Allied Healthcare (Inverness) Housing Support Service 1st Floor 62 Academy Street Inverness IV1 1LP

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1 Allied Healthcare (Inverness) Housing Support Service 1st Floor 62 Academy Street Inverness IV1 1LP Type of inspection: Announced (Short Notice) Inspection completed on: 18 March 2015

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 14 4 Other information 25 5 Summary of grades 26 6 Inspection and grading history 26 Service provided by: Nestor Primecare Services Ltd trading as Allied Healthcare 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 Allied Healthcare (Inverness), 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 3 Adequate Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The trained staff help people with care needs to remain in their own homes. Service users give good feedback about the quality of care provided. What the service could do better Care planning should further improve so that care plans capture relevant information to help care staff to know how to support the service user well. Timing and length of visits should better meet the agreed schedule. Service users should be informed when there are changes to expected staff or rota. Care staff should follow best practice infection control guidance. Management should ensure that the medication training met accredited training requirements. What the service has done since the last inspection This is the first inspection under this registration. Requirements made in last report under Nestor Primecare Services Ltd trading as Saga Homecare - Inverness were generally met. Allied Healthcare (Inverness), page 3 of 27

4 Allied Healthcare had introduced a range of monitoring and auditing procedures to assess service provision. More staff had been recruited. All service users now had a care plan and most had a recent review. Inspection report continued Staff had received training and a supervision system was being implemented. Conclusion Since this service has been re-registered as Allied Healthcare there has been a significant improvement in the provision of care and organisation of the service. People who used the service valued it highly. Management were committed to continuous improvement. Allied Healthcare (Inverness), page 4 of 27

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information in relation to all care services is available on our website at This service was registered on 5 March 2014 as a combined Housing Support and Care at Home service. 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. 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 may be made. Requirements are legally enforceable at the discretion of the Inspectorate. The service is registered to provide (as stated on their registration certificate) 1. A service to adults and older people with physical/sensory impairment and/or memory impairment/dementia and to those in end of life care living in their own homes. 2. The support will be provided by one staff team as agreed in the notice granting registration dated 29 January The provider shall inform service users and their representatives that the care service is registered with the Care Inspectorate and shall ensure that they are made aware of the name of the registered service with its contact details, as it appears on this certificate. 4. The provider will address any requirements from previous regulatory activity. Allied Healthcare (Inverness), page 5 of 27

6 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 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. Allied Healthcare (Inverness), 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 a short notice announced inspection which was carried out by a Care Inspector. We visited the service on 10, 11 and 18 March 2015 between the hours of 9.30am and 5.00pm. We provided feedback to the Service Manager and a national operations manager at the end of the visit. The feedback included recommendations and areas of improvement. As part of the inspection, we took account of the completed annual return and self assessment that we asked the provider to complete and submit to us. We sent 160 Care Standards Questionnaires to the service for people who used the service and 74 were returned completed. We also sent 80 questionnaires to be completed by the staff and 26 were returned. During the inspection process we gathered evidence from various sources, including the following: We spoke with: - 5 people who used the service - 1 relative of a person who used the service - the service manager - 2 care coordinators - 1 senior care worker - 9 care workers - Internal SVQ verifier - 1 national manager Allied Healthcare (Inverness), page 7 of 27

8 We looked at: - evidence from the service's most recent self assessment - support plans of people who use the service - review records - participation information, including Care Standards Questionnaires - staff training records - risk assessments - policies and procedures - minutes of meetings - staff handbook - service website. - Consideration of the National Care Standards - Care at home service and Housing support service 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 Allied Healthcare (Inverness), page 8 of 27

9 What the service has done to meet any requirements we made at our last inspection The requirement Each person using the service must have a review of their agreed plan of care and support at least once every six month period and more frequently when indicated by a change in their needs or circumstances. The provider must put in place systems for regular reviews of each personal plan at least once in every six month period, to ensure the way care and support is planned and provided is current and meets the needs of the person using the service. Accurate records are to be maintained. The provider must ensure that where it has been agreed, representatives of the person using the care service are offered the option to be fully involved in the review of care and support plan. This is in order to comply with Regulations 5(2)(b) of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for completion: 31 December What the service did to meet the requirement We found that many of the care plans had been reviewed in the past six months. A senior carer and the coordinators were responsible for the reviews and we could see that a record was made of the discussion and actions identified. The requirement is: Met - Outwith Timescales Allied Healthcare (Inverness), page 9 of 27

