Lowland Care Services Housing Support Service First Floor 166 Irish Street Dumfries DG1 2NJ Telephone: /8/9

Transcription

1 Lowland Care Services Housing Support Service First Floor 166 Irish Street Dumfries DG1 2NJ Telephone: /8/9 Type of inspection: Unannounced Inspection completed on: 7 November 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 14 4 Other information 37 5 Summary of grades 38 6 Inspection and grading history 38 Service provided by: Lowland 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 Lowland Care Services, page 2 of 39

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 2 Weak Quality of Staffing 2 Weak Quality of Management and Leadership 2 Weak What the service does well The service has developed some very positive methods to ensure that they can take on board the views of service users and carers. For example, courtesy calls, a new and more effective questionnaire, new support plans and the personalisation pilot. Once embedded fully within the service, the service will be able to use the information to influence and direct the quality of the service delivered. New support plans in place were seen to contain information based on the individual service user's needs, choices and wishes. Care staff observed supporting service users were seen to be kind, respectful and considerate of individual service users' needs. Staff were knowledgeable of service users' likes dislikes and preferred routines. What the service could do better The service must address each of the requirements and recommendations stated throughout the report, including, but not exclusively, in the following areas: Improving the level and quality of the information within support plans and risk assessments; Removal of all private and confidential information from staff rotas; Undertaking full assessments of service users' ability to manage their own medication, together with an assessment of staff competency in the administration of medication; Review of staff training needs and the development of a staff training plan; Lowland Care Services, page 3 of 39

4 Safer recruitment practice to be followed for all staff; Service user dissatisfaction to be addressed in line with the service's complaints procedure; A formal system for recording and following through to completion any accidents or incidents; The electronic system in place should be used to monitor all quality aspects of care and support visits, staff rotas and travel time between visits; A full system of audit to maintain oversight and monitoring in all areas of the service should be developed. What the service has done since the last inspection Real Life Options have acquired ownership of the service since the last inspection. The post of Director of Older People's Services and Continuous Improvement Partner are now also in post since the last inspection. Conclusion We have discussed the service's strengths throughout this report. The service should work on meeting the reinstated requirements and recommendations, along with the further requirements and recommendations made during this inspection, to improve on the current grades awarded. Lowland Care Services, page 4 of 39

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 2011 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. 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 Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Lowland Care and Housing Support Services work out of two main office bases in Dumfries and Irvine, covering an extensive geographical area. The aim of the service is to provide really good quality care and support to adults of all ages in their own home. They try to encourage independence. provide consistent care and do this whilst working in partnership with service users and their families. Real Life Options have now acquired ownership of Lowland, however Lowland continue to be the Provider of the service but acting as a subsidiary. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 2 - Weak Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 2 - Weak 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 Lowland Care Services, page 5 of 39

6 or by calling us on or visiting one of our offices. Lowland Care Services, page 6 of 39

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection. The inspection was carried out by Care Inspectorate Inspector. The inspection took place over three days in Dumfries on 24th, 25th and 26th September and in Irvine on 6th November. We gave feedback to the Head of Older People's service on 7th November As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us. We sent 100 care standards questionnaires to the manager to distribute to service users and their relatives and carers. Fifty three completed questionnaires were returned. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: * Twenty people who use the service. * Eight family members of people who use the service. * The Head of Older People's Services. * The Continuous Improvement Partner. * Five Coordinators. * Various care staff within the office and when shadowing visits. We spent time over three days within the Dumfries office and also over lunch and tea visits we shadowed staff providing care and support to service users during this time. We spent one day within the Irvine office and visited service users within their own homes while staff were present to carry out the care and support. We looked at: Lowland Care Services, page 7 of 39

8 * The service's relevant policies and procedures relevant to the quality statements examined at this inspection. * Registration and insurance certificates. * Individual support plans and risk assessments of service users. * The Participation Strategy. * Medication system and records * Complaints system and records. * Accident and incident system and records. * Staff files and training records. * Minutes of staff meetings. * Staff rotas. * Quality assurance systems and processes. * The Service's IT systems for allocating staff to visits called Ezi-tracker. 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 Lowland Care Services, page 8 of 39

