Care service inspection report

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1 Care service inspection report Full inspection Inverclyde Centre Housing Support Service 98 Dalrymple Street Greenock Inspection completed on 26 April 2016

2 Service provided by: Inverclyde 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 29

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 4 Quality of staffing Quality of management and leadership 4 Good N/A Good What the service does well The service offers people advice (to try and prevent them becoming homeless) and also support (to gain a tenancy) which can include emergency accommodation at the Inverclyde Centre if required. If service users wish, staff can help arrange access for them to a range of health related services. What the service could do better Assessment and Support Officers (ASO's) work between three different bases; Crown House, Hector McNeil House and the Inverclyde Centre. Access to computers and interview rooms can be problematic due to on-going I.T. problems and a lack of available interview rooms. Staff at times are unclear which building to direct service users to when they wish to meet up with their worker which is a cause of frustration for both staff and service users. The provider should review the logistics involved in running the service with staff, identify the problems and plan how these problems can be reduced. page 3 of 29

4 What the service has done since the last inspection Inspection report Since the last inspection there has been an increased use of the Outcome Star assessment tool used by staff when discussing with service users what their support needs might be. Conclusion The service is well thought of by the people who use it. The service's primary aim is to help people who are homeless or at risk of becoming homeless to identify appropriate accommodation and remove themselves from the homeless register. The service has increased the use of Outcome Star to help service users who may wish additional support to identify what their needs are. We assessed that the service had met the two recommendations made in the last inspection report. page 4 of 29

5 1 About the service we inspected Inspection report The Inverclyde Centre is managed by Inverclyde Council's Health and Social Care Partnership. The Centre registered with the Care Commission in November 2004 to provide a Housing Support Service. The service provides housing support to people who are homeless or at risk of being homeless in the Inverclyde area, it also offers 27 bedsits, two of which can accommodate couples and 4 emergency bed places. Additional temporary accommodation can be accessed, primarily, within Inverclyde. The 'Inverclyde Centre,' is the name given to the service which is a little confusing as there are more people who receive support from the service within the community than live in the building called the Inverclyde Centre. Based in Greenock town centre the service also offers support and advice to people who are homeless or at risk of becoming homeless within the Inverclyde area. People who are interested in what the service may have to offer can see a worker each day (Monday-Friday) in the offices of the Hector McNeil building where staff from the service operate a duty system. Those who are offered temporary accommodation within the Inverclyde Centre may see their support workers there. From the 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. In highly performing services, inspections will consider Quality Theme 1: Quality of Care and support, Quality Theme 1, Statement 3 "We ensure that service user's health and well-being needs are met" will be considered during all inspections. We will also look at one other quality theme. page 5 of 29

6 This service is eligible for this type of inspection and based on our knowledge and intelligence of the service we looked at Quality Theme 1, 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". We chose this based on our knowledge that the service is generally offered to people for a short time and it is important that service users have a clear understanding of this and of what additional supports can be accessed through the service during the time that service users are classed as being homeless. We also considered Quality Theme 4, Statement 2 "We involve our workforce in determining the direction and future objectives of the service" because of the importance of the role staff play in developing the Outcome Star assessment tool within the service. We chose to look at Theme 4, 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," because of the important role that quality assurance plays in trying to develop a service. page 6 of 29

7 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 4 - Good Quality of staffing - N/A Quality of management and leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. page 7 of 29

8 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 The inspection was carried out by one inspectors; Colin McCracken on 20 April 2016 and the 25 April 2016 between 10:30 and 17:30. The first day of the inspection was unannounced by which we mean we did not give the service any warning that we were going to visit that day. Feedback was given to the manager at the end of the second day of the inspection. Prior to the inspection, we sent 100 Care Standards questionnaires to the service to pass out to service users, 17 of these were completed and returned to us. We also sent out 20 staff questionnaires, 8 of these were returned. This gives individuals the chance to contribute to the inspection and to do so anonymously if they wish. Feedback within questionnaires also influences what it is we look at during inspections. During the inspection we had individual discussions with a range of people including: - Three service users - The manager - The senior case worker - Three Assessment and Support Officers - One Accommodation Officer - One Accommodation Assistant - One Homemaker page 8 of 29

