Initial Healthcare Ltd Nurse Agency Flemington House Flemington Road Cambuslang Glasgow G72 8YF Telephone:

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1 Initial Healthcare Ltd Nurse Agency Flemington House Flemington Road Cambuslang Glasgow G72 8YF Telephone: Inspected by: Sarah Gill Type of inspection: Announced (Short Notice) Inspection completed on: 4 July 2012

2 Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 8 4 Other information 16 5 Summary of grades 17 6 Inspection and grading history 17 Service provided by: Initial Healthcare Ltd. Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Sarah Gill Telephone enquiries@scswis.com Initial Healthcare Ltd, page 2 of 18

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 Information 4 Good Quality of Care and Support 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well Initial Healthcare offers a professional service which was highly rated by the clients who were using it. What the service could do better Some improvements could be made to the skills checklist of staff to ensure a more appropriate list to the service types that Nurses are being supplied to. Training and development of Nurses was in the early stages. What the service has done since the last inspection This was the first inspection for this service. Conclusion The service was operating to a satisfactory level. The Manager was keen to improve the service further. Who did this inspection Sarah Gill Initial Healthcare Ltd, page 3 of 18

4 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change if we have to take enforcement action to make the service improve or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website, by calling us on or by visiting one of our offices. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services 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. Initial Healthcare Ltd is a Nurse Agency. It was registered in June The service operates from an office base in Cambuslang and supplies Nurses to services in the Glasgow and Lanarkshire areas. The stated aims of the service are " to provide experienced motivated staff to a variety of care settings." Based on the findings of this inspection this service has been awarded the following grades: Quality of Information - Grade 4 - Good Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Initial Healthcare Ltd, page 4 of 18

5 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. Initial Healthcare Ltd, page 5 of 18

6 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 This short notice inspection was carried out by Sarah Gill (Inspector). Prior to the inspection visit a review of information held about the service was undertaken. This included an examination of the annual return of information which was submitted, the self assessment and notifications of significant event. 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 Initial Healthcare Ltd, page 6 of 18

7 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 self assessment was submitted by the manager as requested. Taking the views of people using the care service into account n/a Taking carers' views into account n/a Initial Healthcare Ltd, page 7 of 18

8 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 0: Quality of Information 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 information provided by the service. Service strengths Initial Healthcare were in their first year of operation and were in the process of developing quality assurance systems. There was positive feedback from clients of the service regarding verbal communication with the service. Areas for improvement The current feedback form used to assess the quality of the service did not have any questions regarding the quality of the written information provided by the service. This could be developed. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Initial Healthcare Ltd, page 8 of 18

9 Statement 2 We provide full information on the services offered to current and prospective service users. The information will help service users to decide whether our service can meet their individual needs. Service strengths We examined the information that was routinely supplied to current and prospective clients. There was an "Initial Healthcare - Statement of purpose". "Terms and conditions" and a "staff handbook". A laminated notice was supplied that gave a 24-hour contact number for the Nurse Agency. The information covered all of the aspects expected by the National Care Standards for Nurse Agencies. Areas for improvement The Information could be developed to be presented to a higher standard. There were plans to develop a website. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Initial Healthcare Ltd, page 9 of 18

10 Quality Theme 1: Quality of Care and Support 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 care and support provided by the service. Service strengths There was an "Initial Healthcare Customer Satisfaction with Company" form that was used to gain feedback from clients. This used a 5 point rating system which was from 1 - very dissatisfied to 5 - very satisfied and there was space for free text comments. There was some very positive feedback on the service. This was mainly in relation to the office staff and the speed of being able to respond to staffing requests. A staff feedback form was also used and this had a 6 point rating scale. Of the 13 forms viewed 7 rated staff as "excellent", 3 "very good", 2 "good" and 1 "average". This feedback form covered staff's technical skills, attitude, ability to work unsupervised and overall performance. This provided a basic and helpful form of feedback. Areas for improvement As 0.1 the quality of the feedback form could be discussed with clients to see if it is asking the questions that are most important to them, to ensure that this helps to provide feedback on the care and support provided by Nurses supplied and that this is appropriate to the area that they have been sent to. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Initial Healthcare Ltd, page 10 of 18

