Care service inspection report

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1 Care service inspection report Full inspection SSCN Social Care Housing Support Service Suite 3, Floor 2 ELS House 555 Gorgie Road Edinburgh Inspection completed on 03 May 2016

2 Service provided by: Support and Social Care Network Ltd 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 28

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 4 Good Quality of staffing 2 Weak Quality of management and leadership 3 Adequate What the service does well The manager of the service had very good knowledge of all service users' care and support needs. Feedback from the service user and relatives we spoke with confirmed there was a consistent team of staff providing the care; visits were largely on time and care staff stayed for the designated support time. We were told that care staff were friendly, courteous, polite and pleasant. Care staff treated service users with dignity when providing personal care. Care staff treated both service users and their relatives with respect. Staff had received training appropriate to the work they performed. Care staff we spoke with evidenced they had a good understanding of the correct procedures to follow if they identified potential adult protection issues when providing care and support. page 3 of 28

4 What the service could do better There were two key areas for improvements:- - The recruitment of all care staff needs to be undertaken safely at all times. - Policies and procedures need to be reviewed and updated so they are relevant and specific to the service and take into account current best practice guidance and Scottish legislation. What the service has done since the last inspection This is the second inspection of SSCN Social Care since it registered with the Care Inspectorate on 23 April It is registered to provide a combined Care at Home service and a Housing Support service. At the last inspection there had been five service users. At this inspection we found three of those service users had ceased receiving a service. Two new service users had commenced receiving the service over the last few months. At the time of this inspection there were four people receiving a service from SSCN Social Care. Conclusion We found the service had met one of the two requirements and one of the two recommendations made at the last inspection. One additional requirement and four additional recommendations have been made at this inspection. The service must progress with meeting the requirements and recommendations as part of the overall service development programme. This includes areas of improvement we have stated we will follow up on at the next inspection. page 4 of 28

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 registered with the Care Inspectorate on 23 April SSCN Social Care is part of Support and Social Care Networks Ltd which is a privately owned company. The service provides a combined care at home and housing support service to older people living in their own homes in various localities of Edinburgh. The service is managed from an office in Wester Hailes Edinburgh. The services' philosophy states:- "We work in a person-centred way to ensure that individual needs and aspirations are met in the best possible way. We seek to involve all our service users and their families carer) in all care/support planning and implementation". The services' mission statement states:- "Our clients are our reason for being and as such, each client will always be provided with the highest level of love, care and companionship. Out care workers who are chosen for their compassion, experience and professional qualifications, will always be polite and courteous, treating each client with dignity and respect they deserve irrespective of their disability, race, ethnic origin, culture, sexuality or religious beliefs, but more importantly, they will become your new friends". 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. page 5 of 28

6 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 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 4 - Good Quality of staffing - Grade 2 - Weak 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 6 of 28

7 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 We wrote this report following an unannounced inspection. The inspection was carried out by one inspector. The inspection visits took place over two days on Wednesday 20 April and Thursday 21 April Subsequently we looked at evidence sent to us by the provider via . Feedback was given to the service manager, who is also the registered manager and provider, on Tuesday 3 May During this inspection we spoke with one of the four service users and three relatives. We met and had discussions with the service manager of the service and two care staff. We also gathered evidence from the following sources: Registration certificate Service annual return and self-assessment Insurance certificate Communication Logs Weekly visit rota Support plans and task sheets Risk assessments Policies and procedures Recruitment records Staff training records page 7 of 28

8 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. Fire safety issues 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 8 of 28

9 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 fully completed self-assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings we grade them under. The service provider identified what they thought they did well, some areas for development and any changes that they had planned. Taking the views of people using the care service into account The views of the service user we spoke with has been detailed in the body of this report. Taking carers' views into account The views of the relatives we spoke with have been detailed in the body of this report. page 9 of 28

10 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: 4 - Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths To assess this statement we looked at service records and held discussions with the service manager. We spoke with one person using the service, three relatives and two care workers. At the start of a new care package the service manager consulted with the new user and relatives to a good level. This ensured the service was tailored to meet the users care needs. The service manager had worked with occupational therapists to make sure carers were providing safe moving and positioning support to service users. Care and support plans we sampled provided good comprehensive detail in relation to the tasks which needed to be undertaken. There were good descriptions of people's health conditions and additional information about the condition. Appropriate risk assessments were in place which detailed risks and actions to be taken to minimise risks. Recorded visit times had been changed on the plans when visit times changed. Relatives told us how the service had stepped in to provide the care and support at the last minute. They told us they had been reaching a crisis point in relation to getting an appropriate and effective service to provide their relative's page 10 of 28

