PRESS
Contract Monitoring Report
- Name/Address of Provider: Planned Residential Support Services (PRESS), Festival House, Victoria Business Park, Ebbw Vale, NP23 8ER
- Date Of Visit: Monday 22nd January 2024
- Visiting Officer(s): Amelia Tyler: Contract Monitoring Officer, Caerphilly CBC
- Present: Steve Smothers: Responsible Individual, PRESS / Caitlin Smothers: Registered Manager, PRESS
Background
PRESS is a supported living provider based in Ebbw Vale, who have had a contract with Caerphilly CBC since 2011 to provide care and support to people living within the borough. At the time of the visit the provider had two residential properties in Caerphilly and one that is registered as a supported living property.
The last visit to the main office was completed on the 5th May 2022 and the report identified four corrective actions one developmental recommendation.
Dependant on the findings within the report, corrective and developmental actions will be given to the provider to complete. Corrective actions are those which must be completed (as governed by legislation), and developmental actions are good practice recommendations.
Previous Recommendations
All staff to be up to date with mandatory training. RISCA version 2 (April 2019) Regulation 9 and Caerphilly CBC contract 13.3. Met. The training matrix demonstrated that all staff working at the supported living property were up to date with all mandatory training.
Two written references, including a reference from the last employer to be held on file. RISCA version 2 (April 2019) Schedule 1, regulation 35, part 1 (4). Partially met. Two staff files were seen during the visit: one contained a reference from the health board but didn’t have a name or designation. The second file didn’t contain any references, but it was acknowledged that she had left the company and returned. It was emphasised by the responsible individual that they do everything possible to obtain two written references (professional ideally) but because there is no official requirement to provide this, or to give any insight into their conduct or suitability to the role, this is incredibly difficult. The contract monitoring officer offered to assist if the individual has previously worker for a care provider within the borough, however, this cannot guarantee the quality of the reference. This has been raised as an ongoing concern as it can become a meaningless exercise rather than assessing the suitability of the person applying for the post.
Interview records to be held on file to evidence the rigorous vetting on applicants. RISCA version 2 (April 2019) regulation 35. Not met. Neither file had interview records. It was stated that these were to be completed by the business administrator. One staff member didn’t require an interview as they had returned to the position within twelve months of leaving. In this circumstance, the original interview should be held on file alongside a statement highlighting the policy that this isn’t needed within a twelve month period.
Copies of birth certificates, passports, and recent photos to be present on each staff file. RISCA version 2 (April 2019) Schedule 1, regulation 35, part 1 (8). Partially met. Passports and recent photos were present on both files, but only one had a birth certificate. The contract monitoring officer recommended that if a birth certificate isn’t available, that a statement is held by the member of staff that is signed and dated.
Consideration to be given to adding date of next review to the policies. Met. The policies and procedures all gave a review period of one, two or ten years apart from the pre-admittance protocol relation to the commencement of service. It is required that all policies and procedures are kept up to date and the responsible individual would update if there were any changes to legislation or processes.
Findings from visit
Desk-top audit
There were no concerns received by the commissioning team from the care management teams or any outside agencies. It was acknowledged that there were no enforcement notices raised during the most recent Care Inspectorate Wales visit earlier in January 2024 and the report was in draft format at the time of the visit. There were no reported complaints or safeguarding referrals made.
The training matrix was emailed prior to the visit and as highlighted above; most of the mandatory training had been completed but there were some gaps identified. This is looked at in greater detail later in the report under staffing information.
A copy of the supervision and appraisal matrix was shared and discussed during the visit; It was noted that staff are scheduled to attend a supervision meeting every three months as required (with one of these being their appraisal). The contract monitoring officer observed that the supervisions held in October 2023 were recorded as giving the month (interim); it is recommended the full date is recorded once the supervision has been completed to ensure accuracy and transparency. There was one supervision session that was a month overdue, and another member of staff was on leave from April to October 2023 and there was nothing recorded following her return to work until January, although the full date was not recorded.
The registered manager and responsible individual said that the longest contract they give is for 40 hours a week. There are only waking night shifts between 9:30pm and 7:30am and it was explained that the staffing ratio at Porset Drive is two staff to four clients during the day and night staff.
Responsible individual
A copy of the checklist completed as part of the regulation 73 visits was seen and was dated 1st November 2023. The contract monitoring officer noted that this didn’t evidence any conversation or feedback from the clients or staff as required.
A copy of the statement of purpose was seen and it was acknowledged that this had has been reviewed in July 2023 and this had last been amended to include the new address for the Caerphilly complaints team.
Discussion was held around what the contingency plan is if the registered manager and responsible individual were both unexpectedly absent for more than 28 days and it was stated that a notification would be submitted to Care Inspectorate Wales and the commissioning team and the oversight of the service and the necessary responsibilities would be completed between the other managers and deputy managers with support from the business administrator.
