Ty Gwernen

Contract Monitoring Report

• Name/Address of Provider: Ty Gwernen, Sunny View, Argoed, Blackwood, Caerphilly, NP12 0AL
• Date of Visit: Tuesday 5th December 2023
• Visiting Officer(s): Amelia Tyler:  Contract Monitoring Officer, CCBC
• Present: Teresa Matthews:  Deputy Manager, Enable care services

Background

Ty Gwernen is a large, detached home situated just outside of Blackwood town.  The home is owned by Enable Care Services and was registered with CIW in 2007 and can provide care for a maximum of seven adults (aged 18 and older) with mental health needs. 

At the time of the visit the home was fully occupied with six people being supported by Caerphilly CBC and one from a neighbouring authority.  It was noted by the contract monitoring officer that the files detailed who the placing authority is.

The previous monitoring visit was carried out on the 20th September 2022 and at this time there was one corrective and eight developmental actions highlighted. The purpose of this visit was to determine whether these actions had been completed and work through the monitoring tool used by the commissioning team.  The findings are outlined in the section below.  It is acknowledged that since the previous visit, there had been concerns identified with Care Inspectorate Wales (CIW) and Priority Action Notices had been issued.  A new responsible individual had been appointed who was also the registered manager for two of the three properties owned and managed by Enable Care Services.  It was noted that there were plans in place for the deputy manager to act as the registered manager whilst undertaking the necessary qualifications.  The day-to-day running of the home was being carried out by the deputy manager at the time of the visit.  The responsible individual agreed to let the contract monitoring officer know of any progress in relation to the structure of the service.

Dependant on the findings within the report, corrective and/or developmental actions will be given to the provider to complete.  Corrective actions are those which must be completed (as governed by legislation etc.) and developmental actions are those which are deemed to be good practice.

Previous Recommendations

Personal plans to be signed by the individual receiving care and/or representative.  RISCA version 2 (April 2019) regulation 15 (6) Met.  The files of two residents were seen during the visit and it was noted that both personal plans had been signed.  One file recorded that the lady was asked to contribute towards the document, and it appeared she was satisfied with the contents.  The plan also contained the initials of the support staff that had been involved and signed on the 23rd November 2023.  It wasn’t clear on the second plan who had signed the personal plan; the contract monitoring officer thought it was the next of kin, but this wasn’t recorded.  It is recommended as good practice that the name of the person is clearly recorded, and if this is done on their behalf, then the relationship is also noted.

Consideration was to be given to the managers swapping homes to deliver training. Met.  At the time of the visit there was only one member of staff that was overseeing the three homes.  Due to the increased responsibility, external training is to be sourced and the quality of this training is to be assessed.  It was noted that training has been accessed through the local authorities and the contract monitoring officer has contacted the workforce development team to have Ty Gwernen added to the distribution list for available courses.

It is good practice to ensure there are a minimum of two interviewers present during all interviews. Partially met.  It was noted on one of the interview records that the candidate had been interviewed by two senior members of staff, but the other had only been interviewed by one person.  It is recommended that two people conduct interviews should the outcomes be challenged and to minimise and conflict of interest.  The responsible individual explained that where possible, this is now being done. 

All interviewers to sign and date the interview record and highlight their designation within the company. Not met.  One of the interview records had been signed by a member of staff conducting the interview, but there was no name of interviewer, interviewee, or date.  To ensure transparency and accountability, all documents are to be completed in full.

Once reviewed, policies and procedures record the designation of the reviewer and date of next review. Met.  All policies and procedures seen were clearly dated and stated that they were to be reviewed every twelve months.  The responsible individual reviews all policies and procedures and ensures consistency by making the same version available in each home. 

It is recommended that the author of the quality assurance reports sign the document and their designation. Met.  A copy of the most recent report was provided which was dated 23rd November 2023 and this had been completed by the acting responsible individual.  It was noted that the report states monthly audits of the compliments and complaints book are to be carried out by the responsible individual and this is to be changed to the deputy manager.

The manager to consider nominating staff for reporting and recording training that haven’t attended for over 6 years. Met.  It was confirmed with the responsible individual that the recording and reporting training is a one off course.

