Care service inspection report

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1 Care service inspection report Full inspection Bield at Home - Linlithgow/Biggar Support Service Westport Resource 1 St Ninians Road Linlithgow Inspection completed on 11 March 2015

2 Service provided by: Bield Housing & Care Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY page 2 of 38

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 3 Quality of staffing 3 Quality of management and leadership 3 Adequate Adequate Adequate What the service does well The service was started in response to Bields tenants' requests that they wanted Bield to provide their care at home service. Currently the service is providing a care at home service at the developments in Westport, Linlithgow, where the service has been expanded to people living in the local community and in Castlebrae glebe, Edinburgh. The service in Langvout Court Biggar remains part of the registration but did not provide care at the time of our inspection. The service is designed to be purchased directly from Bield by the person using the service via self-directed support. We found that the small number of people who used the service were very happy with the care and support provided. We also found enthusiastic and committed staff who demonstrated person centred values when they carried out their work. page 3 of 38

4 What the service could do better Inspection report The service must improve the systems to ensure medicines are always managed properly. Support plans also need to improve so that the person-centred care we saw being carried out can be done so consistently. The provider needs to consider how to ensure staff receive the training they need and that the lines of management and management responsibilities are clear. What the service has done since the last inspection This is the second inspection of this service. At the first inspection of the service we made requirements about the need to improve support plans, medication administration and staff training. We also made recommendations about the involvement of people who use the service and systems to monitor the quality of the service. The provider's action plan stated there were plans for review of the service in the areas we identified. We found that further work is needed to ensure good outcomes for people. Since the last inspection the provider has completed an evaluation of the service. Conclusion This is a valued care at home service that helps people live in their own homes. The service has some key strengths including the committed staff who demonstrated person-centred values. There are some parts of the service that must be improved to make sure care is always given reliably. page 4 of 38

5 1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was registered with the Care Inspectorate on 29 October Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Order or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Bield at Home Linlithgow and Biggar is a pilot care at home service developed in three existing sheltered housing services where housing support is already provided by Bield Housing Association. The pilot started in December 2012 at the sheltered housing developments in Langvout Court, Biggar and Westport, Linlithgow. In July 2014 a third development was added to the registration at Castlebrae Glebe in Craigmillar Edinburgh. The Castlebrae Glebe location has been added to the Care Inspectorate registration until the end of April 2015 initially. This service is part of a pilot project that also includes a service operating in Dunfermline, which is separately registered and inspected by the Care Inspectorate. The majority of current service users are tenants within Bield sheltered housing developments or in the surrounding areas in these geographical locations. Service users purchase the service using self directed page 5 of 38

6 support payments following an assessment of need by the local authority. They can also purchase the service privately. The aims and objectives of the service are stated as: Inspection report - 'To work with tenants, their families and other main carers to develop a responsive, needs led service which - enhances current service provision - To give tenants choice about the services that they purchase - To support people to live independently in their own home/tenancy - To provide a person centred, flexible service - To help maintain tenants within their current tenancies.' The support available includes assistance with domestic tasks, personal care, administration of medication, shopping, travel to appointments or day care services, social contact and hospital discharge. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people page 6 of 38

7 using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 3 - Adequate Quality of staffing - Grade 3 - Adequate Quality of management and leadership - Grade 3 - Adequate Inspection report This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. page 7 of 38

8 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection The Inspector made an announced visits to the two parts of the service providing a care at home service, at Westport, Linlithgow and at Castlebrae Glebe Edinburgh. Due to the nature and distances of the services we prearranged these visits. We visited clients who used the service operating from Westport in Linlithgow on Wednesday 25 February 2015 between 8am and 4pm when we also spoke with the sheltered housing manager. We visited the part of the service operating from Castlebrae Glebe Edinburgh on Thursday 26 February when we spoke with one client and the sheltered housing manager. We requested information from the named manager and received this by . We gave feedback to the manager and the manager of Westport Resource centre on Wednesday 11 March At the time of the inspection there were eight clients receiving a service from Westport in Linlithgow from three staff. As part of the inspection we met four clients and two staff. There were two clients and two staff using the service from Castlebrae Glebe and we met one client and one staff member. We also sent out 40 care standard questionnaires to people who use the service and received 11 responses. Some of the responses received were from the clients who used the non-personal care service operated from Langvout Bank, Biggar. During the inspection we spoke with the sheltered housing managers, care staff, the service manager and the named manager of the service. We also spoke with relatives of people using the service. As part of the inspection we sampled the following: Care files page 8 of 38

