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Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Village Homecare Services (Wales) Ltd
30 Uplands Crescent
Uplands
SA2 0PB
Type of Inspection – Baseline
Date of inspection – Tuesday, 27 January 2015
Date of publication – Monday, 23 March 2015
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Summary
About the service
Village Home Care is a large domiciliary care agency which currently provides a service to
people living in Swansea, Carmarthenshire, Caerphilly and Newport Local Authority areas.
The registered office is in Swansea, with satellite offices in Ammanford and Caerphilly.
The registered provider is Village Home Care Services Wales Limited, which is part of the
MITIE group. The registered manager is Emma Lewis.
What type of inspection was carried out?
This was a scheduled announced baseline inspection which looked at the themes of the
quality of life for people using the service, the quality of staffing and the quality of
leadership and management.
This inspection was carried out by one inspector. The methods used were:
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Visits and telephone calls to people using the service, including discussions with their
relatives where appropriate
An announced visit to the agency’s registered office
A visit to one of the satellite offices
Examination of documentation relating to the five people
Examination of three staff files
Examination the staff training matrix and training programme
Discussion with staff
Discussion with the Registered Manager
What does the service do well?
There were no areas of exceptional practice identified during the inspection
What has improved since the last inspection?
The length of call times was clearly monitored and any variation from the scheduled time
was investigated and documented.
What needs to be done to improve the service?
The registered persons were notified that they were non compliant with Regulation 16 (2)
(a) as staff had not received training updates in a timely manner.
The registered persons were informed that they were non compliant with Regulation 23 (2)
and (3) as there was no evidence that the quality monitoring system was fully developed
and there was no annual quality of care report.
It is recommended that the registered persons ensure that the systems for confirming that
care is not commenced without a suitable assessment and care plan in place and for
recording the updating of care plans is reviewed.
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It is recommended that the registered persons carry out a review of the staffing levels and
workload to ensure there are sufficient staff to complete all the contracted care.
It is also recommended that the registered persons discuss preferred hours with all staff
and clearly document their decision about whether they are willing to do extra hours.
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Quality Of Life
People receiving a service can feel reasonably assured that they will be provided with
care that can meet their needs.
We (CSSIW) spoke to people using the service and their relatives both on the telephone
and face to face and they told us that they were generally satisfied with the care from the
agency. They felt that they received the care that had been agreed with their care
manager. They also told us that staff from the agency had come to assess them prior to
care being commenced.
We looked at a sample of care files, including two for people who had recently started
receiving care and found that they were well completed documents. However a concern
had been reported that care plans were not put in place before care was commenced
and this issue was also highlighted in one response from a staff questionnaire. In the
records seen in the office we did not find any evidence of this. We also visited one
person who had recently started receiving a service from the agency and we saw all the
relevant paperwork in place in the house. However we discussed the process of
instigating care plans with the registered manager and the manager of one the satellite
offices. Both described a process of ensuring that they saw the care plans and signed
them off before care is commenced. Another concern had been reported that the care
plans were not updated and therefore contained out of date information. No evidence of
this was found in the sample of care plans seen during the inspection. However in the
light of the concerns expressed to CSSIW and the information from staff it is
recommended that the registered persons ensure that the systems for confirming that
care is not commenced without a suitable assessment and care plan in place and for
recording the updating of care plans is reviewed.
We looked at the medication policy and procedure as a number of medication errors had
occurred and been reported through the safeguarding process since the previous
inspection. We discussed this with the registered manager who explained that the
medication training had been updated and there was also a medication quiz for staff to
complete. Competency checks and spot checks on staff were also carried out and
documented. We found that action had been taken to reduce the number of medication
errors but this needs to continue to be given a high priority to ensure that medication
errors are significantly reduced.
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Quality Of Staffing
People using the service cannot be completely confident that staff are fully competent or
that they will always receive continuity of care from familiar staff. However people said
that the large majority of staff were caring and helpful.
We looked at three staff files and found that they contained all the required
documentation including application forms, photographs, Disclosure and Barring Service
(DBS) checks and references. We therefore found that there was evidence of a robust
recruitment process.
