Hampshire County Council

Executive Member - Adult Social Care Item 1

27 October 2006

Re provision of Services at Stocklands Older Persons Home and Day Centre

at Calmore, Totton

Report by the Director of Adult Services

1

Summary

1.1

The following decisions are sought:

The Executive Member approve the proposal for the reprovision of residential, day services and associated office facilities at Stocklands, and that the process to end the current service is completed by March 2007, subject to the care needs of the residents and the day centre service users being met.

2

Reason(s)

2.1

This decision supports the corporate strategy by :

`Hampshire safer and more secure for all' by providing safe and secure environments for the users of both services.

`Maximising well being' for the residents of the home and the service users of the day centre, and `enhancing our quality of life' by providing improved reprovided quality services.

2.2

This work has focused on two key areas of the overall asset management of the buildings and their fitness for purpose to meet the needs of current and future service users.

2.3

Stocklands is a two storey purpose built older persons home with an adjacent day centre built in 1972. Part of the home also accommodates the In-House Home Care service, a voluntary sitting service and Adult Placement staff. The adjacent Day Centre was built at the same time and is a single storey building and comprises of a main room, two smaller rooms, toilets, a bathroom, and office and a kitchen area (meals are provided from the residential home main kitchen).

2.4

It has become increasingly difficult to accommodate potential residents whose needs are either high physical dependency or dementia care due to the layout and facilities of the home in terms of `fit for purpose'(table attached).

2.5

It has been agreed as part of the recent discussions between Property, Business and Regulatory Services and adult Services Department that there would be significant costs to bring both the residential and day care buildings up to modern requirements/standards. Major work would be required on bedroom sizes, which would reduce the capacity to about 30 beds from the current 50, as well as upgrading all the facilities. (This would also increase unit costs).This major structural work for the residential home, as well as the fire safety work has been estimated by Property Services to be in excess of £1.5m at current prices, and in the region of £145,000 for the day centre to provide separate heating, public utility services and catering facilities.

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

None

5

Dispensation granted by the Standards Committee

5.1

None

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 Social Care

27 October 2006

Re provision of Services at Stocklands Older Persons Home and Day

Centre, Calmore, Totton

Report by the Director of Adult Services

1.

Summary

1.1

1.2

1.3

1.4

1.4.1

1.4.2

1.4.3

1.4.4

1.4.5

1.4.6

1.5

1.5.1

1.5.2

1.5.3

1.6

1.6.1

1.6.2

1.6.3

1.6.4

1.7

1.7.1

1.7.2

1.8

1.8.1

1.8.2

1.8.3

2

2.1

2.2

2.3

This paper brings together work that has been undertaken by Adult Services and Property, Business and Regulatory Services regarding Stocklands, which is one of Hampshire County Council's Older Persons Homes and Day Centres.

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

Stocklands has been assessed by Adult Services as not meeting 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 (a table identifying the key factors included in the regulations on `Fit for Purpose' is attached). The main issue here is to identify whether a building meets the needs of the current (and future) service users. With increasing frailty, both physically and mentally, of older people the size of bedrooms and access to other communal areas are an important factor. This enables carers to use additional equipment such as hoists and electric profiling beds to ensure safe moving and handling of residents.

The Stocklands building does not easily lend itself to these requirements nor would it currently meet the requirements for the provision of services to older people with dementia.

Stocklands

Stocklands is a two storey purpose built older persons home with an adjacent day centre built in 1972. Part of the home also accommodates the In-House Home Care service, a voluntary sitting service and Adult Placement staff. All these staff would need to be relocated if the reprovision is approved. The adjacent Day Centre was built at the same time and is a single storey building and comprises of a main room, two smaller rooms, toilets, a bathroom, and office and a kitchen area (meals are provided from the residential home main kitchen).

Stocklands is a home that provides care to 50 residents who are mostly physically frail but there are a number of residents who have degrees of Dementia. Being built in the 1970's, it was built for a much fitter resident group and was not therefore designed to take the more dependent resident admitted today. 43 of the current 50 bedrooms are very small and below 9 sqr meters, which means that it is very difficult to access for moving and handling equipment to enable staff to assist residents. The layout of the building with long corridors also presents difficulties for residents with mobility problems. Toilet facilities are particularly difficult to access and require modernisation. Access to bedrooms for wheelchair users is also a major issue with restrictive access, and is not acceptable to the Commission for Social Care inspection standards (the standards stipulate that 12 sqr mtrs is required).

