Care service inspection report

Transcription

1 Care service inspection report Full inspection North Lanarkshire Support Service Housing Support Service Unit Fountain Business Centre Ellis Street Coatbridge Inspection completed on 20 May 2016

2 Service provided by: Turning Point Scotland 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 enquiries@careinspectorate.com page 2 of 33

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 3 Adequate Quality of staffing 4 Good Quality of management and leadership 4 Good What the service does well The service had improved the way it involved people in their care and support and how it gathered views about service delivery. Individuals we spoke with, including people who used the service, family carers, staff and a care manager, described the service in positive terms and could give us examples of how it was making a positive difference to the lives of supported individuals. What the service could do better Staff shortages and staff turnover continued to have a negative impact on service delivery and had slowed down the pace of progress within the service. Changes in management had also been disruptive to some extent, but we could see that the new management team was taking the service in the right direction. We have noted a number of recommendations in this report in respect of participation, medication management, quality of staffing and quality assurance. An effective service development plan needed to be put in place to ensure sustainability with what had been achieved so far and to drive forward continuous improvement. page 3 of 33

4 What the service has done since the last inspection We found significant improvements with regard to participation as different involvement processes were now in place to gather people's views and respond to their issues. Effective quality assurance measures, such as regular staff supervision and file audits had been introduced. The service had relocated to better office space and this had assisted management functions, teamwork and engagement with people who used the service. We found that managers had a clearer understanding of their role and responsibilities as a result of better management structures and direction from the registered manager. Support plans were more up to date than in the past and medication management was developing in the right direction. Inspection report Conclusion Overall, we noted an improving picture with signs of further capacity to improve. The service now needed a period of management and staffing stability to sustain what had already been achieved and address outstanding areas for improvement. We were pleased to note that managers were clear about what needed to be done and were committed to ensuring that service users received the best possible outcomes from receiving the service. page 4 of 33

5 1 About the service we inspected Inspection report North Lanarkshire Support Service is a combined housing support and care at home service, provided by Turning Point Scotland. It operates 24 hours a day, 365 days per year with management on call for emergency situations. Under the North Lanarkshire personalisation agenda, people who use the service have self-directed support budgets and an outcome support plan is built around this to meet the person's needs within the allocated budget. The service aims to enable people to live as fulfilling and independent life as possible, designing supports that are as individual as the person is. The Care Inspectorate regulates care services in Scotland. Information about 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 page 5 of 33

6 Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 3 - Adequate Quality of staffing - Grade 4 - Good Quality of management and leadership - Grade 4 - 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. page 6 of 33

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection One inspector carried out this unannounced inspection with the assistance of an inspection volunteer who spoke with some people by phone. The inspection took place on 12, 13 and 16 May 2016 during the day and early evening. We returned on 20 May 2016 to provide feedback on our findings to the service manager. 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 return to us. Prior to the inspection, we received 10 responses from the 27 care standards questionnaires distributed to people who used the service. We also sent out 30 staff questionnaires and received three back. During the inspection process, we gathered evidence from various sources including the following: - We met and spoke with five people who used the service in their home and another four service users at the office base in a group - We spoke with two people who used the service and a relative by phone - We met and spoke with six relatives during our home visits - We spoke with a group of seven staff in the office base and met another four staff during our home visits - We spoke with the service manager, a service coordinator and the three assistant service coordinators - We spoke with a care manager who was attending a training event at the office base - We observed staff and service user interaction during our home and office page 7 of 33

8 visits. We looked at a range of documents including: - Personal plans, including risk assessments and review paperwork - Daily progress notes - Staff training records - Team meeting minutes - Staff supervision and appraisal records. - Quality audits. - Participation information - Certificate of Registration - Notifications submitted to us since the last inspection - Complaint log - Service improvement plans - Accident and incident records Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. page 8 of 33

9 Fire safety issues Inspection report We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at page 9 of 33

10 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. All sections of the self assessment had been completed. Further comment has been made on the self assessment within this report. Taking the views of people using the care service into account We spoke with 11 people who were being supported by the service, either individually, in a group or by telephone. We also considered people's views that had been gathered by the service, through methods such as meetings and questionnaires. From this feedback we gained the impression that most people were satisfied and happy with the overall quality of service. Comments made by people about their view of the service are reflected throughout this report. Taking carers' views into account We met with six relatives during this inspection and spoke with another by phone. Overall, we received glowing reports about the staff who supported their family member. Views on service strengths and areas for improvement were noted and we have referred to these in this report, where appropriate. page 10 of 33

