Hampshire County Council

Executive Member - Adult Social Care Item 1

26 May 2006

Re provision of service at Courtbourn Older Persons Home, Farnborough

Report by the Director of Adult Services

1

Summary

1.1

The following decisions are sought:

1. The Executive Member approves the reprovision of residential services from Courtbourn and that the process to end the current service is completed by the end of October 2006, subject to the care needs of the residents being met.

2

Reason(s)

2.1

This decision supports Aim 1 of the Corporate Strategy by - maximising life opportunities by assisting timely delivery of caring services and Aim 5 - making sure services continuously improve.

2.2

This consultation has focused on two key areas these being the overall asset management of the building and its fitness for purpose to meet the needs of current and future service users.

2.3

Courtbourn was built in 1900. It is a two storey converted building with a major extension built on in 1987 (map attached). Unfortunately as part of that extension it had a two storey wooden construction link, which does not meet the current fire regulations. It is situated in a major residential area and has large grounds.

2.4

It has become increasingly difficult to accommodate potential residents whose needs are either high physical dependency or dementia due to the layout and facilities of the home. This includes: very long corridors with sloping floors on the upper floor where most of the bedrooms are; difficult-to-access bathrooms/toilets; long distances between bedrooms and bathing/toilet facilities; and the inability to install the latest moving and handling equipment, both fixed and mobile. This presents limited opportunities to accommodate the type of resident who now needs residential care.

2.5

It has been recognised as part of the recent discussion between Property, Business and Regulatory Services and Adult Services Department that there would be significant costs in meeting the requirements of the fire survey and upgrading the facilities of the home (refurbishment) even without carrying out major structural work required to meet the needs of present day service users. This would be in excess of £1.2M at current prices.

3

Other options considered and rejected

3.1

None

4

Conflicts of interest declared by the decision-maker or other Executive Member consulted

4.1

Not 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

Not applicable

Approved by:

..........................

Date of decision:

.........................

Councillor Patricia Banks

Hampshire County Council

Executive Member - Adult Services Item 1

26 May 2006

Re provision of Service at Courtbourn Older Persons Home, Farnborough

Report by the Director of Adult Services

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of the following Corporate Aims

Aim 1 - maximising life opportunities by assisting timely delivery of caring services

Aim 5 - making sure services continuously improve

1.

Summary

1.1

This paper presents the outcome of the consultation that has been undertaken by Adult Services regarding the reprovision of the residential services at Courtbourn, which is one of Hampshire County Council Older Persons Homes.

1.2

1.3

This consultation has focused on two key areas: the overall asset management of the building; and its fitness for purpose to meet the needs of current and future service users

The basis of the consultation has been that Courtbourn does not meet the expectation of the Commission for Social Care Inspection in terms of being `fit for purpose' which is a term used within the Care Standards Act 2000.The main consideration here is to identify whether a building meets the needs of the current (and future) service users. With increasing frailty of residents both physically and mentally, bedroom sizes are the most important factor, followed by access to bathrooms and toilets. This enables care assistants to use additional equipment such as hoists and electric profiling beds to ensure safe moving and handling of residents. The Courtbourn building does not easily lend itself to these requirements.

2.

Courtbourn, Farnborough

2.1

Courtbourn was built in 1900. It is a two storey converted building with a major extension built on in 1987 (map attached). Unfortunately as part of that extension it had a two storey wooden construction link, which does not meet the current fire regulations. It is situated in a major residential area and has large grounds.

2.2

Following the extension in 1987, Courtbourn catered for 46 residents who, although physically frail, were at that time quite mobile and had a high level of self care. The home had 9 double bedrooms at that time and by April 2003, this was not considered as appropriate for the dignity and choice of residents. The capacity was then reduced to 39 (leaving 1 double bedroom) with a second reduction to 29 in July 2004 as a result of the concerns identified in fire safety strategy audit involving Hampshire Fire and Rescue Service.

2.3

It has become increasingly difficult to accommodate potential residents whose needs are either high physical dependency or dementia due to the layout and facilities of the home. This includes: very long corridors with sloping floors on the upper floor where most of the bedrooms are; difficult-to-access bathrooms/toilets; long distances between bedrooms and bathing/toilet facilities; and the inability to install the latest moving and handling equipment, both fixed and mobile. This presents limited opportunities to accommodate the type of resident who now needs residential care.