It was noted that the initial assessment does not ask what the individual’s preferred language is however, there is a Welsh Language policy that was last reviewed in December 2023 and is reviewed every two years.The policy outlined the limitations on the company to be able to offer a bi-lingual service as they have no clients or staff that can communicate in Welsh. It was documented that they would fully support any member of staff that expressed a wish to learn the language and use this in their role.
Tenant information
At the time of the visit it was explained that there was one supported living property and two smaller residential home within the borough. There were no plans to take on any more properties within the borough either as landlord or support provider.
The supported living property is owned and maintained by United Welsh. The contract monitoring officer was informed that the two residential properties are owned by a private landlord. It was reiterated that the ladies living at the home are not contractually obligated to their support provider.
The responsible individual said they have a good working relationship with the landlord and that normally any work is carried out in a timely manner, although there have been instances where this has taken longer than anticipated. It was stated that where there was a health and safety issue at one of the properties, this was arranged by the support provider and the landlord then paid for the work that had been carried out.
Individuals are referred to the provide through the care management teams in social services. The tenancy selection process includes reading through the care plan compiled by the placing authority, carrying out a meeting with the person to do an initial assessment to see if they can meet their needs, then use the pre-admission protocol to carry out compatibility assessments and talk to existing tenants about a new person moving to the property and carry out trial periods with a sex week review.
Tenant files
The tenant files were not viewed at the office as this will be completed during the visit to meet with the tenants.
Manager’s questions
Medication is audited by the staff three times a day and the manager also completes a monthly audit. At the time of the visit it was explained that there were no clients who had covert medication, and it was noted that if this were needed, they would request a multi-disciplinary meeting to discuss the individual’s best interests.
As mentioned previously, the provider does not implement the active offer and the contract monitoring officer was told there is currently one member of staff across the organisation that can speak fluent Welsh.
Discussion was held around the medication procedures and the manager explained that the Medication Administration Record (MAR) is signed by the individual staff member giving the medication. Medication is stored in a lockable cabinet in the living room.
Client and stakeholder feedback is normally obtained verbally on a weekly basis, and it was stated that this is captured more formally during the three weekly team meetings where the key workers will share any comments or issues on behalf of the people they support. It was also highlighted that the responsible individual will occasionally ask to sit-in on appraisals of staff to get direct feedback from how they feel about their role, the service and how this could be improved.
The responsible individual forwarded a copy of the six-monthly regulation 80 report which outlined any trends and actions that needed to be completed. The last report was dated June 2023 and the contract monitoring officer was told that the information was still being compiled for the July – December period at the time of the visit.
No changes have been required because of the feedback obtained, although the contract monitoring officer was told that the clients no longer wanted a sofa in the main living room and have purchased their own armchairs. They were all supported to purchase any items they wanted, including furniture and windows blinds.
The outcome of any quality assurance process is shared with staff via the company WhatsApp group and staff will then share this verbally with the clients. There is no evidence of the formal report being actively shared with stakeholders that may had fed into the process.
The responsible individual and registered manager are aware of where to access advocacy for the people they support where needed. It was highlighted that at the time of the visit there was only one lady that was had an advocate.
If there was an incident where one of the individuals wanted one of the others to leave the property, the contract monitoring officer was told that a multidisciplinary meeting would be arranged with the social work team if required. They would talk to the clients involved, investigate the issue raised and look at some conflict resolution. It was stated that although there have been some low level disputes, there has never been anything raised in the supported living property that hasn’t been resolved.
Where a member of staff was struggling to support a client, it was stated they would discuss the matter with both parties and consider any training needs. It might be settled with a change of staff (so the clients have different key workers) or a change in practice with the team. As a last resort, the contract monitoring officer was told the member of staff would be given the opportunity to work in one of the other properties.
Complaints and compliments
The contract monitoring was provided with three compliments received in the second half of 2023: one was from a lady working in a local nail bar, one from the community nurse and one from three nurses at a local hospital. All compliments commented on the care and support given by staff and how well presented the client was when admitted to hospital.
It was acknowledged that the service user guide is very user friendly and accessible and gave clear advice on how clients could make a complaint if needed. This had been updated and contained accurate information. It wasn’t possible to case track a complaint to ensure a satisfactory outcome as there haven’t been any complaints. It was explained that staff try to take a proactive approach and try to take a positive but proportionate methodology towards risk management. As a result of a previous fall, a stairlift had been fitted as it was agreed this was a positive outcome to maximise the lady’s independence as much as possible.
The manager reiterated that if this were to happen that the complainant would be notified of the outcome in writing, and this would be held on file to allow a full audit trail.
Staff would be informed of any complaints appropriately, respecting confidentiality and professionalism. Any lessons learned would be shared by the managers across the company to share good practice and development opportunities.