Additional information to be incorporated into activities record to evidence the promotion of independence. Partially met.  It was acknowledged that there are individuals living at the home that are unwilling or unable to do some activities of daily living such as putting their washing in the washing machine, strip their beds or help with meal preparation, however, the activities records should be strengths based and focussed on what they can do.  It was acknowledged that a lot of improvement had been made around this, however, if they choose not to go out or participate in the daily running of the home, the activities record must state how they are supported to decide what they want to do instead. 

Agreements to be written up about how relatives, friends etc would be informed of any incidents, this should be signed and dated by the client, if possible and, or representative. Met.  At the time of the visit there were templates in place that had been developed to document this, but these were not completed.  Following the visit, the responsible individual stated that these had now been completed and signed by the appropriate representative with the agreement of the individual (where possible).

Findings from Visit

Desk top audit

The training matrix provided demonstrated mandatory training such as safeguarding, infection control, fire awareness, medication and first aid etc. had been completed.  There was also evidence of non-mandatory training including pressure ulcer prevention, epilepsy, dignity, and the mental capacity act.

It is recommended that future training dates are not recorded until completed and that the dates are clear i.e. it was noted that one course was recorded as 09/10/01/24.  If this is a two day course this should be noted as 09/01/24 and 10/01/24 after completion.  Following the visit the responsible individual has updated the matrix to show what courses have been booked on-line and the dates will be recorded once this has been completed

It was noted that concerns and safeguarding issues had been raised since the last visit and these had been followed up with the commissioning team, safeguarding team and CIW and increased monitoring had been carried out in the interim to support the staff and people living at Ty Gwernen.

There was a service user guide observed on both client files; the guide had not been dated, so it wasn’t possible to confirm if this was the most current version and there was no detail around how to make a complaint or signposting to the complaints policy.    This was completed following the visit and the contract monitoring officer saw a copy of the guide that had been signed and dated by the resident.  It was pleasing to note that the individual who can sign had signed and dated the user friendly version of the policy on the 18th September 2023. 

Both the responsible individual and deputy manager were both registered with social care Wales.

Resident records are held in the manager’s office which is located directly off the utility area and the contract monitoring officer was told that although this is open during the day when the deputy manager is present, this is locked at night when not being used.

Responsible individual

It was explained that the quarterly regulation 73 visits were being carried out by the new responsible individual as required.  The contract monitoring officer noted that the most recent one had been dated 5th October 2023.

Following the visit, the contract monitoring officer was provided with a copy of the statement of purpose that was updated 12th December 2023.  The document clearly outlined how to make a complaint, who to, and how this would be followed up.

It was explained that if the responsible individual and registered manager were unexpectedly absent for a period, that a regulation 60 notification would be submitted to CIW and shared with the commissioning team of the placing authorities within the first 7 days of the absence.  It was highlighted that this had been incorporated into the statement of purpose.

All mandatory policies and procedures were present at the property including safeguarding, staff development, client finances, infection control, and medication etc. except for staff discipline.  All of these had been reviewed annually apart from the use of control and restraint, complaints and whistleblowing which did not appear to have been reviewed since 2019 and safeguarding.  The responsible individual confirmed this had been completed following the visit and the whistleblowing policy was observed to have been completed on the 23rd December 2023.  The staff disciplinary procedure was seen following the visit and this had been reviewed and amended in December 2023.  It also highlighted that the next review was due on or before the 5th December 2024.

File and documentation audit

The contract monitoring officer viewed two client files as part of the visit, and it was noted that there was information provided from Caerphilly and there were care and treatment plans in place.  There was an initial document on both files that had been completed by the previous manager but had not been signed or dated.  It was confirmed that this would be completed in full for any future residents.

Personal plans were person centred and contained details around preferences and routines.  Although one resident was unable to sign the document herself, it had recorded that she had been asked to contribute to the document and she appeared satisfied with the contents and had been initialled by the staff member that had had input and signed in November 2023.  As mentioned earlier, the second plan had been signed but it wasn’t clear who by.  The manager must ensure that if there are no appropriate representatives to sign on their behalf, this is to be noted on the plan.

Reviews were evidenced as having been carried out at least every three months and risk assessments around topics such as communication, community access, personal hygiene etc. had also been appropriately reviewed and updated where needed.

