Pro-Care Support Services
Contract Monitoring Report
- Name/Address of Provider: Pro-Care Support Services, Imperial Buildings, Bridge Street, West End, Abercarn, NP11 4SB
- Date Of Visit: Monday 20th November 2023
- Visiting Officer(s): Amelia Tyler: Contract monitoring officer, Caerphilly CBC
- Present: Lynne Richards: Responsible Individual / Adele Hurn: Deputy Manager
Background
Pro-Care Support Services is a relatively new supported living provider within Caerphilly Borough and the contract has been in place since 18th November 2021. The provider has three properties, one of which is in Caerphilly and the other two in a neighbouring borough. This is the first formal monitoring visit to be carried out at the office with the intention of going out to visit the supported living property and meet with the tenants in early 2024.
The purpose of the visit was to go through staff and client files and complete the monitoring template used within the commissioning team.
Depending on the findings within this report, the Manager may be given corrective and/or developmental actions to complete. Corrective actions are tasks which must be completed (as governed by legislation etc.) and developmental actions are those deemed to be good practice.
Previous Recommendations
Findings from visit
At the time of the visit there were three tenants living at the property and it was stated that these were all supported to move by Caerphilly CBC. There were no vacancies and no concerns had been raised by the care management team or any external agencies.
The previous inspections were carried out by CIW (Care Inspectorate Wales) on the 17th and 30th March 2022 and at this time here were no priority action notices or areas for improvement highlighted. There had been no safeguarding reports or complaints recorded over the previous six months.
Documents obtained prior to visit
The training matrix was shared with the contract monitoring officer prior to the visit and was reviewed. The findings are recorded in the induction and training section below.
Supervision and appraisal matrices were provided following the visit.
Staff Rotas were provided from 16th – 29th October and 6th - 19th November 2023 and it was acknowledged that the three staff members with the same name were recorded as 1, 2 and 3. It is recommended that the full names of staff are recorded to remove any confusion. It was also observed that the rota recorded times as 7/7 or 8/8 or N for a night shift; the manager must ensure transparency and either record the shift patterns in the 24 hour format or use am and pm and be clear in giving start and finish times.
The manager explained the staffing levels are one sleeping support assistant between 7pm and 7am, it will then change to another staff member from 7am, two members of staff at 8am and increasing to three at 9am. It was noted that there are sometimes four staff members on duty depending on what they were doing. The rota did have a section for notes with any pre-arranged appointments, events, or activities. There appeared to be one occasion where there was only one support assistant on shift between 2 – 7pm when the night shift started.
Responsible individual
Copies of the quarterly regulation 73 reports were provided, and it was noted that these were completed every other month which is above the required frequency. The previous visits were completed on the 22nd June, 29th August and 4th October 2023. Although they gave a pen picture of what was happening in the home, it did not evidence any comments or direct feedback from the clients themselves or staff.
The statement of purpose was forwarded, and although there was no review date on the document or a future planned review date, the electronic version was saved as 1st April 2022. To meet regulatory requirements the document needs to be reviewed annually and this should be evidenced on the document.
As the responsible individual is also the registered manager, it is recommended that a contingency plan be formalised in the statement of purpose to outline what would happen if they were unexpectedly absent for a period.
Mandatory policies and procedures were present including admissions, infection control, staff support and development, whistleblowing, medication, and complaints etc. The staff disciplinary policy and infection control policies were dated 7th November 2018, and the others were last reviewed on the 5th September 2022. Policies and procedures need to be reviewed to ensure the guidance is still up-to-date and it is therefore deemed good practice to include the next review date.
Tenant information
As previously highlighted, the company support three properties and they are owned by the Burles group and the contract monitoring officer was informed that there is an intention to purchase another home in the borough that will be a five bedroom property. The manager said they have a good working relationship with the landlord and any issues are reported and rectified in a timely manner.
Individuals are referred to the provider through social services and the initial visit to the home is normally completed by the allocated social worker to see if they think the placement is suitable.
The tenancy selection process is following the social worker visit, if the home is suitable, they share the care plan, the manager will then meet with the person and complete an initial assessment. Compatibility is considered with any existing tenants and then transition meetings are planned where they look at interaction with staff and other people living at the property.
It was explained that there are trial periods and probationary periods where they review the placement and if it is working for all parties.
File audit
Although not seen, the contract monitoring officer was told that all client files are held securely in lockable cabinets at the homes.
Two files were viewed for gentlemen living at the property in Caerphilly and it was noted that these contained risk assessments, personal plans written by Pro-Care and an integrated assessment completed by the local authority. The documents covered areas including personal care, communication, accessing the community, finances, transport, and mobility. One file contained specific information around a nut allergy and visual impairment and the second file contained risk assessments around accessing the community and using the kitchen.
