1 - Report Summary

The Orchard is an Extra Care scheme managed in partnership by Knightstone Housing Association and Bath & North East Somerset Adult Social Services and Housing. Overall, the scheme caters for elderly people with housing, care and support needs. A review of this service was previously carried out in November 2005 by Sarah Shatwell, on behalf of Bath & North East Somerset Supporting People Team.

This review will assess and validate the support service against the Supporting People contract in the context of the overall service being provided to service users.

The housing related support service comprises an on site part time scheme manager,  with Bath & North East Somerset care staff responding to alarm calls outside of the scheme managers working hours.

The review identified that the service has passed in five areas of the quality assessment framework and has attained two level B scores in Support Planning and Security, Health and Safety alongside three level C scores in Needs and Risk Assessment, Fair Access, Diversity and Inclusion and Complaints; narrowly missing a level B score in complaints; and one Level D score in Protection from Abuse.

7 - Strategic Relevance

The review seeks to ascertain the quality of the service using the quality assessment framework and also the strategic relevance, both in terms of the Bath & North East Somerset Supporting People Strategy and in the wider context of other local authority and government agenda.

The Orchard provides 20 units of Extra Care accommodation. The on site Scheme Manager provides housing related support and housing management to tenants, whilst the on site care team meet the care needs of the Extra Care tenants. The on site catering staff provide a mid-day meal for tenants in the communal lounge. The Review found that the teams work well together with the B&NES care team providing the pull chord response service whilst the Scheme Manager is not on duty.

Service users are in receipt of an Extra Care package therefore benefit from having a care plan as well as a support plan; there being an identified split between care and support. The review found that there have been regular meetings providing a strong communication link between the Scheme Manager and the Care Manager. This handover of information provides continuity for the service user, as well as identifying any potential further need in either the care or support plan. There have been historical issues over Supporting People funding providing care which had been identified in the last review report. During the validation visit, there was no evidence to suggest that the Scheme Manager was providing anything other than housing related support or housing management tasks.

The review found that the service at The Orchard is considered to be strategically relevant within the national and local context.

The Bath & North East Somerset Supporting People Five Year Strategy sets out a number of objectives, and in the context of this review The Orchard demonstrates that it is able to meet a number of those strategic objectives as set out below. In Addition, The Orchard is also able to demonstrate that it meets some of the improvement priorities as set out in the strategy.

Objective 1 – Partnership working

This objective specifically highlights the example of partnership working. The Orchard has worked in partnership with Bath & North East Somerset and the Primary Care trust in order to develop Extra Care provision for older people. The provider has been able to focus some of their resources away from the more traditional sheltered housing for older people to Extra Care provision therefore providing support for older people with changing support and care needs. This partnership working has been a key element of the transition to the overall Extra Care provision within Bath & North East Somerset. 

Objective 3 – Providing Choice

The Orchard offers a range of needs based services; it aims to encourage and facilitate independent living with the peace of mind and security for service users that they will be able to have their ongoing care and support needs met as their needs change.

Objective 7 – Crisis Prevention

The Orchard provides a range of options for vulnerable people which reduces the need for acute or crisis interventions.

The council is currently in the process of implementing a model of holistic care for older people by investing £27 million in new ‘Community Resource Centres’ which comprises residential and day care services, Extra Care flats and a base for domiciliary care with the overall aim of promoting independence for older people.  Developing capacity in Extra Care provision will reduce the demand for residential services and will impact positively on hospital admission and discharge figures. 

The Orchard contributes to this model of care & support provision.

The Bath & North East Somerset Corporate Plan Framework (published and approved in November 2003) sets out the key actions and targets that need to be achieved to enable the Council to realise its Community Strategy, Improvement Priorities, performance and financial objectives.

The Supporting People programme will have a direct or indirect impact on the priorities highlighted above and the review found that The Orchard contributes to the second improvement priority:

‘Promoting the independence of older people’

In addition The Orchard meets some of the objectives as set out in the Bath & North East Somerset joint older people’s strategy (2005-2008).

Objective 3.4 Service Delivery

Objectives:

To ensure that services are focused on supporting and maintaining older people in the community and avoiding unnecessary admission to hospital or residential care.

To ensure that services are responsive and flexible and offer real choice to older people. 

From the actions identified in this objective the review found that The Orchard contributes in the following way:

The on-site care and support provided at The Orchard enables service users to receive care and support in response to changing need, potentially avoiding and/or reducing any necessary admission to hospital or residential care.

The Governments’ white paper, Our health, Our care, Our say sets out the objectives for people with longer term needs stating:

‘People with longer term needs want services that will help them to maintain their independence and well-being’ highlighting the need ‘to move away from fragmented to integrated service provision’

The review found that The Orchard contributes to this national agenda by providing services which promote independence and well-being for their service users.

Further to this The Orchard is able to provide integrated care & support on a needs led basis, catering for the long term needs of service users.

8 - Quality Assessment Framework (QAF) Outcomes

The objectives were assessed as follows:

C1.1 – Needs and Risk Assessment

Referral routes to the service include nominations via the homesearch register and via the Extra Care Panel and occasionally direct referrals. The providers’ allocation policy relies on the complaints procedure as a mechanism for service users to appeal against any decision made, however this is not necessarily deemed accessible to service users who have not yet accessed the service as the complaints procedure is not widely offered at applicant stage. Service users that apply directly are sent a standard letter which explains the appeals procedure.

Examples of good practice include:

• The Scheme Manager has attended a training course in needs assessment and support planning.
• Joint risk and needs assessments are carried out with the Care Manager.
• Regular liaison is maintained on a consistent basis, usually weekly, between the Scheme Manager and Care Manager, this ensures changing needs are detected and plans put in place to meet those needs.

