Decision details

The Lead Cabinet member is requested to approve consultation on the future delivery model for the Councils three care homes (CRCS).

(1)  To undertake a consultation, including with staff, residents and relatives on the following proposals.

·  To develop Cleeve Court residential home into a centre of excellence for dementia care including nursing care.

·  To enhance our offer at Combe Lea residential home to enable younger people with more complex needs to remain closer to home.

·  To close the remaining 11 places at Charlton House Nursing home and then develop the site to provide alternative care provision and/or housing options that would meet the needs of the local community now and into the future.

·  To offer community groups/charitable organisations use of the day centre spaces at the community resource centres at a reduced rental rate if the organisations offer services that are accessible to the care home residents and the community.

(2)  To ask officers to bring forward a further report including recommendations following the consultation.

The Community Resource Centres (CRCs) were part of the original integrated community services contract held by Virgin Care Services Limited which commenced in April 2017. In September 2019 Sirona gave notice on the CRC contract to Virgin Care.  B&NES undertook an options appraisal and Cabinet took the decision to return the service in house and be run by the Council. The contract value did not reflect the actual costs of delivering the service.

Since taking the service back in-house in 2020, B&NES has invested significantly across all areas of CRC services including increased pay for staff and training and equipment to support care.

The CRC provision includes Charlton House which is registered to provide 30 nursing care beds over 2 separate floors, Combe Lea which provides 30 registered care beds and Cleeve Court which provides 45 registered care beds. Following a CQC inspection in October 2022, which identified a number of concerns, the council took the decision to temporarily close 15 nursing care beds on one floor at Charlton House. Significant progress has been made since this time and the CQC currently rate the service as ‘requires improvement’.

However, the contract for the 3 homes remains underfunded and, when using the actual costs of delivery of care, the block budget is only sufficient to provide 1 floor at Charlton House. In addition, the budget does not cover any agency cost pressures over and above 17% contingency costs. If all factors remain the same, the CRC service is facing a potential overspend of circa £1 million in 2023/24 and a decision has been made to review the services provided.

It is worth noting that there is ample alternative provision of general nursing care home services for adults in B&NES but there are shortfalls in complex needs services. The Charlton House building is relatively new and is of high quality, so is suitable for several alternate uses. The estates department and children’s services have begun to scope the building for possible long-term accommodation and discussions are underway with other partners for temporary use of the building as a step-down ward over winter.

The council continues to operate the 3 CRC services with an additional investment of £795k into the base budget year on year. The service aims to maintain occupancy levels at 90% and increase the numbers of self-funders which provides additional income to the Council. This option has been discounted due to the difficulties in recruiting staff and the impact on the council budget.

The Council ceases to operate Charlton House and no longer provides nursing care. The 11 service users who require ongoing nursing care will need to be placed with private providers. This option has been discounted as the council has applied to the CQC to continue to be a provider of nursing care. This option would have a financial impact on the commissioning budget if external providers were commissioned as opposed to using the vacant beds at Cleeve Court.