9 We also carried out a review of a range of policies, procedures, records and other documentation, including the following; - care plans - service information pack - provider's aims and objectives - The Provider's DVD 'Journey through homelessness' - Staff meetings - Complaints folder - Self-evaluation - Strategic plan Health and Homelessness Standards - Inverclyde Health and Social Care Partnership Committee meeting minutes - Inverclyde Council's leaflets on the Homelessness Services - Service user Involvement and Consultation Strategy - Inverclyde Council's performance appraisals overview 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. page 9 of 29

10 Fire safety issues Inspection report 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 10 of 29

11 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care inspectorate received a completed self-assessment document from the manager. The manager identified what they thought the service did well, some areas for development and some planned changes. We discussed how the management team should look to improve this assessment prior to submitting it next year. A self-assessment should include more examples which highlight the impact that the service has made, particularly in regards to what the outcomes have been for people using the service under each heading. A self-assessment should also highlight areas identified within the services own quality assurance processes where the service has not achieved the standards it would hope to meet and tell us what action plan has been put in place to rectify this. page 11 of 29

12 Taking the views of people using the care service into account Prior to starting the inspection we sent 100 care standard questionnaires to the service and asked them to distribute them to service users. We received 17 replies. Thirteen strongly agreed with the statement "overall. I am happy with the quality of care and support this service gives me," three agreed with this statement and one disagreed. We had the opportunity to speak with three service users individually during the inspection. We have included comments and views from people using the service within the body of the report. Taking carers' views into account Given the nature of the service there were no relatives available to speak with during the inspection. The focus of the service is short term work to help rehouse therefore the service has little involvement with relatives. However service users and staff both said that depending on the circumstances staff would liaise with family members, although this was more to facilitate contact rather than to discuss support needs. page 12 of 29

13 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths The service was good at supporting service users to meet their health and well being needs. We arrived at this conclusion after considering the following: - Discussions with 3 service users - Risk assessments - Feedback from the 17 returned care standards questionnaires - Notifications to the Care Inspectorate - Outcome Star assessments As part of the Health and Social Care Partnership the service is quickly able to access health staff based within the Inverclyde Centre including; a nurse, an alcohol councillor and a drugs worker. Staff will also refer on to other agencies to provide additional longer term support where it is felt this may be of benefit to an individual with specific needs, for example; addiction or mental health issues. This shows us that the service recognises where a more individual approach may be required to meet someone's needs. The Health Workers use a health toolkit which they support service users to complete; this takes about 1 ½ hours and helps service users to identify themselves if they have any health support needs. page 13 of 29

14 The service has increased the use of the Outcome Star assessment tool with service users since the last inspection. This is used where it is considered that additional support needs may be required. Outcome Star is an assessment tool which gives staff a structure to follow in working with individuals to identify their needs, develop their outcomes and measure progress made in each area. The tool has the potential to help the service and the wider organisation monitor outcomes and evidence the support they are providing and the impact this has for individuals. The system is a visual aide which can help people see the progress they have made during regular reviews of their outcomes. The accommodation staff phone everyone in the Inverclyde Centre's each morning to ensure that everything is o.k. The outcome from this is that people are reassured that if they are unwell this would be identified quickly by staff. The health team delivers in-house training for staff on some medical matters such as understanding behaviours, Naloxone and Assist training with most recent training being on legal highs. They also continue to run the HAD-IT group within the Inverclyde Centre where they have discussion topics such as Drug Awareness and the impact of stress and they will also bring in outside speakers to the group. The service users we spoke with were very complimentary about the support that they received and what it had meant for them. Comments included; "The outcome star helps you focus your mind; it's all about baby steps." "They are guiding me in the right direction." "I've done a Star chart with my worker, it was very useful and this lead to an action plan." "I've two group meetings to go to this week where I get health advice and support. The groups have brought me out of myself I was very introverted before." page 14 of 29