9 What the service has done to meet any requirements we made at our last inspection The requirement The following requirement had been made as a result of an upheld complaint made in May 2013 and finalised in October The provider must ensure that a personal plan which sets out how the service user needs will be met within 28 days of first receiving the service. Where that written plan aims to provide direction in terms of a service user's specific needs for moving and handling a suitable risk assessment must first be carried out to inform this. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - Welfare of users. What the service did to meet the requirement We have discussed progress on meeting this requirement under Quality Statement 1.3. The requirement is: Not Met The requirement The following requirement had been made as a result of an upheld complaint made in May 2013 and finalised in October The provider must ensure that systems for monitoring and quality assurance are effective. Specifically, that assessments and other records are in place where required and that these have been scrutinised for their accuracy and suitability before implementation. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - Welfare of users. What the service did to meet the requirement We have discussed progress on meeting this requirement under Quality Statement 4.4. The requirement is: Not Met Lowland Care Services, page 9 of 39

10 The requirement The following requirement had been made as a result of an upheld complaint made in May 2013 and finalised in October The provider must make arrangements to ensure that practice in terms of medication support reflects good practice and that systems for monitoring this are robust. The provider's action plan must show how it would aim to achieve this. Specifically: * that medication records are readily accessible * that information about medication to be administered is monitored for consistency and what action would be taken when necessary to address any discrepancy * that support staff are adequately supervised for their competency in medication administration and record keeping * how any variance in terms of instruction for, with the actual practice in, administering medication will be managed. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - Welfare of users. What the service did to meet the requirement We have discussed progress on meeting this requirement under Quality Statement 1.3. The requirement is: Not Met Inspection report continued The requirement The following requirement had been made as a result of an upheld complaint made in May 2013 and finalised in October The provider must ensure that any complaint made under the complaints procedure is fully investigated and, within 20 working days after the date on which the complaint is made, or such shorter period as may be reasonable in the circumstances, inform the complainant of the action (if any) that is to be taken. This is in order to comply with: SSI 2011/210 Regulation 18(3)(4) - Complaints. What the service did to meet the requirement We have discussed progress on meeting this requirement under Quality Statement 4.4. The requirement is: Not Met The requirement The following requirement had been made as a result of an upheld complaint made in May 2013 and finalised in October Lowland Care Services, page 10 of 39

11 The provider must review personal plans at least once in every six month period whilst the service user is in receipt of the service. This is in order to comply with: SSI 2011/210 Regulation 5(2)(b)(iii) - Personal plans. What the service did to meet the requirement We have discussed progress on meeting this requirement under Quality Statement 1.3. The requirement is: Not Met Inspection report continued What the service has done to meet any recommendations we made at our last inspection The following two recommendations were made as a result of an upheld complaint received in November 2013 and finalised in February Recommendation 1 The service provider should ensure that care staff receive training in the principles of good record keeping. This is in order to meet National Care Standards, Care at Home, Standard 3: Your personal plan. Progress We found that no further action had been taken to plan or implement training in the principles of good record keeping. We have discussed this further under Quality Statement 3.3. This recommendation has not been met and will be repeated. Recommendation 2 The service provider should, after obtaining consent for service users, record when and in what circumstances relatives and representatives will be contacted. This is in order to meet National Care Standards: Care at Home: Standard 4: Management and staffing. Progress We found no recording to evidence that the above recommendation had been met. We have discussed this further under Quality Statement 1.1. This recommendation has not been met and will be repeated. The following recommendation was made as the result of a complaint in June Although this was not upheld, a recommendation was made to improve practice. Recommendation 1 Lowland Care Services, page 11 of 39

12 The service provider should be able to demonstrate that the confidentiality, privacy and dignity of service users are respected when care staff use drivers to take them to and from their place of work. This is in order to meet National Care Standards, Care at Home, Standard 9: Private life Progress This recommendation was made in relation to care workers who were unable to drive and used drivers to transport them to and from the vicinity of service users' homes. We found that there was now an agreement in place for staff who used drivers to be dropped off at a nominated point to maintain the confidentiality, privacy and dignity of service users. We consider that this recommendation has been met. 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 a fully completed self assessment document from the provider. We were satisfied with the way the provider had completed this and with the relevant information included for each heading that we grade services under. Taking the views of people using the care service into account "Well done to Lowland Care and thankyou for your commitment". "The staff up to now have been very cheery, very helpful, and I am very satisfied". "The best are good - I have had to request a few don't come as I have no trust in them". "I have lately had cause to complain concerning the times of my visits but this seems to have been resolved". "Very happy with the kindness and care received from all the carers". "Happy with the service - running really good". "The carers come at different times. This confuses me. I need to know that my carer is coming at 9am not I have a set routine in the morning, I don't like my routine being disrupted". We have detailed further comments throughout the body of this report. Lowland Care Services, page 12 of 39

