Care service inspection report

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1 Care service inspection report Full inspection Stirling Home Care Service Support Service Wallace House Maxwell Place Stirling Inspection completed on 13 May 2016

2 Service provided by: Sue Ryder Service provider number: SP Care service number: CS Inspection Visit Type: Announced (Short Notice) 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 25

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 6 Quality of staffing 6 Quality of management and leadership Excellent Excellent N/A What the service does well The provider offers an excellent service to older people living in their own homes. They have a person centred approach and work hard supporting people to achieve their outcomes. The staff team are committed and forge good trusting relationships with people they work with. The people who use the service are welcomed and encouraged to participate in all aspects of their support which contributes to people feeling in control. What the service could do better We have advised on the areas for improvement throughout the report. What the service has done since the last inspection The service has created further ways for people to communicate with each other and have been enabled to use technology such as video conferencing to support this. The provider has continued to offer people a person centred service as well as offering a skilled and committed work force'. page 3 of 25

4 Conclusion Inspection report Based upon the findings of the inspection we have concluded that the people who use the service receive a high standard of care from experienced and highly motivated staff. page 4 of 25

5 1 About the service we inspected Inspection report Sue Ryder provides this care at home support service operating throughout the Stirling area. Their staff support vulnerable adults in their homes with various packages of care to meet their needs. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 6 - Excellent Quality of staffing - Grade 6 - Excellent Quality of management and leadership - N/A This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. page 5 of 25

6 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 25

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 looked at: - personal plans, - relevant paperwork pertaining to the service, - recruitment processes. - we spoke to staff - we spoke to people who used the service - attended a meeting with staff. 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 7 of 25

8 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 8 of 25

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. The provider submitted the self assessment with all sections completed. Taking the views of people using the care service into account These are reflected throughout the report. Taking carers' views into account These are reflected throughout the report. page 9 of 25

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 6 - Excellent Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths For this statement we looked at the following evidence: - Risk assessments - Accident and Incident forms - Complaints log - Personal files - Medication logs - Daily logs. We also attended part of a staff consultation meeting which had been arranged for information sharing following the feedback from a survey sent out to staff. The personal files we looked at contained information regarding people's health needs and outcomes. These were very detailed and demonstrated a step by step illustration of how staff should support individuals to achieve their outcomes on a daily and weekly basis. The information we looked at in the personal plans regarding health needs matched up with the daily logs written by staff. This evidenced that staff had a good knowledge and understanding of how people wished to be supported according to the plans. page 10 of 25

11 We were also able to see from the daily logs, excellent examples of staff reporting any health concerns to their line manager and additionally how they responded to health issues requiring emergency services. This demonstrated that staff were confident and well trained in what was expected of them in these situations and that people were given the best support as a result of early interventions. As part of the inspection we looked at risk assessment pertaining to individual people in relation to health and safety. One great example of this was around staff supporting someone who had Parkinson's and other health needs. Part of the risk assessment was for staff to emotionally reassure him in relation to their skills. All staff are made aware of their roles and responsibilities while they are supporting people in relation to communication with the office. This was in relation to observing any health deterioration such as skin viability or a lack of food in the house. We saw an example of this in the log book where a staff member reported that a person did not seem to have a lot of food. This information will then be communicated to the relevant agencies such as GP, social work or next of kin. This contributes to a robust management of people's health care needs and collaborative working with other agencies. We saw that two of the staff are Dementia champions who will attend staff meetings and support staff to develop their understanding in relation to Dementia. Areas for improvement Senior staff should ensure that they also check language staff are using to describe situations in daily logs so that it reads professionally and maintains people's dignity. Seniors should ensure that all medication that is being administered by staff including creams should be clearly named and staff should have knowledge of what the treatment or medication is. page 11 of 25

12 Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 12 of 25

13 Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service Strengths The service assessed people's communication needs at the referral stage and these were written into the person's personal plan. We saw that people who may need a hearing aid will have this written down so staff are aware that when they go in on shift that they will need to support the person to wear it. We saw evidence of the various communication used for people who require support in this area. Examples include: - - Video conferencing - Big font sizes for reading - Telephone - Face to Face - Staff - Post cards - Communication logs - Google Hangout. The provider also gave an example where a worker will sing during her time she is supporting the person to let them know she is there. This is simple however innovative and person centred practise which makes the person feel safe and secure. Additionally staff will check that the person has their community alarm pendant on or close by as well as having their remote control for door entry. We looked at evidence in relation to people who are part of the National Service Group for Sue Ryder and how they are facilitated to communicate with each other across the country using video linking. This cuts down on travelling for people who may find this difficult and limits the costs of public travel. page 13 of 25

