Eildon Ltd - Support Services Housing Support Service Eildon House 39 High Street Inverness IV1 1HT

Transcription

1 Eildon Ltd - Support Services Housing Support Service Eildon House 39 High Street Inverness IV1 1HT Inspected by: Donna Harvey Type of inspection: Unannounced Inspection completed on: 23 June 2014

2 Inspection report continued 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 28 5 Summary of grades 29 6 Inspection and grading history 29 Service provided by: Eildon Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Donna Harvey Telephone enquiries@careinspectorate.com Eildon Ltd - Support Services, page 2 of 30

3 Inspection report continued 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 3 Adequate Quality of Staffing 2 Weak Quality of Management and Leadership 3 Adequate What the service does well The people who used this service were very happy with the small teams of staff who supported them. They knew their local management and felt they could speak to them at any time. Staff were happy in their jobs and also felt they had good support from their local manager. What the service could do better The management need to improve how they carry out checks on people who apply for jobs. They also need to carry on learning about how to meet their responsibilities to us, the Care Inspectorate. What the service has done since the last inspection We made several requirements and recommendations at the last inspection. The management had made good progress with most of them. They had done most of the things we asked them to do. Conclusion This service had made a lot of progress since the last inspection. Eildon Ltd - Support Services, page 3 of 30

4 Inspection report continued Who did this inspection Donna Harvey Eildon Ltd - Support Services, page 4 of 30

5 Inspection report continued 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 The service was registered with the Care Inspectorate on 4 October In May 2013 it extended the terms of its registration to provide a care at home service. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services 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. Eildon Ltd is registered to provide a housing support and care at home service to adults who have experienced homelessness, as identified by the provider at the point of application and are living in their own homes. The aims of the service are to "enable those who require support to enjoy a valued life". The service aimed to "support adults to achieve a level of independence and maintain their accommodation". One of the service's objectives was to "work in partnership with other agencies, the public, private or voluntary sectors to provide a good quality of personal care and home based support". The service had two offices; one based in Inverness town centre and the other in Macduff, Banffshire. Based on the findings of this inspection this service has been awarded the following grades: Eildon Ltd - Support Services, page 5 of 30

6 Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 3 - Adequate Inspection report continued 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. Eildon Ltd - Support Services, page 6 of 30

7 Inspection report continued 2 How we inspected this service The level of inspection we carried out In this service we carried out a high 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 We wrote this report after a short notice announced inspection. This service had a Manager (based in Inverness) and two local managers, based in Inverness and Macduff. The first part of the inspection was when we asked the Manager to issue questionnaires to the people who used this service. We also asked the Manager to distribute questionnaires, on our behalf to the staff. All the users of this service live in their own homes in the community. However, the service had just completed their questionnaire survey of user satisfaction. We did not wish to burden the people who used this service with completing another questionnaire, which would have arrived just after the service's own survey was completed. Instead, the service's management shared the detailed findings of their own survey and we report on this throughout the report. We telephoned the local Macduff manager on Monday, 16 June We then carried out our first visit at the Macduff office on Tuesday, 17 June 2014 between 9:15 am and 6:00 pm. We visited the Inverness office between 9:15 am and 5:00 pm on Wednesday, 18 June We then returned to the Macduff office on Monday, 23 June 2014 between 9:00 am and 2:00 pm where we concluded our examination of records, and gave feedback to the Director, the Manager and the Macduff manager. 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 spoke with: * The relatives of two people who used this service (one in very general terms and one in more depth on the telephone) * Four of the people who used the service (one of these was by telephone) * Three direct support staff in person and a further one by telephone * Both local managers * The Manager * The Director of the company Eildon Ltd - Support Services, page 7 of 30

8 * Two independent professionals who have regular contact with some of the supported people. We looked at: Inspection report continued * Certificates of registration * The support files for the people this service supports which included, 'Support Plans' and review records * Medication records * Accident records * Incident records * Staff records * Minutes of staff meetings * Records related to the supported people and/or their families involvement and participation in the service. 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 Eildon Ltd - Support Services, page 8 of 30

