Contact: Vincent Oliver, County Manager - Residential/Day Care for Older People ext: 5720

1 Summary

1.1 The following decisions are sought.

1.1.1 That following a report to the Executive Member, Social Care on the 21 June 2002, approval be given to a change in the function of the Home, and the resident group. This would be to have the whole home providing residential care to older people with dementia including 6 intermediate care beds (total beds would be 37). This would mean a decrease in the overall current numbers from 48 to 37 residents.

1.1.2 That approval for the new service for the refurbished Malmesbury Lawn, due for completion in 2004, be given in principle, subject to finalisation of the detailed project appraisal.

2 Reason(s)

2.1 The previous report indicated that the Home would have the dual purpose of providing intermediate nursing care and long term residential care for older people with dementia. As a result of subsequent discussions with the National Care Standards Commission, fully closing the Home during refurbishment would mean a new registration on re-opening, requiring ensuite facilities for every bedroom. Having costed this and given the increased loss in the number of bedrooms, it was not considered financially viable for the authority to proceed.

3 Other options considered and rejected

3.1 None appropriate.

4 Conflicts of Interest declared by the decision-maker or a Member or Officer consulted

4.1 None applicable.

5 Dispensation granted by the Standards Committee

5.1 Not applicable.

6 Reason(s) for the matter being dealt with if urgent

6.1 None

Approved by: Date of decision:

Councillor Felicity Hindson

Contact: Vincent Oliver, County Manager - Residential/Day Care for Older People Ext: 5720

1 Summary

1.1 The purpose of this report is to advise members and seek approval for the new plans for the use of Malmesbury Lawn as part of the re-investment strategy for Older Persons Homes.

1.2 The re-investment funding of over £1m is the final part of phase two of the strategy. The Social Services Department has been fortunate in securing significant other funds as part of the Governments initiative for Intermediate Care. Together these funds will enable a high quality residential care service to be provided at Malmesbury Lawn to older people with dementia.

1.3 The previous report to this committee on the 21 June 2002, described a plan to provide Intermediate Nursing Care and Residential Care for older people with dementia at the Home. Given the regulations of the National Care Standards Commission and the cost to move to this service, it has been decided that the costs and loss of bed numbers would not make this plan viable.

1.4 The new plan is to provide a residential care facility for 37 older people with dementia of which there will be 6 Intermediate Care beds. This is a reduction of 11 beds from the current number of 48.

2 Background

2.1 Malmesbury Lawn is the last of four homes to be refurbished in the re-investment strategy. Work was originally planned to start towards the end of the work at Green Meadows, which is only 6/7 miles away in Denmead, so that the impact on local `bed capacity' was minimised.

2.2 The additional funding (as indicated in paragraph 1.2) became available from the Government under the Building Care Capacity, Intermediate Care Capital fund, which will give the opportunity for a 6 bed intermediate residential care facility to be integrated into the Malmesbury Lawn refurbishment.

2.3 The 6 bed intermediate care facility will be a separate part of the building and will provide short term care for up to 6 weeks for older people with dementia. It will provide two types of service: firstly, a `step-up' facility enabling people who live at home but who require additional support and intervention to re-skill and re-enable them in order that they can return home; and secondly, as a `step-down' facility to enable people to be discharged from hospital, receive additional support, so that they can return home earlier.

2.4 Since the inception of the refurbishment at Malmesbury Lawn, there has been a significant change in the local commissioning needs for residential care with a focus on older people with dementia rather than physical frailty and provision of intermediate care. This resulted in the need of a changed specification for the unit.

2.5 Property, Business and Regulatory have now redesigned the plans to accommodate 31 residential care beds for older people with dementia and a 6-bed intermediate care unit for the same client group but with higher needs.

These plans were approved by the local National Care Standards Commission on the 14 October 2002.

3 Proposals

3.1 The current plan is to start major building work in March/April 2003 which will provide a high quality service for this user group with a build period of approximately 1 year (to be confirmed).

3.2 In order to maintain our current registration (of `Older People with Dementia (OP/DE') with the National Care Standards Commission of Older People with Dementia (OP/DE) we have to maintain a minimum number in the home whilst building works proceed. This will then count as a `variation in registration' rather than a `new registration' which would require us to provide ensuite facilities for every bedroom.

3.3 In discussion with our colleagues in Property, Business and Regulatory and Health and Safety it has been agreed that we will maintain up to 5 of the most vulnerable residents at Malmesbury Lawn during the building works.

3.3.1 In identifying these residents extensive assessments and consultations have taken place with residents, their relatives, key workers in the home; and other interested parties. In addition we have been advised by the National Care Standards Commission that these residents can remain at the home, after the alterations even if `out of category' by Social Services asking for an individual `variation in category'.

3.3.2 The Health and Safety advisers will be fully involved in assisting with the risk assessments of the part of the building still occupied. There may also be a potential to use part of the new day centre `to accommodate' these residents during times of greatest disruption.

3.4 Plans are already well advanced to re-accommodate up to 18 of the current Malmesbury Lawn residents at Green Meadows which is just coming back fully `on stream' after major refurbishment. Other options for the other residents are being catered for through a dedicated care manager for the scheme.

3.5 Plans are in progress to use the vacant accommodation of Malmesbury Lawn during the period before building works starts for a temporary step up/step down facility jointly set up between Health and Social Services.

3.6 Plans are also advanced in meeting the reduced staffing requirements to `run' the remaining service at the home, and the interim service for the winter period.

4 Financial Implications

4.1 Capital

The estimates for the capital costs of the refurbishments are not yet finalised, but will be sourced from the re-investment strategy and the Building Care Capacity, Intermediate Care capital funds and Performance Fund.

4.2 Revenue

The estimated revenue costs of this scheme are shown below:

	2002/03	Full Year Effect
	£000	£000
Staff	0	41
Loss of income	32	33
External Purchases	75	164
TOTAL	107	238

4.2.1 The extra staff costs cover the additional cost relating to intermediate care and the increased hours required to cover the 31 EMI beds. This does not take into account the additional staffing that will be required due to the National Care Standards Commission regulations.

4.2.2 The loss of income reflects the fact that the policy is not to charge for intermediate care (6 beds).

4.2.3 The external purchases represents the cost of buying 11 places in the independent sector as the overall capacity will reduce from 48 to 37.

5 Recommendations

5.1 That approval for the new service for the refurbished Malmesbury Lawn, due for completion in 2004, be given in principle, subject to finalisation of the detailed project appraisal.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act

NONE