Agenda Item No. 4

The Vale of Glamorgan Council


Scrutiny Committee (Social Care and Health): 4th January, 2016


Report of the Director of Social Services


Commissioning Domiciliary Care Services from the Independent Sector: Follow up Report


Purpose of the Report

  1. To inform Scrutiny Committee about the outcomes of the inter-disciplinary inquiries made in respect of allegations broadcast in the BBC television programme, 'Week In, Week Out', about 1st Grade Care domiciliary care agency.


  1. That Scrutiny Committee notes the current arrangements for working with the independent domiciliary care sector to ensure that it provides safe and effective care and support services.
  2. That Scrutiny Committee notes the contents of the report and actions to address concerns relating to 1st Grade Care.
  3. That Scrutiny Committee receives an update in six months on the quality assurance processes in place to support the commissioning of high quality domiciliary care services and how the Directorate is responding to issues within the sector.

Reason for the Recommendations

To ensure effective scrutiny of a key function undertaken by the Council.


  1. This report is provided in response to a Request for Consideration from Councillor Richard Bertin and it follows on from the report presented to Scrutiny Committee on 13th July, 2015 - Commissioning Domiciliary Care Services from the Independent Sector.
  2. 1st Grade Care has been in operation within the Vale of Glamorgan since 2011 when it was first registered with the Care and Social Services Inspectorate Wales (CSSIW). During this time, the organisation has not had concerns raised that had warranted it being managed within the Council's provider performance measures, which are used to monitor and improve the delivery of care commissioned by the Council from independent social care providers. 1st Grade Care is registered to provide care to individuals in their own homes and in the following categories: older persons, older people with dementia, physical disabilities, sensory loss/impairment, and mental health.
  3. Week In, Week Out broadcast on 9th June reported that 1st Grade Care had left a 92 year old woman alone on the floor when she fell. The programme stated that the care provider had been accused of ordering a member of staff to leave the service user and go to another call before an ambulance or relative arrived. The member of staff was interviewed on the programme and wished to remain anonymous. In addition, the programme reported that the family of the service user had many concerns with 1st Grade Care, including missed and shortened calls.
  4. Every week, 34 independent sector organisations are providing 11,624 hours of domiciliary care to 1,099 service users across the Vale of Glamorgan. As stated in the report in July, this Council commissions domiciliary care through 'spot contract' arrangements. This is in contrast to the 'block purchase systems which operate in some local authorities and which have proved problematic when large-scale contracts come to an end. When used in combination with individual assessment of need and the use of brokerage, spot contracts can ensure that every individual care package for all service users is bespoke. Where it funds the care package, the Council retains a statutory accountability for the way in which these services are provided.

Relevant Issues and Options

  1. The report of the CSSIW annual inspection of 1st Grade Care in September and October 2014 was published on 9th January this year. It highlighted that a non-compliance notice regarding staff training (Regulation 16 (2) (a)) had been served on the registered person for the service. There were other areas of concern. These relate to; i) number of suitably qualified staff (Regulation 16 (1) (a)), and ii) continuity of care (Regulation 16 (1)(e)), but did not result in non-compliance notices.
  2. CSSIW then conducted a further baseline inspection of 1st Grade Care which started on 13th May, 2015. Week In, Week Out was broadcast while the inspectors were completing their work and so they extended the exercise, conducting further visits. Their final visit took place on 2nd July, 2015. The inspection report was published in September. Areas of improvement against previous inspection visits were noted as:
  3. "The non-compliance notice issued at the previous inspection with regard to staff training was found to be met" and "Progress against Regulation 16 (1)(a) and Regulation 16 (1)(e) had been made and there was no evidence of ongoing non-compliance". It should be noted that CSSIW judged the organisation as compliant in the area of staff training but it did issue another non-compliance notice:
  • "Regulation 13 (a) - Non- compliance - Processes need to be put in place to enable the agency to monitor late and missed calls and to take appropriate actions in a timely manner when issues arise to ensure service users safety and wellbeing - timescale for completion 30/09/2015."
  1. In response to the non-compliance notice, 1st Grade Care advised inspectors that they had improved their monitoring arrangements (including installation of an electronic monitoring system), and they believed suitable arrangements were in place. The system was designed to enable them to track any late or missed calls, alerting on-call staff/supervisors to take action. This would include ensuring that there was adequate support and timely communication with the service user.
  2. Since issuing their inspection report in September 2015, there have been no further issues raised by CSSIW in relation to the operation or quality of service provided by 1st Grade Care within the Vale of Glamorgan.
  3. Between 28th October and 11th November, CSSIW completed a further inspection. The report has been prepared and it is currently with the provider for comment. We have been informed by the Director of 1st Grade Care that areas of non-compliance have been satisfactorily addressed and that consequently the provider is compliant with the National Minimum Standards. Officers have been advised that the provider is not intending to challenge the report. The report is due to be published by the end of the calendar year. It is anticipated that CSSIW will be able to report their findings at this meeting of the Scrutiny Committee.
  4. As detailed in our previous report to Scrutiny, the Contracts Team in Social Services has a robust monitoring function. Once alerted to the issues highlighted by Week In, Week Out, our staff worked with 1st Grade Care to identify any issues regarding quality of care and to take remedial actions so that all service users were safeguarded. They have visited the organisation on three occasions, developing an action plan which is being carefully monitored. Key themes identified through the monitoring process echo some of the earlier observations by CSSIW but it has not been judged necessary to make use of the Authority's escalating concerns process.
  5. 1st Grade Care has worked constructively with our contract monitoring officers. They have been willing to accept support, to share information requested by our staff and to learn from any errors. There has been a clear commitment to providing a high quality service.
  6. The electronic monitoring system introduced by the organisation to prevent missed or late calls has not been able to deliver the reports originally requested by our Contracts Team within the Action Plan, we were therefore concerned we were unable to validate progress. 1st Grade Care has been working with the vendor of the system, it has now been concluded that they cannot provide the reports. However, the Provider has offered Contract staff the opportunity to view the system at the office to validate this action point. It is important to note that having an Electronic Monitoring System is not a condition of contract and not all providers have this facility. 1st Grade Care has been able to demonstrate that it has a robust system in place and that the office is appropriately staffed to monitor missed and late calls. The action plan has been amended to reflect this position.
  7. As stated earlier, it was reported in the Week In, Week Out programme that a member of staff was advised to leave a service user alone following a fall once she had contacted the ambulance. The member of staff alleged that she was told to go on to her next call by the agency, 1st Grade Care.
  8. The Protection of the Vulnerable Adult (POVA) Team in the Vale of Glamorgan was able to contact the member of staff. She confirmed that this was the instruction given and that she did leave the service user alone. She was unable to remember the date or time of year this occurred. She alleged that advice to leave the service user had been given on other occasions.
  9. Given the uncertainty about the date when the alleged incident took place, a detailed chronology was constructed, cross-matching information from several sources. It identified all falls that the service user had experienced during a fifteen-month period. All information held by a number of agencies confirmed that the service user was not left alone at any time. There is documentary evidence that domiciliary carers were present for a handover to paramedics on the occasion which appears to us to have been the one described in the programme. The POVA investigation found that on no occasion was the service user left alone following any of her falls while she was receiving support from 1st Grade Care. There had been no concern raised at the time of the alleged incident. The gap between the alleged incident and the Week In, Week Out programme is believed to be at least two years.
  10. In summary, the POVA team has fully investigated this allegation in collaboration with other relevant agencies, including the Welsh Ambulance Service, the provider, South Wales Police and CSSIW. The investigation concluded that that there is significant evidence which contradicts the claims made in the programme and the outcome is recorded as 'disproved'.

