Regulated Care Provider: Business Failure and Transfer Policy

1. Introduction

Background

Section 38 of The Care Act (2014) imposes a temporary duty on local authorities in the event that a regulated provider becomes unable to provide a regulated activity to an individual due to a business failure. This duty applies regardless of whether the individuals care is funded by the local authority or not. This temporary duty is invoked where the following criteria are met:

The provider must be a registered care provider
The provider must be unable to carry out the particular activity. Where the provider is able to continue the activity despite business failure the duty will not be triggered.
The activity that the provider is unable to carry out must be a regulated activity.
The inability to carry out the activity must be due to the provider’s business failure.

The Act states that a local authority must ‘for so long as it considers necessary’ meet the needs for care and support which were being met immediately before the business failure occurred. The local authority is not required to continue the services that were previously provided and has discretion as to how it will meet those needs, though this should be agreed with the individual where possible.

The policy ensures that the care and support needs of service users continue to be met in the event of an unplanned business failure. This policy is for regulated businesses providing regulated care activities such as:

Homecare provided by domiciliary care agencies;
Residential care homes;
Nursing care homes

This policy details our response to an imminent provider failure, and should be used to support our business failure checklist.

The duty applies as soon as a local authority becomes aware of a business failure, and applies to both adults in need and their carers.

Our temporary duty will not be triggered in the event of a planned provider closure, when we would expect to receive sufficient notice of at least six months advising of a planned closure. Providers should alert us via the following ASC Contracts and Quality Monitoring email: asccontractsandqualitymonitoring@somerset.gov.uk

In discharging this duty, local authorities are not required to carry out a needs or financial assessment or make a determination of eligibility. Local authorities have the power to charge for the cost (except for the provision of information or advice) in meeting the person’s care and support needs. Where the person is ordinarily resident in another local authority’s area, the local authority discharging its temporary duty may recover its costs from the former. However, the duty does not extend to people in receipt of NHS funded Continuing Healthcare – the duty in these cases remains with the NHS – as the local authority does not have the power to meet needs which are required to be met by the NHS.

Risk mitigation

Our existing quality assurance and contract monitoring activity will help us to identify early warning of potential failure. We will aim to support providers, using our Quality Policy and guidance from the Care Provider Commissioning and Quality Board, to help them improve, and where this is not possible to have a planned exit strategy.

Where there is a planned strategy, good practice will require that the processes of this policy continue to be followed, but it should be recognised that the duties on the Council are only for those people it currently supports. The Council recognises its safeguarding duties for vulnerable people.

Regulated care providers registered in Somerset are responsible for informing the Local Authority in the event of a planned or unplanned closure.

In the event of a planned closure, the provider must give the Local Authority a minimum of 6-months’ notice before the planned closure date.

All regulated care providers are required to maintain business continuity plans that should be regularly reviewed.

Care Continuity

The aim of this policy is to ensure the care and support needs of all service users can continue to be met in the event of an immediate business failure by a regulated care provider in Somerset. It details what to do and who is responsible to make sure people are safely transferred to replacement and appropriate services.

The types of failure covered in the plan include imminent closure or cessation of a services; cancellation of registration through a Care Quality Commission (CQC) enforcement action; immediate closure caused by fire or flood for example.

Policy objectives

To outline the trigger criteria to activate the response plan;
To establish appropriate response teams following the notification of a business failure;
To set out the roles and responsibilities of those detailed in the plan;
To describe communications in terms of notification and on-going working;
To set out the contingency measures that will guide the incident response;
To provide a key contact list that can be referred to in the event of an incident occurring

2. Policy activation

The following individuals have responsibility for activating this policy:

Director of Adults Services
Deputy Directors of Adult Social Care (Operations, Commissioning)
Service Manager – Quality Assurance.

The response will be led by the Adult Social Care Quality Assurance Team; a lead will be identified and ensure this policy is followed and the following undertaken:

Convene a provider failure response meeting following a business failure notification being received
Devise an action plan and allocate tasks / duties
Set clear timescales for activity
Seek legal advice as / where required
Keep Directors and senior managers fully briefed
Ensure all meetings and decisions are recorded for audit and assurance purposes.

A dedicated team of operational staff and a lead manager will be identified, including input from the NHS and Business Support as necessary to be responsible for:

All care and support decision making
Ensuring all identified care and support needs are appropriately met
Communicating with individual service users and families
Ensuring advocacy support is available
Implementing the business failure checklist.