10 The requirement That all staff are informed of the 'No reply policy' and that action is taken to ensure that this policy is properly implemented. This is in order to comply with SSI 2011/210 Regulation 4(1) Welfare of users National care standards for care at home. Standard 4. Management and staffing. Timescale for completion: 31 December What the service did to meet the requirement We could see a record that all care staff had been informed of this policy. Staff spoken with were aware of what to do if they did not get a reply when they went to a service user's house on a scheduled visit. The requirement is: Met - Outwith Timescales Inspection report continued The requirement It is required that the management systems in place ensure that visits are undertaken within a reasonable time frame of the agreed time and that when the service is aware of potential delayed visits service users and/or other relevant persons are, as part of the process, informed in a timely manner. This is in order to comply with SSI 2011/210 Regulation 4(1) (a) (b) Welfare of users National care standards for care at home. Standard 4. Management and staffing. Timescale for completion: 31 December What the service did to meet the requirement Action has been taken and the situation has improved. We found though that all of the service users spoken with commented on significant delays in receiving scheduled calls and indicated that they often were not told of changes to the rota. There were also comments through the Care Standard questionnaires. This requirement has not been fully met. The requirement is: Not Met The requirement The provider must ensure that all complaints are fully investigated and within 20 working days after the date on which the complaint is made, or shorter period as may be reasonable in the circumstances and inform the complainant of the action (if any) that is to be taken. Allied Healthcare (Inverness), page 10 of 27

11 This is in order to comply with SSI 2011/210 Regulation 18 (3) (4) Complaints. Timescale: From time of inspection feedback What the service did to meet the requirement The service now had a detailed complaint monitoring system which was overseen by head office. There have been no complaints in the past months. The requirement is: Met - Outwith Timescales Inspection report continued The requirement The service provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of the service users: a) Ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. In order to do this the service provider should take into account: a) Staff recruitment and induction b) The assessed need and risk assessment of the person using the service This is in order to comply with SSI 2011/210 Regulation 15 (a) (b) Staffing. Timescale: From time of inspection feedback. What the service did to meet the requirement There have been more staff recruited and through their electronic monitoring systems they can more accurately calculate the number of staff needed. The requirement is: Met - Outwith Timescales 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 Allied Healthcare (Inverness), page 11 of 27

12 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. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We spoke with five service users during the inspection. Comments received included: "All the carers are very good and helpful. The timings have improved but the evening meal visit can still be very late." "The office coordinator comes out to see if everything is all right." "The carers can't wait to get out. They rush off to the next visit." We received 76 completed care standard questionnaires and 94% agreed or strongly agreed that they were happy overall with the quality of care they received. Comments received included: 'Some carers look upon following the care plan as a race to be completed asap. I agree that I should do as much for myself as possible but some carers use this time to phone friends, children etc. and are unaware of what I am doing and where I have to struggle. Carers can be changed from the rota without notice.' '1. Staff do not stay the whole allocated time, and when they come in they often comment...(name of service user)is not 'ready'. 2. "Treat me with respect?" Scope for improvement. 3. A little kindness would not go wrong. 4. I would like bedtime to be later. 9.00pm for someone of my age is too early.' 'Very happy with the carers I get. Only one carer who wasn't meeting my needs but I phoned office and they dealt with. So grateful for the service and care that I get.' 'Always receive great care. Carer also has a good relationship with the community/ district nurse. 'I am really very grateful, that there is just such a service. Allied Healthcare (Inverness), page 12 of 27

13 'I am disappointed that my carer of almost a year has been taken off my list - that is my main carer. She still works a few yards away from my address but no longer comes to me at 7.00am most days as before. I realise it has been difficult to organise carers over the holiday period but I would like to mention that I received unpleasantness from a very recent recruited carer during the recent holiday break. This was very uncalled for. Lastly, I would like to mention that my carer, mentioned above, attended me as a 'fill in' for someone. She and I were very pleased to meet again.' Taking carers' views into account We spoke to one relative during the visit. He had concerns about the evening visit which was often late. He was happy with the quality of care his wife received. We received comments from carers through the completed care standard questionnaires, including: '...(name of service user) has some memory issues and can be hard to move at times. There were some issues with no carer arriving therefore... did not receive her morning medication which I gave her when I popped in for a visit. It is sometimes rather late when she gets her AM medication. There does not seem to be common sense with some young carers. They could do with a little training to do the job properly.' 'The quality of care that is provided for my sister is first class. All her carers, without exception, are punctual, pleasant, polite, obliging and very attentive on her personal needs. One could not wish for a better team of ladies.' Allied Healthcare (Inverness), page 13 of 27

