Care service inspection report

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1 Care service inspection report Full inspection Home Care Services - Mainstream Team Housing Support Service Southbank House Southbank Business Park Kirkintilloch Glasgow Inspection completed on 29 April 2016

2 Service provided by: East Dunbartonshire Council Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY 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 6 Quality of staffing 5 Quality of management and leadership Excellent Very Good N/A What the service does well The service has very good methods of involving the people who use the service and supports them to make choices. The care teams encourage and support people who use the service to be as independent as possible, whilst providing opportunities that contribute to meeting their health and wellbeing needs. What the service could do better The service should involve people who use the service more in the ongoing development of the staff team. The service could include some observations of competency in the supervision processes of staff. What the service has done since the last inspection Staff have continued to develop strategies to support the involvement of people in the service and improve the support that they receive, which continues to be well organised and planned efficiently. page 3 of 27

4 Conclusion Inspection report The service strives to have a consistent staff team which all service users and families value. The service provided an excellent level of care and support and the staff team was skilled and committed. page 4 of 27

5 1 About the service we inspected Inspection report Home Care Services - Mainstream Team is an integrated care at home and housing support service. The service is run by East Dunbartonshire Council and is based in the Kirkintilloch area. The service is provided to people living in East Dunbartonshire including older people, people with physical and sensory impairment, people with learning disabilities and people experiencing mental health problems. At the time of this inspection, some people who were using the service were also receiving care and support from other providers as part of contract arrangements with East Dunbartonshire Council and other providers. Home Care Services - Mainstream Team provides long-term support and this includes personal care, emotional support, social support and housing support. The overall aims of the service, as stated in the aims and objectives (March 2013) included: - to improve the lives of customers and the people who care for them - to ensure the welfare and safety of vulnerable people in their own home - to provide a quality local authority home care service to vulnerable people in their own home. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April From 1 April 2016, the way in which we carry out an inspection has changed. We choose which quality themes and statements are inspected for better performing services, to be more proportionate and targeted in our work. page 5 of 27

6 Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 6 - Excellent Quality of staffing - Grade 5 - Very Good Quality of management and leadership - N/A 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. 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 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 following an unannounced inspection which was carried out by one inspector. The inspection took place on Monday 25 April 2016 between 9am and 4pm, at the service's headquarters; it continued on Tuesday 26 and Wednesday 27 April 2016 from 9am until 4pm. We had contact with people using the service on Thursday 28 April We returned to the service's headquarters on Friday 29 April 2016 between 9am and 11.30am. We gave feedback to the management team on Friday 29 April As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. We sent 80 care standards questionnaires to the manager to distribute to people who used the service. Thirty eight people sent us completed questionnaires. We also asked the manager to give out 40 questionnaires to staff and we received 14 completed questionnaires. During this inspection process, we gathered evidence from various sources including the following: We spoke with: - people who used the service and their relatives - the registered manager - the service delivery improvement officer - home care organisers - the review officer - home care support workers. page 7 of 27

8 We looked at: - information about the service - minutes of meetings - questionnaires - policies and procedures - care plans - support staff personnel information. 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 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: 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 received a fully completed self assessment document from the provider. 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 they thought the service did well, some areas for development and any changes they had planned. Taking the views of people using the care service into account We received an abundance of comments from people using the service. These included: "The staff are excellent, very supportive and friendly." "I feel this service has helped me to stay in my own house. I get lots of support from the carers and they are very friendly and take time to talk to me." "All carers have been very helpful and have been treating us with utmost respect and made us feel very good in ourselves. We cannot fault them in any way. Both of us have carers attending to us at this time, as we have both been in hospital at different times. I wish to thank them very much for their attention and help." page 9 of 27