The daily recordings were viewed, and it was acknowledged that the detail had improved, and the terminology being used by members of staff.  Discussion was held with the deputy manager around increasing activities both within and outside of the home and it was noted that more activities were being offered and one resident had been supported to watch a local rugby match and other residents had been to see a musical show ‘disco inferno’ in Blackwood.   The contract monitoring officer had put the deputy manager in contact with the arts development officer in Caerphilly who had arranged to carry out some work with the residents at Ty Gwernen.  It was acknowledged that photo albums were going to be developed with residents to capture the activities and events they enjoy and to promote reminiscence work.  The responsible individual also highlighted that they were introducing a musical bingo game as this is a common theme that is enjoyed by all residents.

There was evidence that the home was making appropriate referrals to outside agencies such as opticians’ appointment being due in July, an advocate meeting that had been held on the 23rd September 2023, a social worker review on the 23rd September 2023, in addition to dental appointments, flu vaccines, and podiatry.  It was noted on one file that the resident was still waiting on the Deprivation of Liberty Safeguarding (DoLS) assessment.

Although it was explained that the residents can often change their minds on a regular basis, the contract monitoring officer acknowledged that there were agreed goals and outcomes noted, such as painting their bedroom, learning some Welsh phrases, and going on trips to the seaside.  Although some expectations of the residents may not be viable (such as wanting to walk again or live independently), it is recommended these still be documented as a goal as it demonstrates their involvement in the support provided and verifies that the staff have done everything to help them achieve these goals, even if the ambition can’t be met in full, what steps can be taken to meet these half way.

It was stated that although some residents have life histories in place (such as the ‘this is me’ booklet) this isn’t in place for everyone.  The contract monitoring officer was told that these were being worked on for those that don’t have them.  Following the visit, the responsible individual explained these had been completed in September 2023 and these were seen during a follow-up visit.  This was also discussed with the arts development officer and was felt that this is something that could be further developed into the activities and photo albums.  Where there in little input from families and minimal information about their past, staff can only record what is known and what they have learnt about them since they have been at Ty Gwernen.

Through discussions held with staff during the visit and the ongoing informal meetings, it was observed that staff do have a good knowledge of the residents and what they like doing etc. such as one resident loving a curry and two residents who don’t like any pasta or spaghetti.  One resident will often have nocturnal traits and be quite restless at night but has a more restful night when wearing pyjamas, and how another person is often reluctant to go out in the community and engage in any events or activities but will go the local barber and enjoys going to the betting shop.  The contract monitoring officer was told that another gentleman doesn’t mind what he’s doing, but benefits from being busy and having a sense of purpose.

Staffing and training

The contract monitoring officer was told that the staffing levels were three on days and two waking night staff.  It was acknowledged that where possible, any staff absences are covered by the staff team, but where this isn’t possible, they will use agency staff.  The contract monitoring officer confirmed with the agency that all necessary information is shared with the provider prior to them starting a shift.

Training is sourced through the local authority and by the responsible individual; on the day of the visit there was fire awareness and COSHH (Control of Substances Hazardous to Health) being delivered by the responsible individual.  Due to the change of role and the increased responsibilities of the responsible individual, they have reduced capacity to be able to deliver training and this should be sourced externally to ensure staff are fully up to date will their training.  Following the visit the responsible individual advised most training is completed with outside trainers or e-learning.

As previously mentioned, there were interview records held on both staff files.  It is acknowledged that the provider is going through a period of transition, and it may not be possible to have two senior staff conducting interviews, however, this is to be considered and carried out where workable.  It was highlighted that Ty Gwernen now has two new seniors so interviews will take place with both senior members of staff in the future where possible.

The quality of the training is evaluated through supervisions, and team meetings and evaluation forms are also provided.  Gaps in training are identified through observations, record keeping and the training matrix.  It was explained following the visit that the gaps in training matrix is because they were waiting on the training to become available or are new starters.

It was acknowledged that the active offer in relation to the Welsh language is not evidenced on file.  It is required by legislation that all residents are asked what language they wish to communicate in and demonstrate working towards actively offering a service in the Welsh language.  The contract monitoring officer was told at the time of the visit that two members of staff can communicate in Welsh and no residents had expressed a wish to speak Welsh. Although one resident had mentioned to staff that she would like to learn and speak more Welsh, this wasn’t reflected in the personal plan or within the file.  During the follow up meeting the responsible individual said this information had been captured and included in the personal plans and this was seen in two of the resident’s files.

