Decision details

(1)  To develop Cleeve Court residential home into a centre of excellence for dementia care without nursing.

(2)  To enhance the offer at Combe Lea residential home to enable younger people with more complex needs to remain closer to home.

(3)  To de-register the remaining 10 places in use at Charlton House nursing home and then develop the site to provide a residential school for young people with complex needs.

(4)  To offer community groups/charitable organisations use of the day centre spaces at the community resource centres at a reduced rental rate.

(5)  To commence a full feasibility study in relation to the change of use for Charlton House to a residential school.

The budget for the three homes remains underfunded and, when using the actual costs of delivery of care, the block budget is only sufficient to provide one floor at Charlton House.  In addition, the budget does not cover any agency cost pressures over and above 17% contingency costs.   The 2023-24 Community Resource Centre outturn forecast at Quarter 3 is a balanced budget. If the second floor was opened there would be a budget pressure of circa £1 million. The decision ensures a better use of public resources.

There is ample alternative provision of general nursing care home services for adults in B&NES but there are shortfalls in complex needs services and services for younger age groups. There are currently 25 available nursing care home vacancies and 30 residential care home vacancies in the B&NES area for over 65s. There are 3 nursing homes in the Keynsham area with available beds.

As part of the approach to service development at Community Resource Centres the Council’s aim has been to improve services for the most vulnerable and ensure that we are focussing on areas of highest and most complex need.

As a unitary authority with a high number of EHCPs we need to ensure that the needs of children and young people can be met locally.  Achieving this will ensure that the needs of this vulnerable young people can be met within their local area, supporting close family ties and giving these young people access to the local community, local friendships and local employment and training. We will be more efficient with the use of resources offering more local provision, freeing up places in our over-subscribed special schools and preventing out of county placements. 

The initial consultation for Cleeve Court was to develop the home into nursing dementia care, however, respondents who did not agree with the Cleeve Court proposals felt that it would place additional pressure on staff who struggle to deliver existing services and would require further training.

The challenge associated with the recruitment of nurses was also highlighted. The council has struggled to attract qualified nurses despite market supplements and pay grades that are comparable to the NHS. Additionally, the council does not have the clinical infrastructure required to deliver nursing services within the budgets available.

Therefore, the recommendation was to continue to develop the service to support people with complex dementia who can be supported in a residential setting, including those with early onset dementia and to not seek nursing registration from Care Quality Commission (CQC).