Welsh council failing to assess risks to vulnerable adults, finds inspection

A Welsh council has been criticised for failing to properly assess risks to vulnerable adults after an inspection found no evidence that assessments were being completed.

Inspectors found “nothing” that identified risk in care and support plans produced by Newport Council’s adult social services, despite the high levels seen in some cases.

In one case, a new provider was identified for an individual who had previously exhibited abusive behaviour towards care staff, but no risk assessment was carried out and no interventions had been put in place to address or manage the person’s behaviour.

This approach was “unacceptable” and needed to be addressed as a matter of urgency, before it placed individuals and their carers at risk of serious harm, the Care and Social Services Inspectorate for Wales (CSSIW) said in its report.

The inspection took place in November and December 2014 and focused on the quality of outcomes for older people with complex needs.

The report also stated there was little evidence of contingency planning in high risk cases, or of practitioners supporting adults to take risks in a positive and person-centred way.

“Crisis culture”

The inspection found the quality of care and support plans was otherwise adequate, but services focused too much on managing crisis, rather than preventing it.

The “culture of responding to crisis” meant there was little transfer of skills to individuals, leaving them with little idea of how to manage their own care and support arrangements or deal with further crises, the report said.

This also led to problems within the council’s own residential homes, where people were placed inappropriately when other arrangements broke down. If practitioners had completed more timely reviews, people would not have been allowed to remain in situations that were not meeting their needs, the report said.

“Extreme frustration”

The council was also criticised for its “dysfunctional” point of access arrangements, which service users reported as being extremely frustrating.

Some people expressed concerns at having to provide very personal information to call centre staff with no social care training and a number of individuals had no idea how to contact social services or their social worker if they had one.

The inspection identified numerous entry points to social care that meant people would have significantly different experiences of the system, depending on the route they came through.

Improvements to the adult social care response system were due to be made in January 2015, but the current approach was “not adequate” for people who need to make a referral in potentially distressing circumstances, the report said.

“Promising signs”

The report did praise the council for a number of improvements, including the development of a social care hub at the Royal Gwent Hospital, which had reduced delayed transfers of care and facilitated a more integrated approach to hospital discharges.

It said the Protection of Vulnerable Adults (POVA) team was providing a “professional and responsive” service and senior managers were taking steps to address the concerns raised by the inspectorate. However, the scale of changes needed would require the full commitment of elected members.

Inspectors concluded that the council faced “significant challenges” in delivering care and support for older people with complex needs and made a series of recommendations.

These include the development of a more robust approach to risk assessment, a more outcome-focused approach to assessing the need of older people, and being clear about where the responsibility lies for care management and reviews.

The report also recommended that staff define a pathway for older people that clearly sets out the team structures, supporting systems, tools and processes.

Paul Cockeram, cabinet member for social care and wellbeing at Newport Council, said: “Newport Council has already put in place the majority of the recommendations made by the report and it is anticipated we will be fully compliant by the end of June.

“The recommendations were consistent with our own priorities, which form part of a programme of transformation we are currently undertaking. I’m pleased the inspectors found some positive signs of improvement and that senior managers were not only aware of concerns, but were taking steps to address them.”