9 Inspection report continued What the service has done to meet any requirements we made at our last inspection The requirement The provider must further develop the personal plans to ensure that they provided background information and details based on appropriate referrals. This is in order to comply with: The Social Care and Social Work Improvements Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - Regulation 5 (1). Timescale: One month of receipt of this inspection report. What the service did to meet the requirement The management team have successfully addressed this requirement. We discuss this under Quality Theme 1, Statement 3. The requirement is: Met - Within Timescales The requirement The provider must ensure all personal plans should be reviewed on a six monthly basis. This is in order to comply with: The Social Care and Social Work Improvements Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - Regulation 5 (2) (b) (iii). Timescale: Six months of receipt of this inspection report. What the service did to meet the requirement The management team have successfully addressed this requirement. We discuss this under Quality Theme 1, Statement 1. The requirement is: Met - Within Timescales Eildon Ltd - Support Services, page 9 of 30

10 The requirement The provider must ensure that all risk assessments properly identified the degree of risk and put in place appropriate measures to minimise the likelihood of any harm or incident occurring. This is in order to comply with: The Social Care and Social Work Improvements Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - Regulation 4 (1) (a). Timescale: One week of receipt of this inspection report. What the service did to meet the requirement The management team have successfully addressed this requirement. We discuss this under Quality Theme 1, Statement 3. The requirement is: Met - Within Timescales Inspection report continued The requirement The provider to put in place robust, safe recruitment and selection processes which complied with current best practice guidance (such as 'Safer Recruitment Through Better Recruitment' - guidance in relation to staff working in social care and social work settings). This is in order to comply with: The Social Care and Social Work Improvements Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - Regulation 15 (a). Timescale: One week of receipt of this inspection report. What the service did to meet the requirement The management team had not successfully addressed this requirement. We discuss this under Quality Theme 3, Statement 2. The requirement is: Not Met The requirement The provider must ensure that all members of staff are: (i) Appropriately inducted. (ii) Receive training appropriate to the work they perform. (iii) Receive regular support and supervision. (iv) Appropriately registered with the Scottish Social Services Council (SSSC). Eildon Ltd - Support Services, page 10 of 30

11 Inspection report continued This is in order to comply with: The Social Care and Social Work Improvements Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - Regulation 15 (a) (b) (i) (ii) and The Social Care and Social Work Improvements Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) - Regulation 4 (1) (a). Timescale: Three months of receipt of this inspection report. What the service did to meet the requirement The management team had successfully addressed this requirement. We discuss this under Quality Theme 3, Statement 3. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection 1. The provider to survey the views of service users and carers about ways in which the quality of care and support could be further improved. An action or improvement plan based on these surveyed views and suggestions should be devised and implemented. National Care Standards, Care at Home: Standard 11 - Expressing Your Views. The management team had successfully addressed this recommendation. We discuss this under Quality Theme 1, Statement The provider needed to ensure that the personal plans adopted a person-centred approach to individual care and support planning arrangements. An outcome focused approach should be put in place and ongoing records used to evidence what results were being achieved. National Care Standards, Care at Home: Standard 3 - Your Support Plan. The management team had addressed this recommendation, though there is room for further development. We discuss this under Quality Theme 1, Statement In order to move forward standards of care and support it is recommended that the service improves the quality assurance processes being used, to ensure that areas for improvement are identified and actioned by the management team. National Care Standards, Care at Home; Standards 4 - Management and Staffing. Eildon Ltd - Support Services, page 11 of 30

12 Inspection report continued The management team had not successfully addressed this recommendation. We discuss this under Quality Theme 4, Statement 4. 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 Manager. We were satisfied with the way they completed this and with the relevant information included for each heading that we grade services under. The Manager identified what they thought the service did well, some areas for development and any changes that were planned. Taking the views of people using the care service into account We asked the Manager to issue questionnaires to the people who used this service. All the users of this service live in their own homes in the community. However, the service had just completed their questionnaire survey of user satisfaction. We did not wish to burden the people who used this service with completing another questionnaire which would have arrived just after the service's own survey was completed. Instead, the service's management shared the detailed findings of their own survey and we report on this throughout the report. The service's survey was carried out in the first quarter of this year. The Manager also gave us access to questionnaires that users of this service had completed since the last inspection in In total we saw that 26 people who used this service (or their representative) had returned a questionnaire to the service. The findings were that overall the majority of people were very happy with the service they received. There was only one person who had expressed dissatisfaction, and we saw that the local manager had taken appropriate action to address their concerns. The views of the people who used the service and their family/carers as gained by the service greatly informed the findings of this inspection and are included throughout the report. Eildon Ltd - Support Services, page 12 of 30