It was acknowledged that one of the personal plans was written in first person which helps to maintain the focus on the individual. The document was strengths based and concentrated on what the person can do rather than what support staff need to do. There was detail around preferences such as referring to the shower as the ‘sprinkler’ and listening to Bon Jovi. It was highlighted they don’t like hot drinks or the word ‘No’. There was additional information noted around their normal routine and it was noted that the risk assessments had last been reviewed on the 14th October 2023 and this was to be reviewed every two months.
The second personal plan seen highlighted that it was important to him to visit his mother’s grave. The gentleman likes egg, sausage and chips and doesn’t like being rushed or staff doing things for him that he is able to do himself.
Neither file contained copies of the initial assessment; it is a regulatory requirement for a detailed assessment to be completed prior to the commencement of the service being delivered outlining how they will meet the person’s needs.
It was acknowledged that the Caerphilly care and support plans were reflected in the personal plans, and these included outcomes such as having a ground floor room to enable him to manoeuvre around the property safely. The contract monitoring officer recommended that these be developed to include wellbeing outcomes in line with the national outcomes’ framework.
Risk assessments were linked to the personal plans and included action to address any identified risks. There was an assessment around the expression of pain, and it was recommended that this be signposted to the pressure area risk assessment.
There wasn’t much evidence of referrals being made to external professionals as it was explained this hadn't been needed, but there were records of Orthotics appointments and a medication review being completed on the 15th November 2022. Both files had missing person’s profiles in place.
Neither personal plan had been signed and it had been recorded that one gentleman was unable to sign and another had refused to. Where possible, an appropriate representative should be asked to sign on their behalf and for this to be detailed to evidence their involvement in compiling the document.
The company policy is to review risk assessment and personal plans every other month and it was noted on one file that the most recent one had been done on the 21st October 2023, but this was the only one recorded, so it wasn’t possible to verify if this was being done every other month. It was stated that they were looking forward to Christmas and a new tenant moving in. The second file had gaps in reviews being carried out as they had been recorded on the 18th April and then again on the 18th October 2023. This referred to a Halloween party, a trip to Porthcawl and Zumba classes. It was pleasing to note that staff had noticed a huge increase in confidence. The contract monitoring officer acknowledged that the number of seizures had reduced, and weight had been maintained; it was emphasised that it would be beneficial to have specific information i.e. how many seizures had he had? Is the outcome (desired goal) to lose, maintain or gain weight?
Manager’s questions
Medication audits are completed mid-month, and the previous form had been completed by the deputy manager. No covert medication was being administered and it was explained that medication is held in lockable safes in their bedrooms. The member of staff that administers the medication is responsible for signing the MAR chart (Medication Administration Record).
Feeback is obtained from clients and stakeholders by sending out questionnaires. The contract monitoring officer was informed that these had been amended to make them more user friendly. It was reported that the response rate was under 40%. Discussion was held around the feedback and the manager said that no changes had been made following the questionnaires as they provided positive comments and had not identified any areas for improvement.
It was noted that there were members of staff that worked sleeping night shifts and day shifts which meant they were regularly working more than 48hours a week. The manager confirmed that they had signed the disclaimer to opt out of the working time directive and were spoken to during supervision to ensure their wellbeing.
During the visit, it was noted that the active offer is discussed as part of the initial assessment, but this could not be evidenced as these documents weren’t available. There were no staff or tenants that spoke Welsh or had expressed a desire to speak Welsh. In order the comply with legislation, the provider must ensure this is discussed as part of the initial contact.
It was explained that the current tenants are not formally involved in the selection process of potential new staff. Tenants are involved informally and given the opportunity to ask the candidates any questions, but this is not recorded. It is for the manager to consider if this is something that could be developed in future and formal recordings of observations and feedback from the tenants is included in the decision making.
Discussion was held around safeguarding and the manager and deputy manager stated that they would contact the safeguarding team if there was any allegation or evidence of any type of abuse. Depending on the nature if the concerns raised, they would also contact the police if necessary.
Complaints and compliments
The manager explained that tenants are supported to make complaints through having regular opportunity to speak to them in private at the property. The tenants guide also offers user friendly advice on how to make a complaint. There are daily conversations with staff and formal review meetings with social workers where they can raise any issues.
There hadn’t been any concerns raised to case track the action taken but the contract monitoring officer was told that if a complaint were made, the complainant would be able to choose what format they received the outcome, and a written outcome would also be provided and held on file to evidence closure of the complaint.
Depending on the nature of the complaint it was stated that staff would be informed in a 1:1 meeting if the issue related to an individual staff member, or if it was a general concern i.e. parking at the property or tasks not being completed as required, this would be raised as part of a team meeting.
Compliments were not being held formally and it is recommended that a compliments and complaints file be implemented in each property to capture any issues which can then be incorporated into the quarterly reports. The manager said that one of the befrienders of a gentleman at the property had purchased gift cards as a thank you to the support staff for the care provided. It was explained that they had also received an email from a social worker praising the quality of support at the home and the contract monitoring officer requested a copy of this. It was pleasing to note that they have good relationships with the neighbours and will invite them to any parties or BBQs held.
