Care service inspection report

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1 Care service inspection report Full inspection 1st Homecare Ltd Housing Support Service Banchory Business Centre Burn O Bennie Road Banchory Inspection completed on 10 June 2016

2 Service provided by: 1st Home Care 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 23

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 4 Quality of management and leadership Good Good N/A What the service does well The management and staff in this service support people who stay in their own homes to live as independently as possible. There is a small group of staff and they have good relationships with the people they support. The people who get a service, like and trust the staff. What the service could do better The service could do more to show the outcome of reviews, so that it is clear what actions will be taken. They could also do more to show how they are supporting people to get what they want from their support. What the service has done since the last inspection Support plans and risk assessments have improved since the last inspection. The service has reduced slightly in size and the staff team has been very stable. Conclusion This service provides support for people staying in their own homes. They have worked hard at improving support plans and risk assessments. People who use the service and their relatives are happy with the support they get. page 3 of 23

4 1 About the service we inspected Inspection report 1st Homecare is registered to provide a housing support and care at home service. The service is to be provided to older adults, adults with a learning disability, and adults with a physical disability living in their own homes. The office is based in Banchory, but at the time of the inspection the staff and people being supported were all in Aberdeen City or in central Aberdeenshire. Their website states: 1st Homecare delivers flexible support for people with an illness or disability, who want the independence to continue living in their own homes. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service registered with the Care Inspectorate on 8 May 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 page 4 of 23

5 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 - Grade 4 - Good Quality of management and leadership - N/A 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 5 of 23

6 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. This was carried out by one inspector. The inspection took place on Friday 3 June 2016 between 12.30pm and 3.30pm. It continued on Tuesday 7 June from 8.00am until 4.30pm. We gave feedback to the manager and the deputy manager on Friday 10 June As part of the inspection, we took account of the completed annual return that we asked the provider to complete and submit to us. We sent 30 Care Standards Questionnaires (CSQs) to the manager to distribute to people receiving a service. Fourteen people sent us completed questionnaires. We also asked the manager to give out 12 questionnaires to staff and we received 4 completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: - four people using a service - two family carers - the manager - one home care senior - two home care support workers. We looked at a range of documents and policies, including: page 6 of 23

7 - support plans - risk assessments - review records - questionnaires - daily recordings - newsletters - weekly reports - evidence of meetings with outside health professionals - accident and incident records - staff records - staff supervision notes - staff appraisals. We also shadowed a worker during some morning visits. 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 page 7 of 23

8 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 Inspection report page 8 of 23

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. Due to a misunderstanding about the notification the service did not submit a self assessment before this inspection. The manager agreed to submit one now. Taking the views of people using the care service into account The people we spoke with and the questionnaires we received showed that people were happy with the service they received. In response to the comment, 'Overall, I am happy with the quality of care and support this service gives me', nine people strongly agreed and four agreed. Comments from people we talked with included: - "I'm very happy with the service. They have been very helpful". - "I get the same people most of the time. There are two really good ones". - "I'm very happy with them. They're very reliable". - "They're generally on time. If there was a reason for being late they would let me know". Comments from questionnaires included: page 9 of 23

10 - "Very happy with the service but could use more help with showering and personal care". - "It would be nice to know which carers were coming to see me in advance". Taking carers' views into account Carers we spoke with were also very happy with the service. Some of the questionnaires we received had been completed by relatives or carers on behalf of their relative and these were also positive. Comments from people we talked with included: - "...(person using the service) can get upset. They do very well and are very patient". - "They're terrific. They're very nice, and they care". Comments from questionnaires included: - "Friendly staff who treat... with respect. We don't feel we have been made aware of the complaints policy (at the time of writing this is unnecessary)". - "... is very happy with the service given". page 10 of 23

11 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 inspection of this service showed that service users' health and wellbeing needs were met to a very good standard. Before somebody started using the service a senior member of staff would meet them, discuss what they wanted from a service and they would jointly agree if this service was suitable and could meet their needs. This meant that people were clear what the service could offer, including when their support would be available. Support plans had improved since the last inspection, with details of the routine for different times of the day and personal information about the person, their background and previous history. Where members of staff have personal information about the people they are supporting it helps to develop conversation and build a relationship. A member of staff told us how knowledge of a person's employment had led to her sharing a photograph and the person was very interested and became more motivated than usual. Daily notes were kept in a file in the person's home, saying what the member of staff had done on that visit, and how they had found the person. These were about to be replaced with notebooks as they would be safer than loose sheets page 11 of 23

