Providing professional care in the home environment.
Pride in care (North Wales)
2013- April 2014
To monitor all
aspects of the service being provided including the day to day running of the
office, team leader management, call time monitoring and the level of care
being provided. To be as honest and open as possible to ensure that people
using our service and their loved ones know not only our strong points but our
weaker points and what we intend to do to address them.
To identify aspects of the service that can be improved,
systems that work well.
Care planning (including):
Initial reviews, care plans, time allocation, travel time
allowances and service user preferences.
Records of care provided.
Hazard and risk management.
Provision of care.
The person completing this Quality assurance report must
utilise all monitoring reports and gather information to be able to build a
picture on the quality of the service being provided. Evidence is to be sort to
ensure the following is taking place this is then to be compiled to allow the
report to be completed.
Information available prior to the service starting, this is
to include the information gathered in the initial review process, time scale
given from referral to start date.
Level of information gathered during the initial review and
whether this enabled the administration staff to complete a detailed care plan
prior to the care package beginning.
Details held in the care plan ensuring they are personalised
and outcome focused, outcomes are agreed for carers to achieve and for the
service user to achieve. Instructions are clear and precise enough that the
person reading the care plan understands exactly what tasks are required and
how to carry them out.
Risk assessments and care plans identify hazards and relate
to each other.
Service user day books are relevant to the care being
provided and are used as a control measure to minimise risk and are there for
included in risk assessments.
Evidence of joint working in the best interest of service
users and any referrals.
Service user feedback with regards to their service provision.
Evidence how service users are centre their care provision
and how they are involved in the planning and continued development of the
Evidence that staff receive the appropriate training that their
records are up to date and in line with current legislation including regular supervision,
annual appraisals spot checks and induction/probation training periods.
Team leaders are managed and have sufficient time to carry
out their duties and the quality they are carried out in. Managers carry out
their duties and the documentation is as required.
assurance report April 2013 -April 2014
gathered with regards to acceptance of a service user:
Last report stated:
Prior to a care package
starting we receive a care plan from the social worker that outlines the duties
we are required to carry out, although
this document is detailed it does not go into the required depth of how the
service is to be provided.
Prior to starting the package of care we carry
out an initial assessment. During the
initial assessment review the information gathered is of a good standard and
detailed enough to allow the administration staff to complete a detailed care
plan. The initial review details likes, dislikes, preferences and is person
centred allowing the service user to give details on how they want their care
package run. The review also gathers personal history of the service user which
assists in conversation making and seeing the person as an individual. The
review does show evidence that the service user has been involved by requiring
a signature. It is also split in to two parts one being a routine that the service user wants to rebuild/ set up or
maintain and the other part being what is required by who and how.
Once complete the form is
taken back to the office and used to construct a careplan this is then returned
back to the service user for approval and signing. Two copies are taken one
stays with the service user and one is returned to the office for the office
service users file.
There has only been a
slight development in this, now the two review books have been altered to
contain slightly more information, they have been amalgamated in to one single
book. During our 2014 CSSIW inspection we was informed that even though there
were details on how to contact the office in and out of working hours on the
front of the care pack file, contact details in the statement of purpose and
details on how to make a complaint within the file some service users did not
know how to contact the office. We have therefore added a section to the review
that requires the team leader to discuss and show the service users how to do
What works well:
The reviewing form is very detailed and has
lots of prompts for the team leader to follow when carrying out the review.
There is also room on the backs of the forms for further information. There is
clear evidence that the service users and relatives input to the care plan and
the plan of care is based around them.
Recommendations for improvement:
Further improvements need
to be made with regards to introducing the main carers for days and nights
prior to the package starting. Some team
leaders need to incorporate more information and ensure the signature forms are
All parts of the review
form/book needs to be completed.
Reasons they cannot be implemented:
Sometimes it is not
possible to introduce the planned carer as the review maybe carried out while
the planned carer is carrying out a service to other service users and may not
The quality of service user’s
files is of a high standard they are easy to follow and all relevant
information is easy to find due to an index in the front. There is an
electronic file as well as a hard copy. The electronic copy has a list of all
concerns over the whole time of the service being provided and list all phone
call and a complete list of every call and the carer who called.
There are details on the
service user and their NOK, DR and District Nurses, their living circumstances
and mobility amongst other details.
