DOMICILIARY CARE AGENCY London Borough of Bromley Bromley Social Services Civic Centre Stockwell Close Bromley Kent BR1 3UH Lead Inspector Ann Wiseman Announced Inspection 27th June 2006 10:00 London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 1
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 London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 2
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. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 3
SERVICE INFORMATION Name of service London Borough of Bromley Address Bromley Social Services Civic Centre Stockwell Close Bromley Kent BR1 3UH Telephone number 020 8464 3333 Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration London Borough Bromley Mrs Joy Rosemary Bennett Domiciliary Care Agencies Category(ies) of registration, with number of places London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 4
SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: The London Borough of Bromley, Direct Care Division, provides Domiciliary Care to people living in their own homes, within the boundaries of the borough. Mrs Joy Bennett is the registered manager. The carers undertake tasks, such as, personal care, preparing meals, assistance with medication and healthcare related tasks. Many of the care packages need two carers to undertake the service users needs. There are specialist teams within the agency who care for people with brain injuries, a twilight team who work from 20.00 to 01.00, The Carelink emergencies service and the Immediate Response team monitor and visit service users if they are taken ill in the middle of the night. The agency also has a standby agency worker on duty from 07.00 until 11.00 so they can respond quickly if a regular carer is unable to work for any reason. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 5
SUMMARY This is an overview of what the inspector found during the inspection. This was an announced Inspection and because of the long term absence due to sickness of the Registered Manager the Inspection was facilitated by the Head of Direct Care Services and another Manager in the service, All staff involved in the Inspection conducted themselves in a friendly and open manner and were very helpful throughout. During the Inspection Service Users files were examined as well as a sample of the Agency s policies and procedures, health and safety files and staff personnel files. The Inspector visited some of the Service Users in their own homes and was able to talk to some of their family members. Overall the Agency offers a good standard of service to the Service Users, who report that the care staff respect their privacy and dignity and enable them to live as independent lifestyle as possible. The Agency is well managed and has all the organisational backing of a large London Borough. The Inspector found failings in how the information received from the Criminal Records Bureau is managed, the issue has been corrected and is being investigated by the Agency. What the service does well: The Agency has a large number of experienced and knowledgeable care staff who have built up a good relationship with the Service Users. Of the people who returned the survey sent by the Commission, a large majority say that they receive a good service. The Agency offers a wide range of services to people who can be highly dependant, there are arrangements in place to offer support in an emergency during the night. What has improved since the last inspection? A Quality Assurance process has been implemented and the Agency is working towards increasing the frequency of formal supervisions for care staff, personal development Interviews are on a rolling program and are going ahead. What they could do better: Protection of Vulnerable Adult training is not given a high enough prominence and should be added to the mandatory training list for all staff including office staff. Evidence has been found that Criminal Records Bureau checks are not being processed with due care and attention. A system must be put in place that will prevent criminal convictions being overlooked. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 6
New Service Users do not get an assessment by the Agency at the beginning of the service and care staff will go to the house with no other information than what is given to them via the care manager s assessment which is also used as their care plan. It would be good practice if perspective Service Users received a visit prior to the commencement of a service by the planning officer so he can collect information to be used in drawing up a care plan. The visit would be a good opportunity for the Agency to look to the health and safety of both the Service User and care staff and check for any risks or areas of danger that may need to be dealt with. 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. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 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 the following standard(s): All standards in this area have been assessed on this occasion. Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. Service Users and their relatives are furnished with sufficient information to be able to make an informed judgment about the service that is offered. Basic assessments are carried out before personal services are offered and contracts are given. Service Users on the whole receive a flexible, consistent and reliable service. Personal information is stored appropriately. EVIDENCE: The agency has a clear and well-presented Statement of Purpose and Service Users Guide, which are given to all service users. The text is written in plain English and is available in appropriate formats such as, large print, Braille and London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 9
can be produced in other languages. Both documents give an overview of the process for the delivery of care and support for service users and is reviewed annually and updated. All Service Users are given a written individual contract. Some were available to be seen in the file held at the Service Users home, but on some occasions the files were found to be incomplete and often the only information the Inspector was able to see was the daily record sheet. Care managers assess Service Users and their assessment is sent to the agency. However it is a very basic assessment and contains very little information on which to assess the agencies ability to offer a service to the Service User. The commission sent out some surveys prior to the Inspection to a number of Service Users chosen at random a good proportion have been returned. The Inspector also met some Service Users in person. Overall the Service Users have felt that they received a flexible, consistent and reliable service that met their needs. Most dissatisfaction occurred over the weekend arrangements; staff are entitled to have one weekend off in three and this means that Service Users have different carers at weekends which makes them feel that they are not receiving a consistent service. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 10
