Elite Care (Scotland) Ltd Housing Support Service 4 Alfred Place City Road St. Andrews KY16 9XG Telephone: &

Transcription

1 Elite Care (Scotland) Ltd Housing Support Service 4 Alfred Place City Road St. Andrews KY16 9XG Telephone: & Type of inspection: Announced (Short Notice) Inspection completed on: 6 February 2015

2 Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 7 3 The inspection 11 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Elite Care (Scotland) Ltd Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Elite Care (Scotland) Ltd, page 2 of 24

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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well It was evident that the staff and management were committed to providing a very good service to the clients. Clients spoke very highly of their regular support workers. What the service could do better Several areas for improvement were identified during this inspection details of which can be found throughout the body of this report. What the service has done since the last inspection One recommendation was made during a complaint investigation carried out by the Care Inspectorate regarding care and support. This recommendation was met and details can be found under quality theme 1 - statement 3. One recommendation was made as a result of the previous inspection regarding staff supervision. This recommendation was met and details can be found under quality theme 4 - statement 4. Conclusion The service continues to operate at a very good level. It continues to monitor service planning and delivery involving stakeholders and strive towards continuous improvement. Elite Care (Scotland) Ltd, page 3 of 24

4 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 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 The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. You can find the most up-to-date grades for this service by visiting our website, by calling us on or visiting one of our offices. 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. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Elite Care (Scotland) Ltd is a privately owned service which was established in 1984 and provides a range of nursing, domestic, care and support to people in their own homes. The service registered with the Care Inspectorate in April The housing support/care at home service is available twenty-four hours a day, seven days a week. Support packages are provided on an individual basis, designed to meet individual needs. The service is managed from a main office base in St Andrews. The service is available across North East Fife, Perth and Kinross and Tayside. There are two satellite offices, one in Crieff and one in Dundee; the one in Dundee is mainly used as a staff training room. The head of service was responsible for overseeing the running of the service. Three service managers (one in each area) were responsible for the day-to-day running of Elite Care (Scotland) Ltd, page 4 of 24

5 service delivery to clients and the supervision of staff. On the day of the inspection 530 people were receiving the service. The provider and head of service were present throughout the inspection. The aims and objectives of the service stated that: 'We believe our clients have the right to be cared for in a compassionate, caring and professional manner ensuring that their needs are met by respecting their privacy, comfort and wishes. We strive to distinguish ourselves from other care providers by ensuring value through quality care. We guarantee a professional personal approach, first class planning and competitive prices. Our objectives: To discuss with you informally and without obligation what your needs may be. With your help, to carry out an assessment to enable you and Elite Care (Scotland) Ltd to determine how best to proceed. Such an assessment to be carried out by a Senior member of the company, at your home, in your presence and that of a member of your family, or friend if you wish so. To discuss areas such as - health and safety, mobility problems, dietary needs and medication relative to your care. To communicate to you the outcome of the assessment. To agree, or not agree, a programme of care. In the event of agreement, to draw up a contract of care, the start time, the number of hours needed, the cost, method of payment, risk management, the name of the carer(s) and other relative information, particularly cover arrangements of illness of a carer and complaints procedure. To provide you with a signed copy of the agreement. To provide you with a copy of our code of practice. We encourage our staff to maximise their potential in terms if personal and professional development and to be proud of the service they provide. Keeping in touch with our clients, their relatives and other agencies to ensure your needs are being met, as well as re-assessment. and through staff in attendance. Based on the findings of this inspection this service has been awarded the following grades: Elite Care (Scotland) Ltd, page 5 of 24

6 Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good 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. Elite Care (Scotland) Ltd, page 6 of 24

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. This was carried out on 06 February 2015 between 11am and 5pm. We gave feedback to the provider and the head of service on this date. As part of the inspection, we took account of the completed annual return and self-assessment forms that we asked the provider to complete and submit to us. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: * five clients via the telephone * the provider * the manager * seven members of staff including three who were on induction. We looked at: * minutes of residents' and relatives meetings * care plans, accident and incident records * care plan audits * medication audits * staff files * staff training records. We also sent out 20 questionnaires to people who use the service and their relatives and we received six responses. The views they expressed to us have been used to inform this report and some of the detailed comments which have been anonymised to maintain confidentiality can be read throughout this 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 service, so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Elite Care (Scotland) Ltd, page 7 of 24

