Advice Centre
Essential Information
Who can help?
The Care Quality Commission (CQC) can help you. The CQC publishes inspection reports and can deal with complaints made against registered services. See the Useful Contacts page for contact details of your local CQC office.
Details of other organisations that can help you are also available on the Useful Contacts page.
Care home contracts
The Office of Fair Trading (OFT) market study on care homes for older people found that a number of care home contracts for self-funding residents (those paying the charges themselves) were unfair or unclear.
The main areas of the study focused on:
- the lack of price transparency (the cost of care, what the price included, how often the price was reviewed).
- the need for better complaints procedures.
- complex or unfair terms that made it difficult to understand the rights and obligations of the resident and of the care home under the contract.
- the procedure for ending a contract.
- the administering of medication.
It is advisable to consult a solicitor before signing any contract, to ensure that the terms are fair and you understand your rights and obligations. The Fair Terms for Care report applies only to those paying for their own care. You can get it from the OFT (ask for reference number OFT 780 688). Visit www.oft.gov.uk.
Careline
Careline is Bradford Council's 24-hour community alarm system providing a monitoring and response service to people living in their own homes.
The alarm unit operates over the telephone network and equipment supplied by Careline simply plugs into a telephone and electric point. At the Careline Centre, information provided and approved by you is held securely on a computer database and is instantly available so that effective action can be taken in any emergency situation. The moment a call is received the operator will know your name, address, GP and any contact or keyholder details.
Careline has access to mobile response teams who operate throughout the District. They are trained in first aid and are a back-up to named contacts. If you are interested in Careline or just want more details contact 01274 533770.
Telecare
Telecare is a new service designed to help people remain living at home independently for as long as they choose. The service uses Careline as the hub of the system. Telecare is basically a range of sensors that can be added to the Careline system that activate when a problem is detected. Sensors can be installed that respond to problems such as the presence of poisonous carbon monoxide gas, forgetting to turn off a gas cooker, falls, leaving sink or bath taps running or a fire within the home. Other sensors can be used to help carers, for example if a person starts to go out at inappropriate times a sensor can be fitted on the door to let the carer know.
Telecare can help people who want to stay in their own home but need some assistance, for example, we can provide a sensor that switches on a light when a person gets out of bed at night, or a dispenser to remind people to take their prescribed medication. The sensors are also able to call for help if you are unable to do this yourself - so you know that help is always there when you need it. Telecare can help if you want to feel safe at home, are worried about falling or you are becoming forgetful. If you want any more information on Telecare, please contact: Careline 01274 533770.
Direct payments
Direct Payments are an alternative way of receiving part or all of your services from Bradford Adult and Community Services or the Bradford District Care Trust after an assessment of your needs has been carried out by a care manager/social worker. The aim of a Direct Payment is to give you more flexibility in how services are provided to meet your social care needs. This is done by giving you money instead of directly providing services. It allows you greater choice and control about how your care is delivered. You can buy your own services for yourself, for example if you employ staff, they would report directly and be accountable to you. You could contract with a care agency and that agency would then be answerable to you, not the local council.
With Direct Payments comes responsibility, particularly your legal responsibilities as an employer or your responsibility to pay invoices sent to you from a service provider. You will also be accountable to the council for the Direct Payments money they have given you. You can get help, advice and support from the Direct Payment Support Team who can be contacted on 01274 438700.
Quality Standard 3 in residential and nursing care homes
The Quality Standards are drawn from a recent Department of Health document 'Standards for Better Health' that describe the level of quality that health care organisations are expected to meet. These Standards have been used to help promote better care in five key areas: delivery of high quality care; wound and skin care; prevention of falls; nutrition and end of life care.
These locally agreed standards have been developed jointly with the Bradford NHS and Bradford Council and are higher than the National Minimum Standards required to run care homes. An additional quality premium is paid to those homes who can demonstrate they are meeting the specific criteria for the five key areas.
The current Quality Standards can be viewed on the local NHS website www.learnonline.nhs.uk. If you are looking for a care home and would like to know if they are currently meeting the latest quality standard please telephone the Commissioning Support Unit on 01274 437924.
Inspection and registration of care services
The Care Quality Commission (CQC) registers, inspects and reviews all adult social care services in England in the public, private and voluntary sectors. CQC began operating in April 2009, when it took on the work previously done by the former Commission for Social Care Inspection, as well as that of the Healthcare Commission and the Mental Health Act Commission.
Following an inspection, each care service is given a report of how it rates against national standards. It also receives a quality (or star) rating. This provides an 'at-a-glance' idea of how a service is performing overall, and is useful when people are considering potential care homes or home care agencies.
The ratings range from three to zero stars, with three stars representing an 'excellent' service, two stars 'good', one 'adequate' and zero 'poor'. Each service's rating can be seen on the CQC website: www.cqc.org.uk
How is a care service's rating decided?