14 The manager advised that the staff teams are made up of core staff for people they support, this allows for continuity, consistency and familiarity for the person. As a result the staff team are able to understand and communicate with people who may struggle with or have limited communication. We sampled reviews of the individual support packages which help people and their relatives communicate how they feel about the service. The reviews can be called at any time if the relative or person requests this. The complaints procedure is given to each person at the beginning of the service delivery and we saw that this is written in different sizes according to people's need. Other opportunities are offered to people such as surveys, pop up coffee shops and phone calls made to people on a weekly basis to see how the service is going. We also looked at the daily log of calls which are made to the provider's office from people who use the service, families and staff. These are documented and discussed at staff meetings so all staff are aware of how people are feeling and what they wish to change. The manager will also organise a home visit to discuss any difficulties or views that people have. We saw an example of this and how the manager responded to a person who was not happy with certain aspects of the service. The manager involved the social worker and arranged a meeting. This situation was resolved. Areas for improvement The provider should continue to look at improving communication methods to meet various needs. At feedback the manager agreed to re-issue the complaints procedure for both service and the Care Inspectorate to ensure people have possession of this. This is in response to people's Care Inspectorate Questionnaires where some people ticked they were unaware of the procedure. page 14 of 25

15 Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 15 of 25

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths Some of this statement will be met through quality theme 1, statement 4 which was also looked at during this inspection. The provider demonstrated how people who use their service are involved in assessing staff from the beginning by participating in the recruitment process. This is facilitated by the provider by inviting people to take part in the interview panel or by putting forward questions to candidates which were devised by the person. We saw that people supported are also very involved in the induction of new workers into the organisation. This was made to happen by people supported to attend the induction courses and speaking to new recruits about their experiences such as Mr M who spoke about what qualities he would like in a worker and JD who explained to staff why safer handling is important due to an injury she sustained. Furthermore, people will show new staff around the offices and introduce them to the staff who work there. This sends a strong message to new staff from the beginning that the people who use the service are integral to how the provider delivers the service. This is excellent practice by the provider. page 16 of 25

17 People who use the service are able to take part in post card surveys and questionnaires throughout the year to have their say on both the service they receive and the staff members. We saw evidence of this being fedback through team meetings. During the inspection we looked at supervisions and could see that positive feedback had been given to staff members which came from the people using the service. One example of this was "one particular staff member SW being so kind and thoughtful makes me feel better". We also saw an example of a worker who had missed a shift and how this was discussed and reflected on. This was confirmed through speaking with staff who felt this positive feedback gave them a boost in confidence. We visited people who used the service and asked if they felt included and listened to in relation to improving the service delivery. Some comments they made are as follows - I am very happy with the service - I am very happy with my team, I like when they come in - Yes I feel listened to and have met with two seniors. - I enjoy the two girls who come in but the young ones can't cook. The manager fedback that Sue Ryder had adopted the 'Talking points' tool which is a personal outcome focused approach developed through the Joint Improvement Team. People who use the service and staff were interviewed by the Head of Quality, the focus was on maintenance, independence and quality of life, unfortunately we did not see the evidence of this at the time we were inspecting. Areas for improvement The provider should continue look at ways of capturing evidence to illustrate how they involve people in all aspects of their service delivery. page 17 of 25

18 Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 18 of 25

19 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths For this statement we looked at: - 10 staff files - Staff Training - Staff Training plan for the year - spoke to staff including the administrator - Reflective accounts. We saw that the staff files contained documentation in relation to staff training and what each staff member had achieved. As specified in theme 3, statement 1, all staff must complete a one week induction programme inclusive of training such as: - Safer handling - Adult support and protection - Certificate on the principles of End of Life - Whistleblowing - Dementia awareness - Falls management - Safe guarding children. We saw from the staff files that most staff have completed their SVQ 2 or 3 or are embarking on doing it. The provider has received government money to put staff under the age of 25 through their SVQ's which will help the provider meet the SSSC's expectations of trained staff. page 19 of 25

20 We also looked at paperwork contained within the staff files which pertained to the principles of The National Standards which were read and signed by staff members. This allowed staff to have the knowledge of why they work in the way they do and what is expected from them as workers in social care. The staff we met with spoke positively about their job. They feel supported by their colleagues and line managers and feel they can approach their supervisors with any difficulties they may have. This adopts a trusting and honest culture throughout the service. Staff participated in supervision which they advised was a positive experience along with receiving good feedback about their practice. We saw that staff had spot checks carried out on their practice while they are on shift. One example of a check was on a worker being observed carrying out the following tasks: - Medication administration - Preparation and hygiene - Safer handling of a person in a hoist. This ensures that there are quality control measures in place to improve service delivery and the opportunity to support staff development. We attended a staff meeting which was named 'Engagement Consultation' which had been arranged by the manager. The reason for the meeting was for the manager to address the staff survey responses and to improve the service delivery. This was an opportunity for the staff to put forward their views. These meetings happened over a course of two days to ensure that all staff were given the same information and opportunity. This was excellent leadership practice in working with teams to achieve goals. Areas for improvement The service should ensure that all medications are named on the staff signing sheet so staff are aware of the medication they are administering. page 20 of 25

21 As discussed with the manager, the provider must notify the care inspectorate of all accidents and incidents which are relevant in relation to the service registration. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 21 of 25

22 Quality Theme 4: Quality of Management and Leadership Quality theme not assessed 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. page 22 of 25

23 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. page 23 of 25

24 9 Inspection and grading history Date Type Gradings 17 Apr 2015 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 6 - Excellent Management and Leadership 6 - Excellent 28 Apr 2014 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 6 - Excellent Management and Leadership 6 - Excellent 10 May 2013 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 6 - Excellent Management and Leadership 5 - Very Good 1 Jun 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 17 Aug 2011 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed page 24 of 25

25 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 25 of 25

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