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 report continued 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 Elite Care (Scotland) Ltd, page 8 of 24

9 What the service has done to meet any recommendations we made at our last inspection One recommendation was made during a complaint investigation carried out by the Care Inspectorate regarding care and support. This recommendation was met and details can be found under quality theme 1 - statement 3. One recommendation was made as a result of the previous inspection regarding staff supervision. This recommendation was met and details can be found under quality theme 4 - statement 4. 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 provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how the people who used the care service had taken part in the self-assessment process. Taking the views of people using the care service into account For this inspection, we received views from five people using the service via telephone conversations. Three clients chose to complete the questionnaires. Everyone spoken with said they were very happy with the quality of the service. People spoke very highly about the staff that supported them and cared for them and all respondents said that staff treated them with respect. We have included further comments and views from people using the service throughout the report. Elite Care (Scotland) Ltd, page 9 of 24

10 Taking carers' views into account Inspection report continued Three carers returned questionnaires to us. The feedback they gave us was positive. Elite Care (Scotland) Ltd, page 10 of 24

11 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: 5 - Very 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 The service was performing at a very good level in the areas covered by this statement. In order to assess this statement we asked the manager to provide us with information about how people who use the service are involved in the care and support provided. We looked at care plans, client reviews and methods of communication with people who use the service. We also listened to the people we spoke with who used the service and used the comments made to us in Care Inspectorate questionnaires which were returned to us. Every client had a contract in place detailing the service they are to receive and useful information such as contingency plans, advocacy details and closure contingencies. It also contained information about how to make a complaint, the Care Inspectorate and local authority details. Each client also had a detailed care plan. We saw evidence that the clients and their carers had been involved in making the care plans. Clients had the opportunity to express their views about service planning and delivery during their monthly meeting with their key worker and care plan reviews. Each key worker meeting and care plan review was recorded. Questionnaires were sent out to clients/carers annually or if something specific arose which required their opinion. Elite Care (Scotland) Ltd, page 11 of 24

12 Quarterly newsletters were sent out to staff and clients. The newsletters kept clients up to date with relevant information such as weather precautions, changes to systems which may affect them for example SDS (Self Directed Support) and staff training. The service had started the 'Elite Client Focus Group' to help shape future service planning and delivery. Letters were sent inviting clients and their carers to become involved. The focus group is held in the office in Dundee however we were informed that a new venue is being sought to accommodate clients who use wheelchairs. The provider stated that the service would organise transport if necessary to encourage people from all areas to attend. During one of the meetings clients stated that one area for improvement was communication. The service has since developed improved welcome packs which contain more helpful information about Elite, other services available and the national care standards. Clients had also requested a carer from the 'Carer's Focus Group' to attend their meeting which they did and delivered a presentation on 'a day in the life of a support worker'. They also requested further information on SDS; one of the service managers gave a presentation on this. Comments received from clients during the inspection included: "Yes, I am asked my opinion about what I want" "They're always asking me if I'm happy" "We get newsletters telling us what's going on" "If I need to know anything I just ask and they tell me". Areas for improvement One of the service managers stated that she intended to develop regular newsletters specific to her area so that clients could be kept up-to-date with local news. 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 At this inspection we found that the service was performing at a very good level for this quality statement. To assess this statement we looked at care and support information including assessments, care plans including social activities and reviews of care. We spoke to the service managers, staff and clients and we also looked at what action had been taken to meet the outstanding recommendation. The services Elite can provide include: Elite Care (Scotland) Ltd, page 12 of 24

