SECTION 1 SERVICE SPECIFICATIONS. Service Specification for Care Homes with/without nursing

Transcription

1 Module B, Section 1 SECTION 1 SERVICE SPECIFICATIONS Section 1: Service Specification for Care Homes with/without nursing Service Commissioner Lead Provider Lead Period Date of Review Key Service Outcomes The key service outcomes below are based on the CQC essential Standards of Care March 2010 and Adult Social Care Outcomes Framework 2012/2013: 1. People with care and support needs have enhanced quality of life. 2. People are helped to recover from episodes of ill health or following injury. 3. People have a positive experience of care. 4. People are treated and cared for in a safe environment and protected from avoidable harm. Performance indicators for the outcomes are outlined in Section 3 Part 1 of this Module. The outcomes depend on other services that are complementary to the Care Home with Nursing services in some cases. The Home should work co-operatively with the relevant services to meet outcomes. 1. Purpose of Service The objective of the service is to deliver care in Care Homes with or without Nursing that meets the outcomes outlined above. 2. Scope 2.1 Any exclusion criteria The scope does not include Continuing Healthcare Service Users Who are not registered with a GP within the NHS Dorset CCCG catchment area 2.2 Interdependencies with other services The Services should be seen as part of wider integrated adult health and social care services working in partnership with GPs, Primary Health Care teams, acute providers, local authorities, community mental health teams, the voluntary & community sector and independent providers. The Provider must demonstrate how it will work with these other organisations to support Service Users and their carers to successfully manage the Service Users conditions. The 1

2 Provider should as a minimum have a well-developed and audited pathway for communication with GPs and the wider health, voluntary and social services environment. 3. Service Delivery 3.1 The Care Home with and without Nursing General The Provider will: Maintain CQC registrations for all Homes Maintain the Home, equipment and daily living adaptations in good working condition in accordance with CQC Essential standards of quality and safety guidance (CQC Essential Standards) Outcome 10, Safety and suitability of premises Involve Service Users in decision making regarding furnishing and décor as per CQC Essential Standards Outcome 10L Personal accommodation The provider will: Give Service Users their own designated single room unless the Service Users requests otherwise with the approval from the Commissioner (CQC Essential Standards Outcome 10L); Enable Service User is to have access to their room at any time and as often as they wish; Have call alarm system to enable Service Users to get help (CQC Essential Standards Outcome 10F); Not move Service Users to an alternative room/accommodation, without prior consent from the Service User and the Commissioner (except in an emergency); and Have furniture and fittings appropriate for Service Users including those with physical disabilities, bariatric requirements, severe epilepsy or behavioural disturbances Visitors The Provider will share their visiting policy with Service Users and any appropriate interested persons on admission. Every Service User has the right to refuse to see a visitor. The Provider will support this decision. The Provider will maintain a Service User visitor log Advocates The Provider will: Support Service Users use of advocates (as defined in CQC Essential Standards) as per CQC Essential Standards prompts 1A, 1H, 71 and 17A; Make a referral to an independent advocate when a conflict arises in the Service Users life and the Service User has no relatives or is particularly frail or vulnerable. In these instances Provider will also notify the Commissioner; inform any advocate representing a Service User of major changes in the Service Users life. 2

3 3.1.5 Service Users possessions (a) General The Home will handle Service Users money and valuables as per CQC Essential Standards Outcome 7C and 7M (b) Property Service Users will be allowed within reason, personal property (e.g. pictures, music systems, televisions, computers) in their room. Service Users and or their advocates will be responsible for the maintenance of these items. Providers will have procedures in place for protecting and securing Service Users possessions kept in their own rooms. The Provider s public liability insurance will cover Service Users property for theft or damage. This will not apply if damage was caused by the Service User. Service Users will under no circumstances be required to sign a waiver of liability. When the Service User no longer resides in the home, as agreed with the Commissioner, the Provider will contact the Service Users next of kin/a named representative so they can collect the Service Users personal effects. Where no next of kin/named representative exists the Provider will contact the Commissioner, who will make the necessary arrangements (c) Money The provider will recognise the Service Users right to conduct personal finances. In some cases personal finances will not be managed by the Service User, power of attorney or a Local Authority appointee. In these cases the Provider, in agreement with the Local Authority, may apply to the Court of Protection for the right to manage the Service Users personal finances. If granted, the Provider must notify CQC on inspection, the Local Authority and the Commissioner. If the Provider is responsible for Service Users finances, money must not be pooled across Service Users, and must be held in individual named person accounts. The Service User will be expected to pay for the following items (this list is not exhaustive): Tobacco, cigarettes and alcohol; alcoholic beverages; newspapers and magazines, where specifically ordered by the Service User; clothing and other similar personal items; personal travel incurred at the Service Users request (excluding travel relating to the 3

