Introduction
Theme and background Authority
About Ringerike municipality and implementation of audit
County Department of discovery
Further follow-up of audit
the County has the spring of 2014 audited Ringerike municipality and examined how the municipality safeguards obligations they have for health and care services law. The County has investigated how services are approved and implemented. We also examined how the municipality responsible for supervision duty, user participation and evaluation of services.
Authority gave grounds for establishing three deviation:
- municipality has not established systems to ensure the proper performance
- municipality does not assess systematically whether assigned services are acceptable
- The processing of service carer is not in accordance with the applicable rules
were also given a note:
Not all users have showers and practical assistance when the service should be rendered on a movable holiday.
report discusses both the noted discrepancies and the parts of the service were examined without uncovered discrepancies or made comments.
Date: 06/04/14
Wenche Jensen
audit manager
Anna Mech
Accountant
Ole Johansen Bennie
auditor
This document is electronically approved and transmitted without signature
Supervision is legality. The purpose of the audit is to enhance service and legal certainty for users. Governor is in the law of municipal health services § 12-3 given the authority to oversee how the municipality to attend to his duties under the Act.
This report was prepared by system audit in Ringerike municipality in the period 13.01. 14 to 04/06/14. System audit consisted of a review of documents and case files and interviews with employees and managers. The purpose of the system audit is to assess whether services are reasonable and in accordance with legal requirements, and if the municipality operates its own adequate planning and control of the services they provide. The local authority has a statutory duty to engage in quality improvement efforts and internal controls. [1]
During the audit, we examined whether it is compiled routines in the areas audit included. We also checked whether these are available and known to the employees. Next, we assessed whether procedures are in accordance with the regulations. We controlled what is practiced, whether this is in accordance with internal procedures, and whether practices are well enough documented in the material presented.
Theme of the audit was on Ringerike municipality provides services practical / personal assistance and carer to residents of the municipality who are entitled to these services. The County considered whether it was argued in the decisions that assigned services were reasonable in design and scope. Furthermore, we investigated whether assigned services are implemented. We examined whether the municipality safeguards assessment requirement, supervision requirement and user requirement. The County also examined whether assigned services are evaluated and changed in conjunction with changes in demand.
the County has seen this oversight council proceedings leading up to the decision, how the municipality follows the decision and how the cooperation between ordering and performing in the municipality. The County has not looked at how the services are performed to the individual user. Authority is further limited to care services in the home, we have not seen health services are handled by a healthcare professional.
the County adds at the start of plans for the communities we should be supervised, and what will be the theme. For some of the system audits is the theme adopted by the State Board of Health, as part of the nationwide audit. Supervision of practical / personal assistance and carer is an audit, we have taken the initiative and we chose to oversee the Ringerike municipality on the basis of complaints and messages that have been received by the County Governor.
Ringerike municipality is home to approx. 29,000 inhabitants. The services the County as of the Authority, is organized in a book and utførerdel. Subscriber unit, hereinafter referred to as the Awarding Agency, makes a decision and sends the message to perform device, which initiates and executes services. The services assigned by the Assignment Office. The unit is currently acting head because unit managers on leave. It’s Home-based services are responsible for performing part, and company manager is responsible for nine different entities that provide services with residents in Ringerike municipality. Acting Municipal Director Kirsten Orebråten is the leader of both unit managers covered by the audit. Ringerike municipality has started an internal review where they among other things looks at the organization of the services covered by the audit. It is prepared an action plan for allocating office to be implemented in 2014. Through this work, the current policy documents are revised and incorporated in the business. Awarding Agency aims to meet residents with “one voice.” Furthermore, the introduction of procedures for quality service and award procedures for documentation. The municipality will also develop procedures for internal control where this is lacking. The County has received copies of two reports that the municipality has ordered; one from Buskerud kommunerevisjon IKS and KPMG. Both reports were published in autumn 2013, and touches partly the same space as the County on the audit.
manager of the agency for booking office is responsible for finance and personnel. There is one employee discipline leader who is responsible for the technical part. She supervisor in individual cases. Staff in the office are divided into different groups, divided on the services they are responsible. The various groups have weekly meetings where complex issues are addressed.