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: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service Strengths We found that the service was performing well under this quality statement. We concluded this after we spoke with service users, family carers, a care manager, staff and managers, reviewed feedback from questionnaire responses and sampled records such as support plans and minutes of meetings. Since the last inspection, there have been concerted efforts under a new management team to make improvements in a range of areas including participation. Following the previous inspection we made two recommendations in relation to this statement. The first recommendation was in relation to developing a range of participation methods for people to be involved in their care and support and for their views to be listened to. This recommendation was now met. The service had introduced individual participation and involvement plans for each person so that preferred ways of becoming involved were identified and known. For instance, one person wanted to be involved in staff recruitment and this was subsequently arranged. In general, service user involvement in staff recruitment was becoming part of the norm for this service. page 11 of 33

12 In addition, satisfaction questionnaires had been introduced along with an annual Stakeholder event and a quarterly involvement group, known as North Lanarkshire Support (NLS) Connect. We could see that these initiatives were fully evaluated and were leading to service users' and family carers' views having influence on the running of the service. For instance, changes to staff rotas, introduction of a keyworker system and a revised service information pack were improvements resulting from people's feedback. This meant that the service recognised the diversity of people being supported as a consequence of having a range of participation methods. We made a second recommendation about ensuring that all service users received a review of their support package, at least six monthly. Better systems were in place to keep track of reviews and we could see that regular reviews were now happening for the majority of people. We noted from the minutes of sampled review meetings that people were very much active participants in the process and able to self-determine the support that they received. Managers were aware that there remained a small number of overdue reviews which now needed prompt attention and we have repeated the recommendation on this basis (See Recommendation 1). We met with service users during home visits and in the office base. We observed positive and friendly interactions with staff. People were offered choices about their weekly and daily support plans. When we spoke with people they told us that they felt listened to and that they could influence the service provided. For instance, one person told us that they had raised concerns about a staff member and this was addressed right away. The first North Lanarkshire Support Connect meeting for service users had been held where citizenship, charter for involvement, the Scottish Government's 'Keys to Life' learning disability strategy, voting and other service and community level involvement opportunities were discussed. Consequently, people were given information about how they could exercise their rights and responsibilities and ways that their voice could be heard. The Connect forum had the potential to further enhance participation processes in this service and we will review progress at the next inspection. We suggested to the manager that exploring the use of independent facilitation for this meeting would be a very good way of developing the self advocacy aspect of this forum. page 12 of 33

13 We spoke with service users, family carers and a care manager who told us that they felt the service was moving in the right direction and felt more involved as a result of the service developments over the last year. For instance, comments included, "The family are happier, good outcomes and more flexibility". "Good communication between Turning Point Scotland, the family and us". "Issues raised have been addressed". Since the last inspection, the service had relocated to more spacious office accommodation in the same building. This promoted more drop in opportunities for service users to engage with staff, as we observed during the inspection. Areas for improvement Our evaluation of 4 - Good for this statement reflected the developments that have taken place since the last inspection and the better outcomes for people that have resulted. However, staff shortages and management changes over the course of the year, have hampered progress to some extent. Consequently, the service needed stability and the opportunity to address areas for improvement in many aspects of service delivery. For participation, the service now needed to sustain the new initiatives introduced to involve people and continue to develop them, including involving family carers and other agencies. We noted that support plans were more person centred and outcome focused than previously, but managers were working to address different standards of completion of paperwork. A system of file audits had been introduced and we could see that this was a work in progress. We pointed out to the manager that audits would benefit from tighter control over timescales for addressing issues raised and a section for confirming that appropriate action had been taken. page 13 of 33

