Tus Nua Care Services Ltd Housing Support Service 6 Springhill Gardens Dundee DD4 6JF Telephone:

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1 Tus Nua Care Services Ltd Housing Support Service 6 Springhill Gardens Dundee DD4 6JF Telephone: Type of inspection: Announced (Short Notice) Inspection completed on: 10 March 2015

2 Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 10 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Tus Nua Care Services Ltd 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 enquiries@careinspectorate.com Tus Nua Care Services Ltd, page 2 of 21

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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well This new service was committed to a person centred model of support for people with a learning disability and, in some cases, mental health issues. Its support planning, quality assurance, staffing and actual support were all in place even though service users had only been in the service for the last 2 months. What the service could do better The service is very new and had not had time to embed all its proposed protocols as these need a longer time frame. Processes like staff appraisal, supervision and staff meetings have not happened yet. These are, however, planned to take place once a full staff team is in place and the service has been operating a little bit longer. What the service has done since the last inspection This is the first inspection of a new service. Conclusion This service was already operating at a good level of support for the two service users in placement. They confirmed that things were going well and that they were beginning to settle in and build relationships with staff. Tus Nua Care Services Ltd, page 3 of 21

4 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 the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Tus Nua is a 3 bedded house of multiple occupancy which incorporates support and care for up to 3 tenants with a learning disability and, in some cases, mental health issues. Support is provided 24/7 with staff sleeping over and providing person centred support for the tenants. The aims of the service are to provide personalised partnership support for people in their own home environment. Tus Nua Care Services Ltd, page 4 of 21

5 Based on the findings of this inspection this service has been awarded the following grades: 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. 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. Tus Nua Care Services Ltd, page 5 of 21

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection This report was written after a short-term announced inspection which took place on 10 March As requested by us, the service sent us an annual return. The Care Inspectorate wrote to the service to request completion of the self assessment form which was duly completed. 4 questionnaires were sent to the service users and staff 3 were returned. In this inspection we gathered evidence from the following sources:- Interviews with 1 staff. Interviews with the 2 service users. Interviews with manager of the service. Inspection of personal plans. Inspection of records. Inspection of policies and procedures. Observation of staff practice. Tus Nua Care Services Ltd, page 6 of 21

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 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 Tus Nua Care Services Ltd, page 7 of 21

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 Care Inspectorate received an extensively detailed and fully completed self assessment document from the service provider. We were very impressed with the way this had been completed and with the information they had provided under each theme that we were inspecting. Taking the views of people using the care service into account 2 service users were spoken with during the inspection and nine care service questionnaires were taken into account. They were generally very positive about the service. Here are some of the things they said:- The staff here are brilliant. They help me with my money, with my shopping and with my cooking. Before I came here I visited a few times to see if I liked it. Yes I have a copy of my support plan. They are good listeners and I feel safe here. This is a good service I have no complaints. The staff are polite and friendly. I get to watch lots of football on the TV. They manage my medication for me: put the tablets in a little plastic cup and then I swallow them. I've been here 6 weeks and feel I am really settling in. Tus Nua Care Services Ltd, page 8 of 21

9 Taking carers' views into account No carers were spoken with during this inspection. Inspection report continued Tus Nua Care Services Ltd, page 9 of 21

10 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: 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 This brand new service was operating at a good level for its stage of development. Here are some of the strengths which were evidenced. The service had already carried out their first six week review of a tenants placement. Minutes were seen by the inspector. The review allowed all the professionals involved in the person's life, the tenant and the service to discuss the support provided. The six week reviews are, and will be, accompanied by an evaluation tool which stakeholders complete to give feedback on the service. One of these was seen and contained positive feedback on how the service was functioning so far. The service has a full participation strategy which outlined how the service will gather views of tenants and other stakeholders. This included annual participation questionnaires, use of tenants meetings, tenants evaluations, reviews and the complaints procedure. The service had a competent complaints procedure within the welcome pack that new tenants and their families get. This provided another forum for the airing of issues of concern for people in relation to the service. The service had staff trained in talking matts and had invested in boardmaker. The service saw effective communication with tenants as an important part of enabling people to participate in their care. It was clear from observation of staff working with tenants that choice was respected. One tenant wished to go for a walk so this was arranged. Tus Nua Care Services Ltd, page 10 of 21

11 Despite the fact this service had only been working with people since January 2015, the inspector was satisfied that the participation needs of service users was being met and that plans were in place to set up longer term participation strategies. The tenants spoken to were relaxed and happy about the service they received. Areas for improvement The service should implement what it has outlined in terms of participation strategies over the time until the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Tus Nua Care Services Ltd, page 11 of 21