Manual handling training was on the training matrix, and it appeared that all staff had completed this within the past three years.  Food hygiene and safeguarding training was recorded and there were two new starters that had to complete the e-learning course.  Infection control, medication awareness, and challenging behaviour were all evidenced on the matrix.  It was noted that two people had to attend medication training and dementia, and four needed to attend challenging behaviour and dementia.  It was discussed that training around challenging behaviour had been completed and that positive behaviour support is to be arranged when it becomes available through the local authority.

The two staff files viewed both contained two references and although one did not have a professional reference from a domiciliary care company they had worked for previously, there was clear evidence that verbal and written requests had been made.  It is recommended that where a professional reference cannot be obtained that another character reference is sought.

It was acknowledged that job descriptions, applications forms, copies of passports, DBS checks, photographs, training certificates, evidence of induction checklist, and signed contracts of employment were all on file.  Although there was an interview record that contained basic information about the response received during the interview, this did not give sufficient detail to outline what was asked, the response was provided and how they reached a decision about whether to employ them.  It is a regulatory requirement to ensure there are rigorous selection and vetting systems in place.

There were unexplained gaps in employment on one of the files viewed between 2011 and 2014.  Following the visit it was explained that they were a stay at home parent during this period and this had been recorded on the application form.  The second application form only gave the years (employed 2020 – 2022 and 2022 – 2022) so it wasn’t possible to determine whether there had been any gaps, this was addressed following the visit and the contract monitoring officer observed that this had been completed. 

Supervision and appraisal

The staff supervision matrix was viewed which evidenced that these were being held every three months.  There were two new members of staff that had not been added at the time of the visit.  In the follow up meeting with the responsible individual it was confirmed these new starters had been added.

It was noted that all members of staff are expected to participate in an annual appraisal.  The contract monitoring officer was informed that there were three appraisals that had been carried out by the responsible individual but had not been added to the matrix.  The two new starters would not be required to complete this until they had been in post for twelve months (this has been added since the monitoring visit).

Supervisions are carried out as a formal, confidential, 1:1 meeting that is carried out with a senior staff member.  This can be as part of a medication competency assessment, observation, documentation audit etc.  It was advised that the template be reworded to encourage more of a two way conversation and open discussion to provide both parties the opportunity to look at any areas for refection and development.

Approach to care

The contract monitoring officer commented that the culture within the home was improving, and that support staff were looking to incorporate the people living at Ty Gwernen more nd encouraging a client led approach.  Staff were being more empowered to think more creatively and be more flexible within their roles.

Throughout the monitoring visit, and the visits prior, staff were heard asking the residents what they would like to do, and on one occasion asking one of the ladies if they would like a game of connect 4.  There was 70’s disco music playing during one visit which the residents appeared to enjoy.

As previously mentioned, the home has contacted the arts development officer which should promote and inspire some positive wellbeing outcomes for the residents at the home.  It is felt this will also upskill staff and give them more ideas about what they can introduce.

There were lots of plans over the festive period such as Christmas parties, a Christmas concert from a local school, meals out at a local restaurant.  Discussions were also held around the possibly of painting an external mural and making intergenerational links with local nurseries etc.

Residents are encouraged to choose what they would like to eat and are supported to do the food shopping if they are willing.  There is a planned menu in place, although it was stated that this isn’t set in stone and alternatives are offered if they don’t fancy what is on the menu.  Staff demonstrated a knowledge of individual preferences, and it was noted that residents can choose when they want to eat as one lady was seen eating her breakfast at approx. 11.00am as she had had a restless night and wanted to sleep in late.

Residents are encouraged to eat a healthy and balanced diet and the deputy manager highlighted that there are always plenty of fruit and vegetables available and there are no allergies or intolerances with any of the current residents.

Health and safety

The contract monitoring officer was informed that there had been no accidents or incidents during the past month, and therefore there were no updates required to any personal plans or risk assessments.  It was however noted that earlier in the year there was a resident who had slipped in their bedroom during the night on three occasions, and following this, appropriate measures had been taken such as having a bed sensor in place and all documentation had been reviewed and updated.

The previous fire assessment was completed on the 29th November 2023 and there was a recommendation that three lights needed to be replaced and this had been forwarded to the proprietor.  It was noted that fire drills were being carried out every other month and it was recommended that the full date is documented for transparency and accuracy and the sheet be updated to provide outcome of the drill i.e. What is the anticipated evacuation time and how long did it take?  Were there any issues? Any required actions?  All members of staff had taken part in a fire drill apart from the two new starters.  The responsible individual has shared a template with the deputy manager to discuss in the next team meeting and complete fire drills and capture who did what, how long it took and if there was any advice around how this could be improved.

