Spinal Homecare Services Support Service Care at Home 157 Stricklandgate Kendal LA9 4RF Telephone:

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1 Spinal Homecare Services Support Service Care at Home 157 Stricklandgate Kendal LA9 4RF Telephone: Inspected by: Karen Fraser Type of inspection: Announced (Short Notice) Inspection completed on: 31 March 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 9 4 Other information 17 5 Summary of grades 18 6 Inspection and grading history 18 Service provided by: Spinal Homecare Services Ltd Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Karen Fraser Telephone Spinal Homecare Services, page 2 of 19

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 4 Good What the service does well The service provides high quality care to people that allows them to live in their own homes. The service pays good attention to each person's needs and wants. The care staff and manager are experienced and skilled in providing care and want to provide the best quality of care possible. What the service could do better The service currently provides care in Scotland to 2 individuals only, both of whom live at some distance from the main offices of Spinal Home Care Services and accordingly the service manager. The service should strive to ensure that staff supporting clients in Scotland are fully supported and communicated with on a frequent basis to ensure their supervision is effective and sufficient. What the service has done since the last inspection The service has continued to look at ways they can increase people's involvement in improving the service. Conclusion This is a very good care at home service which is highly thought of by the people who use it and their families. The manager and small staff team are committed to maintaining a high standard of care, taking on board suggestions and ideas from people they care for. Spinal Homecare Services, page 3 of 19

4 Who did this inspection Karen Fraser Spinal Homecare Services, page 4 of 19

5 1 About the service we inspected Spinal Homecare Services Ltd. were registered with the Care Inspectorate in April 2011 as a Care at Home service. The service which operates on a national basis provides care at home to service users, from 16 years of age, who may have diverse needs due to spinal injury and / or other physical disabilities. The agency office base is located in Kendal, Cumbria. At this inspection Spinal Homecare Services Ltd were providing 24 Hour live-in care and support to two service users in Scotland. The service provides care packages to the service users by providing personal assistants who generally work for two weeks followed by a week off when a replacement carer is provided. The service provider's Statement of Purpose which is available in different formats and languages, incorporates a comprehensive aims and objectives statement and embraces commitments "to provide quality services for service users through caring, competent and well-trained staff and "to involve service users in planning and review of services that are provided for them, to ensure their needs are met". The provider stated that the rights of the service user are considered to be paramount in the operation of the service. The agency provides a person centred, flexible and responsive support service to people who live as independently as they can in their own homes. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very 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. Spinal Homecare Services, page 5 of 19

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a high 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 We wrote this report after a short notice announced inspection of the service. We gave the service a few days notice to ensure the manager was available when we visited. During the inspection we gathered evidence from a number of sources including the examination of a range of policies, procedures, records and other documentation. Evidence sampled included: Certificate of Registration 2 Personal Plans Staff Training Records Recruitment files Client Satisfaction Survey Report - June 2013 Client Review Forms Service User's Guide Various Policies and Procedures Staff Newsletters Incident and Accident records Carer Contact Logs Complaints Register Service Improvement Report As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to submit to us. We issued 2 care standard questionnaires to people using the service in Scotland and we received one completed questionnaire. We spoke with the Manager of the service at length. Spinal Homecare Services, page 6 of 19

7 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 Spinal Homecare Services, page 7 of 19

8 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 manager submitted a comprehensive self-assessment of the service as requested by the Care Inspectorate in a timely manner. Taking the views of people using the care service into account Taking carers' views into account Spinal Homecare Services, page 8 of 19