12 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths This brand new service was operating at a good level for its stage of development in relation to the care and support it was giving to tenants. Here are some of the strengths which were evidenced. Each service user had an agreed support plan which outlined how the service was going to support them. These contained good detail on how people were to be supported, relevant risk assessments such as for people at risk of absconding, having seizures and personal safety. It was clear from support plans that there was involvement from external health professionals such as local GPs, speech and language therapy and psychiatry for those that needed this kind of support. The inspector saw evidence of a protocol for when one tenant runs off. There was notification evidence to confirm this. It was clear that this service supported people to live their lives as independently and fully as they were able. In interviews service users spoke positively about the support they received. Activities of support included assistance with appointments, shopping, attending social events and going for a walk (which the inspector observed). Staff were trained to support service users to take their medication and be clear about protocols in relation to certain sorts of drugs such as sedatives and those medicines to be taken as required (PRN). A check of one tenants medication records showed competent practice. Each tenant had a copy of their support plan which had been personalised for their individual communication needs. One person had a plan which contained lots of pictures to represent the support and activities in their lives. Although this was a new service reviews had already taken place to monitor and assess outcomes for service users. Tenants confirmed they were involved in reviews. Transitions into the service: tenants also confirmed that they had received a high level of support and gradual introductions to the service prior to coming to live there. The inspector was impressed with the support planning for the service users. This was already at a high standard for such a new service. This demonstrated that the service had prioritised support which the inspector agreed was the most important part of what the service did. Tus Nua Care Services Ltd, page 12 of 21

13 Areas for improvement It was noted that the support plans did not have a system for demonstrating that they were up-to-date. See recommendation 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Support plans should also be demonstrably up-to-date. National Care Standards 3 Housing Support Services - Management and Staffing Arrangements. 4 You can be confident that all the staff use methods that reflect up-to-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice. Tus Nua Care Services Ltd, page 13 of 21

14 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 Please see Quality Theme 1 statement 1 for information in relation to this statement. Areas for improvement Please see Quality Theme 1 statement 1 for information in relation to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Tus Nua Care Services Ltd, page 14 of 21

15 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found that the service had an enthusiastic and well trained workforce who were confident in their roles. Here are some of its strengths:- Staff who were interviewed had been recruited from a care background and brought knowledge and experience with them. The manager was a trained Learning Disabilities Nurse and had worked for the service providers in a previous service. It was clear the recruitment of staff had been undertaken with effective support for people with a learning disability in mind. Staff interviewed at the inspection had been recruited using recognised good recruitment practice: including police checks and references. This ensured as far as possible the safety of tenants. The service had already trained their staff in adult protection, administration of medication and had commissioned specific training on self-harm. The service also had a training plan in place for staff which included an intention to provide vocational training (SVQs) for staff. With the service being so new this had understandably not started yet. Interviews with staff and showed that they were all aware of the National Care Standards and could apply them to their work role. All spoken with confirmed they had been given SSSC codes of practice. It was the intention of the manager to explore these in supervision and team meetings when they commenced in the near future. The service also had a comprehensive set of policies and procedures which lay out expectations of good practice for staff. Observation of staff practice with service users showed that good relationships had already been built up and that staff were supportive and professional in their approach. The inspector was impressed with the levels of enthusiasm and commitment shown by staff towards the people they supported. Although this was a newly formed service good relationships and professional support was in evidence. The two new tenants stated that they liked their staff group. Tus Nua Care Services Ltd, page 15 of 21

16 Areas for improvement The service should continue to implement supports for staff as the service get established. At the next inspection it is expected that there will be a track record of supervision, team meetings and other staff supports to be in place. Though this service was already operating at a good level. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Tus Nua Care Services Ltd, page 16 of 21

17 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 Please see Quality Theme 1 statement 1 for information in relation to this statement. Areas for improvement Please see Quality Theme 1 statement 1 for information in relation to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Tus Nua Care Services Ltd, page 17 of 21

18 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 service had a good quality assurance system in place. Here are some of the strengths identified:- It is clear that the health and wellbeing of service users was at the core of what this service does with its person centred and detailed approach. (The information for this can be found in Quality Theme 1 statement 3). The service had a good level of participation whereby service users, staff and other stakeholders can have an input into what the service delivers. (The information for this can be found in Quality Theme 1 statement 1). The service had effective systems in place to support staff, to develop their skills via training and supervision - they also involve staff in developing the service. (The information for this can be found in Quality Theme 1 statement 3). As well as the formal system in place to ensure quality, the service had created a culture of care for service users which meant that on a day to day basis people's needs and choices were listened to and, where possible, acted upon. Their needs were very important and this was evident in the way staff and management interacted with them. The service had a competent quality assurance strategy in place and was managing day to day its quality. Areas for improvement It is expected that by the next inspection the service will have a full array of quality assurance practices in place. This would include:- regular audits of support plans, medication audits, annual development plan, involvement in wider forums in learning disabilities and all the other practices a good service has that can only be evidenced over time. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Tus Nua Care Services Ltd, page 18 of 21

19 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 None noted. 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). Tus Nua Care Services Ltd, page 19 of 21

20 5 Summary of grades 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 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. Tus Nua Care Services Ltd, page 20 of 21

21 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: Tus Nua Care Services Ltd, page 21 of 21