12 where pages could be mislaid. The daily notes were collected, read by the senior home carer and then scanned so there was a long-term record of the support provided. Any issues arising from the notes could then be discussed with the staff member or the person receiving support. See also areas for improvement. Risk assessments had again improved since the last inspection. They provided details of risks to people receiving a service, staff and other people such as family members, with measures which staff needed to take to reduce the risks. Reviews of support were happening regularly and these provided an opportunity for people to discuss any changes to their support and to identify any changed needs. Some of these reviews included care managers, which meant action could be taken on changes that required more resources. The service was working jointly with other professionals, including; GPs, care managers, community nurses and occupational therapists (OTs). Several people whose files we saw had comprehensive moving and assisting guidelines provided by the OT for example, with these being completed following joint visits with staff. Where people work together to share expertise it helps improve the quality of care provided. Staff received moving and assisting training and also had completed medication training. They had also undertaken adult support and protection training and were aware of their responsibility to report any harm or risk of harm to the people they were supporting. They would contact the senior staff or sometimes summon help directly where they had concerns about someone's health. This showed that the service had developed over the period since the last inspection, with improved support plans detailing the support to be delivered, joint working with health professionals and commissioners and confident experienced staff who communicated concerns or changes regularly. Areas for improvement While daily notes were detailed and had previously been audited we saw that some people had several months of daily notes in the file in their homes. These page 12 of 23

13 ought to be collected, checked and feedback given to members of staff or action taken on a more regular basis. The records for when support plans and risk assessments were written were not very clear. It looked as though there had been a gap of several months between some people first receiving support and the risk assessment being produced. On discussing this with the manager and senior home carer they assured us this was not the case and were able to provide original risk assessments for the period concerned. The documentation could be clearer to show when documents were originally produced and to identify that the current document is a reviewed risk-assessment, rather than an initial one. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths The inspection of this service showed that service users' care and support needs were met using person-centred values to a good standard. Support plans were person-centred, with personal information about the person's background, how they preferred to be supported and agreed outcomes for each person using the service. (See also areas for improvement). We saw that support plans had been reviewed as required and the senior staff were tracking these reviews to make sure they were not missed. People told us of contacts with senior staff, where they were visited and the service was reviewed. The home care senior also worked shifts to cover for leave or sickness, which meant she knew the people being supported and the support they received, which helped for reviewing services. (See also areas for improvement). page 13 of 23

14 Most of the staff had been in post for some time and they knew the people they were supporting well. People we spoke with told us of good relationships and of staff who would respond to their requests and support them in the way they wanted. The service had worked on reducing the number of staff who worked with each person and had agreed a key group, written in their support plan, who would work with each person. In the past people had been concerned about the number of staff who worked with them, but people we spoke with were happier about this now. This all meant that the service was working to produce support which was person-centred and tailored to the person's needs and wishes. There were some limitations to this, as hours of support had to be agreed with the commissioners of the service, and staff were busy, meaning the preferred support times were not always available. This was discussed and agreed with the person being supported or their families at the outset of the service. Areas for improvement While reviews were taking place and information in support plans was updated as a result, there was not a minute available of reviews. A minute could be taken and would include information about who was present, what was agreed, with a copy provided for the person receiving support (see Recommendation 1). The service had agreed outcomes for people using the service, but these could have been further developed, with clearer evidence of how the outcomes linked to the support plans and of progress being made towards achieving them. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations Minutes of care reviews should be taken and these should reflect who was present, what was discussed, what was agreed, and who is responsible for taking decisions forward. page 14 of 23

15 The minutes should also be circulated to people present so they have a copy and have the opportunity to comment. National Care Standards for care at home. Standard 3: Your personal plan. page 15 of 23

