Deborah Tosler – Chief Executive, Prospect Housing and Support Services reports back on her recent attendance at the CQC Adult Social Care Intelligent Monitoring Meeting:-

I was really lucky to attend a day on behalf of ARC where CQC were consulting on their plans for intelligent monitoring in the adult social care sector. CQC plan to introduce this across all the sectors they regulate. The aims of this are to:-

i) Help them decide when an inspection should take place
ii) Identify potential risks to people who receive services
iii) Inform key lines of enquiry for inspections
iv) Contribute to ratings assessments

Intelligent monitoring reports are put together by a specialist team of staff who present a report to an inspector before they do an inspection. They are built around trying to answer the 5 key questions:-

Is the service safe?
Is the service effective?
Is the service responsive?
Is the service well lead?
Is the service caring?

The reports for inspectors will include data obtained from:-

i) The PIR completed by the provider,
ii) Intelligence from CQC staff,
iii) Intelligence from ‘Your Experience Webforms,
iv) Questionnaires received from people who use services, staff, relatives and friends and community professionals (community services only)
v) Feedback from LA safeguarding Boards
vi) Feedback from the HSE (residential only)
vii) Provider profile on the NHS Choices site (residential only)
viii) Feedback form the Chief Coroners Office (residential only)
ix) Feedback from the Food Standards Agency (residential only)
x) CFOA Fire Notice Register (residential only)

Intelligent Monitoring reports will not be published in the Adult Social Care Sector.

CQC have formulated indicators of risk which are reported on in these reports. (Please treat these with care as they were only for consultation and will change as comparative data becomes available).

For all schemes the indicators of risk CQC were consulting on were:-

i) Receiving more than one ‘qualified’ whistle blower enquiries in the last 12 months
ii) Previous enforcement activity in the last 12 months
iii) CQC have received more than one complaint about a location in the last 12 months
iv) Any negative comments received in the last 12 months outside of the inspection
v) Higher than expected staff vacancy rates (currently suggesting 10% for community services and 3% for residential care.
vi) Higher than expected turnover (currently suggesting 22% for community services and 17% for residential care)
vii) Not having a registered manager in place
viii) More than 2 changes of registered manager at a location in the last 12 months
ix) Serious case reviews in the last 2 years
x) No equality and diversity policy in place

There are others just for residential care. These include:-

i) Ratio of staff to beds (currently suggesting 1.66 staff to each bed).
ii) One or more (per bed) serious injury notifications in the last 12 months
iii) One or more (per bed) deaths in the last 12 months
iv) Three or more safeguarding incidents per 10 beds in the last 12 months and at least 8 incidents in the last 12 months
v) RIDDOR notifications made in the last 2 years
vi) HSE complaints made in the last 2 years
vii) Current HSE enforcement or prohibition notice in place
viii) One or more residents having developed a moderate or severe pressure ulcer in the last 12 months
ix) One or more emergency admissions to hospital due to a pressure sore, UTI, pneumonia, pneumonitis, dehydration or lower respiratory tract infection in the last 12 months
x) One or more per cent of residents having had a fall which results in moderate or severe harm or death in the last 12 months
xi) Moderate, severe or fatal harm has been caused by the administration of medicines to one or more people in the last 12 months
xii) Less than three stars for a food hygiene rating
xiii) A fire enforcement notice in place

The following for Community services:-

i) The ratio of staff to hours is at least 0.08
ii) Number of visits taking pace within 30 minutes of the start time in the last quarter (no data suggested)
iii) Proportion scheduled visits missed in the past 28 days (No data suggested)
The following for community services and residential services:-
i) More than 3% vacancy rate for care staff in residential homes and 6% in community services
ii) Less than 85% of staff have completed induction within 12 weeks of employment
iii) Less than 48% of care staff hold a Diploma in Health and Social Care
iv) For those care staff without a Diploma number not working towards a diploma (no data yet)
v) More than 17% turnover of staff
vi) Less than 90% permanent staff
vii) One manager for every 12 staff members in community services and one manager for every 10 staff in residential services
viii) More than 26% staff in residential care and 6% in community services leaving due to their working conditions
ix) More than 2% vacancy rate for management staff
x) There is no member of staff with a management qualification
xi) The manager doesn’t hold a care qualification

There were some providers who were concerned about how this report would be used. CQC were quite clear that these were only a tool and that no analysis or commentary would be provided with them.

The workshop involved providers and CQC staff working together:-

i) To identify what are the key signals that indicate risk of poor quality care and how these might be measured and monitored
ii) Whether any other sources of data would be available to CQC
iii) Concerns about the quality of data and how it might be interpreted

CQC plan to collate the information from the workshop and do an internal evaluation. A second draft will be produced in April 2015 with feedback gained from the workshop I attended and a third draft in September 2015 incorporating the results from the internal evaluation. Further workshops will run in November with the model launched in April 2016.

Deborah Tosler
Chief Executive, Prospect Housing and Support Services