It is a guide for granting practices in the community, most recently revised in December 2012. Guide describes criteria for allocating services by health and care services law. Furthermore, it states that it is issued guidelines for how employees should exercise the necessary discretion. Employees must take into account the principle of user participation and Leon principle (lowest effective level of care) when assessing the need for services. Where the local authority has a duty to provide assistance, this obligation is met and in the guide it says that aid can not be rejected for financial reasons. The criteria for the award of practical assistance is comprehensive and detailed. The routine specifies that there should be an individual assessment. It says in the guide that where there is a need for washing windows, this shall be at the expense of another sink. It is equivalent to a separate, detailed procedure for the award of practical assistance in the form of training. The municipality has also routine for allocating carer. It is shown here that it is prepared guidelines for case management, but that these applications will be assessed individually. It will be used a “døgnur” by allocating a carer. The County has not been submitted to any of the guidelines referred to in the guide.
municipality receives an application, it shall be carried out a home visit. Information from this visit is central to the assessment process. It emerges from conversations with employees that applicants are consulted when services are designed and evaluated, and the municipality is trying to fulfill your requests within the scope of the regulations.
written notification of the decision [2] for each local authority reaches a decision. The municipality portions decision aid in practical assistance (cleaning) and home nursing. Home care includes besides necessary health care, personal assistance in the home. This means that applicants requiring both practical and personal assistance, made two decisions on this, by various provisions in the health and care services law [3] . Decision on practical assistance is given in time, while in decisions about personal development, it is stated what the applicants will get help unless this is time estimated. Performs under the supervision put forward a list that is used when the employee work schedules set up. The list was created in May 2011.
municipality routine to process deviations, complaints and feedback in health care. It’s unit manager is responsible for ensuring that all employees are familiar with discrepancies must be notified and it must always be provided feedback to the report. The routine defines that difference is the lack of fulfillment of the requirements defined in the laws, regulations etc. Moreover, it defined what a complaint and feedback are. It is also informed about current business systems. All deviations, complaints and feedback will be notified with a copy to the quality advisor. It is this that is responsible for systematization, analysis and reporting of quality choice and political choice. The municipality did not provide a complete overview of the deviation, then the quality advisor was on vacation.
It is a collaboration between award office and business Home-based services. The purpose of this is to ensure the content and quality of the services covered by the contract and ensure cooperation between the parties. The agreement regulates the changes in users’ needs should be reported through Performs a BE-note to the Assignment Office. Awarding Agency shall make a new assessment and provide feedback performs. Regular assessments shall be made through scheduled meetings between ordering and carrying out according to procedure. The staff is aware that they should write BE-note, and this is done largely according to the procedure. It does not, however, conducted meetings, such as routine describing.
the County issued audit notification 1/13/14. List of documents the company has submitted in advance of the supervisory visit is given in the appendix to this report. Opening meeting was held on 07/04/14. 12 people were interviewed. Among these were three units of home care services represented, managers, acting chairman and deputy acting Local authority. Overview of documentation were reviewed during supervision visit is given in the appendix. The final meeting was held on 08/04/14. From the County attended senior counselor Wenche Jensen, senior advisor Ole Johansen Bennie and adviser Anna Mech. Wenche Jensen was an audit manager.
the County investigated both how the award office investigates and makes decisions and performs on implementing services and follow procedures related to the evaluation of the decision.
guideline to Assigning office has no procedures related to the evaluation of the decision. It is also not submitted any procedures to ensure that this Assignment Office. In practice, decisions mainly evaluated annually, and it becomes an evaluation date in the decisions. There are varying practices for how long it should take from the decision date to the evaluation date, but this is not related to tjenestebehovets character. It is established practice that essentially ensures that decisions are evaluated within the given deadlines.
User participation in Ringerike is ensured through monitoring meetings with the applicant. However, there is little documentation what comes up at the meetings, which are not included as part of the reasoning in the decisions. The municipality is studying systematic cases, regardless of whether they come as a result of an oral or written request. This applies to both new cases and evaluations. However, there are no procedures for case management in the community beyond the aforementioned supervisor. This allows seemingly identical cases can be treated differently depending on who is the executive officer and without justified by individual needs. There is no assurance of decisions in terms of counter-signing. The individual officer makes the decision alone in the simpler cases, while more complex issues are discussed in the weekly academic meeting. It has also been reported that changes in the needs of users have not been captured by measures office.
practice of making annual resolutions and one decision per. assigned service allows applicants with complex needs are many decisions to deal with. In some cases, set revurderingsdato very short time after the date of decision, in some cases longer than a year, but in most cases, set revurderingsdato routinely one year after the date of decision. This is not illegal, but can create uncertainty for the individual applicant, related to what happens after the scheduled evaluation date. This also creates a lot of extra work for the municipality.