11 care and support. All relatives we spoke with told us they considered the service was meeting their relative's care needs to a good level. Feedback from the service user and relatives we spoke with confirmed there was a consistent team of staff providing the care; visits were largely on time and care staff stayed for the designated support time. Care staff we spoke with evidenced they had a good understanding of the correct procedures to follow if they identified potential adult protection issues when providing care and support. Areas for improvement We advised the service manager that care and support plans for established service users should be further developed to include preferences and routines in the task details. We were aware that one service user needed more observational support when taking their medication to ensure their safety however the care and support plan had not been updated with this change to support. We discussed this with the service manager and will follow up on care planning at the next full inspection. At the last inspection we advised the manager to review whether a relative or representative had third party legal powers and arrangements in place on the service users behalf. At this inspection the manager evidenced they were aware of whether the current service users had legal representation. However this was still not recorded on the care and support plan. One relative who had welfare power of attorney had not been invited to their relative's six month care review. A person with welfare power of attorney should be consulted and involved in decisions about care, care planning and reviews of care. This is because the client has chosen them to make some decisions on their behalf. We have made a recommendation. (see Recommendation 1). From reading care notes we advised the service manager to remind care staff that they need to accurately record how they provided medication support. This will ensure medication support needs can be monitored through those recordings. page 11 of 28

12 We found the medication and adult support and protection policies and procedures needed to be revised and made more robust. Improvements to policies and procedures have been further detailed in this report under section Quality Theme 4 Statement 4. With the application of prescribed creams taking place at the last inspection we had recommended the manager introduced a body map document which would clearly identify where each cream needed to be applied. This would be an aid for support workers who do not frequently visit the client and ensure the client is supported in the correct way with their prescribed creams. The body map could also be used in the future if medication support included the application of prescribed pain/memory patches. The service had not progressed with this. The recommendation is repeated. (see Recommendation 2). Relatives told us they were currently satisfied with how they were told which carer would next be visiting. This was largely because there was good consistency of staffing. We advised the service manager that the process of giving people prior knowledge of who will be visiting should continually be reviewed. We will follow this up at the next inspection. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 2 Inspection report 1. The provider should ensure where a service user has a third party legal representative that this information is recorded in the care and support plan. Third party representatives with welfare responsibilities should be invited to all care reviews and consulted and involved in decisions about the service user's care. National Care Standards. Care at Home - Standard 3: Your personal plan. Standard11: Expressing your views. page 12 of 28

13 2. The provider should introduce the use of a body map document when clients are being supported with the application of prescribed creams and pain/ memory patches. National Care Standards. Care at Home - Standard 8: Keeping well - medication. page 13 of 28

14 Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths To assess this statement we looked at service records. We spoke with one person using the service and three relatives. The care and support plan template allowed for the recording of information which would promote person centred care. Service users and relatives had been involved in the development of their care and support plans. We were told that care staff were friendly, courteous, polite and pleasant. Care staff treated service users with dignity when providing personal care. Care staff treated both service users and their relatives with respect. We sampled completed communication log records evidenced recordings made about tasks undertaken were written in a respectful manner. Spot checks of care staff were undertaken by the service manager and senior carer. The checks included observing how effectively care staff interacted with and supported service users when providing care. Areas for improvement The provider should continue to monitor the quality of care through regular spot checks of all care staff, service user surveys and formal six month reviews. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 14 of 28

15 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service Strengths We sampled the content of care staff files which included recruitment documentation. We found the storage of information provided easy access to documentation we were sampling. Areas for improvement On checking the recruitment records for care staff we found evidence of unsafe recruitment in relation to ensuring a PVG check had been received for one care worker who was providing care and support. We saw inconsistencies on the application form for one applicant about previous employment which warranted further discussion with the applicant and a possible additional reference sought. The date references and PVG checks were sent for and returned was not recorded. This impaired our ability to check on safe recruitment to the required level. We have made a requirement for the provider to ensure the recruitment of all care staff is undertaken safely at all times. (see Requirement 1). page 15 of 28

16 At the last inspection the service manager told us they had been in the process of developing an induction handbook for new care workers. This had not progressed. For this to be successful the current written policies and procedures needed to be reviewed and revised to reflect the service's current operations and activities. These should include the services current procedures for inducting care staff at the start of their employment. Improvements to policies and procedures have been further detailed in this report under section Quality Theme 4 Statement 4. Grade 2 - Weak Requirements Number of requirements The provider must make proper provision for the health, welfare and safety of service users. In order to do so, the provider must not employ any person in the provision of the service unless that person is fit to be so employed. In order to achieve this the provider must:- - Ensure all staff working in the care service have an appropriate and satisfactory Protection of Vulnerable Groups (PVG) Scheme Membership prior to them working with people who use the service.. - Establish appropriate procedures to monitor and record the progression of references sought and the PVG application / update to ensure accurate and up to date records are kept. - Ensure best practice guidance is followed in relation to the seeking of references. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 9 (1) Fitness of Employees: A provider must not employ any person in the provision of a care service unless that person is fit to be so employed. Timescale for completion: 2 weeks from receipt of this report. Inspection report In making this requirement, the following National Care Standards, Care at Home, have been taken into account: Standard 4 Management and staffing. page 16 of 28

