Care and Social Services Inspectorate Wales Care Standards Act 2000
Inspection Report Absolute Care (Wales) Limited 162 Donald Street Roath Cardiff CF24 4TP
Type of Inspection – Focussed Date(s) of inspection – 21st and 31st January 2014 Date of publication – 2 April 2014
You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers Please contact CSSIW National Office for further information Tel: 0300 062 8800 Email: cssiw@wales.gsi.gov.uk www.cssiw.org.uk
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Summary About the service Absolute Care is a domiciliary care service that provides personal care to service users in their own homes. Established in 2008 the provider undertakes work for both local authority referred and private clients. What type of inspection was carried out? This was an unannounced, routine, focussed inspection and considered the quality of life of service users and their experience of using the service. Information for this report was gathered from the self-assessment of service documentation, an inspection of four care files, inspection of staff supervision and training records, a discussion with the registered provider and manager, a discussion with a staff member, discussion with service user family representatives and inspection of other sample documentation. What does the service do well? The care plans are person centred and personalised with individual needs and preferences known and catered for. In order to improve service delivery, understanding of service user need and communication, the service has developed the management structure to include 3 team leaders who are each responsible for a team of carers and an allocated number of service users. Service user family feedback evidences well prepared staff who understand the need of the individuals they care for. What has improved since the last inspection? The registered manager has registered with the Care Council for Wales and is compliant with the Domiciliary Care Agencies (Wales) (Amendment) Regulations 2013. What needs to be done to improve the service? The quality assurance process should include feedback from professional stakeholders (e.g. health, case managers).
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Quality of life Overall, the service users have a good quality of life, where their individual needs and preferences are known and catered for and where staff have a robust and clear understanding of their need because methods of communication and management structure has been developed. People using the service have a voice and are encouraged to speak up and are listened to and they feel they have choice and influence in their care. Care plans inspected reflect individual preferences and need and are based on the original assessment. The plans were reviewed regularly, in the four care files we (CSSIW) inspected, and changes requested by service users are acknowledged, an assessment is completed and plans are individualised according to needs, wishes and preferences. The care plans viewed were thorough and recognised family input, if they are involved. A service user’s family member said that ‘there is great communication with the office and they always tell us if things have changed’. Another service user’s family member spoken with said staff were familiar with her father and ‘know his needs. If there are any problems - they tell us’. People experience well-being and feel their individual needs are recognised and catered for. The care files evidence that the delivery of the assessed needs is based upon an understanding of the service user and their abilities and capabilities. Service user families spoken with, informed us of the lengths that the service go to ensuring that the well-being of their relative is paramount to the service. We were informed that care files include photographs of how a chair needs to be placed at the table for meal times (if this is applicable). Another service user family member had read the daily records which, she feels; ensure that any issues are communicated to the team leader and subsequently to the family. One family member felt that the service ‘goes over and above what is required’. She felt it important that we reflect, in this inspection report, how a staff member persevered to walk in snow last year to ensure that her Dad ‘had his daily shower’. People using the service are helped to look after themselves, trust them to ensure they remain as healthy as possible and have access to medical support if required, and people are helped to maintain nutrition and hydration. The care plans inspected have detail of the individual conditions of service users and they reflect the emphasis on ensuring the physical well-being of service users is maintained. The care plans indicated when a service user should be encouraged to help themselves as much as possible. A staff member spoken with said that, if she has any concerns over the health of an individual she cares for, she expresses this concern to her team leader. Care files indicate relevant risk assessments and reviews are undertaken to ensure that 4
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the service reflects the ‘updated’ needs of the individuals. Families informed us that they were invited and involved in reviews and we found evidence that the service was working collaboratively with the social work department, health professionals and their families. Service user families spoken with said that ‘they take great care of my Dad’ and ‘they are brilliant. We are really pleased and my father really enjoys the company when they are there’. Another added that the staff are kind and caring. People using the service develop relationships and feel recognised and valued by others. The care files indicate that the person centred planning ensures that the individuality of service users is maintained. In addition, the area team structure enables the staff to become familiar with a number of service users and vice versa. Staff commented on their role within this structure and said that it enabled them to communicate more effectively and build relationships with a group of service users. During this inspection, we spoke with the manager, team leaders, staff and service user family representatives and they all commented on the service user being at the forefront of service delivery. In the annual quality of care review there were comments such as ‘staff are always friendly and helpful’, and ‘… very pleased with the service and (name of carer) is great’.
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Quality of staffing People can be confident that they cared for by competent staff. Staff are trained to ensure that service users place them at the heart of the service they provide. A view of the training and supervision records indicate that person centred planning is an integral part of the relationship. A staff member spoken with said that her induction included ‘shadowing’ and experienced staff member, who placed an emphasis on building good relationships with the service users.
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Quality of leadership and management People feel they get good quality care as there is a clear management structure. The service has developed their management structure so that three team leaders are responsible for a given number of staff and, proportionally, an allocated number of service users. The structure, we (CSSIW) were informed, allows staff to communicate more effectively on any request for change to current care plans. These requests can come from service users, their families or the local authority if they initially referred to the service.
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Quality of 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.
Focussed 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 focussed 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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