DOMICILIARY CARE AGENCY Leonard Cheshire (Ware) 2 Wells Yard Ware HERTS. SG12 7AS Lead Inspector Louise Bushell Announced 16 th August - 12 th September 2005
The Commission for Social Care Inspection aims to: Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Internet address www.csci.org.uk
This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this agency are those for Domiciliary Care. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Leonard Cheshire (Ware) Version 1.40 Page 3
SERVICE INFORMATION Name of service Leonard Cheshire (Ware) Address 2 Wells Yard, Ware, HERTS. SG12 7AS Telephone number 01920 466111 Fax number 01920 466140 Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration Leonard Cheshire Joanna Wright DCA No. of places registered (if applicable) 0 Category(ies) of registration, with number of places Leonard Cheshire (Ware) Version 1.40 Page 4
SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 th Feburary - 25 th Feburary 2005 Brief Description of the Service: In 2000 Hertfordshire County Council awarded a block contract for providing domiciliary care services in the county to the Leonard Cheshire Foundation, which is a registered charity. Leonard Cheshire Care at Home Services is part of the Leonard Cheshire Foundation. The Ware branch provides domiciliary care services to the surrounding area s. The agency provides personal care at home for older people, adults with mental health issues, learning disabilities, physical disabilities, terminal illness and recovering from illness, children with physical disabilities or learning disabilities, children and families, Dementia and Extra Care. Leonard Cheshire also provides staff and service users with an Out of Hours Service. Leonard Cheshire covers a geographical area consisting of East Hertfordshire and Broxbourne including Waltham Cross, Cheshunt, Hoddesdon, Broxbourne, Hertford, Ware, Buntingford and surrounding villages. The agency has attained Investors In People Status, which was recognised in 2004. Leonard Cheshire (Ware) Version 1.40 Page 5
SUMMARY This is an overview of what the inspector found during the inspection. This was the second announced inspection for the agency since registration in February 2004. The Inspection process was completed over a three-week period and included one to one discussion with service users, staff and the management of the agency. A total of 28 service users were contacted for feedback using various sources such as the postal system using questionnaires, telephone contact or visits. A total of 17 care workers were approached for feedback and information regarding the service. This inspection has also been completed with last contracts inspection, which was completed in December 2004. This was a very positive inspection with all standards inspected reaching an almost met or met level. Feedback from both staff and service users was mainly positive highlighting the many benefits and advantages the service offers to people in the community. Where information has remained the same following the last inspection this has been transferred to this report. What the service does well: The manager of this service has a good insight into the required standards for domiciliary care and has worked hard to maintain a high level of service delivery, which is currently being offered. There are some excellent policies and procedures in place to ensure that any service users needs are fully assessed and met and there is a regular review process to ensure that these standard are maintained. The agency now has in place effective paper work regarding initial assessments of service users, risk assessments and care plans. These documents appear to be very effective for the agency and the service users. Commendable amounts of positive feedback have been received from numerous service users, regarding the management of the service and the quality of carers working. Complaints are dealt with effectively by the service with well documented records maintained. The agency has received positive feedback from professionals with regards to the effective management of adult protection issues. Leonard Cheshire (Ware) Version 1.40 Page 6
What has improved since the last inspection? Following the last inspection a number of improvements have been made to the agency. Care plan documentation has been reviewed and upgraded and now all service users are signing their care plans, which are also effectively reviewed. Manual handling and general risk assessment paperwork has also been upgraded to ensure essential information and details are contained within them. This makes the documents more effective and protects the service user and the staff member. A contracts review occurred in April 2005 in which many positive comments and accounts were made. A new training assistant has been employed by the agency which will further supporting the effective management of the training needs of the staff team. Monthly monitoring review visits are now fully in place, which further supports in the reviewing of all risk assessments and care plans. What they could do better: There is a need for the agency to ensure that all staff have been subject to suitable pre-recruitment checks and clearance prior to commencement of one to one work with any service user. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Leonard Cheshire (Ware) Version 1.40 Page 7
DETAILS OF INSPECTOR FINDINGS CONTENTS User Focused Services (Standards 1 6) Personal Care (Standards 7-10) Protection (Standards 11-16) Managers and Staff (Standards 17-21) Organisation and Running of the business (Standards 22-27) Scoring of Standards Statutory Requirements Identified During the Inspection Version 1.40 Page 8
User Focused Services The intended outcomes for Standards 1 6 are: 1. Current and potential service users and their relatives have access to comprehensive information, so that they can make informed decisions on whether the agency is able to meet their specific care needs. 2. The care needs requirements of service users and their personal or family carers when appropriate, are individually assessed before they are offered a personal domiciliary care service. 3. Service users, their relatives and representatives know that the agency providing their care service has the skills and competence required to meet their care needs. 4. Each service user has a written individual service contract or equivalent for the provision of care, with the agency, except employment agencies solely introducing workers. 5. Service users and their relatives or representatives know that their personal information is handled appropriately and that their personal confidences are respected. In the case of standards 5.2 and 5.3, these do not apply to employment agencies solely introducing workers. 6. Service users receive a flexible, consistent and reliable personal care service. In the case of standards 6.3 and 6.4 these do not apply to employment agencies solely introducing workers. The Commission considers Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT we looked at outcomes for standard(s) 1, 2, 3, 4, 5 & 6 All information and assessments provided to the service users, are comprehensive enabling them to make informed choices on whether the agency is able to meet their needs. EVIDENCE: Version 1.40 Page 9