9 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 We found the service was performing to a very good standard in relation to this statement. We did not re-grade at this inspection. We looked at individual's records, including care plans and reviews, surveys and complaints and compliments records. We looked at questionnaires returned by people using the service to us and to the service and we spoke with the manager. We found the service continued to involve people in the planning and review of their own care, supporting them to express their views about their care and support. The review form the service used specifically asked for any suggestions for improvement. The service completed its Client Satisfaction Survey in June This was one method only being used by the service to receive feedback, Other methods, such as verbal feedback and greater involvement in reviews are being used by the service according to the methods preferred by clients. Areas for improvement The service is continuing to consider ways of successfully increasing people's involvement in improving the service. Currently the service produces and issues a newsletter to staff only. The service could consider issuing a similar newsletter to clients also. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Spinal Homecare Services, page 9 of 19

10 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The service was very good at meeting people's health and wellbeing needs. To assess this we looked at questionnaires returned to us by people using the service and to the service. We looked at individuals' care records and at staff training and supervision records. We spoke to the manager. We found the strengths we had found at our last inspection continued, including: detailed care plans, which had been developed and agreed in accordance with the client's specification. care plans included all relevant health information and contacts. care plans were subject to regular review and in line with the legislation. The review of support was clearly client led. records maintained by the service to show that care staff had met the client's daily routine and needs. This meant that people could feel confident that staff had the information they needed to provide the care they required to help them stay as well as possible. People who returned questionnaires to us and to the service agreed or strongly agreed that they were happy with the service overall and that regular checks were made by the service that their needs were being met. Areas for improvement Whilst all care plans and risk assessments sampled were found to be subject to regular review, with any changes to the care plan noted, we found that on occasion, risk assessments were simply dated and signed as having been reviewed, with no changes noted. Where the review indicates no change to the care plan, this should be recorded as such. The service should continue to explore ways to develop ways in which the service provision can be further improved to ensure this high level of client satisfaction is maintained. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Spinal Homecare Services, page 10 of 19

11 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 strengths noted under Quality Theme 1 Statement 1 are also relevant to this statement. The questionnaires the service used to gather people's views asked specific questions about care staff's performance. The responses indicated overall satisfaction with the care staff's skills, training and quality of the care provided by staff. The service's induction and training plans for staff had been structured based on the care needs of the people using the service. We heard that where an individual had specific care needs, staff had opportunities to learn about these. Areas for improvement We discussed with the manager how they might look at appropriate ways people can be involved in improving the quality of staffing, including involvement in future staff selection. They could also consider how people using the service and / or their relatives could be involved in staff training, for example staff induction training. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Spinal Homecare Services, page 11 of 19

12 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service's performance was very good in making sure people received care from staff who had the skills and knowledge required to meet their needs effectively. To assess this we took into account the views of people using the service and their relatives. We looked at a sample of staff records, including recruitment, induction procedures, supervision notes and training and qualifications and we spoke to the manager. The service had systems in place to support staff to be suitably skilled to meet people's needs. Staff commented in returned questionnaires to the service that they had good access to training to help them carry out their work. A number of staff were going forward with the carer's Diploma in Healthcare Studies - an accredited award delivered by Spinal Homecare Tutors. Staff attending the office base for this training would receive their supervision sessions at the time. Mandatory update training in Moving and Handling, First Aid, Health and Safety was undertaken by a Regional Manager on a quarterly basis ensuring all staff received update training within required timescales. A suitable induction process was in place for all newly recruited staff. People who returned questionnaires to us strongly agreed that they were confident the staff have the skills to support them. The service had a small team of care staff supporting the client's living in Scotland. The service strived to ensure that regular contact was made with the staff located in Scotland and a care contact log was maintained to record all communication with staff to and from the service. This meant that staff felt confident in contacting managers at any time for support as required. With care staff supporting clients in Scotland being located at some distance from the service's main office base, staff meetings were difficult to organise due to logistics. A newsletter was now being issued to all staff to help keep staff up to date with various issues of importance, including any recently reviewed policies; action to be taken following same as well as requests for suggestions from staff regarding service improvements. Team meeting minutes would be discussed at individual staff supervision. Areas for improvement Inspection report continued Whilst we acknowledge that with a small staff team providing care in Scotland, priority had to be given to delivering care. However, the service must consider ways to Spinal Homecare Services, page 12 of 19

