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1 Carr Gomm - Edinburgh Housing Support Service London Road Edinburgh EH7 5AT Telephone: Inspected by: David Todd Type of inspection: Announced (Short Notice) Inspection completed on: 5 August 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 23 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Carr Gomm Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: David Todd Telephone Carr Gomm - Edinburgh, page 2 of 27

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 4 Good Quality of Management and Leadership 4 Good What the service does well The service provides support and care to people with different needs. There are lots of opportunities for people using the services to take part in groups and activities that try to make each part of the service better. What the service could do better The service could make sure that people using the service know who is visiting them and that they are happy being supported by that person. The service should ensure that staff understand the needs of each person they are working with. What the service has done since the last inspection A number of staffing changes have taken place and some staff have left the organisation. Some posts have not yet been filled and the work is covered by relief or agency staff. Some Managers have moved to different parts of the service. The service has improved how it checks that the outcomes people have set for themselves are moving forward. Carr Gomm - Edinburgh, page 3 of 27

4 Conclusion Inspection report continued The service provides good support and care to people. In some services it needs to ensure there is better staff consistency and knowledge about the people they work with. Who did this inspection David Todd Lay assessor: Sandra Darling Carr Gomm - Edinburgh, page 4 of 27

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Before 1 April 2011 this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and Recommendations. If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or a 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 based on best practice and the National Care Standards. 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 ('the Act') and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Carr Gomm - Edinburgh provides a combined housing support and care at home service. Support is provided to adults with a wide range of needs living in their own homes or in shared accommodation. The type of support each person receives is detailed and reviewed through a personal planning process. The number of hours of support people receive varies. There is a 24 hour on call service which people who are assessed as needing this can use. At the time of the inspection 140 people were being supported by the service. There are six staff teams within the service. Some teams provide visiting support services to individuals who live in their own homes. Others provide support services to people who live in shared accommodation or sheltered housing complexes, leased to Carr- Gomm by housing associations or by the National Health Service (NHS). People receiving support have individual tenancy agreements. Each team has a service manager and a local staff base, or is based in the main office. All service managers report to the Operations Manager (the named manager for the service) who also works from the main office base in South Edinburgh. Carr Gomm is a national provider which has a number of similar services across Carr Gomm - Edinburgh, page 5 of 27

6 Scotland. The organisation's headquarters is in Edinburgh. Carr Gomm states its aims are 'to help people in Scotland live in their own homes, in a safe way, to do things that they want to and try new things'. 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 4 - Good Quality of Management and Leadership - Grade 4 - Good Inspection report continued 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. Carr Gomm - Edinburgh, page 6 of 27

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 announced (short notice) inspection. The inspection was carried out by Care Inspectorate Inspector David Todd. This took place on 16 July 2013 between 9.30am and 5pm, on 17 July 2013 between 9.30am and 4.30pm, on 18 July 2013 between 10am and 4.30pm and on 19 July between 1pm and 4.30pm. Lay Assessor Sandra Darling took part in the inspection on 16 July We told the Manager what we found at the inspection on 5 August As requested by us the care service sent us an annual return. The service also completed a self assessment form. In this inspection we gathered evidence from various sources including the relevant sections of policies, procedures and other documents including: Sampled support and care plans Reviews of support and care plans Risk assessments Support agreements Communication books and diaries Team meeting minutes Recruitment records Support and supervision records Appraisal records Staff training records Incident and accidents Complaint records Quality assurance information Complaints policy Minutes of meetings for people using the services Discussions with: the Manager three service Managers Carr Gomm - Edinburgh, page 7 of 27

8 six Staff. We met with people using the service in each place we visited and spoke with one relative during one of the visits. We visited the services at Lochend, Merchiston, Corstorphine and the Visiting Support Team based at London Road, Edinburgh. We sent out 75 Care Inspectorate Care Standard Questionnaires to people using the service, their relatives and carers. We sent out 45 questionnaires to staff. 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 Carr Gomm - Edinburgh, page 8 of 27