The Statement of Purpose was updated in April 2004 and is reviewed annually thereafter or, as and when required. The Statement of Purpose and Service Users Guide are one document. The revised document has been provided to all service users. The document is user friendly and can be provided in various formats upon request. All the information required for the Statement of Purpose and Service Users Guide is included in the document, including contact details for social services, the local Primary Care Trust (PCT) and the General Social Services Council (GSCC). It also provides details of the agency s insurance cover. A comprehensive assessment is completed for all new service users. It is in the format of a tick box with comments and covers all aspects of care needs and the services that are provided to meet them. Referrals are taken directly from Social Services District Teams, or from private individuals. It is the responsibility of the District Manager to carry out a Service Delivery Assessment prior to the service commencing, or with two working days in exceptional circumstances. The assessment includes discussion with the service user regarding needs and choices, details of other agencies involved, support mechanisms, risk assessments including medication and to access any other relevant information. Once the care has commenced, the senior care worker carries out a review visit. A formal service review is carried out after six months and after three months with regards to the medication policy. Carer workers feedback to the District Managers with any concerns and in turn the District Managers feedback to Social Services. The agency has a robust referral and assessment process. Feedback obtained from service users confirmed the processes as detailed to be accurate and a true account of the process. The agency has, following the last inspection, introduced an initial service delivery assessment form, which appears to be an effective document. Evidence was seen from the training records, from the questionnaires returned by care workers and from discussions with care workers of a good training programme being in place. All staff have training in moving and handling, training is also available for specific needs including dementia, Health & Safety and risk assessments, medication, complaints and Protection of Vulnerable Adults Procedures. Training surrounding Child Protection is now under way. This is running in the format of an introduction to working with children and families course. A national briefing has been completed by Leonard Cheshire Safe Guarding Children, which is linked with the NSPCC Full Stop. The manager informed the inspector that plans for specialist training is included in the rolling training programme. All new care workers shadow an experienced worker for a week, and learn of individual service users needs during this introductory process. A detailed induction-training package is offered to all staff on commencement of employment. Version 1.40 Page 10
Most of the service users contacted felt that the care workers understand their needs well and all service users contacted knew who to go to and how to complain. The evidence from discussion with managers and care workers was that the agency is able to meet the needs of the service users. Each service user has a written agreement on file. Following the last inspection the agency introduced a new private client contract which is now operational. The response from service users questionnaires and from all the service users spoken to was that they feel confident that their care workers have respect for confidential information and that they would not discuss personal details of one service user with another. The agency has policies on confidentiality that are discussed as part of the induction training. The Statement of Purpose and the Service Users Guide provides a policy summary concerning access to records and confidentiality. Following discussions with staff it was determined that those spoken to have a very clear understanding of the boundaries of confidentiality and confirmed that this is discussed at team meetings and as part of the induction training. All confidential records are appropriately locked away in lockable filing cabinets. Most of the service users spoken to were satisfied with the reliability of the care workers, and felt confident that care workers that they knew would arrive and would have the knowledge and abilities to meet their needs. Most service users commended the care workers highly for their politeness and skills. Version 1.40 Page 11
Personal Care The intended outcomes for Standard 7 10 are: 7. The care needs, wishes, preferences and personal goals for each individual service user are recorded in their personal service user plan, except for employment agencies solely introducing workers. 8. Service users feel that they are treated with respect and valued as a person, and their right to privacy is upheld. 9. Service users are assisted to make their own decisions and control their own lives and are supported in maintaining their independence. 10. The agency s policy and procedures on medication and health related activities protect service users and assists them to maintain responsibility for their own medication and to remain in their own home, even if they are unable to administer their medication themselves. In the case of standards 10.8 and 10.9, these do not apply to employment agencies solely introducing workers. The Commission considers Standards 8 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT we looked at outcomes for standard(s) 7, 8, 9 & 10 Service users have individual care plans tailored to meet individual needs, this ensures that all staff are aware of the care to be provided to each person. Care tailored to meet individual need ensured that all service users feel valued as a person and there rights to privacy are upheld. EVIDENCE: Version 1.40 Page 12
