CarePlus Scotland Ltd - Home care services Support Service Care at Home Riggs Farmhouse Freuchie Cupar KY15 7HY

Transcription

1 CarePlus Scotland Ltd - Home care services Support Service Care at Home Riggs Farmhouse Freuchie Cupar KY15 7HY Inspected by: Karen Mack Beth Martin Type of inspection: Announced (Short Notice) Inspection completed on: 20 February 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 25 5 Summary of grades 26 6 Inspection and grading history 26 Service provided by: CarePlus (Scotland) Ltd Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Karen Mack Telephone enquiries@careinspectorate.com CarePlus Scotland Ltd - Home care services, page 2 of 27

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 3 Adequate Quality of Staffing 2 Weak Quality of Management and Leadership 2 Weak What the service does well Clients and families told us that the service was reliable and consistent in the care delivered. They also told us they know who to contact if they have concerns and that the manager is approachable and responsive. Families commented on the positive attitudes of the care staff and that they were professional, friendly and well presented. What the service could do better Recommendations and Requirements have been made as part of the Inspection process and are addressed under the relevant Quality Themes and Statements. What the service has done since the last inspection This was the first Inspection for Careplus Scotland Ltd since registering with the Care Inspectorate in October Conclusion The manager and staff team at Careplus are focused and responsive to the needs of the clients. The clients we spoke to told us they were happy with the care and support provided. The manager welcomed the Inspection process as a means of identifying specific areas for improvement. There was evidence during the inspection process that the manager was working to address the recommendations and requirements made. CarePlus Scotland Ltd - Home care services, page 3 of 27

4 Who did this inspection Karen Mack Beth Martin CarePlus Scotland Ltd - Home care services, page 4 of 27

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was registered with the Care Inspectorate in October 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 Inspectorate. Careplus Scotland Ltd (Careplus) was registered in October 2011 and is a newly established independent provider of home care based outside Freuchie, Fife. The provider also has a nurse agency 'Medicare Scotland' but this service is not active at this time and is not considered as part of this inspection. Laura Reevie is a Registered Nurse and the Registered Manager and Provider of the service. The manager has identified 2 carers who have responsibility for work scheduling and allocation. The service currently has 11 clients around the North East Fife area. At the time of inspection there were 8 regular staff members. The aims of the service are to 'provide home care support to people who need nursing and care services at home. Through thorough and regular staff training and evaluation programme, we promote choice, advocacy, respect, independence and rights, so that people who need support can maintain their independence longer, and remain in their own homes as long as they are able'. Careplus provides services through the Social Work Department, private arrangement and Direct Payments. Based on the findings of this inspection this service has been awarded the following grades: CarePlus Scotland Ltd - Home care services, page 5 of 27

6 Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 2 - Weak 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. CarePlus Scotland Ltd - Home care services, page 6 of 27

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection This report is based on a short notice announced visit to the office base of Careplus Scotland Ltd on the 7th November 2012 by Beth Martin (Inspector). On that date Beth Martin met with staff and clients. Further office visits and client visits were undertaken by Karen Mack on 11th and 12th of February Inspection feedback was given to the Manager on 20th February. The inspection focused on 3 Quality Themes this year with 2 or 3 statements under each theme heading. During this Inspection we gathered evidence from various sources including: Relevant sections of policies/procedures/records/documents Care plans of people using the service Staff Records Training records Direct observation of staff practice Questionnaires that had been issued and returned to the care service from people using the service Questionnaires returned to the care Inspectorate All of the above information was taken into account during the inspection process and was reported on. For the purpose of this report, people using the care service will be referred to as 'clients', a term used within the service inspected. 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 CarePlus Scotland Ltd - Home care services, page 7 of 27

8 Inspection Focus Areas (IFAs) Inspection report continued 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 CarePlus Scotland Ltd - Home care services, page 8 of 27

9 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: No 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. 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. Careplus had not completed a self assessment prior to this Inspection. The provider was reminded of the importance of completing and submitting Self Assessments as required by the Care Inspectorate. Taking the views of people using the care service into account Clients' comments about the service were positive and are included in the report. This information was gathered from: * Completed questionnaires from people using the service. * People we spoke to during the inspection process. Taking carers' views into account Relatives/carers comments about the service were very positive and are included in the report. This information was gathered from: * Completed questionnaires from people using the service. * People we spoke to during the inspection process. CarePlus Scotland Ltd - Home care services, page 9 of 27