13 personal care overnight care companionship care domestic care. If a client was noticed to have a healthcare need for example foot care or eye care staff will support them to seek the appropriate care or inform the client's family. They will also escort clients to appointments including going the hairdresser. We were able to confirm from the staff training records that staff were given training which would support them to meet people's health needs. We were told that efforts were made to match clients with staff who have similar interest. Some clients receive companionship care and they choose how to spend their time with the support worker. Some clients chose to do flower arranging, shopping, cooking or going out for lunch. Support workers will escort clients to weddings and parties and go on trips to the cinema and bowling. One client was supported to attend church every week. Every client who lives alone was asked if they had Christmas dinner organised and if not a dinner was purchased and staff ensured they had a hot meal on Christmas day. This happened even if Christmas day fell out with their normal care package hours. Clients had six monthly formal reviews whereupon their families and social workers were invited to attend if the client wished. This provided an opportunity for clients to express their views about the service they received and request changes if desired. Clients who had social workers also had social work reviews; copies of which were given to Elite to keep all parties updated. Care plans were comprehensive and up-todate. Staff completed the daily record sheet which gave them the chance to record the care they had carried out. Risk assessments relating to the environment and risk of falls were also carried out where appropriate. There was a summary of the tasks required to be done by the staff at each visit for those clients with very complex needs. This meant that staff were aware of the needs and preferences of each client and the support offered was sufficient to meet the person's needs. One recommendation had been made as a result of a complaint investigation carried out by the Care Inspectorate. This was regarding clients' visiting times being cut short due to staff shortages. The service had devised an action plan to prevent recurrence which included: absence management training for coordinators absence analysis (with human resource involvement) return to work interviews improved communication between coordinators/managers and clients when there is a change of carer/time Elite Care (Scotland) Ltd, page 13 of 24

14 annual leave management updated 'on call' and 'out of hours' guidance for all staff. We were informed that these measures had led to improvements and no further complaints had been received. This recommendation was met. Comments received from clients during the inspection included: "My carers look after me well" "I don't know what I would do without them" "They do much more than they're supposed to I'm sure" "They always cheer me up". Inspection report continued Areas for improvement We were informed by one of the service managers that she intended to start doing peer care plan audits. This means that teams of staff will be responsible for auditing care plans for clients in other teams to ensure they are kept up-to-date and contain sufficient information to guide staff in meeting individual client's' needs. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Elite Care (Scotland) Ltd, page 14 of 24

15 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The evidence for the grade awarded in this statement is included in Theme 1 Statement 1- Service Strengths above. Areas for improvement The area for development for this statement is included in Theme 1 Statement 1- Areas for Improvement above. 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 At this inspection we found that the service was performing at a very good level for this quality statement. To assess this statement we looked at the induction process, staff training, staff qualifications, the minutes of staff meetings. We also spoke with the staff on duty. The company had a training programme in place to ensure that the staff team received induction and on-going training opportunities. This helped them to support and care for clients of the service. The programme of staff training was evidenced and seen to be appropriate to the needs of the clients of the service. Training delivered in the last year included; self-directed support involving people voice and eating Elite Care (Scotland) Ltd, page 15 of 24

16 PEG feeding (Percutaneous Endoscopic Gastrostomy) MAPPA (Multi-Agency Public Protection Agency). Inspection report continued The provider told us that a training analysis had been carried out and it had been highlighted that not all staff were up-to-date with all mandatory training. The provider had written to the staff informing them that if this was not rectified they would be unable to provide care and support to clients without the specific skills and knowledge required. This meant the provider was putting measures in place to maximise clients' safety. We spoke with seven members of staff. They had a very good understanding of their role and confirmed they had good awareness of the National Care Standards and the Scottish Social Services Council. They told us they enjoyed working for Elite and received very good training and support. The three members of staff on induction said that they wanted to work for Elite because they had heard good things about it. One person said she had a friend who was a client and had told her that the standard of care and support was very high. Feedback from people who use the service identified high levels of satisfaction with the staff team. Staff had access to an e-learning system which had training topics relevant to their job and were subject to passing a competency test after each topic prior to receiving a certificate. We were also informed that staff can request specific training to their role for example all staff providing care and support to one client were undertaking training on challenging behaviour. This was at the request of the client's relative in case they have difficulty managing in the future. We sampled three personnel files. We found that there were very good processes and procedures for the safe recruitment of staff. On the day of the inspection 29 members of staff had attained an SVQ level II certificate and seven members of staff were undertaking the training. 13 members of staff had attained an SVQ level III certificate and two members of staff were undertaking the training. The provider and head of service had an SVQ level IV in Health and Social Care and the RMA (Registered Managers Award). Comments received from clients during the inspection included: "I know they get training and they certainly know what they're doing" "They're always very polite" "They always treat me with respect and I respect them" "I would be lost if I didn't have them". Areas for improvement The provider should continue to monitor staff progress in meeting the mandatory training requirements and take appropriate action if necessary. Elite Care (Scotland) Ltd, page 16 of 24