Staffing information
The training matrix was provided prior to the visit, and this documented that there were nine members of staff that supported the individuals living in Porset Drive. Everyone has done manual handling, food hygiene, safeguarding, first aid and medication training. It was noted that four had attended fire training.
It was reflected on the matrix that only two staff members had completed visual impairment training, but it was discussed during the meeting that it was difficult trying to source any sensory impairment training at present. The contract monitoring officer observed that one member of staff had yet to complete infection control training and six to complete positive behaviour management. There was one member of support staff to attend dementia training. Following the meeting it was highlighted that the database hadn’t been completed correctly and it was confirmed that all staff had attended infection control training.
Although it was noted that no staff had done communication training, there were four that had completed understanding autism and it is recommended that the remaining four also attend this course. The contract monitoring officer noted that nobody had completed training around challenging behaviour, but this is partially covered in PBM (three staff have attended) and understanding autism and it wasn’t felt that this was a particular need in this property. Following the meeting the responsible individual stated that as none of the individuals living at the supported living property display any significant behaviour they would find it very difficult to access any training. Only four staff have attended fire safety training at the time of the visit.
Non-mandatory training that is required to meet the specialist needs of the people being supported include diabetes awareness, pressure care, palliative care, epilepsy, brain injury and recording skills.
Training is delivered through a mix of electronic and classroom based learning and it was explained the quality of these courses is evaluated through evaluation forms, culture training, competency assessments, observations on shift, supervision and the feedback received from the people being supported.
Communication between the teams was reported to be good and the contract monitoring officer was told there is a WhatsApp group for staff that enable the responsible individual or registered manager to share information and it was explained that this is outgoing only.
As previously highlighted, both staff files contained job descriptions, full employment histories, signed and dated contracts of employment, copies of passports, recent photos, and training certificates. There was some information missing that was going to be shared with the business administrator.
Supervision and appraisal
The supervision sessions are formal, confidential 1:1 sessions and these were recorded and held on file. Appraisals are carried out at least annually with the first session being approx. one year from their start date. It was noted that staff are expected to complete a pre-appraisal so they can contribute meaningfully to the meeting and consider their role, what has gone well, identify areas for development and what their ambitions are for the future.
The manager of the supported living premises is supported through regular supervisions with the responsible individual. There are three managers, three deputies and a business administrator who work closely together and support each other to share good working practice and ensure consistency. It was stated that there is good succession planning and the senior staff team try to promote internal development for those that wish to grow and progress.
Staffing issues
The contract monitoring officer was provided with a matrix to evidence that all staff had a valid DBS certificate, and they were all clear and checked at least annually.
It was acknowledged that four staff have left over the past twelve months that had worked in Porset Drive which equates to 44% of the staff team. The reasons give were due to personal reasons, wanting to work with young people or to leave the sector completely. It was pleasing to note that in the same period the provider had also managed to successfully recruit four new starters who were reported to be getting on well.
There were no staff on long term sick at the time of the visit and they don’t use any agency staff. The contract monitoring officer was told that there is an on-call policy where a senior member of staff would be called in an emergency, however there is no rota in place currently as there hasn't been a need to implement one.
Corrective / Developmental Actions (To be actioned within three months from the date of this report)
Corrective
Two written references, including a reference from the last employer to be held on file. RISCA version 2 (April 2019) Schedule 1, regulation 35, part 1 (4).
Interview records to be held on file to evidence the rigorous vetting on applicants. RISCA version 2 (April 2019) regulation 35.
Copies of birth certificates, passports, and recent photos to be present on each staff file. Where this isn’t available a signed, dated, written statement from the employee to be available. RISCA version 2 (April 2019) Schedule 1, regulation 35, part 1 (8).
As part of the quality review process, the provider must actively encourage feedback and provide an analysis of the feedback received to stakeholders. RISCA version 2 (April 2019) Regulation 8.
The quarterly visits carried out by the responsible individual to evidence discussion with staff and clients. RISCA version 2 (April 2019) regulation 73.
Developmental
The supervision and appraisal matrix to provide the full, accurate dates of the meeting.
After a long period of absence, supervisions to be held and recorded with the staff member to support their return to work.
Conclusion
It was noted the manager and responsible individual had a thorough understanding of their workforce and the needs and abilities of the people they support. The files were well laid out and although there were some gaps identified, the information was easy to locate if available.
There were no concerns raised and although there were six actions were identified, it is felt these will be easily achievable within the three month timescale.
The contract monitoring officer would like to take the opportunity to thank everyone involved for all their time collating the information, during the meeting and for their hospitality. Unless there is any need to move the next visit forward, it is planned that the next visit will be in approx. twelve months’ time.
- Author: Amelia Tyler
- Designation: Contract Monitoring Officer
- Date: 14th February 2024