The Good Care Group Scotland Ltd Support Service Care at Home The Bell Tower Newliston Kirkliston EH29 9EB

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1 The Good Care Group Scotland Ltd Support Service Care at Home The Bell Tower Newliston Kirkliston EH29 9EB Inspected by: Julie Tulloch Type of inspection: Announced (Short Notice) Inspection completed on: 8 January 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 9 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: The Good Care Group Scotland Ltd Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Julie Tulloch Telephone The Good Care Group Scotland Ltd, page 2 of 20

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 The Good Care Group provides an individually tailored live-in care service to meet the specific needs and preferences of the people they support. As part of this bespoke service people who use the service can choose their carer from those who most closely match their needs profile. The service has provided care to 5 clients since they were registered in July From the people we were able to ask about the service we found the feedback was positive. People were complimentary about their carer, the direct care they received and had found the management supportive. What the service could do better The manager needs to review and update the guidance provided for staff to reflect Scottish legislation and best practice. Participation could be improved by progressing some of the plans and ideas to help people give their views on the service and it's development. What the service has done since the last inspection This was the first inspection of the service which was registered in July With an office base in Kirkliston West Lothian, the care at home service is provided throughout Scotland. The Good Care Group Scotland Ltd, page 3 of 20

4 Conclusion Inspection report continued The Good Care Group has put a framework in place which should provide a personcentred live-in care service. The limited number of people who have used the service spoke highly of the service they received and good outcomes have been achieved so far. The service needs to maintain the quality of care they are providing as the numbers of people using the service increase. Who did this inspection Julie Tulloch The Good Care Group Scotland Ltd, page 4 of 20

5 1 About the service we inspected The Good Care Group is registered to provide a Care at Home service to adults living in their own homes. The provider has chosen to do this on a live in basis. The service offers personal care and support to predominantly older adults living in their own homes. The service has an office base in Kirkliston West Lothian from which it coordinates care throughout Scotland. Since registration in July 2012 the service was provided to 5 people. The Good Care Group has an affiliated company based in London which is registered with the English regulator, The Care Quality Commission. The London office provides a 24 hour call line for The Good Care Group in Scotland's staff and clients. The services stated mission statement is 'to provide the highest quality in home care and support services, enabling the elderly to enjoy staying safely in their own homes and own community for as long as possible'. 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. The Good Care Group Scotland Ltd, page 5 of 20

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 We wrote this report following a short notice inspection. Inspector Julie Tulloch visited the office premises in Kirkliston West Lothian on Friday 12 July 2013 between 10:30 and 14:30. 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. During the inspection evidence was gathered from a number of sources including; The guide provided to clients A sample written agreement Statement of purpose Advocacy policy Prevention of adult abuse policy and guidance for staff Dealing with accidents and emergencies guidance for staff Complaints policy and procedure Privacy policy Confidentiality policy Record keeping policy and procedure Key holding policy Handling of money policy and procedure Minutes of meetings Staff interview format and questions Sample care pathway document Staff appraisal template Staff supervision and review template Sample medication record Training materials New carer briefing We viewed two clients care plans and associated documents on the electronic data base. The Good Care Group Scotland Ltd, page 6 of 20

7 We spoke with: one client who had previously used the service two relatives of previous clients one relative of a current client. two care staff a director the care delivery manager the manager Inspection report continued The manager was asked to contact all the service users currently receiving a service and give them the opportunity to share their views with us in a way which suited them. During the period of the inspection there were no clients who we could visit to see how care was being delivered and we obtained their views or the views of their relative by telephone. These findings are therefore based on a very small sample and did not include any observation of direct care. 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 The Good Care Group Scotland Ltd, page 7 of 20