9 What the service has done to meet any recommendations we made at our last inspection Four recommendations were made at the last inspection. 1. The service should ensure that the reasons for giving medication when required (PRN medication) are recorded in the medication administration record. National Care Standards, Care at Home, Standard 4 - Management and staffing and Standard 7 - Keeping well - medication. We saw that PRN medication was recorded separately on a MAR sheet. The Manager told us this had helped improve peoples' care, for example, helping staff think about alternatives ways to support people to manage their behaviours. This recommendation had been met. 2. The service should ensure that support plans and reviews are signed by the person using the service and/or their representative. National Care Standards, Care at Home, Standard 2 - The written agreement and National Care Standards, Housing Support Services, Standard 4 - Housing support planning. There were still examples of support plans that had not been completed or signed by participants. We have made the recommendation again (see statement 1.3). 3. The service should develop ways of working to ensure that the privacy and dignity of people using the service is respected. National Care Standards, Care at Home, Standard 4 - Management and staffing and Standard 9 - Private life. We found that the service had made changes to the way people were supported to ensure that their dignity was respected. This recommendation had been met. However other issues came up during the inspection (see statement 1.3). Carr Gomm - Edinburgh, page 9 of 27

10 4. The service should ensure that joint review sessions and annual appraisals take place for all staff. National Care Standards, Care at Home, Standard 4 - Management and staffing. This recommendation has not been met. Please see statement 3.3. Inspection report continued 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. We received a fully completed self assessment document from the service provider. The service provider had completed brief updates to the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. The provider had graded themselves but we did not agree with those grades. Taking the views of people using the care service into account We sent out 75 Care Inspectorate Care Standards Questionnaires to people using the service and their relatives. Ten were returned by people using the service. Comments included: 'generally are there for me' 'my level of support has improved over the last twelve months, especially at weekends' 'staff support me. They are kind and helpful. Everything is ok'. Eight people strongly agreed and seven people agreed that 'overall, I am happy with the quality of care and support this service gives me'. One person disagreed with this statement. We spoke with eleven people during the inspection. People were very positive about the support they received. Comments included: Carr Gomm - Edinburgh, page 10 of 27

11 'fine on occasions' 'don't want to change anything' 'sometimes I am quite happy with them' 'great staff'. Other comments can be found in the relevant quality statements. Taking carers' views into account We sent out 75 Care Inspectorate Care Standards Questionnaires to people using the service and their relatives. Two were returned by relatives and advocates. Comments included: 'communication could be better at times' 'staff changed quite a lot recently' 'overall I think there is a good standard of care' We spoke with relatives who thought that the standard of care and support was good. However people also said they were concerned about the changes in staff and how this affected their relative (because they needed consistency). Carr Gomm - Edinburgh, page 11 of 27

12 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 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 We found that people using the service and their families were fully involved in discussions about the care they wanted and changes to it. People we spoke with said they were always involved in their reviews. One relative we spoke with said they were invited to review meetings. They said they were pleased that the care given was good. They thought the Manager listened to their views and acted on them. As part of the review people were helped to think about how they wanted to take part in planning their own care, assessing the work of staff or influencing the wider organisation. This was recorded in Personal Involvement Plans. People we spoke with talked about how they were involved in different activities and groups. These included making up questions for interviews, designing the 'perfect support worker' and 'publicising the organisation and its work'. Some people said they thought doing this was important for them and Carr Gomm. Many people using the service met regularly with Managers and we saw that there were usually very good relationships between them. This meant people had chances to comment on and influence the quality of their care, support and staff. This information was used to make changes to the service provided. For example the Lochend service had started a newsletter following a request made at the 'house meeting'. Staff we spoke with described how they supported people using the services to take part in different group meetings and forums. The organisation had developed many different ways people and their relatives could be involved. These included Carr Gomm - Edinburgh, page 12 of 27

