Clinical Quality Assessment in Nursing Care homes

1. Clinical Quality Assessment in Nursing Care homes Anne Moore Director of Nursing and Clinical Quality, Safeguarding Director of Infection Control

2. Rationale & Context • Serious Case Review findings • Increase in number of Adult safeguarding referrals – quality of nursing care • Care Quality Commission Essential Standards – opportunity to strengthen • Improved patient experience -Quality outcomes

3. CQA Programme – Project Brief The scope and objectives are detailed below: • Objective 1 • This project will report the findings of the baseline audit within the first tranche as prioritised • Objective 2 • This project will report on soft intelligence collated as a result of the audit assessment. • Objective 3 • This project will report on a proposed set of core standards to measure and monitor clinical quality nursing care in care homes to inform and ensure contract compliance • Objective 4 • This project will report on the learning outcomes • Objective 5 • This project will report on prospects for continuous improvement of clinical quality standards in care homes

4. The Assessment Framework Key Standards • Nutrition and hydration • Falls • Pressure Ulcers • Infection prevention and control • Continence care • Diabetes • End of life • Dementia care • Stroke

5. Key activity • Appointment of 1 x Nurse CQA post • Completion of self assessments & agreed Improvement Plan • 60 nursing care homes across Tees • 2 visits per each home ( 1 base line, 1 validation) • Communication strategy – all Stakeholders • Reference Group - monthly • Interim report – October 2010 • Final Report – December 2010

6. Initial Findings & Feedback • 14 base line audits completed across Tees • ( Hartlepool 1, Stockton 7, Mbro 3, Redcar & Cleveland 3) • 7 ( Southern Cross ) • 7 ( includes Bupa, Executive Care, no of private owners • 14 Improvement Plans agreed

7. Initial Findings & Feedback • Key areas for improvement ( Policy, procedures, workforce development , leadership & management & retention & recruitment of qualified competent staff, clinical supervision, formal induction, audit & care planning. • Evidence of Clinical Standards – variance despite a number of corporate providers with frameworks for supporting improvements in clinical ‘quality’ • Self assessment – received positively by all of the nursing care homes – opportunity expressed by care home staff to share best practice with colleagues working within the sector although limited mechanisms to do this outside of LA/NHS support. • Information within the self assessment enabled signposting to tool kits , guidance and access to a range of resources to drive quality improvements ( including local expertise) – awareness limited with some care homes regarding current & up to date information

8. Initial Findings & Feedback • CQC expectations /regulations – lack of clarity in relation to clinical requirements e.g reporting of pressure sores • Confidence in corporate organisations questioned in relation to implementing improvement plan – ( Resource led/driven – e.g availability of staff to undertake identified training within working hours • Lack of consistency in corporate response to drive and deliver improvements in clinical practice & quality outcomes

9. Key Challenges • Sustaining and embedding improvements ( quality of care) • Self Assessments – baseline and validation • Joint working between LA and NHS to monitor ‘quality outcomes’ across a spectrum of need • Contracts – essential standards must be contained • Sharing Intelligence and best practice

10. Questions?