Q-Care
Unit 1, Foxes Lane, Oakdale Business Park, Blackwood NP12 4AB
Tel: 01495 741310
Email: stephen.stone@q-care.co.uk
Contract Monitoring Report
- Name of Provider: Q Care
- Date of Visit: 14 November 2023
- Visiting Officers: Ceri Williams - Contract Monitoring Officer CCBC
- Present: Stephen Stone – Branch Manager Q Care Caerphilly
Q Care have been a registered provider of domiciliary care services within the Caerphilly Borough for several years.
The purpose of the monitoring visit was to review the recommendations made during the previous contract monitoring visit carried out in August 2022, and to look at the documentation for people in receipt of a package of care and staff files.
Dependent on the findings within the report, Q Care will be given corrective and developmental actions to complete. Corrective actions are those which must be completed (as governed by legislation etc), and developmental actions are good practice recommendations.
Previous Recommendations
Corrective Actions
Q Care to ensure that personal plans provide the sufficient detail required for care staff to ensure the individuals care and support needs will be met on a day-to-day basis. (Regulation 15, Regulation & Inspection of Social Care Act (Wales) RISCA). Partly Met: See body of report
Ensure that risks that are identified and that comprehensive Risk Assessments are in place to mitigate any risk to an individual’s well-being. (Regulation 15, RISCA). Met: All personal plans viewed had identified risks and accompanying risk assessments in place to mitigate.
Staff to evidence in daily recordings that skin integrity is being checked as in line with the care plan. (Reg 21 RISCA) Timescale: Immediate & Ongoing. Not met: Daily recordings viewed were not evidencing that skin integrity is routinely checked.
All staff to be up to date with mandatory training and any refresher courses required, to enable them to fulfil their role. Not Met: Staff are overdue training.
The RI to include feedback from individuals receiving the service in quarterly report. (Regulation 73, RISCA). This information was not provided.
Any regulation 60 notifications submitted to the regulator to also be copied to CCBC Commissioning. (CCBC Contract). Not Met: No regulation 60 notices have been copied to CCBC.
Service Provision
Call monitoring records were viewed for a number of clients. The reports evidenced that calls are not taking place consistently within half hour of the scheduled call times.
The carer continuity, which is the number of carers attending a call over a certain time period, for the packages reviewed, was over the target amounts set in the contract with the provider.
The electronic call monitoring system sends alerts if calls are late or potentially missed, and this system is monitored at all times. When alerts come through, staff are contacted to ask if they are on their way and if necessary other arrangements are made to cover calls, and clients should be informed of any issues. The system is also monitored during evenings and weekends.
There is a communication system in place to log calls received from care staff to the office to report concerns regarding clients, or to report cancelled calls etc. This acts as an audit trail to explain any calls which appear to be not attended, or any other relevant information that needs to be logged.
Care & Planning Process
Q Care use a document called ‘My Care and Support Plan’ as an initial assessment and Personal Plan. This is a comprehensive care planning document. The document includes personal details, life history, people who are important to me, plans and outcomes, routine and breakdown of daily care calls, medical conditions and how they impact and why the individual needs care & support.
Two client’s files were viewed while at the monitoring visit. Both client’s files contained a CCBC Care and Support Plan. CCBC Care & Support Plans were cross referenced with the Q Care ‘My Care & Support Plan’. All care and support identified in the local authority care plan had been transferred into Q Care’s my care and support plan. However, on cross referencing the second file some elements of care and support required and identified on the local authority care plan had not been transferred in detail into the Q Care support plan, this was discussed with the manager at the visit. The manager explained that some of the information was historic and that a current review was being undertaken for the individual, after which the care and support plan would be updated.
Life history information was detailed on both personal plans and included details of family, past occupations and interests and hobbies.
The personal plans viewed both included detailed and clear instructions on what support was needed on each call. Both plans were person centred, written from the view of the person receiving care and support and included likes, dislikes, routines and abilities of what could be achieved independently.
Both personal plans had been signed by the person receiving care and support or by a representative, evidencing their involvement in the production of the personal plan.
There were suitable detailed risk assessments in place of both files viewed which accurately described risks identified with providing care and support and actions to take should the risk occur.
Reviews of care and support plans were present on both files viewed. All reviews on file had been carried out over the phone. The review paperwork was detailed and included a summary and any actions to be taken following a review. Although there were completed reviews on file these were not taking place consistently within the timeframes set out in regulations.