10 "I find all the staff are very friendly, helpful and courteous. They are always very helpful and cheerful." "My needs are very minimal. At all times assistants have been prompt, efficient and courteous - very satisfactory." "All the staff have been very helpful and supportive and I look forward to their visits." "Carers try to accommodate time of call when necessary, which helps greatly. Carers are always calm and efficient, even if the patient is upset or unsure. They take time to assure that all is well, including other people in the home." "The level of service provided by the individual carers is great and I am happy with this. The times of visits and irregularity of them is not meeting my needs." "I am happy with the care service, but due to the new rotas being implemented I find that I have no continuity of staff. Therefore this has impacted on my support, as lots of different staff need to be continually informed of my daily needs." "I am visited four times a day by the carers from East Dunbartonshire Council and I am very happy with the care and attention they give me. When I was at a clinic a nurse passed a remark about how clean and well-presented I was and asked who was looking after me. I was able to tell her that it was the carers from East Dunbartonshire Council and that I would give them 10 out of 10." "All the carers coming here have been extremely efficient, caring and helpful to client and family. Sometimes forget carers' names but always pleased with their chat and personal care." page 10 of 27

11 Taking carers' views into account We received comments from carers, which included: "The service is provided for my 88-year-old relative who lives with me. We can't praise all the staff highly enough - without exception the care received has been excellent. We cannot fault any aspect of the service that has been provided. Every single person that comes has been lovely, caring and friendly." "The service has been and is fantastic for my elderly relative. Without this she could not live independently at home. The service never lets her down. All staff are kind and helpful." "The organiser has to be commended for the support/service provided to us as a family regarding my relative's care plan. The carers who come in provide exceptional care and give time and respect to my father. They are trustworthy and obliging. My relative feels very comfortable in his own home with the carers who attend to him. As a family we would like it to be noted that the organiser has been extremely helpful and the carers are a credit and asset to East Dunbartonshire!" "I have had the carers in for just over a year now and I am delighted with every one of them - they are pleasant and very helpful in every way. When my relative was diagnosed with dementia and before the carers started coming I was very stressed out, but now that we are in a routine with constant assistance, I can relax much more. I could simply not do without their wonderful support!" "My relative's carers have been excellent and are always cheerful." "All of the carers communicate well with relative, joke with him and treat him with respect; do all they can to meet his needs. There are occasional 'blips' at times, but people are human and immediately correct pleasantly when I mention it. Altogether I am very satisfied since my relative changed to the ED complex needs team." page 11 of 27

12 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: 6 - Excellent Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths We found that the service performance was excellent for this statement. The service was delivering high quality care resulting in excellent outcomes for people using the service. At this inspection, we focused on the support being provided by the reablement and complex care teams in Kirkintilloch and the surrounding area. We looked at personal plans, information on staff training and spoke with people using the service and with staff. People using the service had excellent support plans that identified a range of care needs. We were able to see that these plans reflected individual needs accurately and that staff implemented planned care skilfully. People told us that the staff were excellent or very good. We found that the plans were the subject of a regular audit and noted any changes that had occurred. This meant that people had accurate support plans which reflected and continued to meet their current needs. page 12 of 27

13 We observed that the outcomes for people had a focus on reablement and measured progress towards maximising independence and wellbeing. These outcomes included support with washing and dressing; maintaining safety and comfort; supporting mobility; supporting eating and drinking and continence management. We saw that support plans reflected actions required by staff to enable positive outcomes for people using the service. We noted an abundance of favourable comments from people using the service in respect of the support they received to meet their health and wellbeing needs. These included: "The team of carers are so dedicated to looking after their patients. Full praise to the organiser and all of the hard-working, kind and really nice-to-know people who are doing such a hard job and making it all look so easy. Great work by all." "A team of wonderfully hard-working people have shown me the best care and attention to nurture me back to reasonable mobility. It has been a revelation seeing the amount of work the carers have to cope with and a really memorable experience for me. I will not forget meeting all 'the guys' and what they have done for me." "The quality is excellent. A great comfort to my relative and a breath of fresh air for me, they kick-start my day. Look forward to their visit every morning." "We like the fact that it is more or less the same carers who come, so please keep this up." "Very satisfied %." "I thought the level of support I received was excellent. I have no complaints at all." "I thought the service was excellent. The carers were very nice and willing to do their best to help my relative in her final illness." page 13 of 27

