1. Introduction/Purpose
The Provider Quality Support Policy (Quality Policy) has been developed to establish a formal and coordinated response to quality concerns in relation to residential and nursing care homes, domiciliary care services and unregulated care services (e.g. day services, supported living services etc.) for all adults and older people. This is in line with our duty of the Care Act (2014) in regards to market oversight and provider failure and the CQC Emerging concerns protocol.
The Quality Policy establishes a formal means of responding to provider concerns where thresholds for whole service safeguarding adult Enquiry are not met, but where there is a clear need for service improvement to minimise the risks presented to service users by the quality of care being provided.
The Quality Assurance & Improvement team also provide informal advice and support to providers who are not part of a formal process.
The purpose of the Quality Policy is to: –
- enable remedial actions to take place for the specific areas of concern identified, thus stabilising poor operational performance and subsequently improving and sustaining the standards of care delivered by a provider;
- coordinate activity across all agencies to enable effective communication, avoid any duplication and minimise involvement to ensure a proportionate response;
- clearly describe to providers the Quality Support Threshold criteria.
- proactively avoid whole service safeguarding and escalation of provider quality concerns;
- contribute towards improving the overall quality of the provider market.
2. What is a Provider Quality Support Process?
A Provider Quality Support Process is aimed at enabling the provider to improve and sustain the quality of their services.
Dealing with concerns about providers is routinely a matter for the local Health and Social Care Community Services Manager (CSM) or Disability Lead who will ordinarily act as the Responsible Manager (RM) for a Provider Quality Support Process (see section 5).
This policy is intended to supplement the guidance provided in the Devon and Torbay Safeguarding Adults Board Multi-Agency Policy, which should always be considered in the first instance and throughout a Provider Quality Support Process to ensure the most appropriate and proportionate route is taken.
A Provider Quality Support Process should never run in parallel with a whole service safeguarding enquiry. However, a Provider Quality Support Process may supplement, but does not replace individual safeguarding adults enquiry.
3. What can trigger a Provider Quality Support Process?
There are a number of routes that can trigger a Provider Quality Support Process. Please see threshold table in Section 4 for full details.
- Where it is decided from Local Authority intelligence and information that the risk and concerns do not meet the necessary thresholds to proceed under a whole service safeguarding adult Enquiry.
- Following the closure of a Multi-Agency Whole Service Safeguarding Adults process.
- As the result of an Inspection by CQC or Other Regulatory Body
- As a direct response to Commissioning or Procurement Information, Contract Monitoring, Complaint, or Incident Reporting routes.
4. Quality Support Threshold Criteria
An initial meeting or discussion will be arranged to consider whether criteria for a formal process have been met. If it is agreed the criteria has been met, regular Provider Quality Support Review Meetings will be arranged.
Timescales for delivery of improvement must also be considered. All Provider Quality Support Processes are different and timescales for delivery of improvements required will be set within individual service improvement plans. Progress will be reviewed in Provider Quality Support Review Meetings and if insufficient progress has been made this would give rise to the need for further escalation.
The table below is intended as a guide to the Quality Support Threshold Criteria as a means for ensuring consistent application of the Quality Policy.
| PQSP Thresholds |
| The service has been issued with CQC warning notice, Notice of Proposal/decision to cancel registration, repeated breaches and/or an overall rating of Inadequate or Requires Improvement |
| Lack of effective leadership and management resulting in people not receiving the care and support required to meet their needs and/or manage their health or medical conditions |
| Lack of robust governance systems leading to failings in effective management of quality and safety and/or Regulatory compliance in the service |
| Insufficient evidence of ongoing and sustained improvements in the quality and safety of the service |
| Absence or poor quality of records that support the delivery of care and support required to meet people’s needs |
| Care plans and individual risk assessments are not kept up to date, lack personalised details, are not regularly reviewed and/or do not meet the requirements of the Mental Capacity Act |
| The service provider does not employ sufficient numbers of staff with appropriate ability, skills, knowledge, training or experience to meet the needs of people using the service |
| Staff do not receive adequate training or supervision to support them in meeting peoples needs |
| Patterns or trends are emerging from multi-agency sources that suggest there are concerns about the poor quality of care from a provider |
| Themes from Contract Default Notices to be considered may include: Nutrition and Hydration, Continence care, falls, environment, privacy, dignity, end of life care, lack of social engagement, personal care needs, auditing, monitoring, documentation, consent, high number of individual safeguarding concerns, fire safety, equipment, management of meds, IPC |
5. Who is the decision maker within a Provider Quality Support Process?
The Responsible Manager (RM) for a Provider Quality Support Process will ordinarily be the CSM or Disability Lead (or delegated lead) for the geographic locality within which the service provider is based, or their nominated deputy.
Note: If the majority of service users are NHS funded the RM will be the senior manager for that organisation.
