There are a range of ways in which the Council and NHS works with the providers of social care services to ensure that the services they are delivering are safe and of a high quality. The starting point for this work is the London Multi-Agency Adult Safeguarding Policy and Procedures and in particular section 5 of the policy and procedures. More details of the multi-agency policy and procedures and how these apply to service providers can be found on the London ADASS website.
Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of a range of health and social care services. The CQC set out what good and outstanding care looks like and make sure services meet fundamental standards below which care must never fall. The CQC monitor, inspect and regulate services to make sure they meet the fundamental standards of quality and safety and publish reports after each inspection of a provider, including performance ratings to help people choose care. The CQC have a range of statutory powers to take action against providers who do not meet the required standards and ultimately can cancel a provider’s registration where the failures are serious enough.
The CQC currently regulate and inspect residential and nursing care homes, home care, and other services where personal care is provided as part of the service. The CQC does not currently regulate and inspect day care services.
The CQC website includes detailed inspection reports and ratings for all of the providers it regulates, and these entries are searchable by post code so that residents and/or their families can find local care services and get an overview of the quality of those services.
Commissioning for Quality
Quality services are those that place the health and welfare of people who use services as paramount and deliver positive outcomes. These are evidenced in the characteristics of the service through policy, procedures, standards, and structures for overseeing and maintaining service delivery to the requirements set by the Care Quality Commission (CQC) and/or by robust contract monitoring. Where the Council does not contract with a provider and/or the provider is not regulated by the CQC it will still need to maintain health and safety standards and where it delivers care and support, it should still have quality and safeguarding measures in place.
PAMMS is a web based quality assurance system that has been developed by all of the Local Authorities in London and was introduced in April 2019. It currently covers residential and nursing care homes and in future will also cover home care services (in 2020) and supported housing services (in 2021). Merton is fully committed to encouraging local care providers to participate in PAMMS by uploading the required quarterly returns. The Council is also increasing its use of the system to monitor the quality of care homes locally and when making placements in other parts of London.
Where the Council has a contract with a provider to deliver care services to its residents the Council regularly monitors those providers to ensure that the services they provide are safe and effective. The Council does this through a variety of means including visiting the provider, talking to service users and families, and requesting and analysing information from the provider. The Council also uses an Electronic Care Monitoring solution with its main home care providers. This system enables the monitoring of when care visits start and finish, and generates data that enables the provider and the Council to check that individuals are getting the care that they have been assessed as needing.
Merton Joint Intelligence Group
Merton Joint Intelligence Group (MJIG) is a partnership group that is co-ordinated by the Council and includes the CQC, NHS, Police, Healthwatch and other local agencies. The group meets monthly and shares information about local care providers. This group provides valuable local intelligence about providers and any concerns that there are about the safety and quality of their services.
The London Multi-Agency Adult Safeguarding Policy and Procedures sets out arrangements for working with providers as a means for responding to potential business failure (contracts and commissioning responsibilities) and details how allegations of organisational abuse are managed where safeguarding concerns are identified as serious matters within an organisation as opposed to single concerns that may be addressed under Section 42 (safeguarding responsibilities). Safeguarding concerns in this sense relate to patterns of reported abuse or neglect, about one provider, or where a single concern indicates a serious matter that warrants closer inspection under adult safeguarding processes. In some instances, safeguarding action may be initiated following a Safeguarding Adult Review or run in parallel to one. This ‘Provider Concern’ framework is based around a six stage process:
- Decision to initiate provider concerns;
- Initial Provider Concerns meeting;
- Findings meeting;
- Update meeting (if required);
- Quality Assurance; and
- Closure of the provider concern process.
The Council will utilise this framework and the six stage process as and when it is necessary to do so. Depending on the findings from the investigations undertaken contractual action may follow and/or an embargo may be placed on new placements or packages of care being commissioned from the provider in question. Any such embargos are communicated to other London boroughs. In the most serious of circumstances the Council may decide to move existing service users for whom the Council is commissioning care and advise other authorities and people using Direct Payments accordingly.