Care service inspection report

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1 Care service inspection report Full inspection Loreburn Housing Support Service Housing Support Service 27 Moffat Road Dumfries Inspection completed on 31 May 2016

2 Service provided by: Loreburn Housing Association Ltd 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 28

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 5 Very Good Quality of staffing N/A Quality of management and leadership 5 Very Good What the service does well Loreburn Housing Support Service works well with people to identify their support needs. The young people who use the service are supported to secure and sustain their own tenancy. Those living within one of the sheltered developments are supported to maintain an independent tenancy. Staff members build good, supportive relationships with people who use the service. What the service could do better The provider must review the service they deliver to ensure they comply with their conditions of registration. The provider and manager are required to review and update customers Service Agreements. All staff must be aware of the Care Inspectorate Notification Guidance and submit information to the Care Inspectorate as required. Since the last inspection some staff members have moved into new positions. The manager must ensure that staff attend training required to enable them to have the necessary skills to carry out their new role. page 3 of 28

4 What the service has done since the last inspection Inspection report Since the last inspection the service has had a management and staffing restructure. The service has also undergone a service review, to ensure it is delivering the service in the best way possible to meet the needs of those supported. Loreburn Housing Support Service has increased its partnership working with other organisations which includes working with Let's Get Sporty. Conclusion Loreburn Housing Support Service was highly thought of by the customers who used the service. The service had undergone a number of changes since the last inspection and continues to review the services. Throughout this time we felt it delivered a high quality of support to all of its customers by a skilled and caring staff team. page 4 of 28

5 1 About the service we inspected Inspection report 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 Loreburn Housing Association is a Registered Social Landlord and subject to inspection by The Scottish Housing Regulator. The registered service includes the sheltered development service and the young people's supported accommodation service. There are six sheltered development complexes for older people and three supported accommodation projects for young people across Dumfries & Galloway. An outreach service for young people and families operates within parts of the region. The aims of the service for young people are to provide housing support to vulnerable young people and families, empowering them to make decisions and manage their lives, enabling them to move into and sustain their own independent accommodation. The aims of the sheltered housing service are to provide a sheltered development service and emergency alarm system, ensure every customer has a support plan tailored to their needs and enable all customers to maintain an independent tenancy. Since the last inspection the senior management team at Loreburn Housing Association had changed. The Loreburn Housing Support Service had a new Supported Housing Manager in place. The service had restructured and both the Sheltered Development Service and Young Peoples Service were undergoing service reviews, these were being conducted by an external company. More information can be found about Loreburn Housing Association on their website Recommendations page 5 of 28

6 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 5 - Very Good Quality of staffing - N/A Quality of management and leadership - Grade 5 - Very Good Inspection report 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 28

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection. The inspection was carried out by one Care Inspectorate Inspector. The inspection took place on Monday 16 May 2016 between 9.30am and 5.00pm, Tuesday 17 May 2016 between 10am and 5pm and 7pm and 8pm. We attended a community event on the afternoon of Monday 23 May. On Friday 27 May we met with Loreburn Housing Association Chief Executive, Supported Housing Manager and Care Inspectorate Registration Team. We provided feedback to the Chief Executive and Supported Housing Manager on Tuesday 31 May As part of the inspection, we took account of the completed self-assessment form that we asked the provider to complete and submit to us. We sent fifty care standards questionnaires to the manager to distribute to people who used the service. Thirty five customers sent us completed questionnaires. We also asked the manager to give out thirty questionnaires to staff and we received seventeen completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: - Chief Executive - Supported housing manager - Supported housing team leader (older people) - Supported housing team leader (young people) - Two supported housing engagement officers page 7 of 28

8 - Customer engagement manager - Housing management officer - Three supported housing advisors (older people) - Four supported housing advisors (young people) - Concierge - HR assistant - Seventeen people living within sheltered developments - Four people living within supported accommodation for young people. Inspection report We looked at: - The service's policies and procedures relevant to the quality statements examined at this inspection. - Registration and insurance certificates - Individual support plans including outcome stars of people who use the service. - Information provided to customers through newsletters and notice boards. - Complaints system and records. - Accident and incident system and records. - Staff files and training records. - Employee handbook. - Minutes of staff meetings - Loreburn housing support service business plan Annual plan - supported housing team 2016/17. - Quality assurance systems, reports and audits. The service used the term 'customer' rather than service user to refer to the people who were supported by Loreburn Housing Support Service. We will use this throughout the report. We visited JM Barrie House, Gifforn House and Nithsdale Mills sheltered developments. We met with customers within small group settings within Gifforn House and Nithsdale Mills. We met with young people individually at Hope Place and Sir John Richardson Place in Dumfries. During this inspection we also observed interactions between staff and customers within their accommodation and also at a community event held at page 8 of 28