13 Taking carers' views into account Inspection report continued Most of the people who completed the service's questionnaires had been assisted by family or staff to do so. Some of the returned questionnaires made this clear, others did not. We have included all views from the questionnaires under supported people's views. We spoke in person with the family members of two supported people. One was a very brief conversation, the other a longer telephone conversation. Both of these people were very happy with this service. Eildon Ltd - Support Services, page 13 of 30

14 Inspection report continued 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: 3 - Adequate 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 assessed this quality statement by: * Communicating with some people who used this service * Speaking with family members of people who used the service * Speaking with staff * Examining records such as reviews and the company's own questionnaire survey. The service was able to demonstrate an overall good level of involving people in assessing and improving the quality of their care. We made a requirement at the last inspection for the management to make sure that they carried out reviews of peoples' support at least every six months. The management had managed to meet this requirement. We saw that they had reviewed most people's care at least every six months. We saw two examples where the reviews had not taken place. The records made by the local management gave information to explain why they had not gone ahead. We clarified with the Inverness local manager that reviews could take place without a social work or health professional being there, if their availability was continuing to cause delays in holding reviews. We had recommended at the last inspection that the management should carry out a survey. We looked at the records of this survey and they were very positive. The records held in the Aberdeenshire office were also good at showing the local manager kept in regular contact with the supported people. When we spoke with someone supported from the Inverness office, they also said they regularly saw their local Eildon Ltd - Support Services, page 14 of 30

15 manager who would visit, "to see how we were getting on". We found that an overwhelming majority of people were very satisfied with the care and support that they received. On a couple of occasions people had referred to some initial "teething problems". However, they felt these had all been addressed. This shows us that the service's management and staff had responded positively to their views, and made adjustments based on people's views. Areas for improvement We advised the Inverness manager to consider different models of support planning for a specific person. We suggested she explore, 'Essential Lifestyle Planning' with the supported person. We think this style of planning would make it easier for the supported person to be more involved. We discuss this a little more under Quality Theme 1, Statement 3. The management need to make sure that they tell people what the outcome of any complaint or concern they make is. We make a recommendation about this under Quality Theme 4, Statement 4. 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 We assessed this quality statement by: Inspection report continued * Communicating with the people who used this service * Communicating with the family members of people this service supports * Communicating with staff * Examining records such as support plans, reviews, and multidisciplinary meetings. Overall we have graded this statement as adequate. There were aspects of care that were of a higher standard. However, there are several areas that need development, hence the grade. We made a requirement at the last inspection for the management to, "develop the personal plans to ensure that they provided background information and details based on appropriate referrals". We found that all the supported people had personal plans. This service provides three types of care packages which can be roughly divided into three categories; Housing Support, Domiciliary Care, and Supported Living. The Housing Support and the Domiciliary care packages were well supported Eildon Ltd - Support Services, page 15 of 30