14 "Staff were always very nice and respected me. Excellent service." "The carers were perfect." "The service surpassed our expectations. All the care workers were very helpful and will be missed." "The service made a difficult time somewhat easier due to the friendly, efficient support afforded to us. Nothing seemed to be too much bother. It would be invidious of me to single out any particular carer as each gave his or her best." "Home care service excellent - first class." "The care provided has been excellent." "Excellent service - the team has been fantastic." "I cannot thank the home care reablement team enough for all the help and assistance given to me for the period after my discharge from hospital. The service was excellent and very appreciated." An up-to-date copy of the support plan was kept in the homes of people using the service. Daily log sheets were included in the support plans and this enabled people using the service, and their carers, to ensure that plans were accurate and continued to meet people's needs. The service was excellent at making sure that people got appropriate care and medical attention when they needed it. We found very good examples of recording how service users' healthcare needs were being monitored. This included clear guidance to staff on any actions which needed to be taken following medical attention. We saw that staff included a variety of approaches to support people using the service to have healthy lifestyles. We found evidence that the service promoted healthy eating and exercise, where appropriate. page 14 of 27

15 We found that some people using the service were involved in an e-frailty research project with the service and Edinburgh Napier University. The project used a series of tests and figures, collated by wristbands and heart rate monitors worn by those involved, to establish patterns of behaviour and possible triggers for falls. The people involved in the project were extremely positive about its benefits. These included being more knowledgeable and aware about their activity, fitness and heart rate, and more informed about their general wellbeing. We noted evidence of excellent collaboration between district nurses and the service to support people who had been identified, by nurses, as at risk of developing a pressure ulcer. District nurses had made pressure ulcer prevention referrals to the home care team that identified the support to be provided at every visit. This included care in the areas of skin, surface, incontinence and nutrition. Feedback from district nurses and people using the service acknowledged that carers had assisted with all aspects of pressure prevention and had provided valuable support. We found that the service had reviewed its monitoring form that was used to monitor changes in people's circumstances, assess risk, suggest solutions and record actions. Through a period of consultation with organisers and carers, the form was amended to ensure that it provided information to help prioritise when people's needs were to be reviewed or to monitor a specific area of need. This meant that carers were provided with consistent, accurate and up-to-date information to assist and care for the people receiving support. We looked at the staff training plan and training records and saw evidence of training received in areas such as adult support and protection. The training programmes, both refresher and mandatory, supported staff to provide high quality care. We found well-trained, skilled and knowledgeable staff who were able to respond to health issues that affected people using the service. page 15 of 27

16 Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. The service should ensure that it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 16 of 27

17 Statement 6 People who use, or would like to use the service, and those who are ceasing the service, are fully informed as to what the service provides. Service Strengths We found that the service performed at an excellent level in this area. We came to this decision after we spoke with the management team, home care organisers, support staff and people using the service. We also examined information received by people who used, or would like to use, the service as to what the service provides. We saw that each person using the service received a Home Care Services pack. The pack contained delivery information, such as agreement plans, home care leaflets describing all aspects of the service and additional information, such as details around power of attorney. The information contained all expected materials around the service delivery and complaints processes. This gave people using the service the opportunity to be listened to and empowered to make decisions about the service. We examined the results of a consultation process with people using the service on the Care Inspectorate's self assessment document. In particular, the question which related to this statement: "Is there a signed service level agreement and information leaflets about the service in your care plan folder?" We found that every respondent answered yes to this question. Further questions including "Is the service what you expected?" and "Do you know how and to whom you would make a complaint?" received answers of yes. We noted that respondents had graded the service as either excellent or very good in relation to this statement. This meant that people using the service could evaluate the information received to ensure that it continued to meet people's needs. page 17 of 27

18 People that we met and spoke with told us that they had received very good information on what to expect from the service. We reviewed the service's terms and conditions incorporated into the written agreement and found there was appropriate information in relation to ending the service. We found that anyone receiving support from Home Care Services, or when about to leave the service, would be fully informed as to what the service provided. We concluded that the information was in keeping with, and surpassed that detailed by, the National Care Standards around informing and deciding. Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. The service should ensure that it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 18 of 27