14 We came across examples where review minutes were not available. It was reported that this was due to a delay in receiving them from Social Work Services. In the interim period, managers should compile a minute of the review to reflect what was agreed, decisions reached and the outcome for changing and delivering support plans. We came across a number of examples of support plan records including outcome plans, review minutes and risk assessments not signed off by service users. Consequently, we could not fully verify their agreement and involvement with what was written. This needed attention (See Recommendation 2). Issues raised by supported individuals and family carers should be better reflected in service improvement plans and should also inform the service's self assessment and grading evaluation with more emphasis on how these activities have improved outcomes for the individual (See Recommendation 3). For instance, we found from speaking to people that staff consistency and staff changes remained a concern for individuals, but was not formally reflected in action plans or the self assessment. Comments from people included, "The turnaround of staff has been quite frequent. Staff seem to do a lot of hours". "There's the odd occasion were mistakes are made. No-one turned up, missed visit, rota mixed up". "High turnover of staff. Can be difficult getting used to people and then they leave". "It has been getting progressively better, but starting to decline again ever so slightly, lost a lot of good staff lately". page 14 of 33

15 Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations Managers should ensure that every person who used the service received a review of their support package at least six monthly and be able to evidence a record of the review in support plan files. National Care Standards (NCS) 3 Care at Home - Your Personal Plan 2. Support plan records, including outcome plans, review minutes and risk assessments should be signed off by service users or their representatives to show agreement and involvement. NCS 3 Care at Home - Your Personal Plan 3. Issues raised by supported individuals and family carers as well as outcomes should be better reflected in service improvement plans and inform the service's self assessment and grading evaluation. NCS 11 Care at Home - Expressing Your Views page 15 of 33

16 Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths We found that the service was performing adequately in terms of promoting people's health and well-being. We came to this conclusion after observing staff interacting with people using the service, speaking to people and sampling records. We noted developments in the management of medication in line with a previous recommendation we had made. Medication administration sheets were now in place and staff were receiving medication training. Plans were in hand to introduce competency based training and roll out a fuller medication file for each person to improve accountability in this area. We noted that where medication errors had taken place, these had been properly investigated and action taken to minimise reoccurrence. We make further comment about medication management under the section, 'areas for improvement'. We noted that plans were in hand to introduce an electronic signing in and out system linked to smartphone technology to track staff whereabouts and ensure service user safety. The manager expected this to be in place within a couple of months following the delivery of new phones and system set up. We found a better awareness of the Scottish Government's 'Keys to Life' strategy for people with learning disabilities. A copy was available in the staff office and this document had been discussed at meetings with service users and staff alike. A new review format linked to the 'Keys to Life' principles was also about to be introduced. This meant that closer attention would be given to regularly reviewing how well the person was achieving good outcomes such as improved health and wellbeing, relationships and community involvement. Where and when regular staff and teams were maintained, we found positive reports of how the person's health and wellbeing had improved. For instance, one carer told us: page 16 of 33

17 "I can relax with the regular staff. They pick up on the small details. He cannot communicate verbally and regular staff can tell when he is in pain. The less regular staff do not see these things". A service user told us: "I can approach my main worker about anything, for example if my mood is down". Consequently, when a consistent team of staff was maintained, it meant that there was greater opportunity to identify changes in health and wellbeing and respond quickly to those changes. We made a recommendation following the last inspection in relation to developing risk assessments, where there were identified risks. We could see significant progress with this with detailed and measurable risk found in sampled support plans. Where necessary, multi-disciplinary meetings took place to ensure the service worked in partnership with other agencies to keep the person safe and develop appropriate risk management plans in this regard. In general, support plans were person centred and outcome focused and people could give us examples of how staff's delivery of their support plan had made a positive difference to their life. For instance, one person was now eating better and protected from financial exploitation. Another person was no longer at risk of alcohol dependency and staff could tell us how his life had dramatically changed for the better. People who used the service and their families often dealt with their own medical matters and appointments, but staff were available to support the person with this as required. We noted that managers and staff recognised their duty of care, and, for instance, would report any concerns of alleged abuse to the relevant agencies. Staff described an open culture whereby any concerns of wrongdoing or misconduct would not be tolerated and would be reported. Staff knew about the provider's Whistleblowing Policy and their responsibilities regarding reporting any forms of alleged or suspected abuse. Not all staff had received adult protection training, but the manager was able to provide us with upcoming training dates which would address this matter. page 17 of 33