16 by the personal plans that were in place. The design of the plans made them easy to read and provided clear and descriptive information to guide staff. We felt the "daily routine" parts of the plans were particularly helpful for staff. The service also provides two "bigger" care packages and these plans would benefit from some development (see areas for development below). We saw that local management had good links with other professionals concerned with people's health. We saw evidence of frequent contact to discuss changes in people's health and wellbeing. This means staff were able to respond quickly to people's changing needs. In one instance we saw that local management had been successful in agreeing extra support for a person to meet their needs. We saw records in the Macduff office that showed support staff appropriately sought guidance from their local management. One example we saw showed staff reported their concern to their manager, then followed her advice and gained prompt medical attention for the person they were supporting. The staff we spoke with in Inverness also reported that they got very good support from their management. The people who used this service and a family member told us they were very happy with the support they got. They felt the local manager was very approachable, they had frequent contact with them and the local manager and staff would be very conscientious in addressing and meeting people's needs. We made a requirement at the last inspection about risk assessments. The management had successfully addressed this requirement. We saw several such assessments. The ones we thought best were for the housing support clients in Macduff. Please see areas for improvement below. Areas for improvement Inspection report continued The service provides what we are calling, 'Supported Living' to two people. These are full care packages where staff supported the people all day, every day. These are the support plans that needed some development. For example, weekly/monthly routines may be useful. We think management should consider if an 'Essential Lifestyle' type of plan would be useful for one particular person. The last inspection made a recommendation about adopting a person-centred approach to individual care planning. We think the plans for the larger packages of care, as described here need more information in them in order for any new staff to have enough information to carry out the care and support that is needed. We have reworded the recommendation to make it clear where the development is needed. See Recommendation 1. The management should develop their medication management. Where staff have full responsibility for managing people's medication, staff should use copies of each prescription issued by a health professional. They can use this to check pharmacy provided Medication Administration Records and/or to inform their writing of Eildon Ltd - Support Services, page 16 of 30

17 Medication Administration Records, and to provide a clear audit trail to the prescription. Any handwritten record should be signed and dated and where possible checked by a second staff member. See Recommendation 2. The risk assessments that had been completed for people receiving domiciliary care in Macduff were too big. Risk assessments need to be regularly reviewed and updated, for example after an accident or near miss. They need further development to make them more user-friendly and easier to review. We made some suggestions to help guide management, for example, we discussed providing nail care. Whilst there are risks associated with cutting nails there are also risks to people's wellbeing if their nails are not cut. A sensible and balanced approach with the supported person would identify the way forward for individuals, taking account of any specific conditions, such as diabetes. We also directed the management to the Health and Safety executive's documents and would advise them to visit their website, which includes a section titled "Sensible Risk Assessment in Care Settings". See Recommendation 3. The management need to ensure they keep a monitoring records of accidents and incidents. This will meet their responsibilities to keep certain records and show they have carried out suitable analysis of causes and such like. See Recommendation 4. A description of registered care service's responsibilities for record keeping is included in the Care Inspectorate's "Records all Services (excluding Child Minders) Must Keep and Notification Reporting Guidance", which is available on the Care Inspectorate's website This document was updated on 10 June We saw an example where staff had kept good records of the financial transactions they were responsible for. These had been checked by the local manager. This means the service's staff were acting appropriately to keep the supported person's finances safe. However, we also found an example where staff were doing some shopping for a supported person. There is no reason why staff should not support people in this way. However, all such support should be included in the personal plan and have the necessary financial records made to safeguard the supported person and staff. See Recommendation 5. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 5 Recommendations Inspection report continued 1. The provider develops the personal plans for people receiving larger care packages (such as all day support). Plans should be based on the supported person's needs and dreams and provide enough information to guide staff through all the tasks required of them. Eildon Ltd - Support Services, page 17 of 30

18 Inspection report continued National Care Standards for Care at Home, Standard 3; Your Support Plan. 2. Staff should use copies of each prescription issued by a health professional to inform their writing of Medication Administration Records and to provide a clear audit trail to the prescription. Any handwritten record should be signed and dated, and where possible checked by a second staff member. National Care Standards for Care at Home, Standard 8; Keeping Well - Medication. 3. The management develop their risk assessment process to reduce the amount of paperwork it produces, whilst identifying and taking sensible and proportionate measures to control risks. The risk assessments should form part of an individual's support plan. Management should ensure they are reviewed alongside the plan and after any relevant accident or incident. National Care Standards for Care at Home, Standard 3; Your Support Plan. 4. The management keep a monitoring records of accidents and incidents. This should show they have carried out suitable analysis of individual occurrences and of any collective themes or triggers. National Care Standards for Care at Home, Standard 4; Management and Staffing. 5. Staff must keep a record of the date, amount and purpose of any money spent on behalf of a person using the service. The record should also include the name and signature of the person authorising spending, and witnessing receipt and return of money or valuables. National Care Standards for Care at Home, Standard 4; Management and Staffing. Eildon Ltd - Support Services, page 18 of 30