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 the following standard(s): All of these standards were inspected on this occasion. Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. Carers assist the Service Users to live as independently as possible and Service Users feel that care is given in a respectful way and preserves dignity. Medication is only given as set out in the medication guidance policy. EVIDENCE: Assessments are drawn up by the Care Manager and given to the agency with the referral, they are not very detailed or particularly personal to the individual, they do not record preferences, personal goals or wishes. The service is divided into several areas and each area is allocated a planning officer. The planning officer will only visit the Service Users after a package has been put in place and cares have already been working in the house for a while. The suitability of the care package is dependant on the accuracy of the assessment and risk assessments carried out by the Care Manager. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 11
This is an area that has been raised at a previous Inspection and was discussed again at this one. The acting service manager and one of the planning officers feel that the majority of the staff are experienced enough to be able to deal with most unexpected and emergency situations and to recognise when further assessments and risk assessments are needed. It is recommended that prospective Service Users are visited by the Planning Officer to enable him to gather extra information to enable him to write a more detailed personal Service User plan that details their care needs, wishes, preferences and personal goals and to carry out risk assessments that may be necessary. He will then be in a better position to place carers in the house who would be best suited to the Service User. Please see Recommendation 1 Surveys returned indicate that care received is given in a way that made the Service Users feel comfortable and that the carers respected their privacy and dignity. Carers listen to what the Service User has to say and allow them to make decisions and enable them to live as independently as possible and to stay in their own home. As set out in the Agency s medication policies and procedures careers only support and enable the Service Users to take their medication. The do not dispense or administer medication. Arrangements are made to have medication dispensed into dosset boxes. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 12
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 the following standard(s): All standards in this section were examined during this Inspection Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. The Health and safety of both the Service User and the staff is protected, risk assessments are carried out to minimize the risk of accidents or harm occurring. Safeguards are in place to protect Service Users monies. Records are kept in the house of services and care given. EVIDENCE: The agency has the practice and procedures required to comply with Health and Safety legislation. Risk assessments are on file that have been carried out by trained risk assessors and covers areas such as moving and handling. If necessary carers will work in pairs. The risk assessments and support with London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 13
personal care given enables the Service User to maintain independence and to stay in their own home. The agency has strict guidelines when carers handle service users money to shoping and they know they must not accept any financial rewards from service users. All financial transactions undertaken on behalf of the service users are recorded, signed and dated. When service users are unable to take responsibility for their financial affairs their relatives or their care managers will make arrangements to keep their finances safe. Records are kept in the Service Users home that records key events and activities undertaken. During the visits to Service Users the Inspector was always given access to these records, but other information required to be given to the Service Users was not always available for inspection, it is recommended that it would be good practise for care staff to check that all information provided by the agency to the Service Users is in order and up to date from time to time, some of the files are very old and falling apart and contained very old copies of the Service Users guide and are in need of replacement. Please see recommendation 2 London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 14
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 the following standard(s): All standards in this group have been examined on this occasion. Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. Recruitment process is normally robust within the Agency and required practice and procedures are in place. A training schedule for POVA must be put in place so staff can receive training within six months of starting work at the Agency. The Agency is working towards compliance with NVQ qualification requirement and has improved it s frequency of 1-1 formal supervisions. EVIDENCE: The Agency has a rigorous recruitment and selection policy procedure which all members of staff of the London Borough of Bromley have to complete before being employed, The inspector looked at some of these files and found the them to be in immaculate order. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 15
Recruitment procedures should protect Service Users from abuse by stopping people who have abused in the past from getting a job in social care. However when a sample of staff records were examined one was found to have a CRB check that indicated that the staff member had been convicted of theft when young. (This would not automatically preclude her from working but implications must be considered) On further examination of the file it was noted that she had signed a declaration when taking up post that she did not have any criminal convictions. When asked what process had been undertaken in deciding that this person was not a threat to the people she was working with, the personnel officer realised that no action had been taken and the CRB had been placed on file with the conviction overlooked. Action was taken to rectify this error immediately and an investigation instigated, it is a requirement that the Inspector will be kept informed of the of the investigation and it s out come, another requirement will be that all staff records are reviewed to check that CRB checks have been undertaken and that they are clear of convictions, or if not clear, the decision behind continuing to employ that staff member is recorded and kept on file. Please see Requirement 1 and 2 All files seen had copies of the job descriptions and specification. Staff members are given an introduction to Protection of Vulnerable Adult training during induction training, which is a rolling program which is relatively new, not all staff have undertaken it. Others will receive a more in depth look at POVA issues when they undertake an NVQ assessment, just under 50% of the staff team have achieved a relevant NVQ. It is essential that staff have a good understand all aspects of abuse, how to recognise signs of abuse and who to report it to. This training should be received soon after employment. It will be a requirement that POVA training must be included in the services regular training schedule. Please see Requirement 3 Steps have been taken to increase the number of staff supervisions carried out and evidence has been seen that they are happening a little more frequently that in the past but the improvement must continue and this Requirement will be carried over from the previous inspection. Please see Requirement 4 Staff are competent and have received mandatory training. Training around the protection of vulnerable adults needs to be more in depth. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 16