4 Service Users care needs); hairdressing optical services; dental services; chiropody; legal advice; holidays; social activities not provided by the Home; and toiletries over and above those provided by the Home Equipment The Provider will be expected to provide the standard equipment (lists available via links below) where required, either through their equipment suppliers or a GP at no additional cost to the Commissioner or Service User. The standard equipment list for NHS Dorset is Split between East and west and can be found at Service Spec appendix A (East) & B (west) The Provider will maintain equipment as per CQC Essential Standards Outcome 11. If following a clinical review it is identified that an Service User requires equipment considered Specialist, the Provider must contact the Commissioner to discuss purchasing arrangements prior to supply Equipment provided by the Commissioner Specialist Equipment provided for a Service User by the Commissioner must be: Managed safely and securely; Operated in line with the manufacturer s instructions; Made available for maintenance Have available evidence of a service log and audit of maintenance Only used in relation to the named Service User. In the event of the equipment no longer being required for the Service User for whom the equipment was identified, the Provider must advise the Commissioner within 24 hours in order that arrangement can be made for the equipment s collection. 3.2 Staffing General Need The Provider will ensure that: Systems are in place to maximise staff continuity and minimise use of temporary 4

5 staff. The Manager is registered with the CQC within four months of commencement of employment. The Manager possesses a minimum of NVQ Level 5 or equivalent Recruitment The Provider will have recruitment practice and policies in line with CQC Essential Standards Outcome 12A and Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations Staff Training The Provider will ensure that: A training matrix including induction and mandatory training for all staff is in place. Staff will receive learning and development opportunities necessary to carry out their roles and maintain their skills as outlined in CQC Essential Standards Outcome 14A and/or the Nursing & Midwifery Council. Staff must be competency assessed to deliver care and treatment to meet all Service Users needs safely and to an appropriate standard and this must be reviewed on an ongoing basis In order to meet a Service Users needs, training may include acquiring specialist nursing care skills as required Responsibilities of Staff (a) General The Provider will: Maintain awareness of the Service Users needs as outlined in CQC Essential Standards Outcome 4A, informing the Commissioner or Safeguarding if any needs are not being met; and Ensure staff are clear about their responsibilities and aware of Standards as per CQC Essential Standards Outcome 12A and 12B (b) Registered nurses Each Service User must have a Named Registered Nurse. The Named Registered Nurse will: Be responsible for developing, evaluating and updating the Service Users Care Plan in a timely manner; Coordinate the care for the Service User as specified in the individualised Care Plan; Work with the Service User and any members of family/friends involved in the Service Users life; and 5

6 delegate nursing care provision with an appropriate level of supervision as outlined in CQC essential Standards Outcome 24A and in accordance with Nursing & Midwifery Council s Code of Professional Conduct. 3.3 Administration The provider will comply with CQC Essential Standards Outcome 21A and all applicable statutory and legal obligations concerning record keeping. On request the Provider will give the Commissioner any records relating to the provision of the Service. These will be provided to the Commissioner within two weeks of the request being made at no additional cost to the Commissioner Policy Requirements The Provider must comply with all relevant current legislations This includes adherence to the latest CQC Essential Standards of care and quality guidelines ( at any time of writing. This contract will be assumed to incorporate any changes made to the legislation and governing bodies. 3.4 Admission into care Pre-placement assessment The Provider will meet and assess the potential Service Users to determine whether they can meet the Service Users needs. In reaching this determination, the Provider will consider the impact that meeting this Service Users needs may have on other Service User within the home. This assessment will occur and be reported back to the Commissioner within 48 hours of the Commissioner s request for assessment. If the Provider assesses that they can meet the Service Users needs then the Commissioner will confirm the admission arrangements with the Provider. On confirmation of placement, the Commissioner will give the Provider copies of the relevant assessments as required. The Provider will offer an introductory visit as per CQC Essential Standards Outcome 4W. The Provider will ensure that the Service User is registered with a NHS Dorset CCG GP at the time of admission. The NHS Commissioner and Provider will complete a Memorandum of agreement (Placement Agreement) for the Service User. 6