Key actions: planned business closures

In the event of a provider alerting the QA Team or any ASC Directors to an impending / planned business closure prior to this news being in the public domain or shared with their own staff or clients/residents, this information will only be shared at Adult Social Care Senior Leadership Team level for awareness to support planning and readiness activity. It will not be shared more widely until the news has been shared by the provider themselves with those directly affected.
Once in the public domain, the Quality Assurance Team will liaise with affected elected Councillors and the Lead Member for Adult Social Care, and arrange for a Member Briefing to be circulated that same day to inform the wider Council leadership team and all councillors, as well as Comms Teams and our call centre. The Member Briefing document will also be circulated via the ASC newsletter, The Loop, to ensure local authority staff also aware and where appropriate with NHS ICB colleagues.
The QA Team Lead will communicate developments with the relevant operational team and secure social work support as required, as well as with other key stakeholders (sourcing care, external commissioners etc) to commence a smooth and effective closure process and make arrangements to support affected residents/clients by clarifying next steps.

Key actions: unplanned/emergency failures:

Once a business failure notification has been received, the Quality Assurance team lead will call a business failure planning meeting promptly after the council is made aware of the business failure. All nominated officers will attend the planning meeting as a priority. This may include representatives of the Care Provider Commissioning and Quality Board.
The regulated care provider will be asked to supply the Council with a copy of an up-to-date service user resident’s grid (see appendix 1) within 24 hours.
The Quality Assurance lead will ensure that all funding authorities are promptly identified and informed of the provider business failure.

We recognises that a range of contingency responses maybe needed – this may include the following:

The QA Response Team will actively engage other funding authorities to effectively co-ordinate and support the closure process.
If market capacity is available, the Response Team may opt to re-provide services either in full or in part through existing contractual provision and assist self-funding service users in procuring alternate services from available provision.
Liaison with the Local Authority’s Sourcing Care Service to identify and prioritise existing vacancies and capacity in the county.
Accessible care provider lists will be available for the Incident planning meeting (to be compiled by the Sourcing Care Service and Procurement Teams)
Where there is limited or no market capacity available, the Local Authority will aim to prevent the provider from closing by providing short-term business or financial support to ensure that the service closes in a planned and managed way, for example, by asking another provider to provide short-term business support.
We will ensure that the individual’s needs that were being met before the business failure will continue to be met, though this may not be by the in the same way.
Wherever possible Care Home resident friendships and/or relationships will be taken into account when sourcing alternative accommodation.
We recognise that it is important to be clear as to the reasons for the business failure. Consequently, good communication will be essential, particularly for services users and their families / advocates who will require reassurance and information on any proposed business continuity plans. Equally, staff teams may be crucial in ensuring continuity of care is maintained and will equally need to be kept informed throughout the process. We will liaise and meet with service users / relatives / the CQC / and others as appropriate

3. Business Closure/Failure Checklist

Key Questions

What is the timeframe? When is the closure date?
How many people are impacted (service users and carers)?
Who are the key stakeholders to involve?

Process management

The nominated Quality Assurance Team lead, in liaison with the Locality Operations Manager, will:

schedule regular multi-agency meetings of the involved organisations and key stakeholders to agree roles, responsibiltiies and key actions, as well as timescales and communications across the closure period.
establish any time commitments or planed absences, and identify the need for any delegation with the Locality Operations Manager.
Consider using business support staff to help coordinate all written communication; they will be the information officers and must ensure effective version control is used for all communication.
identify and utilise a core group of practitioners to work with the residents/service users and their families.
Ask the provider to provide details of all their residents/service users, including next of kin and funding arrangements. If a Care Home, information should also be provided on any individuals attending day care, in receipt of meals supplied by the Home, or with short breaks planned.
Ask the Sourcing Care Service to identify alternative available capacity or provision in the county.
Establish a clear message for all involved stakeholders about why the action is being taken
Consider the effect and impact on all care provider staff time and activity (including management, carers, domestics, catering) to maintain safe levels of operation through the process.
Consider the need to commission additional or interim provision to support with care delivery.
Seek advice around any Infection Prevention and Control implications and periods of isolation – for example, COVID, flu, norovirus, scabies and other infections
Risk assess utilities to ensure they remain fully available until planned closure.

