Inspection Report on Wrexham County Borough Council Domiciliary Support Services Greenacres 67 Rhosddu Road Wrexham LL11 2NW Date Inspection Completed 27 April 2021 Welsh Government © Crown copyright 2021. 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 email: [email protected] You must reproduce our material accurately and not use it in a misleading context. About Wrexham County Borough Council Domiciliary Support Services Type of care provided Domiciliary Support Service Registered Provider Wrexham County Borough Council Adults and Children's Services Registered places 0 Language of the service English Previous Care Inspectorate Wales This is the first inspection since the service was inspection reregistered under Regulation and Inspection of Social Care (Wales) Act 2016. Does this service provide the Welsh Yes Language active offer? Summary The service comprises of different services under one registration. These are Community Living Service, which supports people in their own homes who have a disability and specialist support needs; Recovery service which supports people with enduring mental ill health and Homecare and Reablement who provide support to individuals with a wide range of needs in their own homes, including within extra care services. People feel they are treated with dignity and respect and staff are friendly. People know who to raise any concerns with, and feel they would be listened to. Personal plans in Community Living Service (CLS) and Recovery service show people’s individual needs and outcomes are well understood and important in how support is provided. Personal plans for people who use the Homecare & Reablement assessment service need to contain more detail to ensure needs and risks are consistently understood. These should be reviewed at least every three months. There are good measures in place to protect people receiving a service. There are good recruitment processes in place and staff receive robust training on a wide range of topics including safeguarding. There are good infection control measures in place to protect individuals and care workers. CLS and Recovery service have a strong quality assurance system in place, and are developing these further. The Homecare & Reablement assessment service have poor quality assurance systems in place, and need to ensure this is addressed. The Responsible Individual (RI) needs to ensure that three monthly visits to all services are carried out to improve oversight of the services. Well-being People are happy with the support they receive. People spoken with told us they are treated with dignity and respect and staff are friendly. One person said ‘Staff are caring compassionate and gentle’ and another said staff are ‘wonderful’. People said they know who to raise any issues with, and felt they would be listened to. Within the CLS and Recovery service personal plans and one page profiles show peoples individual circumstances are well understood and important in how support is provided. Personal plans for people within the Homecare service need to contain more detail to ensure people’s individual needs and circumstances are understood. There are good measures in place to protect people receiving a service. Staff receive training on a wide range of mandatory subjects including safeguarding. Care staff told us they would report any concerns about people’s safety and welfare. There are good infection control measures in place to protect individuals and care workers, including a good supply of personal protective equipment (PPE). People told us they feel safe when receiving support from the service. Risk assessments for key elements of care are in place, although these should be more personalised within the Homecare and Reablement service. People within the CLS and Recovery service have many opportunities to contribute to decisions about their life. This includes regular reviews of personal plans and surveys about the service. The Homecare and Reablement service need to improve how they support people to contribute to decisions about their lives and the service. People have information which informs them about the service, including using easy to read information and information in Welsh. Care and Development Overall individuals are provided with good quality of care and support. Within the CLS and Recovery service, people’s personal wishes are well known to their support workers. Peoples support plans contain thorough details which helps to ensure staff are consistent in their approach. Their plans and risk assessments are regularly reviewed. Within the Homecare service personal care plans should contain comprehensive details about how to support people and must be reviewed three monthly or if needs change. Risk assessments were found to be too generic and needed more detail. The provider is required to address this in order to achieve compliance with regulations. People receiving services told us they are happy with their support, and did not feel rushed. People we spoke with described support workers as kind and respectful. One person said support workers are ‘reliable, helpful, professional, skilled. Happy and friendly’. A family member told us ‘They have given my mum total respect at a time in her life that has become challenging’. People who received support from the Reablement team were happy they had been supported to regain their independence. The service has safe systems for medicines management. There is a robust policy in place describing procedures to be followed. Medication records are audited by senior support workers. If errors occur healthcare advice is obtained and staff are re-trained. The service promotes hygienic practices and manages risk of infection well. Since the coronavirus pandemic they have introduced an additional policy to advice staff on extra precautions required. Staff spoken with said they receive regular updates on best practice. Support workers confirmed they have access to sufficient PPE and people receiving services said they feel safe with the current practices in place. There are good mechanisms in place to safeguard vulnerable individuals to whom the service provides care and support. They have an up to date safeguarding policy. Staff are aware of the policy and receive training on safeguarding. Support workers told us they would feel confident to report any issues to the management team. People told us they feel safe with the care workers. Leadership and Management The service is mostly provided in accordance with the statement of purpose. This document clearly describes who the service is for and how it will be delivered. Each part of the service has its own service user guide, available in English, Welsh and easy to read versions. This is provided to all individuals in receipt of a service and ensures that people know what to expect and who to contact if they have any concerns. The Responsible Individual (RI) has plans on how to develop and improve the service. The service has not ensured that Regulation 73 visits have been carried out as required. The recently appointed RI told us they are aware of the requirement to do these and have started to carry this out. They advised us they have identified areas for improvement and are working with others to ensure these changes are made. The CLS and Recovery service carry out regular quality of care reviews that show a wide range of people’s views are sought and actions to improve the service are identified. The Homecare and Reablement team have not carried out quality of care reviews as required, so are therefore non compliant with the regulation and this needs to be addressed. We saw all the required policies and procedures are in place, however we advised the RI that some of these should be reviewed to ensure they contain up to date references. We saw records that showed the service deal with complaints satisfactorily when they are received. Individuals are supported by a service that has sufficient numbers of staff who are suitably fit and have the knowledge, competency and skills to meet their needs. We saw records that showed required pre-employment checks are carried out as required. The service has in-house training for most subjects, and we found support workers training is up to date. Support workers told us they feel they have good training and development opportunities. Recently recruited staff praised the induction process and training. This includes training on all mandatory subjects and shadowing experienced staff members before working alone with people. We saw that staff receive regular supervision, and this includes observation of their practice and feedback is provided. Staff also receive comprehensive annual appraisals. The service has carried out reviews when they have identified organisational difficulties. Staff told us these had worked very well and improvements have been made which has improved staff morale. Regular staff meetings are held within the CLS and Recovery Service. This ensures staff receive up to date information and have opportunities to share information. This was not so consistent with the Homecare teams, and we advised the RI and manager this should be addressed. Support workers told us they feel well supported as the management team are supportive and approachable. The service ensures travel time and care time are delineated. Care workers told us they have sufficient time to travel between calls. People who receive a service told us that care workers are usually on time, and are not rushed in care delivery, with enough time to complete the support required. Areas for improvement and action at, or since, the previous inspection. Achieved Areas for improvement and action at, or since, the previous inspection.