Service user files have
the most recent care plan as well as the previous care plan, this evidences
that reviews are taking place and care planning changes are implemented. There
are copies of social services care plans and agreements such as IPO's or
purchase agreements. There are copies of reviews and planned review dates in
the hard copy as well as the electronic copy. Risk assessments are present and are
We are now rolling out our
new format care plans, day books and risk assessments, the aim is that the
careplan give much more detail on the tasks to be completed and the day book
acts as a prompt and a risk management tool to prevent mistakes in key areas of
support, it also assists in the reviewing of the service being provided and can
be used to monitor service users and carers. We believe this is a large step
forward in the monitoring, reviewing and management of service being provided.
The files are easy to
access and to follow, the index is accurate and also the cssiw check list in
the front assists the person completing the file. The file also has a section
to state who completed it and who checked it. The monthly reviews of care work
well to identify changes in care. Client concern sheets also work well in
keeping a record of carers concerns of service users welfare and carers have
access to the outcome form so that they know their concern has been addressed
and action is being taken.
During March 2014 I carried out an inspection on every
service user file and found that firstly several care plans appeared out of
date, further investigation found that the reviews had been carried out and
where there was no change the care plan remained the same. I have made the
administration staff aware that where there is no change to the care plans then
this needs to be recorded along with the date on the office copy of the care
plan, to include the date of the review and outcome on staff plan and archive
all old information prior to 2014.
From April 2013- February
2014 the care plans were detailed since February I have started to introduce
new care plans with even more detail, I have also redeveloped the risk management
so that risks are identified and the control measure ensures the correct
information is recorded in to care plans. The new care plans are also reflected
in the new days books. We produce two copies of care plans one that we keep
with the service user and one that we keep in the office these care plans are
kept in arch leaver files and include a full care info pack. The copy at the
service users home contains one care plan and this is always the most recent.
The copy at the office has two care plans and includes the current care plan
and the previous one this file is used only for office staff or inspectorates
of CSSIW (we maybe removing this due to the confusion this has caused with
The instructions part is
very detailed and allows the reader to understand exactly what is required how
to achieve the outcome and where everything required is kept. The care plan
also identifies the key workers and this can be checked via the EMS. The care
plans are split up in to individual care plans, such as morning, tea, social
support ETC so this makes easy reference to the person reading, each call has
its own care plan. All care plans are signed and dated by the care manager and
What works well:
The individual care plans
make easy reading and save time looking for instructions. The details are of a
high standard and are easy to follow. The care plans are outcome focused and
person centred. Over the past few months the care plan details have
incorporated the risks associated with the service and instructed to refer to
the risk assessment, this is starting to filter through all the care plans.
Where service users needs
have changed and we have needed to update care plans we have linked with social
workers in the local authority to arrange reviews and have their service
delivery plan updated so that ours mirrors theirs and we are all working with
the same information. We feel that the
joint working with the brokerage team, social services, district nurses and
Occupational therapists works well and helps us to improve our service
During the 2014 Inspection
there was only one recommendation made with regards to care plans in the office
and that was these are audited more thoroughly as one of the office
administrators had placed the new 2014 care plan in the same section as the
previous 2013 care plan the inspectorate stated this was a risk as it may cause
confusion to carers if they managed to illegally take a client file from the
office. All files are audited on a regular basis and the inspectorate was
informed that the careplan was placed in to the file as it was being carried to
her as it had just been updated.
We are considering
removing the previous care plan as it is only there for inspectors to see the
changes in service.
Through my inspection I
have recommended that the Key workers section of the care plan be kept updated,
this is to be done in pencil to allow for changes.
I Also made recommendations with regards to care plans
in the previous section that stated " I have made the administration staff
aware that where there is no change to the care plans then this needs to be
recorded along with the date on the office copy of the care plan, to include
the date of the review and outcome on staff plan and archive all old
information prior to 2014"
Prior to February
2014 we used person centred day books
they were of a good standard and required carers to answer pre set questions
based on the service users care plan and identified needs and risks. As of 2014
I have taken over in more of a management position, I have now rolled out the
new 2014 day books that are much more care plan management structured Since
Taking over as the Manager in March I have rolled out these new day books to
approximately one third of our service users and aim to have these with every
service user by the end of July 2014 These books tie in with recommendations
and instructions from other stake holders in the service users provision of
care. The day books include information for District nurses in the format of
output charts for catheter management, body charts for monitoring areas of
concern, diet record charts for
diabetics and so on.
These give good risk
management ensuring that service user’s needs are met.
The new format 2014 is
much better, not as detailed as a care plan but does ensure all the needs are
met, that risks are managed and good clear recording to ensure service users are
getting the required service.