13 Taking carers' views into account Inspection report continued "Most carers very good - my relative is better with familiar faces". "My only comment was the consistency of carers but this is a bit better". "Quite happy that they would respond to any concerns that I may have". "Quite happy". "Can be a variation in timings". "The service keeps me up to date and the carers go the extra mile". "Carers are all great". We have detailed further comments throughout the body of this report. Lowland Care Services, page 13 of 39

14 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found that the service was demonstrating adequate practice in the areas covered by this Quality Statement. All of the service users we spoke with during the inspection told us that they received a weekly rota to inform them of the staff details and times of visits for the following week. This could be in a format suitable for the individual, for example we found that some service users had their rota ed, or in large print. Service users spoke positively of knowing in advance what staff would be supporting them. In conjunction with the local authority, the service was piloting a personalisation project to identify and meet individual outcomes for people. As part of this, the service had developed one page profiles for service users and staff to identify what is important to them and the best way to support them. This was an effective way for the service to look at staff skills and interests that would perhaps be suited to a particular service user. As part of the pilot, staff were completing learning logs which would be evaluated regularly to ensure that the care and support was meeting individual needs, choices and preferences. The service had recently developed new support plans which had been put in place for some areas of the service. The team leader had met with each service user to consult with them to develop their individual support plan. Of the support plans that had been completed, we saw these to contain good detailed information on the service user's choices, preferences and daily routines. We have discussed these in more detail under Quality Statement 1.3. We observed staff supporting service users in a kind and considerate manner and Lowland Care Services, page 14 of 39

15 offering choices in their daily living activities. We saw a good practice example where the carer consulted with the service user prior to documenting in the care diary, to ensure they knew what was being written in regards to their visit. We found that since the new ownership, the service was evaluating ways to improve on the current participation and involvement methods in place. For example, questionnaires had previously been sent to service users and their families. The service had however, identified that the questions were not appropriate and therefore the quality of information poor they received was poor. The service had also appointed a Continuous Improvement Partner who told us that the questionnaires have been reviewed and updated and these are in the process of being redistributed. The feedback received will then be collated and evaluated. We will check progress on this at the next inspection. Courtesy calls were in the process of being carried out for service users and families. Completed records evidenced positive feedback, but these had not yet been monitored or evaluated at the time of inspection. The service told us that they were planning to develop a "participation form" which would be sent to service users, families and carers to identify how they would like to be involved. For example, within the areas of questionnaires, reviews, or recruitment. This information will enable the service to plan the most effective ways for people to participate in a way that they choose. We saw that there was a new service user guide in place that had recently been finalised and was due to be distributed to service users and families. This included informative details of the service provided, including staff training, out of hours support, confidentiality, accident and incident procedure, how service users can express their views and arrangements for the end of the service. Areas for improvement Inspection report continued The service was making progress in the development of new methods to enable service users and their families to be able to participate in the service provided. However, although these methods had been developed they were not yet fully in place and therefore we could not see the outcomes, or changes to the quality of care as a result of these. We will check progress on this at the next inspection. We saw that the service had a participation strategy in place. However, on examination of this we found that this did not reflect the actual methods or practice in place. For example, this stated that the service held an open forum for service users, families and other representatives which was not the case. It did not contain detail of the new methods developed, or how feedback from participants would be used to improve and influence the provision of care. It is important that all service users, families, staff and other stakeholders know the different ways in how they can make comments or be involved in the service provided. The strategy should also detail Lowland Care Services, page 15 of 39

