Agenda item

To provide an overview of the work of the Quality Assurance Service within the Adults, Health and Wellbeing Department

1)    To accept the report that provided an overview of the work of the Quality Assurance Unit within the Adults, Health and Well-being Department

2)    To note concern about the lack of staff capacity in the unit and the risks that could emerge in regards to the safety and well-being of those receiving care, the sustainability of the market and the consequent risks to the Council.

3)    That the Chair will send an e-mail to the Cabinet members to convey the Committee's concern about the lack of staff capacity and the need to secure adequate staff capacity in order to offer suitable support and monitor the quality of services.

Submitted – the report on the Quality Assurance Service within the Safeguarding Unit, by the Senior Safeguarding and Quality Assurance Manager.  The item was intended to provide details on how the Council monitored the County's adult care provisions, which included a range of organisations.  She provided an overview of the team's work.  She noted the concern that the Service was responsible for monitoring a number of establishments , but had only managed to monitor a limited number, and had been unable to visit the domiciliary care or day care services.  Furthermore, she noted that during Covid, they had been unable to conduct the unannounced visits as would have happened usually, and instead the staff had made telephone contact with the providers.

She reported that five homes had been placed under the Escalating Concerns procedure over the past 18 months.  The Quality Assurance Team had worked with each one to prepare and implement improvement programmes in order to overcome problems and improve the quality of care services. One of the possible effects of the process was an embargo on admissions being imposed, which in turn had an impact on individuals and their families, and of course a lack of money coming in to sustain the business.  She also reported that three homes in Gwynedd had closed over the past two years.

The Senior Safeguarding and Quality Assurance Manager referred to the Winterbourne View report, where a lack of monitoring was reported as being a factor, together with a lack of overview by the Commissioners.

She confirmed that visits to the various sites were conducted roughly every two years at present, but ideally we needed to visit every six months.  She noted that when a problem arose, visits took place to try and prevent a site from being placed under the Escalating Concerns procedure. While this was absolutely essential, it did have an impact on the team's ability to monitor other services.

Members were given an opportunity to ask questions, and the responses were noted as follows:

Concern was expressed that five services had entered the escalating concerns procedure, and concern about the stark difference in the frequency of visits by Gwynedd Council and a neighbouring authority. Members questioned whether there was a way of diverting resources, be those financial or other, to strengthen the service. The Senior Safeguarding and Quality Assurance Manager confirmed that, following a case of escalating concerns, the next stage was to formulate a development plan and give the service the opportunity to secure improvements.  She stated that she shared the concern about the lack of resources, and referred to the unsuccessful bid made in 2020/21 for a budget to employ additional staff. She noted that the bid would be re-submitted this year. 

Another Member noted that it was a difficult situation, and that the figures were very similar to the situation before 2016, but the Senior Safeguarding and Quality Assurance Manager stated that the difference by now was the good relationship with providers, area teams and the officers.

The Head of Service confirmed that the issue regarding capacity was significant, although he accepted that the sharing of resources to all services that were under pressure was challenging.  He noted that this was an area of work where funding could be allocated, but they would still need more, but he reported that he was pleased to see the early signs of concerns being addressed immediately.  He noted that resources across the Department were consumed when a home was in difficulties, and took staff away from other work.   He noted that there had been some positive developments during the Covid period, such as greater trust between the Department and the providers.

He noted that the changes that had happened and changes that were afoot in domiciliary care demonstrated the need to monitor quality assurance effectively, but that they did not have the capacity to do this fully at present. He noted that temporary funding did not offer a long-term solution.  He stated the importance of being aware of the team's work, and the importance of feedback from providers, and noted his appreciation that the team was making every effort to work proactively.

Members gave thanks for the honest report which raised concerns, but they also gave thanks for the good collaboration, and the need to protect this collaboration. 

The Committee stated that they were there to support, and would appreciate an update within six to nine months, although it was concerned as to how some issues could be resolved. 

They gave thanks for the report and noted that there had been career development opportunities within the department, with a Home Manager having joined the Team, while one member of the team had moved to be a Provider Area Manager.

The Cabinet Member for Adults, Health and Well-being reiterated the fact that this was an honest report and that the observations would be taken into consideration, together with options within the Department.

It was agreed to accept the report, and to note the concern about the issue of capacity with the Cabinet and the desire for something to be done about it.

RESOLVED:

1)    To accept the report that provided an overview of the work of the Quality Assurance Unit within the Adults, Health and Well-being Department

2)    To note concern about the lack of staff capacity in the unit and the risks that could emerge in regards to the safety and well-being of those receiving care, the sustainability of the market and the consequent risks to the Council.

3)    That the Chair would send an e-mail to the Cabinet members to convey the committee's concern about the lack of staff capacity and the need to secure adequate staff capacity in order to offer suitable support and monitor the quality of services.