9 Risk assessment documents Individual contracts/agreements How to make a complaint booklet Complaints handling procedure Satisfaction survey analysis Employee rotas Medication Administration Records (MARs) Medication audit documentation Service User Guide Team meeting minutes A sample of electronic care records Bield business strategy Service evaluation and action plan Recruitment and selection policy/procedure Interim medication policy and procedures (support services care at home) Adult support and protection good practice guidelines Abuse of Vulnerable Adults policies procedures and guidelines Participation strategy for service users and carers Values, vision and mission statement. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. page 9 of 38

10 Fire safety issues Inspection report We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at page 10 of 38

11 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a self-assessment document from the provider. This was a relatively new service which was becoming established and this may account for the lack of detail within the document. There was some relevant information which we used to choose our sample of evidence. Taking the views of people using the care service into account At the time of the inspection the service were operating over three locations. At Langvout Court Biggar, there were no clients using the service for personal care, these clients were receiving domestic support. We did not visit this location as part of the inspection but received positive responses from people who used the service in care standard questionnaires. At Castlebrae Glebe in Edinburgh, there were two clients receiving the service and we spoke with one client and two family members. At Westport in Linlithgow, there were eight clients using the service and we spoke with four clients. All of the comments we received were positive about the service. Some of the positive comments we received included: 'Very happy with the service for (my relative), don't know how we'd manage without it', 'I find the staff from Bield( (Westport) very helpful and pleasant. They treat us as human beings in a happy atmosphere', 'Happy with service so far', 'I can only say all staff have been excellent, doing a great job. This is a really page 11 of 38

12 great service', 'The service has been very good to date, all the carers are pleasant and efficient', 'I'd rather have Bield helping me as I've had other agencies but they never turned up', Taking carers' views into account We spoke with two carers during the inspection. Some carers responded to us through care standard questionnaires. Overall carers were very happy with the care at home service. page 12 of 38

13 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service Strengths In order to assess this statement we looked at the services relevant policies and procedures. We also looked at the results of the last client, relative and stakeholder satisfaction surveys and how any comments raised had been responded to. We took into account information we saw in clients' homes and what people who used the service and their families told us during the inspection. We also listened to the views of staff. We found that the service provided some opportunities for clients and their families to participate in assessing and improving the quality of care and support. At Castlebrae Glebe there was an information booklet which contained a range of useful information about the service, client's rights, the standards and quality of service promised by the service and details about how to make a complaint. This guide also contained contact details of the Care Inspectorate and the Scottish Public Services Ombudsman. In addition each client had a service user agreement which outlined the details page 13 of 38

14 of the terms and conditions of the service and included information about reviews of the service. There was guidance for staff in how to respond to complaints. Staff said there had been no complaints made about the service. page 14 of 38

15 We saw letters of thanks from clients' families at the Westport office. These expressed how families appreciated the support of the service and said how having the service had helped their relatives remain at home. We also heard directly from family members at Castlebrae Glebe who were also delighted with the service for their relative. The services quality framework said that client satisfaction surveys should be sent out twice a year. The most recent survey results available were from May We found that the results from this survey had been collated. 17 clients had responded. Five were clients from Langvout Court, eight from Grantsbank and four from Westport. All of the comments were positive and clients said they were satisfied or very satisfied with the quality of care and support received from Bield at Home service. Each client had the opportunity to comment on the service at six monthly care review meetings. These meetings give clients the opportunity to discuss how the delivery of care and support affects their individual circumstances. We saw at Westport care reviews were carried out and there was an electronic system to alert the sheltered housing manager when they were due. Castlebrae Glebe clients were new and reviews had not yet been carried out. In the client files we sampled we saw that the care plan had been signed by the client. This suggests that they had been involved in agreeing their care and support. The sheltered housing manager who coordinated the Linlithgow service from Westport was new. She recognised the need to meet all of the clients personally and ask them about the service they received. The sample of clients we visited knew all of the staff, the sheltered housing manager and senior managers by name. Most said they would phone or ask their family to phone on their behalf if they had any concerns. We sent 40 questionnaires for the service to send out to clients and we received 11 responses. We also visited five people who receive this service in their own homes. All of the clients who we met and who responded to questionnaires were very pleased with the service they received. page 15 of 38