16 what action the service will take in response to suggestions or comments and how this will direct and influence the service provided. We have made a recommendation. (See recommendation 1 below) The following recommendation was made as a result of an upheld complaint received by the Care Inspectorate in November 2013 and finalised in February Recommendation The service provider should, after obtaining consent for service users, record when and in what circumstances relatives and representatives will be contacted. Progress From the information we examined within personal plans and within the electronic system, we could not see that this was clearly recorded to ensure all staff were aware of this. It is important that the service is aware when they need to contact relatives and representatives after consultation with them. We also noted an expression of dissatisfaction by a relative when they were not contacted when there had been an incident. We have discussed this further under Quality Statement 4.4. The service could consider asking people this question on the planned "participation form" which could then be recorded in personal plans and within the office. This recommendation has been repeated. (See recommendation 2 below) Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The service provider should ensure that the Participation Strategy is reviewed to reflect the current participation methods in place and detail how the service will involve, consult and inform service users and carers in all aspects of the service provided. This should include how the service will feedback to service users and carers any results of involvement and participation. National Care Standards, Care at Home, Standard 4 Management and Staffing; Standard 11 Expressing Your Views. 2. The service provider should, after obtaining consent for service users, record when and in what circumstances relatives and representatives will be contacted. This is in order to meet National Care Standards: Care at Home: Standard 4: Management and staffing. Lowland Care Services, page 16 of 39

17 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We assessed this statement by speaking with service users, relatives, staff and looking at care plans and risk assessments in place. We examined accident and incident reports to evaluate how these had been recorded, evaluated and followed through to completion. Our findings led us to conclude that the service was demonstrating practice to a weak level in the areas covered by this quality statement, having the potential to lead to poor health and welfare outcomes for service users. The service had developed a new support plan format and at the time of inspection we saw that these were currently being completed for each service user. This was to ensure that there was sufficient information to enable all staff to carry out the care and support in a safe and consistent way. Of the completed support plans we looked at, we found these to contain a good level of information for the care and support to be carried out with clear respect to individual choices and preferences. We observed staff to be committed and knowledgeable of service user's individual needs, daily routines and how they like the care and support to be carried out. Staff were able to give us confidential examples of individual's support needs and the action that they would take should they have any concerns. We noted from looking at service user diaries that staff were very good at recording any changes or concerns to ensure this was carried forward. Relatives of people who use the spoke positively of the support in place to meet their family member's healthcare needs. Comments included; "The staff really encourage my relative to keep mobile". "I know my Mum is safe". "The carers are very good and know how to use the stand aid". Service users told us; "The carers are really good at giving me a hand - I am 98!" "They help me with my medication and putting on creams". "Staff always make my meals really nice". Areas for improvement Inspection report continued The following requirement had been made as a result of an upheld complaint made to the Care Inspectorate in May 2013 and finalised in October Requirement The provider must ensure that a personal plan which sets out how the service user's needs will be met within 28 days of first receiving the service. Where that written plan aims to provide direction in terms of a service user's specific needs for moving and handling a suitable risk assessment must first be carried out to inform this. Lowland Care Services, page 17 of 39

18 Progress; We noted that although the new support plans were in place, we found by observing staff practice and by speaking with them and service users, that there was crucial information that was not included within the care plan. For example, where a service user required support with catheter care this was not referred to within the plan for each visit. Where staff were required to use moving and handling equipment there was not enough information to allow staff to carry this out in a safe manner, and in a way that the service user found acceptable. Where one service user had swallowing difficulties and required a minced/mashed diet, or some foods blended, this was not documented within the care plan. We also found that staff were keeping a specific healthcare chart and through monitoring they would evaluate when to contact the relevant healthcare professional. None of this information however was within the care plan. We saw where a service user was supported with mobility needs, and moving and handling equipment was used, that the care plan and risk assessment lacked sufficient information on the techniques in place. For example, "hoist onto commode". Other examples included guidance that did not contain enough information on the support individuals needed with their mobility or to take their medication. Through discussion with staff we found that regular consistent staff were aware, and able to inform us, of the health care needs and support in place for service users. It is important, however that this information is clearly documented within a care plan along with any associated risks, to ensure that all staff, including those who may be covering for absence, have access to this information for the support to be carried out consistently and safely. We found that only service users within the Annan area had the new support plans in place but these were not in place for service users in the other areas. We saw that some support plans were handwritten, but at the time of inspection these were to be typed up and then put in the individual service user's home. Some service users had the new personalisation documentation in place which gave good person centred information for staff to access. However these did not contain important information on healthcare needs, mobility or medication and there was no information detailing the care and support to be carried out at each visit. Within the Dumfries area, we found that the main focus had been placed on the personalisation pilot and we were informed that this had left limited time to enable the new care plans to be put in place. The requirement made at the last inspection has not been met. We have amended the previous requirement to incorporate our findings during this inspection. (See requirement 1 below) We visited service users who had quite specific healthcare and support needs and associated risks, however they had no care plans or risk assessments in place. For example, poor mobility, risk of falls, mental health needs, and medication support including creams. The outcome of this was that staff were recording care needs in the service user's diary or writing instructions on stickers on the front of folders. We also Lowland Care Services, page 18 of 39