What works well:
risk management factor.
of meals and drinks.
of personal hygiene.
that needs are met and independence levels are monitored.
service users to go on to the 2014 format.
Administration staff employed to meet the requirements of our needs.
Updating the printer to have a finisher will increase
To assess the provision of
care I have gone through service user day books, team leader spot check books,
quality assurance sampling questionnaires to service users, time monitoring on
the EMS, manager monthly check reports and quarterly audits. I have checked the
complaints and compliments register and the concerns and outcomes register and
my finding are as follows:
The service user day books
indicate carers are carrying out the care as required and documenting this, the
day books and care plans are detailed enough for the carers to follow. The team
leader spot check books indicate there is a good level of care being provided
with good guidance. The record book evidenced that carers presentation was
clean and tidy and those whose uniforms needed replacing were addressed. There
is solid evidence that company supplied gloves and aprons are worn when
required. Also that service users are communicated with clearly and
professionally, Manual handling equipment is used competently and confidently, service
users are given choice and that their dignity is being protected. There is
evidence that extra duties have been taken on when required and information
passed on to family to ensure problems are rectified this shows carers are
using their initiative and sharing information. There is clear evidence that
carers are promoting independence. Spot check forms also show carers are polite
and show patients not rushing service users. Where care is refused this is
recorded and passed on to the relevant persons. Spot check books also show poor
points and address these with the carer there and then preventing the issue
from arising in the future and sharing experience with the carer. Overall the
spot check books evidence that there is a high standard of care being provided
and where there are issues they are dealt with there and then by the team
leader ensuring the standard does not slip.
quality assurance sampling questionnaires:
Of the 30 questionnaires
returned throughout the year there is clear evidence that overall the service
is providing a high standard of care throughout the whole range. There is room
for improvement is several areas.
Service users explained there
were issues with some communication with regards to changes of carers and that
their schedules only ran from Monday to Friday and rarely cover the weekend.
It is also evidenced that
the majority of the service users are more than happy with the service with feedback
"They always let me
know who is calling"
"All carers are very
good and friendly, they look after me well".
"People vary, some
are excellent, and some are improving".
"Very polite, very
good, carers are very helpful and were good to my husband before he died".
"They are sensitive
to me when I have a bath"
"The care package was
not very good, but now I receive excellent care with all the girls being very
One service users that has
been with us for more than three years did rate the service as below average
stating that they only want one older carer, they don't know who is going to be
calling, young carers ruin the carpets with their shoes and their call time was
15 minutes earlier than what they want.
When checking the EMS
records it is clear carers spend the correct allocated time, where they have
run over the allocated time a Change of circumstances has been recorded and
sent to social services, if this has been regular then reviews with social
services have been requested so changing needs of service users are identified.
I am introducing Manager
monthly check reports to be are carried out on a monthly basis and require the branch
manager to check that our in house care plan is relevant to social services
care plan, that the day book is relevant, monthly records are relevant to the
care plan, to identify if any outcomes have not been achieved, to assess the
continuity of care being provided if this can be improved, any concerns
reported, assessing the risk assessments. To check for nok details, missing
entries into day books, checks on allocated time via teleconfirmation, feedback
from main carer, feedback from the service user and an action plan for any
There was an issue with
recording of medication records, carers had been writing "A" for
administered and "R" for refused. however there was no key for this
and only the employees of Pride in care knew what this meant which caused confusion
with outside agencies checking the record. Further information can be found
within this report with regard to improvements made in this area.
What we do well: (care provision)
Communication with service
users and family is a strong point and has received a lot of praise and
continues to be a key point in the provision of the service. We also carryout
duties in a professional manner, protecting dignity and offering choice, the
service is flexible and meets the needs of service users. Service users are not
rushed and feel that carers are carrying out their duties to a high standard. Our spot checks monitor the level of care
being provided and team leaders give supervision, advice and support during
checks to ensure our carers provide a high standard of care during the last 12
months we spent in excess of £2500.00 on these checks to ensure that we provide
a high standard of care. Our rates of pay and travel expenses are very
competitive. We have kept our over heads as low as possible so that we are able
to achieve high rates of pay and travel expenses along with well structured
teams and team leaders.
Communication with regards
to change of service, late calls and schedules has much room for improvement
and has shown to be a weaker area of the service.
