1. health and fitness

Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Blaenau Gwent County Borough Council Supported Living Scheme
Abertillery Sports Centre
Alma Street
Abertillery
NP13 1QD
Type of Inspection – Baseline
Date(s) of inspection – Thursday, 26 March 2015
Date of publication – Tuesday, 28 May 2015
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Summary
About the service
Blaenau Gwent Supported Living Service is registered with the Care and Social Services
Inspectorate Wales (CSSIW) as a domiciliary agency to provide personal care to older
persons, people with physical disabilities, people with sensory loss/impairment, people
with mental health problems and people with dementia.
The service currently provides personal care in supported living accommodation located in
five properties in the Blaenau Gwent area. The service has an office base in Abertillery.
The registered provider has a nominated individual who represents the company and the
Registered Manager is Joanne Hawkins.
What type of inspection was carried out?
We (CSSIW) visited the agency’s office on an announced basis followed by a visit to a
supported home on the 26 March 2015 to conduct a baseline inspection. To inform our
report we considered the following:
information held by CSSIW about the service
a discussion with the Registered Manager and staff
limited discussion with several people using the service
an examination of three staff files
an examination of supervision and training records
an examination of the provider’s quality assurance review and consultative
questionnaires to people using the service, family representatives and stakeholders
an observation of daily care practices at a supported home in Tredegar.
What does the service do well?
We found areas of consistent good practice particularly in respect of the monitoring of the
quality of care, ensuring that health needs are maintained during stays away from the
supported home and specific needs training. We saw evidence in care files, staff files and
quality assurance documentation that demonstrates that the provider places emphasis on
these areas.
What has improved since the last inspection?
We found that service delivery plans we saw were regularly reviewed and that deprivation
of liberty arrangements are detailed in the care file at the supported home.
What needs to be done to improve the service?
No non-compliance notices were issued on this occasion.
We found that the service were not fully compliant with Regulation 16(4) of the Domiciliary
Care Agencies (Wales) Regulations 2004 and National Minimum Standards for Domiciliary
Care Agencies (Wales) 21.2 in that all staff meet with their line manager at least once
every three months. We were informed that staff meet their line manager every three
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months but its alternate one to one and group supervision.
We informed the Registered Manager that the consultation process would be improved if
questionnaires for people using the service were available in a more accessible format for
those with learning disabilities.
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Quality Of Life
People can be assured that they have a voice, are encouraged and supported in making
choices and their rights are protected. We considered the agency statement of purpose
which declares the philosophy of supporting people’s rights. We spoke with staff who
understood their role in safeguarding vulnerable people and people’s rights to privacy,
choice, dignity and respect, and we observed daily care practice where people were
provided with choices and influence in their daily living such as meals, snacks and drink.
We saw staff who were familiar with the communication needs of people and supported
them in making choices about where they would like to sit or supported them in
communicating with us. Staff were very respectful of their wishes and needs. When we
spoke with staff we were informed of the communication needs of one person we saw
who used body language, eye contact and touch. We were also made aware that tenants
meetings were regularly held in order for people to have a say in aspects of daily living.
We saw notes of meetings where holidays were discussed along with decoration, meals
and activities.
People can be assured that they will be supported in achieving an active and fulfilling
lifestyle as possible based on their individual needs and abilities. We saw a care plan
which included an ‘activity’ planner and staff, we were informed, would discuss with
individuals their wishes. During the inspection visit one person returned from a day
centre activity and she discussed with us her recent holiday to the south coast. She was
talking to staff about her next holiday activity.
In the care files we inspected we saw evidence of a variety of social outings, events and
activities which included trips to the theatre, pubs, restaurants and one service user
spoke about a visit to the X-Factor auditions which she enjoyed immensely.
Generally, people’s physical well-being is maintained and they can have access to
specialist and medical support. Because of the complex nature of people’s physical
health needs the service maintain constant communication with the health service. In
addition, care plans reflect the health needs of people using the service and so enable
their needs to be anticipated by the staff.