Service users / residents

Consider need to bring in another provider.
Establish a resident/service user grid to include relevant funding authorities (both LA and NHS). Establish on the grid a risk assessment for each individual. Update the grid and risks on a regular basis and make available to key stakeholders.
For domiciliary care, ensure all clients (LA/CHC/Private/Direct Payments) are captured on the grid, so no one is missed or inadvertantly put at risk. Ensure there is a double checking process in place.
For Care Homes, consider placing a poster in the Reception area with brief details of what is happening, along with names/phone numbers of key contacts for residents / families to use should they wish.
Ensure customers understand what is happening and why; consider who is best placed to tell them and how, having regard to capacity.
Consider and engage advocacy support as required.
Establish whether Best Interests decisions are required for any one. Consider whether an IMCA needs to be involved.
Take into account any DoLS and ensure arrangements are put in place for the receiving provider. Take advice from the MCA and DoLS team as required.
Review care needs and prepare up to date assessments. Consider the involvement of others as required (eg. District Nurses, CPNs, OTs).
Identify and agree responsibility for meeting equipment needs, ensuring anything they need is in place with the receiving provider.
Request the provider to supply an inventory of outstanding equipment and arrange for collection by Millbrook.
Identify new placements/provision, taking into account bed availability, staffing, and service user/resident/family wishes alongside the context and urgency. Consider existing friendships / relationships between residents.
Agree the minimum level of documentation required with the identified receiving provider.
Ensure medicines are up to date and in sufficient quantity to support transfer. Ensure arrangements are in place for any controlled drugs and share with receiving provider.
Ensure arrangements are in place for identification of individual property and packing. Agree how personal belongings will be transferred.
Assess transport needs (for example, ambulance and stretcher needed, taxi with wheelchair access). Agree transport arrangements between stakeholders.
Ensure any remaining residents or clients continue to be supported until they move or their provision changes. Ensure no resident becomes socially isolated. Ensure no resident remains alone on their own within the home (the last two should both leave on the same day).
Arrange for a follow up review as soon as possible after transfer with operational social care colleagues.
Agree with stakeholders any further standard review follow up.

Communications

Residents and relatives: Tell them what is happening (including advocacy support). Arrange a face to face relatives meeting to include provider, SCC, CQC and any other key stakeholders as appropriate (eg NHS colleagues)
Press: Inform the LA Communications Team of developments and plans, and consider similar for CHC/NHS and or/provider. Prepare a reactive statement and agree with the comms team how any media enquiries will be responded to.
CQC: Establish clear lines of communication and engagement with the regulator. Consider the need for the involvement of an inspector as required.
Health: Liaise with NHS colleagues (eg CHC) including senior managers as required. Complete joint assessments with District Nurses; ensure Primary Care/GPs are alerted to the planned closure via ICB colleagues. Consider transfer of notes to new GPs. Share updates with somicb.infectionpreventioncontrolteam@nhs.net re new homes residents are moved to in order to support monitoring of any IPC issues
Local Authority/Service comms: Alert the Commissioning and Quality Board of developments and advise the ASC Senior Management Team (particularly where there are issues of high risk or affecting organisational reputation). Consider what the Emergency Duty Team need to know. Alert Somerset Direct (Call Centre) and consider need for a ‘script’ to support any enquiries they may receive. Ensure involved ASC staff are routinely updated and provide wider general update to all ASC staff via The Loop once news is in public domain.
Elected Members / Politicians: Alert the Cabinet Member for Adult Social Care as well as any local divisional councillors for the area of Somerset affected; complete and submit an Elected Member Information Sheet and circulate via Democratic Services team.
Receiving providers
Utility companies
Placing authorities: Ensure timely engagement with placing authorities (including CHC/FNC) re plans and timescales. Ensure reviews are undertaken of their funded individuals.
Finance: Establish funding authorities as part of resident/service user grid (both LA/NHS FNC/CHC). Ensure communication re assessments and transfer arrangements/new destinations to support finance team oversight.
Other relevant individuals: Consider who else has links to the home or service: what information or support may they need (eg volunteers, micro providers, village or community agents)
Interim management arrangements: Confirm staffing cover required, as well as costs and invoicing arrangements. Consider need for any interim provider to re-assess customer needs and put in place daily care plans.