9 Sir John Richardson Place. This enabled us to see how staff engaged with and supported customers, depending on the level of support they required. 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 9 of 28

10 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. We did not receive a self-assessment document from the provider as requested. We contacted the provider and they later submitted a fully completed self assessment. We were satisfied with the way the provider had completed this and with the relevant information included for each heading that we grade services under. Taking the views of people using the care service into account Customers we spoke with and who returned questionnaires told us: - 'There is nothing I could fault, couldn't be happier services are wonderful'. - 'Staff are always willing to help, service is reliable and flexible'. - 'Staff are always there if you need a chat, always asking how you are'. - 'I cannot praise highly enough all staff I have been involved with'. - 'I have always been treated with the utmost kindness, respect and understanding'. - 'I feel very secure and safe'. - 'Communication could be improved, don't always know what is happening'. - 'The service has been invaluable, particularly the emotional support which has been consistent'. - 'The support helps my health and wellbeing'. - 'Used to have live in wardens, things have changed now. Not always someone here and at times it feels like no one is here'. page 10 of 28

11 - 'Staff support me when I need help, I am very happy living here and very content. I am very grateful for all that staff do for me'. - 'Communal areas are hopeless; we used to have great nights here'. - 'Staff not only qualified but very passionate about their work'. Taking carers' views into account During this inspection we did not speak with any family members. page 11 of 28

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: 5 - Very Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths At this inspection, we found that the performance of the service was very good for this statement. We concluded this after we spoke with customers and staff, observed practice and examined a range of relevant documentation. We looked at a sample of the providers operational guidance and noted that there were detailed policies and procedures in relation to: - Outcome star referral procedure - Risk assessment guidance - Adult support and protection The provider had in place an Adult Support and Protection Policy and Procedure, this included guidance for staff. Staff were further supported in this area by attending local multi agency Adult Support and Protection training delivered by the Local Authority. In discussion with staff we felt they were aware of their responsibilities in relation to adult protection. The service used the 'Outcome Star' tool, during the inspection we looked at a sample of support plans and completed outcome stars. We found referral information and initial meetings were used to assess customers health and wellbeing needs. An outcome star and risk assessments were completed and an page 12 of 28

13 action plan developed from these. This detailed what was required to meet the customers needs. To monitor how well the support was helping the customer we saw that reviews took place which involved the completion of a further outcome star. We found most of the outcome star reviews to follow the timescale set out in the guidance or more frequent if required. The service supported and enabled customers to access other services to ensure all their health needs were being met. This included for example their GP, district nurse, mental health support and addiction services. We found that this support had led to improved quality of life for people, as recorded within their outcome star. Morning phone calls were made to customers within the sheltered developments; this was also a way of assessing health and wellbeing on a daily basis. Care Providers supported some of the customers within the sheltered developments. The staff would contact the care provider or make health care appointments on the customers behalf if there were concerned about a customers health or wellbeing. During the inspection we observed communication between care providers visiting customers, family members and sheltered development staff. Customers we spoke with said: - 'I have yearly conversations about my support and complete my outcome star'. - 'I have been happy living here as I can hop on the bus into town and maintain my independence'. Speaking with staff we felt they were aware of the needs of the people being supported. We thought the service worked well to support people to achieve their personal outcomes which were reflected in their agreed action plans. Customers who returned care standards questionnaires told us, they agreed or strongly agreed that overall, I am very happy with the quality of care and support this service gives me. Areas for improvement As mentioned above, an Adult Support and Protection Policy was in place, we found that the guidance contained names and contact details which were page 13 of 28

14 incorrect and out of date; this should be reviewed and updated. We also suggested that all staff members attend a refresher Adult Support and Protection training session. The provider should also ensure that staff working within the young people's service and with children should complete Child Protection Training. During the inspection we found that some of the outcome star reviews within the sheltered developments were overdue. Staff members should have adequate protected time to meet with customers to complete reviews, identify outcomes to be met and develop action plans to meet these. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 14 of 28

15 Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths At this inspection, we found that the performance of the service was very good for this statement. We concluded this after we spoke with customers and staff, observed practice and examined a range of relevant documentation. Loreburn Housing Association had a range of policies and procedures in place which underpinned the values of the organisation. These included whistle blowing, safe recruitment, equality and confidentiality. Each customer had a support plan containing an outcome star that was reviewed as per guidelines, or earlier if required. We reviewed a sample of support plans from both the younger people's and older people's service and saw that customers and relevant others, if appropriate, were involved in the development of these. We found the information recorded within the plans included information on customer's life style, beliefs and faith. Outcome stars provided the main body of information about support that people needed. Action plans were developed and reviewed with the person. We could see the support provided and the impact this had on improving outcomes for them. Independent Advocacy was available and customers who needed or requested this service were supported to access it. A key worker system was in place for the young people's service, staff and customers were matched depending on needs and the staff skills. We could see that people were supported to make choices; this included receiving support at a time which suited them. During the inspection we were told about developments at Hope place and within an adjoining flat. A group of young people had been fully involved in this project and we felt this allowed them to have a say in what type of environment would meet the needs of young people. page 15 of 28

