Oakridge Support Service Ltd Housing Support Service 5 Diriebught Road Inverness IV2 3QW Telephone:

Transcription

1 Oakridge Support Service Ltd Housing Support Service 5 Diriebught Road Inverness IV2 3QW Telephone: Inspected by: Derek Priest Type of inspection: Announced (Short Notice) Inspection completed on: 19 December 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Oakridge Support Services Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Derek Priest Telephone enquiries@careinspectorate.com Oakridge Support Service Ltd, page 2 of 24

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 6 Excellent Quality of Staffing 6 Excellent Quality of Management and Leadership 6 Excellent What the service does well The service provided an appropriate level of support to maintain and improve the independence of the tenants in domestic and social environments. The service has provided various opportunities for the tenants to express their views about the service. What the service could do better The service should consider options for the support needs of tenants who due to a deterioration of health may require more personal care. What the service has done since the last inspection The service had acted upon the suggestion to develop the independence of the tenants in relation to their medication. This had been achieved and only two tenants now received their medication from staff. Conclusion This service has continued to perform at an excellent standard which has enabled the tenants to be independent at home and in the community. The service has grasped the principles and criteria that has been put in place for Housing Support Services. Oakridge Support Service Ltd, page 3 of 24

4 Who did this inspection Derek Priest Oakridge Support Service Ltd, page 4 of 24

5 1 About the service we inspected 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 Requirements and Recommendations If we are concerned about some aspect of a service, or think it could do more to improve, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Oakridge Support Services Ltd provides support to up to 16 adults with a learning disability, in a terrace of four houses mainly in a residential part of Inverness, close to the city centre. The service aims to assist tenants to access community based activities, maximise each individual's potential, promote individuality and independence while providing a level of security through planned support. Staff work with tenants to achieve the quality of life they strive for and to practise in a manner that does not stigmatise or disadvantage tenants. In addition to working with tenants individually and in small groups, as appropriate, the service also provides a 24 hour warden service, with a sleep-in staff member between 11pm and 7am. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 6 - Excellent Quality of Staffing - Grade 6 - Excellent Quality of Management and Leadership - Grade 6 - Excellent Oakridge Support Service Ltd, page 5 of 24

6 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. Oakridge Support Service Ltd, page 6 of 24

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report after an unannounced inspection on Wednesday 18 December 2013 between 10.30am and 6.30pm and Thursday 19 December 2013 between 9am and 3pm approximately. Feedback was provided to the manager of the service, the Area manager for the service and the NHS Highland Contract Monitoring Officer with responsibility for the service. The inspection was carried out by Derek Priest, an Inspector with the Care Inspectorate. During the visit we gathered evidence from various sources, including written records: - current self assessment document - six Care Standard Questionnaires returned by residents - 8 tenants support plan overview - 2 tenants full support plans - various policies - staff training records - business plan. Discussions with various people, including: - five tenants - the manager - support worker - 3 support assistants. 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 Oakridge Support Service Ltd, page 7 of 24

8 Inspection Focus Areas (IFAs) Inspection report continued 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 Oakridge Support Service Ltd, page 8 of 24

9 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. Every year all care services must complete a self assessment form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the provider completed this, and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes planned. Taking the views of people using the care service into account Six Care Standard Questionnaires were received from tenants at the service. All stated that they were very happy with the quality of service that was provided. Comments included: * "I like my key worker" * "I like my housemates" * "I like Oakridge VIP Group" * "I speak to staff when I am sad" * "I have a safe in my room for my money" * "Staff wait until I say enter" * "I speak at Oakridge VIP Group" * "I am happy and staff are nice" * "We do everything we want" * "Staff help me give me advice" * "I have spoken to people at interview". Oakridge Support Service Ltd, page 9 of 24

10 Five tenants were spoken with during the inspection. They explained how staff supported them and how they could ask staff for support at any time. Taking carers' views into account No family members were available during the inspection visit. Oakridge Support Service Ltd, page 10 of 24