13 * joining in planning and working groups * joining in special groups to comment on specific aspects of work * helping recruit new staff * forum meetings * being a member of the organisation's Board * being a member of the organisation, with voting rights The organisation had a clear commitment to ensure peoples' views were heard. If people had difficulty making their views known staff encouraged people using the service to make use of advocates. An advocate is independent of the service and helps a person make their wishes clear. The service had good links with a local advocacy service. This service provided advocates to a large number of people throughout Carr Gomm services. Ten CI Care Standard Questionnaires were returned by people using the service. Four people strongly agreed and six people agreed that 'the service asks for my opinions about how it can improve'. Areas for improvement Personal Involvement Plans were now part of the support plan and appeared to be checked as part of the six monthly review. However it was not clear how people had been supported to put their plans into practice. The service could consider how to do this. The service could consider how it could use external consultancy to help people using the services assess and improve it. This would give a more independent view of how well the services are doing. The service could consider how to demonstrate how people using the services and staff feed into the self-assessment the service prepares prior to inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued People using the services had individual care and support plans. Mostly, these contained detailed information about the health needs each person had, showing which health professional and staff member was responsible for the care. Each person had a key worker who was responsible for keeping care plans up to date and ensuring that they and, where appropriate, their relatives or advocate, were involved Carr Gomm - Edinburgh, page 13 of 27

14 in this process. People we spoke with said their relatives were invited to reviews and we saw that their participation was recorded Plans we sampled showed how staff helped people using the service to meet their health needs. These included supporting people to make appointments with their GP or other health professionals, attending appointments and supporting people to manage appointments or procedures they found difficult, for example attending hospital. The services showed how they kept in contact with people who had to spend time in hospital. People using the service and families told us: 'The staff look after me well...a good stepping stone out of hospital...the service is excellent...staff are very caring'. 'I am so happy with (name) home. She is cared for so well'. 'Better than hospital'. Inspection report continued 'Excellent - could do with more staff at weekends though. Sundays are worst'. Staff we spoke to said they knew the health needs of people using the service. Staff were able to discuss health problems that had affected people using the service. We found that, for example, where peoples' behaviour had changed, the time was taken to review what had happened, bring in specialist help and access training, to try to improve the service offered. Staff told us how they supported people to develop their skills, confidence and abilities. This would mean, for example, some people using the service could choose to move on to less supported settings. Carr Gomm was able to provide a range of services to meet peoples' needs and abilities. People using the service were helped with taking medication. Sometimes they took it themselves. Sometimes staff helped by reminding people. In some services, for some people, staff were responsible for managing the medication. Whenever possible, peoples' medication was stored securely in their own rooms. This meant they could take it in private. The organisation had a medication policy and procedure. Staff received training and completed workbooks, some of which had been rewritten recently. All these measures provided guidance to staff working in care at home and supported living settings to manage medication with the person using the service to meet their needs and when possible, to increase independence. Some people using the service had 'advance statements'. People were able to write Carr Gomm - Edinburgh, page 14 of 27

15 down what treatment they wanted if they became ill. This meant people were able to make their wishes clear and provide guidance for health professionals and staff. Staff said they were trained to carry out any specific procedures to meet peoples' needs, such as peg feeding and the use of midazolam to help people manage their epilepsy. Areas for improvement At the last inspection we said the service wanted to make support plans more outcome focussed. This would make work done measureable. We found that this had progressed in many services and that staff were asked to review work done towards meeting the outcome monthly. Some comments were made by the person being supported or by their relatives. This was not yet being achieved consistently across all the services. We thought some outcomes were quite wide ranging and could benefit from being more focussed. At the last inspection we looked at a sample of personal plans. Some did not have signatures of people using the service or their representatives, to show their agreement to reviews and notes. We again found plans where they were not signed nor an explanation given, or the notes had not been completed following reviews. We have made the recommendation again (see recommendation 1). When we looked at support plans, service questionnaires, recorded comments made by people and heard what people we spoke with said, we found that peoples choices about which staff should visit them were not always respected. Visits were made by staff that people using the service did not want, or who did not know them. In part this seemed to be because the changes to the staff structure meant that staff had changed and there was more reliance on relief and agency staff. This meant that, for example, staff did not always understand the needs of the people they were supporting. In particular this affected the Visiting Support Service. The service should take steps to resolve these issues quickly and we have made a recommendation (see recommendation 2). We also followed up a complaint made to the Care Inspectorate. We made a requirement and recommendation. We saw some progress had been made in the planning of rotas. However this did not yet meet all peoples' needs or that they were not always told about changes. We have made the requirement and recommendation again (see requirement 1 and recommendation 3). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 3 Inspection report continued Carr Gomm - Edinburgh, page 15 of 27