15 "I will carry on seeing... (the nurse) and... (the alcohol councillor) after I've moved out but I may get referred to another group once I've settled." "The staff sorted out my buroo money, helped me get food initially and let me use the phone when I moved in at first." "I've seen the nurse a few times and they got me to see a dentist. I've got depression and the nurse made it clear I could speak to them any time I needed to." "Staff will go out of their way to speak to me." "I've been in three weeks and I've got a planning meeting today with my family and lots of workers coming to it." "Without this service and care I would be living on the streets." Areas for improvement While there were very good examples of the service meeting service user's health and well-being needs, the statement is not graded as 'very good,' because many of the care plans we sampled remained unclear about what support was being provided. Care plans did not capture the outcomes that the service helped individuals to achieve. Service user's may not wish to engage with the service, or stop engaging with staff as soon as they receive an offer of a house which could be within a few weeks. This makes it difficult to develop the Outcome Star as it normally would be in a service where someone would review their scores over a longer period of time. The samples of Outcome Star assessments we viewed were variable in quality and staff we spoke with were very honest with us regarding their varying confidence levels in completing the assessments. Staff also said that although they would like to help people develop a housing support plan their priority was in helping people be re-housed and therefore planning a housing support service was further down their list of priorities. page 15 of 29

16 At the last inspection we noted that the service intended to explore the possibility of a web based system which will allow different professionals to read and complete different sections on the same Outcome Star assessment. There continues to be problems with I.T. systems not linking up properly between offices and between NHS staff and Inverclyde Council staff. This is another reason that care plans have not developed the way that management had envisaged at the last inspection. The Outcome Star assessment tool would be greatly improved if different professionals could feed into it what outcomes they were helping someone work towards. (see recommendation one under this statement) Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The provider should review with staff how they can assist staff to overcome I.T. difficulties in order to make recording and accessing records easier for staff. National Care Standards 3 Housing Support Services - Management and Staffing Arrangements page 16 of 29

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 The service was good at informing people who are interested in using the service or in leaving it about what this involves and their options. We came to this conclusion after: - Speaking to people who use the service - Viewing the provider's 'Journey through homelessness' DVD - Reading the Tenant's handbook given to service users at the Inverclyde Centre - Reviewing returned care standards questionnaires - Service user meeting minutes held at the Inverclyde Centre The Scottish Executive's Homelessness Task Force recommended a holistic and joined up approach to tackling homelessness in Scotland. It involves proactive involvement from whichever agency the homeless person first approaches to help ensure that all the needs are assessed and addressed as effectively as possible. Within the Inverclyde Centre this is achieved by people being seen by a nurse who can then refer colleagues who are alcohol and drugs councillors. Assessment and support officers can also provide information and arrange for appointments at local doctor and dental practices. An outcome from this is that people told us that they were well-informed about what support they could receive to maintain or improve their health. After an initial meeting with an Assessment and Support Officer people are offered a further meeting to discuss developing an Outcome Star tool which will help them look at their needs. Some people choose to take up this option others choose not to. Those who take up this option are given clear guidance over what additional support could be provided through the service. page 17 of 29

18 Service users who move into the Inverclyde temporary accommodation unit are given a handbook which includes the terms of their temporary tenancy and the rules which tenants should comply with. People we spoke with told us that as well as being given the handbook this was explained to them when they moved in. The service has made a DVD which shows someone journey from first approaching the Homelessness Service to being re-housed in their new tenancy. People we spoke with said they were clear about the help they could receive. Comments from people who use the service related to this statement included: "Everything was well explained, my head was all over the place but they allowed me time to digest the info." "I see the councillor once a week, my named worker twice a week and my homemaker helped me complete my application for housing." "Even the front desk staff gave me the information that I needed." "It is clear that I can be here for as long as it takes." "They made it clear that they will continue to help me depending on what me needs are at the time." "You ask the questions, you'll get the answers." "They explained the rules when I moved in." "Service has been more than helpful with supplying information, guidance and help." "Your staff has been so helpful making sure everything was o.k. and even made me feel relaxed." page 18 of 29

