Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Ceredigion County Council Targeted Intervention Service Minaeron Vicarage Hill Aberaeron SA46 0DY Type of inspection Baseline Dates of inspection Wednesday, 11 February 2015 & Monday, 16 February 2015 Date of publication Tuesday, 16 June 2015 Welsh Government Crown copyright 2015. You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context. Page 1
Summary About the service Ceredigion County Council Targeted Intervention Service (formerly Ceredigion County Council Home Care Service) is registered with the Care and Social Services Inspectorate Wales (CSSIW) as a domiciliary care agency. They provide personal care and a reablement service to individuals in the county of Ceredigion. Care is provided to people aged 18 and over with a diversity of needs, within the person s own home. The agency s registered office is located at Ceredigion County Council s offices at Min Aeron, Aberaeron. There are four community office bases located in Cardigan, Lampeter, Aberaeron and Aberystwyth. The agency is owned by Ceredigion County Council. The Responsible Individual is Susan Darnbrook and the Registered Manager with day to day responsibility for the agency is Emma Whiteley. What type of inspection was carried out? An unannounced baseline inspection was carried out at the Cardigan office by CSSIW on 11 and 16 February 2015. We visited three people who use the service at their own home on 16 February 2015. The inspection looked at the three relevant themes for Domiciliary Care Agencies in Wales: quality of life, quality of staffing, and the quality of leadership and management. The following methodology was used: Examination of the agency s Statement of Purpose Examination of a range of documentation pertaining to staff, including staff files and staff training Examination of a range of documentation pertaining to people who used the service Examination of a sample of policies & procedures Discussions with people who use the service Discussions with staff members Examination of recorded accidents/incidents. What does the service do well? The agency works hard at providing person centred assessment and support, thereby enhancing people s opportunities to maximise their independence. The multi-disciplinary team works in partnership to provide a range of skill and expertise in meeting the people s needs and maximising independence. What has improved since the last inspection? This was the service s first inspection since the agency s transition from Ceredigion County Council Home Care Service to Ceredigion County Council Targeted Intervention Service (TIS). TIS has been operational since October 2014. It continues to be in its infancy and is continually developing. Page 2
What needs to be done to improve the service? No non compliance notices were issued as a result of this inspection. However, we notified the provider that they must address the following areas of non compliance for the benefit of people using the service. We notified the registered persons that the service is non compliant with Regulation 14. This is because of the service user files examined within the Cardigan community base did not contain documentation relating to the pre-assessment, health and safety checks or service delivery plan for active people using the service. We explored this matter further with the registered manager. The documentation had been completed prior to service commencement and was then stored within the person s home file. Copies of this documentation should also be kept within the person s file in the community base. We notified the registered persons that the service is non compliant with Regulation 15 (1) (b) Schedule 3. This is because there was evidence that not all the required documentation had been included within staff members files such as a statement by the person and by the registered person as to the state of the person s physical and mental health. There was no evidence to demonstrate that the TIS assistants had received formal supervision. We noted that the service is operational from four community bases and administrative support was provided from a further two offices. The agency is registered to the Ceredigion County Council office in Min Aeron, Aberaeron. Further exploration in relation to the organisation functioning in this manner needs to be explored by CSSIW. Page 3
Quality Of Life Ceredigion County Council Targeted Intervention Service (TIS) has been operational since October 2014. The service aims to help people to remain at home, prevent unnecessary admission to hospital and care homes, support timely discharge from hospital and assist people to return home from residential care. It is a time limited enabling service (up to a maximum of six weeks) offering the provision of trained health and social care professionals and assistants to maximise independence by working alongside the service user in developing, implementing and monitoring the individuals Targeted Intervention Plan. At the time of the inspection the number of referrals received consisted of approximately 473. When ongoing care needs are identified care provision is transferred to the independent sector. Overall we found that the agency provided a high standard of care which was person centred to the individuals to whom they are delivering the care. We found that the agency effectively assisted people to maintain and, where possible, enhance people s level of independence or wellbeing. The care provided is assessed to be good because people are treated as individuals. One person using the service told us (CSSIW) that they feel comfortable and that they feel appropriately supported and valued by staff. The service demonstrated a continued commitment towards providing a person centred service which supports people s recovery from their illness and helps them in daily life and daily living tasks with the aim of increasing the individuals independence skills. We examined