shared interests with people using the service.
  • The service spent a lot of time planning the care for people and ensured they were matched with carers with whom they could develop a close bond.
  • The service used specialist workforce management software to ensure safe staffing levels. These were closely monitored daily. They were then analysed and discussed at monthly management meetings.
  • Staff were given enough time in between calls to travel to the next appointment. People who used the service told us that the system worked and staff were always on time.
  • Patients and their families were encouraged to approach staff if they felt improvements could be made to their care.
  • Inspectors saw evidence of the management team working closely with a number of outside health organisations to research the best possible care for people with certain health conditions. The information gained was cascaded throughout the organisation and included in training packages. This led to staff having an exceptional understanding of the medical conditions that the people they cared for suffered from.

Debbie Westhead, Deputy Chief Inspector, for Adult Social Care in the North, said “This is a service where the staff and management are clearly passionate about providing personalised care and have created an environment where people are treated with compassion, dignity and respect in a persons’ own home. People and their relatives were overwhelmingly positive about the high quality, individualised care that was provided by the staff.

“The staff and management should be proud of their achievement in attaining our highest rating and I would like to congratulate them on their provision of high quality care.”


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Are You Ready for National Start-Ups Day on 22nd October?

National Start-Up’s Day celebrates the UK’s flourishing start-up community for a third consecutive year on the 22nd October 2018.

Established in 2016, the #NationalStartupsDay campaign builds on the success of the past two years; last year, on Twitter the hashtag trended across the UK, generating hundreds of thousands of impressions while top brands, entrepreneurs and organisations gave their support to the campaign through social media engagement.

The event is designed to showcase exciting and innovative start-ups, while connecting start-up founders with advice and materials to help them succeed in business.

Supporters in previous years include the FSB, Dragons’ Den star Jenny Campbell, Margot James, Tech Nation, and Startup Bootcamp, while the message was also spread overseas with the French Embassy and the US economic development administration sharing their support.

All those involved in business, from start-ups to larger businesses with valuable advice for those starting out, are encouraged to get involved with the campaign and spread the word by sharing the hashtag #NationalStartupsDay and #PeoplesChampion on Monday 22 October 2018.

Organisers will be generating awareness of the UK’s most promising and innovative early-stage small businesses by showcasing profiles of over 70 inspiring start-ups in the running for #PeoplesChampion nominations for the Startups Awards 2018.

Readers and start-up peers will get the chance to vote for the companies they deem to be most deserving of the People’s Champion title, with the winner set to be revealed at the Startups Awards 2018 ceremony on Wednesday 21 November.

They will also be sharing a host of dedicated free advice, guides and materials across our social media accounts – on TwitterInstagram, and Facebook – to support start-ups and encourage the next generation of entrepreneurs.

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CQC Reports One In Seven Older People Can’t Access The Care Services They Need

This year’s State of Care Report from the CQC shows that most people receiving care are still getting good care – but there are significant issues accessing care, with one in seven older people having unmet care needs.

The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England shows that overall, quality has been largely maintained, and in some cases improved, from last year. This is despite continuing challenges around demand and funding, coupled with significant workforce pressures as all sectors struggle to recruit and retain staff. The efforts of staff, leaders and carers to ensure that people continue to receive good, safe care despite these challenges has been recognised and applauded in the report.

Key Challenges For The Care System

The report concludes that people’s experience of care varies depending on where they live; and that these experiences are often determined by how well different parts of local system work together.

Ineffective collaboration between local health and care services can result in people not being able to access the care and support services in the community that would avoid unnecessary admissions to hospital, which in turn leads to increased demand for acute services.

The most visible impact of this is the pressure on emergency departments as demand continues to rise, with July 2018 seeing the highest number of attendances on record.

Many people have more difficulty accessing support or to have to travel unreasonable distances to get it. For example, inappropriate out of area mental health placements – with some people being placed hundreds of miles from their homes – vary considerably by region. And the CQC’s review of children and young people’s mental health services found that some children and young people were ‘at crisis point’ before they got the specialist care and support they needed, with average waiting times varying significantly according to local processes, systems and targets.

Posing a threat to effective collaboration between health and social care is the continued fragility of the adult social care market, with providers closing or ceasing to trade and contracts being handed back to local authorities. Unmet need continues to rise, with Age UK estimating that 1.4 million older people do not have access to the care and support they need. In two years, the number of older people living with an unmet care need has risen by almost 20%, to nearly one in seven older people. While the government made a welcome NHS funding announcement in June 2018, the impact of this, and last week’s short-term crisis funding for adult social care, risks being undermined by the lack of a long-term funding solution for social care.

Peter Wyman, Chair of the Care Quality Commission said “The fact that quality has been broadly maintained in the face of enormous challenges on demand, funding and workforce is a huge testament to staff and leaders.

“But we cannot ignore the fact that not everyone is getting good care. Safety remains a real concern: although there have been some small improvements 40% of NHS acute hospitals’ core services and 37% of NHS mental health trusts’ core services were rated as requires improvement on safety. All providers are facing similar challenges – in acute hospitals, the pressure on emergency departments is especially visible – but while many are responding in a way that maintains quality of care, some are not.

“Our other big concern is the fragility of the adult social care market. Two years ago, we warned that social care was ‘approaching a tipping point’ – as unmet need continues to rise, this tipping point has already been reached for some people who are not getting the good quality care they need. It is increasingly clear without a long-term funding settlement for adult social care, the additional funding for the NHS will be spent treating people with complex conditions for whom care in the community would have been more effective both in terms of their health and wellbeing and use of public money.”