16 We visited customers within their own homes and within communal areas. We observed relationships which were relaxed and friendly and customers appeared at ease communicating with staff. From looking at support plans, records of contacts and speaking with people who had been supported, we felt that the service was achieving the outcomes expected. Areas for improvement During the inspection some customers told us that the sheltered development had changed over the years and they felt that there was a lack of staff and activities on offer now. They also felt that suggestions had been made but not followed through. They were also unclear about the staff role and still referred to staff as wardens. One customer told us: - 'Staff are not here and we don't know when they will be here'. We discussed with staff the need to keep customers fully informed of changes within the service and the impact this may have on their support. The service had introduced supported housing engagement officers; we look forward to seeing how these positions develop and the difference they will make for people living within the sheltered developments. As mentioned above, customers were given a choice of when they could receive support. We found this to be limited to within Monday to Friday between set times. We also found that this was most likely to be the time when young people were at college, or at work. At the feedback session we discussed the lack of support within the evenings and at weekends when people could be more vulnerable. We visited the transition flat within JM Barrie House; the aims of this flat and the outcomes it provided for customers were seen to be positive. However, we raised concern about the use of one of the rooms within the flat whilst the flat is occupied and also the steep stairs and use of a stair gate. The provider should make alternative space available for visiting services in order to maintain customers privacy whilst they are living in the transition flat. The provider should reassess the space available and if they are to continue to use upstairs page 16 of 28

17 and downstairs as separate facilities a more secure and permanent structure should be put in place as an alternative to the stair gate. We found three of the Young Peoples services to operate Close Circuit Television (CCTV) on the outside of the buildings and within the corridor and kitchen. We discussed the reasons for this with the provider and requested they develop a policy and procedure to ensure usage was justified. For example, the protection or safety of individuals, and is proportionate: the minimum necessary intrusion into the privacy of individuals. Also considering consultation with customers regarding CCTV, location, purpose and access to footage, how long it will be kept, security of storage and disposal. We referred the provider to CCTV Strategy for Scotland and Mental Welfare Commission "Rights, Risks and Limits to Freedom" (see Recommendation 1). From the support plans that we looked at we found Service User Agreements required to be reviewed and information required updated (see Recommendation 2). Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations - 2 Inspection report 1. The provider should develop and implement a policy and procedure for the usage of Close Circuit Television (CCTV) usage within the service. National Care Standards - Housing Support Service - Standard 2 - Your legal right, Standard 7 - Exercising your rights. 2. The Supported Housing Manager should ensure that customers receive a written agreement which clearly defines how the service will meet their needs. The supported housing manager should ensure these are discussed and are routinely reviewed with customers to ensure they are fully involved in this process. page 17 of 28

18 National Care Standards - Housing Support Service - Standard 2 - Your legal rights. page 18 of 28

19 Quality Theme 3: Quality of Staffing Quality theme not assessed page 19 of 28

20 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service Strengths At this inspection, we found that the performance of the service was very good for this statement. We concluded this after we spoke with customers and staff, observed practice and examined a range of relevant documentation. Loreburn Housing Association had a Loreburn Housing Support Service Business Plan in place. The Business Plan consultation and satisfaction survey carried out reflected the National Care Standards; the feedback collated was used to improve the quality of the service. Loreburn Housing Association had a vision, mission statement and set of strategic objectives in place. These all aimed at achieving the best they could for the customers they supported within the community. Staff members were aware of the aims of the service. Each staff member had roles and responsibilities. From the returned care standards questionnaires staff told us they received appropriate training to carry these out and felt attendance at training was encouraged. The staff team were supported to complete a Scottish Vocational Qualification and the provider was introducing a future leaders programme. This provided staff with the appropriate qualifications to meet and maintain registration with the Scottish Social Services Council (SSSC). During the recent restructuring of the service, opportunities were available for staff to apply for different positions within the service. This included taking on more responsibilities. Some staff had been matched to positions within the service based on their qualifications, qualities and experience. We felt staff page 20 of 28