Following the last inspection the agency has fully adapted their individual care planning system and introduced a document, which fully describes the details of the specific care to be provided to the service user. The service user also signs the care plan on implementation and review. All service users spoken to said that the care workers are polite, sensitive to their needs and respect their privacy and dignity. Staff spoken to discuss the training and the induction package that had been provided and confirmed that the ethos of good practice is to ensure that the care and support provided is achieved in a manner that maintains and respects the privacy, dignity and lifestyle of the person receiving care. They confirmed that further training is provided to ensure this is being provided and also that they receive practice supervision from the senior carer who makes an assessment on their skills and abilities. A number of staff have completed and are currently completing their National Vocational Qualification (NVQ) in care, which further encompasses the ethos of good practice that the agency promotes. The agency follows the Hertfordshire County Council Adult Care Services policy on administering medication. This identifies the parameters and the circumstances for assisting with medication and health related tasks and identifies the limits to assistance and task that may not be under taken without specialist training. All care workers are trained in administering medication as part of their induction; the medication charts are checked at review visits to the service users. Assistance with medication and other health related activities is defined within the care plan and will form part of the risk assessment and management process. Version 1.40 Page 13
Protection The intended outcomes for Standards 11-16 are: 11. The health, safety and welfare of service users and care and support staff is promoted and protected, except for employment agencies solely introducing workers. 12. The risk of accidents and harm happening to Service Users and staff in the provision of the personal care, is minimised, except for employment agencies solely introducing workers. 13. The money and property of service users is protected at all times whilst providing the care service, except for employment agencies solely introducing workers. 14. Service users are protected from abuse, neglect and self-harm, except for employment agencies solely introducing workers. 15. Service users are protected and are safe in their home, except for employment agencies solely introducing workers. 16. The health, rights and best interests of service users are safeguarded by maintaining a record of key events and activities undertaken in the home in relation to the provision of personal care, except for employment agencies solely introducing workers. The Commission considers Standards 11, 12 and 14 the key standards to be inspected at least once during a 12 month period. JUDGEMENT we looked at outcomes for standard(s) 11, 12 & 14 Risk assessments are well managed and structured within the agency, thus ensuring that the initial assessment of risk have been completed for the protection of the service users. Staff must be suitably vetted prior to working with service users thus ensuring their protection. EVIDENCE: Version 1.40 Page 14
All care workers have appropriate health and safety training, including moving and handling and food hygiene. The agency has appropriate procedures for safe working. The care workers are issued with mobile phones and panic alarms, and they sign in electronically by phone when they arrive and leave each service user s home. The agency has systems and procedures in place to comply with the requirements of the Health & Safety legislations. All polices and procedures were viewed during the inspection were seen to be well organised and of a comprehensive nature. Following the last inspection all district managers and co-ordinators have now completed additional health and safety training. Appropriate risk assessments were seen for individual service users, including moving and handling and the use of specialist equipment. Manual handling assessments are carried out where a need is seen during the assessment. Following the last inspection the risk assessment process that the agency follows has been upgraded. The agency now completes a detailed manual handling risk assessment, which covers all areas of identified risk. In addition to this the agency now has a standardised risk assessment form which is completed when the initial assessment is completed and at periodic reviews of the service users needs. The agency has a procedure in place for reporting new risks, which arise. The agency also has a responsible and competent person on call and contactable at all times when care and support staff are on duty. The agency has comprehensive policies and procedures for the protection of vulnerable adults and children, including Whistle Blowing to ensure the safety and protection of service users. The procedures reflect the local multi-agency procedures including the involvement of the Police and the passing on of concerns to the Commission for Social Care Inspection. The agency has received positive feedback for the effective management of adult protection issues. All staff receive training on the Protection of Vulnerable Adults (POVA) and appropriate training is planned for Child Protection training. There is a need for the agency to ensure that all care workers are suitable vetted prior to commencement of employment and working on a one to one basis with service users. Version 1.40 Page 15
Managers and Staff The intended outcomes for Standards 17-21 are: 17. The well-being, health and security of services users is protected by the agency s policies and procedures on recruitment and selection of staff. 18. Service users benefit from clarity of staff roles and responsibilities, except for employment agencies solely introducing workers. 19. Service users know that staff are appropriately trained to meet their personal care needs, except for employment agencies solely introducing workers. 20. The personal care of service users is provided by qualified and competent staff, except for employment agencies solely introducing workers. 21. Service users know and benefit from having staff who are supervised and whose performance is appraised regularly, except for employment agencies solely introducing workers. The Commission considers Standards 17, 19 and 21 the key standards to be inspected at least once during a 12 month period. JUDGEMENT we looked at outcomes for standard(s) 17, 19 & 21 As previously stated staff must be suitably vetted prior to working with service users thus ensuring their protection. Staff receive appropriate training and receive regular supervision. EVIDENCE: Version 1.40 Page 16