The rating is based on the outcome of a 'key' inspection by the Commission, which looks at all aspects of the way the care service is run. The focus is very much on the standards of care that people who use the service receive and whether they are happy with their care. Virtually all inspections are unannounced.
For care homes, the inspectors look at seven categories or 'outcome groups' based on the National Minimum Standards. These are: choice of home; health and personal care; daily life and social activities; complaints and protection; environment; staffing; and management and administration. Obviously, the more areas that are judged to be 'excellent', the more likely a home is to be given three stars.
Around 80% of the 18,500 care homes in England are providing 'good' or 'excellent' quality care, according to the CQC.
Quality ratings began in January 2008 and most care services have received a key inspection since then, so have got a star rating. However, some are shown as 'not yet rated'. There are two main reasons for this: one is that those that are newly-registered may be awaiting their first inspection (which must be done within six months of registration); the other is that services that have a good inspection record in the past can go two or three years before a key inspection is carried out to determine their rating. So the number of services without a rating will gradually be reduced as time goes on.
What if a care service has a 'poor' (zero stars) rating?
If this happens the home will have to complete an improvement plan. This will include what action is going to be taken to improve services and the date the action will be completed. The home will receive another key inspection within six months. It may also face 'random', or spot, inspections. If the home fails to show significant improvement, it will be warned that it may face enforcement action by the Commission. If all else fails, this could mean deregistration (effectively closure).
Currently there are fewer than 500 care services with a ?poor' rating. Services that have had deregistration notices served on them but are not yet closed (pending a possible appeal) are shown on the CQC website as having a 'suspended rating'. (Appeals are heard by an independent tribunal.)
When considering a care home or home care agency, it's always a good idea to check their inspection reports and star rating on the CQC's website.
How solicitors can help
Our care and legal system is complex, and the implementation of the Mental Capacity Act 2005 means we are at a time of immense change in the law, making expert advice vital. The Act legalises current best practice and common law principles concerning people who may lack mental capacity and those who take decisions on their behalf. The Act affects everyone aged 16 and over and provides a statutory framework to empower and protect people who may not be able to make some decisions for themselves, for example, people with dementia, learning disabilities, mental health problems, stroke or head injuries.
A solicitor can give you impartial advice about wills, making gifts, estate planning and Powers of Attorney. Some can also offer guidance on immediate and long-term care plans, ensuring (if applicable) the NHS has made the correct contribution to your fees.
Lasting Powers of Attorney
(LPA) allow you to appoint someone you trust to make decisions about your personal welfare, including healthcare and consent to medical treatment, and/ or your property and financial affairs. A LPA is only valid once registered with the Office of the Public Guardian. It allows for a person of your choice to make decisions on your behalf at a time when you may be unable.
The Court of Protection
The Court of Protection can issue Orders directing the management of a person's property and financial affairs if they are incapable of managing their own affairs should they not have a LPA. The Court procedure is presently very slow and the fees are quite expensive so preparing a LPA is always advisable, providing you have somebody sufficiently trustworthy to appoint as your attorney.
An 'advance directive' allows you to communicate your wishes in respect of future medical treatment but it is not legally binding. You may instead wish to make a living will, properly known as an 'advance decision' setting out treatment that you do not want to receive in specified circumstances, which would legally have to be followed, even if you die as a result.
Any proposed Gift out of your estate needs careful consideration of the benefits, risks and implications, particularly on any future liability for care costs or tax liability
Long-term care
Whether you remain in your own home or move into sheltered or residential care, you may qualify for financial assistance in the form of social care and NHS-funded care and welfare benefits.
If you don't have your own solicitor, ask family or friends for their recommendations. Contact several firms, explain your situation and ask for an estimate of cost and an idea of time scales involved. Many firms will make home visits if necessary and will adapt their communications to meet your needs. It's important to find a solicitor who specialises in this area of the law.
Quality Standard 3 in residential and nursing care homes
When you move into a home you should feel able to complain about any aspect of your life there which affects your happiness or comfort. This might be anything from the way you are treated by the staff to the quality of the food you are served. You should also feel free to make comments and suggestions about possible improvements to your surroundings and the services provided.
Making a complaint should not be made difficult for you. Homes are required under the National Minimum Standards to have a simple and easy to use complaints procedure. If you are concerned about the care that you, a friend or a relative are receiving in a residential home, it makes sense to speak to the manager of the home about your concerns before you take any further action. The problem may be resolved quite easily once they are made aware of it. However, if you are worried about doing this or the possible effects, you can contact the Care Quality Commission who will consider the information you give and decide how to respond.
Your local office of the Care Quality Commission is:
CQC North Eastern Office
St Nicholas Building
St Nicholas Street
Newcastle upon Tyne
NE1 1NB
Email: enquiries.northeastern@cqc.org.uk