16 Overall we found that the service offered a good range of ways for clients to be involved in participating in assessing and improving the quality of care and support provided. Areas for improvement Plans to develop a newsletter for the service had not yet been carried out. We thought this could help the service keep residents and relatives informed with the developments of the service and a good way for the provider to ask for feedback. Although the results of the last customer satisfaction questionnaire had been collated we thought more could be done to report back to clients the overall findings and any emerging themes and actions. We discussed how the service could use their planned newsletter to do this. From our evaluation we thought the services at the three locations were developing in different ways, because of this we thought it may be better to collect the views of the people who use the service separately. This means the service can respond specifically for each area. At the last inspection of the service we noted that the providers' participation strategy had not been reviewed to ensure it met the needs of people receiving a care at home service. A participation strategy sets out the ways that people can make their views known about the service and also states how they can influence decisions about improvement in the quality of the service. The action plan from the provider told us that the participation strategy was due to be reviewed and anticipated this would be completed by November We found the participation strategy in use was dated November 2011 and the review had not been completed as planned. We made a recommendation at the last inspection which we have made again. See recommendation 1. Opportunities could be expanded and developed to ensure all clients can contribute regularly such as those who are unable to complete a questionnaire or those who have communication difficulties. page 16 of 38

17 We have awarded a good grade because the people who used the service had opportunities to make comments about their service they received and because the number of clients and staff group was small these requests could be responded to. The provider needs to ensure that as the planned growth of the service takes place that it has the systems to ensure a good level of service is maintained. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. The provider should develop the participation strategy so it is tailored for the Bield at Home service. This should include how the provider plans to engage with service users and their families/representatives and evidence how the comments made have been used to improve the service. This takes account of National Care Standards Care at Home, Standard 11 Exercising your rights. page 17 of 38

18 Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths We did not look at all aspects of health and wellbeing during this inspection. In order to assess this statement we looked at care files in clients' homes, risk assessments, the medication policy and protection of adults from abuse policy. We also visited clients in their homes and listened to what they said about their care. We also spoke with relatives and staff. We saw that support plans contained a photograph of the client as well as details of who should be contacted in an emergency. They also contained a care needs summary. At Westport the support plans set out and included the current need, the expected outcome for the support being provided and any actions needed. The staff we spoke with were aware of the value of supporting clients to maintain their independence as much as possible. At Castlebrae Glebe a paper based system was used for the support planning as there was no access to the electronic system. The support we saw was carried out in a very caring and understanding way. Staff were compassionate and treated clients with respect, checking on health and wellbeing. Visits were unhurried and carers and clients had a good rapport. From the records we viewed and staff we spoke with we concluded that carers who had concerns about the health and wellbeing of clients sought advice appropriately and made referrals to health care professionals. We saw that six monthly review meetings were taking place involving clients and their representatives. We found there was a call monitoring system in place where staff kept a page 18 of 38

19 written record of the time of their visit. This could be monitored by the manager and provided a clear record of who had provided support and the consistency of visit times. We also sampled contact notes and saw that staff made an entry for all visits. There was no evidence of any missed visits. This was confirmed by those service users we met with. This is an important strength of the service as clients said dependability and reliability is important to them. At the last inspection we had concerns about the management of medication. We saw that the service had worked hard to address these. Some improvements had been made and some areas for development remain. These are described below. page 19 of 38