19 Inspection report continued 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 We assessed this quality statement by: * Communicating with the people who used this service and their family/ representatives * Examining records such as review meeting minutes * Communicating with staff. This statement was examined in conjunction with Quality Theme 1, Statement 1. Please read that statement for a full account of the evidence about supported people, and family/representatives involvement in assessing and improving the service. The service has an adequate level of involving supported people in assessing and improving staff. In relation to this statement, we saw that the manager in Macduff had asked people if they were happy with their staff during her monitoring visits. We saw that this feedback had been very positive. The management had developed individual "staff specifications" for their two "Supported Living" clients. Staff had been recruited specifically to each of these roles. Areas for improvement Please see Quality theme 1, Statement 1, which highlight areas for development that are also relevant to this quality statement. All staff completed a "client specific" induction checklist. However, this checklist contained a lot of generic areas, such as accident reporting, which could be covered in the general staff induction. Having client specific induction checklists is a good idea, the management just need to adapt what they have, to be more focused on the individual. The management should consider how they will use the feedback they receive from Eildon Ltd - Support Services, page 19 of 30

20 the people they support to influence their training and support of staff. As the service grows and takes on more staff management, they should also consider how they will involve their clients in choosing staff to support them. We saw in a complaint investigation record that a member of staff had been by a client of their concern, regarding a member of staff and they had not reported it to management. Management stated this had been addressed during a staff meeting, which unfortunately was not minuted. Management were aware that records of this meeting should have been kept. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We assessed this quality statement by: * Communicating with the people this service supports and their family/ representatives * Speaking with staff and examining the questionnaires staff returned to us * Examining staff records such as team meetings, 1:1 support session minutes and training records. The service had many positive qualities in regards to this quality statement however, some of the checks made on potential staff had not been appropriately made, and therefore we have graded this statement as weak. Since the last inspection the service has improved their recruitment practices. We saw that applicants completed application forms, had copies of job descriptions and were asked to provide at least two references. Many of the records we examined showed the service had received suitable references. Areas for improvement Inspection report continued The last inspection made a requirement about staff recruitment. This requirement remains in place though we have reworded it to ensure our expectations are clear. The management's understanding of carrying out police checks through the Protection of Vulnerable Groups' (PVG) scheme was incorrect. We clarified the position. When employing persons who are not scheme members, then the management must apply for a PVG Scheme Record. When employing persons who Eildon Ltd - Support Services, page 20 of 30

21 are already PVG members, the management must apply for a PVG Scheme Record Update. See Requirement 1. We found one example where the management in Inverness had appointed a new member of relief staff (those who work as and when required, normally to cover staff absences) without any form of PVG membership or check. We are aware that the service had a recruitment crisis however, this is not acceptable practice and cannot be repeated. See Requirement 1. There are refinements and improvements that the management could make to the rest of their recruitment practices. For example, how they get applicants to account for any omissions or discrepancies in their application during recruitment. We directed the management to several documents, including, 'Safer Recruitment Through Better Recruitment' and advised them to use these documents to inform the development of their recruitment and selection procedures. See Requirement 1. By the time of our feedback session with the provider and management, they had already began developing a stronger recruitment procedure. They had also discussed how to keep better quality control of their recruitment. All were committed to adopting safer recruitment practices. Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider follows safe recruitment and selection processes which comply with the Protection of Vulnerable Groups (PVG) and with best practice guidance (such as 'Safer Recruitment Through Better Recruitment', produced by the Scottish Government). In order to comply the provider must: Inspection report continued a) Develop a written recruitment and selection procedure in keeping with the PVG scheme and with best practice guidance 'Safer Recruitment Through Better Recruitment'. Timescale: A draft copy of this should be sent to the Care Inspectorate within 1 week of receipt of the draft report. b) Ensure all staff currently working for the service that were scheme members prior to their recruitment, have since had a PVG Scheme Record Update carried out. Management should send us a written account that shows the PVG status of Eildon Ltd - Support Services, page 21 of 30

