Home Care Monitoring

Guy Pettengell,

Head of Operational Contracts

Hertfordshire context

• Hertfordshire provides Home Care services to over Hertfordshire provides Home Care services to over 8,500 service users8,500 service users

• Through around 90,000 visits every weekThrough around 90,000 visits every week

• Around 3,000,000 hours of care per yearAround 3,000,000 hours of care per year

• All services provided through external provisionAll services provided through external provision

The aims of monitoring

• To ensure that contracted services continue to meet the HCC contract standards

• To ensure that HCC is able to offer our Service Users a range of high quality, consistent and secure home care services

How we use monitoring data.

• Evaluate and approve new providers

• Ongoing Contract Management– Monitor provider quality– Support remedial action where necessary

The process.

• Approval

• Inspection

• Quality Monitoring and Benchmarking

• Electronic Monitoring

Approval Process.

• Providers must be registered with CSCI

• Providers must prove they meet HCC Contract Standards

• HCC’s policy is to only contract with approved providers

Contract Standards.Standard 1 The agency operates on a sound financial footing.Standard 2 The agency maintains proper insurance arrangements.Standard 3 The agency operates an effective Quality assurance system.Standard 4 The agency ensures that management systems and staff

workloads enable safe and effective service delivery to service users.

Standard 5 Staff are competent and receive training necessary to meet the needs of service users.

Standard 6 The agency complies with Health and Safety LegislationStandard 7 The agency provides a professional service, respecting the

rights of service users; and does not discriminate in the provision of services or its employment practices because of race, religion, gender, disability, age or sexual orientation.

Standard 8 The agency has effective arrangements for service users to make representation about the nature and Quality of the service received.

Standard 9 Service users are protected from abuse and exploitation.

Additional Standards for live in care providers.

24 Hour Live In Care

Standard 10 The agency has effective arrangements for the replacement of a careworker in case of emergency.

Standard 11 The agency must ensure formal monitoring of the Quality of service and standard of care provided is conducted on-site with the service user on a

monthly basis.Standard 12 The agency must conduct monthly on-site

supervisions with care workers. Standard 13 The agency produces written guidance for

careworkers regarding standards of personal behaviour expected whilst providing a live in service.

Approval – How?

• Provider makes an application:– Includes 2 year Accounts– Includes appropriate insurance

documentation– Includes 2 professional references

• Contracts Officer carries out an initial evaluation of policies / procedures against contract standards

• Financial viability and insurance checked

• Employment status checked

• Indicative price

• Any requirements are notified with specified timescales

• Once requirements met the contracts unit carries out an initial inspection

• If the provider passes this inspection and meets all of HCC’s contract standards they become eligible to contract, and will be added to the Approved List

How we monitor and strive to improve standards

1. A minimum of one annual Inspection against contract standards (inc. QMO feedback).

2. Through EF1 data.

3. Through RR1 data.

4. Through QQ1 / 2 feedback.

5. Through Electronic Monitoring.

6. Quality Matrix (Benchmarking).

7. Six monthly reviews with Block providers.

1.Inspection

• Annual Contract compliance inspection (full day)• Published Inspection Report including QMO

feedback• Any Requirements Identified, action plan agreed• Report scored (based on three levels of risk

current / imminent / possible) and entered in Quality Matrix

EF1 (Electronic Form 1)

• EF1 completed monthly by SST and sent to Contracts Unit listing all concerns / complaints / compliments

• Concerns weighted by 14 categories / and by volume

• Info collated into Countywide spreadsheet to identify any trends

• Major concerns / issues / trends taken up directly

• Quarterly evaluation entered into Quality Matrix

3.RR1 (Referrals/Refusals Form 1)

• RR1 returned to Contracts by SST on a monthly basis

• Used to monitor take up of work inc. increases / decreases

• Results added into Quality Matrix

4. QQ1 / 2 Quality Questionnaires 1 and 2

• Quality Questionnaires (QQ1) sent to SST’s for completion

• Quality Questionnaires (QQ2) completed by contracting team inc. electronic monitoring performance

• Data entered into Quality Matrix

5. Electronic Monitoring.

• A number of K.P.I’s are used in respect to monitoring provider performance, inc:– Arrival time within 15 minutes– Continuity of Care– Average length of calls– Invoice Split

6. Quality Matrix.• All data entered quarterly into Quality Matrix

• The scores achieved for each of the elements are then entered to produce the final ‘Total Quality’ Score. However each individual element has a minimum ‘benchmark figure’ to exceed.– Inspection Report (60%)– Feedback from QMO’s (70%)– Quality Questionnaires (60%)– EF1 (60%)– RR1 (90%)– Electronic Monitoring criteria (75%)

7. Six monthly reviews

• All relevant data obtained through monitoring is discussed with provider (inc. QMO feedback)

• Actions to improve service (inc. timescales) agreed

• Ongoing monitoring of action plan at formal reviews (either 1, 2 or 3 monthly)

• Links with CSCI – e.g work ceased with Level 1 services

The future• The Monitoring processes used by the Contracts Unit have

achieved recognition as an example of Best Practice by the Audit Commission for the Joint Review Toolkit: http://www.joint-reviews.gov.uk/money/homepage.html

• Hertfordshire is recognised nationally as the leader in the implementation and use of Electronic Monitoring. (DOH Case Study), and in market management (CSIP e-book).

• However with nearly 90,000 visits each and every week things do go wrong. Because of this the Contracts Unit continues to work with colleagues to strive for continuous improvement and better quality services.