20 We were given a copy of the interim medication policy and found this was used to inform staff practice. All staff at Westport had been given medication training during their induction. Where medication was part of the agreed care and support, there was a monitored dosage box which was prefilled by a pharmacist. We saw that staff followed the medication policy during our visit to clients' homes when helping them with their tablets. We looked at six support plans and associated documents in clients' homes. We found that the plans we sampled had an initial risk assessment. Clients had a written agreement about what was being provided and the times of the agreed visits. Clients had signed their agreements and care plans which suggest they were involved in the assessment. Areas for improvement At the last inspection we made a requirement about medication. This was based on a visit to Westport Linlithgow. At this inspection we visited both the Westport base and the Castlebrae Glebe base. Medicines were supplied differently in each service. At Castlebrae Glebe medication was sent in monitored dosage devices with medication administration charts (MAR) by a community pharmacists. At Westport MAR charts were being written up by the sheltered housing manager. This practice did not follow the providers interim medication policy and procedure. We have asked the manager to review this and send us information about how it will ensure staff are able to follow the providers' medication policy and procedures. See recommendation 1. At the last inspection we made a requirement about medication. This was because there were gaps in recording that did not show whether medicines had been given and also because there was no audit trail of who had prescribed some medicines. We found the same issues. At this inspection staff said that the gaps were because family members were giving the medicines at those times but staff had not recorded this on the MAR. The MAR sheets produced by the service did not contain the usual section where an explanation for omissions or discrepancies could be recorded. page 20 of 38

21 Where the responsibility for administering medication is shared with another party, such as family or another agency, this should be detailed in each individuals support plan. The relevant support plans we looked at did not contain this. We found handwritten entries on the MAR charts when it was not clear who had prescribed the medication. Although there was some audit of medication records this had not identified or addressed the issues we found. We have amended the previous medication requirement to reflect our findings at this inspection. See requirement 1. At the last inspection we noted that recordings in support plans were not consistent for all clients. We looked at support plans in both Westport and Castlebrae Glebe. We noted that one service used an electronic Caresys system but the other could not access this. Each location recorded information in a different way. In both areas we saw and heard from staff and people who used the service. We found that staff had a lot of information about peoples needs and how they liked these to be met. However we found that this individualised information was not recorded. While the clients needs are being met by a small staff group the verbal transfer of information maybe enough. However there is a risk as the service continues to expand that vital information may be lost. This could affect outcomes for people who use the service. Some support plans were a risk assessment rather than the plan. Risk assessments are needed as part of the assessment of needs. This should lead an individualised and personalised support plan which details the clients needs and how these needs should be met. The person using the service and/or their representatives should have a key role in this process. When care is delivered this needs to be evaluated to ensure the planned care continues to meet clients needs. We have made a requirement about support plans again. See requirement 2. We noted that staff rotas indicated that staff should be in two different homes at the same time and did not allow staff time between visits. This was particularly for some clients who lived within a sheltered housing facility. We discussed the difficulties that this caused for staff with the local manager who agreed to ensure that there is time for staff to move between houses and that this is recorded on the rota. page 21 of 38

22 One client who needed help to transfer did not have a moving and handling risk assessment. This is important as it helps staff to think about parts of care that could pose a hazard and ways to help safely. See requirement 2. Grade 3 - Adequate Requirements Number of requirements - 2 Inspection report 1. The provider must ensure that all medication is administered and recorded in line with best practice. This must include but is not limited to ensuring that: - when medication has been taken that there is a record of this in the MAR - when medication has not been given that there is a record of this in the MAR - staff know how to use the codes supplied on the MAR sheets - action plans are used to record issues identified as a result of medication audits and the action that has been - taken to address the issues. - it is clear who has authorised handwritten entries on the MAR charts. This is to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210 Regulation 4 (1)(a) a requirement about welfare of service users. Timescale: To commence within 24 hours and be achieved within seven days of receipt of this report. 2. The provider must ensure that residents' personal support plans are an accurate reflection of their current need and contain sufficient detail for staff to provide support in a consistent and personalised way. This must include, but is not limited to ensuring: - risk assessments are fully completed to identify and consider any actual and potential risks. - support plans include details of all information from a detailed assessment of needs which may affect how care and support is to be delivered page 22 of 38

23 - that support plans contain relevant information regarding medication administration - that care is evaluated - that there are detailed records of six monthly review meetings - that referrals are made to other agencies when needs are identified, for example for a moving and handling assessment. This is to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulation 2011, SSI 210. Regulation 4(1) (a) a requirement about welfare of service users and Regulation 5 a requirement about personal plans. Timescale: To be achieved by 30 July Inspection report Recommendations Number of recommendations The manager should send information to the Care Inspectorate describing how they will ensure staff will be able to follow the providers' interim medication policy and procedure at the part of the service operating from Westport, Linlithgow. This takes account of National Care Standards Care at Home Standard 2 Management and staffing arrangements and Standard 4 Support arrangements. page 23 of 38