It has become increasingly difficult to accommodate potential residents whose needs are either high physical dependency or dementia care due to the layout and facilities of the home in terms of `fit for purpose'(table attached).

A recent (second) fire safety audit has confirmed that there are a number of shortcomings in relation to fire integrity and safety of the building, and there is a need to undertake some immediate remedial work to improve the overall fire safety of the building. This is currently being addressed. If the building was retained for a longer period, major fire safety work would need to be carried out and this would be of significant cost.

Given the factors raised in paragraph 1.4.1, and in order to bring the building up to modern requirements/standards, major work would be required on bedroom sizes, which would reduce the capacity to about 30 beds from the current 50, as well as upgrading all the facilities. (This would also increase unit costs).This major structural work, as well as the fire safety work has been estimated by Property Services to be in excess of £1.5m at current prices.

The adjacent day centre (which is a separate building) is also in need of some modernisation in relation to toilet and bathing facilities. The day centre accommodates 20 people per day for 5 days per week. There are currently 62 service users attending the centre. The main services of heating, electricity and water are supplied from the main building.

Re-provision for existing service users

There are currently 37 permanent residents at Stocklands (at October 06). The majority of these residents were admitted from within a 5 mile radius of the home. As part of the consultation process, all residents have had meetings with the dedicated care manager (supported by staff of the home) to discuss potential alternative accommodation options should the decision be made to reprovide the service. All residents have had individual needs assessments, the outcome of which informs the consultation process.

There are other local authority homes within a 10 mile radius, as well the opportunity to assess the impact that the new ENHANCE Forest Court (within 1 mile of Stocklands) will offer. Other opportunities will also exist in the independent sector homes. At least 16 of the residents have been identified as meeting the criteria for Forest Court Nursing Home and a number of others for other local authority homes in the near locality as well as independent homes

Plans are in progress for the reprovision of the day service, following consultation with service users and the following alternatives have either been offered or still being planned.

A small group of existing service users could move to two other In-house day service at Cranleigh Paddock, Lyndhurst or the Masters House, at Nightingale Lodge at Romsey. It is also possible to open up an extra day at Cranleigh Paddock to offer a further 12 places for either people with physical frailty or dementia. The third option is to reprovide the existing Calmore Day service with a reduced capacity of 15 places using a number of the existing staff in another location within Totton (active discussions are currently taking place with New Forest District Council to further this). This would also give an opportunity to start to introduce a new approach for a Wellbeing and Day Opportunities Centre..

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 prevent 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, which indicates downward trend in demand for residential care places

There are already a number of services within the locality to support older people to remain at home, including social clubs, meals on wheels, sitting services and transport. There is currently active work being undertaken to further develop extra care housing, in conjunction with the District Council. This is where people have their own tenancy, similar to sheltered housing, but where care is provided on site in accordance with people's assessed care needs. It therefore provides a complete alternative to residential care, and at a much reduced cost to the Department, as "bed and board" elements are met by the individual.

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 are in the process of being established.

Staff

There are currently 55 permanent staff equivalent to 37 whole time equivalents employed by Hampshire County Council working at Stocklands.

The options for their future employment are that they would be offered a number of options within the service sector including an opportunity to relocate to the new service at Forest Court, as well as other local authority homes. There has also been an opportunity for staff to explore wider redeployment options within Hampshire County Council.

Consultation Process

The reprovision of this service has been subject to a 12 week consultation period. This is compliant with the Hampshire Compact and Cabinet Office guidance. The responses have been very mixed from dismay and concern to the other extreme where people have understood as to why this has happened - see attached Consultation Plan.

The consultation has included (with an extract of comments where made):

The regular service users of Stocklands (as indicated in Paragraph 1.5.1) with their relatives. The meetings with care management and the Homes staff have generally gone extremely well with considerable support from many relatives. Once involved and options considered, many residents/relatives have been anxious to move and found it difficult to understand why they had to wait before the move was actioned. Those residents who were considered suitable for Forest Court nursing home visited the service on the 24^th September, with staff or relatives, and there were many positive responses. A few residents have expressed their desire to remain locally in Totton, and this can be accommodated using independent sector homes.