8 What the service has done to meet any recommendations we made at our last inspection This is the first inspection of this service. There are no recommendations outstanding. 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. We prompted the service to submit their self assessment. We received a comprehensively completed self assessment. 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 some planned changed. The service included information on how they involve people using the service in improving the quality of the service. Taking the views of people using the care service into account There were two people using the service at the time of the inspection. They were not able to speak with us directly or complete a questionnaire due to communication difficulties. We spoke with their relative or representative to gain views of the service. We also spoke with previous service users by telephone. Taking carers' views into account We spoke with one carer of a person who was currently using the service and three carers of people who had used the service recently to inform this inspection. The Good Care Group Scotland Ltd, page 8 of 20

9 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 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 The service provided some good opportunities for residents and relatives to give feedback and make suggestions for improving the service. People using, or who had used the service, or their families told us the information provided to them before using the service was clear and comprehensive and they were able to discuss what they wished the service to provide for them before the service commenced. This meant that people using the service could specify what they required and received the care and carer they needed. For example packages were tailor-made to include personal care, nutrition and cooking of meals and caring for pets, accompanying on outings and attending appointments. We found that the service have built-in regular reviews of the care plan to ensure people who use the service are continually given an opportunity to remain in control of their care plan. We heard how care was amended out with these built-in times in accordance with changing client needs or expressed wishes. This shows that the provider has good awareness of the need to be flexible to provide the correct support for people when they need it. Areas for improvement Client satisfaction questionnaires are distributed regularly by the service. Due to a poor response and small number of people who have used the service, questionnaires have not provided any feedback which would allow the service to make changes. The service have recognised that questionnaires may not be suitable for the people who use their service. We thought it was good that the service had identified this and have The Good Care Group Scotland Ltd, page 9 of 20

10 chosen to review the format, shorten the questionnaire and look at alternative ways of gathering feedback, such as through developing family support events and forums. We would encourage the service to look at obtaining feedback on the service they provided to clients from health professionals and partner agencies that they work with. The services performance in participation could be further developed by considering use of communication devices such as talking mats for people with a cognitive impairment or independent advocacy where appropriate to the circumstances. We discussed with the manager that the guide given to clients about the service needed an adjustment to say that complaints could be made directly to the Care Inspectorate without first using the provider's complaint procedure. The manager agreed to make this change. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Based on the evidence found during this inspection we graded the service as good for this statement. We decided this after speaking with relatives of people using the service, staff and from looking at records and electronic care plans. Relatives of people who use the service said there was a comprehensive care plan which they had been involved in planning and had agreed to. They said they had received written information about what would be provided and had a written agreement. We saw a copy of the information given to prospective clients. This pack gave comprehensive details about the organisation and the services provided. We spoke with people who were using, or who had used, the service and/or their relatives, who confirmed that they had received this information pack when they started using the service. They told us this was useful and relevant. People we spoke with confirmed they had a signed written agreement. The level of care was determined through information gathered by the service and an in-depth assessment. This gave people an opportunity to express their views and be involved in making decisions about the care and support they needed. We noted that The Good Care Group Scotland Ltd, page 10 of 20

11 the service had a robust system to ensure needs could be reviewed once the service had commenced. With the clients permission the service is proactive in contacting the clients G.P for a health status report to ensure they can fully meet the clients healthcare needs. We saw that the systems and processes which the provider had put in place considered the health and wellbeing of people who used the service. We saw that caring for pets, getting out, being part of the community and retaining the role within the family were also recognised as being important for maintaining health and wellbeing. This means the service demonstrated person-centred values. The care delivery manager introduces every new carer to the client and ensures they have the skills to carry out the care plan. In addition to a 5 day induction training and electronic learning package, staff competency in use of specific equipment or techniques is checked in the home setting prior to the carer's placement. We could see that by providing a very individual service people were supported to live their lives in keeping with their social and cultural values and beliefs. Areas for improvement From speaking to the limited number of clients who had used the service, we could see there may be opportunity for greater partnership working when a number of agencies are caring for a client. The service may wish to consider the use of independent advocacy services to ensure people who use the service can express their views about their care. This is important as their views may differ from family members or the person paying for the service. Because of the nature of the service and the limited number of clients who were using the service we were unable to assess the quality of care and support in the home setting. We have based our findings of providing a good performance on speaking with a very small number of relatives, clients and care workers by telephone. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Good Care Group Scotland Ltd, page 11 of 20