24 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The service continued to perform at an adequate level in relation to this Quality Statement. Some of the strengths in participation already identified in quality of care and support statement 1 also apply to this quality statement. The idea of setting up this care at home service had come from tenants already using the providers' sheltered housing who said they would prefer that their support was delivered by staff employed by Bield. We spoke with some care staff who already worked in other parts of the providers services, these staff offered some continuity for clients as they were already known to them. In the self-assessment the manager told us that tenants staff and carers were involved in a steering group to set up the service. Areas for improvement This is a small service which is starting to establish staff teams. Initially most staff had been employed on a casual basis with no opportunity for people who use the service to be involved in staff recruitment. However, we thought there may be opportunities to ask residents and relatives if they wished to be involved in staffing matters, staff training, as part of staff development and annual appraisal. We recognise that the opportunities for the provider to involve people in staffing would have been limited while they set up this new service. We would hope that by implementing the providers' participation strategy and providing training for staff in the strategy that further improvement would be made. page 24 of 38

25 Grade 3 - Adequate Number of requirements - 0 Number of recommendations - 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths In order to assess this statement we observed interaction between staff and residents, looked at records, spoke with staff and people using the service. We also looked at staff supervision and staff training. At the time of the inspection there were three home care assistants employed to provide care and support to eight clients from Westport and two staff providing 50 hours of support to two clients at Castlebrae Glebe. We spoke with three home care assistants during the visits to the premises. We saw positive interactions between care staff and clients. The interactions demonstrated dignity and respect for the clients as well as person-centred values. Comments about staffing made to us by clients confirmed our observations. Initially staffing for the service was provided by casual staff who were already employed in other services offered by the provider. As more people began to request the care at home service,the project manager recognised that this structure did not provide the stability or continuity of service that they wished to provide. During this inspection we saw that recruitment had taken place to employ staff specifically for the care at home service. Staff who were recently employed had received induction training and this was recorded in staff training records. This meets part of a recommendation which we made at the last inspection about ensuring that induction training is recorded. page 25 of 38

26 Both managers we spoke with at Westport and Castlebrae Glebe said that all home care assistants staff will be given the opportunity to apply for a Scottish Vocational Qualification (SVQ). One carer had started the course at Westport and when they have completed this, another staff member would be offered this opportunity. One manager also said that the provider was looking at how they can support all staff to achieve a qualification such as an SVQ, to enable them to register with the Scottish Social Services Council (SSSC). This is the body which will ensure that people working in care services are qualified and registered for their role. Employers will have to ensure that employees are registered according to the role they perform. The register will open for workers in care at home services in The provider had identified training in dementia care, called dementia awareness. New carers at the Westport location had received this during induction. Some staff already employed by the provider also had received training. We talked with the manager about the need to match this training with the Scottish Government's Promoting Excellence Framework and to have a strategy in place to show how and when they will support staff to achieve the necessary levels of training. The training programme is provided by the NHS and Scottish Government to promote an understanding of dementia in the wider community, but also to ensure that all staff working with social care are trained to an appropriate level in dementia care. We will follow-up progress with this at our next inspection. At the last inspection we made a requirement that staff receive training in administration and recording of medication. We noted that this training had been completed and this requirement is met. We had some concerns about medicines management which we have described in Quality of Care and Support Statement 3 and Quality of Management and Leadership Statement 4. At the last inspection we made a recommendation that a systems was put in place to record and monitor staff training and the impact that this has on staff competence and outcomes for service users. We saw records of training that had been completed and found evidence of medication competency being checked. However more work was needed to plan staff training which we have detailed below. page 26 of 38