Day Centre service users and their carers have all had opportunities to voice their opinions at the 5 sessions held in August. There was high service users satisfaction expressed at the meetings about the current day care, but an overall negative response to reproviding the day centre given its importance of maintaining people at home and carer respite. This was prior to the service users being aware of the potential reprovision options for day care.

Homes staff have all been interviewed and initial options for future employment agreed. A number of employees have chosen to move across to Forest Court and some to other homes within Adult Services. Some staff are considering the redundancy option, although negotiations are still in progress and a final figure is not yet known. There are also ongoing discussions with day Centre staff about options.

Two local and one County voluntary organisations were advised of the proposal (Age Concern and Alzheimers) but as yet no response has been forthcoming.

The local PCT (as at July 2006) was consulted and are generally supportive of the approach. However a local Consultant in Old Age Psychiatry did write expressing concerns about the loss of a valuable local resource, both in terms of the home and the day centre.

A copy of the July Social Care Executive report was also sent to New Forest District Council and a response is awaited.

A briefing session and visit to the service took place with the local Member, Cllr Alan Weeks on the 18^th August, and he was opposed in principle to the closure. A letter has also been received from Totton and Eling Town Council expressing their concern about the loss of both a local residential care home and the day service. An invitation to visit was also extended to the local MP, Julian Lewis, but this was not taken up.

As part of the consultation process, the Adult Services Policy Review Committee has considered the proposals and `it is a recommendation to the Executive Member - Adult Social Care that she agree to the reprovision of services at Stocklands Older Persons Home. Additionally it be a recommendation to the Executive Member for Policy and Resources that all capital receipts from the sale of the home be retained for Adult Social Care use'.

Financial Impact

The current gross annual budget for Stocklands is £873,977 for 50 residents with a net figure of £530,000 pa. The unit costs are £354 pw and the occupancy for 05/06 was 95%.Clearly this has reduced with the numbers reducing and no further permanent admissions have been made. Allowing for the transitional costs of closing the home (including the costs of redundancies) and the lead-in time, the savings for 2006/2007 are £100,000 and for 2007/8 are £430,000

If the home was refurbished and the bed numbers reduced to 30, the unit costs would be £451 per week

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 paragraphs 1.6.3 and 1.6.4. In the short term, if the loss of local In-house capacity results in an increase of local purchasing of residential placements this will be based on an average net cost of £232 per place per week and is dependent upon how many residents can be placed in other Hampshire County Council homes.

3

Impact Assessment

3.1

4.

4.1

4.2

4.3

In compiling this report and developing the strategy, regard has been given to the County Council's 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.

Conclusions

Clearly Stocklands residential care home does not meet the service requirements either for 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 £1.5M it is unlikely that it would meet the needs of future service users.

The day centre, whilst providing a well respected service would both require over £145,000 to upgrade and would compromise the sale of the site if a decision was taken to reprovide the residential services. Given the high level of service user satisfaction and the need to have some form of day care in the locality, if approval is given to reprovide then the service will be reprovided in three ways: i) use of existing day centres at Cranleigh Paddock at Lyndhurst and the Masters House at Romsey; ii) bringing into operation and extra day at Cranleigh which is not currently used and iii) reproviding a smaller and lower capacity (upto 15 places per day) service using a local facility in Totton possibly in conjunction with New Forest District Council (subject to further discussions).

The consultation process, as indicated in paragraph 1.8.2, received a limited response regarding the residential part of the service but more significant for the day service. Whilst there were some strong views about the need to retain a local resource, it would not be appropriate to invest in 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 proposal for the reprovision of residential, day services and associated office facilities at Stocklands, and that the process to end the current service is completed by March 2007, subject to the care needs of the residents and the day centre service users being met.

LINK(S) TO CORPORATE STRATEGY

Yes No

_

Hampshire safer and more secure for all

_

Maximising wellbeing

_

Enhancing our quality of place

Date/Actions

Progress/Response Received

Residents and Relatives

Meetings with all residents and those relatives able to attend on 20 July 2006.

July - October: Individual meetings with residents/relatives, Care Manager and members of Stocklands staff when appropriate.

All 37 residents now had individual sessions with Care Manager and options discussed.

No letters of complaint about the reprovision of residential provision received.,

Generally an understanding of the reasons why reprovision being considered, although clearly a number of residents anxious.

Positive experience for those potentially being considered for the new nursing home at Forest Court when they visited on 24 Sept 2006.