7 3.4.2 Service Users transfer to Provider care Service Users may be transferred to Providers from a range of locations, e.g. acute hospital environment, own home or other Providers. Alternatively, the Service User may be an existing resident of a home and require an increased/decreased level of care provision. Service Users will be transferred into the care of the Provider with relevant documentation as detailed in CQC Essential Standards Outcomes 6A and 6B Activity upon admission Upon admission the Provider will develop a full person centred Care Plan within 48 hours for, and in conjunction with, the Service User in line with CQC Essential Standards Outcome 1B and CQC Essential Standards Outcome 4A). The Provider will also Give the Service User information about the Provider s services as per CQC Essential Standards Outcome 1H: and Introduce the Service User to their nominated Named Registered Nurse. Upon admission the Commissioner will notify the Provider of the date by which the Service Users eligibility for Continuing Healthcare will next be assessed 3.5 Care within the home Service Users needs and Provider requirements The Provider will assess Service Users needs in accordance with the CQC Essential Standards Outcome 4A The Service User, their representative, the Commissioner or the Provider may request a review of the Service Users needs at any time. If there is a significant change in the Service Users needs or if the requirements of the existing Care Plan are not being met the Provider will notify the Commissioner as soon as is reasonably practicable. The Provider will meet the requirements detailed in Table 2. The Service Users may not have all of these needs but where they exist the Provider must ensure they are met in a timely manner. The Provider will meet all requirements for all Service Users. The Provider will refer Service User to specialist care as appropriate. Table2: Service Users needs and requirements of Provider (non-exhaustive) Need Behaviour Aggression, violence o passive nonaggressive behaviour Severe dis-inhibition Requirements Support behaviour as per CQC Essential Standards Outcome 7F, 7G and 7H, in particular: Understand and identify potential 7

8 Intractable noisiness or restlessness and/or walking with purpose Resistance to necessary care and treatment (this may therefore include non-concordance and noncompliance, but see note below) Severe fluctuations in mental state Extreme frustration associated with communication difficulties Inappropriate interference with others Identified high risk of suicide Cognition Marked short term memory issues Long term memory problems Disorientation of time and place Limited awareness of basic needs and risks Difficulty making basic decisions Dependant on others to anticipate basic needs Psychological and Emotional needs Unable to express their psychological/emotional needs Mood disturbance Hallucinations Anxiety Periods of distress Withdrawn from attempts to engage in daily activities trigger behaviours that present a risk for each person or to others; and Having staff with the skills and knowledge to be able to respond immediately to reduce the likelihood of this behaviour happening or recurring. Ensure behavioural incidents are recorded and the care plan is modified in response to these incidents. Provide appropriate specific therapeutic activities. Review as per CQC Essential Standards Outcome 2A, 2C, in particular: Following any advance decision made in line with the Mental Capacity Act 2005 that the person using the service may have made, wherever this is known by the provider. Along with: Encourage Service Users family/friends to visit and bring in their personal possessions (for instance photographs) Use reality orientation and validation techniques Have a communication strategy to assist Service Users to express needs and make decisions Prompts to motivate towards engagement with daily activities Provide additional support to facilitate Service Users involvement as required Support Service Users with life changing events as required in accordance with CQC Essential Standards Outcome 4A Recognise Service Users depression and its effects on behaviour (as per CQC Essential Standards Outcome 4D). Refer Service Users to primary and secondary care services Staff must be skilled to recognise psychological and emotional 8