Resource Implications (Financial and Employment)

  1. During 2014/2015, the Council spent over £10 million on domiciliary services that were provided via contractual arrangements with the independent sector.
  2. Improved commissioning practices ensure that the right services are available, for the right people at the right time and that best use is made of the resources available within Social Services.

Legal Implications (to Include Human Rights Implications)

  1. Part 1 of the "Commissioning Framework and Good Practice guidance" is issued under Section 7(1) of the Local Authority Social Services Act 1970 and it provides standards with which local authorities are expected to comply. Commissioning practice should not place constraints on people's statutory rights to have their need for social care met by the services which the Council makes available under the relevant legislation. Legal Services are consulted in respect of issues in respect of commissioning and/or de-commissioning decisions.
  2. Part 2 of the framework provides good practice in commissioning and procurement. This is not a statutory requirement. Part 2 should be taken into account by anyone carrying out internal or external reviews of Local Authority performance.
  3. Domiciliary and day care services constitute a range of services which are generally provided or secured by Social Services Authorities with the aim of enabling the people who receive them to continue them to live in the community. The Welsh Government encourages the Council to make cash payments (direct payments) in lieu of community care services.
  4. The statutory basis or the statutory regime governing community based services are founded on the National Assistance Act 1948 and are to be found in various different legislation.
  5. The Care Standards Act 2000 creates the framework for the regulation of care services with details contained in Regulations and Guidance."

Crime and Disorder Implications

  1. There are no crime and disorder implications as a direct result of this report.

Equal Opportunities Implications (to include Welsh Language issues)

  1. Commissioning of care services has to ensure that these are accessible to all those eligible to receive them. This requires Equalities Impact Assessments to be carried out, where appropriate.

Sustainability and Climate Change Implications

  1. Effective delivery of commissioning responsibilities helps to ensure that the Council's assets are managed efficiently and effectively and that best use is made of the resources available for social care services, establishing sustainable models of assistance and support as well as contributing to the most appropriate ways of meeting the needs of vulnerable people.

Corporate/Service Objectives

  1. Commissioning activity contributes to the corporate priority of "working with partners to meet the diverse needs of our residents in ways that will safeguard and support those who are most vulnerable and in greatest need; help people to keep fit and healthy; and increase social cohesion and equality of opportunity for all."

Policy Framework and Budget

  1. This is a matter for Executive decision.

Consultation (including Ward Member Consultation)

  1. There are no implications for individual Wards as a direct result of this report.

Relevant Scrutiny Committee

  1. Social Care and Health

Background Papers

Commissioning Domiciliary Care Services from the Independent Sector - Scrutiny Committee (Social Care and Health): 13th July 2015

CSSIW Inspection reports

Contact Officer

Suzanne Clifton, Interim Head of Business Management and Innovation

Officers Consulted

Carolyn Goodall (Legal Services)

Janey Morgan (POVA)

Gaynor Jones (Contracting and Finance)

Responsible Officer

Philip Evans, Director of Social Services