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 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 found the performance of the service was adequate in relation to this statement. We saw evidence that Careplus had some measures in place to invite comment from the clients and families using the service, on the quality of care and support they received. See Areas for Improvement. Some of the ways people could get involved in their care were as follows: An information pack is given to clients when they start the service. This included information on the service in general, the complaints procedure and details of how the service planned to monitor and maintain standards. This means that people using the service and people thinking about using the service know what the service has to offer. Clients and families who use the service can raise issues through informal discussion with staff and the manager. We saw that this happened through telephone contact with the service and the managers' visits to clients' homes. Clients that we met with told us that the manager visited them regularly: 'At the beginning she visited once or twice per week, it's now around monthly as things are settled' 'I've never had cause for complaint; we have had a lot of co-operation' CarePlus Scotland Ltd - Home care services, page 10 of 27

11 'The manager's been out a few times, she asks us about the service. We were all involved with the care plan, which was good - we all sat down together' 'The manager is always very particular about discussing everything with me before she implements it' The service had developed a questionnaire for clients to complete and had 5 returned at the time of the inspection. The questionnaire allowed for clients to rate the service and provide comments. The satisfaction rate was very high - between 80% -100%. It asked the clients for feedback in several areas including staff reliability and consistency, staff training and confidentiality. The service told us that they would further develop the questionnaire and use this information to help develop the way forward for the service. Areas for improvement The service informed us that, formal ways in which clients and families could participate in assessing and improving the quality of the care and support provided by the service, was in the early stages of development. At this time, a lot of feedback was through informal discussion. As an example, clients may wish to provide feedback on the information given to them when they start the service or on the qualities that they believe carers should have. See Recommendation 1 Whilst clients had been having their care needs reviewed, this was not being recorded formally. During the course of the Inspection the service was advised to develop a structured review process along with a review document. This would allow clients and relatives to have their care and support needs formally reviewed, recorded and monitored allowing the client and their relative more involvement. This would also allow the service a clear record of the clients' needs and changes in their care and support. We discussed this with the manager and informed them that there is a legal requirement to review an individual's care needs at least every 6 months. See Requirement 1 Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must ensure that regular reviews are held.reviews of clients personal plans must evidence how clients and their representatives have been consulted about how the service is meeting service users' health, welfare and safety needs. CarePlus Scotland Ltd - Home care services, page 11 of 27

12 This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations SSI 2011/210. Regulation 5 (2) (b) Personal Plans Timescale - Within 6 weeks of receipt of this report. Recommendations 1. It is recommended that the service develops a 'participation strategy' which sets out the ways that the service will involve clients and relatives in assessing and improving the quality of care and support, staffing and, management and leadership within the service. This should include methods to demonstrate how suggestions and concerns raised result in positive outcomes for clients. Reference is made to: National Care Standards: Care at Home. Standard 1 Informing and deciding CarePlus Scotland Ltd - Home care services, page 12 of 27

13 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found the performance of the service was adequate in relation to this statement. All clients had an assessment of their care needs prior to starting the service. The care plans we sampled considered how changes to that individual's health affected their daily activities, such as washing and dressing, eating and mobilising. The care plans detailed the visits required and the care to be offered during the visits. Clients and relatives told us that they were involved in the care planning. See Areas for improvement. There was evidence that the service was consistent and reliable in who was providing the care and also in the times of the visits. Clients and relatives told us that this was very important to them: 'There is continuity - that's why we chose Careplus, if they are running behind they always phone' 'Carers the night before tell me who to expect, their time keeping is good' 'There have been no missed visits, the service is good' Inspection report continued At this time, the staff scheduling is done by a carer who knows the clients and staff in a certain area. See Areas for Improvement. Comments from Clients and families about the quality of the service provided include: 'Our carer is very suitable. He has an understanding of my sons needs' 'Staff are friendly and respectful, they always tell me if something is out of the ordinary' 'I can see that there is a good relationship between the carers and District Nurses, that's good' The manager also told us of the close work undertaken with health professionals and the benefits for the clients. The manager gave examples of how this joint working has enabled clients with complex care needs to return home from hospital. One client told us how the service had supported her after a move into a new home and the benefits of the care and support from Careplus 'We have a different life since the service started'. CarePlus Scotland Ltd - Home care services, page 13 of 27

14 We saw that a client, who had used the service on a temporary period, had written to the service to thank them for the high level of support the service provided. Areas for improvement As the service develops and expands, the manager should consider the best method of informing clients about the timing of their visits and who will provide them. A written rota provided to clients on a weekly basis could be considered. Whilst care plans were developed to provide details on the clients care and support needs, we saw examples where they needed to be more detailed to inform staff of how to meet these needs. As an example, one plan stated 'requires all assistance' under the heading of personal hygiene, this did not inform carers of the way that the client would like to have their care met or of any areas they could manage independently. This means it can be more difficult for staff to support the clients to meet their care needs. During the Inspection process the manager had reviewed the care plans and we saw that the content was being updated. See Recommendation 1 In two care plans we looked at, there was no detailed information on how to support the clients with their manual handling needs. This means that the staff may not be aware of the level of support required and it can be difficult for staff to support the client safely. The manager told us that in most cases a manual handling assessment was provided by the Social Work Department, when this is not the case the service must ensure that a specific plan is in place. See Recommendation 2 and Requirement 3 under statement 3.2. Staff told us that they would like to be involved in developing the care plans. They suggested another way of recording the daily contact with the clients. The manager is aware of this and has discussed care planning with the staff. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service should ensure that they provide a care plan that meets the care needs and personal preferences of the clients. This should: Detail needs and preferences and set out how they will be met in a way that the client finds acceptable. CarePlus Scotland Ltd - Home care services, page 14 of 27