Business Home-Based Services is responsible for implementing services. This is done in accordance with applicable procedures, the area covered by the audit. It is evaluated how fast it is necessary to initiate services, and home is inserted immediately, if necessary. The County had conversations with committed staff both in performing and order, which stretched far to ensure that residents in Ringerike municipality get the services they have on decisions. However, it is clear that there is an under-reporting of deviations, even if they express that “they get it.” Deviations routine is not sufficiently known and implemented in the organization.
County Department concluded that the municipality’s duty to investigate is taken care properly for Public Administration. Furthermore, the participation by patient and user rights law [4] attended, although this is poorly documented. The municipality implements services that are resolved on, within a reasonable time.
In the following, the County Review the deviations and the notice given in the audit. When it gets to differ, this is because the community has a practice in violation of law and / or regulation. This constitutes illegal operation that the municipality must take measures to change. Notes are given where the supervisory authority believes there is a basis for improvement. The practice is not illegal, and the County can not require the municipality to change this. The supervisory authority does not follow up notes afterwards supervision.
the County made observations of illegal practices:
Deviation 1
- municipality does not meet systematic guidance duties [5] . There is no written information material aimed at the public, and when it comes carer, it is difficult to find information about this on the internet
- staff informs not systematically about services in Ringerike municipality
- There is little current procedures for processing and decision is not quality assured before being sent out. This can lead to impaired discrimination of cases
- decisions contain no assessment of whether the user meets the conditions for patient and user rights Act § 2-1, a second paragraph
- justifications of decisions are generally very deficient [6] . There is scarce descriptions of the facts, and there is no explanation for the exercise of discretion. It is not apparent why the allocated services cover the actual needs [7] .
Overall, this amounted to the County’s evaluation practices that involve deviation from the statutory requirements for service. The County formulated discrepancy as follows:
municipality has not established systems to ensure the proper performance
This deviation from the Public Administration Act § 11 and Chapter V.
Comment
staff performing the service in Ringerike municipality stated that they are working effectively and mostly fail to provide the services they should be facing residents in Ringerike municipality. They discuss with users if there is a basis for evaluating the services, but this is not systematic. There is no routine for that service providers should inform the service for care, where they consider that this might be appropriate. Several stated that they did not know the service well enough to be able to guide on this.
Ringerike municipality makes decisions and apportioning services without considering whether the conditions for patient and user rights law are met. The law cited, however, in the decision. The majority of the decisions that the County has undergone, is very short and contains little or no fact. This is especially revurderingsvedtakene. In an internal report that the municipality has ordered, and the County has been presented, it is stated that the decision of the municipality granting services do not require supplementary decisions where it gets rejected. This is too narrow interpretations of the law on health care law, and it weakens the applicants’ legal rights. When it comes to decisions about health care, it must be fact which the municipality finds, where the information is retrieved from a rationale for why meted services cover the applicant’s actual needs. The situation around the user can change from year to year, and it is therefore important that the council refers to the fact which they have assumed.
Deviation 2
- It is not an adequate system to ensure that changes in users’ needs are captured
- community has standards for the award of practical assistance, and it is up to the individual officer whether this standard can be deviated. Sentencing in the decision is not related to the applicant’s needs. The standard takes little account of the nature of property
- no assessment of total services to the users’ needs
- the County has taken two decisions, as the basis of information in the case is considered to be below soundness requirement [8]
- decisions about practical assistance contains terms that users can get washed windows, but it may be at the expense of assigned services
- municipality deviation system does not capture the systematic failure of services
- User participation is not documented beyond that it is carried out home visits.
Overall, this amounted to the County’s evaluation practices that involve deviation from the statutory requirements for service. The County formulated discrepancy as follows:
Ringerike municipality considering not systematically allocated for services is acceptable
This deviation from the Public Administration Section V, health and care Act § 4 -1, internal regulations and Quality Regulations.