17 The following Codes of Practice for Employers of Social Service Workers have been taken into account: using rigorous and thorough recruitment and selection processes, checking criminal records and relevant registers, 1.3 seeking and providing reliable references. Number of recommendations - 0 page 17 of 28

18 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths To assess this statement we looked at service records and held discussions with the service manager and two carers. At the last inspection a requirement had been made in relation to ensuring all care staff received training appropriate to the work they perform and that training records were in place which were updated regularly. Since that inspection training had been provided to staff and training records were up to date. The requirement had been met. A competency spot check had been undertaken for some of the care staff since the last inspection. During the spot check the service user's views were sought on the competency of the carer being observed. Areas for improvement Two of the current service users had a diagnosis of dementia. Whilst care staff had recently undertaken dementia awareness training more in depth training needs to be provided. We directed the service manager to the Scottish promoting excellence framework dementia training which could be utilised by the service as a training resource. We advised the manager the Care Inspectorate expect all older peoples service providers ensure their care staff have appropriate dementia skills training which meets the level and standard of training provided by this resource. At the feedback meeting the service manager confirmed they will progress with appropriate dementia training. We will follow this up at the next inspection. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 18 of 28

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service Strengths To assess this statement we looked at service records and held discussions with the service manager and two carers. Written minutes showed team meetings had taken place throughout the year. There had been five meetings held since June The minutes evidenced the service manager reminding care staff about best practice and training. Staff were updated about organisational activities and potential new business. The care staff we spoke with confirmed they were encouraged to attend the meetings and that the meetings took place. They told us they were able to express their views and put forward their ideas. From records sampled we saw some care staff had met with the service manager to undertake a one to one supervision meeting. Areas for improvement During the feedback meeting we discussed the need for team meetings minutes to detail additional topics covered at the meetings as well as the items on the standing agenda. Supervision records evidenced the manager advising care staff to read the policies and procedures. However it was unclear which policies and procedures they should read. Care staff told us they were not directed to specific policies and procedures to read. Some of the policies and procedures held as paper copies in the office were not up to date. We advised the service manager to page 19 of 28

20 identify specific policy and procedure topics for staff to read. Discussions about the topics could then be discussed at their next supervision meeting. We will follow this up at the next inspection. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 20 of 28

21 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 Service Strengths To assess this statement we looked at service records and held discussions with the service manager and two care workers. The service manager was registered with the Scottish Social Services Council (SSSC) as per regulatory requirements. A condition had been placed on the registration for the manager to attain appropriate qualifications over a three year period. The manager was currently undertaking one of the qualifications. Care staff told us the service manager was very supportive. If they have any problems the manager responded quickly and provided necessary advice. The service manager had a very good knowledge of all the service users' care and support needs. Areas for improvement At the last inspection we had advised the manager to expand the information provided on the service agreement as to the possible termination of the service by including a notice period for each party. At this inspection we saw this had only partly been achieved. We found whilst a contract had been signed with the local authority to provide the care service to two recent new service users that no service agreement had been entered into between the service and the user. We have made a recommendation. (see Recommendation 1). The service had an authorisation form which service users could complete and tick as to who they agreed could view their care and support information provided by the service. This included whether to allow the Care Inspectorate to page 21 of 28

22 read this information. At the last inspection we reminded the service manager that the Care Inspectorate has the right to view all service user's care information provided and held by the service as part of our regulatory duties. At this inspection we found the form had not been revised. We have made a recommendation. (see Recommendation 2). The service had met a recommendation made at the last inspection to revise the complaints policy and other literature to ensure service users knew they could make a complaint at any time directly to the Care inspectorate. However complaints information held in service user's files in their homes had not been amended. We have made a new recommendation that the service replaces old complaints information with the newly revised information. (see Recommendation 3). At the last inspection we advised the manager they should be checking to see that planned targets of internal processes are being met through monthly audits. We saw no evidence of audits being undertaken. We recognise the service is still small however audits are important to check on overall service quality and this time period is ideal to develop the auditing foundations. We will follow up on quality assurance checks through auditing processes at the next inspection. The service was not keeping up to date rotas where changes had been made to the carer who actually attended the scheduled visit. During the inspection we discussed with the service manager the necessity for rotas to be up to date to evidence which worker undertook each visit. At the feedback meeting we saw the manager had started to make changes to the rotas to reflect who actually attended the visits. We were satisfied the improvement will be maintained and will check accuracy of rotas a the next inspection. As detailed in previous quality statements the provider needed to make improvements to policies and procedures. To support the initial start-up of the care service the service manager had purchased "off the shelf" policy and procedure documents. These documents formed a template from which the manager needed to review and revise to reflect the service's current operations page 22 of 28