14 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 grade for this statement was good after we looked at policies, results of surveys, minutes of meetings and talked to staff and service users. The service demonstrated commitment to supporting participation in a number of ways. Surveys were used to obtain feedback about the service. There were postal questionnaires to service users linked to the length of time they had received care. There were also occasional one off surveys for example 'What makes a good care worker?' There were 'first shift follow up forms' used after a new worker's first shift on their own completed by service users and supervisor. This helped to identify any training or other issues early in the new worker's employment. We could see that results were collated from the annual and 8 week surveys and comparisons made regionally and nationally. An action plan had been created related to the findings. The organisation had developed a participation strategy that provided examples of strategies and gave positive reasons as to the importance of service users and their families being involved in the improvement of the service. The policy stated: 'The purpose of the Customer Involvement Policy is to encourage a culture of best practice in the management and delivery of customer involvement within the healthcare group and to ensure that customer and care perspectives are an integral part of the culture of the organisation with the aim of providing truly person centred services.' Service users were provided with information about the service including about the participation policy and aims and objectives. From the questionnaires and from Allied Healthcare (Inverness), page 14 of 27

15 speaking to service users we found that they felt comfortable calling the office and speaking to the coordinators about their concerns. We could see that staff acted on service users' wishes about their care including decisions about the staff who attended them. Service users had a care plan in their house with a paper and electronic copy in the office. Service users were usually involved in the preparation of their plan and we could see that their preferences were recorded. The service aimed to review each plan six monthly with the service user and/or a close family relative if appropriate. This was an opportunity to consider the service provided and whether it could be improved. Many of the care plans had a recent review. There was a suggestion box in the hall of the office. Inspection report continued A newsletter was issued occasionally which informed of events, staff news and information about the service. Management have organised forums for service users and their families but they have been very poorly attended. The aim of the forum was to discuss the service and issues relevant to service users. Areas for improvement Management should continue to promote participation within the service, giving consideration as to how to involve service users who have communication problems and/or dementia. Management should develop participation strategies to influence recruitment, training, appraisals and management of the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that the service grade for this statement was adequate after we looked at care plans, visited service users along with care staff and looked at a range of records both paper and electronic. Allied Healthcare (Inverness), page 15 of 27

16 During the inspection we looked at six care plans, some in the office and in the service user's house. In the office, plans contained information about the individual and their health needs, allied professionals involved in their care, family and emergency contacts, details of food and other preferences and an indication of their hobbies and interests. The service used screening tools to help assess possible risks, for example of pressure sores. Risk assessments were completed about the environment, nutrition, moving the individual, taking medicines, use of chemicals (cleaning fluids etc.) and an overall risk assessment checklist. These assessments were updated. There were sections to record what was important to the service user and what the individual wished to achieve. There was good narrative to prompt care staff about information to record. Plans seemed up to date, legible and there were some signatures of service users to show they agreed with the content of the plan. Most of the care plans examined had a review within last 6 months. We spoke with the senior care worker whose remit was to review care plans and she stated that although she had recently been promoted to this post she had reviewed many of the care plans. Results from the Care Standard questionnaires indicated that 93% of respondents agreed that their needs and preferences were detailed in a personal plan. Each care plan should have a timetable showing when the service user should receive a service and from whom. This was sent out to service users every 2 weeks. Coordinators stated that the rota would inform service users of changes of staff though if it was a short notice change a coordinator would phone the service user. Care staff should fill in a log each time they provide care at the service user's house. Logs should contain times of going into the service user's house and of leaving and what they did while there. The written logs were returned to the office to be audited by senior staff and filed regularly. There was also an electronic monitoring system which was activated by the staff member making a free phone call via the service user's landline both when they arrived and left. If there were two staff assigned both staff had to do this. Data could be obtained from this system including how well the staff member was meeting the scheduled times. If the staff member was 15 minutes late to a visit, this should be electronically flagged up to the coordinator who could take action to locate the worker and inform the service user. There was very good feedback from service users about the care staff that helped them. Areas for improvement Inspection report continued At feedback we heard that a new electronic system was to be introduced which would be able to take existing data about review dates and highlight when reviews were required to be completed. It was hoped that this would enable senior staff to keep up Allied Healthcare (Inverness), page 16 of 27