Complaints and compliments

The deputy manager stated that if a complaint were received, they would follow the complaints procedure and would feed back to the complainant either verbally or in writing, depending on which they request.  If the outcome is provided verbally, a written statement would be retained on file to ensure there is a full audit trail.

If a complaint were received in relation to a staff member it was reported this would be investigated appropriately and the disciplinary procedure followed if necessary and the commissioning and safeguarding teams would be informed.  This would be shared with the other home managers and staff team confidentially once any investigation has been completed.  If a general concern came in such as the noise level or staff parking, this would be recorded in the communication book and shared at a team meeting.

Although there hadn’t been any compliments recorded in the book over the previous six months, it was acknowledged that four were documented sine the 13th July 2022.  The contract monitoring officer reminded the deputy manager that staff should be proactive in recording compliments and sharing with the commissioning team.

It was explained that there is an advocate in place for the service user that requires this service.

Resident and stakeholder feedback

Over the previous six months there has been increased monitoring carried out by the commissioning team and social workers to help support staff and residents through the period of transition.

The contract monitoring officer was aware that the feedback obtained from residents can change from day-to-day.  Where one resident explained they felt anxious and had expressed a wish to live independently, this was followed up appropriately and a multi-disciplinary meeting and mental capacity assessment had been carried out.  As previously highlighted, the culture at the home appeared more client led and staff were more pro-active in involving the residents in any decision making and there were more activities being carried out, particularly over the festive period.

During the visit, all residents appeared content in their home, and it was pleasing to observe staff interaction with them and between themselves.

Home environment

There is a smoking shelter outside the back entrance to the property for anyone wishing to use it and there had been a lot of maintenance carried out within the home including having new windows fitted and the main toilet being refurbished.  It was acknowledged that all communal areas have been redecorated and new furniture purchased.

It was explained that work is going to be carried out on the Manager’s office and the utility room to make the office bigger and the files more accessible.  The washing machine and tumble dryer had also been moved downstairs to reduce the noise level on the main floor.

The residents’ rooms that were seen were well maintained and they had chosen their own colours to make it feel more personalised.  All areas of the home were clean and tidy, and it was noted that there are locks on all bathroom and bedroom doors.  Residents do not have their own keys due to lacking capacity and this was reflected in the risk assessment.  There is only one resident who has their bedroom door locked when not being used for health and safety reasons, and this was also fully recorded on their file.

The deputy manager stated there were no lockable cabinets in residents’ bedrooms, it is a requirement that all residents have safe and secure storage facilities for any personal belongings.

Staff questions

The staff members that were spoken to explained that they were aware of how to access all personal plans and risk assessments and were made aware of any updates through the communication book and team meetings.  Staff are also expected to read and sign any documentation that has been reviewed.

It was stated that the responsible individual and deputy manager spend time engaging with staff and residents and they are available for any support if needed.

One member of staff said that they take it in turns taking the residents out and accessing the community, either going to a coffee morning at the local church, shopping, taking them to the hairdresser or barber etc, and they normally get to go out at least once a week with the residents.

It was noted that the support staff had a good knowledge of the residents and their preferences, routines, and health needs, i.e., it was explained that one person is quite independent with all personal care but has fibromyalgia so had noticed they are starting to struggle more walking up the hill to Ty Gwernen.  They explained that the person has a sweet tooth and enjoys any sweet foods, loves dancing, talking about their family and pampering.

Discussion was held around the communication difficulties of the residents and the contract monitoring officer was told that one person living at the property was deteriorating and was sometimes struggling to converse with staff.  It was felt that staff didn’t require any additional training around communication but would sometimes need to use picture cards or use yes and no questions to determine what their wishes are.

The contract monitoring officer spoke to three members of the team, two of which were new starters.  All three stated they felt able to be flexible in their role and weren’t overly restricted by tasks and routines.  They explained that they have chance to just sit and talk to residents; it was noted that they are normally busier in the mornings, but always try to engage with them and encourage those that are able, to be involved with any household tasks.

If there were a quiet five minutes where they felt there was a lack of stimulation, they said they would sing and dance with residents, have a game of cards, a quick game of bingo or connect 4.

All staff said they felt encouraged to offer suggestions about improving the quality of life for residents and that any suggestions would be listened to.  They said they were consulted about the general running of the home, and the member of staff that had been in post the longest said they felt they were working together as more of a team now than previously.