C1.2- Support Planning

Support plans were in place for service users, the Scheme Manager agrees the plan in consultation with the service user when they first enter the scheme, and ongoing in a consistent and planned way.

Examples of good practice include:

• Service user needs are reviewed periodically and the review identified clear evidence of a timetabled schedule for reviews of support plans to occur.
• Service users were aware of that they could initiate a review of their support plan at any time, the tenants handbook supports this and contains information explaining support plans; including advice that service users can choose their review date.

C1.3 – Security, Health and Safety

There is a health and safety policy which is less than five years old, which incorporates the consumer protection act 1987, the health and safety at work act 1974, and the disability discrimination act 1995. The review found that the front door entry system is not currently operational, allowing unchallenged access to the main building; this may present a security risk for vulnerable service users. The provider is however, currently investing in a new door entry system linked to service users individual flats, this will be rolled out to all service users in due course but is being initially installed into a number of flats based on the identified vulnerability of the service users within those flats. The review found that service users do not generally lock the front doors to their individual flats.  A health and safety inspection of the building was carried out by the provider in 2005 and a fire inspection carried out in 2007. The Scheme Manager does not currently adhere to the personal safety tracking system for lone working, preferring to adopt a more common sense approach.

Examples of good practice include:

• Health and safety issues are included as an agenda item for the staff annual performance review and staff supervision meetings.
• Health and safety site inspections are carried out monthly and monitored by the sheltered housing team manager at area level.

C1.4 – Protection from Abuse

There is a procedure in place which has been reviewed in the last five years. The procedure includes a whistle blowing policy, and is in accordance with the public interest disclosure act 1998 and the department of health guidance ‘no secrets’. The Scheme Manager has been subject to an enhanced CRB check.

At the time of the review it was found that service users are not currently made aware of the procedures for reporting abuse, which is a requirement to reach to minimum standard in the quality assessment framework. The review found no evidence of leaflets or posters on display on notice boards or in communal areas. The service user handbook covers areas such as bogus callers and staying safe, however, protection from abuse or neglect is not covered in any in depth way.

C1.5 – Fair Access, Diversity and Inclusion

There are written policies covering equal opportunity, anti-discriminatory practice, harassment and allocations; which have been reviewed in the last five years. These policies are included in the Scheme Managers manual and are included as part of staff induction. Information is made available to service users via the tenant handbook, via the notice board and via the provider website. The review found evidence that service users are able to have their cultural needs met through the support planning process.

Examples of good practice include:

• The Scheme Manager has undertaken Equality and Diversity training and has completed an NVQ2 in social care, which incorporated meeting the needs of service users from different cultures.
• The RNIB visit the scheme to provide audio, large print and Braille books for tenants, and have provided various pieces of equipment for service users to use within their own flats. This has been arranged in response to support planning by the Scheme Manager.

C1.6 – Complaints

There is a written complaint procedure which is less than five years old; the tenant handbook contains information for service users on how to complain. All complaints are recorded and the review found evidence that complaints were dealt with in an appropriate way within agreed timescales. Results of complaints were fed back to service users.

Examples of good practice include:

• All complaints are escalated to area level where they are recorded.
• Outcomes of complaints are reviewed at area managers meetings, to enable the provider to identify areas that arise more than once and to work towards continued service improvement.

10 - Evidence and Risk Assessment

There are risk assessments and a fire risk assessment in place for the scheme, with further in depth assessments being carried out on a periodic basis by the area office.

The support and care staff are adhering to a joint fire procedure ensuring a cohesive approach to this aspect of safety.

The review identified a risk to the security to the front of the building, access to the building is not restricted; a door entry system is in place but not in operation. The Scheme Manager’s office is located along the end of the entrance corridor and a visitor would be greeted at this stage, whilst she is on duty. This may present a risk to the security of the building whilst the Scheme Manager is off duty.

There were no other operational risks identified in the service delivery or organisational structure during the review process.

11 - Value for Money

Through the performance workbooks it is evidenced that service users are receiving an average of 0.80 hours of support per service user per week. This falls slightly below the regional benchmarks* as set out below. There is however, an element of support being delivered through the alarm only contract with B&NES. The B&NES service is responsive rather than proactive which makes it difficult to monitor in terms of the housing related element, but may well serve to bring the overall support service within the benchmarks.

Number of Total Hours allocated to support per service user per week.

The cost per support hour per week is £15.61 and therefore falls below the benchmarks* for Extra Care Services as set out below. The cost does however, fall within the benchmark* for mainstream sheltered.

Cost per hour of support provided per service user per week

The total unit cost of support per service user per week is £12.49 and therefore falls below the benchmarks* for Extra Care Services as set out below. The unit cost falls within the mainstream sheltered benchmarks.

Total unit cost of support per service user per week

The total unit cost of support per service user per week for the B&NES element of the service is £4.10 per service user per week and is viewed to be an alarm only type support service.

The review identified that the B&NES care staff are responding to around 50 alarm calls per 24 hour period and an element of these will be housing related.

The unit cost for the B&NES contract falls outside of the benchmarks* for Alarm only services as set out below. An element of this cost, however, could be apportioned with the unit cost for the Knightstone contract; bringing it closer to the benchmarks as set out above for Extra Care Services.

 Total unit cost of support per service user per week

*Mark Goldup final benchmarks (from executive summary). The benchmarks are pre-review and are due to be updated in the very near future, with more up-to-date information.

The Supporting People team are focussing in more detail on Value for Money and thus have devised a methodology for assessing Value for Money.

Using this tool, The Orchard Value for Money score is found to be reasonably good.

The Value for Money tool takes into account the quality of the service and the strategic relevance and so is weighted in these areas rather than focussing solely on unit cost and support hours.