Care service inspection report

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1 Care service inspection report Full inspection Assistance In Care Services Ltd Support Service 1 New Law House Saltire Centre Glenrothes Inspection completed on 12 May 2016

2 Service provided by: Assistance In Care Services Ltd 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 38

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 Good Quality of staffing 3 Adequate Quality of management and leadership 2 Weak What the service does well Assistance in Care Services Ltd continues to provide a very responsive, flexible and person centred service to a small number of service users within their home and their community. Service users and their families told us that the care and support offered was consistent, reliable and of a high standard. We could evidence that the care and support was provided by a regular and consistent staff team. People we met told us of the real positive impact of the support provided. For many people, this service was enabling them to remain in their own homes. What the service could do better It is of concern that the service has made little progress in terms of the recommendations and areas for improvement identified through previous inspection visits. Under quality theme 4, we have also reported on the provider's practice in terms of accurate documentation. page 3 of 38

4 The management team acknowledged the need to improve practice in these areas and this is reflected in the grade awarded for quality theme 4, quality of management and leadership. What the service has done since the last inspection The main developments are: - The manager has reviewed the way that they assess people's needs, in certain geographical areas, to ensure that their needs can be met before committing to delivering the service. - The quality assurance manager has registered with the Scottish Social Services Council (SSSC). - There has been an increase in care staff. - The manager is providing less direct care and support (now around seven hours per week) as a result of the staffing changes. Conclusion The service provided to service users and their families is of a high standard. A consistent and considerate staff team provided good quality support, the service is very flexible and responsive. We had no concerns about the standards of care and support provided to service users and their families. However, we could not evidence developments in the staff training structure or in the quality assurance systems as recommended through previous inspection visits. This was of concern as the lack of formal training, support and structure within the service could impact upon the way service users' needs are met and evaluated. page 4 of 38

5 At the time of the inspection visit, the provider/manager had applied to the Care Inspectorate to change the legal entity of the care service. This would involve the service re-registering with the Care Inspectorate and a change of name. We have written to the provider/manager about operational matters that should have been better managed in respect of this process. page 5 of 38

6 1 About the service we inspected Inspection report Assistance in Care Services Ltd is registered with the Care Inspectorate to provide a support service to adults living in their own homes, and in the community. The office base is in Glenrothes. At the point of this inspection, Assistance in Care Services Ltd delivered a service in the Fife area. At the time of our visit, 12 people were using the service and most of these people directly commissioned their service. Some people funded their support package through self directed support (SDS) where people are assessed through social work and receive a budget to spend on support that they think best suits their needs. The provider does not intend to dramatically increase the size of the business as they are confident that this allows them to be responsive and flexible. The written aims and objectives of the service include: 'To provide an exemplary service by ensuring each person is treated individually and equally' 'To deliver a person centred and outcome based service, and, to promote and develop domiciliary care services to enable individuals to live in their own homes with support, wherever feasible and preferable, and maintain independence for as long as possible.' The service user guide states that Assistance in Care Services Ltd will: 'Recognise the rights of individuals to lead independent lifestyles within their own homes and with appropriate support, where practicable.' The manager of the service is also the registered provider of the service and, as reported, had made an application to the Care Inspectorate to change the legal entity of the care service. page 6 of 38

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 - Grade 3 - Adequate Quality of management and leadership - Grade 2 - Weak 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 38

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 When we plan how we will inspect a service we review the intelligence we hold about the service. This will include: - The self assessment we ask the service to complete where they evaluate how they are performing - The annual return we ask the service to complete where they provide information about the needs of their service users and detail their staff team - Notifications the service provides to us informing us of events that impact upon the service - Any complaints the Care Inspectorate has received - Recommendations and requirements made through inspection or complaints - The risk assessment we complete. This information informs the intensity of the inspection. We wrote this report following a short notice announced inspection. For this service a short notice visit was necessary as the office is open on a part time basis only. The manager also delivers care and we had to arrange suitable times to visit. We visited the office base on Monday 18 April 2016 and went on to visit service users in their homes late afternoon and early evening. We visited the office again on Wednesday 20 April. To conclude the inspection process, and provide formal feedback to the care manager and quality assurance manager, we visited the office on Thursday 12 May At this meeting, the case holding inspector was joined by an inspector from our Registration team. page 8 of 38

9 During the inspection, we gathered evidence from various sources including: - The service user guide - Relevant sections of policies and procedures including quality assurance and the training manual - The service's most recent annual return - Three care plans for people using the service including risk assessments - Minutes of staff meetings - Six staff files - Staff supervision records - Information from staff training records - Information on quality assurance systems - Service users' financial transactions and the provider's invoicing system - Care standards questionnaires returned to the Care Inspectorate. We spoke with: - Four service users in their homes - Four relatives on the telephone - One carer in person - Three carers on the telephone - The care manager - The quality assurance manager. Inspection report At the time of the inspection, 12 people were using the service and seven permanent staff members supported the care manager in the delivery of the care service. All of this information was taken into account during the inspection process and was reported on. For the purpose of this report, people using the care service will be referred to as service users, a term used within the service. Relatives will be the term used to refer to any family members or carers that we spoke with. page 9 of 38

10 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 report 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 10 of 38