27 When we looked at staff supervision we found this varied between each location. Castlebrae Glebe staff had a three month supervision interval which was well established and took place as planned. This differed from Westport which we have described below. Currently a sheltered housing manager has taken on the additional responsibilities of co-ordinating the care at home service during normal working hours. We saw that at times there were competing demands from the different services for which they had responsibility. In order to address this the provider has put plans in place to employ a co-ordinator at Castlebrae Glebe who will co-ordinate that part of the service. No plans had been made about the services at Westport or Langvout Court for a similar post. We have made further comment about this in Quality of Management and Leadership Statement 4. Areas for improvement At the last inspection we made a requirement that all staff with supervisory and management responsibilities are appropriately trained and supported so they are able to respond in line with best practice to any allegations regarding staff conduct. In response to this the providers action plan said that Adult Support and Protection was planned to take place on 30 May 2014 and that notification procedures would be reviewed with staff at supervision. When we checked the training records of staff we found that not all staff had received training in adult support and protection. We also found that the policy did not make it clear to staff how they made a referral or contain the relevant contact details to do so. It is essential that all staff and especially those who work out of hours have access to this information to prevent unnecessary delays where they suspected a vulnerable adult is at risk of harm. We have made the requirement again with amended wording to allow this work to be completed. See requirement 1. We found that the systems for staff supervision varied between each location. At Westport staff were asked to plan to meet every six - eight weeks with their manager. Bield had a toolkit to help implement their support and supervision and appraisal training but most staff had not completed this yet. Part of the system included agreeing and signing a supervision contract but from supervision records chosen at random we found this was not always in place. The service had a system for continuous personal development. When fully page 27 of 38

28 implemented this could be used to extend staff skills, knowledge and understanding as part of supervision and appraisal meetings. It could also be used to identify staff training needs. The provider should consider using their quality assurance systems to ensure consistency of practice across the locations of the service. We discuss quality assurance processes in Quality of Management and Leadership Statement 4. We will monitor the services progress to achieve this and report at future inspections. Staff training responsibilities were split between the providers learning and development department and by local resource managers and sheltered housing managers. We saw that training completed or booked was recorded. In addition there was some e-learning. However, there was no staff training needs analysis. This helps managers analyse the training needs and helps the manager plan staff training. During our inspection we found that one member of staff had not received moving and handling training but was working with people who may have needs in this area. In addition there was no plan for the staff with day-to-day management responsibilities to have training for the additional responsibilities that the new service brought to their role. We note that the providers' evaluation of the service has made recommendations about training which they should take forward. In addition a clear training plan which has management oversight is needed. See recommendation 1. We spoke with staff about how they communicate important information to each other and access information about clients when they are working out of hours. Staff have developed systems to pass on information to their colleagues before they go on days off. These systems rely on the flexibility of staff who are willing to be contacted when they are not at work. While this has provided continuity for people who use the service, the manager should consider the long term sustainability of these arrangements. Overall, we found that staff were well motivated and helped to ensure clients received a service which was dependability and reliability. There was continuity of care worker and there were no missed visits which helped people who use the service to have confidence in the care and support they received. These are key strengths in a care at home service and these have influenced the grade page 28 of 38

29 awarded. However the provider needs to progress the areas of development to ensure staff are supported. Grade 4 - Good Requirements Number of requirements - 1 Inspection report 1. The provider must ensure that all staff with supervisory and management responsibilities are appropriately trained and supported so that they are able to respond in line with best practice to adult protection concerns. This must ensuring that staff know how and when to notify other agencies. This is to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a) a requirement about welfare of service users and Regulation 15 (b) (i) a requirement about staffing. This also takes into account National Care Standards Care at Home Standard 2 Management and Staffing arrangements. Timescale: To be completed by 30 July Recommendations Number of recommendations It is recommended that the service progress staff training and development needs as identified in their evaluation. In addition a training needs analysis which includes both training provided through the training department, e- learning and training provided locally should be developed. This should be monitored by a manager to ensure staff receive training for the work they do. This takes account of National Care Standards Care at Home Standard 2 Management and staffing arrangements. page 29 of 38

30 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service Strengths The service continued to perform at an adequate level in relation to this Quality Statement. Some of the strengths in participation already identified in Quality of Care and Support Statement 1 and Quality of Staffing Statement 3 also apply to this quality statement. Areas for improvement We recognise that the opportunities for the provider to involve people in management and leadership would have been limited while they set up this new service. We would hope that by implementing the providers' participation strategy and providing training for staff in the strategy that further improvement would be made. Grade 3 - Adequate Number of requirements - 0 Number of recommendations - 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide page 30 of 38