15 Allow for staff to detail the care and support provided for the client National care Standards - Care at Home - Standard 3 - Your personal plan 2. The service should ensure that they provide a care plan that provides clear and accurate information and guidance for staff on how to meet the identified needs and risks - this must include safe manual handling. National care Standards - Care at Home - Standard 3 - Your personal plan CarePlus Scotland Ltd - Home care services, page 15 of 27

16 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 evidence for the grade awarded for this statement is included in Theme 1 Statement 1 Service Strengths Areas for improvement Areas for Improvement for this Statement are included in Theme 1 Statement 1 - Areas for Improvement Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 CarePlus Scotland Ltd - Home care services, page 16 of 27

17 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 found the performance of the service was weak in relation to this statement. We saw that the manager was keen to employ staff with previous care experience and a strong value base. At this time, posts were not advertised externally and staff were recruited through interviews after personal recommendations were made. See Areas for Improvement. The manager and staff told us that staff work in teams of two, which allowed for more experienced staff to support the new starts in the service. This meant that the clients were introduced to the new staff by carers that were familiar to them. This also meant that new starts were supported by experienced carers. Induction training was planned on an individual basis for each new staff member and the service planned to further develop personal development folders for staff. See Areas for Improvement. Areas for improvement Inspection report continued The service must be able to evidence that it has followed a robust interview process. The manager should consider being assisted in the interview procedure. This would enable an accurate recording of the interview process. We sampled 8 staff files. There was evidence that the service did not have two references for all staff. In exceptional circumstances, when a second reference can not be obtained, we recommend that the service keeps written records of steps taken to seek references and evidence of the assessment made to appoint the staff member. See Requirement 1 In the files sampled, we saw evidence that not all staff had a current PVG check. The provider has a responsibility to register with Disclosure Scotland as a counter signatory. This would ensure more effective communication between Disclosure Scotland, which would enable safer recruitment. The provider must develop an effective system of ensuring each employee has undergone a satisfactory Protection of Vulnerable Groups (PVG) check. See Requirement 1 We discussed Safer Recruitment practice with the manager during the assessment process and advised that a Recruitment Policy is developed to support the recruitment procedure. See Requirement 1 CarePlus Scotland Ltd - Home care services, page 17 of 27

18 From looking at staff files including application forms, we saw that there were occasions when the service had no evidence to support staffs claims of training that they had recently undertaken. As an example, one staff member stated that she had completed manual handling training 6 months before starting work with Careplus. There was no evidence to support this and no evidence that the carer had attended manual handling training since starting with the service. See Requirement 1 Staff we met with could not clearly recall the theoretical and practical training included at Induction. There was no clear documented evidence in staffs' files or on a training database. The service must be able to evidence that staff providing care to clients have the appropriate skills and training. See Requirement 1 under Statement 3.3. Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider must demonstrate that it has followed best practice guidance in relation to safe recruitment practices and must not employ any person in the provision of a care service unless that person is fit to be so employed. This must include: i) Developing and following the organisation's recruitment procedure and risk assessment system in relation to safer recruitment. ii) Developing an effective system of ensuring each employee has undergone a satisfactory PVG check. This would include the provider being registered as a Counter signatory with Disclosure Scotland. iii) Ensuring that the provider can evidence that it has evaluated the skills, knowledge and experience of applicants as part of safer recruitment practice. The provider must be able to demonstrate staff have undertaken appropriate training for the job they are to do. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations SSI 2011/210. Regulation 4 (1) Welfare of Users, Regulation 9 (1) Fitness of Employees Regulation 15 (a) (b) Staffing Scottish Executive 2007 'Safer Recruitment through Better Recruitment' CarePlus Scotland Ltd - Home care services, page 18 of 27