2.4

The capacity in the home has been reduced due to the restriction on its use. The occupancy in 2004/5 was only 82%, this is due to the reduced capacity because of the restricted use of bedrooms and fitness for purpose of the building. In addition, there is also an overall reduction in demand for the type of service offered by the home in the Farnborough area.

2.5

Given the configuration of the building, it does present difficulties in being able to manage efficiently the deployment of the workforce and ensure a safe environment. This environment has been further compromised because of the fire safety concerns, necessitating additional staff resources and therefore increasing unit costs.

2.6

It has been recognised as part of the recent discussion between Property, Business and Regulatory Services and Adult Services Department that there would be significant costs in meeting the requirements of the fire survey and upgrading the facilities of the home (refurbishment) even without carrying out major structural work required to meet the needs of present day service users. This would be in excess of £1.2M at current prices.

3.

3.1

Re-provision for existing service users

There are currently 15 permanent residents at Courtbourn (at 15^th May 2005). The majority of these were admitted from within a 5 to 7 mile radius of the home, whilst others came from the Basingstoke and Alton areas. As part of the consultation process, all residents have had an opportunity with their relatives to have a meeting with a Care Manager (supported by the staff of the Home) to discuss alternative accommodation options.

3.2

There are 6 other local authority homes within about 12/15 miles of Courtbourn which may provide potential accommodation options, whilst other independent care homes could be considered if appropriate.

3.3

During the consultation period, no other permanent residents have been admitted but 4 beds were identified to provide respite care if required. Only 2 are currently in use.

4.

4.1

4.2

4.3

Re-Provision for future service users

Adult Services' strategic direction is for older people to be supported to remain at home, rather than moving into residential care. This not only prevents unnecessary dependency but is usually where older people prefer to be.

It is therefore projected that the need for residential care will diminish as more older people remain at home for longer. This is borne out by the Department's activity data for 2005. From February to December the number of older people in residential care in Alton and Aldershot fell from 333 to 311. At the same time, services to older people in their own homes increased. The number of older people receiving domiciliary care rose from 729 to 801.

There are already a number of services in the Aldershot area to support older people to remain at home, including social clubs, meals on wheels and transport. In particular there is extra care housing. This is where people have their own tenancy, similar to sheltered housing, but care is provided on site in accordance with people's assessed care needs. It therefore provides a complete alternative to residential care, at a much reduced cost to the Department, as the "bed and board" elements are met by the individual.

4.4

It is proposed that any decrease in the overall residential care capacity will be replaced by additional extra care that is available at an affordable rent. A comprehensive strategy has been developed to address how to increase the provision available from registered social landlords, and specific discussions have begun with one provider to upgrade one sheltered housing scheme into extra care.

5.

Staff consultation and redeployment

5.1

There are currently 34 permanent staff employed by Hampshire County Council working at Courtbourn. There are only 6 full time workers in that number with the rest being part-time. The 24 hour nature of the service means that staff are required to work on a 3 shifts-a-day system. There is a requirement therefore to have a minimum number of staff on at each shift, but as the number of residents reduce, and when vacancies occur, the staffing numbers reduce to that minimum.

5.2

Individual and group consultation has been undertaken with all staff at Courtbourn. This has also included consultation with Trade Unions.

5.3

The options for their future employment are that they will be offered redeployment within one of the 3 homes within a 5/10 mile radius. There will also be the opportunity for staff to explore wider redeployment options within Hampshire County Council.

5.4

Of the 34 staff, most of whom work part-time, 24 are looking at redeployment within Hampshire County Council Older Persons homes. Through individual negotiation the remaining group have indicated that they wish to be considered for redundancy/ retirement.

5.5

The cost of the latter will be in the region of £100,000 to the department and is covered in paragraph 7.1

6

6.1

6.2

6.3

6.4

6.5

Consultation Process

The reprovision of this service has been subject to a 12 week consultation period, which started on the 24 February 2006. A summary of responses is attached (Courtbourn Consultation Plan). This is compliant with the Hampshire Compact and has included:-

The regular service users of Courtbourn have been consulted (as indicated in Paragraph 3.1) with relatives (if they have any) and Care Managers have met all of them. Individual needs assessment have taken place taking into consideration where relatives live, or where, for example, there are certain alliances between residents who wish to move to the same home (where possible).