18 Areas for improvement We made a recommendation following the last inspection that service users should be offered a copy of their support plan in an accessible format and the person's decision to take up this offer should be recorded for reference purposes. This remained an area for improvement (See Recommendation 1). In line with good practice guidance and the provider's own medication policy, each service user should receive a risk assessment in respect to ordering, storage, disposal and administration of prescribed medication and level of responsibility and support required. Sampled medication records also highlighted that staff needed to pay closer attention to good practice guidance in relation to record keeping for medicines (See Recommendation 1). We discussed good practice guidance with the manager at the inspection feedback in relation to medication management in a care at home setting. As noted under Quality Theme 1 Statement 1, staffing was raised as an area of concern by a number of people who received the service. Family carers and service users, for instance gave us examples of where staffing arrangements had the potential to impact negatively on service delivery: "The second member of staff not arriving till 11.30am when it should be 10.30am. This affects his routines and personal care needs." Inspection report "I find it difficult when I get a different person to support me every day. I used to have regular support people and the continuity of that helped but now it's a different person every day and it is difficult to build a rapport with so many people coming and going" Staff also highlighted problems to us resulting from rota changes and a lack of staff, which impacted on service delivery. We concluded from this and from other feedback we received that staff shortages and deployment was affecting the delivery of support packages and service continuity. We could see that the organising of staff into three geographical 'hubs' had meant more efficient usage of available staff resources, but difficulties experienced by staffing shortages and retention of staff meant continued to undermine consistent service delivery. The manager advised us of revised staffing rotas and recruitment plans aimed at finding a solution to this issue. page 18 of 33

19 The training that staff received contributed to them being able to offer support in an informed, person centred manner, complementing the knowledge gained in the course of working with people over time. However, training records and feedback from a number of people we spoke with indicated that many staff had not received training in key areas related to supporting good practice and the specific needs of individual service users. These included, diabetes, alcohol and substance misuse, peg feeding, mental health awareness and personality disorder. The manager was able to provide us with details of upcoming training that was planned and we have made an associated recommendation to support improvement in this area (See Recommendation 3). Increased confidence and independence through staff support had led to meaningful community engagement for people. For instance, one person had enjoyed a holiday and opportunities to get out and about, which had not been previously available. However, we did come across family carers who described a lack of creativity when it came to social support for their family member: "Staff take him to the shopping centre and the park all the time. They could do other things with him for instance, take him to a service user group to meet his friends". It was important to ensure that the service's approach to SDS did not result in isolation or a lack of meaningful activity. The new keyworker role encouraged a more person centred approach, but a number of staff told us that they were not sure about what was expected of them in this role, indicating the need for further learning and development in this area. Managers may find the following good practice guidance of use in the development of staff practice, all of which can be found at the online resource, The Hub (Available at, Care Inspectorate and Partners. (2015). Prompting, assisting and administration of medication in a care setting: guidance for professionals. Care Inspectorate (2012). Guidance about medication personal plans, review, monitoring and record keeping in residential care services. page 19 of 33

20 Scottish Government Joint Improvement Team (JIT) (2012) 'Talking Points' Personal Outcomes Approach Practical Guide. Grade 3 - Adequate Number of requirements - 0 Recommendations Number of recommendations Service users should be offered a copy of their support plan in an accessible format and the person's decision to take up this offer should be recorded for reference purposes. NCS 3 Care at Home - Your Personal Plan 2. The manager should ensure that medication management is in line with best practice guidance, particularly regarding support planning and assessment and the recording of medication administration. NCS 8 Care at Home - Keeping Well - Medication 3. Opportunities for staff training, learning and development, should continue to develop in line with staff's role and service users' specific support needs. NCS 3 Care at Home - Your Personal Plan and NCS 4 Care at Home - Management and Staffing page 20 of 33

21 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 The service was performing well in the areas covered in this statement. We came to this decision after we spoke with supported individuals, family carers, staff and others, and looked at relevant documents that recorded involvement in staffing; for example, reviews. The strengths noted in Quality Theme 1, Statement 1 are relevant to this statement. Stakeholder events, satisfaction questionnaires and reviews of the support plan provided the opportunity for supported individuals and their relatives to discuss their views on staff and suggest improvements. We saw from the sampled records that we looked at that comments were generally positive about staff. There were similar responses to our care standard questionnaires. Of the 10 questionnaire responses we received, there was a 100% response of strongly agree/agree to the questions about staff having relevant skills and treating supported individuals with respect. During our home visits and time at the office base we observed good working relationships with positive interactions between staff and supported individuals, based on a sound knowledge of the person's needs and preferences. page 21 of 33

