Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Caer Las Cymru 740 Carmarthen Road Gendros Swansea SA5 8JL Type of Inspection Baseline Date of inspection 19 February 2014 Date of publication 21 March 2014 You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers Please contact CSSIW National Office for further information Tel: 0300 062 8800 Email: cssiw@wales.gsi.gov.uk www.cssiw.org.uk
Summary About the service Caer Las Cymru is part of a larger company called Cymdeithas Caer Las, and is registered as a domiciliary care agency with the Care and Social Services Inspectorate Wales (CSSIW). The agency provides a service for up to thirteen adults with mental health (functional) needs who reside in two supported living projects in Swansea and also for an agreed period following their move on to their own homes in the City and County of Swansea; One project known as The Willow Project consists of a complex which has seven, one bed roomed flats. The agency provides 24 hour domiciliary care within this project and the agency s office is also situated here. The other project consists of two, three bed roomed houses. The agency provides 42 hours a week tenancy support at this project. The registered manager is Elizabeth Mander and the responsible individual is Kirsty Ellis. What type of inspection was carried out? This report is based on the findings of an unannounced planned baseline inspection undertaken by two inspectors, which looked at three quality themes relevant to domiciliary care agencies: the quality of life, quality of staffing and quality of leadership and management. We (CSSIW) considered the information from the self assessment of service statement (SASS) and annual data collection (ADC) forms which were submitted by the registered persons prior to the inspection. We visited both supported living settings and met some of the people receiving a service and saw the interaction between them and staff members. We also talked to the registered manager, staff on duty and looked at a sample of care files and staff files. What does the service do well? The registered manager and all staff members are knowledgeable about people s health and social care needs which ensures that staff can adapt to the changing needs of the people they are caring for. What has improved since the last inspection? The agency works with all people who live at the Willow Project to produce a quarterly newsletter which they had all contributed to. What needs to be done to improve the service? There were no issues of non-compliance noted at this inspection 3
Quality of life Overall people using the service can be confident that the registered persons make every effort to ensure that the continued high standard of care offered is maintained. This is because we saw that staff demonstrated a commitment towards providing people with good quality person centred care. All care plans and risk assessments seen were person centred and linked in with the daily recordings. All of the people we spoke to said they felt they were listened to and involved in the planning and delivery of their care. People also told us that, any queries or concerns they had regarding their care plans and risk assessments were addressed by staff in a fair and appropriate manner. All care plans and daily recordings are stored electronically with hard copies also available. We saw that all care files and staff files were stored securely in the Manager s offices of both supported living settings which were locked when not in use. People can be confident that their health and well being is being protected. We saw from samples of care files that people receiving a service attended regular reviews with their care manager from the Community Mental Health Team and General Practitioners visits were booked appropriately. Care files seen confirmed that all accidents and incidents forms were completed and any actions needed were followed up appropriately. We observed the overall management of medication at the Willow Project and saw that the system for ordering, storing and administering medication was appropriate and we saw that a risk assessment was in place for one person who self medicates. The British National Formulary (BNF), that staff were using to refer to, if they were administering medication they were unsure of, was the September 2008 Version. We recommended that a current BNF would be more appropriate. The Registered Manager confirmed that this would be purchased. We also recommended that daily room temperatures were needed in the agency office, which was where the medication cupboard was situated to ensure medication was stored at the correct temperature which is below 25 degrees centigrade. This was addressed within 24 hours. We saw staff encouraging people receiving a service to maintain their independence and be active, positively occupied and stimulated; We saw that cooking, cleaning and laundry tasks were encouraged to be part of the every day routine for people. During the inspection visit we observed people accessing the community for leisure activities both alone and accompanied. Within the sample of care files seen there were individual risk assessments in place for all the external activities accessed. People who live at the Willow Project told us they had enjoyed working with staff to produce a quarterly newsletter. We saw that this was interesting and encouraged people to share their interests and future plans. Since the last inspection visit three people have moved into their own flats with initial input from the staff team based at the Willow Project. Some people who have moved out of the Willow Project now live locally and we saw that they continue to socialise with people who still live there as they have become good friends. People receiving a service can be confident that they will be treated with dignity and respect and that staff were knowledgeable and understood their individual needs and preferences. We also found that the people experience warmth, attachment and belonging. People we spoke to in both supported living units told us they were well looked after and we observed good interaction between individuals and staff who talked together in an informal, relaxed manner. 4
Quality of staffing People receiving a service are cared for by familiar staff. There is a stable team of eight care staff with a low sickness rate. Agency staff are not used as the company has a small bank of care staff that cover for holidays and are available for emergency cover for sickness. People can be assured that their care will be provided by staff who have benefitted from an appropriate training programme. We saw that the mandatory training programme included training relevant to the needs of the people being cared for and included mental health awareness, mental health first aid, professional boundaries and digital inclusion which will help staff when they assist people with their benefits, as these claims forms are now only available on line. We also saw that all staff attend an annual team day which is a practice development day provided by the company and includes input from the registered manager and responsible individual (RI). Bank staff cover at both supported living units for this day to ensure all staff can attend. The registered manager confirmed that over fifty percent of care staff had completed an appropriate social care course. People receiving a service can be confident that staff recruitment procedures are appropriate. We saw a sample of staff files which provided evidence that a robust and consistent recruitment process is in place. We saw staff duty rotas which evidenced appropriate staffing levels. Staff have been working both day and night shifts on a three monthly rotation for the past eighteen months. The registered manager feels this has improved the continuity of care for people receiving a 24 hour domiciliary care service. We saw that a supervision and appraisal allocation plan was in place that evidenced that all staff receive formal individual supervision three monthly plus an annual appraisal. People receiving a service can be confident that they are being cared for by staff who want to make a positive difference to their lives including promoting and assisting their independence. 5
Quality of leadership and management The registered manager is an experienced social care worker and is registered as a manager with the Care Council for Wales. The registered manager said she feels well supported by RI from whom she receives formal, individual, supervision. Although the registered manager has completed an NVQ level 4 in social care she is currently completing the Qualification Credit Framework (QCF) level 5 diploma in the management of social care. People receiving a service can be confident that due care and attention is given to compliance with national minimum standards and regulations. The statement of purpose and the service user guide seen were current and relevant. People can also be confident that they will experience a consistent service based upon quality improvement. We saw a current Quality of Care Audit that was relevant and promoted an on going improvement to the service. It was evident that the registered manager has an open door policy and, during the inspection visit at the Willow Project, people receiving a service were observed entering into conversations with her. People appeared confident in their approach and seemed satisfied with the outcome of the conversations. We observed that the registered manager was also approachable and professional in her manner with the staff members on duty. 6
Quality of environment This section is not completed as CSSIW do not consider the environment as an area for inspection of domiciliary care agencies. 7
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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. Focussed 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 focussed 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. 9