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 At this inspection, we found that the performance of the service was good for this statement. The evidence reported in quality of care and support statement 1 also applies to this quality statement. Before the service starts each client is sent profiles of carers who have been matched with the criteria from the assessment. The manager of the service told us that this was based on skills, experience, personality and personal psychological profiling. We were told that the person proposing to use the service can choose to decline the profiles offered or meet the carer prior to making a decision. Carer introductions are not charged for by the service to encourage free choice. We thought the service had considered the importance of ensuring that carers who were going to live in the clients home needed to be considered carefully by the client and their families to try to ensure the client/carer relationship was successful. We were told that the built-in review times provided opportunity to comment on the quality of staffing and the suitability and compatibility of carers. We heard how the reviews were carried out with the involvement of the care delivery manager who supervises care staff during their placements. We heard that there were opportunities for the client to speak with this supervisor or a director not involved in their day to day care. This may make it easier for clients to express their views about the carer. There was also access to a 24 hour call centre if the client or their relative felt more comfortable speaking with people with whom they did not have a relationship. We heard from family members and staff that clients had requested changes to carers and this had been carried out with a satisfactory outcome. Areas for improvement Ways of helping people who use the service to participate in general, which are discussed in quality of care and support statement 1, would also apply to this quality statement. The Good Care Group Scotland Ltd, page 12 of 20

13 As the providers business grows there is likely to be a wider choice of staff with different skills and personalities which may provide more choice for people who use the service. There may be opportunities to include past clients or relatives in future recruitment and training of staff. The manager has recognised that this could help improve the service and has included the idea in the self assessment submitted to us before the inspection. Development of this idea could improve the services performance in this quality statement. Grade awarded for this statement: 4 - Good 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 We found the service had a good level of performance in this quality statement. Carers attend a five-day residential induction training prior to being placed with a client. Additionally there is a probationary period and a twelve week e-learning package which carers complete. We saw staff were provided with information about policies, procedures, professional boundaries and the conduct expected by the organisation. This meant the provider had set out clear expectations for staff and the service it expects them to deliver to clients. Condition specific training is provided by the provider for staff. We were given samples of the training for Multiple Sclerosis and Parkinson's disease. Discussion with the manager and minutes of meetings demonstrated that the provider was committed to providing an opportunity for each member of staff to achieve a qualification. We raised with the manager that carers should be working towards qualifications which will enable them to register with the Scottish Social Services Council (SSSC). The SSSC is the body responsible for registering those who provide care in Scotland. The registration of all carers who provide care at home services is planned. The manager told us she had already contacted the SSSC to ensure the training for carers would allow them to register. We will monitor progress of this at future inspection. The provider recognised the increased potential for carer stress in their workforce because they are living with the clients who they look after. Care staff had a two-hour The Good Care Group Scotland Ltd, page 13 of 20

14 rest period built into each day to try to reduce the potential for this. Relatives of clients we spoke with said carers took the agreed rest period. Carers confirmed to us they received their rest period and said they were flexible about the time it was taken to accommodate their clients individual needs. Each carer receives 3 monthly supervision sessions from their regional care manager. We were told that annual appraisal is linked to pay review and includes a check that refresher training is up to date. There are systems to monitor carer performance and performance improvement plans are used where concerns have been identified. Areas for improvement We sampled The Good Care Group Adult Support and Protection policy. We found that the general content of the policy did not reflect Scottish legislation. The policy needed updated to include local authority guidance on reporting any issue relevant under Adult Support and Protection. Very positively, we found that the service had responded to our comments during the inspection to ensure carers had the relevant local authority contact details while the policy and training materials for staff were updated. We have made a requirement about this, see requirement 1. From the policy documents and guidance we sampled, we found they did not reflect Scottish legislation and best practice guidance. This means staff would not be able to respond appropriately when situations arise during their placement with a client. It also means staff may have received incorrect instruction during training. Due to the small number of clients and the support available from the care delivery manager this had not had a detrimental impact on people who use the service. At feedback it was agreed that the manager would review and update policies and procedures to reflect the correct legislation and best practice. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. The Adult Support and Protection policy should be reviewed to include relevant Scottish legislation, local authority guidance and best practice. This is in order to comply with SSI 2011/210 Regulation 4(1) (a) - a regulation regarding the welfare of users. This also takes account of National Care Standards - care at home Standard 4, Management and staffing arrangements Timescale: To be achieved by 28 February Inspection report continued The Good Care Group Scotland Ltd, page 14 of 20