16 Requirements 1. The provider must ensure that the service is provided at the agreed times and in such a way that it meets the identified needs of the service user as agreed in the support plan. This is to comply with Social Work Improvement Scotland (Requirements for care services) 2011 (SSI2011/210) Requirement 4(1) - Welfare of users - A provider must make proper provision for the health, welfare and safety of service users. It also takes account of National Care Standards, Care at Home services, Standard 2 - The written agreement and Standard 4 - Management and staffing. Recommendations Inspection report continued 1. The service should ensure that support plans and reviews are signed by the person using the service and/or their representative. National Care Standards, Care at Home, Standard 2 - The written agreement and National Care Standards, Housing Support Services, Standard 4 - Housing support planning. 2. The service should ensure that peoples' wishes are respected. Staff who give support should understand the needs of the people they are visiting. The service should ensure that people they support know who is to visit and that they agree to this. National Care Standards, Housing Support Services, Standard 3 - Management and staffing arrangements, Standard 6 - Choice and communication and Standard 7 - Exercising your rights. 3. The provider should ensure that service users and their relatives are advised when a carer will be late attending or care cannot be provided due to exceptional circumstances. National Care Standards, Care at Home, Standard 4 - Management and staffing. Carr Gomm - Edinburgh, page 16 of 27

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Please also see statement 1.1. People using the service we spoke with said they had been involved in interviewing new staff. They said they were supported to do this. Peoples' relatives were also involved. Training was given to help people manage this role. People using the services are encouraged to take part in staff training sessions. For example, in its self assessment, the services highlighted that people using the service had taken part in recovery awareness training and are part of the Wellbeing and Recovery Group. We also saw that family members worked with staff to help staff learn and develop ways to work with their relatives. Areas for improvement The service should continue to develop the ways that people they support are involved in recruitment and in training opportunities. Ways should be found to involve people consistently in these and other activities. Grade awarded for this statement: 5 - Very Good 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 Staff beginning work with Carr Gomm - Edinburgh were given an eight day induction. This included an introduction to values in practice, medication, food hygiene, infection control, moving and handling and emergency first aid. They then had time to shadow other staff in the service where they were based. Carr Gomm - Edinburgh, page 17 of 27