11 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 6 - Excellent 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 At this inspection we found that the service had continued to provide an excellent level of support for this standard. The service had developed a participation policy which identified how the tenants would be involved in making decisions about the service. This included individual discussion, group meetings, expressing their views and their role in the recruitment of staff. The service was clearly orientated to enable the tenant's independence. Family members were also encouraged to express their views. Each tenant was given a choice of keyworkers recently. Most tenants chose to retain their existing keyworker but it was explained that some had requested a change. In one instance this was a return to their previous keyworker with who they felt more comfortable. All staff members were aware of the needs of all of the tenants that they were supporting. Keyworkers were on duty during the tenant's home day to support them with various activities that they had planned. Keyworkers discussed the wishes of the tenants and supported them to make arrangements for holidays, activities and other tasks in relation to their correspondence. House meetings were held in each of the four shared houses within the service. This meeting discussed general issues relating to the household. Tenants confirmed that these meetings took place. An additional, V.I.P. meeting had been introduced since the previous inspection. This Oakridge Support Service Ltd, page 11 of 24

12 meeting involved the tenants of all four houses. This meeting was chaired by a tenant. Issues raised at the meeting was reported back to the manager and feedback at the next meeting. A voting system using pictures of the tenants was used to enable the tenants to vote for the chairperson. This role would be voted on annually. Tenants that completed Care Standard Questionnaires reported that they liked the V.I.P. meetings and that they spoke up during the meeting. Tenants attend various advocacy groups in the local area with one tenant being the chairperson of one of these groups. The tenants that were spoken with all appeared confident in making their own decisions and raising issues. Tenants at the service, their families and other stakeholders were provided with questionnaires on an annual basis. This year's questionnaires were issued to the tenants after they had been offered the choice of a normal or pictorial questionnaire. The questionnaires were still being received by the service. A number of these were viewed and they provided a very positive view of the service. Tenants were encouraged to be independent in various aspects of their daily life. It was observed that a tenant was preparing supper for their fellow tenants in the house. The staff member guided the tenant and observed that they were carrying out tasks independently. Tenants were involved in the planning of their weekly menus taking account of each others preferences. Menus were planned on a four weekly rota and reviewed every three months. A regular review of the support being provided was carried out at the service with tenants and their families being involved as appropriate. The manager provided evidence where the tenant made decisions about who was to attend the review and also when they would be going home on holiday. Tenants at the service were involved in planning their holidays. Staff members supported them to select, plan and book their holiday. However, due to the nature of the service staff members were unable to accompany the tenants on holiday. Similarly, staff supported tenants to arrange trips to various activities but again was unable to accompany them. An example was given where staff members had accompanied a group of tenants to attend the pantomime, in their own time. The service had continued to hold family open days with the recent providing a good turnout of family members. These meetings provided the family members to have access to the manager and other staff members, although they were accessible at any time. Tenants were provided with the opportunity to be involved in the interview process for new staff. Tenants agreed on a number of questions that they would like to ask at the interview. Tenants were introduced to candidates when they arrived for interview. Feedback was taken from the tenants. Oakridge Support Service Ltd, page 12 of 24

13 Tenants were also asked about their views of the staff members as part of the appraisal system. Any issues were discussed with the staff member to improve the support that was provided. The tenancies were on a furnished basis and the company replaced furnishings as necessary. Tenants were involved in sourcing estimates and providing preferences to the organisation. Tenants were also involved in selecting wall and floor coverings for their own and communal areas. Areas for improvement The service should continue to provide opportunities for the tenants to be involved in making decisions about their support and the shared tenancy. The service should continue to source a wider range of holiday opportunities for the tenants. Although they reported that they enjoyed going to the service in the South West of England where they received support, a wider range of opportunities could be found. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection we found that the service was performing at an excellent standard for this statement. The tenants lived in four shared tenancy houses in a residential area of Inverness. A staff office was available as part of the complex but was independent of the houses and had a separate entrance. Most of the tenants have lived in their houses for a number of years with a few since the service opened. Some tenants stated that they had moved houses to be with their friends. A support plan was available for each tenant. An overview of the support being provided was held in the staff office with the main file being held by the tenant. The staff version provided a one page profile of the tenant with detail about their preferences and support need. These had obviously been developed in conjunction with the tenant as the format and design of this page was different for each of the eight files that were viewed. This document also gave detail about support needs and routines. Detailed information about support hours in relation to Housing Support Service criteria was also included. This was also different for each tenant. Oakridge Support Service Ltd, page 13 of 24