31 Service Strengths Bield at Home was initially set up as a pilot project to provide a care at home service for tenants within or in the local surrounding areas of three sheltered housing complexes run and managed by Bield. The service is designed to be flexible and people who use the service can drop in or drop out of the service as they wish. As part of their quality assurance processes the provider has gathered feedback at two points during the pilot, in January 2013 and May Feedback results included Grants Bank which is regulated separately by the Care Inspectorate and did not include Castlebrae Glebe as this is a relatively new part of the project. We could see that the feedback received was helping the provider to make decisions about how to develop the service. In addition the provider was gathering information to identify whether they could meet similar needs in other of their premises. Feedback from staff and other stakeholders had led to the decision to appoint a co-ordinator at Castlebrae Glebe. The on-call arrangements for management support and out of hours contacts differ at each location. Through listening to staff and people using the service, the provider had recognised that the current arrangements may not be sustainable as the service grows. They had recognised the need to put a more sustainable arrangement in place. We will follow up developments with this and the impact on outcomes for people who use the service at the next inspection. Areas for improvement Staff meetings had been held at Westport. We could see that a range of relevant issues had been discussed. It was unclear how the issues raised were taken forward with the manager. This was because of the organisation and management arrangements that are currently in place. Our findings suggested that each of the areas were operating differently. This was because the needs of people differed in each of the three locations. For example Langvout Court tenants requests for domestic support, Westport tenants and people in the local area requested a more traditional care at home service and Castlebrae Glebe tenants requested more intensive support. We also found that the staff member taking day-to-day management decisions at each location is not named as the manager. The overall named manager for the Bield page 31 of 38

32 at Home service is the project manager for the pilot project. In addition the day to day manager at each location also had management responsibilities for other services and had different line managers for these services. It could be difficult for staff to separate issues and to know which line manager should deal with each matter. In conclusion we found the line management structure and lines of accountability were unclear. We have discussed our findings with the providers' representatives. The providers' own evaluation of the service had recognised that the branches needed to be organised appropriately. See recommendation 1. Although some audits were in place we found that the service needed to continue to develop a broader range of audits, and to use the information from them more effectively. This would help to identify where improvements in the service were being made, and where more work was needed. For example, the improvements needed to care planning and medication recording as we have described in Statement 3 of Quality of Care and Support. Our findings showed that information from audit was not always achieving the desired outcomes in staff practice. We made a recommendation at the last inspection and have made this again. See recommendation 2. Grade 3 - Adequate Number of requirements - 0 Recommendations Number of recommendations - 2 Inspection report 1. It is recommended that the provider review the management arrangements within the service to ensure that the lines of accountability are clear. The review should include consideration of the roles and responsibilities of the day-to-day and overall management of the service. This takes account of National Care Standards Care at Home Standard 2 Management and staffing arrangements. This also takes into account Scottish Social Services (SSSC) Code of Practice for Employers Section 1.4, 2.3 & It is recommended that the provider puts into place effective systems for assessing and monitoring the quality of all aspects of the service, this could page 32 of 38

33 include a range of audits and checks to gather information about the performance of the service, and this information should be made easily available to the manager. Following from these audits and checks, there should be a clear record of what areas for improvement were identified, what actions are to be taken to address those areas for improvement identified, timescales for the actions to be completed. Where actions are completed this should be clearly recorded with the person with overall responsibility ensuring actions have been taken. Information from individual checks or audits could be analysed to identify patterns or trends which might indicate that further action is necessary to improve the service. This takes account of National Care Standards Care at Home. Standard 2 Management and staffing arrangements. 5 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must review support plans to ensure they are an accurate reflection of current need. This must include, but is not limited to ensuring: - there is a detailed support plan in place for all service users - full details of those parties with legal responsibilities and the extent and limits of these responsibilities are recorded - there are detailed records of six monthly review meetings with action plans -support plans include details of all appropriate medical information which may influence how care and support is to be delivered - referrals are made to other agencies for diagnosis/support as required - service user agreements are completed in all cases - risk assessments are fully completed and in place for any risks linked to care and support needs as well as within the environment in which care and support is being delivered. page 33 of 38

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