Staff have already had a number of meetings as a group and individually with Human Resources, the Service Manager and with union representation.

Voluntary organisations including Age Concern, Hampshire and a local Carers group (Alzheimer's Society), which represents users with similar needs to those users of Courtbourn, have been consulted and the latter responded positively to the proposal.

A copy of the SCE Consultation paper was sent to the local PCT on the proposals to re-provide services from Courtbourn.

6.6

A meeting was held with local County Councillors on the 7 March 2006 at Courtbourn, when there was an opportunity to look around the home and discuss the situation with residents and staff. Members were supportive of the approach that we were taking.

6.7

The local MP - Gerald Howeth was sent a briefing paper on 27^th March and was generally in agreement to the specific issues regarding Courtbourn.

6.8

6.8.1

6.8.2

In conclusion the number of responses (as seen in the attached table) have been limited, apart from the local press interest. Generally local people are disappointed at the loss of a local Hampshire County Council residential service in Farnborough and believe that money should be invested in the building. Concern has also been expressed about the impact on residents.

Comments have included:

`The proposed closure of Courtbourn with no alternative provision will reduce access to high quality residential care at a time when the population is ageing';

`Although I do understand that the building has to reach the required standards to satisfy Health and Safety to comply with new regulations, the thought of the residents' home closing is devastating to them';

`I am very concerned at the prospect of Courtbourn Care Home closing and leaving Rushmoor area with no council Home for the elderly'.

There have also been supportive comments as well including one from the local Alzheimer's Society which states: `Having read the report on Courtbourn, we fully understand why reprovision is considered necessary. The home is clearly not `fit for purpose' for older people with mobility impairments, or for those with dementia'. It goes onto make some positive suggestions regarding future provision.

For those people who have responded the limitations of the building have been clarified in writing and the potential cost of refurbishing and improving the building.

7

7.1

7.2

7.3

Financial impact

The ongoing savings of the net running costs of the home are £461,300. Allowing for the transitional costs of closing the home (including redundancies, see paragraph 5.5) and the lead-in time, the savings in 2006/07 are expected to be £130,000.

The cost of re-provision for future service users will depend on the extent to which residential care will be replaced by extra care in the community, as referred to in section 4.3. In the short term, if the loss of local In-house capacity results in an increase of local purchasing of 15 residential placements then the potential full-year cost is estimated at £167,965, net of client contributions.

The anticipated net savings were included in the department's budget preparation.

8

Impact Assessment

8.1

In compiling this report and developing the strategy, regard has been given to the County Councils' duties in relation to the Race Relation Amendment Act 2000 and Hampshire County Council's own race equality scheme. No adverse impact has been identified.

9

Conclusions

9.1

Clearly Courtbourn does not meet the service requirements either for the existing or future service users given the levels of dependency of older people being referred to the Department for residential care. Even with significant investment of over £1.2m it is unlikely that it would meet the needs of future service users.

9.2

The consultation process, as indicated in paragraph 6.8, received a limited response. Whilst there were some strong views about the need to retain a local resource, it would not be appropriate to invest in a building at significant cost that would only still meet basic standards, let alone meet the needs of a modern service.

Recommendation(s)

That:

1

The Executive Member approve the reprovision of residential services from Courtbourn and that the process to end the current service is completed by the end of October 2006, subject to the care needs of the residents having been met.

Date/Actions

Progress/Response Received

Staff

1^st management staff meeting/briefing: 30 January 2006

1^st Meeting with all staff(including Unions): 1^st February 2006. 2^nd meeting with all staff : 20 February

Between 2 February and end of March all staff had individual interview

All staff now been interviewed and future employment options discussed

Service Users

Meetings with residents and relatives (where appropriate)

Process started on 1^st February and complete

All residents now seen individually with care manager/Team Manager/Service Manager and member of staff.

All relatives either seen or communicated with by phone/letter or E Mail. There has been only been one letter from a relative - and one E Mail

Voluntary Organisations

Letters and discussion with local Carers /Alzheimers Group and Age Concern

Initial telephone discussion with local Carers group

Response received and supportive of reprovision

NHS

Letter sent to Blackwater Valley/North Hants Cluster

Response awaited

Care Management

Care management actively involved since the beginning of consultation.