18 Staff said training was good. They had access to five days formal training each year. This included refresher days for mandatory training as well as training directly relevant to the work they were doing. A wide range of relevant training was offered. This included mental health first aid and adult protection training. The organisation were committed to helping staff gain Scottish Vocational Qualifications (SVQs) at levels 2 and 3. Some staff had completed the award and others were working on it. Staff were encouraged to use the training packs the organisation had. Topics included infection control and medication. Staff discussed how they used the packs for example in team meetings to develop practices. Sometimes, people using the service attended these meetings. This meant they could learn about the topic and give their views about how staff could work with them. Staff said they had joint review meetings with their manager four times each year in line with the organisation's support and supervision policy. They said they found the meetings helpful. One of the four meetings was used as an appraisal. Staff said they would discuss if they had achieved their own objectives from the previous year, set new ones and plan their training for the year. Staff said they could speak to their managers at any time if they had problems or issues. Managers were asked to record these informal meetings. This helped show how support was given. Areas for improvement At the last inspection we noted that the service was being re-structured, that some staff were leaving the organisation and support assistants were being introduced to all the services. Since then some staff have left, support assistants have been employed and most of the managers have moved between services. There are still a number of vacant posts. These are being covered by the use of regular relief and agency staff. Some staff have found this quite disruptive. We also found that the service to people, especially but not only in visiting support, had been affected and continued to be so. This had, for example, meant some people had received visits from staff they did not wish to work with or, they felt, did not understand their need for support. This was difficult for the service users concerned as they felt they were not being listened to (please also see statement 1.3). We looked at a number of joint review notes from each of the teams we visited. Sometimes we found that meetings had not taken place for some months. Some staff told us they did not have a regular joint review meeting. Managers told us that one reason for this was that staff had been moved between teams or that changes to the service had made it more difficult to meet formally. Managers also told us they were trying to complete appraisal meetings and saw that these had been planned for the next few months. It is however important that these meetings take place consistently (see recommendation 1). Carr Gomm - Edinburgh, page 18 of 27

19 Overall we found that motivation was good although some staff who had gone through the recent changes were finding it more difficult, affecting morale. We saw that, in one service, attendances at team meetings remained poor. We were told about ways being considered to address this. Minutes of the meetings could be passed on to those who were not there but discussions were limited by this. We thought each service should try to find ways to encourage participation. At feedback we discussed what the loss of experienced staff meant to the service and the effects this had on the people being supported. The Manager told us how they had planned each service around key, experienced staff who would act as supports to newer workers. However other service managers told us there was a need to provide newer staff with more specific training in, for example, mental health issues and autism awareness. There were now fewer staff with an SVQ qualification (see recommendation 3). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. The service should ensure that staff are available in adequate numbers to provide a consistent service. Support staff should consult service users' support plans thoroughly when supporting them so that they are fully aware of how the service users would like to be helped. National Care Standards, Housing Support Services, Standard 3 - Management and staffing arrangements. 2. The service should ensure that joint review sessions and annual appraisals take place for all staff. National Care Standards, Care at Home, Standard 4 - Management and staffing. 3. The service should ensure that a training needs analysis is completed and that training is planned to meet these needs as soon as possible. National Care Standards, Care at Home. Standard 4 - Management and staffing. Carr Gomm - Edinburgh, page 19 of 27

20 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good 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 People were supported to attend a range of Forum meetings. Forums are where people using the service, relatives, staff and people from other agencies meet together with a particular purpose. The meetings cover different topics and have included issues such as 'direct payments'. Staff encouraged people to get information and discuss how they are affected. People are also asked to say whether the meeting worked well for them. If not meetings formats are adjusted to make them better in the future. We spoke with people who had taken part in the Forums. They said they had got a lot from them and found them 'informative' though people also said the meeting about changes to welfare benefits had been 'difficult to understand'. The organisation has an Involvement Manager. It is their job to encourage people to participate in assessing and improving the services, at all levels. We saw that people using the service took part in different groups and their views were fed into the organisation. We saw how the manager had used different methods to help people who found it difficult to give their views. Areas for improvement The service should continue to develop the ways that people they support are involved in assessing and improving the work being done. Ways should be found to involve people consistently in these activities. When we spoke with people using the service and looked at other issues raised in different meetings or by telephone we saw that, although concerns were addressed and reassurances given, the changes made to the support were not maintained. We discussed this with the Manager. They told us that systems, such as rota management and staff recruitment were now in place. This should mean that people using the service will know who is coming to support them. It will also mean that, gradually, the service will have enough permanent staff to meet the needs of people being supported. We will monitor progress at the next inspection. Carr Gomm - Edinburgh, page 20 of 27