19 "All staff within this centre are awfully supportive and easy to communicate and support all my needs." "I've had great support and communication." Areas for improvement Due to the fact that people often choose to disengage with the service of their own accord the service did not have a lot of evidence of supporting people plan for exiting the service. The provider should consider providing more information specifically around the housing support service. At present the information about the support available and the analysis of the support is all tied up in information about the homelessness service as a whole. As explained earlier housing support is only a small part of the Homelessness Service making it harder to evidence the specific impact that the housing support service has on the people who use the service. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 19 of 29

20 Quality Theme 3: Quality of Staffing Quality theme not assessed page 20 of 29

21 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service Strengths The service was good at involving the workforce in determining the direction and future objectives of the service. We arrived at this conclusion after considering: - Staff questionnaires - Team meetings minutes - Management meeting minutes - Self-assessment for the service - Development plan for the service - Discussions with management and staff Staff told us that they had been given the opportunity to take part in Hub events where staff from Inverclyde had the opportunity to go to events run in another local authority to discuss issues like how to deal correctly with discharging of duties. Some staff had been given the opportunity to take part in the housing options peer review group. This is where some staff who have received the training will go to another local authority to review how they are implementing certain policies, in turn staff from the other local authority will do the same in Inverclyde. The outcome from this is that there is an external pair of eyes reviewing the practice in this area which may throw up new areas for development. A second outcome may be that staff feel empowered that their opinion matters which encourages their involvement in the development of this page 21 of 29

22 service. We noted that different members of staff are given the opportunity to chair team meetings which evidenced that problems within the service were discussed frankly by the staff team. An outcome from this is that management were aware of the difficulties that staff were experiencing working between offices and with different I.T. systems. Most of the staff have been supported to attain a suitable qualification to register with the Scottish Social Service's Council when the registration for housing support staff opens others already had a suitable qualification when started with the service. Staff we spoke with were all aware that the manager sent the Care Inspectorate a self-assessment of the service prior to the inspection taking place; although it varied how much input staff felt that they had to this process. Several Assessment and Support workers told us that the fact their senior had previously been a front line worker helped management understand the problems that they encountered. Areas for improvement Several staff also told us that the staff team was now effectively spread between three buildings and this could feel a bit disjointed at times. The outcome of this we were told by some staff was that communication between the different members of the team was not as good as it once had been. One staff told us it is frustrating trying to get hold of colleagues at times and they could understand why service users got frustrated as sometimes they were sent between different buildings when they want to find their workers. This is emphasised by the I.T. problems that have been mentioned earlier where staff can't all get access to the systems that they need in the buildings that they are in. (see recommendation one under statement 1.3) We discussed with the management team that the service should encourage input from Homemakers into developing the Outcome Star support tool. While the management team view homemakers as having a central role in the support planning role our discussions with staff suggest that there is room to increase homemakers involvement in developing support plans for service users. page 22 of 29

23 We spoke with the manager about how the service could better evidence that staff are able to influence the direction of the service. This was largely by clarifying what the outcomes/improvements have been as a direct result of staff involvement in team meetings, the self-evaluation process and the services development plan. We received a lot of feedback from staff that their time was spent largely on housing issues with far less time to focus on support issues. The provider should consider how as a provider of a housing support staff can ensure that they have time to focus on support issues. The provider should involve staff in this discussion and inform the Care Inspectorate of the outcome. (See recommendation one under this statement.) While some staff have had the opportunity to gain care qualifications other staff have housing qualifications. The provider should ensure that those without care qualifications have the opportunity to expand their knowledge and understanding of care issues. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The provider should review with staff how they can improve the amount of time they have available to focus on support issues with service users as opposed to housing issues. National Care Standards 3 Housing Support Services - Management and Staffing Arrangements page 23 of 29