22 There was regular contact for people receiving the service with the management team, particularly assistant service coordinators, as this was built into the rota. This management presence allowed for the development of effective relationships with managers and meant that people being supported could discuss any staff issues with confidence. People we spoke with were familiar with the managers at this service. People who used the service were encouraged to participate in the recruitment of new staff. Service users we spoke with told us that they were clear about the procedures in place if they had a complaint about a staff member. They were aware of how to make a complaint and we could see that those received were appropriately investigated. Feedback from questionnaire responses showed less awareness of the complaints procedure and we asked the manager to ensure this was raised with service users and relatives. Areas for improvement The last inspection noted that service users and family carers were not asked to give feedback on individual staff, including new staff, during formal supervision and appraisal processes. This remained an area for improvement. Assistant service coordinators were able to carry out direct monitoring of staff practice through their involvement of the rota. It would be good to keep a record of this to support service user involvement in the assessment process and assist staff learning and development (See Recommendation 1). At the last inspection we had noted that not everyone we spoke with felt that staff had adopted an ethos of respect towards service users. Written information that we sampled indicated that a small number of service users and family carers still questioned the attitude of a few staff. We were pleased to note that managers had responded by discussing professional boundaries at team meetings as a standing agenda item and during supervision sessions to promote a culture of respect and professionalism. A system of direct observation of staff practice, as noted in the previous paragraph, would also help in this regard. page 22 of 33

23 Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations Direct monitoring of staff practice should be formally recorded to evidence service user involvement in the assessment process and assist staff learning and development processes. NCS 4 Care at Home - Management and Staffing and NCS 11 Care at Home - Expressing Your Views page 23 of 33

24 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths We found that the service was performing to a good standard against the areas covered in this statement. We concluded this having looked at staff training records, spoken with staff, stakeholders and people who are supported by the service. Staff and management described service improvements which were a "work in progress" under the new management team. People recognised an improved management structure and defined roles and responsibilities. This had been lacking in the past. Consequently, we found that these structures contributed to a more motivated team of staff. Having an approachable and supportive management team meant that staff felt able and inclined to seek support where necessary. We made a recommendation following the last inspection that team meetings and individual staff supervision sessions should be held on a more regular basis with a more accountable record of the meeting kept. Since then, more regular general team meetings were taking place and a new layer of 'Hub' team meetings had been introduced under the direction of the three Assistant service coordinators. Managers paid closer attention to maintaining regular supervision for staff as well and this now needed to be sustained across the whole staff team. Records of meetings were more meaningful than previously as they showed the reader what was discussed, decisions reached and action plans. Some staff had received an annual appraisal of their work and this was being rolled out to the remaining staff. Staff were issued with mobile smartphones which allowed them to write up their daily notes, refer to staff rotas and send s. This facilitated good communication and contact with supervisors. page 24 of 33

25 Areas for improvement Issues raised under other quality statements in this report in relation to staffing, particularly, limited training, short staffing and high staff turnover were also relevant to this statement. These issues were raised again by management, and staff who reported that they had an impact on staff morale, consistency of support and continuous improvement of the service. Managers were well aware that a period of stability was now needed. We understood that staff would be observed as part of medication competency assessment. As noted under Quality Theme 3, Statement 1 it would be good to extend formal observational monitoring of staff practice to other areas of services user engagement to make sure that staff are following best practice guidance. In anticipation of staff's responsibility to be accountable for maintaining their own continuous professional development when registered with the Scottish Social Services Council (SSSC), we talked with managers about how the service might embed a culture of self-directed learning at the service. Resources to enhance their skills and knowledge including the 'Hub' at the Care Inspectorate website, SSSC Step into Leadership programme and the Institute for Research and Innovation in Social Services (IRISS) would help in this regard. The HUB is an online library of resources includes publications, policy and legislation in social care as well as good practice guidance. SSSC is responsible for registering the social care workforce. IRISS promotes positive outcomes for the people who use Scotland's social care services. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 25 of 33

26 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 We found that the service was performing to a good standard against the areas covered in this statement We came to this conclusion after speaking with people and sampling participation processes. The strengths noted in Quality Theme 1, Statement 1 are relevant for this statement. The management team were accessible to people who used the service and family carers in a number of ways. For instance, assistant support coordinators provided direct support to people as part of their role. This meant that people using the service, had easy and direct access to managers. It also meant that there was opportunity for additional support and guidance for staff. Areas for improvement The areas for improvement noted in Quality Theme 1, Statement 1 are relevant for this statement. The service improvement plan and self assessment needed to be developed to include issues raised by stakeholders and shared with everyone. This would demonstrate their participation and inclusion. page 26 of 33

