Agenda item

To consider the report.

a)    To accept the report, welcome the progress already made since the first audits and thank the care homes’ staff for their service.

b)    Declare concern for care homes’ staffing challenges and problems that emerge as a result of that such as difficulty completing training. 

c)     Ask the relevant department to consider how we can ensure that every home reaches high assurance levels in the future.

d)    Ask for the Care Scrutiny Committee's Chair and Vice-chair to be invited to attend the Governance and Audit Committee meetings in the future when there are discussions regarding care homes’ internal audit reports.

e)    Inform the Governance and Audit Committee members of the observations and decisions of the Care Scrutiny Committee members.

 

The report was presented by explaining that Cyngor Gwynedd had 13 care homes that supported and cared for adults across the county, and that they were inspected frequently by a wide range of internal and external auditors. It was noted that this report gave specific attention to audits that had been held by the Council's Internal Audit Service and they had inspected three care homes during the 2022/23 financial year. Those homes were Plas Gwilym, Hafod Mawddach and Bryn Blodau. It was explained that the purpose of the audits was to ensure that suitable arrangements were in place for appropriately managing and maintaining the homes in accordance with relevant regulations and standards.

 

It was explained that the inspections had concluded that the assurance level of the homes in question was limited, therefore there was a need to take steps in order to improve compliance with the controls and to reduce the risks that were highlighted. In response, it was explained that the service had committed to implement actions for mitigating the risks that were highlighted and a list of those actions were provided in the report.

 

It was noted that follow-up audits had been held in the three homes in question in October 2023 in order to ensure that the service / home had implemented the actions they had committed to. It was confirmed that an improvement was seen in every home but there were further actions to be taken in order to reduce the risk further. It was explained that the number of matters that continued to need attention related to staffing matters, such as training and supervision. It was noted that the situation was challenging and varied between homes. It was confirmed that the situation and individual homes continued to be monitored to ensure that the actions would be implemented.

 

During the discussion, the following observations were noted:

 

 

-        The members expressed their thanks for the report and the progress made since the first audits was welcomed.

 

-        All care home staff were thanked for their work and commitment to their clients. It was noted that the praise from the people of Gwynedd for the homes was very good and that it was worth noting.

 

-        Attention was drawn to the fact that the internal audit reports of the care homes were submitted to the Governance and Audit Committee before the Care Scrutiny Committee, and it was proposed that representatives from this committee should attend the Governance and Audit Committee meetings in the future when discussions are about care homes' internal audit reports.

 

-        Concern was expressed about the fact that only three homes were being inspected annually and it was asked how to ensure standards in homes that are not inspected that year.

o   In response, it was explained that Internal Audits chose three homes at random each year to inspect, and other audits also happened, whether external ones or internal ones by the service.

o   It was noted that the service tried to learn from every audit and that any comments or suggestions for improvements were implemented in each home.

 

-        Members were encouraged to visit care homes in the county as the staff and the residents would be glad to see them.

-        It was noted that the individuals went to care homes with much more severe needs now and this led to increasing pressure on the staff. Attention was drawn to the domiciliary care staff who had difficulty meeting their hours as there were no hours available, and it was asked if it was possible to get some of these to help in the care homes.

o   In response, it was noted that this was something to consider, and hubs were created in some care homes for domiciliary care staff so that staff could complete training, etc. but there was room to develop this further.

 

-        Concern was expressed about the staffing problems, and it was asked if there was a need to look at how the contracts were issued in order to attract more staff. It was noted that the shifts could be long and maybe offering a variety of shorter ones would be a way of attracting people to fill the posts.

o   In response, it was confirmed that shifts of varied lengths were offered and not all of them were long ones that were over ten hours.

o   However, attention was drawn to the fact that some members of staff saw it better to work longer shifts as that meant working fewer days.

o   It was noted that the department tried to do everything within its ability to be as flexible as possible and that individuals had a choice on what types of shifts they wanted to work. But the need was noted to ensure fairness for the whole staff, therefore there was a need to be consistent and sensible when considering what was possible.

o   It was noted that there was more work to be done to attract young people to the field.

 

-        It was asked how serious the staff shortage was and was there a need to depend on agency staff in some homes.

o   In response, it was confirmed that agency staff continued to be used in some homes but not all. It was explained that the situation varied significantly with some homes better at retaining staff than others.

o   It was noted that there was a challenge in terms of competing with the Health Board in context of weekend wages, etc. as they offered much better terms than the Council.

 

-        Concern was expressed about the lack of training / time to hold training and it was asked had the department considered looking at other ways of holding training, for example in snippets or virtually.

o   It was noted that offering on-line modules was useful if they had problems reaching the appropriate training levels but not as good as holding the training face to face. It was explained that the virtual modules were more useful as refresher sessions.

o   It was explained that the training sessions were being offered in the homes also and the department was open to holding the sessions in many different ways.

 

-        A question was asked about the external audits such as those by Care Inspectorate Wales and was there a connection between the problems that became apparent in the internal audits and in the external audits.

o   In response, it was noted that the Quality Assurance Team was an internal team that audited services and did the same type of inspections as Care Inspectorate Wales.

o   It was explained that an effort was made to coordinate aspects between the different teams and that everyone had a role to play. However, it was noted that there was a need to be cautious by ensuring that there was not too much pressure being put on the front-line services in terms of audits.

o   It was admitted that further work needed to be done on coordinating the audits. 

 

 

RESOLVED

 

a)     To accept the report, welcome the progress already made since the initial audits and thank the care homes’ staff for their service.

b)     Declare concern for care homes' staffing challenges and problems that emerge as a result, for example, difficulty completing training.

c)     Ask the department to consider how we can ensure that every home reached the high assurance level in the future.

d)     Ask for the Care Scrutiny Committee’s Chair and Vice-chair to be invited to attend the Governance and Audit Committee meetings in the future when there are discussions regarding care homes’ internal audit reports.

e)     Inform the Governance and Audit Committee members of the observations and decisions of the Care Scrutiny Committee members.