‘Minimum standards are not enough’ says Care and Social Services Inspectorate Wales

Article by Amy Clifton, National Assembly for Wales Research Service

Care and Social Services Inspectorate Wales (CSSIW) is responsible for inspecting social care and social services to make sure they are safe for the people who use them. CSSIW’s latest annual report (2013-14) will be debated in Plenary this afternoon.

CSSIW inspections now focus on four quality themes:

  • Quality of Life
  • Quality of the Environment
  • Quality of Leadership
  • Management and the Quality of staff.

CSSIW reports that 85% of adult care and 96% of childcare inspected met the required standards during 2013-14. CSSIW’s chief inspector concluded:

While we have found that most care is good in Wales, minimum standards are not enough and our focus must be on supporting all sectors to achieve excellence.

During that period CSSIW issued 1,303 non-compliance notices (i.e. warnings that a service is in breach of regulations) to 343 services, and identified 57 services as ‘services of concern’ (where urgent action is required to safeguard and protect the wellbeing of service users). CSSIW says it worked with the services to take corrective action, and the majority of them (68%) made sustained improvements. As of 31 March 2014, 26 services remained ‘services of concern’.

Table 1 Amy

Source: CSSIW annual report 2013-14

The report notes that failures in leadership and management are commonly highlighted across all types of services when serious non-compliance is identified.

Quality of life is a particular feature of non-compliance in adult residential care services. Problems with assessments, care planning, nutrition and hydration, and administration of medication are commonly identified.

Concerns raised

Pie Chart Amy

Source: CSSIW annual report 2013-14

The number of concerns referred to CSSIW has doubled since the last annual report. During 2013-14 CSSIW responded to 2,170 concerns raised by others, which resulted in 284 additional inspections.

The large majority of those concerns (around 85%) related to adult services. The bulk of concerns were raised by professionals (52%); followed by relatives, friends or advocates (20%), staff (10%) and service users (5%).

CSSIW states that the biggest challenges are found in adult care homes where the services are more complex, levels of need are high and the risks presented are greater. The data it prepared for the Older People’s Commissioner’s review of care homes indicated that nursing homes for older people were much more likely to be the subject of concerns, be of greater risk, or have problems with compliance.

National Review of Commissioning for Social Services in Wales 2014

CSSIW reviewed how well local authorities commissioned social care in Wales, including dementia care services. Its conclusion was:

We found that local authorities and health boards needed to make major changes to the way they plan and commission services for people with dementia.

Quality Judgement Framework

In Spring 2014 CSSIW piloted a Quality Judgement Framework with 43 children’s day care settings. It used the SOFI (Short Observational Framework for Inspections) as part of the methodology to deliver a judgement on each of its four themes: (quality of life, quality of staffing, quality of leadership, and quality of environment). CSSIW’s four ‘judgements’ were offered against three bands for the pilot: good, satisfactory, and poor. The University of South Wales conducted an independent evaluation of the pilot.

Building on this work, CSSIW plans to run a pilot in adult care homes in 2015. CSSIW’s quality judgement framework pilots are referenced in the Explanatory Memorandum of the Regulation and Inspection of Social Care (Wales) Bill which was introduced last month. The Bill currently gives the Welsh Ministers powers to introduce new inspection ratings on the quality of services (through regulations).

NB: The Minister for Health and Social Services launched a new pilot project Think About Me: Good Care Guide in Newport last week. This new “Trip Advisor-style guide” aims to help care home residents and their families to research the quality of homes and review them online. It was developed by the Good Care Guide with Aneurin Bevan University Health Board and the South East Wales Academic Health Science Partnership. It will initially be piloted across Gwent but may be rolled out further if successful.

Forthcoming review

CSSIW states that it plans to work with Healthcare Inspectorate Wales to undertake a review of support and services to people with learning disabilities, drawing on findings from Winterbourne View (i.e. the abuse of adults with learning disabilities at Winterbourne View care home, near Bristol which was identified by BBC Panorama).

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