Induction and training
It was noted that the training matrix only recorded the month and year of the training; to ensure accuracy and transparency it is recommended that the full dates are logged.
The matrix evidenced mandatory training such as infection control, manual handling, safeguarding, fire safety and epilepsy awareness. There had been a lot of training delivered in 2023 and there were no courses that required refresher training. It was acknowledged that no training had been recorded around challenging behaviour (or positive behaviour support) or communication.
Pro-Care Support Services do not use the Social Care Induction Framework, and the manager explained that all staff are qualified to QCF level 2 as a minimum, except for two. It was noted that there were four members of staff that work at the home in Caerphilly that have not yet been placed on the Social Care Wales register (one of which was on maternity leave). It is a requirement that all staff are registered within six months of starting employment.
The contract monitoring officer was informed that the quality of the training provided is evaluated through spot checks, observations, supervisions and feedback from clients and visitors. The manager explained that most training is delivered on-line, and they have also sourced training through a neighbouring authority. The contract monitoring officer said they would contact the workforce development team and add Pro-Care to the mailing list.
Supervision and appraisal
A copy of the supervision and appraisal matrix was forwarded following the visit, and it was evidenced that all staff at the property had completed their annual appraisal. As with the training matrix, only the month and year was recorded, and it is recommended that full dates are provided to ensure accuracy.
Most supervision sessions were held every quarter and there were one two instances on the matrix where there was a four month gap rather than three, but it was acknowledged that this could have been caused by annual leave, sickness etc. There was also a staff member that was recorded as having a supervision ‘due’.
It was reported that supervisions are held as formal, confidential, 1:1 meetings that are planned as a two-way conversation where the supervisee is also involved and can raise any issues and provide their own view of their performance and that of the service.
As the home manager is also the responsible individual, it was stated that most of the support comes from the deputy manager and the staff team. The contract monitoring officer also noted that support is available through external agencies such as care managers, health professionals, care inspectorate Wales and commissioning teams.
Staffing issues
Discussion was held over how many staff had left the company over the previous year and the manager said that three had left; one left as they had a second job and their personal circumstances had changed, one left the sector completely and the third didn’t feel the role was what they expected. It was reported that they had successfully recruited six new members of staff in the same period.
At the time of the visit it was stated there was one support staff on long term sick and one was on maternity leave, and these were being covered by the staff pool. They do not use agency and in the event of an emergency the staff are to contact either the manager or deputy manager who operate a duty rota between them. It was noted that there were senior members of staff but there was some succession planning in place as there is an experienced member of staff that is going to be put forward to complete their NVQ level 4.
Corrective / Developmental Actions (to be completed within three months from the date of the report)
Corrective
The statement of purpose to be reviewed at least annually. RISCA version 2 (April 2019) regulation 73.
The manager must ensure all members of staff are registered with Social Care Wales within six months of commencement of employment. RISCA version 2 (April 2019) regulation 35.
All staff to complete training around communication and challenging behaviour. RISCA version 2 (April 2019) regulation 29.
The responsible individual must visit the property at least every three months and speak to the clients (where possible) and staff and to evidence their feedback in their reports. RISCA version 2 (April 2019) regulation 73.
Copies of the initial assessment to be made available. RISCA version 2 (April 2019) regulation 15.
The provider to evidence the delivery or work towards actively offering a service in the Welsh language to individuals whose first language is Welsh. RISCA version 2 (April 2019) regulation 24.
Developmental
Full dates of training courses, supervisions, and appraisal to be recorded on all matrices.
The contact details for the customer service department in Caerphilly CBC to be incorporated into the statement of purpose, complaints policy and whistleblowing policy.
Consideration to be given to adding the next review date on the polies and procedures.
Clear short term and long terms goals to be developed with a focus on wellbeing.
Conclusion
The contract monitoring noted that the files were well organised, and information was easily obtained. All policies and procedures were detailed and was a useful resource for tenants and staff members.
There was some really detailed personal information available that provided a thorough knowledge of the people being supported, what their preferences are, hobbies, routine and anything that might cause them any upset as well as medical, mental, and physical health needs. If a new starter were to start with the company, the personal plans and risk assessments give a comprehensive insight to enable them to provide support in the way they wish to be supported.
The visit identified six corrective and four developmental actions, and the contract monitoring officer is confident these will be completed within the next three months. Unless it is deemed necessary, the next monitoring visit to the office will be in approximately twelve months’ time.
The contract monitoring officer would like to take this opportunity to thank the deputy manager and manager for their time, help and hospitality throughout the monitoring process and looks forward to visiting the property in the new year.
- Author: Amelia Tyler
- Designation: Contract monitoring officer
- Date: 14th December 2023