Integrated commissioning

Regulated personal care tasks as defined by CQC*:

• Getting up and/or going to bed
• Eating or drinking
• Continence management/aids
• Washing or bathing
• Dressing
• Oral hygiene
• The care of skin, hair and nails
• Support with moving and handling
• Prompting and supervising a person to do any of the types of personal care listed above, where that person is unable to make a decision for themselves about performing such an activity without being prompted and supervised. Support with medication is also considered as part of the support plan.

More information can be found on the CQC website: Scope of registration: Regulated activities - Care Quality Commission

*Please note the above is a list of regulated personal care tasks as defined by CQC and is not an exhaustive list of activities that might be undertaken as part of meeting a person’s care plan.

The first action is for the Adult Social Care practitioner to work with the individual and their carers as much as possible to identify a person’s outcomes. This is done on a case by case basis and people’s outcomes will be unique depending on what their care and support needs are this is a requirement of the Care Act 2014.

The assessment process should be:

• Person-centred approach to assessment
• Build on the individual’s strengths: 'start with what’s strong, not with what’s wrong'
• Involve the individual and their carers as much as possible
• Proportionate assessment: focus on the issues that are of greatest importance to the individual at that time
• Consider the least restrictive way of supporting the individual to get the outcomes that they want
• Look at the full range of resources available to the individual – universal services, voluntary and community sector, commercial providers
• Tailor the support to the person, not the other way around
• Support plans need to be proportionate to the needs to be met, and should reflect the individual’s wishes, preferences and aspirations.
• Remember that services are chargeable – look for the most effective and efficient way of meeting the individual’s preferred outcomes

Once the assessment process is concluded a plan of support is established that sets out how a persons assessed needs will be met. Where this is via the provision of domiciliary homecare, there is then a determination made about how much time would be typically needed to undertake the range of tasks to meet those assessed needs. Typically time bandings are applied from a minimum of 15 minutes with options to add further 5 minute increments as deemed necessary to allow sufficient time to undertake the tasks to meet assessed needs. Meeting a persons assessed need and the tasks necessary to do that, will always take precedent over the allocation time. Circumstances for the individual during any support visit will always be taken into account in order for assessed needs to be met.

• At the point that the care provider makes an offer to take on the support package, they are able to query the time/tasks allocated to a call. Care Brokerage can then inform the commissioning social worker, to consider.
• If the care worker identifies that more time or less time is needed regularly, they should raise this with their Manager. The manager will review the evidence, this might include observational practice of the care tasks delivered and a review of the Electronic Call Monitoring data.
• Where a change to the package of care is identified a request for a re-assessment is made by the provider to Salford Adult Social Care. This should include any evidence to support the request, such as Electronic Call Monitoring reports.
• If this does not address the issues raised then the care worker should review their employers escalation policy

Every individual that we support is different and the best way of supporting them will vary from day to day. It is common for the same task to take different lengths of time on different days. Care workers should always work with residents in a person-centred way to identify the best way of supporting the person on a particular occasion.

For occasional variations in the length of time required to complete tasks:

1. Additional time is needed to complete the required support, for example, if the person is unwell, the care worker can stay longer and inform their manager/office of the reasons why. Following discussion with adult social care the provider will be able to request the additional time when invoicing Adult Social Care, including the reasons.
2. If the full call duration is not required, for example a family member is visiting, the care worker can confirm that no other tasks are needed and record this in the visit notes.

If this is a regular occurrence:

a) and b) The carer should raise this with their manager, who will request a re-assessment and supply evidence to support the request for a re-assessment.

If the call is taking longer and therefore having an impact on the carer’s ability to meet subsequent visits on time, a temporary increase can be requested whilst waiting for Adult Social Care to re-assess.

The care worker should contact emergency services as required and inform the office.

Contact should then be made with the next of kin/emergency contact to inform of this and arrange for them to take over from the carer, if possible.

This could be carried out by the care worker on site, Branch staff or 'On Call' care co-ordinator.

If the care worker has to remain until assistance arrives, the office may have to arrange cover for any remaining visits on the carer’s rota.

