Statement of Purpose Template
Section 1: About the provider	
Service provider	This should be the name of registered provider	
Legal entity	Individual 							
	Limited company					
Public limited company				
Limited liability partnership				
Charitable company					
Charitable incorporated company			
Other corporate body					
	Committee						
Charitable trust					
Other unincorporated body					
	Local Authority						
	Local Health Board						
	Partnership							
Responsible individual	This should be the name of the person designated as the responsible individual	
Manager of service	This should be the name of the person who will manage the service on a day to day basis. 	
Name of service		
Address of service		

Section 2: Description of the location of the service	
a)	Accommodation based services
This section should include where the service is located and a description of the area, community facilities and services available to support the range of needs of the people the service is intended for as described in section 3

b)	Community based services e.g. domiciliary support services 
This will be the regional partnership area in which the service is provided please refer to the Statement of Purpose guide for a full break down for each regional partnership area.	
 (tick the area where the service is provided)	
Gwent regional partnership board						
North Wales regional partnership board					
Cardiff and Vale regional partnership board					
Western Bay regional partnership board					
Cwm Taf regional partnership board						
West Wales regional partnership board					
Powys regional partnership board						

	

Section 3 About the service provided	
a)	Range of needs we can support	
In this section describe the range of health or care needs the service will provide support for, including any specialist services/care provision.
Detail the care and support the service offers and to whom
It is important that you describe the range of needs your service is able to meet.  Your service will need to be flexible and therefore may not necessarily be meeting all of these needs all of the time.  This is because people’s needs change and services need to be adaptable in responding e.g. increasingly frail elderly people who can have a wide range of changing needs including palliative care towards the end of their lives.	
b)	Age range of people using the service		
c)	Accommodation Based services 
	Maximum Capacity

Detail the number of people able to use the service, for example in a residential setting, this will be the maximum number of people who can be accommodated	
d)	Community based services only
	Number of Care Hours delivered
Detail the average number of care hours delivered per week. (tick the relevant box)
0-250 	 					
251-500					
501-750					
751-1000					
1001-1500					
1501-2000					
2001-3000					
3000+						

Section 4: How the service is provided	
In this section, you should set out clearly how you intend to provide the service.  You should describe how you will support people to achieve their best possible outcomes and provide care and support in a way that protects, promotes and maintains their independence, safety and wellbeing. If you have said that specialist care is offered, you must use this section to detail what makes it a specialist service.  You should include details of any specific models of care being used at the service and the involvement of any external specialist agencies that will provide help and support in areas of expertise.
This section should also include:	
a)	Arrangements for admitting, assessing, planning and reviewing people’s care
•	Arrangements for managing planned, urgent and respite admissions
•	Arrangements for initial and ongoing assessment of care and support needs
•	How the personal plan will be developed and reviewed in consultation with the person receiving care and support and or their representative
	
b)	Standard of care and support
Where appropriate, this needs to describe how the service will support people to:
•	be as physically, mentally and emotionally healthy as possible;
•	be safe;
•	be involved in activities, hobbies or individual interests;
•	access education, learning and development opportunities;
•	have control over everyday life and where relevant participation in work;
•	maintain their linguistic, cultural and /or religious identities;
•	maintain family and personal relationships; and develop their potential, learn and practice life skills.	
c)	Language and communication needs for people using the service 

This section should also describe how the provider will meet people’s language and communication needs including the extent to which the service makes provision for the Welsh language offer (Welsh Government information pack on the active offer ).	

Section 5: Staffing arrangements	
This section needs to describe how the staffing arrangements are appropriate for the range of needs and specialist services to be provided as described in section 3.
It should demonstrate how staff will be deployed to provide reliable and safe care to individuals.  

This should include the following:	
a)	Numbers and qualifications of staff	This section should include the numbers and qualifications of the following staff: 
•	manager and their specific qualifications;
•	deputy manager and their specific qualifications;
•	other supervisory staff and their specific qualifications;
•	registered nurses and the nature of their registration e.g RGN, RMN, RNLD etc;
•	senior social care staff providing direct care and a description the qualification levels i.e. level 2/3 QCF**;
•	other social care staff providing direct care and a description the qualification levels i.e. level 2/3 QCF** and
•	other types of qualified staff not listed above and a description the qualification levels.
Where specialist care e.g. dementia, palliative care etc is provided, you must be able to demonstrate the staff qualifications, training and skills to provide this specialist care. 
The number of staff required should be sufficient to draw upon to sustainably and reliably meet the needs of a typical rota.
**In the case of domiciliary support service, you may wish to provide the total numbers of social care staff working in an average week, the total number of staff hours per week and description the qualification levels i.e. level 2/3 QCF.	
b)	Staff levels	This section should include the day time and night time staffing levels that will normally be in place. This is the planned number of staff on a day to day basis the service will deploy i.e. the typical rota.
•	In care home services where individuals are assessed as requiring 24 hour nursing care (due to the intensity, complexity and/or acuity of their needs), this section should describe the number of registered nurses that will be working at the service at all times. 
	
c)	Specialist staff	In this section record the number and details of specialist staff. 
	
d)	Deployment of staff at service (for accommodation based services only)	In this section describe how the staffing will be deployed across the care environment / accommodation design and layout to oversee and meet the needs of those individuals. This is of particular importance for multi-floor or multi-building sites. 
In describing staffing levels, you may have fixed numbers or ratios. You should explain how dependency levels are factored into your determination.
You may wish demonstrate the staff structure by a diagram.	
e)	Arrangements for delegated tasks 
	In this section detail the governance arrangements for the delegation of any specialist care tasks or decision making.
Demonstrate how staff will be deployed to provide reliable and safe care to individuals	
f)	Supervision arrangements	In this section detail the supervision and support arrangements, particularly for care and support staff.
	
g)	Staff training	In this section detail the staff training programme.	

Section 6: Facilities and services	
Accommodation based services only 
This section is where you should describe the design, layout, facilities and/or equipment available and how they support the range of needs of the people the service is intended for as described in section 3 above. If there are any unique or specific features about these, you should describe them here.
N.B. This section does not apply to supported living arrangements	
You should provide information about:	
a)	Number of single and shared rooms	Detail the number of single and shared rooms	
b)	Number of rooms with en suite facilities	Detail the number of rooms with en suite facilities	
c)	Number of dining areas	Detail the number of dining areas	
d)	Number of communal areas	Detail the number of communal areas	
e)	Specialist bathing facilities	Detail the specialist bathing facilities at this service	
f)	Specialist equipment	Detail the specialist equipment at this service	
g)	Security arrangements in place and use of CCTV 	Detail the Security arrangements in place and use of CCTV	
h)	Access to outside space and facilities at this service	In this section describe the outside space and facilities available and how these can be accessed by people
It is important that you describe how the environment and facilities support people with impairments to have as full a life as possible and to have access throughout the home and its surroundings.	
i)	Community based services only:
In this section you should;
•	provide information about the facilities to; securely store records; 
•	meet with people using the service;
•	provide staff training; and
•	meet with staff.	

Section 7: Governance and quality monitoring arrangements
	
In this section, you should describe the oversight and governance arrangements in place to establish and maintain a culture which ensures that the best possible outcomes are achieved for individuals.  
This should include the arrangements for: 
•	how the responsible individual will maintain oversight of the management, quality, safety and effectiveness of the service including frequency of visits to the service;
•	management structure of the service, lines of accountability, delegation and responsibility;
•	the measures that will be used to monitor, review and improve the quality of care and support;
•	arrangements for dealing with complaints and
•	arrangements for consulting people using the service, staff and other stakeholders to affect the way in which the service is delivered and improved