Provider failure in another local authority area

In the event of the Local Authority being notified by another LA of a regulated provider business failure in their area, and where we have individuals placed out of area, identify and allocate operational team support to help Council-funded individuals to move to suitable alternative provision as part of the closure process. Please also refer to: Advice note – commissioning out of area care and support services (local.gov.uk) for good practice in out of area commissioning arrangements.

Additional considerations during COVID-19 pandemic

It is important you understand the COVID-19 outbreak status of the regulated provider setting, including current health status of all residents and/or service users as part of resident grid activty. Determine provider staffing situation / absence linked to COVID. Determine PPE requirements to ensure adequate infection, prevention and control as part of any coordinated response activity. Liaise with Public Health and IPC team/s as required as part of process.

4. Care Provider Transfer Checklist - ASC Commissioning

This guidance has been drawn up to support robust and effective commissioning and quality activity during care provider transfer activity.

Key Questions

The nominated Adult Social Care Commissioning lead should immediately consider the following:

What is the timeframe? When is will the transfer take place?
How many people will be impacted by the transfer (service users and carers)?
Which key stakeholders will need to be involved (internally and externally)?

Process:

The nominated Commissioning lead is expected to:

schedule in regular multi-agency meetings of the involved organisations and key stakeholders to agree roles, responsibilities and key actions required, as well as timescales and communications across the transfer period;
establish any time commitments or planed absences of critical leads, and identify the need for any delegation or cover;
Ask the existing (original) care provider to provide details of all their residents/service users, including next of kin and funding arrangements.
Ensure that the incoming provider has a contractual arrangement with Somerset Council, or has been approved on one of the DPS Frameworks, SASiS or Homecare.
If a Care Home, information should also be provided on any individuals attending day care, in receipt of meals supplied by the Home, or with short breaks planned. This information should also be shared with the ASC Quality Assurance (QA) team.
Request that a QA visit be undertaken prior to service transfer by the ASC Quality Assurance team, and also make arrangements to ensure a follow up QA visit is taken forward within 6 weeks of transfer to new provider to mitigate any quality/safety risks.
Establish a clear message for all involved stakeholders about why the transfer is being taken and how the process is being managed.

Service users / residents:

The existing care provider is expected to progress the following to support an effective transfer process:

Establish a resident/service user grid to include relevant funding authorities (both LA and NHS). Establish on the grid a risk assessment for each individual. Update the grid and risks on a regular basis and make available to key stakeholders.
Ensure residents/clients and their families understand what is happening and why; consider who is best placed to tell them and how, having regard to capacity.
Review care needs and prepare up to date assessments. Consider the involvement of others as required (eg. District Nurses, CPNs, OTs).
Agree the minimum level of documentation required with the identified new/receiving provider.
Ensure medicines are up to date and in sufficient quantity to support transfer. Ensure arrangements are in place for any controlled drugs and share with receiving provider.
Arrange for a follow up review as soon as possible after transfer with operational social care colleagues.

Key communications:

To be progressed by the nominated Commissioning lead

Local Authority/Service comms: Alert the Commissioning and Quality Board of transfer and developments and advise the ASC Senior Management Team (particularly where there are issues of high risk or affecting organisational reputation).
Ensure Lead Member – Adult Social Care is aware of transfer activity along with any elected Councillors within the affected constituency area; keep brief through the process.
Alert Somerset Customer Contact Centre and consider need for a ‘script’ to support any enquiries they may receive. Ensure involved ASC staff are routinely updated and provide wider general update to all ASC staff via The Loop once news is in public domain. Consider what the Emergency Duty Team may need to know.
Finance: Establish funding authorities as part of resident/service user grid (both LA/NHS FNC/CHC). Ensure communication re assessments and transfer arrangements/new destinations to support finance team oversight.
Health: Liaise with NHS colleagues (eg CHC) including senior managers as required. Complete joint assessments with District Nurses; ensure Primary Care/GPs are alerted to the planned transfer via ICB colleagues.

5. Policy review

This policy and process was reviewed for accuracy in May 2023.

It will be reviewed on at least an annual basis via the LA Quality Assurance Team or as/when any legislative or relevant changes impact on provision and response.

6. Learning from Home Closures and Business Failure

We encourage individuals involved in home closure/business failure situations in Somerset to log their reflections and learning as part of our routine quality and improvement activity – please feedback via the form below:

Home Closure and Business Failure – Learning and Reflections Form