Day Centre Service Users and Day Care

Day Centre, 5 sessions were held with service users (to cover each day of the week) and any relatives who were able/willing to attend meetings on 8/9/14/18/24 August 2006.

Quite a different response to the residential home. Many concerns expressed at potential loss of day centre and impact on relatives respite as well. One letter and one telephone call received. Local member involved and a lot of local press interest. Care Management input started and will be completed by end of November

Staff

First management meeting/briefing on 20 July 2006 followed immediately by full staff meeting the same morning. Unions previously consulted.

In addition a meeting was held with other day centre staff who were unable to attend on the 20 July 2006.

All staff have now had one-to-one sessions with Human Resources and future employment options are being considered.

Voluntary Organisations

A copy of the July SCE report was sent with an accompanying letter to Age Concern Hampshire, Age Concern, Forest East and the local Alzheimer's Group.

Response form the New Forest Branch of the Alzheimer's Society emphasised the importance of day care to support carers as well.

NHS

Letter and copy of the consultation SCE report sent to the New Forest PCT (July 2006).

Generally supportive of approach.

Letter received from Consultant in Old Age Psychiatry expressing concerns about the loss of a local resource both the residential and day care centres and the need for more not less local facilities.

District Council

Two letters and copy of SCE report sent to New Forest District Council.

Responses awaited.

Letter received from Totton and Eling Town Council expressing concern about loss of local residential and day care facility and impact on local employment.

Local Members/MP

Letter and copy of SCE report sent to local member Cllr. A. Weeks and MP, Dr. Julian Lewis.

Cllr. A Weeks was invited to view the home and day centre and attended on the day centre consultation meetings. Letter submitted to PRC stating Cllr. Weeks opposition to reprovision.

Response from MP awaited.

Policy Review Committee

On 27 September 2006 full debate on the proposal

Recommendation to the Executive Member for Adult Social Care that should she agree to the reprovision of services at Stocklands Older Persons and Day Care:

(a) it be a recommendation to the Executive Member for Policy and Resources that she request that all capital receipts from the sale of the home be retained for Adult Services use

(b) that existing residents are consulted about alternative accommodation

(c) that new day care facilities be provided as close to the existing facilities as possible

(d) staff be offered acceptable alternative employment where possible

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

_

"The layout and size of the building could be problematic for people who have short term memory problems, and for those with very poor mobility" - CSCI Report dated 19 April 2005

Building layout does not promote residents independence in terms of distance between bedrooms and communal areas

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

_

Occupancy is high. However Forest Court will be opening 2006/ 07 which will provide Nursing & Residential Care for 80 Older People (Frail Elderly & Dementia)

2 (a)

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

_

The main lounge is situated by the front entrance with a lot of activity in that area. Quieter lounges are provided upstairs

(b)

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

_

Refurbishment & Upgrading currently underway - maintained to a reasonable standard

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 main lounges is situated by the front entrance. The level of activity in this 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

_

Size of bedrooms

43 Bedrooms are under 9.3 square meters plus 6 are below 10 square metres

Although accepted at registration as this was an existing building, this does not provide adequate space for higher dependency residents.

That is: Lack of space for mobility equipment & carers to provide support/ assist with personal care.

No fixed tracking for hoists in bedrooms

(g)

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

_

CSCI have raised a concern that there is a need for a "medical room" for treatment - the distance between the main lounge & bedrooms is too far to take physically frail residents back to their bedrooms.

(h)

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

_

(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

_

(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

_

Five bathrooms are in the process of being up graded - two already completed. An outstanding CSCI requirement identified in November 2004

(k)

Any necessary sluicing facilities are provided

_

Upgrading of sluices is an outstanding CSCI requirement identified November 2004

(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

_

Bedrooms are very small limiting storage space in bedrooms

The number of electric sockets in bedrooms is inadequate - an outstanding CSCI Requirement Nov 2004 (cost of £150,000)

(n)

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

_

No tracking for hoists in the building

(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

_

Lighting in the corridors could be improved

4. (a)

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

_

Bedroom Closures to meet Fire Requirements

One bedroom is closed due to high Fire Risk

Fire Audit placed Stocklands as a high risk requiring extensive work to bring up to standard - a high priority

Removal of asbestos:

Loss of Income:

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

(b)

Provide adequate means of escape

_

See Fire Audit