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 the following standard(s): All standards in this group were examined on this occasion except 23. Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. Service Users receive a consistent service, the Agency has robust policies and procedures that are reviewed regularly, up to date records are kept. Complaints are dealt with in an appropriate and timely manner. EVIDENCE: The Inspector was able to meet five Service Users in their own home and some of their families, eleven User surveys have been returned to the commission. On the whole people were happy with the service that they receive, saying that they get a good standard of care from a regular carer, the Agency will normally contact the Service User if a carer is unable to make a visit and will inform them of any changes. Occasionally Service Users are not contacted if there are changes and either do not get a visit or an unknown carer will arrive without notice. On one occasion a lady, who is blind with poor mobility, received a visit from someone different to her usual carer, the staff member rang the bell and the door was opened London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 17
remotely as normal by the Service User, but the carer failed to introduce herself or inform the Service User that her usual lady would not be coming. The Service User was very upset when she realised during the visit that there had been a change. Some Service Users said that at weekends they do not receive regular carers, this is because the staff rota is done in a way that allows staff to have one weekend in three off, meaning that weekend work will be coved by different staff depending on who is on duty, this is unavoidable with work patterns as they are and the agency endeavours to make the pool of carers each Service Users will have as small as possible. Another Service User feels that the care staff do not always have the expertise they need to meet his needs, this is subject of an ongoing complaint and will be monitored by the commission. Please see Requirement 5 Keeping the Service User informed of changes is good practice and it is recommended that Service Users are always informed in advance of any changes to the normal service. Staff should be reminded of the importance of communicating with the Service User while in their home. Please see recommendation 3 Policies and procedures that were examined were found to be as required and are reviewed at regular intervals. Record sheets were found in all homes visited and appeared to be detailed, the Inspector was informed that the agency is in the process of redesigning it recording sheet to enable staff to record the visit in more detail. The Agency s complaints procedure is robust and is overseen by the London Borough of Bromley s complaints department. The complaints file was examined and most complaints do not progress beyond first stage, those that are escalated are responded to within timescales set by the Borough and are dealt with in accordance with the complaints procedure. A rolling program of quality assurance visits has been introduced. A dedicated staff member visits Service Users in their own home and assists them to complete a user survey and will also make sure that information needed is in the house and will highlight any areas that may need risk assessments done. The information gathered will be collated monthly and areas of concern actioned. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 18
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 2 18 3 3 3 19 2 4 3 20 3 5 3 21 2 6 3 Personal Care Organisation and running of the business Score Standard Score Number 7 2 22 3 8 3 23 3 9 3 24 3 10 3 25 3 Standard Number Protection Standard Score Number 11 3 12 3 13 3 14 3 15 3 16 3 26 3 27 3 London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 19
Are there any outstanding requirements from the last inspection? 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 2002 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. DO17 17.4 An investigation has been instigated into why no action was taken when a CRB check was 24/09/06 returned indicating the staff member had been convicted of theft. The Inspector will be kept informed of the of the investigation and it s out come. 2. DO17 17(4) All staff records are reviewed to check that CRB checks have been undertaken and that they are clear of convictions, or if not clear, the decision behind continuing to employ that staff member is recorded and kept on file. 24/09/06 3. DO19 15(2a) POVA training must be included in the regular training schedule. 24/10/06 4. DO21 15(4) All staff must meet on a one-toone basis at least 3 monthly. 24/10/06 5. DO26 20 The Inspector must be kept informed of the progress and outcome of the ongoing complaint. 24/10/06 London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 20
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 Good Practice Recommendations Standard 1. DO2 It is recommended that any prospective Service Users is visited by the Planning Officer to enable him to gather extra information to write a more detailed personal Service User plan that details their care needs, wishes, preferences and personal goals and to carry out risk assessments that may be necessary. 2. DO5 It is recommended that it would be good practise for care staff to check that all information provided by the agency to the Service Users is in order and up to date from time to time, some of the files are very old and falling apart and contained very old copies of the Service Users guide and are in need of replacement. 3. DO6 Keeping the Service User informed of changes is good practice and it is recommended that Service Users are always informed in advance of any changes to the normal service. Staff should be trained in the correct procedure in introducing themselves and keeping the Service User informed. London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 21
Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 London Borough of Bromley DS0000052225.V291430.R01.S.doc Version 5.1 Page 22