14 The main support plans provided greater detail about the support to be provided for the tenant. The support plans were supporting the tenant to be independent in all aspects of their personal care, work, home-life and social lifestyles. Information included what the person could do for themselves and also the support that they needed. Examples of support being provided included the following: * Supporting the person to be responsible for all aspects of their personal hygiene. * Supporting the person with travel arrangements to work and social events. * Supporting the person in relation to their finances and access to benefits - detailed weekly budget plans were available which detailed regular expenditure. * Supporting the person with domestic duties including cleaning, house security, refurbishment, shopping and cooking - development of menus, shopping and cooking. Meals were prepared from scratch with each tenant having the opportunity to cook for the tenants in their house. This was observed on one occasion where the tenant did all aspects of the meal with guidance and supervision from the staff member. * Supporting the tenant in maintaining a healthy lifestyle - as above meals were prepared using fresh and healthy ingredients. Recipes were available to ensure that the tenants were able to follow these with the required level of staff support. Weekly timetables also showed that the tenants followed healthy activities where they attended local gyms and swimming pools. Risk assessments had been developed for all these aspects and these gave very clear information about the risk and the control measures that were in place. This included where tenants were self medicating. All risk assessments were viewed to be reviewed on a three monthly basis. Regular internal and external reviews of the support being provided were carried out. The external reviews were part of the NHS Highland annual review process with the care officer being in attendance. Tenants also attended work placements or day care placements. One tenant took pride in showing the inspector a certificate that they had received from their work place. All tenants were registered with local GP (General Practitioner) and Dental practices. They also received support from other healthcare professionals as required. Staff members accompanied the tenant to medical appointments if requested by the tenant. This was important to ensure that the tenant was clear of the information that was given and that support could be amended if necessary. Since the previous inspection the service had reviewed medication procedures for all Oakridge Support Service Ltd, page 14 of 24

15 tenants. Now only two tenants were administered medication. For the other tenants their medication was stored in their rooms and they were reminded to take their medication. This has increased levels of independence for these tenants. Safe systems continued to be maintained. Systems were in place for the regular checking of medication when received from the pharmacy and the empty "nomads" for return to the pharmacy. Annual medical and medication reviews were carried out by the tenant's GP. A list of suitable homely remedies, advised by their GP, was available for each tenant. The tenants had an active social lifestyle. This included attending the gyms and swimming pools as previously identified. The tenants also attended the cinema, various advocacy groups and social evenings in various pubs. It was noted that the tenants chose to attend some of these activities as a group. Tenants also visited friends in the other houses in the complex or elsewhere in Inverness. Within the four houses tenants were often invited for meals with their friends who stayed in another house. Areas for improvement The support plans provided a very good level of information about the tenants and clearly promoted their independence. It was noted that one tenant's health was beginning to deteriorate and may not be as able to participate in social. It was felt that the service should look for alternative support to enable this tenant to continue to participate in these activities. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Oakridge Support Service Ltd, page 15 of 24

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths This Quality Statement has been reported as part of Quality Theme 1, Quality Statement 1. Areas for improvement Any Recommendations or Requirements have been reported as part of Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection we found that the service was performing at an excellent standard for this statement. Staff members at the service were very motivated and explained their role as developing the independence of the tenants and encouraging them to be part of the community. All staff members were recruited appropriately with the necessary references and PVG checks being carried out. An appropriate recruitment policy was available within the service. All new staff members undertook an induction period. This included the new staff member shadowing a senior staff member. The length of time for the induction period was based on the senior staff member being satisfied that the new employee Oakridge Support Service Ltd, page 16 of 24

17 was competent to carry out various tasks at the service. New Staff members had a three month probation period. During this time regular meetings were held with their mentor to discuss progress through the induction period. The service had a very low staff turnover and those that had left in the past year had valid reasons. The staffing structure was the Manager, Support Workers and Support Assistants. Only Support Workers were rostered for sleep-over shifts. The service encouraged progress within the organisation. Staff were delegated specific responsibilities within the service based on their specific skills and interests. All staff members undertook core training. This included health and safety, food hygiene, first aid and fire training. These training courses were repeated every two years for all staff. Adults at risk training was also part of the core training but was repeated every three years. The adults at risk training involved the completion of a workbook which was signed off and then staff had to complete an exam. This training had been completed by all staff members. A training record was available for each staff member which showed that the above core elements had been completed by all staff. Additional training was supplied that met the needs of the tenants. Examples were as follows: * Diabetes training - one tenant requested that their key worker received training to have the knowledge and increase awareness among all staff to support specific tenants. This is being rolled out to other staff too. * Medication Training - provided by the local pharmacist that supplies their medications. This was repeated annually. * Equality and Diversity * Health and Nutrition * British Sign Language (BSL) - all staff members have completed elements of BSL, to enable them to communicate with a resident who is deaf. * Dementia - All staff have completed the "Supported Derek" programme as a team and had certificates signed by the facilitator. The staff members were also progressing through a sixteen week distance learning Dementia Awareness Course. The Manager of the service held an SVQ (Scottish Vocational Qualifications) level 4 and her Registered Managers Award and was registered with the Scottish Social Services Council. The vast majority of the staff members also held an appropriate SVQ qualification for the service. During the inspection it was observed that the staff members were very knowledgeable about the tenants and were always available to discuss issues with the tenants. Tenants visited the office on many occasions during the inspection. Two monthly staff meetings were held where various issues were discussed including policy and procedures and specific tenant issues. Regular supervision was carried out Oakridge Support Service Ltd, page 17 of 24