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - 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 The inspection of this service showed that staff had been recruited in a safe manner to a very good standard. Recruitment since the last inspection had been limited. The service was continuing to try to recruit staff but was not having a great deal of success. Where a member of staff had been recruited we saw that the process was thorough, with a detailed application form, interview notes and a rationale for appointment. We also saw that two references from previous employers were taken and a protection of vulnerable groups (PVG) update was applied for, prior to the person starting work. After recruitment a three day formal induction was in place, which included protection of vulnerable adults training. There were also opportunities for the new member of staff to shadow existing home care support workers and to read support plans and files before being expected to work on their own. Members of staff we spoke with said that the training available was appropriate, met their needs and gave them an opportunity to get to know people at an early point. The manager was in the process of agreeing funding and making arrangements for members of staff to undertake a Scottish Vocational Qualification (SVQ) in health and social care, which is a recognised qualification for people working in page 16 of 23

17 Social Care. This will help staff to prepare for registration with the Scottish Social Services Council (SSSC) when the register for housing support workers opens. This all showed that the service was working to make the recruitment of staff safe and effective to reduce risks for people using the service. Areas for improvement The service is continuing to try to recruit members of staff and should maintain standards of checking people before they start and supporting them during their induction period and beyond. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths The inspection of this service showed that there was a professional trained and motivated workforce operating to national care standards to a good standard. Staff members we spoke with and the responses from staff questionnaires showed that staff were motivated. They recognised the importance of what they did and knew that they may be one of the few points of contact for someone living alone. They recognised people's vulnerability and understood their responsibility to report any concerns they had. Staff training was from a mixture of different places and formats, with some training provided by Real Life Options (RLO) which was the parent organisation, some such as moving and assisting being purchased from local training page 17 of 23

18 providers and others such as individual sessions on supporting an individual being sourced from local providers. Staff had received medication training and were aware that they needed to provide the agreed level of support. At the time of the inspection none of the people they were supporting needed medication administered, with people administering their own medication, staff prompting or family members taking responsibility for administering medication. Members of staff had one-to-one support on a three-monthly basis and also had an annual appraisal. This meant there was an opportunity to discuss each person's work. The senior home carer also worked alongside people and did spot checks, where she would monitor a visit, ask the person being supported how their service was going and provide feedback for the member of staff. There were a variety of informal ways for staff to be supported, including; newsletters, phone calls and some team meetings. (See areas for improvement). Staff we spoke with said that they felt supported and knew that they could contact senior staff at the office. There was also an on-call system, where senior staff took turns on a rota basis to be available for staff to contact them for advice and support. The evidence gathered showed that there were systems for staff training and support in place and that the service and organisation had checks in place to monitor the quality of service provided. Areas for improvement While there were occasional team meetings in place they were not happening very regularly, with the most recent one being about a reorganisation within the company which had meant new terms and conditions for staff. Staff members who are often working on their own need an opportunity to discuss their work, share ideas and agree a consistent approach. Team meetings also provide an opportunity for training sessions and discussion. These can be particularly useful in areas where sharing experiences is helpful, such as adult support and protection. page 18 of 23

19 Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 19 of 23

20 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 Since the last inspection there has been one upheld complaint. This related to the service terminating the support package for someone while the person was in hospital and not providing support when they returned home. One requirement was made: page 20 of 23

21 The provider must ensure that it develops and implements policy and procedures which set out the roles, rights and responsibilities of the provider and service user in the event of service cancellation. In order to achieve this, the manager must ensure that all service users have access to written agreements which sets out the terms and conditions for changing or ending the service. In addition, the manager of the service must ensure that direct care staff are able to effectively demonstrate their understanding of the policy, procedure and practice in relation to service withdrawal and cancellation. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, No 210: 4(1)(a) - Requirements to make proper provision for the health and welfare of service users. The following National Care Standards for Care at Home Services have been used in developing this requirement: National Care Standard 1: Informing and deciding. National Care Standard 2: The written agreement. Timescale: To be fully implemented by 31 March The service had implemented a 'moving on policy' which gave information on the process for stopping the service, including the steps that should be taken. We discussed this with the manager during the inspection and she accepted that the situation could have been handled better and that she had learned from the experience. The new policy provided a way of clarifying for everyone what the situation was. This requirement has been met, within the timescale required. Inspection report page 21 of 23

22 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 26 Jun 2015 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 29 Aug 2014 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good page 22 of 23

23 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 23 of 23

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