the care files of two people using the service held in the Cardigan Memorial Hospital community base. We identified that the records held within the office did not contain documentation relating to the pre-assessment, health and safety checks or service delivery plan for active people using the service. We explored this matter further with the registered manager. It was explained that as the person accessing the service is continually being assessed and the service delivery plan is continually evolving as independence is increased, the documentation which had been completed prior to service commencement was stored within the person s home file. This was evidenced by examining the care records of two people who had been discharged from the service and also was contained within the records of the three people we visited at home. Copies of this documentation should also be kept within the person s file in the community base. We notified the registered persons that the service is non compliant with Regulation 14. We found that people using the service were able to exercise their rights and they were seen to be treated with respect and dignity. The three people we visited who use the service when asked if they were treated kindly by staff and shown dignity all informed us that they were. They confirmed that the care they received took into consideration their lifestyles, likes and dislikes. This gave the person receiving care a feeling of respect and worth. We were informed that the people providing the care were polite, courteous and professional in their work and that they took time to listen and act on requests made where possible. It was apparent that overall the service made every effort to provide the same staff to ensure continuity of care and to enhance trust and the building of good relationships. We were informed that individuals are involved in planning and reviewing their care needs. Page 4
Records examined and discussion with the person who uses the service confirmed this. Page 5
Quality Of Staffing People using the service can be confident that they will receive good quality care from dedicated and competent staff. The multi-disciplinary team consists of occupational therapists, social workers, physiotherapists, assessing and reviewing officers, therapy and social care assistants, targeted intervention service assistants and access to other professionals if necessary such as nurses. A professional undertakes an assessment and develops an individual target intervention plan with the person which may consist of aids and adaptations for rehabilitation or re-enablement or for personal care covering basic tasks such as bathing, dressing and undressing, mobility and transfers, kitchen skills and exercise programmes developed under the instruction of a physiotherapist or occupational therapist. People enjoy being cared for by motivated staff who are appreciated and want to make a difference to people s lives. The people we spoke to advised that they were happy with the support they were receiving and felt that staff knew them well and were very good. We saw compliments such as **** was brilliant with me. She put me at ease and we got on so well. One person we visited stated I feel so much more confident now and am able to do more for myself thanks to the equipment they provided. People can be confident that staff caring for them have been robustly and safely recruited. This is because we looked at the records of four staff members which confirmed that all required checks were undertaken on staff before they started work. Clear systems were in place to obtain references, criminal record checks (now known as Disclosure and Barring Service (DBS) checks), full employment history, and evidence of qualifications, together with the other information required by regulations, such as proofs of identity, recent photographs and birth certificates. However staff files lacked a statement by the person, and either the Registered Provider or Registered Manager in relation to the person being both physically and mentally fit for the purpose of the work which he or she is to perform. We also noted a lack of formal supervision for the TIS assistants however they participate in weekly case review meetings. We notified the Registered Manager that the service was not compliant with Regulation 15 (1) (b) Schedule 3. People can be assured that care staff are trained and competent to undertake the tasks required of them and that updates to training are undertaken as and when necessary. We saw evidence of continuing staff training. We saw that a high proportion of staff held a professional qualification. 92% of staff had undertaken carer awareness training and we were informed that all staff had participated in a 10 week training program in July/August 2014 prior to the transition from Ceredigion County Council Home Care Service to the Ceredigion County Council Targeted Intervention Service. Overall, we found that people were being properly cared for by well trained staff who were appropriate, kind, and considerate towards those they attended. This made the people using the service feel respected and safe. Page 6
