Home Care Monitoring

1
Home Care Monitoring

• Guy Pettengell,
• Head of Operational Contracts

2
Hertfordshire context

• Hertfordshire provides Home Care services to over
  8,500 service users
• Through around 90,000 visits every week
• Around 3,000,000 hours of care per year
• All services provided through external provision

3
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

4
How we use monitoring data.

• Evaluate and approve new providers
• Ongoing Contract Management
• Monitor provider quality
• Support remedial action where necessary

5
The process.

• Approval
• Inspection
• Quality Monitoring and Benchmarking
• Electronic Monitoring

6
Approval Process.

• Providers must be registered with CSCI
• Providers must prove they meet HCC Contract
  Standards
• HCCs policy is to only contract with approved
  providers

7
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 Legislation
• Standard 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.

8
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.

9
Approval How?

• Provider makes an application
• Includes 2 year Accounts
• Includes appropriate insurance documentation
• Includes 2 professional references

10

• Contracts Officer carries out an initial
  evaluation of policies / procedures against
  contract standards
• Financial viability and insurance checked
• Employment status checked
• Indicative price

11

• 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 HCCs contract standards they become
  eligible to contract, and will be added to the
  Approved List

12
How we monitor and strive to improve standards

• A minimum of one annual Inspection against
  contract standards (inc. QMO feedback).
• Through EF1 data.
• Through RR1 data.
• Through QQ1 / 2 feedback.
• Through Electronic Monitoring.
• Quality Matrix (Benchmarking).
• Six monthly reviews with Block providers.

13
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

14
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

15
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

16
4. QQ1 / 2 Quality Questionnaires 1 and 2

• Quality Questionnaires (QQ1) sent to SSTs for
  completion
• Quality Questionnaires (QQ2) completed by
  contracting team inc. electronic monitoring
  performance
• Data entered into Quality Matrix

17
5. Electronic Monitoring.

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

18
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 QMOs (70)
• Quality Questionnaires (60)
• EF1 (60)
• RR1 (90)
• Electronic Monitoring criteria (75)

19
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

20
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.ht
  ml
• 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.