9 Communication (relates to difficulty with expression and understanding, not with the interpretation of language) Sometimes unable to reliably communicate Unable to express needs, even when assisted Mobility Unable to consistently weight bear Completely unable to weight bear High risk falls Needs careful positioning Unable to assist or cooperate with transfers and/or repositioning Involuntary spasms or contractures Nutrition food & drink At risk of malnutrition, dehydration and aspiration Significant unintended weight loss or gain Dysphagia/Risk of choking Alternative enteral feeding methods eg PEG, NG, NJ 9 problems and refer to appropriate services Support Service Users relationships (including partners, families and friends) as per CQC Essential Standards Outcome 4A Have an activity programme tailored to meet the Service Users needs and prevent isolation as per CQC Essential Standards Outcome 7G Communicate with Service Users as per CQC Essential Standards Outcome 12A, 12B, 14A and 1G Special assistance or equipment may be needed to ensure accurate interpretation of needs Able to anticipate needs through non-verbal signed Have individual falls and moving and handling risk assessments which enable the Service User to maintain optimal mobility Staff must be trained in moving and handling and falls prevention Provide and maintain mobility equipment. Replace where necessary Appropriate and timely referral to the falls assessment team if required Support the Service Users nutritional requirements in line with CQC Essential Standards Outcome 4A, 5A, 5B, 5C and 5H Staff must be familiar with nutritional assessment tools and refer to the Dorset Nutritional Care Strategy for Adults Seek GP/dietician advice when a significant change in weight occurs Skilled intervention to ensure adequate nutrition/hydration and minimise risk of aspiration to maintain airway Ensure that staff are trained and

10 Continence Incontinent of urine and/or faeces Catheterised Requiring stoma care Chronic urinary tract infections Tissue viability Skin condition that requires ongoing evaluation and re-assessment Risk of skin breakdown requiring intervention Pressure damage or open wound Open wound, pressure ulcer with full thickness skin loss and narcosis extending to underlying bone Breathing Shortness of breath which may require the use of inhalers or nebuliser Episodes of breathlessness that do not readily respond to management competent in delivering alternative enteral feeding methods Recognise normal patterns and act on abnormal occurrences (seeking specialist advice as required) Assess, identify and take appropriate action in response to an infection. Have appropriate management supervision and equipment (for instance, in relation to catheterisation and bowel management) Have appropriate training in catheter and stoma care Undertake continence assessments and promote continence with individual continence programmes Refer to the Continence Service in a timely manner Have policies and procedures that comply with current NICE guidance and CQC tissue viability guidelines (CQC Essential Standards Outcome 20I) Trained and competent staff to promptly recognise and act on changes to risk factors as per CQC Essential Standards Outcome 16B Have equipment to maintain skin integrity Manage skin conditions Have evidence based wound management policy that meets local tissue viability referral criteria Have a nominated tissue viability link nurse for each home who undertakes training in wound care to recognise problems as the occur and seek specialist advice Staff must be trained and competent to use equipment and oxygen to support Service Users breathing as prescribed 10

11 Requires low level oxygen therapy Breathing independently through a tracheostomy Difficulty in breathing which requires suction to maintain airway Medication management Requires supervision and administration and/or prompting Non-concordance or noncompliance Administration of complex medication Medication via PEG Requires ongoing pain control EOLC (including Controlled Drugs) Altered states of consciousness- can include a range of conditions including stroke and epilepsy Manage medications in accordance with CQC Essential Standards Outcome 9 Management of Medicines Provide evidence that all RNs are regularly assessed as competent in the management of medication Monitor fluctuating conditions and side effects Have a written procedure for medicine management which includes managing nonconcordance, non-compliance, disposal of medication, nonprescribed medication and covert administration of medication Ensure a programme for medication reviews is in place and/or as required Use a range of tools to assess pain Administer analgesia as prescribed and monitor effect using pain assessment tool Use non-pharmacological methods to reduce pain and discomfort Manage medication for rapidly deteriorating or changing conditions Have a system to ensure access to anticipatory end of life drugs Staff must be trained in administering complex medication including via PEG Staff are trained in the use of syringe drivers Implement individualised management plans End of life care Evidence that Provider has implemented systems and processes for managing EOLC and evidence that staff are trained and 11