Quality Of Leadership And Management People can be confident that Emma Whiteley who is the Registered Manager is appropriately qualified and registered with both the Care Council for Wales (CCW) and CSSIW. She is supported in her role by two locality managers, one covering the North and the other the South regions of the county. We visited the community base office at Cardigan Memorial Hospital and examined a range of policies and procedures which were stored both electronically and in printed form in a file in the office which was accessible to all staff. We saw evidence that staff had signed to confirm they had read them. The Medication policy for Ceredigion County Council has been under review since June 2014 with consultation with Hywel Dda Local Health Board. For people who are assessed as needing assistance with medication the Ceredigion Medicine Administration Scheme (CAMS) is used with the support of local community pharmacists in which all TIS staff are trained. The Manual Handling policy had not been reviewed since October 2006 however appeared appropriate. There was not an organisational policy for the protection/safeguarding of vulnerable adults however there was a copy of the All Wales Interim Policy and Procedures for the Protection of Vulnerable Adults from Abuse. The registered providers are reminded that organisational policies need to be in place and should be reviewed at least annually to ensure they remain current and appropriate. We examined the service s Statement of Purpose. This is an important document which sets out the aims and objectives of the service, and what and how care is delivered. This had been comprehensively written and outlined the referral process, which includes referrals from a GP or community nurse if a person is living at home, via hospital staff or a self referral process. We saw from the records of people discharged from the service and those in people s own homes that a comprehensive assessment of their care needs on commencement of the care and thereafter was reviewed on a regular basis or as needs changed. We were informed that individuals are involved in planning and reviewing their care needs. The process for reviewing people s care was good and had been undertaken in a timely manner. Reviews included weekly case review meetings, where those involved with the person s care meet to discuss developments/changes. This ensured that people received the care they required at all times. We saw records of team meetings which were held for management and staff to discuss operational matters. There were systems in place to provide the same staff to ensure continuity of care and to enhance trust and the building of good relationships. The rota is constructed to provide where possible a maximum of three (3) care staff to the one service user. Care staff have no more than seven (7) people for whom they deliver care. This reflected the person centred approach the agency used. This is a service in its infancy. There were robust quality monitoring processes in place to ensure that the service provided was of a good quality and is continually developing. As the service has only been operational since October 2014 there is no annual quality assurance report at this time. There are regular developmental meetings held and there Page 7
is consultation with people using the service, stakeholders and staff. Each person who uses the service is provided with a copy of the organisation s complaints procedure. To date there have been no complaints made and we observed that there had been eleven (11) compliments made since December 2014 which contained comments such as the service has been invaluable and **** has greatly improved under **** care and is much more confident. Excellent. Overall people using the service can be confident that the service was well run. People receive effective support from a service which can fully meet their needs and support in maintaining or improve independence. Page 8
Quality Of The Environment The Quality of the Environment theme is not appropriate to Domiciliary Care Agencies. However, we noted that the service is operational from four community bases and administrative support was provided from a further two offices. The agency is registered to the Ceredigion County Council office in Min Aeron, Aberaeron. Further exploration in relation to the organisation functioning in this manner needs to be explored by CSSIW. We visited the Cardigan Memorial Hospital community base; there were no copies of registration or insurance certificates on display. We identified that staff and service user records were securely stored. There appeared to be limited space and equipment for staff to utilise however they made best use of what they had in running an effective service. Page 9
How we inspect and report on services We conduct two types of inspection; baseline and focussed. Both consider the experience of people using services. Baseline inspections assess whether the registration of a service is justified and whether the conditions of registration are appropriate. For most services, we carry out these inspections every three years. Exceptions are registered child minders, out of school care, sessional care, crèches and open access provision, which are every four years. At these inspections we check whether the service has a clear, effective Statement of Purpose and whether the service delivers on the commitments set out in its Statement of Purpose. In assessing whether registration is justified inspectors check that the service can demonstrate a history of compliance with regulations. Focused inspections consider the experience of people using services and we will look at compliance with regulations when poor outcomes for people using services are identified. We carry out these inspections in between baseline inspections. Focussed inspections will always consider the quality of life of people using services and may look at other areas. Baseline and focused inspections may be scheduled or carried out in response to concerns. Inspectors use a variety of methods to gather information during inspections. These may include; Talking with people who use services and their representatives Talking to staff and the manager Looking at documentation Observation of staff interactions with people and of the environment Comments made within questionnaires returned from people who use services, staff and health and social care professionals We inspect and report our findings under Quality Themes. Those relevant to each type of service are referred to within our inspection reports. Further information about what we do can be found in our leaflet Improving Care and Social Services in Wales. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office. Page 10