In the event of concerns relating to a provider of services covering multiple localities or a provider of strategic importance to commissioners, further consideration should be given to appointing either the relevant Care Direct Plus Centre Manager or Assistant Director as RM and involving relevant Senior Manager(s) from Integrated Adult Commissioning and Health.
The Provider must be informed of their right to appeal any decision made within a Quality Review**. Providers must submit their appeal in writing within 10 working days of the date of the decision, and will be considered by the RM within 28 days of receipt of the appeal.
**Note: There is no right to appeal against a Contract Default Notice enshrined in the contract.
6. Concluding a Provider Quality Support Process
The Provider Quality Support Process will only be closed with the agreement of attendees at a Provider Quality Support Review Meeting. All risks must be reviewed as part of the decision to conclude the Provider Quality Support Process.
The rationale for closure of the Provider Quality Support Process should be fully recorded and clearly communicated to the provider. Any on-going support and/or monitoring arrangements required should be agreed.
There may be scenarios necessitating more in-depth and frequent monitoring following the Provider Quality Support Process (PQSP). This enhanced monitoring is designed to create a robust mechanism for continuous improvement and accountability.
7. Governance and Reporting Arrangements
Governance Arrangements
Devon County Council has pre-determined routes for organisation governance and reporting which help to ensure the right levels of accountability, decision making and coordination is maintained across the organisation as a whole. Those relevant to the Provider Quality Support Process are as follows: –
- Devon Safeguarding Adults Board (for assurance of follow through of SAR recommendations);
- Integrated Adult Social Care Leadership Team;
- Integrated Adult Social Care Commissioning Team;
- Integrated Adult Care Social Care Operations Leadership Team;
- Integrated Adult Social Care Operations Community Services Managers Forum;
- Social Care Leadership Group;
- Joint Local Authority/ICB/CQC Meetings;
- Quality Assurance and Improvement Team;
- Devon Safeguarding Adults Team Managers;
- Integrated Adult Social Care Commissioning – Commissioning Team.
It is wholly necessary to ensure the relevant internal and external stakeholders are kept informed of progress and any actions being undertaken within a Provider Quality Support Process. A confidentiality statement covering the sharing of information (see appendix 1) will be communicated at all Provider Quality Support Meetings.
General expectations of all professionals operating within a Provider Quality Support Process are:
- Openness, transparency and clear communication across all agencies and with providers;
- Clearly documented procedures covering all professional involvement;
- Robust documentation of all work undertaken.
8. References
CQC Emerging concerns protocol
Devon Safeguarding Adults Board Multi-Agency Policy and Guidance
Policy and guidance – Devon Safeguarding Adults Partnership) (link reviewed 13/12/2022)
Appendix One
Provider Quality Support Policy
Quality Review Meetings
Information Sharing and Confidentiality Statement
Chair to read out the following statements at the start of each meeting held:
Devon County Council: Confidentiality Statement
This Quality Review meeting is held under Devon County Council’s Provider Quality Support Policy.
The matters raised are confidential to the members of the meeting and the agencies they represent and should only be shared with others who have a legitimate right to know, whether in the participant’s own agency or organisation, or elsewhere.
Minutes of the meeting are distributed with the strict understanding that they will be kept confidential and in a secure place. In certain circumstances it may be necessary to share the minutes of this meeting with others who have a legitimate interest in the matters discussed in the meeting, such as the Care Quality Commission, other commissioners and other agencies or organisations. Any request for receipt of the minutes should be referred to the Chair of this meeting or to the Responsible Manager for approval.
Devon County Council: Equal Opportunities and Anti Discriminatory Statement
Devon County Council is committed to advancing equality, eliminating discrimination, and fostering good relations for groups protected by the Equality Act 2010. We also need to be mindful of any reasonable adjustments that may need to be made to overcome a disability to enable full participation. We want to ensure this is a safe and inclusive space where everyone can participate fully. Comments or practice that could amount to discrimination or harassment are not acceptable and will be challenged by the Chair and/or other meeting members.
Devon County Council: Conduct and Courtesy
It is expected that meeting members treat each other with dignity and respect. Any behaviour from meeting members which does not exhibit expected standards of professionalism, dignity or respect for others will not be tolerated and will be challenged by the Chair.
| Version | 4.1 |
| Strategic Owner | Solveig Wright, Deputy Director of Integrated Adult Social Care, Commissioning |
| Business owner | Solveig Wright, Deputy Director of Integrated Adult Social Care, Commissioning |
| Date of approval and commencement | 2017 |
| Last review date | Feb 2025 |
| Last reviewer | Pete Lock, Senior Quality Improvement Officer Becki Billing, Senior Policy Officer |
| Next review date | Feb 2027 |
| Changes at last review | Approach to meetings being recorded amended in appendix |