17 to date with reviews of care plans and risk assessments more effectively. We had found that some risk assessments had not been updated or reviewed for over a year. We could see from records in the office that not all care plans had been reviewed at six monthly intervals. The form 'What is important to me' had good prompts for staff for example about food and drink, activities and hobbies, about my health issues, but in several plans there was very little information about the service user to help staff get to know the person and their preferences. We acknowledge that service users may not always wish to share information about themselves though staff should explain why there is a need to record some essential details in order that they receive consistent care from all staff. We found that logs of staff contact were not always audited in the office. We could see that scheduled visits were not always recorded. Some care plans in the service user's house needed to be sorted out; there was out of date information and contact templates with nothing on them. See Recommendation 1 about care plans. Service users spoken with were unhappy with timing of visits, care staff arriving late and rushing through the visit. There was a service user who needed carers to help her to the toilet who often had too long to wait between the lunch visit and the next meal visit, there was a service user who was hungry by the time lunch visit came as it was often late and someone would like to get up much later and go to bed much later. There had been a request to change the times of this last visit over a year ago. There were several reports that service users were not always informed of a change of worker. A requirement had been made in the last report about this and will be continued. We reported at feedback that two service users had indicated that they were unhappy about the way they had been handled by a particular worker. The manager indicated that she would speak to the member of staff concerned and provide training if necessary. We could see that some aspects of infection control procedures were not being followed. See Recommendation 2. Some service users were risk assessed as needing two staff due to their mobility problems. From looking at records, speaking to a new member of staff and service users we found that on occasion staff were having to manage alone. This practice puts both the service user and member of staff at risk of injury. Management should ensure that this does not happen. See Recommendation 3. Allied Healthcare (Inverness), page 17 of 27

18 We found that staff were not using the codes on the medication records correctly. There is a recommendation about training in statement 3.3. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 3 Requirements 1. It is required that the management systems in place ensure that visits are undertaken within a reasonable time frame of the agreed time. The service should make service users aware of delays or changes in staff in a timely manner. This is in order to comply with; SSI 2011/210 Regulation 4(1) (a) (b) Welfare of users also takes account of: National care standards for care at home. Standard 4. Management and staffing. Timescale: 1 month from receipt of the report. Recommendations Inspection report continued 1. It is recommended that service users' personal care plans are improved by: 1) Including information about the service user to help staff know the individual and their preferences and interests. 2) Risk assessments and the care plans are reviewed regularly. Care plans should be reviewed at least once in a six month period or more often as required. 3) Care plans in the service user's home are regularly audited to ensure they have all necessary information. This takes account of National care standards - Care at home - Standard 3 - Your personal plan. 2. Management should ensure that care staff follow good infection control practice in relation to the use of personal protective equipment. This takes account of National care standards - Care at home - Standard 4 Management and staffing also NHS and HAI 'Preventing Infection in Care at Home' a guide about standard infection control procedures. 3. It is recommended that management ensure that actions stipulated to reduce significant risk are carried out. This is in relation to service user safe moving and handling procedures. Allied Healthcare (Inverness), page 18 of 27

19 This takes account of National care standards - Care at home - standard 4 - Management and staffing. Allied Healthcare (Inverness), page 19 of 27

20 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 We found that the service grade for this statement was good. For evidence see Quality Theme 1, Statement 1. Areas for improvement See Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - 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 We decided that the service grade for this statement was good after we spoke to staff, service users and looked at personnel, training and supervision records. We looked at the recruitment procedure and spoke to the member of staff who was responsible for interviewing potential staff. The detailed process indicated that the organisation was committed to a safer, robust recruitment procedure and had included the necessity of obtaining two suitable references from immediate past employers, a disclosure check and the candidate attending a strength based interview before being employed. The interviewer had received specific training in order to try and assess the applicant's values and attitudes. The interview answers were scored and recorded. This process helped to ensure only suitably motivated people were recruited. Allied Healthcare (Inverness), page 20 of 27