13 ensure that staff are given all opportunities to receive regular supervision and support despite their distance from the main service base. We sampled a range of policies in relation to staffing and found the majority of these to be suitable. However, one policy which we considered could be strengthened was the policy on "Staff / Client Boundaries". Due to there being only 2 service users receiving care in Scotland, there is a very small number of staff delivering the care to these individuals. Whilst there is excellent continuity of care as a result, it is important that staff are aware of the need to maintain professional boundaries in their role. See Recommendation 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The manager should review the current policy on Staff/ Client Boundaries to ensure this gives stronger guidance to staff in their responsibility to maintain professional boundaries when supporting service users. The manager should ensure that all staff are familiar with the detail of the reviewed policy. In line with Scottish Social Services Council Codes of Practice for Social Service Workers and Employers. Spinal Homecare Services, page 13 of 19

14 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 The information detailed in Quality Statement 1.1 and 3.1 also apply to this Quality Statement. Areas for improvement The areas of improvement detailed in 1.1 and 3.1 also apply to this Quality Statement. In particular, 360 feedback should be a part of the appraisal of managers so that service users, relatives and staff can participate in the assessment of the management and leadership of the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should consider introducing 360 degree feedback so that service users, relatives and staff are involved in assessing the quality of management. National Care Standards, Care at Home, Standard 11, Expressing your views. Spinal Homecare Services, page 14 of 19

15 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 The strengths relating to service user participation in 1.1 and 3.1 are relevant to this Statement. These provided opportunities for people using the service and their families to influence the quality of the service they receive. The strengths noted under 3.3 in relation to having a well-trained, professional and motivated workforce contribute to assuring the quality of the service people receive, providing reassurance that staff delivering their care are safe and competent to do so. We spoke to the manager about how they assure the quality of the service. Because of the size of the service, the manager was involved in many aspects of the service, including planning and review of individual's care, supporting and supervising care staff and developing the service. This meant they had day-to-day opportunities to monitor the quality of the service. Annual survey questionnaires were issued to service users. their families and staff. We read the report collated from the most recent survey. Responses in this were highly complimentary. Responses from staff were equally complimentary. An annual audit on management systems is also undertaken and we read the assessment report for the 2013 Audit. Continual Improvement Reports are completed following any shortcomings identified in the audit process. This meant that we could see the service had effective systems in place to assess and monitor the quality of service that people receive. Areas for improvement Just prior to our inspection visit an incident had occurred in connection with a service user which constituted Adult Support and Protection concerns. Whilst the service responded to the concerns timeously, the manager was unaware of their responsibility to notify the Care Inspectorate of the incident nor of the requirement to notify the Scottish Social Services Council of the matter in relation to the member of staff involved and had failed to do so. Following the direction to do so, the manager made the relevant notifications to both Authorities. The manager must better familiarise themselves with the Scottish Legislation in relation to their responsibilities as a care service registered with the Care Inspectorate and make the necessary notifications to the relevant Authorities as necessary. See Requirement 1. Inspection report continued Spinal Homecare Services, page 15 of 19

16 Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. In order to protect vulnerable adults using the service, the provider must make sure serious incidents involving a service user are reported timeously to the Care Inspectorate and where this involves staff misconduct, to the Scottish Social Services Council. In meeting this requirement the provider should familiarise themselves with the Care Inspectorate guidance for registered services on what constitutes a notifiable incident. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210, regulation 4(1)(a) Welfare of users. Timescale: within 24 hours of the incident. Spinal Homecare Services, page 16 of 19

17 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). Spinal Homecare Services, page 17 of 19

18 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 Good Statement 1 Statement Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 3 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 5 Mar 2010 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership Not Assessed 22 Jan 2009 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Spinal Homecare Services, page 18 of 19

19 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: Spinal Homecare Services, page 19 of 19

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