23 and activities. At the last inspection we had made a requirement for the service manager to do this. At this inspection we found only minimal changes had been made to two policies and procedures. We have repeated the requirement. (see Requirement 1). During the inspection we found it difficult to access some information. We were told defective computer software was a contributing factor. We reminded the service manager at the feedback meeting that it is a legal requirement to make sure all information is available to inspectors on inspection. We also reminded the service manager to ensure that information given to the inspector is accurate and clear. Grade 3 - Adequate Requirements Number of requirements - 1 Inspection report 1. The Provider must ensure that all policies and procedures are relevant and up to date. They must take into account current best practice guidance/any changes to legislation and cross reference other relevant policies and procedures. They must be specific to SSCN Social Care and have an implementation date and a review date. This is in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care services) 2011 (SSI 2011/210) Regulation 4(1) (a) Welfare of users - a provider must make proper provision for the health, welfare and safety of service users. Timescale for implementation: within 16 weeks from receipt of this report. page 23 of 28

24 Recommendations Number of recommendations The provider should ensure that individual written service agreements are drawn up for all service users. This should include information specified in the National Care Standards (Care at Home & Housing Support, Standard 2) which includes details about the ending of the agreement by both parties. Signed copies of the agreement to be held by the service user and the service provider. National Care Standards: Care at Home: Standard 2 - The written agreement and Housing Support: Standard 2 - Your legal rights. 2. The provider should take note that the Care Inspectorate has the right to view all service user's care information provided and held by the service as part of its regulatory duties. As such the provider should revise the authorisation form and make amendments to existing forms held by service users to ensure the authorisation option in relation to the Care Inspectorate is removed. National Care Standards. Care at Home and Housing Support. Standard 1 - Informing and deciding. Care at Home. Standard 4: Management and staffing. Housing Support. Standard 3: Management and staffing arrangements. 3. The provider should remove old complaints information from service user's files in their homes and replace with the newly revised complaints information. National Care Standards. Care at Home - Standard 11: Expressing your views. Housing Support Services - Standard 8: Expressing your views. page 24 of 28

25 4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must ensure that training records are up to date for the manager to accurately identify training needs for each individual staff member and for internal and regulatory auditing purposes. The provider must ensure that all staff receive training appropriate to the work they are to perform and to meet identified individual service user needs. Timescales for refresher training must be set so that staff can attend updates as and when required. Training must include but is not limited to:- - Medication - Moving and Handling - Adult Support and Protection - Infection Control - Food hygiene - Nutrition - Personal care - Dementia This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users; Regulation 15 (b) (1) Staffing - a provider must ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform. Timescale for implementation: within 16 weeks from receipt of this report. This requirement was made on 16 June 2015 The service had met this requirement. Details of this are further reported in the body of this report under Quality Theme 3 Statement 3. Met - Within Timescales page 25 of 28

26 2. The Provider must ensure that all policies and procedures are relevant and up to date. They must take into account current best practice guidance/any changes to legislation and cross reference other relevant policies and procedures. They must be specific to SSCN Social Care and have an implementation date and a review date. This is in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care services) 2011 (SSI 2011/210) Regulation 4(1) (a) Welfare of users - a provider must make proper provision for the health, welfare and safety of service users. Timescale for implementation: within 16 weeks from receipt of this report. This requirement was made on 16 June 2015 The service had not met this requirement. Details of this are further reported in the body of this report under Quality Theme 4 Statement 4. Not Met Inspection report 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The provider should make amendments to complaints literature to make it clear complaints can be made to the Care Inspectorate at any time, without using the service's own procedure first. National Care Standards. Care at Home - Standard 11: Expressing your views. Housing Support Services - Standard 8: Expressing your views. This recommendation was made on 16 June 2015 The service had met this recommendation. Details of this are further reported in the body of this report under Quality Theme 4 Statement 4. page 26 of 28

27 2. The provider should introduce the use of a body map document when clients are being supported with the application of prescribed creams and pain/memory patches. National Care Standards. Care at Home - Standard 8: Keeping well - medication. This recommendation was made on 16 June 2015 The service had not met this recommendation. Details of this are further reported in the body of this report under Quality Theme 1 Statement 3. Inspection report 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 16 Jun 2015 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 3 - Adequate Management and Leadership 4 - Good page 27 of 28

28 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 28 of 28

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