19 found information recorded on loose paper, for example personal care tasks. Where there are identified risks for example in regard to healthcare such as swallowing difficulties, or mobility such as moving and handling, or risk of falls, there must be an accurate comprehensive risk assessment in place. This ensures that staff are aware of the risk and the support in place to reduce the risk. We have made a requirement. (See requirement 2 below) We received notification of an incident resulting in serious injury to a service user. This raised concerns around the quality of information contained within risk assessments and support plans, specifically in regards to moving and handling techniques and procedures. We looked at the individual's support plan and moving and handling risk assessment, and found that these did not contain sufficient detail to guide staff to support the service user in a safe and consistent way. We have also discussed this incident under Quality Statement 3.3 and 4.4. with regard to staff training and quality monitoring and assurance. Given the lack of care planning information available to staff, we found that individual service user's care and support needs were being recorded on the staff rota. We would not consider this to be good practice particularly in regard to maintaining confidentiality and dignity for the service user. (We have made a requirement. (See requirement 3 below) The following requirement had been made as a result of an upheld complaint made to the Care Inspectorate in May 2013 and finalised in October Requirement The provider must review personal plans at least once in every six month period whilst the service user is in receipt of the service. Progress; We found, as detailed above that a high number of service users did not have any personal plans in place. This evidenced that the service was not carrying out regular reviews and reviewing the plan as part of this process. The requirement made at the last inspection has not been met. We have incorporated this into an amended requirement. (See requirement 1 below) The following requirement had been made as a result of an upheld complaint made to the Care Inspectorate in May 2013 and finalised in October The provider must make arrangements to ensure that practice in terms of medication support reflects good practice and that systems for monitoring this are robust. The provider's action plan must show how it would aim to achieve this. Specifically: * that medication records are readily accessible * that information about medication to be administered is monitored for consistency and what action would be taken when necessary to address any discrepancy * that support staff are adequately supervised for their competency in medication administration and record keeping Lowland Care Services, page 19 of 39

20 * how any variance in terms of instruction for, with the actual practice in, administering medication will be managed. Progress; We looked at the system and processes for the administration of medication. We found that there were no monitoring systems in place to ensure that where service users were supported with their medication that this was following best practice and legislative guidance. There was no monitoring or oversight where staff supported service users to take their medication, therefore errors or areas for improvement were not being promptly identified. For example medication audits to monitor the following - completed medication charts; that there is no discrepancy between the medication prescribed and administered; that staff are supervised and assessed as competent in the administration and recording of medication; where staff practice does not follow instruction how this will be managed. Service users' ability to manage their own medication was not being reviewed on a regular basis. The outcome was that where service users were deemed to need only a "prompt", we observed them as needing full assistance with their medication. For example, where one service user was prescribed antibiotics, staff had written this in the diary for every day to ensure all staff administered this. There were occasions where the service user had also forgotten to take the prescribed medication. We also saw that where creams or lotions were to be applied that there was not clear information on the condition it was prescribed for, where/how/when it was to be applied or the start and end date. Medication charts sampled during the inspection were confusing as details had been scribbled on, or amended which had the potential to result in an error. The requirement made in the previous report has not been met. We have incorporated the requirement into an amended requirement in this report. (See requirement 4 below) Grade awarded for this statement: 2 - Weak Number of requirements: 4 Number of recommendations: 0 Requirements Inspection report continued 1. The Provider must ensure that each service user has an accurate, up to date personal plan, which sets out how the service user's health, welfare and safety needs are to be met. The personal plan must reflect current individual health and care needs and be reviewed (i) when requested to do so by the service user or their representative or (ii) when there is a significant change in a service user's health, welfare or safety needs and (iii) at least once in every six month period whilst the service user is in receipt of the service. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Lowland Care Services, page 20 of 39