12 competent in implementing these systems and processes Involve Service Users and their family/friends (as appropriate) in planning for their EOLC as per CQC Essential Standards Outcome 4k. Act in accordance with the NHS Dorset Clinical Commissioning Group DNACPR policy. Offer Advance Care Plans (ACP s) to Service Users at appropriate intervals. Review ACP s as required. Train staff in end of life identification, planning and coordination skills and verification of expected death, in line with a model such as the Gold Standards Framework. Manage care in line with the NICE quality standard for end of life for adults Enhanced Observation If a Service User requires enhanced observations during care (in exceptional circumstances only), the Provider will obtain agreement with the Commissioner in advance of the enhanced observations being put in place. Authorisation will be sought in writing, supported by a clinical rationale. In emergencies, where it is not possible to seek advance agreement from the Commissioner authorisation will be sought the next working day Equality and Diversity The Provider will consider the needs of each Service User in relation to race, age, gender, disability, sexual orientation and religion or belief as per CQC Essential Standards Outcome 1G, 2B, 5C and 10I Infection Prevention and Control The Provider will; Meet the requirements detailed in Department of Health Code of Practice on the prevention and control of infections Appendix A and related guidance published Dec 2010, Health and Social Care Act 2008 and NICE Infection Control guidelines; 12

13 Co-operate with and support screening procedures, in particular Service Users at high risk of contracting healthcare associated infections, e.g. Service Users who will need hospital admissions because of chronic conditions, are going to be having surgery or have pressure ulcers or leg ulcers; Work effectively with other organisations to reduce the risk of healthcare associated infections (for instance, when transferring a Service Users with MRSA between a hospital and the Home); and work with the NHS Infection Control Nurse and/or NHS England to undertake root cause analysis of all healthcare associated infections and take action to prevent further incidences Medication The provider s medicines administration policy will include procedures for Service Users to take responsibility for their own medication if they wish as per CQC Essential Standards Outcome 9A. The Provider will seek information and advice from a pharmacist regarding medicines policies (including the management of homely remedies). Medicine s prescribed for an Service User will not be given to any other person. The Provider will maintain a Controlled Drugs (CD) Register in accordance with CQC Essential Standards Outcome 9B, in particular the Misuse of Drugs Regulations 2001 as amended and any subsequent amendments. The Provider will carry out a monthly self-audit to confirm compliance with CQC Essential Standards Outcome 9. Providers may use their own toolkit for the self-audit Safeguarding The Provider will safeguard users in accordance with CQC Essential Standards Outcome 7 and Protecting Adults at Risk: Pan Dorset Adult Safeguarding multi-agency policy and procedures to safeguard adults from abuse. In addition to the statutory requirement to report all safeguarding issues to CQC and the relevant local authority, all safeguarding issues should be reported to Commissioners at the same time. Providers will be required to have whistleblowing policies arrangements established within the home. Providers will ensure that all staff receive safeguarding training and supervision following a safeguarding investigation if appropriate 3.6 Clinical Governance The Provider will: Have a robust system of clinical governance in place as per page 27 of the CQC 13

14 Essential Standards; Have clear, written description of Staff roles and decision making ability regarding the care of a Service Users as per CQC Essential Standards Outcome 16D; and Have a named registered nurse (role as described in 3.2.4b) as the lead described in CQC Essential Standards Outcome 6A Care Plan and Care Record The Care Plan is an assessment of the Service Users needs, planning to meet those needs, implementing the plan and reviewing and recording those plans. Any agreed outcomes with the individual, representative or commissioner should also be documented and monitored within this care plan. Wherever possible the Service User should be involved in the development of the personal Care Plan. The nursing care record is a record of health and care that an Service User receives and must adhere to the NMC standards for record keeping. The Home must maintain the nursing care record which details, in English, all the nursing care provided to an Service User to confirm that the Care Plan has been implemented. This record must be standardised and include, but not be limited to; The date and time care was provided; The type and frequency of care provided; Observations which may be relevant to nursing need; Achievement of agreed outcomes Action to be taken and the name of the person responsible; and The signatures of the Staff members providing the care Complaints Complaints, concerns and suggestions should be viewed as a means to improving service quality. Providers will effectively manage complaints as guided in CQC Essential Standards Outcome 17A including having evidence of a complaints policy. In the event of a formal complaint the Provider will notify the Commissioner if the Provider is unable to resolve the complaint to the complainant s satisfaction using the Provider s complaints procedure Raising Concerns The provider shall deal with Staff concerns about the Services as per CQC Essential Standards 16A and 16B. 3.7 Interdependencies 14