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Libraries PLR Rate to Rise For Writers

The Government is proposing to increase the rate of PLR payments to 8.52p per loan for 2017/18, an increase of 0.32p for each loan. However it has admitted that the number of loans has continued to decline.

Public Lending Right (PLR) is the right for authors and other rights holders to receive payments from a central fund in relation to public lending of their books by libraries in the UK. It is paid retrospectively, and the proposed increase relates to loans made in 2017/18.

The British Library Board is responsible for making an annual recommendation to the Government of the rate that should be paid for each year. The Board has proposed a rate per loan of 8.52p, an increase of 0.32p from the previous year.

This proposal only relates to loans of physical copies of books and audiobooks. Although PLR has now been extended to remote e-lending, this change was brought into effect at the beginning of the 2018/19 period, with the first payments due to be made in early 2020.

Although this is, of course, good news for authors they are not likely to see a dramatic increase in earnings, as library lending continues to decline.  This reflects the cuts in library services that have taken place across the country, as well as the exclusion of some volunteer-run libraries from the PLR scheme.

Nicola Solomon, Chief Executive of the Society of Authors, said: “We are pleased with the proposal to increase the PLR rate. PLR is a vital source of income for many authors, and the UK’s funding pot for PLR is considerably below that of comparable EU countries.

“However we are saddened to learn that the number of loans of books registered for PLR is decreasing. This is no doubt caused by cuts in library services and the exclusion of some volunteer-run libraries from the scheme. We urge the Government to include volunteer-run libraries within the PLR scheme so that true figures for library lending can be recorded and remunerated.

“We also note that no additional funds have so far been allocated to the PLR fund to coincide with the extension of PLR to e-lending. We are delighted that this change has been implemented, but it needs to be accompanied by an increase in the overall fund, and we urge the Government to review this before the first payments on e-book and e-audio loans are made in 2020.”

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Unregistered Domiciliary Care Provider Prosecuted by CQC

A company director that illegally provided domiciliary care services from three north London addresses has been fined more than £3,500 at Highbury Corner Magistrates’ Court.

The company was not registered with the Care Quality Commission as required by the Health and Social Care Act 2008.

Mr Yousef Jowaheer was fined £1200 for each offence (two offences as Director for CapeHealth Care and Cape Home Care‎) and was also ordered to pay £170 victim surcharge and £966.40 costs, making a total of £3536.40.

He was disqualified as a company director for five years following the hearing on 3 August 2018.

Mr Jowaheer ran care services from different addresses in north London at: Broadhurst Gardens, Camden; Talbot House, Imperial Drive, Harrow and Canada House Business Centre, Ruislip, Hillingdon, over a period of years.

Andrea Sutcliffe, CQC’s Chief Inspector of Adult Social Care, said:“It has taken over two years for this individual to be located, and brought to justice and I would like to thank CQC staff that tracked down and helped prosecute Mr Jowaheer. We register and regulate services so that people can be protected and ensure they get good quality care.”

The company is no longer providing care services.

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Lack of Management Oversight Contributes to CQC Inadequate Rating

A GP practice in the London borough of Newham has been rated Inadequate overall by the Care Quality Commission. Previously it was rated as Good.

Boleyn Road Practice, which looks after more than 6,500 patients, was rated Inadequate for being safe, caring, responsive and well-led. It was rated Requires Improvement for being effective.

There were fundamental and significant concerns regarding governance and leadership and management capability.

  • Inspectors found that staff safety training, medicines management, premises and equipment safety, cervical screening and management oversight all needed to improve.
  • Staff had not always and treated patients with compassion, kindness, dignity and respect.
  • Patients were not always able to access care when they needed it.

Areas where the practice must now make improvements include:

  • Ensuring that all patients are treated with dignity and respect.
  • Ensuring care and treatment is provided in a safe way to patients.
  • Ensuring that equipment and the premises are fit for use.
  • Ensuring good governance in accordance with the fundamental standards of care.
  • Ensuring staff receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
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CQC to Look at Oral Health in Care Homes

Andrea Sutcliffe CBE, Chief Inspector of Adult Social Care, has announced a review of oral healthcare practices in care homes.

Writing about this issue Andrea commented:

“Although many residents of care homes are supported to maintain good oral health, there is evidence to show that some services struggle to provide the support people need.  The consequences can be devastating. The gruesome pictures of blackened, infected teeth CQC’s Senior National Professional Dental Advisor showed me recently were awful and I can just imagine the impact this has on people in pain or embarrassed about the way they look. I was also shocked by some of the other consequences he explained as mouth infections can spread and cause, for example, respiratory problems like pneumonia and other cardiovascular problems.”

Managing oral health poses particular challenges to those working in adult social care:

  • Residents of care homes may have poor manual dexterity, limited mobility, vision problems and cognitive difficulties.
  • Long-term conditions such as Parkinson’s disease and dementia can make it harder to hold and use a toothbrush and go for dental treatment.
  • There are challenges for staff too who may not have the time and understanding to support people appropriately particularly if this is not seen as a high priority in the service or they face resistance from the person they are trying to assist.

Whilst oral health care is not specifically mentioned in the Key Lines of Enquiry, the CQC has expressed concern about a lack of focus in this area.

The CQC has now asked the Primary Medical Services to conduct a thematic review to gather information and produce a national report on the quality of oral health in care homes at present.  Staff will attend inspections to ask some additional questions and speak to staff and those who use services. They will also be looking at whether care homes are following the NICE guidance on oral health in care homes and if not, what the reason for this is.

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