21 Regulation 5 (2) (b) (i) (ii) (iii) Personal Plans. Timescale: Within eight weeks from receipt of this report. Inspection report continued In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing; Standard 3 - Your personal plan. 2. The Provider must ensure that where there is an identified risk to service users or staff, that risk assessments are completed, reviewed and evaluated. They should clearly record all risks to service users and staff and clearly define how each risk will be managed and evaluated. The service manager should include service users and their carers in this process. There must be clear evidence that service users, and carers if appropriate, have been involved in this process. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users. Timescale: Within eight weeks from receipt of this report. In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing. 3. The Provider must provide the service in a manner which respects the privacy and dignity of service users. In order to achieve this the Provider must; 1) remove all personal and confidential information relating to the health, care and support needs of service users. 2) Maintain regular oversight to ensure that the privacy and dignity of service users is not compromised. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (b) provide services in a manner which respects the privacy and dignity of service users. Timescale: 24 hours from receipt of this report. In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing. 4. The Provider must make proper provision for the health, welfare and safety of service users. In order to achieve this, the Provider must; 1) Undertake a full assessment of each individual service user to determine their ability to manage their own medication. From the outcome of the assessment, ensure the support is influenced by this and accurately recorded within the support plan. 2) Ensure details of prescribed medication recorded on the medication chart are accurate, up to date and regularly reviewed for consistency against administered medication. 3) Ensure there are comprehensive systems in place to demonstrate staff Lowland Care Services, page 21 of 39

22 competency in the administration of medication. 4) Develop a system of audit to maintain oversight and monitoring in all areas of medication administration. Outcomes as a result of any audit should be clearly recorded and an action plan developed. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users. Timescale for completion: 8 weeks from receipt of this report. In making this requirement the following National Care Standards, Care at home have been taken into account: Standard 8, Keeping well - medication Lowland Care Services, page 22 of 39

23 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The comments we have made under Quality Statement 1.1 are also relevant to this statement. We have given this statement the same grade of 3, Adequate, as Quality Statement 1.1. Areas for improvement The areas for improvement we have made under Quality Statement 1.1 are also relevant to this quality statement. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Lowland Care Services, page 23 of 39

24 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 was demonstrating weak practice in the areas covered by this quality statement. We concluded this by speaking with staff, looking at recruitment files, supervisions, appraisals, minutes of meetings and training records. New staff told us of the 3 day induction programme in place which they felt was good and gave them the underpinning knowledge needed within their role. Staff also confirmed that they shadowed more experienced staff to enable them to meet service users and become familiar with their needs and daily routines. Staff felt this was a good way to ensure they felt confident prior to working independently. We saw that there was a new induction programme in place which all new staff would now be attending. This was in line with the personalisation approach to support and person centred working. Senior Managers had also attended this induction staff told us they saw this as positive. The new induction covered various areas that are essential when supporting service users, for example diversity; equality; communication; adult support and protection; whistleblowing and human rights. Staff were also fully informed of the Scottish Social Services Council, the National care standards and of the Codes of Practice. This would ensure that prior to staff undertaking their role independently that they would have the core skills and knowledge to support often vulnerable people. Support staff spoke positively of the support they received from their line manager, describing them as supportive and approachable. We looked at training records within the service's electronic recording system and found on the whole, that staff had attended moving and handling and medication administration training. We received very good feedback from staff who had attended training in the personalisation approach that was currently being piloted. Service users were complimentary of the care and support they received from staff and comments included: "They are good carers and I am quite happy". "I wouldn't say a bad thing". "Everyone is different but they are all very, very good". "All carers are very good". "All have different attributes but very good". Families of people who use the service also told us; "I am very happy with the carers". "Everyone is really good". Inspection report continued Lowland Care Services, page 24 of 39