Schedules must include the
weekend carers allocated and if there are changes then these need to communicate
with the service user.
it is recommended that pay
scales be reviewed to try and increase recruitment and retention and this is to
be reviewed on a 200 hour increase i.e. wages to carers increase to be
implemented when we provide 600 hours of care, 800 hours of care, 1000 hours of
care and so on.
We do intend on moving
office locations once our budget allows for this we expect this to be once we
provide in excess of 1000 hours.
With regards to time
monitoring this is mainly carried out by the team leaders, they receive an
email from the EMS where a carer is more
than 15 minutes late, they then find out the reason why. Where this is a
regular occurrence the team leaders tend not to chase this up. The percentage
of confirmed calls is of an acceptable level however there is room for some
administration on the EMS. Deviations reasons should be input to evidence calls
have been checked and to state why the call time is wrong or the carer is
late. Where carers are carrying out call
time changes to suit themselves then disciplinary action should be taken. It
was evident that some call times were as early 40 minutes and as late as 30 minutes
prior/after the original call time and there is no reason stated for this. This
is a rare occurrence and would therefore be easy to record the reason why in
the deviation tab on the database.
Managers to be made aware
of regular late calls and changes made on the system to amend the time (tbc
with service users) Deviation reasons to be recorded where calls are more than
15 minutes past the start or finish time.
There is clear evidence of
joint working and this has been a strong point, good working relations have
been build with all stakeholders and there is clear evidence of reviews being
called prior to the 12 monthly reviews due to service user’s change in
circumstances and changes to social services care plans. As a result of joint working,
recording and reporting we have assisted service users to have the introduction
of manual handling equipment, adaption's to service users homes and clear
records of communication with district nurses, family members and NOK's. It is
evident that pride in care continues to build relationships with outside
stakeholders in the best interest of the service user ensuring an ongoing
support network for service users.
It would be of a slight benefit
to see outcomes from joint working recorded in care plans under the background
in general, this would help in noticing changes in the service whether this be
independence or dependence.
6 staff files were checked
in the process of this QA monitoring and overall the information in them is
detailed and kept in good order, there is a clear index that lists what
information is kept in the file and what page this info is kept on There are 15
sections which go above of that required in the National minimum standards. In
each file there is a information on references these were cross referenced with
the job application form and the people listed to obtain a reference from in
all 6 these were accurate. Where the applicant had worked in care previous to
this was documented and a reference was in place from all previous care sector
positions. Where they had not this was recorded clearly. The newer Job
application forms had been reviewed and updated to include a section to
identify and record any gaps in employment.
There was a concerning
point identified, staff supervisions were not being kept up to date. several
carers had not their supervision meetings, they had been spot checked and there
were no issues with the service they provided but they had not been brought in
to the office for a one to one supervision meeting, this is in breach of the
regulations and action must be taken to rectify this.
There is also a list of
the spot checks and details of what took place during the check that had taken
place. Each file has a signed contract and within the contract is a job
description and some points from key policies. There is also a list of courses
completed and planned in the carer file, a list when they are booked and when they
expire. Completed courses are evidenced by a section for course certificates.
For 2014 I have introduced
a two weekly supervision book for new starters this book will be used for
support and guidance throughout the probation period and used up until the
That supervision meeting
formats need to change and include much more evidence and planned support and
guidance of areas of concern.
Records of staff files are
updated on staff plan so that the electronic database is accurate for the
purpose of monitoring and auditing at the head office.
A recent inspection in
2014 identified that 2 files checked had the gaps in employment checked and
investigated but the manager at the time only recorded that the gap was
investigated and not the reason, this is a breach of the regulations and a
noncompliance was issued. The 2 files were amended the same day and a 100%
check was carried out on all the staff files.
We recently attempted to
gain feedback from 10 staff members but only managed to receive feedback from 4
members of staff, this was done over the phone by the manager of the south
Wales branch to ensure that there was no pressure or biased choosing of staff. On
average staff stated they felt they were treated with respect both on the phone and face to face the
average vote was "very good"
With regards to support,
which included training, spot checks, and helpfulness of senior staff the
average was between good and very good. one member of staff stated she felt
this was average down to not being spot checked enough recently.
Staff felt that the
recruitment and selection was between good and very good and felt new carers do
have enough shadowing. All 4 staff
stated that their morale was either good or very good with regards to their
role. All staff stated that they rated the care they provide as either very
good or excellent. One member did stated she would like more supervision. The
staff stated they felt all the team leaders were very good with one member
saying they were good, there was no negative feedback. The staff were asked how
did they feel the office staff represented the agency all staff stated either
very good or good, one member stated she didn't want to answer. When asked how did they rate their
record keeping staff stated excellent, very good, good and average.