27 Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 27 of 33

28 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 We found that the service was performing to a good standard against the areas covered in this statement. We came to this conclusion after speaking with people and sampling participation processes. The management team used and were developing a range of quality assurance processes to monitor the quality of the service. These included, - Support plan file audits - Monthly key performance reports by assistant service coordinators which were discussed with the manager and covered aspects of service delivery such as review dates, support plan and risk assessment completion, individual service agreements in place and staffing information such as supervision dates. - The provider's 'Impaqt' quality assurance tool focusing on nineteen aspects of service delivery - Participation methods and evaluation reports as described under quality theme 1, statement 1 Regular manager and staff meetings were taking place and we could see how this led to accountability, the sharing of information and guidance, and identifying issues that needed to be addressed. Assistant service coordinators worked alongside front line staff as part of their job, which meant that they could quickly pick up on issues raised. The operations manager's regular presence in the service was noteworthy as this led to external scrutiny of the service's performance. page 28 of 33

29 Areas for improvement We could see that managers had made some important improvements in service delivery since the last inspection, not least with regards to participation and promoting better structure to the staff teams. Managers recognised that the previous year had not been without its challenges including staff shortages and rota problems, which had impacted on some areas of development as noted elsewhere in this report. However, confidence was high that progress would continue to be made and sustained with the current management team in place. For instance, the manager was able to outline the steps he was taking to increase staff recruitment through making links with colleges. The management team demonstrated that it had the capacity to continuously improve the service and we look forward to reviewing progress in due course. Quality assurance processes would benefit from more formal methods of gathering the views of external agencies (See Recommendation 1). The service improvement plan was restricted in scope as it did not involve all stakeholders in identifying areas for improvement. It should also be shared with everyone in a suitable format so that people can see how managers were taking action (See Recommendation 1) Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The service improvement plan should involve and be shared with all stakeholders, including external agencies and family carers, to comprehensively identify areas for development and so that people can see how managers were taking action towards continuous service improvement. NCS 4 Care at Home - Management and Staffing and NCS 11 - Expressing Your Views page 29 of 33

30 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The manager should introduce and maintain a range of participation methods that will enable customers and other stakeholders to be part of the continuous development of the service as a whole. National Care Standards (NCS) 11 Care at Home - Expressing Your Views This recommendation was made on 21 April 2015 This recommendation was now met. We make further comment about this under Quality Theme 1, Statement 1 in this report. 2. Managers should ensure that every person who used the service received a review of their support package at least six monthly. NCS 3 Care at Home - Your Personal Plan This recommendation was made on 21 April 2015 This recommendation was not fully met. We make further comment about this under Quality Theme 1, Statement 1 in this report. page 30 of 33

31 3. The manager should ensure that medication management is in line with best practice guidance, particularly regarding the implications for staff training, support planning and assessment and the recording of medication administration. NCS 8 Care at Home - Keeping Well - Medication This recommendation was made on 21 April 2015 This recommendation was not fully met. We make further comment about this under Quality Theme 1, Statement 3 in this report. 4. Service users should be offered a copy of their support plan in an accessible format and the person's decision to take up this offer should be recorded for reference purposes. This recommendation was made on 21 April 2015 This recommendation was a work in progress. We make further comment about this under Quality Theme 1, Statement 3 in this report. 5. Risk assessments should be included with support plans, where there are identified risks. NCS 3 Care at Home - Your Personal Plan This recommendation was made on 21 April 2015 This recommendation was now met. We make further comment about this under Quality Theme 1, Statement 3 in this report. 6. Team meetings and individual staff supervision sessions should be held on a more regular basis with a more accountable record of the meeting kept, including clear action plans and discussion of best practice guidance, policies and procedures. NCS 4 Care at Home - Management and Staffing This recommendation was made on 21 April 2015 page 31 of 33

32 This recommendation was now met. We make further comment about this under Quality Theme 3, Statement 1 in this 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 21 Apr 2015 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Management and Leadership 3 - Adequate 7 Apr 2014 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good page 32 of 33

33 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 33 of 33