Comment
system to notify any change in BE-form not followed up systematically by municipal employees. There have been failures due to this. There are no procedures for processing in Ringerike municipality, beyond guideline revised in 2012. However, it is introduced standards of service practical assistance, but it is somewhat different perception of what the standard really means. Sentencing happens without it tied to the needs and the residence applicant. Carries out said, however, that they also do other, necessary tasks if they see the need for this, unless it is known whether this is covered by the decision. There is no time stamp of Service “home care” for the part that includes personal assistance. There are very few decisions that provides help as dishwashing and garbage handling. Performs unit presented a list of time estimate used when setting up the lists. This is used as the basis for the services to be performed, and which also includes the services.
Decisions The design and grounds makes it impossible to assess whether services are allocated is justifiable, based on the requirements stated in the case. The decisions lacks fact, the various services provided is not mentioned in context and is not considered against the need for help seeking have.
Deviation 3
- municipal processing of carer there is no evidence that the overall care needs are mapped
- It does not appear the decisions which part of the care that is regarded as “particularly burdensome”
- In sentencing carer to parents, it is not considered what is deemed to be age appropriate care
- In six out of ten resolutions that are submitted to the County, the care salary set at 20% without further justification
- In one decision, the municipality has meted carer in a fixed amount to compensate for the reduction in attendance. It is not considered in the decision whether this is an appropriate level of service. This is not set in the context of other municipal services.
Overall, this amounted to the County’s evaluation practices that involve deviation from the statutory requirements for service. The County formulated discrepancy as follows:
The processing of service carer is not in accordance with the applicable rules
This deviation from the Public Administration Section V and the health and care services law § 3-6.
Comment
Carer occupies a special position because the municipality has no obligation to provide this service [9] , provided it is inserted into other services that can help fulfill the need for a responsible manner. Family or others performing tasks that are regarded as “particularly burdensome” 9 entitled to assistance from the municipality [10] . The municipality must consider both what makes the applicant satisfies the conditions for obtaining services for patients and clients Rights Act § 2-1 a, second paragraph, and consider which tasks are considered to be particularly burdensome. What tasks this is, will depend on an individual assessment of each case. If the municipality does not insert other aid measures, the municipality shall compensate the carer for the hours that are considered to be particularly burdensome possibly less benefit [11] . Parents have a duty of care for their children [12] . The municipality must therefore associate help needs against what assistance needs of children of similar age have and determine what goes beyond that normally provided by parents responsibility. These assessments must be clear documentation in the case and the decision.
municipal supervisor says that hour shall be assessed on the basis of a “døgnur.” The County does not find evidence that this is being done, and it does not appear from the decisions. The enforcement of carer appears to be somewhat random and somewhat standardized although in our review found resolutions of up to 100% carer earlier. The County will also point out that an apportionment percentage without linking it to hours, may be partly very misleading, as it is not stated in the decision what is the basis of the percentages granted.
the County also found reason to give a note:
Not all users have showers and practical assistance when the service should be rendered on a movable holiday.
Comment:
The staff make agreements for showers and practical assistance on other days, but there is no evidence that they fail to capture all . It was also stated that most thought it was okay to take it another day, or they may skip once. However, there is no routine for how this should be handled. The County did, however, likely that users get these services and have not gone into the documentation related to this.
the County asks that Ringerike municipality within the County 06/27/14 sends a plan where the following is shown:
- What measures are foreseen taken to correct deviations
- How management will monitor and ensure that measures are put in place
- How management will ensure that the measures have worked as planned, after they have been working for a while
- What limits the municipality has taken to ensure progress is being rightly deviations.
the County will terminate supervision when the municipality has documented measures and directed deviations. Contact in after work will lead auditor Wenche Jensen, who can be contacted on e-mail: fmbuwej@fylkesmannen.no or tel. 32 26 68 61
1 Health and care Act § 4 -2 Regulations relating to internal control (FOR 20.12.2002 No. 1731) and the Regulation on Quality of Care for care (FOR 27.06.2003 # 792)
2 Public Administration Act § 27
3 Health and care Act § 3-2 no 6 letter a “medical home” and the letter b, “personal assistance, including practical assistance and training and personal support , “
4 Patient Rights § 01.03
5 Public Administration Act § 11
6 Public Administration Act § § 24 and 25
7 The obligation to provide proper services, see health and care Law § 04.01
8 the County has identified the issues facing the municipality after the final meeting
9 See health and care Law § 03.06
10 Cf Patient and User Rights § 08.02
11 Circular I-42/98 of Health and Social Affairs Section 5
12 Children Act § 30
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