Daily records were viewed for both individuals. Notes included all care and support tasks which had been carried out and also commented on the individual’s well-being. Daily records are now captured electronically so all record entries are dated and timed and assigned to the care staff who wrote them.
It was identified, on one set of daily recordings viewed, that care staff were not recording a specific area of need identified for checking/monitoring on the individuals care plan. This was discussed with the manager at the time of the visit.
Recruitment Training & Supervision
Two staff files were viewed; they both included required information such as detailed application form, record of interview including scoring and contracts of employment.
References were present on both files including from previous employers. Signed contracts of employment were also present on both files viewed.
There were copies of documents proving identity on both files.
Disclosure Barring Service checks are applied for and proof that they are received and clear is kept on file. This information was present for both staff files checked. Training certificates were present on both staff files. Files also included evidence of full induction procedure supervised by training department and branch manager.
There was also evidence on file of a meaningful shadowing process for new staff whilst working with experienced staff in the community. Checklists were present for various tasks which had been observed and signed off by senior staff on both files.
A training matrix was provided which evidenced that staff attend mandatory and non-mandatory training courses. The training matrix evidenced that several staff were overdue training in both mandatory and non-mandatory training.
Staff are required to attend supervision with their line manager no less than quarterly. The supervision matrix provided evidenced that some staff were overdue supervision.
Q Care also utilise a system of spot checks and performance observation records with staff in the community which are carried out every three months. Staff are also checked on their competency for Medication Administration and Moving & Handling every six months. The information provided regarding these checks evidenced that some staff were overdue these checks in the community.
Quality Assurance
The provider is required by regulation to produce a six-monthly Quality of Care review. These reports were requested but not provided by Q Care.
The Responsible Individual is required by regulations to visit the service and gain feedback from individuals using the service and staff at least quarterly and evidence these visits are documented. These reports were requested but not provided by Q Care.
The monitoring officer contacted a number of individuals receiving the service for feedback. Feedback for care and support received was good.
However, a few clients did advise that call times can be inconsistent. It was also noted by the monitoring officer that individuals copies of their paperwork, relating to the service they receive, were out of date.
Individuals who use the service and their representatives who were spoken to also raised that they would like access to their records held electronically by Q Care.
Corrective Actions
Calls to take place within half hour of the scheduled call time. CCBC Contract 16.4
Carer continuity to be within the threshold set in the contract. CCBC Contract 27.1
Personal Plans to take into account and include all identified care & support needs identified in the Local Authority care & support plan. Regulation 15 The Regulation & Inspection of Social Care (Wales) Act 2016 (RISCA) Timescale: Immediately & Ongoing
Reviews of Personal Plans are carried out every three months, or sooner if there is a change in the individuals needs, and in line with any reviews undertaken by the placing authority. Regulation 16 RISCA. Timescale: Immediate & Ongoing
Staff to evidence in daily recordings that skin integrity is being checked as in line with the care plan. Regulation 21 RISCA. Timescale: Immediate & Ongoing.
All staff to be up to date with mandatory training, non-mandatory training and any refresher courses required, to enable them to fulfil their role. Regulation 36 RISCA. Timescale: Within 3 months of the date of this report.
Staff meet for one-to-one supervision with their line manager or equivalent officer, or a more senior member of staff, no less than quarterly. Regulation 36 RISCA. Timescale: Immediately & Ongoing.
Quality of Care Report to be produced every six months. Regulation 80 RISCA. Timescale: Six monthly
The RI to visit and seek feedback from staff and service users every 3 months and provide documented evidence of these visits. Regulation 73 RISCA. Timescale: Three monthly.
The paper file should still be maintained in the Individual’s home, ensuring that all of the information / documentation listed in clause 14.2 is included within the file. CCBC Contract 14.4 Timescale: Immediately & ongoing
Any regulation 60 notifications submitted to the regulator to also be copied to CCBC Commissioning. CCBC Contract 38.11 Timescale: As and when required.
Ensure that individuals who use the service can have access to their records and are made aware they can access their records. Regulation 59 RISCA. Timescale: Immediately & ongoing.
Developmental Actions
Consideration for staff to attend training in Pressure Care/Skin integrity.
Conclusion
From reviewing information and feedback from individuals it is apparent that there are areas where improvements are required. Q Care are encouraged to work towards completing the corrective and developmental actions as soon as possible.
- Author: Ceri Williams
- Designation: Contract Monitoring Officer
- Date: 20 February 2024