Care and Social Services Inspectorate Wales. Care Standards Act Inspection Report. CGMD Ltd (Trading as) Cymru Care Services.

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1 Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report CGMD Ltd (Trading as) Cymru Care Services Pontypool Type of Inspection Focused Date of inspection Thursday, 30 July 2015 Date of publication Thursday, 3 September 2015 Welsh Government Crown copyright You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.

2 Summary About the service Cymru Care Services is a family run business with an office base in Pontypool. It was originally registered with CSSIW in 2005 before changing its name in It is registered as CGMD Ltd (trading as) Cymru Care Services, to provide personal care to older people, people with physical disabilities, people with sensory loss/impairment, people with learning disabilities, people with mental health needs, people with dementia care needs and children. The registered manager is Maria Durbin. There is a nominated responsible individual to oversee the running of the agency. What type of inspection was carried out? We (CSSIW) carried out an unannounced baseline inspection of this service on 30 July This was because we had received an anonymous concern about the service relating to lack of staff training, rushed calls and issues regarding confidentiality and communication with staff. We gathered information for inclusion within this report from the following sources: telephone discussions with two service users family representatives discussions with two care workers discussion with the registered manager and other office based staff examination of a selection of service user files and records review of three staff personnel files examination of the agency s Statement Of Purpose and Service User Guide examination of the agency s staff training matrix examination of a selection of individual service user reports from the agency s electronic call tracking system. This system works at the service user s home and records the time that carers arrive and leave. What does the service do well? We did not identify any specific areas of excellence during this inspection that were above the Domiciliary Care Agencies (Wales) Regulations (2004) and National Minimum Standards for Domiciliary Care Agencies in Wales. What has improved since the last inspection? Evidence gathered during the inspection indicated that the registered manager had taken sufficient action to ensure compliance with Regulation 16 (1)(a) This is because we looked at the agency s staff training matrix which indicated staff training and refresher training, in particular, first aid training, was up to date. What needs to be done to improve the service? We informed the registered manager that the service was non-compliant with the following Domiciliary Care Agencies (Wales) Regulations (2004): Regulation 15 (1) (b) schedule 3, 5, 10 & 11 Information and documentation to be available in respect of domiciliary care workers: two written references, a physical and mental health statement relating to the worker. Regulation 14 (1)(a) the service delivery plan to be consistent with the local authority care plan.

3 We (CSSIW) have not issued non-compliance notices in respect of these matters on this occasion as the Registered Manager assured us that the necessary action will be taken immediately. This will be considered at the next CSSIW inspection. Recommendations The registered persons are advised to: Review and update the complaints policy to identify revised timescales in order to manage complaints appropriately. Ensure that full staff meetings are held at least once every three months and minutes are stored appropriately and will be available for future inspections. Page 3

4 Quality Of Leadership and Management Service users cannot be fully confident that the business is run with due care and attention to the regulations. The previous CSSIW inspection report (published 7 th February 2015) identified one area of non-compliance and the need for improvements to the service. This was in relation to a number of issues, most of which have been addressed, including staff having received first aid training/refresher training. A copy of the complaints policy was seen which had not been reviewed and updated accordingly. This review needs to be carried out as a priority, with updates identifying revised timescales in order to manage complaints appropriately. Discussion with the registered manager highlighted that full staff meetings were not being held at the frequency recommended at the previous inspection and minutes were not available. The last full staff meeting was held in January 2015 with the next one planned in August. The registered manager advised that smaller team meetings had been held with carers working with specific service users with complex care packages. Feedback from staff was that this was beneficial as the meeting was more focused towards their specific area of work; however we advised the manager that this does not negate the need for full staff meetings. Service users can feel confident that they will get reliable, good quality care. This is because management closely monitor the electronic call tracking system to ensure call times are adhered to. Discussion with the registered manager highlighted instances whereby the electronic monitoring system had flagged up that calls had been taking longer than the time allocated for a particular service user. This initiated a reassessment of the service user with additional time then being allocated. Spot checks are carried out by the management and senior staff to monitor the quality of care provision and service user plans and risk assessments are reviewed annually or if there is a change in need. Service users family representatives were spoken with and highlighted that the care provided is of high quality with no concerns raised over early/late/rushed calls. One family member was complimentary of good communication from the registered manager. We visited the carers room in the agency s office which carers use weekly. We saw it held communication updates displayed along with an anonymous feedback form, providing staff with an opportunity to raise issues or highlight suggestions for improvement in the service. Service users can be confident that the provider will respond positively to feedback and critical incidents. Evidence of this was seen in the complaints log, with clear recordings and actions taken within the appropriate timescales. Page 4