21 development was encouraged within Loreburn Housing Support Service which meant that employees had the knowledge, skills and capabilities to meet current and future service needs. We saw that the service held regular staff meetings, all staff were encouraged to contribute to the agenda and discussion, and staff confirmed they felt confident sharing and discussing ideas with their colleagues. Minutes of the meetings were produced which all staff had access to. This ensured that staff that were not present at the meetings were still kept up to date with latest information, including changes within the organisation and operational changes. Staff worked as lone workers and managed day-to-day issues whilst supporting customers. We found the staff we spoke with to be very professional, they spoke about their roles and demonstrated knowledge and experience throughout the inspection. Areas for improvement During the inspection staff members told us about their experience of the service and staffing restructure. Some staff members found this period of time to be very challenging, and continued to feel unclear about their role within the service. Other staff felt unsettled and await the outcome of the service review. At the feedback session we discussed the importance of effective communication with staff throughout this period of change. This is to ensure staff feel included and supported in their work place. We looked at staff training records which evidenced a variety of training the staff team had attended. Following some staff moving into new roles and some training being completed a period of time ago we suggested that training needs are reviewed. This would include staff attending refresher training to ensure they are up to date with current legislation and latest good practice. The service had a staff supervision policy in place and some staff told us they received regular supervision, this was not consistent with all the staff team we spoke with. Some staff felt there had been less access to support since the service restructure. All staff member should have the same access to regular support and supervision. Supervision sessions should be meaningful, staff page 21 of 28

22 having the opportunity to discuss work practice and issues or concerns. Staff supervision should also be used to evaluate training attended and what had been learned and also to review and evaluate staff competencies. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 22 of 28

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 At this inspection, we found that the performance of the service was very good for this statement. We concluded this after we spoke with customers and staff, observed practice and examined a range of relevant documentation. We spoke with the Chief Executive and Supported Housing Manager about how the service had progressed since the last inspection. We spoke with the Supported Housing Manger and Customer Engagement Manager who described internal and external processes which aimed to assure the quality of the service, for example: - Health and Safety Audits - Incident and Accident Records - Complaints Procedure - Recruitment Process We found audits to be recorded and monitored and any actions required were identified, improving the support that the service delivered to its customers. Customers were encouraged to give their comments on the quality of the service. We saw evidence of this through a number of opportunities including, house meetings, engagement events, satisfaction questionnaires and outcome star reviews. This gave customers the opportunity to voice their opinion of the service. The feedback received could then be collated to improve the outcomes for people who used the service. One customer we spoke with said: 'I go to [staff name] if I need to complain, she will immediately do something about it, very approachable and helpful'. The returned care standards questionnaires which we viewed agreed or strongly page 23 of 28

24 agreed with the statement that 'the service checks with them regularly that it is meeting their needs'. Areas for improvement The previous manager had left the service since the last inspection and a new manager was only very recently in post. The consequence of this was that we had not received any notifications from the service via the recognised eform reporting system. The service is expected to submit an annual return each year to us; this was not completed. The service was asked to submit a self assessment earlier this year; this was submitted after the requested date and following a reminder from the Care Inspectorate. We use both the annual return and self assessment as part of the inspection process. A change of manager notification had not been completed resulting in the Certificate of Registration displaying incorrect information. We referred the service to Care Inspectorate Guidance on Notification Reporting. See Requirement 1. The service had a complaints procedure which was given to people who accessed the service. This encouraged anyone who was feeling unsatisfied about any parts of the service being provided to express their concern. As well as offering guidance and contact details of other independent agencies people may wish to contact for support to do this. Some customers we spoke with told us they knew how to make a complaint. Other customers told us they did not know how to make a complaint to the service or the Care Inspectorate. We suggested the manager includes an article in their Newsletter as a reminder on how to make a complaint to the service or the Care Inspectorate. Grade 5 - Very Good Requirements Number of requirements The provider must ensure that the Care Inspectorate are notified of all significant events including accidents, incidents, absence of a manager, appointment of new manager without delay. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Registration) Inspection report page 24 of 28

25 Regulations 2011 SSI 2011/28 4(1) (b) - records, notifications and returns. National Care Standards, Housing Support Services, Standard 3 - Management and Staffing Arrangements. Timescale for meeting this requirement is within 24 hours from receipt of this report. Number of recommendations - 0 page 25 of 28

26 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. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. page 26 of 28

27 8 Additional Information Inspection report During the inspection we discussed with the Chief Executive practices which we found that did not comply with the current registration conditions. This included an additional supported accommodation facility for young mothers. Referrals being received and support being provided to people out with the age range the service is registered for. The aims and objectives for the young people's service and older people's service were different and being delivered by different staff teams. We asked the Care Inspectorate National Registration Team to meet with the provider during the inspection to review Loreburn Housing Support Service current registration and advice on how to proceed. The National Registration Team will continue to liaise with Loreburn Housing Association to ensure the Housing Support Services being delivered are registered correctly. 9 Inspection and grading history Date Type Gradings 23 May 2014 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 5 - Very Good Management and Leadership 6 - Excellent 21 Feb 2012 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 17 Jun 2008 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 6 - Excellent page 27 of 28

28 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 28 of 28

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