19 Timescale - On receipt of this report CarePlus Scotland Ltd - Home care services, page 19 of 27

20 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 performance of the service was adequate in relation to this statement. The manager is committed to offering staff the opportunity to obtain a Scottish Vocational Qualification (SVQ) which will enable staff to apply for registration with the Scottish Social Services Council (SSSC). At the time of Inspection, all staff were undertaking a SVQ. Clients and families participating in this inspection were happy with the staff team and support provided. They told us that they were treated with respect by staff and believed staff had the necessary skills to provide their care and support. Relatives commented positively on the appearance and attitude of the care staff. Feedback from clients and families included: 'The staff are always neat in their uniform and wash their hands before and after care' 'Everything staff can do - they do to make life better' 'They are lovely' 'Carers are perfect' Staff told us that they were very well supported by their manager who responded to any concerns they had, or concerns about clients. They spoke to their manager frequently but told us that at this stage supervision and staff meetings were informal. See Areas for Improvement. Areas for improvement Inspection report continued Supervision, direct observation of practice and team meetings were not yet carried out routinely in the service but there was evidence that this was happening informally. As a further support to staff, the service should establish a system of regular, formal supervision, staff meetings and appraisals. See Recommendation 1 and Requirement under statement 4.4. CarePlus Scotland Ltd - Home care services, page 20 of 27

21 The manager confirmed during discussion that consideration is now being given to the ongoing training needs of the staff as the organisation develops. The service must be confident and evidence that at all times the number of staff who are trained and who have the necessary skills will be sufficient to meet clients support and care needs. See Requirement 1. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must evidence that: i) During the Induction process it has trained new start staff in its policies and procedures and expected practice for the role they are to carry out and evaluated their capacity to carry out the work. The provider must be able to evidence how they have met any further training needs identified as a result of this evaluation. ii) The service must evidence a staff development strategy and an effective yearly training plan for its entire staff. These should meet the changing needs of the client group and the staff team. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations SSI 2011/210. Regulation 4(1) Welfare of Users Timescale - On receipt of this report Recommendations 1. The provider is recommended to make use of management practices, such as supervision and appraisal and regular staff meetings to support, develop and guide each staff member in their practice and ensure that each staff member was meeting expected standards of practice. National Care Standards - Care at Home - Standard 4 Management and Staffing. CarePlus Scotland Ltd - Home care services, page 21 of 27

22 Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths The evidence for the grade awarded for this statement is included in Theme 1 Statement 1 Service Strengths Areas for improvement The Areas for Improvement for this statement is included in Theme 1 Statement 1 Areas for Improvement Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 CarePlus Scotland Ltd - Home care services, page 22 of 27

23 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 found the performance of the service was weak in relation to this statement. We saw that the manager welcomed feedback from both staff and clients and was responsive to concerns raised. Clients and staff gave examples of the manager meeting with them and responding quickly to concerns: the manager is available 24 hours - she works along with us a lot' we get really good support' the manager checks the care plans and we know how to contact her' The manager has plans to be involved with 'Community Catalysts' Quality Mark. The organisation works with local authorities, Primary Care Trust's and other voluntary and private sector organisations, to stimulate and support the development of high quality sustainable local enterprises. This organisation will measure and support Careplus in the development of the services Quality Assurance systems. The manager informed us of her plans, along with staff, to attend 'personal outcomes' focused training within the next month. The manager hopes this training and information on personal outcomes will enable the service to evaluate, plan and improve services. Formal quality assurance systems were in the stages of development at the time of inspection and this is reflected in the Grade awarded. See Areas for Improvement. Areas for improvement The service had no formal quality assurance systems to monitor the standards of care and support provided to clients. There was also no formal way to evidence the ways that the service monitors the quality of the care and support provided by care staff. This would allow the service to support, develop and guide each staff member in their practice and ensure that each staff member was meeting expected standards of practice. Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 0 Inspection report continued CarePlus Scotland Ltd - Home care services, page 23 of 27

24 Requirements 1. The provider must have effective quality assurance systems which evidence that: i) The service makes proper provision for the health, wellbeing and safety of clients. ii) The service monitors the quality of the care and support provided by care staff. To achieve this, the provider must develop and continually review quality assurance systems to identify where improvements are needed, to ensure the provider can accurately assess the quality of the service provided. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations SSI 2011/210. Regulation 4(1) Welfare of Users Timescale - Within 6 weeks of receipt of this report. Inspection report continued CarePlus Scotland Ltd - Home care services, page 24 of 27

25 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 Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). CarePlus Scotland Ltd - Home care services, page 25 of 27

26 5 Summary of grades Quality of Care and Support Adequate Statement 1 Statement Adequate 3 - Adequate Quality of Staffing Weak Statement 1 Statement 2 Statement Adequate 2 - Weak 3 - Adequate Quality of Management and Leadership Weak Statement 1 Statement Adequate 2 - Weak 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. CarePlus Scotland Ltd - Home care services, page 26 of 27

27 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: CarePlus Scotland Ltd - Home care services, page 27 of 27