19 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good 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 that the service performance was very good for this statement. We concluded this after we examined personnel records, had discussions with people using the service, the management team and staff. We also looked at records associated with the recruitment of staff. Each of the files sampled included two references, Protecting Vulnerable Groups (PVG) checks, record of skills and experience and contract of employment. We saw that there was a robust and structured induction programme in place for new staff before they commenced work. Focus was on all aspects of good practice, values, relevant legislation and codes of practice. The induction process included new staff shadowing experienced colleagues prior to providing support to people using the service. Supervision of new staff was undertaken very regularly. We found that all new staff had their own induction programme documentation, which was signed off as being completed when proficiency in a subject area had been attained. These were completed to a very good standard and encouraged staff to reflect on practices to help identify ongoing development needs. page 19 of 27

20 Areas for improvement We discussed that the supervision process for new staff could be a mix of observation of practice, question and answer and discussion with their supervisor. The management team advised that they will address this area for development. We spoke with the management team about how people using the service could share their experiences of receiving support during the selection and induction processes for new staff. The benefits for people using the service would be that they contributed to the development of the people delivering the support they received. The management team had identified this as an area for development and had plans for this to occur at the earliest opportunity. We will monitor progress on these suggestions for development at the next inspection. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 20 of 27

21 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths We found that the service performance was very good for this statement. We concluded this after we examined personnel records and had discussions with people using the service. At this inspection, we met with the manager, the service delivery improvement officer, organisers, a review officer and support staff. Staff said that they received very good support to carry out their roles and responsibilities and were very positive and complimentary about the service. Most added that they enjoyed working for the organisation. We found that the service maintained a range of very good methods to support staff. These included: - regular one-to-one supervision - staff appraisal system - regular team meetings - a range of training opportunities - analysis and evaluation of staff training. People using the service, and their relatives, gave positive descriptions of their contact with staff. We saw staff interacting with service users and observed that they promoted choice, dignity and respect and demonstrated effective communication. page 21 of 27

22 When asked if they were aware of the training staff received, some people using the service replied: "I knew they were trained, it shows." "I am aware that they are trained well." "I am aware they are all well-trained, that's obvious." Inspection report We looked at staff personnel files and saw that these, and other office-based systems, were well organised to support staff. We saw evidence that team meetings occurred for the teams that provided support across the East Dunbartonshire Council service area. Members of the teams were able to raise concerns or issues and have these addressed. Action points were identified and reported upon at the next meeting. We saw that the matters discussed at meetings varied and appeared to be very specific to the individual area and service users. Staff discussed the support that they provided in terms of outcomes achieved for the people using the service. Staff described a range of positive outcomes that service users had identified and had been supported to achieve. We saw very good evidence that staff responded effectively to comments from the person receiving support. There was evidence that staff were able to participate and shape the service. Areas for improvement We spoke with the management team about the active involvement of people using the service in the training and development of staff. The management team had plans to develop this area. We discussed how supervision of staff could include some observations of competency, within East Dunbartonshire Council's procedure for the supervision of staff. This would enable staff to be observed completing real practice and involve people using the service in the supervision process. The benefits for people using the service would be that they contributed to the development of the people delivering the support they received. page 22 of 27

23 We spoke with the management team and discussed where a staff meeting minute relates to a specific issue that is identified within the National Care Standards, then the specific standard should be referenced within the staff meeting minute. The manager confirmed she will develop the service's approach to this area for improvement. We will monitor these areas for development at the next inspection. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 23 of 27

24 Quality Theme 4: Quality of Management and Leadership Quality theme not assessed 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. page 24 of 27

25 7 Enforcements We have taken no enforcement action against this care service since the last inspection. Inspection report 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 24 Apr 2015 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 5 - Very Good 30 Apr 2014 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 29 Apr 2013 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 4 - Good Not Assessed 4 - Good 2 - Weak 31 May 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 5 - Very Good 13 Dec 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good page 25 of 27

26 Management and Leadership Not Assessed 16 Feb 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 25 Aug 2008 Announced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 3 - Adequate page 26 of 27

27 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 27 of 27

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