15 3.7.1 Access to primary healthcare services The Provider will comply with CQC Essential Standards Outcome 6I and 6K. The Provider will enable Service Users to access the full range of primary healthcare services via their GP. The Provider will refer Service Users to their GP or other services in a timely manner. Primary healthcare providers are expected to deliver their services. If they do not provide the services this should be raised directly with the Commissioner who will work with the primary healthcare providers and the Provider to resolve it Coordination with CQC and Local Authorities Where possible Commissioners will work with CQC and Local Authorities regarding quality assurance to avoid duplication. 3.8 Access to NHS secondary and tertiary care services Transport The Provider will arrange transport for Service Users attending secondary and tertiary care service appointments. The Provider should liaise with the appointment provider regarding transportation Escorting a Service User The Provider will ensure an Service User is accompanied appropriately to the level of risk and care need associated with the appointment. The first four hours of escorting will not be charged as an additional cost to the Service User or Commissioner. Provider escorting required beyond the first four hours will be charged at the normal hourly rate for 1:1 charged by the provider In the case of a routine hospital admission, the Service Users will remain accompanied up until the point of admission Communication Based on the Service Users needs, the Provider will alert the appointment provider of any interpretation and communication requirements prior to the appointment. 3.9 Hospital Stays Activity supporting an Service Users admission into hospital 15

16 Upon admission into hospital or another provider the Provider will inform; (a) The Service Users next of kin/a named representative as soon as possible (b) The Commissioner verbally and via /letter within 24 hours; and (c) The Service Users GP within 24 hours The Provider will maintain contact with the hospital throughout the Service Users stay and will record this contact within the care plan Activity supporting an Service Users discharge from hospital At the request of the Commissioner and prior to the Service Users discharge from hospital, the Provider will review the Service Users clinical needs to ensure they can still be met by the Provider. The reassessment must take place within 48 hours of being informed that the Service User is deemed medically fit for discharge. If the Provider can continue to meet the Service Users needs, upon readmission to the Home the Provider will inform; The Service Users next of kin / a named representative of the readmission as soon as possible; The Commissioner of the readmission verbally/ /in writing within 24 hours, and The Commissioner of any revisions to the Care Plan within 48 hours of readmission In exceptional circumstances where the Provider can no longer meet the needs of the Service User the Provider will notify the commissioner as soon as possible explaining the rationale for no longer being able to care for the Service User Absence Planned Trips (less than one day) without Provider Staff A Service User may take a planned trip and go out of the home (for instance, with family and friends). On these occasions the Provider will complete a risk assessment in conjunction with the Service User (and the person or persons accompanying them) prior to the outing. The risk assessment should address the care the Service User should receive (including timely administration of medication) and when the Service User is due to return to the Home. A person may not be deprived of their liberty unless authorised under Deprivation of Liberty Safeguards (DOLS) as set out in the Mental Capacity Act Holiday / agreed leave for more than 24 hours The provider will; Apply the same principles re: planned trips to longer periods of agreed leave; 16

17 Inform the Commissioner of the period of leave in advance of the period of leave; Agree the risk assessment with the Commissioner in advance of the period of leave; and Negotiate a retention period and rate with the Commissioner as required Unplanned absence If an Individual does not return to the Home as planned following agreed leave, the Provider will try to contact the Individual and those accompanying them to establish if there is a problem. If the Individual cannot be contacted, the Provider should instigate escalation procedures based on the risk assessment which could include calling the police and raising a safeguarding alert. If the Individual leaves the Home without notifying the Provider, the Provider should instigate escalation procedures based on the risk assessment, which could include calling the police and raising a safeguarding alert. The Provider will notify the Commissioner of the unplanned absence within 24 hours. The provider will adhere to the reporting requirement for an Individual receiving care under any section of the Mental Health Act as appropriate. The Provider will hold the Individuals room for a period of seven days which the Commissioner will fund. If the Individual does not return within seven days the individual placement will cease unless the Commissioner and Provider negotiate an extended retention period Discharge to a third party Individuals will be discharged in accordance with CQC Essential Standards Outcome 6A and 6B. Service Users will not be discharged without prior approval from the Commissioner. All reasonable efforts will be made to prevent an Service Users eviction from the Home. The Provider will work with the Commissioner to take steps to resolve issues as and when they arise. Eviction will only occur if all other demonstrable efforts to resolve issued have been unsuccessful. If, despite all reasonable endeavours to resolve issues, the Provider cannot meet the needs of the Service User, then the Provider and Commissioner will work to discharge the Service User to a service that can meet their needs in accordance with CQC Essential Standards Outcome 4D and Death In the event of the death of an Service User, the Provider will comply CQC Essential 17