Individual sessions taken place with each resident

Meetings will continue with residents/relatives as required.

Local Members

Letter sent to local Members

Meeting held on 7 March 2006 at Courtbourn

Briefing paper to MP - Gerald Howeth sent in March 2006

Meeting held at Courtbourn which gave Members an opportunity to tour the home.

No further comments received.

Letters from Locality

Letters from members of the public

There have been 3 letters from members of the public expressing concern about the loss of a local resource.

Reg.

*

Fit for Purpose

Action Required

23.

Yes

No

1 (a)

Suitable for purpose of achieving the aims & objectives set out in the statement of purpose

_

Non-purpose built old building with an extension built in 1987

Building layout does not promote residents independence in terms of distance between rooms requiring use of wheelchairs by residents who can mobilise themselves over shorter distances with use of walking frames/ sticks

The building layout does not allow for smaller group living areas

(b)

The location of the premise is appropriate to the needs of the service users

_

2 (a)

Physical design and layout of the premises meets the needs of the service users

_

Long sloping corridor plus a shorter sloping corridor leading to this is a potential trips/ falls hazard

Long corridors - unacceptable distance between bedrooms and lounges/ dining areas given the frailty of existing and future service users

(b)

Premises are sound construction and kept in a good state of repair externally and internally

_

Refurbishment/ Upgrading/ Asbestos requires removing

( c)

Equipment provided for service users or carers is maintained in good working order

_

(d)

All parts of the home are clean and tidy

_

(e)

Adequate private and communal accommodation is provided for service user

_

The three main lounges are situated in the same area each leading into one another. This leads to high noise levels from TVs and Music, and a high level of activity in one area. The communal dining room is nearby. Two toilets serving these four communal rooms are insufficient for the number of service users. The level of activity in this one area near to the entrance hall is high

(f)

The size and layout of rooms occupied or used by service users are suitable to meet needs

_

Reduction of double bedrooms

Seven double bedrooms were converted to single rooms in April 2003. That is capacity reduced from 46 residents to 39 residents

One double bedroom retained for couples or those wishing to share a bedroom

Loss of Income:

Seven placements @ £259 per week

Size of bedrooms

Six bedrooms are under 10 square metres. Although accepted at registration as this was an existing building, this does not provide adequate space for higher dependency residents

(g)

Adequate sitting, recreational and dining space provided separately from the service user's private accommodation

_

Dining areas are too small to provide adequate space for service users with mobility equipment. Mobility equipment is removed to provide more space such that the residents independence is compromised

Noise levels are high due to the number of lounges in close proximity to each other

( TVs, music etc)

(h)

The communal space provided for service users is suitable for the provision of social, cultural and religious activities

_

As above (f) - main communal areas serving the whole home are in close proximity. This does not provide quiet space

(i)

Suitable facilities are provided for service users to meet visitors in communal accommodation, and in private accommodation which is separate from the service users' own private rooms

_

As above

(j)

They are provided at appropriate places in the premises sufficient number of lavatories and of wash-basins, baths and showers fitted with a hot and cold water supply

_

Lavatories are not located in the appropriate places e.g. inadequate number near to lounge areas

A number of lavatories on the first floor are too narrow to provide adequate space for use of mobility equipment such as walking frames.

(k)

Any necessary sluicing facilities are provided

(l)

Suitable provision is made for storage for the purposes of the care home

_

(m)

Suitable storage facilities are provided for the use of service users

_

(n)

Suitable adaptations are made and such support, equipment and facilities, including passenger lifts, as may be required are provided for service users

_

(o)

External grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained

_

The grounds are attractive & well maintained. However access could be improved with wider paths for access by wheelchairs/ larger paved area for seating. There is no "safe" garden at present

(p)

Ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users

First floor corridors in a part of the building do not have external windows

4. (a)

Take adequate precautions against risks of fire, including the provision of suitable fire equipment

_

Link passageway to the extension is a wooden construction does not meet fire requirements - leading to room closures

Bedroom Closures to meet Fire Requirements

10 bedrooms closed July 2004 reducing capacity from 39 residents to 29 residents

3 bedrooms closed 26 November 2004 reducing capacity from 29 residents to 26

residents

Loss of Income:

13 placements @ £259 per week

Cost of essential work to comply with the requirements of the local fire services

(b)

Provide adequate means of escape

_

See F ire Audit