The provider can submit a one-off request for additional care time delivered, dependent on the duration. For example if waiting for an ambulance and it could be several hours and attempts to get hold of the emergency contact have failed, the provider must also notify Adult Social Care to approve any extra costs. This can depend on the time of day the incident happens and the request can be logged the next working day if needed.

Homecare providers utilise Electronic Call Monitoring Systems in Salford.

1. The care worker will log in to the visit on arrival. Some systems utilise a 'geo mapping' facility which is based on the carer’s location within set parameters. Other’s have a physical QR/bar code or tag that is in the property which the carer will need to scan.
2. A visit notes record is also completed, to confirm tasks completed and report any issues/concerns. The notes can be an electronic version and part of the App used, or a manual record kept in the property.
3. The care worker would then scan again to log out of the call.

The Electronic Call Monitoring systems support the provider to manage better communication with the individual supported, as they are notified if a visit is not logged into within a 30-minute timeframe. This can be followed up with both the carer, to ensure they are safe and the person supported can be made aware of any delays.

If the original commissioned care package needs to change, a re-assessment should be requested. The Adult Social Care Practitioner will if appropriate provide a revised support plan following this.

The care provider will produce their own revised support plan and associated risk assessments. Any revised support plan must reflect the revised support plan developed by the Adult Social Care Practitioner.

The support plan will provide care staff with information required to meet the individual’s needs and complete agreed tasks.

Some providers use electronic records and support plans/risk assessments are accessed by staff via an App. This allows immediate updates to be actioned.

On occasions, changes to preferred times of visits may be requested by the person being cared for. These can be updated by the provider, with evidence recorded that this was to meet the person’s preference. Adult Social Care should be notified of this change for information purposes.

Care workers should follow employers relevant policies and procedures. This should include information about employer’s escalation and grievance policy and also whistleblowing procedures.

Care workers are able to report issues and request support independently via the below organisations (please note this is not an exhaustive list other organisations might also be available):

If you are worried about employment matters:

• Acas - Disciplinary and grievance procedures
• Trade Unions - Unison
• Citizens Advice Bureau

Care concerns:

• Care Quality Commission
• Salford Adult Social Care
• Healthwatch Salford

All providers in Salford should follow the Salford Safeguarding Adults Board’s policy and procedures for Safeguarding Adults

Providers should have their own internal Safeguarding policies which set out the responsibilities of their staff when a Safeguarding concern is identified. Care workers should be given adequate training by their employers so that they know how to raise a Safeguarding concern.

Trade unions support workers in ensuring their employment rights are protected. All workers have the legal right to join a trade union from day one of employment.

Salford City Council work closely with UNISON to improve standards for social care workers in Salford. UNISON is the UK’s largest trade union and have been involved in securing improvements in pay and terms and conditions in social care. You can find out more at Unison or by contacting the Salford branch confidentially at 0161 794 7425.

The Ethical Employment Standards in the homecare service standards are below. These are based on those developed by Unison in their Ethical Care Charter.

• Zero-hour contracts will not be used in place of guaranteed hour contracts. An offer of a guaranteed hours contact must be made to eligible employees.
• Homecare workers will be paid for their induction period, for travel time between visits, their travel costs incurred to deliver services and other necessary expenses such as mobile phones and data costs.
• All homecare workers will be trained to the necessary standard to provide a good service, to meet the needs of individuals supported (at no cost to themselves and in work time). The minimum requirements must meet the Skills for Care Core and Mandatory Training standards and also include specific conditions, as determined by the needs of individuals supported, for example Parkinson’s disease.
• Homecare workers will be given the opportunity to regularly meet co-workers to share best practice and peer support.
• Those homecare workers who are eligible must be paid statutory sick pay.
• Annual leave entitlements and payments should be calculated in accordance with ACAS guidelines.

In the first instance, any concerns and issues should be raised with the provider directly. A review can be carried to address these and agree any changes required.

If the problem is not satisfactorily resolved, Salford Adult Social Care can be contacted to address these issues.

Different options will be available, dependent on the circumstances, e.g. formal complaint process, safeguarding enquiry, or review. An alternative provider can be requested and the Adult Social Care practitioner will be involved to progress this.

Issues raised are reviewed, where themes and trends are identified Salford Care Organisation will work with homecare providers to improve quality and service standards