18 Standards 4K and 18. The Provider will also notify; (a) The Service Users next of kin / a named representative as soon as is reasonably practicable, so that suitable arrangements (including burial/cremation) can be made; (b) The Commissioner verbally/ /in writing within 24 hours; and (c) The Service Users GP within 24 hours The Provider will ensure that the Service Users medicines are managed in accordance with CQC Essential Standards Outcome 9B. In the case of a suspicious death the Provider will notify the Commissioner as soon as is reasonable practicable. 4. Fees 4.1 Agreed Weekly Rate The Agreed Weekly Rate for all services is set on a case by case basis at outset of the placement. The Commissioner will pay the Provider the Agreed Weekly Rate from the first day of the Service Users admission/eligibility until the date of discharge. 4.2 Enhanced Observation Rates As per Section of this Service Specification the following costs will be charged in addition to the Agreed Weekly Rate, in exceptional circumstances only. 4.3 Rate changes in cases of absence The payment will differ from the Standard Weekly Rate in exceptional circumstances where a Service User is admitted into hospital (for elective or emergency treatment) or goes on holiday / agreed leave for more than one day. If the commissioner wants to agree a bed retainer period, then the Service Provider and Commissioner will negotiate the appropriate level of payment. The level of payment will be a proportion of the Agreed Weekly Rate only; no additional charges will be incurred. 4.4 Payment post Service User discharge or death Following a Service Users discharge or death, the Commissioner will cease payment on the date of discharge or death, unless in exceptional circumstances previously agreed by the Commissioner. 4.5 Financial Penalties 18

19 If the Provider is found not to have informed the Commissioner of an absence verbally/in writing (as required by Sections and of this Service Specification) then the Provider will reimburse the Commissioner for 100% of the Agreed Weekly Rate for the length of the absence plus any additional care costs funded to the Home by the commissioner. Failure to notify death in as specified in 3.12 will result in full reimbursement to the commissioner of any fees paid backdated to the date of death. 4.6 Annual Review Mechanism The Agreed Weekly Rate will be reviewed annually. (unless stated otherwise on placement) 5. Monitoring Section 2 Activity Plan This contract does not guarantee any volume of activity or payment to a Provider and therefore the Activity Plan is not acceptable. Section 3 Part 1 SECTION 3 - QUALITY ASSURANCE REQUIREMENTS AND NEVER EVENTS Section 3 Part 1: Quality Assurance Requirements The section below outlines the quality assurance information the Commissioner will use for all Service Users in the Home receiving nursing care. Two types of quality assurance information will be used information that is specific to the individual Service Users and information that relates to the care and experience all Service Users in the Home. Quality assurance information will be used by Commissioners to ensure that Providers are meeting the service specification and identify areas of concern requiring remedial action. Commissioners will be undertaking quality assurance visits with Homes on an annual and ad hoc basis. Quality Assurance requirements: A copy of NHS Dorset CCG Care Home Quality Assurance Tool is included as Appendix C Section 4 19

20 Section 4 Service Development and Improvement Plan Service Development and Improvement Plans will be developed by the Commissioner and Provider as required. The Parties wish to encourage the improvement of the Services and shall therefore by the Effective Date agree a Service Development and Improvement Plan (SDIP), The Commissioners and the Provider shall comply with the SDIP to the extent applicable to each Party and the Provider shall report performance at the intervals agreed Section 5 Section 5 Incentive Schemes Section 5 Part 1: Nationally Mandated Incentive Schemes There are no national mandated schemes currently applicable to this contract. Section 5 Part 2: Commissioning for Quality and Innovation (CQUIN) There are no CQUIN schemes currently applicable to this contract. Section 5 Part 3: Locally Agreed Incentive Schemes There are no Locally Agreed Incentive Schemes currently applicable to this contract. 20