It is my recommendation that staff receive more spot
checks and these are evened out so that every carer gets checked and support on
a regular basis this is to include assistance with record keeping. Over the
last 12 months more than 330 spot checks were carried out on staff. Staff
questionnaires to be carried out during supervision meetings.
On review of the training matrix it is clear that
training is being provided to all the staff at pride in care, the training is
provided in a room within the same building as the office is located. The room
is fitted with manual handling equipment and can be rearranged to reflect a
service user’s bedroom so that trainees receive training in an environment they
will be working in using equipment they will be using.
This includes the all
Wales passport manual handling.
Emergency first aid &
POVA & Dementia and
Health and safety &
Safe food handling (not food hygiene as the majority of
The food hygiene course
does not apply to the role carers carryout)
Record keeping and company forms.
New for 2014 includes:
Pressure ulcer prevention
Mental capacity training
& Deprivation of Liberties
What we have
improved over the last 12 months:
The initial review forms
have been modified and have become more and more person centred and outcome
focused, the newest format is now in a book format and requires the team leader
to introduce the main carer prior to the service commencing.
We have redeveloped our
care plans and daily record books to be more individualised and person centred. We have redeveloped our risk
management to include better recordkeeping and safer service users care management.
In March 2014 the
MAR Charts had been completely redeveloped and distributed to every service
user. Training was updated to include dementia training.
A manager was employed in
May 2013 and applied to register with CSSIW as the registered manager, she only
stayed with the company for 9 months however during the 9 months she was not informed
by CSSIW of the process of her registration and as a result of CSSIW not
registering the manager we was without a registered manager. The staff files
were improved which included new application forms, a new staff member to take
the role of ensuring these met the requirements of current legislation. Last
year our staff files were missing employment references there were gaps in
employment that had not been identified one had no employment history there was
no evidence on file of supervision meetings taking place.
This year there was an
improvement of the all references were in place, there were no gaps in
employment that had not been investigated however the reasons for the gap had
not been recorded. Two files did not have the most recent supervision meeting
reports in their file however there was evidence that these had taken place on the
electronic system we have as a backup.
The training matrix,
record keeping with regards to courses and course material has improved. We
have also fitted a lockable post box, there was a potential for mail theft and
this was identified by CSSIW.
What we need
to improve on:
Overall the service being
provided is of a high standard however communicating with service users over
changes of the service was the most noticeable downfall of the agency. This can be improved by ensuring service
users are informed of any changes and recording this in the service user
journal and or via the deviation tab on staff plan roster so that this is able
to be audited to see who made the change and why they did not contact the
The local Manager will be
required to fulfil the recommendations within this report to ensure the service
Supervision meetings need
to be checked to ensure these are booked on to the roster system so these do
not get missed.
Management of the office
with regards to reviews of carers and service users to ensure these are carried
out and recorded appropriately.
Over the next 12 months we will be looking to
improve Medication recording ensuring all service users that we administer or
prompt medication to have the correct medication recoding sheets in place.
We also need to improve on gathering feedback
from other stakeholders we work with such as District nurses, OT's, Pova
coordinators etc. At present the QA sampling we send out very rarely gets
returned so over the next 12 months we hope to change the way in which we
gather information from other stakeholders.
The training evaluation forms need to be
completed on each course delivered ensuring there is a complete auditable
feedback trail to be followed.
Staff retention is always an area of concern, it
has been publically documented that the low funding towards providers is the
main reason for low wages. I feel that until this issue of poor funding is
addressed there will always be a high turnover of staff.
Spot check records need more information and the
team leaders need to follow the instructions in the spot check books.
The new 2014 MAR Charts need to be monitored and
audited to ensure staff are completing them.
Staff meetings need to occur more regular with
Supervision meetings need to be more structured
and the meetings must be input in to the system to ensure that carers do not go
more than 3 months without a supervision meeting.
This report was completed
by the registered provider of pride in care and covers the period of April 2013
through to April 2014 this report is based on the services being provided
within the county of Wrexham where we provide a service to approximately 40
service users providing 600 hours
On behalf of myself and
the Local branch manager (Rebekah Swinnerton) I would like to thank all the
carers, team leaders and office staff for the hard work, understanding and
professionalism in a very demanding and ever changing role.
Thank you to all our
service users for your feedback and honesty it does go a long way to improving
the service we provide.