5 Quality Of Life Overall, we found that since the last CSSIW inspection, the registered manager had taken action to address the area of non-compliance we had found at the previous inspection along with addressing the majority of recommendations made. Service users can be confident that appropriate systems are in place to monitor the consistency and continuity of care delivery. This is because the provider utilises an electronic call tracking system which logs the time a carer arrives and leaves the home of a service user, along with recording which carer was in attendance. Evidence of this was seen in the office when we examined a sample of time sheets, which showed that staff were arriving and leaving within the allocated timescales. Conversations with service user representatives reinforced this and they advised that there have been no issues with calls being rushed. New and current service users can be confident that they will receive appropriate, responsive care from staff who have an up to date understanding of their individual needs and preferences. This is because a new system has been put in place whereby carers must attend the office on a specific day of the week to collect their rotas. On these days, office staff, including a senior member of staff, are available to meet with carers to go through any new care packages or change in care plan. In the event of an emergency care package, senior staff endeavour to meet with the carer at the service user s home prior to or on the first call and where this is not possible, senior staff make contact with the carer by phone to relay vital care information. This information was confirmed by two members of staff we spoke with, who advised that they are always provided with adequate information in relation to service user s care needs. They confirmed that they are adequately trained and that if they highlight any additional training needs in relation to a specific service user, the registered manager acknowledges this and takes the appropriate action. An example of this was given where some staff felt they needed a higher level of dementia training in order to work affectively with a specific service user and this was arranged for them to attend. Service users can be confident that they will be treated with dignity and respect by staff. We spoke with family members of service users receiving care from Cymru Care who were complimentary of the quality of care provided to their family member, describing it as fantastic. They confirmed that carers are familiar with and trained to use equipment in the home and that there is a good continuity of carers who arrive on time and do not rush to complete the required care tasks. One family member was complimentary of communication from management and another advised that management have been very quick to respond if there is an issue. Service users can be confident that they are supported to remain healthy because their needs are anticipated and they are enabled to have access to specialist or medical support. This is because the agency has good communication channels with health care professionals and hospital social work teams. Evidence of this was noted from discussions with service user representatives, one of whom highlighted good communication between the agency and healthcare professionals involved to ensure continuity and quality provision of care. Page 5

6 Quality Of Staffing Service users family representatives spoken with were very confident in the competence of staff and their ability to accomplish tasks efficiently, with one describing the quality of carers and care as second to none. Another, when asked about the agency, said you can t fault it. They felt informed by the agency of any changes and did not experience dissatisfaction. They felt that, overall, care is sufficient and provided when needed with carers usually arriving within the agreed time in a relaxed manner. Care workers were perceived as friendly, yet observing professional boundaries and able to adapt to changes in situations, e.g. where a service user developed particular health needs. Carers spoken with were aware of the agency s confidentiality policy and were able to demonstrate how this applies to their day to day work. Service users can be assured that the agency understands the value of continuity of care. Service user representatives told us that they had good continuity of carers and had good relationships with them. Service users can be confident that staff are appropriately trained to meet their individual care needs, including the use of equipment. Evidence of staff training was seen in staff files, on the agency s staff training matrix and from discussions with carers they told us that they received a quality induction period and appropriate training, including refresher training and specific training if a need is identified. Safe care is promoted by the agency having processes for undertaking and recording pre-employment checks, however scrutiny of staff files suggested that management attention is need to ensure that all checks are consistently carried out. We saw an instance where one written reference was missing where a minimum of two is required. Guidance for the delivery of safe care suggests staff receive adequate supervision. Although the agency s intended practice is to provide this at least once every 3 months in line with national minimum standards, the most recent record of supervision seen in one of the staff files examined was dated January Contradictory to this, carers we spoke with talked of regular supervision and opportunities for informal discussions with senior carers and management. The service should address this as a matter of priority. Page 6

7 Quality Of The Environment This theme is not applicable to domiciliary care services. Page 7

8 How we inspect and report on services We conduct two types of inspection; baseline and focused. 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. Focused 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. Page 8

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