Deregistration: Making it work for
residents
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When is a registered residential service not
a care home?
Language – supported housing and
supported living
Access to housing tenure and rights
The promotion of citizenship
Usually people with learning disabilities and
people with mental health needs
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Change of ‘registration’ in situ/remodelling
of existing service, including property
remodelling
‘Decommissioning’ a residential care
service (in-house or external) and
reproviding with housing and support
alternatives
Terminating ‘placements’ and finding
alternative housing with support options
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Local authorities needing to make substantial
spending cuts
Care and support providers reviewing service
models
Drive towards ‘personalisation’ of care and
support
Housing provider concerns with residential
care models
Pressure in the care monitoring system
Financial motivation – local authority?
 Service sustainability motivation – care
provider?
 Housing provider – desirability of care
model and suitability of property?
 When is it in the residents’ interests?
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Not a new idea
 Pre Supporting People
 Valuing People
 Local authority policies
 More recent cost pressures
 Some individuals and self advocates
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Currently 30% of adults (approximately 33,000 people)
with a learning disability live in accommodation that is
registered for persons who require nursing or personal
care with the Care Quality Commission. Feeling Settled,
2011
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Think Local, Act Personal: Next Steps for Transforming
Adult Social Care encourages the facilitation of a:
“broad range of choice in the local care and support
market, including housing options, and personalisation of
the way in which care and support services are delivered
wherever people live”
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Care providers
Support providers
Housing providers
Care Quality Commission
Local authorities/commissioners
NHS (sometimes)
Housing benefit
Families
Advcoates/IMCAs
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People with disabilities and their families have higher
expectations
Supported living offers people more rights and more
disposable income
Following NHS Campus reprovision programme the
focus will shift to reproviding for out of county
residential placements that are perceived as
expensive and of mediocre quality
Economic realities - supported living is perceived to
be a less expensive option
Personalisation agenda
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Residential care more fully regulated
Package can still be attractive – often
marketed to families
Contest cost/savings vs. supported living
Argue that individualised care/support can
also be delivered
Residential services continue to be
commissioned
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May have historic residential services
Prefer to offer proper housing tenure
Concerns about best use of property and
future suitability for residents
But:
◦ May be wary of LA motives
◦ Concerns about monitoring arrangements
◦ Future relationship with support provider
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Choice Support have been able to achieve a
significant reduction in revenue costs as a
direct result of changing services from
Residential Care to Supported Living. They
have reduced their fees to Southwark council
by £164,000 in 2010/11 following the
change of registration of 11 small registered
care homes in that Local Authority
Feeling Settled, 2011
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Care quality and registration requirements
Care management and assessment
Mental capacity
Housing options and tenure
Housing benefit
Ordinary residence
Funding of care and support
Best interests of residents
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What is a Supported Living Service?
“SLS are where people live in their own home
and receive care or support to promote their
independence. If there is genuine separation
between the care and the accommodation,
the care they receive is regulated by CQC but
the accommodation is not.”
CQC Guidance for Providers February 2011.
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It is important that a provider is correctly registered
for the regulated activity they are actually carrying
on. In order for a provider of a supported living
service to be correctly registered to carry on
‘personal care’, rather than ‘accommodation for
persons who require nursing or personal care’, there
must be a clear separation between the provision of
care and the provision of accommodation.
CQC Guidance for Providers February 2011.
Assessment duty and care
management role remains
 FACS criteria
 May have differing approaches to
‘personalisation’ and funding via
‘resource allocation system’
 May have different approaches to
‘person centred planning’
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Support change in registration process?
Any changes required to existing housing (in
situ)?
Alternative housing options required?
More complex ‘housing transfer’
arrangements?
Nomination and voids agreements
Relationship with future support/care
provider
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If someone has capacity, they should sign their own
tenancy agreement
If a person lacks the mental capacity to make his or
her own informed decision about whether or not to
accept a tenancy offer, then an appropriate person
can make the decision through the best interest
process outlined in the Mental Capacity Act.
Some landlords may be content to accept unsigned
tenancies
Someone can sign a tenancy agreement on the
person’s behalf if they:
◦ Have lasting power of attorney (LPA) or enduring power
of attorney (EPA);
◦ Are a deputy appointed by the Court of Protection;
Is there a rental liability
 Do the residents hold tenancy
agreements?
 Are the tenancies ‘contrived’?
 Usual HB/LHA rules will apply
 Involve HB departments early in the
process
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Often a key barrier (for local authorities)
The ADASS national protocol on Ordinary
Residence in 2010, complements the DH
Ordinary Residence: Guidance on the
identification of the ordinary residence of
people in need of community care services,
England
Level of sign up from local authorities was
insufficient to go ahead with the protocol - in
practice issue remains unresolved
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LAs - new services should be at least costneutral and increasingly they are looking for
overall and / or individual reductions in
service costs.
Link to self assessment and Resource
Allocations systems – may be unclear
Future funding security/viability
Individuals need to be properly supported to
maximise the welfare benefits they can claim
once they become tenants
Local authority in South West
 National care provider (learning
disabilities)
 9 residential homes for 52 people
 3 existing Registered Providers
 Long standing services
 Wide mix of residents ages/needs
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Planning:
◦ Local authority – care management and
funding position
◦ CQC – approach and timescales
◦ Housing providers – views and options
◦ Housing benefit – awareness &
circumstances
◦ Individual and families
◦ Advocacy group
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Delivery:
LA – assessments
LA/provider – housing assessments
Advocacy group – individual plans
Care and support ‘models’
Approach to ‘personalisation’
Housing providers – tenancy
agreements/arrangements with care provider
◦ Agreement with CQC – care provider
◦ Agreement with HB – housing providers
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The needs of individuals – putting the person
and carers at the centre of the process
The role of local authority – assessment and
care management process should be clear
Finance – revenue and capital considerations
considered at outset
Relationship between housing and
support/care provider - clarity and any
agreements in place
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Working with CQC – at outset of process
Mental capacity - any problems identified
with correct approach/timescale
Tenancy issues – suitable tenancy ‘models’
and link between holding a tenancy and
capacity; HB issues resolved
Ordinary residence – identified and addressed
Staffing issues – training, culture, TUPE
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Who ‘drives’ the process
Housing and support/care provision
Funding –
◦ Any capital funding requirements
◦ Revenue cost drivers – need to model carefully
(CFCs may not always be reliable)
Capacity and ‘best interest’ processes
Tangible change in support provision and
culture - service quality
Satisfying CQC
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“Feeling Settled” Guide: Changing from Registered
Care Home to Supported Living
www.ndti.org.uk/uploads/files/Feeling_Settled_Fina
l_Report_February_2011.pdf
CQC Guidance Supported Living Schemes:
Regulated Activities for which the provider may
need to register
http://www.cqc.org.uk/publications.cfm?fde_id=17
217
Housing Options: www.housingoptions.org.uk
Ordinary Residence ADASS
http://www.adass.org.uk/index.php?option=com_c
ontent&view=article&id=287&Itemid=238
Ian Copeman
The Housing and Support Partnership, Stanelaw
House, Sutton Lane, Sutton, Witney, OX29
5RY.
Tel: 07894 904355
Email: enquiries@housingandsupport.co.uk