In care files we saw District Nursing Service notes of care they have administered,
appointments attended to Local Health Board physiotherapy departments and multidisciplinary meeting recordings in which the Community Learning Disability Team (CLDT)
were involved.
Also within the care files was evidence that the provider has adopted the local Health
Board hospital assessment scheme (Red, Amber and Green) so that, at times of hospital
admittance, the service provide a needs assessment to the hospital immediately. This
should maintain continuity of care.
Further evidence of supporting people to maintain physical wellbeing included a letter,
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written to the health board, by the home manager airing her concerns over a recent
hospital stay by a person using the service. The letter had been responded too and
offered apologies for a lack of care to the individual. This was an ongoing issue.
People can experience warmth attachment and a sense of belonging and they can feel
supported in times of anxiety and when they are upset. This is because the service fully
understands peoples needs and preferences, and had devised strategies that, on the
whole, help to prevent people becoming anxious.
We spoke with staff who were very familiar with any behavioural difficulties that may be
presented as these were detailed in behaviour plans and risk assessments in the care
files we reviewed.
We observed staff interact with several people returning to the supported home from their
day centre. Staff interactions were calm and personalised, and provided a warm
welcome to people returning. We spoke with one of those returning home who was
complimentary of the staff and the service provided.
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Quality Of Staffing
People using the service can be confident that the personal care they receive is provided
by appropriately recruited staff because the provider has robust procedures in place to
employ staff. We saw evidence in three staff files that the provider had obtained
references, a full employment history, undertaken disclosure and barring service checks
(DBS) and several proof of identity. In addition, the files confirmed that staff complete an
appropriate and recognised 12 week induction whilst in post.
People can be assured that they are able to be supported by staff who have the
knowledge and skills to care for their personal and daily living needs. This is because
staff are given training in general aspects of care and more specialist training where
appropriate. We saw evidence both in the staff files and in the home that people had
received training in epilepsy, dementia, and learning disabilities and ‘network’ training
provided by health professionals who have given guidance in relation to a specific
individual.
There was evidence that medication administration training is regularly provided by a
nationally recognised provider. A notification had been received by CSSIW in relation to
one incident of missed medication and we saw that those staff responsible had been
withdrawn from giving medication until they have undergone refresher training.
The provider is not fully compliant with providing evidence in respect of Regulation 16(4)
of the Domiciliary Care Agencies (Wales) Regulations 2004 and National Minimum
Standards 21.2 that all staff meet with their line manager at least once every three
months on a one to one basis. We did see in documentation that staff have one to one
and group supervision and we spoke to the staff who confirmed this and who said that
they could approach their manager at any time for advice and guidance. However, it is
necessary that all one to one supervision is recorded to fully comply.
As detailed in the quality of life section people can be assured of good interactions with
staff and feel able to develop positive and supportive relationships with staff who
understand their role.
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Quality Of Leadership and Management
People can be assured that all staff managing or delivering a service to them understand
the philosophical aims of what the provider aims to deliver and achieve. This is because
the written statement of purpose clearly sets out these aims and staff spoken with
understood what they are required to deliver and the outcomes they endeavour to
achieve. The Service User Guide is written in a format accessible to people using the
service.
People are able to receive and can feel they get reliable, good quality of care because
the provider has systems in place to monitor, review and improve the service provided.
We saw that Regulation 23 (review of quality of service provision) was being complied
with and that people using the service (and their representatives) were being consulted
and that an annual report is made available. However, we would recommend that the
consultative questionnaires to people using the service are made in a more accessible
format for those with learning disabilities. In addition, we would recommend that any
suggestions, from the consultation and quality monitoring process are developed into an
action plan for improving the service.
Never the less, on the whole people can be confident that they are safe, that the
business is well run by a competent and knowledgeable manager and that due care and
attention is made to the regulations and national minimum standards. This is because
we saw several procedural documents and policies that were familiar to the manager and
staff spoken with. We considered the database relevant to complaints, POVA,
notifications to CSSIW and staff disciplinary and these were fully completed.
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Quality Of The Environment
This theme is not considered in domiciliary care inspections.
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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.
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.
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