21 There was a comprehensive induction process for new employees which included four days of training and evaluation and a week of shadow shifts. There was a system whereby experienced staff could be identified as coaches to help new employees make the transition to becoming competent and fulfilled employees. After the first shift that the new worker completed on her own, service users and the job coach/ senior care worker completed an evaluation which helped to identify at an early stage any issues or training needs. The organisation had developed a training programme for all care staff and each year a training plan was devised. Training was provided both through the classroom and on line. Mandatory training included first aid, safe moving and handling, fire prevention, health and safety, food hygiene, adult protection and about nutrition and hydration. Following each subject the employee had to pass a written or online test to demonstrate understanding and ability to apply within their work role. Other service user related subjects were also offered from time to time to some staff including about peg feeding and epilepsy. An electronic system flagged up staff's training needs and when specific courses needed to be refreshed. This system was also used to record supervision and employment reviews or appraisals. Staff confirmed that they had supervision according to the service policy. Supervision covered a range of topics relevant to care staff roles including about accidents and adult support and protection, and was thought to be useful. Care staff would also have at least one unannounced spot check per year whilst working. These employment procedures helped to ensure that working practices were of a good standard. There were monthly meetings held in the Inverness office and staff were paid for their time to attend. Staff indicated that they felt they could contribute their ideas and opinions to the meetings. Areas for improvement As reported in Quality Theme 1, Statement 3 we found issues regarding medication administration recording. Training about medication was delivered in-house at induction before some staff had experienced this kind of work. As part of their probationary period each new worker would be assigned a care coach who would assess whether the person was competent in various skills including administration of medicines. We could not tell whether the overall medicine training was suitably robust and met with best practice guidance. We suggested that management should consider the competencies of the Scottish Qualifications Authority (SQA), unit HSC 375/CHS3 - Administer medication to individuals and ensure that staff can achieve the competencies outlined there. See Recommendation. Management should consider the use of 'reflected practice' to assess staff's ability to use training in their work. Allied Healthcare (Inverness), page 21 of 27

22 Staff through the staff questionnaires and during interview reported that they needed specific training to help understand service users' health conditions, for example dementia. Dementia is covered in induction though we could see from the post training questionnaire that staff needed more in depth training. Management should consider the 'Promoting Excellence' framework provided free by Scottish Government and SSSC as they are looking to improve this training. Some staff reported that they felt very emotionally affected by the death of service users whom they cared for. Management should consider ways to support staff through bereavement. Staff were concerned at changes being proposed to their terms and conditions. Management planned to introduce paid travel time between service users. This should be beneficial to service users as staff should be able to spend the whole of the allocated time with the service user. It has been reported from service users: "Some carers look upon following the care plan as a race to be completed asap." We discussed the recruitment procedure with regards to the policy of having only one person namely the admin worker conducting the interview. Best practice has advised two interviewers, one to take notes and to observe the candidate whilst talking to the other. It also reduces the possibility of disputes about what was said during the interview. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The provider should consider the competencies detailed in the SQA module for managing medicines to ensure that the training delivered to staff complies with this best practice. In making this recommendation the following National Care Standards for Care at Home services have been taken into account: Standard 8 - Keeping Well - Medication and Standard 4 - Management and Staffing. Allied Healthcare (Inverness), page 22 of 27

23 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 decided that the service grade for this statement should be good. For evidence see Quality Theme 1, Statement 1. Areas for improvement See Quality Theme 1, Statement 1. 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 We decided that the service grade for this statement was good after we spoke with management, service users and looked at a range of electronic monitoring systems and procedures. Allied Health used a range of strategies to assess the quality of the service. Service users' opinions were important to management and surveys were used to formally consult them. Service users confirmed that they found the office staff helpful and approachable. Service users stated that they would contact office staff if they had an issue about the service. People who used the service were asked to give feedback about new staff. Allied Healthcare (Inverness), page 23 of 27

24 Management used electronic systems to monitor aspects of the service including staff compliance with scheduled visits, training and employee development. The quality manager performed an unannounced audit over two to three days. This regular audit had evolved to meet changes in legislation. The service was graded which determines length of time to next audit and its intensity. At the time of Inspection Inverness had a "green" grade which meant that it would not be audited for six months. Following audit an action plan was devised which was monitored by the quality team electronically. Service users were informed about the complaints procedure. The requirement about investigating complaints within 20 working days had been met. We judged that the requirement about having enough care staff had been met. Areas for improvement We discussed notifications that are required to be made to the Care Inspectorate. Included is the necessity to inform us when a service user has had an accident that results in medical attention. We would expect to be notified if the accident happened when the care worker was with them or if the worker was the first person to find them. This also applies in the event of a service user's death. Management and admin were able to show me a wealth of data from the different monitoring systems. There was data to suggest that there were missed visits and very late visits though it was stated that the data was not correct. Monitoring systems to be an effective tool must produce credible and accurate data to support management in their role and which can be audited. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. It is recommended that management ensure that actions stipulated to reduce significant risk are carried out. This is in relation to service user safe moving and handling procedures. This takes account of National care standards - Care at home - standard 4 - Management and staffing. Allied Healthcare (Inverness), page 24 of 27

25 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information 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). Allied Healthcare (Inverness), page 25 of 27

26 5 Summary of grades Quality of Care and Support Adequate Statement 1 Statement Good 3 - Adequate Quality of Staffing Good Statement 1 Statement Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Allied Healthcare (Inverness), 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: Allied Healthcare (Inverness), page 27 of 27

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