11 Statement 3 We ensure our service provides care staff who are most suitable to meet individual service user needs. The care and treatment received by the individual service user, is supported by evidence based practice and up to date policies and procedures. These reflect current legislation (where appropriate Scottish legislation). Service strengths Initial Healthcare policy was to only place staff who had a minimum of 6 months experience within a care setting before accepting that they were suitable to be placed. There was a skills checklist that could be used to assist in ensuring that staff had the appropriate skills and experience. (See below). Areas for improvement The skills checklist was not appropriate to the types of care settings that Nurses were being sent to and therefore needed to be revised. (See recommendation 1.) The evidence of checking that Nurses were up to date in moving and handling, basic life support and other core skills that would be appropriate to care settings such as dementia care could be developed. (See statement 3.2) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should revise the skills checklist to be more appropriate to the types of care settings that Nurses are being sent to. (National Care Standards for Nurse Agencies, Standard 3 - service arrangements & Standard Management and Staffing Arrangements.) Initial Healthcare Ltd, page 11 of 18

12 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 As 1.1. Areas for improvement As 1.1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Initial Healthcare Ltd, page 12 of 18

13 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths The recruitment practices were checked by sampling 3 staff files. There was evidence of an application form which included a skills tick list (See 1.3 recommendation 1), checks had been carried out to verify the ID of the applicant, there were 2 or 3 references taken. There was a summary sheet that detailed the dates of PVG checks being requested and the date of issue. Membership of the Nursing and Midwifery Council had been checked and there was a regular check of this made. Each Nurse had been supplied with an ID badge to show to clients and verify that they were from the Nurse Agency. Areas for improvement Recruitment practices appeared to be improving. A new sheet had been introduced called the "staff checklist" this was being used to evidence a basic induction of the staff member. This could be improved and developed further to ensure that staff were up to date in core skills like moving and handling, basic life support and dementia care. (See Recommendation 1.) There were plans to provide Nurses with regular training updates. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should ensure that Nurses are up to date in the core skills required by the care settings that they are being sent to. This should be evidenced in the induction process. (National Care Standards for Nurse Agencies - Standard Management and Staffing Arrangements.) Initial Healthcare Ltd, page 13 of 18

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 client feedback form that was used was aimed particularly at the "overall rating of our company" and the satisfaction with responsiveness, professionalism and understanding of needs. There was also feedback given on the out of hours service and level of communication with office staff. Of the 13 responses seen 11 rated as "very satisfied" and 2 as "satisfied". These were very positive results. Comments included "Competent and courteous staff, reliable service." Areas for improvement Responses had not been collated but the Manager intended doing this in the future. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Initial Healthcare Ltd, page 14 of 18

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 There was Quality Assurance policy but it was in need of updating (See below.) The service was building a reputation and had been successful in gaining some very positive feedback from clients. The Quality Assurance policy made reference to "spot checks" on staff and this was due to take place. There were other aspects of monitoring quality such as using the client surveys, client visits and complaints and compliments. Areas for improvement The Quality Assurance policy was headed in the name of a former company from July It made reference to staff supervision sessions and staff meetings which may not be possible for Initial Healthcare Ltd to achieve. A new policy should be developed. (See recommendation 1.) Staff feedback on the service had not yet been developed. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should develop an appropriate quality assurance policy that sets out how the quality of the service is to be monitored. This information should be made available to clients of the service. (National Care Standards for Nurse Agencies, Standard 1.1 Information about the Nurse Agency.) Initial Healthcare Ltd, page 15 of 18

16 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 n/a 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Initial Healthcare Ltd, page 16 of 18

17 5 Summary of grades Quality of Information Good Statement 1 Statement Good 4 - Good Quality of Care and Support Good Statement 1 Statement Good 4 - Good Quality of Staffing Good Statement 1 Statement Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 27 Mar 2012 Re-grade Information Not Assessed Care and support Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 22 Feb 2012 Re-grade Information Not Assessed Care and support Not Assessed Staffing Not Assessed Management and Leadership 1 - Unsatisfactory All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Initial Healthcare Ltd, page 17 of 18

18 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 SCSWIS. 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@scswis.com Web: Initial Healthcare Ltd, page 18 of 18