Inspection of a number of staff personnel files occurred. The agency has a robust and comprehensive recruitment and selection process and policy in place. Face to face interviews occur with all staff that are recruited. Two written references are obtained prior to confirming appointment. There is a need for the agency to ensure that all care workers are suitable vetted prior to commencement of employment and working on a one to one basis with service users. All staff are provided with a written contract specifying the terms and conditions under which they are engaged including the need to comply with the agencies Staff Handbook. All staff have received copies of the General Social Care Council (GSCC) Code of Conduct. The agency provides a good training and development programme for care workers, there is a full time training coordinator for the Hertfordshire Leonard Cheshire Care at Home Services. A comprehensive induction training programme includes one week shadowing an experienced care worker and one week induction training. The training includes moving and handling, protection of vulnerable adults and administration of medication. The care workers spoken to felt that the organisation provides a good training programme that meets their needs for working with service users. All care staff receive regular supervision and have their standards of practice appraised annually. Following discussions with a number of staff they were able to determine that they received practice supervision, the senior carers complete this and a record is maintained. The team provide monthly staff meetings allowing for the opportunity of the group to form and bond and the passing of useful information to one another. Following the last inspection, the agency is now providing structured one to one supervisions. Managers and allocated supervisors receive training in supervision and development. Version 1.40 Page 17
Organisation and Running of the Business The intended outcomes for Standards 22 27 are: 22. Service users receive a consistent, well managed and planned service. 23. The continuity of the service provided to service users is safeguarded by the accounting and financial procedures of the agency. 24. The rights and best interests of service users are safeguarded by the agency keeping accurate and up-to-date records. 25. The service user s rights, health, and best interests are safeguarded by robust policies and procedures which are consistently implemented and constantly monitored by the agency. 26. Service users and their relatives or representatives are confident that their complaints will be listened to, taken seriously and acted upon. 27. The service is run in the best interests of its service users. The Commission considers Standards 22 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT we looked at outcomes for standard(s) 22, 25, 26 & 27 Service users receive a consistent, well managed service thus ensuring that the rights and best interests of the service users are safe guarded, with records well maintained and structured with robust and detailed polices and procedures. All complaints are well managed and recorded thus ensuring that all service users and relatives feel confident that their complaints are listened to and responded to. EVIDENCE: The premises and management arrangements were inspected as part of the registration process in February 2004 and there have been no changes since then. The agency has a comprehensive set of policies that cover all aspects of the management of the agency and the provision of care. Polices and procedures are reviewed periodically. Version 1.40 Page 18
Leonard Cheshire produces the complaints policy nationally. The policy is comprehensive in nature and contains all the required information. Several service users said that they have made complaints; most were satisfied with the response. Records of complaints seen during the inspection were detailed and well organised. The manager of the agency holds concise records of the complaints that the agency receives, with clear actions set out and recorded. All telephone calls to the agency are registered and recorded as concerns, with details of how they were dealt with. All complaints are acknowledged in an appropriate form and the investigation is commenced within the period specified in the information given to the service user. The procedure includes time scales and stages for the process. There is a full time contract quality monitoring officer and a thorough quality assurance process that includes a postal questionnaire, telephone questionnaire and monitoring visit for every service user. The relevant team manager deals with any issues brought up by service users. An annual audit report is produced that includes a summary of the responses. Leonard Cheshire also holds a block contract with Hertfordshire County Council; the contracts department of the County Council also completes an audit of the service. The audit report is supplied to Hertfordshire County Council Adult Care Services and will be provided to Commission for Social Care Inspection. Version 1.40 Page 19
SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Domiciliary Care have been met and uses the following scale. 4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls) X in the standard met box denotes standard not assessed on this occasion N/A in the standard met box denotes standard not applicable User Focused Services Managers and Staff Standard Score Standard Score Number Number 1 3 17 2 2 3 18 x 3 3 19 3 4 3 20 x 5 3 21 3 6 3 Personal Care Organisation and running of the business Score Standard Score Number 7 3 22 3 8 3 23 x 9 3 24 x 10 3 25 3 Standard Number Protection Standard Score Number 11 3 12 3 13 x 14 2 15 x 16 x 26 3 27 3 Version 1.40 Page 20
Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Domiciliary Care Regulations 2003 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. 14 & 17 12 All staff must have suitable evidence of clearance and authority to work. Immediate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 1. None None Good Practice Recommendations Version 1.40 Page 21
Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City HERTS. AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Version 1.40 Page 22