17 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Elite Care (Scotland) Ltd, page 17 of 24

18 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very 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 The evidence for the grade awarded in this statement is included in Theme 1 Statement 1- Service Strengths above. Areas for improvement The area for development for this statement is included in Theme 1 Statement 1- Areas for Improvement above. Grade awarded for this statement: 5 - Very 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 A range of evidence was sampled and the performance of the service was found to be very good in relation to this statement. The service had quality assurance systems in place to enable them to identify areas for improvement in service planning and delivery. These included health & safety, medication, environment, accidents and incidents, complaints and quality of care checks. Clients' care plans were audited and also subject to periodic audit by the local authority during client reviews. The service had attained a 'Investors in People' quality assurance award at bronze level. Client questionnaires, quality checks and client reviews enabled the head of service to identify areas for improvement. in service planning and delivery. Elite Care (Scotland) Ltd, page 18 of 24

19 Staff meetings took place regularly; organisational and individual team meetings. Staff who can't attend the meetings are kept up- to- date via phone calls, s or letters. Staff benefitted from a performance related benefit scheme based on dress conduct, time-keeping, flexibility for client needs and a professional approach to clients. Quality care checks are carried out for each member of staff by the service managers and team leaders and recorded on the IT system to highlight any areas for improvement and timescales for the next visit. The service had started a 'You Said We Did' initiative which was another method of taking cognisance of suggestions or concerns, making an action plan and feeding back the outcome. For example one relative felt they did not have enough information about Dementia. The staff signposted her to websites, Stirling University Dementia Centre and bought her a book. Some families had been asking staff how they use moving and handling techniques so easily. The service organised their moving and handling trainer to visit the families and provide training and support. A recommendation was made as a result of the previous inspection regarding the lack of staff supervision. Supervision provides opportunity to discuss professional development and identify any training needs. We found that supervision had been taking place and the aim was to have four contacts with each staff member per annum between supervision, telephone calls and an annual appraisal. The service managers had been mainly responsible for doing this however it was the intention to delegate elements of this to the three newly recruited coordinators. This recommendation was met. The provider and head of service were aware of the SSSC (Scottish Social Services Council) Codes of Practice and their responsibility to report to the SSSC and the Care Inspectorate any dismissal on the grounds of misconduct including theft. They were also aware of their responsibility to ensure that guidelines for the registration of staff with the SSSC are followed. Comments received from clients during the inspection included: "Everybody that comes in is very pleasant; even the bosses" "I've no complaints at all" "If I had any concerns I would just phone the office; they're always nice". Areas for improvement Inspection report continued The head of service should monitor progress on the new scheme of delegation regarding staff supervision to ensure every member of staff receives it in accordance with internal policy. It was highlighted that not all staff meetings are formally recorded. This should be rectified in order to have records for reference and audit purposes. Elite Care (Scotland) Ltd, page 19 of 24

20 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Elite Care (Scotland) Ltd, page 20 of 24

21 4 Other information Complaints Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information On the day of the inspection the following documents were on display in the service: A valid insurance certificate verifying liability insurance cover. A valid registration certificate. Action Plan 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). Elite Care (Scotland) Ltd, page 21 of 24

22 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 28 Mar 2014 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 5 - Very Good 5 - Very Good 18 Dec 2012 Unannounced Care and support 5 - Very Good Staffing 6 - Excellent Management and Leadership 6 - Excellent 5 May 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 9 Jul 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 16 Oct 2008 Announced Care and support 5 - Very Good Staffing 4 - Good Elite Care (Scotland) Ltd, page 22 of 24

23 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. Elite Care (Scotland) Ltd, page 23 of 24

24 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: enquiries@careinspectorate.com Web: Elite Care (Scotland) Ltd, page 24 of 24