22 all staff, along with their names and the date they started employment. Timescale: This should be sent to the Care Inspectorate within 1 week of receipt of the draft report. c) When employing persons who are not scheme members, then the management must apply for a PVG Scheme Record. When employing persons who are already PVG members the management must apply for a PVG Scheme Record Update. Timescale: Immediately, starting from our feedback to the provider on 23 June This is in order to comply with: The Social Care and Social Work Improvements Scotland (Requirements for Care Services) regulations 2011 (SSI 2011/210) - Regulation 15 (a). Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We assessed this quality statement by: Inspection report continued * Communicating with the people this service supports and their family/ representatives * Speaking with staff and examining the questionnaires staff returned to us * Examining staff records such as team meetings, 1:1 support session minutes and training records. The last inspection made a requirement about inducting and training staff. With one exception we saw that staff received an induction and a selection of training. Many of the staff had come to the service with recent training from other employers. The management had appropriately retained copies of the certificates supplied by the previous employer. The staff we spoke with and who sent us a questionnaire were very happy in their work. They described their satisfaction with the level of training and the support they received. Staff felt the service had developed well over the last few months and many wanted to work more hours for this provider. The provider has arranged for all interested staff to undertake a, 'Scottish Vocational Qualification - Level III'. We saw that many staff were very interested and keen to take on this challenge. This is a very good development and we look forward to following the development of this staff team. Eildon Ltd - Support Services, page 22 of 30

23 Areas for improvement Inspection report continued We found one occasion where the staff member's recruitment, had omitted important safety checks (see Quality Theme 3, Statement 2). Their induction had also been condensed over a two day period. The provider has gone to some lengths to training management as trainers and to develop an induction process that should be used for all staff. The provider had arranged for staff to have access to an 'e-learning scheme'. We saw that many staff had undertaken this type of development. We were also pleased that at least one member of the management team had also accessed the training in order to assess its suitability. We suggested that the management develop their use of this resource in order to validate staff's understanding when they have had their most recent training carried out prior to their employment. Each person who used this service had a small designated staff team. Whilst this is very positive we raised a note of caution regarding the two 'Supported Living' packages. Each person who used the 'Supported Living' packages had two staff that worked for extended periods on a "back to back" basis. We saw there were two "relief" staff, however, one of these had restricted availability. In order to cover staff absences each person really needs several identified staff in their team. We are aware of the logistical difficulties in supporting such packages. We are also aware of how happy the people who received this support (and their representative's and family) were with their service. We discussed this with the management team and they had already identified this as an area that needed their attention. Staff were very happy with the informal support they received from their local manager, both in Macduff and Inverness. We saw that the Macduff local manager had kept records of at least some of this support, and of her monitoring visits and spot checks on staff. In Inverness these records were not kept in staff files. We encourage all management to ensure they keep a record of their contact with staff, as it is an important record of the support they provide. We saw some examples where the local manager in Macduff had assessed staff's performance, and this was a good piece of work. However, each assessment involved a considerable amount of writing by the local manager. We think time constraints and competing priorities on management's time would limit the time they had for such written work. We recommend that the service develops a staff support policy/procedure which outlines their aims of and the frequency of supports such as team meetings, 1:1 staff meetings and appraisals. See Recommendation 1. All senior staff who are involved in the recruitment and selection of staff, must be fully aware of and comply with safe recruitment practices as outlined in the service's own procedures and in, 'Safer Recruitment Through Better Recruitment'. Eildon Ltd - Support Services, page 23 of 30

24 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The management team develops a staff support policy/procedure which outlines their aims and the frequency of supports such as; team meetings, 1:1 staff meetings and appraisals. National Care Standards for Care at Home, Standard 4; Management and Staffing. Eildon Ltd - Support Services, page 24 of 30