15 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 Information on participation is also included under statements 1.1 and 3.1 of this report. Client satisfaction questionnaires specifically asked for comments about the management and leadership of the service.the service received a poor response to questionnaires. They have revised them and looked at alternative ways to get feedback from clients and relatives. In addition to the 6 monthly questionnaires, the Director for Scotland makes telephone calls to check on client experience and satisfaction with the management and leadership of the service. Care staff have the opportunity to feedback on the service during regular supervision sessions with the care delivery manager. We were told by the manager that the Chief Executive meets new carers to discuss their experience of the organisation. Areas for improvement Development of the plans for forums and family events described in the self assessment could provide further opportunity to involve clients and their family in assessing management and leadership. The involvement of a facilitator external to the service may provide additional benefits. See under statements 1.1, and 3.1 for further areas of improvement which are also relevant to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 4 The Good Care Group Scotland Ltd, page 15 of 20

16 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 Inspection report continued Overall we found the provider had an effective system to regularly assess and monitor the quality of service that people received. This included; a comprehensive initial assessment which is reviewed with the client at agreed intervals or if there is a change in the clients needs clients choose their carers and can meet carers prior to the start of the care package all carers are accompanied by the care delivery manager and introduced to clients staff receive regular supervision staff are supported by the care delivery manager who is contactable by telephone and makes regular planned and unplanned visits to work with carers and clients. The Good Care Group have a complaints policy and procedure which it includes with the information given to each client. Staff are provided with a copy in the handbook. There was a system for the manager to analyse learning from complaints on a monthly basis. We were not able to see this in operation due to the low numbers of clients using the service. There was a framework in place to discuss health and safety issues arising from placements on a monthly basis and agree actions. This meant that learning could be shared between the team and when similar issues occur staff will know how these can be resolved. There was a system to audit staff training and supervision on a monthly basis. This meant the manager had an accurate picture of the carers skills and could plan training to support staff in their role. The results of client feedback were presented to the Board alongside recommendations. This enabled the provider to us the clients experience to shape the future direction of the service. These areas of strength show a good level of performance. Due to the small number of clients who have used the service to date and the short time since the service has been operating, the sample of evidence was small. The evidence we saw showed a good level of performance which should be maintained and improved by the provider. The Good Care Group Scotland Ltd, page 16 of 20

17 Areas for improvement Managers of care at home services must register with the SSSC by 31 January The manager was not aware of the need to register with the SSSC. In discussion it was agreed this would be progressed and a plan would be put in place for the care delivery manager who acts in a supervisory role to register before June We have asked the manager to provide confirmation that this has been taken forward. We will report on progress in the next inspection report. The complaint policy and procedure should be reviewed to ensure it meets best practice and includes an explanation that a complaint can be made to the Care Inspectorate at any time should a complainant choose this route. The Care Inspectorate contact details should be included with the explanation. The manager agreed to up date this information. Suggestions we have made in quality themes 1 and 3 would also improve the service performance in this quality statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Good Care Group Scotland Ltd, page 17 of 20

18 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 This is the first inspection of the service since registration. 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). The Good Care Group Scotland Ltd, page 18 of 20

19 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. The Good Care Group Scotland Ltd, page 19 of 20

20 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: Web: The Good Care Group Scotland Ltd, page 20 of 20

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