21 Grade awarded for this statement: 4 - Good 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 Service strengths Please also see statements 1.1, 3.1, 3.3 and 4.1 for other relevant information. The organisation has a commitment to providing quality services. The Business Plan for , Year 3, , identified a number of methods to monitor the quality and effectiveness of service delivery. These included developing clear guidelines for each service outlining the role of key and co-workers and developing purposeful and accountable support. There was an emphasis on service managers taking a clear lead role in this work. We saw there remained an emphasis on measuring outcomes. The Edinburgh services have identified specific service objectives. These include increasing the opportunities for people using services to 'hear/share information about their service, the organisation and external strategic issues that impact on their lives'. This action followed requests from people using the service. Service Managers and staff were able to identify monitoring systems within teams. These included the monitoring of financial and medication records daily, weekly or monthly. Actions had been taken where issues were identified. In addition the Operations Manager carried out financial checks in each service quarterly. We spoke to the Managers in each service we visited. We asked them how they knew that the service they were providing was good enough. They said they knew the people using the service well. This meant they became quickly aware if anything was wrong and take action as necessary. As we went round the different services we saw that Managers had built up good relationships with the people using the service. We also noted that managers reviewed the incident and accident reports in each service and, where patterns of incidents emerged, considered how to review the work being done. This had, for example, led to changes in the ways staff interacted with people and also to further staff training. Issues identified locally are recorded in a computerised information management system. The system is called Carista. Managers are required to record monitoring information, including: * incidents and accidents * complaints Inspection report continued Carr Gomm - Edinburgh, page 21 of 27

22 * support agreements and reviews * statistical information about numbers of people supported and hours used * staff issues, including grievance and disciplinary information. This information was checked by senior Managers. The self assessment sent to us by the service stated 'any issues that are highlighted are collated into action plans'. These feed into the Edinburgh Management Team and business planning. Areas for improvement Please also see the comments made in Areas for Improvement, statements 1.3, 3.3 and 4.1 regarding consistency of staffing, the support and supervision of staff (joint reviews) and comments made by people being supported. At the last inspection we were shown examples of the outcomes care plans that were being tried. This time we saw that staff were recording notes to show how outcomes were being met. We saw that people using the service could say what they thought and that this was also written down on a monthly basis. We were told that this information would be used to show how far the plans each person had made had been progressed. This would mean the reasons for changes to care and support plans would be recorded in a consistent way. The organisation expects that more people using the services have an 'outcomes' plan in the coming year. We will monitor their progress at the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm - Edinburgh, page 22 of 27

23 4 Other information Complaints One complaint made to us about this service in the last twelve months was upheld by the Care Inspectorate. This resulted in a requirement and a recommendation. Requirement: 1. The provider must ensure that the service is provided at the agreed times and in such a way that it meets the identified needs of the service user as agreed in the support plan. This is to comply with Social Work Improvement Scotland (Requirements for care services) 2011 (SSI2011/210) Requirement 4(1) - Welfare of users - A provider must make proper provision for the health, welfare and safety of service users. It also takes account of National Care Standards, Care at Home services, Standard 2 - The written agreement and Standard 4 - Management and staffing. This requirement had not been met. Please see statement 1.3. Recommendation: 1. The provider should ensure that service users and their relatives are advised when a carer will be late attending or care cannot be provided due to exceptional circumstances. National Care Standards, Care at Home, Standard 4 - Management and staffing. This recommendation had not been met. Please see statement 1.3. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Carr Gomm - Edinburgh, page 23 of 27

24 Action Plan Inspection report continued Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Carr Gomm - Edinburgh, page 24 of 27

25 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Staffing Good Statement 1 Statement Very Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history Date Type Gradings 18 May 2012 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 5 - Very Good 5 - Very Good 16 Jun 2011 Unannounced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 4 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 30 Sep 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 5 Mar 2009 Announced Care and support 6 - Excellent Staffing 5 - Very Good Carr Gomm - Edinburgh, page 25 of 27

26 Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Carr Gomm - Edinburgh, page 26 of 27

27 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: Web: Carr Gomm - Edinburgh, page 27 of 27

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