25 Inspection report continued Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 We assessed this quality statement by: * Communicating with the people who used this service and their family/ representatives * Communicating with staff. This statement was examined in conjunction with Quality Theme 1, Statement 1. Please read that statement for a full account of the evidence about supported people and family/representative involvement in assessing and improving the service. On a day-to-day basis the supported people had an adequate level of involvement in this area. In relation to this statement, we saw that the service had carried out a satisfaction survey. The results of this had all been very positive and so there had been no further action for the management team to take. Areas for improvement The management team should consider how often they will carry out satisfaction surveys and what information they seek to gain from them and how this will feed into their quality assurance processes. We suggested the management look into the "ladder of participation" to assist them in planning how to develop their involvement of supported people. Areas for development in Quality Theme 1, Statement 1 are also relevant to this quality statement. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Eildon Ltd - Support Services, page 25 of 30

26 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 We assessed this quality statement by: * Communicating with staff * Communicating with the people the service supports and their family/ representatives * Examining the managements oversight of accident and incident records, complaints and staffing issues and their own quality assurance audits. The local manager's kept in close telephone contact with their staff and with the people who used the services. These managers also produced the personal plans with involvement from support staff and supported people. They also carried out the reviews and monitoring visits. As a small service this is currently providing the management team with a reasonable overview of the quality of the service. This had been recently enhanced by the most recent satisfaction survey that they had carried out. Areas for improvement Inspection report continued The management team had not developed a quality assurance system as recommended at the last inspection. We spent some time with the management exploring how they could go about this task. All providers of care services are required to provide the Care Inspectorate with information in their annual return (primarily a statistical record asking how many complaints, accidents and such like have taken place in the preceding twelve month period) and so the quality assurance scheme would do well to gather the information needed to complete this Annual Return. Providers also have to complete their own assessments of how they feel they are performing in relation to all the quality themes and statements. Quality themes and statements are the headings that the Care Inspectorate uses to report on the National Care Standards. It would seem sensible that the service's own quality assurance system should contribute to this self-assessment. See Recommendation 1. The management team need to ensure that they conclude their handling of complaints by informing the person who made the complaint of the outcome or resolution. This should be clearly recorded. We suggested that the management team develop a simple tracking tool, based on their own complaints procedure, to help them ensure they follow all the necessary steps. See Recommendation 2. The management team were not aware of their responsibilities to report certain events to the Care Inspectorate. During the course of the inspection we found there had been events that we should have been notified of. See Requirement 1. Eildon Ltd - Support Services, page 26 of 30

27 Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 2 Requirements 1. The provider must ensure that all appropriate staff in the service understand and know how to comply with the care inspectorate's notification requirements. The Care Inspectorate must be notified of all incidents as detailed within, "Records all Services (excluding Child Minders) Must Keep and Notification Reporting Guidance". This is in order to comply with: SSI 20122/28 4(1)(a) - a requirement concerning records, notifications and returns. Timescale: One week. Recommendations Inspection report continued 1. The service improves the quality assurance processes being used to ensure that areas for improvement are identified and actioned by the management team. National Care Standards, Care at Home; Standards 4 - Management and Staffing. 2. The management team conclude their handling of complaints by informing the person who made the complaint of the outcome or resolution. National Care Standards, Care at Home; Standards 4 - Management and Staffing. Eildon Ltd - Support Services, page 27 of 30

28 Inspection report continued 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 service is carried out over a very wide geographical spread. We understand the provider covering this spread when the service remains so small in the Inverness area. However, as the service grows it will no longer be reasonable for it to continue as one service. We will discuss this issue with the provider at the next inspection. 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). Eildon Ltd - Support Services, page 28 of 30

29 Inspection report continued 5 Summary of grades Quality of Care and Support Adequate Statement 1 Statement Good 3 - Adequate Quality of Staffing Weak Statement 1 Statement 2 Statement Adequate 2 - Weak 3 - Adequate Quality of Management and Leadership Adequate Statement 1 Statement Adequate 3 - Adequate 6 Inspection and grading history Date Type Gradings 31 Oct 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 1 - Unsatisfactory 1 - Unsatisfactory 1 - Unsatisfactory All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Eildon Ltd - Support Services, page 29 of 30

30 Inspection report continued 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: Eildon Ltd - Support Services, page 30 of 30