24 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 The service has good quality assurance procedures in place which involve service users, and staff. We considered the following information in grading this statement: - Discussions with people who use the service - Interviews with the staff of the service - Service's aims and objectives - Compliments records - Complaint records - Service audits - Strategic Plan Health & Homelessness Care Standards - Tenant's meeting minutes - Staff meeting minutes The management team and some staff have been working with other local authority homeless services to develop and pilot a peer quality assurance process. Works is already underway with one peer review having been carried out. Further reviews are included in the South West Housing Option Hubs action plan for Some staff have also been working with management to improve the questionnaires that they sent to service users to make them easier to understand. The provider is demonstrating a willingness to look at ways to improve the service which is essential behind any quality assurance measures. The provider has developed a service improvement plan which looks at numerous aspects of the service. Such as reviewing the information it gives service users about the service to ensure that it meets the expectations laid down in the National Care Standards and ensuring that care plans clearly state page 24 of 29

25 what support needs have been identified. Staff told us that their senior regularly checked the computer system to ensure that they had submitted section five forms and that they have started Outcome Star assessments with people. We were also told that staff are asked to bring reports in with them to discuss at supervision sessions. The outcome is that staff have a clear understanding that they need to try and keep up-to-date with their reports. We received 17 questionnaires back out of the 100 which we sent. 92% said that their needs and preferences were detailed in their care plans. 94% of those who returned questionnaires agreed or strongly agreed with the statement "Overall, I am happy with the quality of care and support this service gives me." During the inspection we spoke with 3 people who use the service, none of them could think of a way the service needed to improve. Areas for improvement The management team should develop its self-assessment which it sends to the Care Inspectorate prior each year. Under each heading they should highlight more examples of outcomes service users have been supported to achieve. As part of a quality assurance process the management team should consider how effective the service's participation strategy has been. There are certain tools that could be used by managers to measure how successful an organisation has become at delivering and outcome focused approach, for example; "Progress for Provider" by Helen Sanderson Associates. As has been previously stated the provider runs a housing support service which is part of a larger Homelessness Service. It would help the grading for this service if they were able to provide information which related to the outcomes for people who received a housing support service. Currently the data the service produces relates to the Homelessness Service in general and most people in the homelessness service do not receive housing support. page 25 of 29

26 Grade 4 - Good Number of requirements - 0 Number of recommendations 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 1. The service should research how they can minimise social isolation within the Inverclyde Centre. National Care Standards 3 Housing Support Services - Management and Staffing Arrangements This recommendation was made on 25 April 2014 The service has held meetings within the Inverclyde Centre to discuss ways of reducing social isolation. Ideas were put forward by those who attended and as a result there are now Had-It groups on twice a week instead of once and the centre has tried quizzes and a gardening group has been organised. This recommendation has been met. page 26 of 29

27 2. The provider should repeat the Shared Solution event which it held in 2012 to review service user opinions on the service following the changes which have been put in place following the last event. National Care Standards 3 Housing Support Services - Management and Staffing Arrangements This recommendation was made on 25 April 2016 Inspection report The service has not held another large event such as the Shared Solutions event but instead has opted to hold regular meeting lead by the local advocacy group to discuss the service and other issues of mutual interest with service users who wish to attend. This meeting has been assessed as being met. 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. 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 25 Apr 2014 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good page 27 of 29

28 Management and Leadership 4 - Good 26 Apr 2013 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 3 - Adequate Not Assessed 3 - Adequate 3 - Adequate 27 Apr 2011 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 5 - Very Good Not Assessed 5 - Very Good Not Assessed 8 Jan 2009 Announced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good page 28 of 29

29 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 29 of 29

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