All three members of staff said they would pull a colleague to the side if they felt they had done something that was poor practice or they thought was wrong.  All three explained they would report it to a senior member of staff or to the proprietor if this didn’t appear to have been acted on.  It was noted that they were aware of the need to escalate any concerns appropriately to the safeguarding team and/or CIW.  They all said that could identify any training needs and one mentioned they had recently attended a challenging behaviour course.

Registered manager questions

The manager was managing three services at the time the visit was carried out but as previously mentioned, this is likely to change in the near future.  There are no planned dates for visiting the three properties, but these are all completed every three months.

It was reported that there is no CCTV at the property and there were no issues with the fabric of the property or equipment.  It was stated that residents can control the temperature in their rooms and can access the thermostat.

There were no outstanding regulation 60 notifications, and it was highlighted that the last referral to a professional was in September to occupational therapy due to deteriorating mobility and a referral had also been made in November to the care management team to arrange for a multi-disciplinary team meeting about the wishes of one gentleman at Ty Gwernen.

The contract monitoring officer was told that the home was up to date with their deprivation of liberty safeguarding referrals and it was noted that one was due to expire early in the new year and would be referred appropriately.  It was acknowledged that this had been done during the follow up meeting.

Community participation is carried out through attending various appointments etc. and it was explained that relatives are invited via their Facebook page and/or by post (such as the Christmas party).

General observations

There were no issues raised in relation to the appearance of the residents and they were all dressed appropriately for the time of year and one resident said they were looking forward to seeing their family over Christmas. 

All areas were clean and tidy and there were no concerns in relation to the safety or comfort within the home.  As previously mentioned, there are positive plans to increase the size of the office that will make the files more accessible.

Staff appeared knowledgeable and positive about the developments being made within the home.  It was pleasing to observe encouraging, meaningful interaction between staff and residents

Corrective / Developmental Actions

Corrective actions

Copies of interview record and the scoring mechanism to be held on file for new starters to evidence their fitness to fill the post.  RISCA version 2 (April 2019) regulation 35

Individuals have safe and secure storage facilities (i.e. lockable cabinets) for their personal belongings including money, valuables, and where appropriate medication.   RISCA version 2 (April 2019) regulations 43 and 44

Developmental actions

It is good practice to ensure there are a minimum of two interviewers present during all interviews.

All interviewers to clearly record designation, signature, and date of interview.

Consideration to be given to recording the name alongside the signature on personal plans to ensure transparency.  If this is done by a representative, the relationship should also be noted.

Agreements to be written up about how relatives, friends etc would be informed of any incidents, this should be signed and dated by the client, if possible and, or representative.  Following the meeting the responsible individual explained this had been completed and will be reviewed by the contract monitoring as part of routine monitoring.

To ensure accountability, it is recommended that all policies and procedures contain the name and designation of the person carrying out the review.

Evidence to be held of monthly audits being completed of compliments and complaints.

All personal outcomes to be documented in the personal plans (whether they are achievable or not) to evidence the support is client led and that staff have done everything possible to help them accomplish these goals.

The full date of fire drills to be recorded and a comment on the outcome.

Conclusion

Ty Gwernen is a relaxed and homely setting that provides a high standard of care to the residents that live there.  Staff were able to demonstrate a sound understanding of the support needs and offered care and reassurance when needed.  There were no concerns raised during the monitoring visit.

Despite going through a very challenging period with the Covid pandemic and some staff changes, it appeared that the members of staff at the home have a close working relationship that offers continuity.  The contract monitoring officer has praised staff in the way they supported their clients through this period of change.

Of the previous nine recommendations, five were met, two were partially met and two were not met.  It is felt this is largely down to the previous lack of communication and change of management.  There is an evident change in culture and although there are ten recommendations identified in this report, the contract monitoring is reassured that these will be viewed as an action plan going forward (many had already been actioned between the initial visit and the follow up meeting).

The contract monitoring officer is grateful for all the information provided and would like to thank everyone involved for their time and hospitality.  Due to the ongoing investigation, informal routine monitoring will continue monthly and unless it is required beforehand, the next formal visit will be carried out in approx. twelve months’ time.

• Author: Amelia Tyler
• Designation: Contract monitoring officer
• Date: 8 January 2024 (amended 17 January 2024)