A concern had been expressed about staff working in excess of 50 hours per week , not
having enough breaks and having less that eleven hours between shifts. We discussed
the staffing levels with the registered manager and satellite office manager and looked at
the information returned in the staff questionnaires. It was clear that there has been a
turnover of staff and despite working at staff recruitment and retention the agency had
continuing staff vacancies. This meant that there was not always continuity of staff for
people using the service and this was commented on in questionnaires returned from
people using the service. It also meant that staff were asked to cover extra hours and
some were happy to do this. However a concern has been expressed that staff who did
not want to work extra hours may feel pressurised to do so. We discussed the workload
and were informed that currently new packages of care were only taken on when there
was a vacancy created from the end of a previous package of care. We saw that staff
were asked to opt out of the Working Time Directive as part of the recruitment process
and therefore were asked to agree to have less than eleven hours between shifts. It is
recommended that the registered persons carry out a review of the staffing levels and
workload to ensure there are sufficient staff to complete all the contracted care. It is also
recommended that the registered persons discuss preferred hours with all staff and
clearly document their decision about whether they are willing to do extra hours.
A concern had been expressed that staff were not sufficiently trained before commencing
employment or during their on going employment. We looked at the induction process
and saw that a suitable system was in place. When we looked at a selection of the staff
files we saw records of completed induction training. We looked at the staff training
matrix and discussed the training with the registered manager and training team. We
were informed that the training programme had been updated with some training to be
completed on line, there was also training available at weekends and during the evenings
to encourage staff to attend. We also looked at the updated medication training
programme and saw evidence of training and competency checks in staff files. However
it was clear from the training matrix that some of the update training had not taken place
in a timely manner and was therefore out of date. This had also been an issue identified
at the previous inspection. The registered persons were notified that they were non
compliant with Regulation 16 (2) (a) as staff hade not received training updates in a
timely manner.
We discussed the call allocation with staff, including those who worked as part of the
team monitoring the timing and length of calls. We saw that there was a new Electronic
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Call Monitoring System, which was screened by staff during the hours when calls were
being made. This allows the office staff to know if a call has been missed or is late and
provides information about the length of the call. We discussed the amount of travelling
time allocated between calls and found that different systems were used in different
areas. We were told that some Local Authority commissioners included travel time in
their commissioning process, particularly in the rural areas when there could be long
distances between calls. In the city we saw that five minutes was uniformly provided on
the staff schedules as travel time between calls. It is recommended that travel time
between calls is reviewed to ensure that staff are provided with sufficient time between
calls.
We looked at the supervision records in staff files. The records included annual
appraisals, supervision and spot checks carried out in the community.
We found that overall people felt they had good interactions with staff when familiar staff
were carrying out their care. However because of the turnover of staff people were
sometimes cared for by staff who did not know them. We also found that, despite the
supervision system there was some feelings of stress amongst staff.
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Quality Of Leadership and Management
Overall people can be assured that the registered persons have put a clear management
structure in place to ensure that the business is well run. However there is a need to
develop the quality monitoring system and to complete an annual quality of care report.
We have received an application to change the registered provider of this service, and
others, to Mihomecare. This application is currently being processed as CSSIW and will
mean that once the registration process is complete this service will merge with another
domiciliary care agency in Swansea and the satellite branches will be separately
registered with their own registered manager.
We saw that there was clear information about the service, including service user guides
provided to people receiving a service. People told us that they felt they were receiving
the service they expected and that they were contacted and visited by supervisors from
the agency who discussed and reviewed their care.
We saw that there was information gathered from quality questionnaires sent out to
people using the service. However there was no overall quality of care report available
including the views of Local Authority commissioners and staff as people using the
service and their representatives. The registered persons were therefore informed that
they were non compliant with Regulation 23 (2) and (3).
We found that although there were the expected management and administration
systems in place there was a need to develop the quality monitoring processes to ensure
that they resulted in improved outcomes for people using the service and effective
support for staff.
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Quality Of The Environment
Not applicable for Dom Care Agency
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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.
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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.
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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;
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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.
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