25 "...(name) treats my relative with respect and care". "All staff are very pleasant". "I have to compliment the company for having the same staff as it is very important to my relative as they take a long time to build up relationships with people". Areas for improvement Inspection report continued We looked at staff training records and found that current practice was not in line with the organisation's policy in place for staff training and development. For example, the policy states that "staff training and development aims to recognise the needs of; people who use our services, staff teams, individual staff members and the organisation". We saw that the core training in place and that staff had attended, was moving and handling, medication and first aid. From information within the electronic staff training records we identified that some of these had expired and were overdue. Where these were due to expire we could not see any evidence that these had been planned for or arranged. There was no system in place to maintain oversight and monitoring of all staff training attended, planned, required, or when due for renewal. The service's training plan did not include Adult Support and Protection as part of the core training to be regularly updated. It is important that staff are aware of Adult Support and Protection procedures to ensure they are aware of local guidelines and of their role and responsibility in relation to supporting adults who may be at risk. We also found that training was not identified or planned to meet individual service user's needs. For example, child protection, cerebral palsy, dementia, diabetes and mental health as some examples. Given the high level of service users who are living with dementia, we would expect staff to have sound knowledge and awareness of this condition. We have directed the provider to the Promoting Excellence Framework. This is a framework for all health and social care staff working with people with dementia, their families and carers. The framework outlines four levels and each level is specific to the workers role and responsibility. We discussed an incident under Quality Statement 1.3 regarding moving and handling techniques and procedures. We found that although staff had previously undertaken moving and handling training, this was overdue given that we were told this training should be updated at least every 18 months. There was no evidence to demonstrate that staff practice and competency had been monitored regularly. The outcome following of the incident was that staff would attend refresher training which would be followed up with regular supervision sessions. We questioned if the outcome of the lack of regular training and of comprehensive monitoring and supervision of moving and handling practice may have been a contributing factor to this incident. It is important that the service have a comprehensive staff training plan in place to ensure that staff have the skills and knowledge to support service users safely, and in line with best practice guidance and legislative requirements. Where individual service users have specific health care needs, it is vital that staff have an awareness and understanding of these to meet their needs. We have made a requirement. (See requirement 1 below) Lowland Care Services, page 25 of 39

26 We found that written records within staff files did not correspond with electronic records held for supervision, appraisal or spot checks. Staff had attended a recent supervision and/or appraisal but we could find no evidence that these had been carried out before this. We questioned the quality of the supervision recently carried out where this had not identified or highlighted important training and support needs for a staff member. We discussed the implications of this with the Senior Manager and Continuous Improvement Partner. Staff confirmed that they had not received regular supervision or appraisal until recently. There were no records to evidence that regular staff meetings were being held, other than one which was held to mainly discuss the new ownership of the organisation. Staff told us that they would find regular team meetings helpful to support them within their often isolated role. We would expect staff performance and practice to be monitored through regular supervision, appraisal and monitoring systems. Any training needs identified through these processes can then be planned for. We have made a requirement. (See requirement 2 below) Recruitment files examined for new staff identified that safe recruitment practices were not being followed. For example we found that references were not in place prior to commencement of employment. Where references were in place, these did not contain adequate information nor were they verified. It is important that the service ensures a reference gives them enough information to make an informed decision, and that they verify the authenticity of it. We also saw other examples of poor practice where long gaps in employment had not been discussed, or comments on references that we would have expected further clarification. We noted that these staff members had been signed off by the service as being fit to work. Although recruitment checklists were in place these were not routinely monitored or audited as part of quality assurance. Given the vulnerability of service users that staff support, the service must ensure that they check staff are fit to carry out their role prior to commencing employment. We have made a requirement. (See requirement 3 below) We have made a requirement under Quality Statement 4.4 that the service maintains oversight and monitoring in the areas of staff recruitment, supervision, appraisal and training. The following recommendation was made as a result of an upheld complaint received by the Care Inspectorate in November 2013 and finalised in February Recommendation The service provider should ensure that care staff receive training in the principles of good record keeping. Progress We found that no further action had been taken to plan or implement training in the Lowland Care Services, page 26 of 39

27 principles of good record keeping. This recommendation will be repeated. (See recommendation 1 below) Grade awarded for this statement: 2 - Weak Number of requirements: 3 Number of recommendations: 1 Requirements Inspection report continued 1. The provider must ensure that it has a comprehensive staff training plan in place and that this links to staff supervision and appraisal. The provider must ensure that all staff receive training appropriate to the work they are to perform and to meet identified individual service user needs. Staff must attend updates as and when required. This training must include, if appropriate, but is not limited to; * Dementia. * Child Protection. * Adult Support and Protection. * Diabetes. * Mental health. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users; Regulation 15 (b) (1) Staffing - a provider must ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform. Timescale for completion; 8 weeks from receipt of this report. In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing. We signposted the Provider to the following; * Promoting Excellence Framework * Standards of Care for Dementia in Scotland Informed About Dementia Workshop Facilitator's Guide... dementia_informed_workshop_interactive.pdf * Level 1 - Informed about Dementia DVD Lowland Care Services, page 27 of 39