18 at the service. The manager mentored the Support Workers, and Support Workers mentored Support Assistants. Areas for improvement The service should continue to encourage the staff members to identify their training needs and to make these available. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Oakridge Support Service Ltd, page 18 of 24

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 6 - Excellent 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 This Quality Statement has been reported as part of Quality Theme 1, Quality Statement 1. Areas for improvement Any Recommendations or Requirements have been reported as part of Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 6 - Excellent 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 At this inspection we found that the service was performing at an excellent standard for this statement. The service had a number of systems in place to evaluate the service that was being provided. This included the stakeholder questionnaires which were issued annually by the service. On a daily basis the Support Worker on duty allocated staff members to ensure that the needs of the tenants were met on a daily basis. This included ensuring that sufficient staff support was available to meet the tenant's home day tasks, social activities and work placements. Staff members had delegated duties such as supporting tenants meetings, doing fire checks, ensuring that first aid packs were appropriately stocked, Health and Safety Oakridge Support Service Ltd, page 19 of 24

20 checks, preparing rota's and other roles. The service had a "Business Plan" which identified Objectives for the service. These included: 1. Maintain and maximise a high standard of support to tenants 2. Comply with Regulation and National Care Standards 3. Raise awareness of Support Service and its Aims and Objectives 4. Ensure the high standard of service provided, is on-going and monitored 5. Ensure staff recruitment procedures are met and maintained to the required standards and best practice guidance 6. Ensure on-going structured training programme covering all employees is on-going and monitored 7. Monitor all financial aspects of the business with the aim to improving systems if required 8. Develop business to provide additional support and care as required 9. Maintain houses and surroundings to a high standard and comply with all current regulations. Each of the above aims were sub divided giving more direction to the explanation of the objective. This document was on-going with all staff members being involved in entering detail about how these were being achieved. This document provided details as to how these were being achieved. In relation to Objective 1, details included: - A record of risk assessment reviews were available - Dates of reviews were recorded including three monthly updates - Dates of when Support Plans were audited were also included. All staff members were involved with this process e.g. by entering whenever they reviewed a risk assessment. This appeared to be an excellent system to monitor the objectives. A wide range of policies were available at the service. A Quality Assurance policy confirmed the methods of evaluation as explained earlier plus monthly meetings with the General Manager. The Participation Policy explained how the tenants would be involved in the service and this was consistent with the Business Plan document. All tenants were supported in relation to their finances and benefits. Staff members assisted them in checking their bank statements for income and expenditure to ensure that they were in receipt of their benefits and that balances were accurate. Tenants also received support if necessary to check money that they held in their Oakridge Support Service Ltd, page 20 of 24

21 room if this was necessary. Regular checks were also made to the petty cash held by each house. Areas for improvement The service should continue to develop the above systems to ensure that the service provides the same level of support. Some additional involvement of stakeholders could be added to the process. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Oakridge Support Service Ltd, page 21 of 24

22 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). Oakridge Support Service Ltd, page 22 of 24

23 5 Summary of grades Quality of Care and Support Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Staffing Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Management and Leadership Excellent Statement 1 Statement Excellent 6 - Excellent 6 Inspection and grading history Date Type Gradings 23 Sep 2011 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 6 - Excellent 13 Feb 2009 Announced Care and support 6 - Excellent Staffing 6 - Excellent Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Oakridge Support Service Ltd, page 23 of 24

24 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Oakridge Support Service Ltd, page 24 of 24