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. We received a fully completed self assessment document from the service. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade the services under. The provider identified what they thought the service did well, some areas for development, any changes they had planned and grades they awarded themselves based on their performance under the quality indicators. We reviewed the self assessment before inspection and reviewed some of the evidence that the provider said they had to evidence their performance. Taking the views of people using the care service into account We asked the manager to distribute care standards questionnaires to all of the people using the service (as it is a smaller service). We received four completed questionnaires out of a possible % of respondents agreed that overall they were happy with the quality of care. 75% of respondents stated that they had a personal plan or support plan which contained information about their support needs. One person stated they did not want a plan in their home. page 11 of 38

12 100% of respondents knew the names of the staff who provided their support and care. 100% of respondents stated staff treated them with respect. 100% of respondents stated staff had enough time to carry out the agreed support and care. Comments from people we met are included in the body of the report. Taking carers' views into account Some of the questionnaires returned to us were completed by relatives and carers of the service users. People indicated that they were happy with the service provided. One relative commented: 'The high quality service provided has been invaluable to our family in supporting our father to remain in his own home. XXXX, XXXX and XXXX [manager and 2 staff members] are all very professional, approachable and reliable. They have a sound knowledge of dementia and cater to our father's needs very well. They are flexible with his care package to ensure that he is happy and settled within the personal and social care provided.' page 12 of 38

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 Services undertake a self assessment before an inspection. This service evaluated its performance under this statement as good. To assess this statement, we: - Verified information contained within the service's self assessment - Met with four service users in their homes - Spoke with four relatives over the telephone - Spoke with the staff team - Observed how staff supported and engaged with service users - Assessed documents available to us including care plans, risk assessments, medication systems and recordings and records of care reviews - Considered how service users' care needs were assessed and evaluated and what the outcomes were. We concluded that the service was performing at a very good level in relation to this statement. page 13 of 38

14 Assistance in Care Services Ltd had chosen to remain a small provider and there was strong evidence that this supported them in being a very flexible and responsive service. This was confirmed by the service users and relatives that we spoke with. People knew what to expect from the service and told us that the service more than met their expectations. Every person we spoke with told us that the service was reliable, that they knew which staff visited them and that if changes were made (or staff significantly held up) they would be informed. Service users received a written schedule every week informing them which staff would visit - and we evidenced that there was very little variation in service users' staff teams. Some people told us that the manager provided their visit if staff were unavailable. The manager confirmed that they continued to offer around seven hours of direct support weekly. One relative had some experience of visit times varying but told us that they had spoken with the manager and that the situation had been resolved for a few months now. Comments from service users and relatives included: 'No missed visits, all on time as they should be.' 'Certainly seems to be consistent care with a real understanding of my relative's care needs.' When we observed staff practice and interaction with service users, it was apparent that they knew people and their needs very well. We saw examples of staff knowing what comforted and reassured people. One relative told us: 'Staff know what can trigger XXXX's [relative's] behaviour, know how to settle and reassure.' We saw this in practice. Service users and relatives could give us examples of the positive impact that the service had upon their quality of life. Some relatives stated that the service was enabling their relative to remain in their own home and that the service user's health had improved since the service started. Comments included: page 14 of 38

15 'The service has helped my XXXX [relative] stay healthy, good food, gaining weight, health much better.' 'Physically and mentally improved.' We saw how staff used their time to gain the best outcomes for people. For example, one person could become restless in their home but enjoyed visiting local cafes and shops. An agreement was in place between the family and the service that staff could be responsive to the person's mood and needs and go out for a coffee/lunch when best suited the individual. As a result, they were settled when they did return home and benefited from being out and remaining involved in their interests and local community. A staff member commented: 'The outcomes are so much better, it is really person centred care.' We looked at the plans of care for the people we visited and one additional plan in the office base. Overall, we found the plans to be informative and included a range of risk assessments. From reading these plans we gained a real insight into that individual, their interests and preferences and their support needs. For example, there was real detail about what an individual could do independently and clear guidance on what help was required. In other plans, food likes/ dislikes, hobbies and preferred routines were recorded. In one plan, the life history information would have enabled us to speak with that person about their life's work, interests and hobbies as it was well detailed. Overall, people were very happy with the support provided and had confidence in the care staff who visited. Further feedback included: 'Treated properly.' 'Excellent service.' 'Made a difference to us.' 'Real trust.' 'First class - no complaints.' 'Couldn't do without the service.' 'Very good service.' '1-1 attention.' page 15 of 38

16 Areas for improvement We had concerns about the service's record keeping and this is reflected upon further under quality theme 4, statement 4, and the resultant grade awarded. The service was unable to evidence that it had a clear process in place for formally reviewing people's care needs. This lack of consistency was confirmed through our discussions with relatives and documents we examined. We had discussed this at previous inspection visits and could not evidence progress made. We acknowledged that the manager was responsive to staff and service users needs but there were examples where the manager could not evidence the outcomes from either reviews of care or responses to relatives' feedback. As an example, in one of the plans of care we sampled, the outcome from the review and the plan of care did not correspond. (See recommendation 1) We spoke with the manager about the consistency and detail in the care plans. For example, in some of the plans the detail could be expanded upon to inform the reader more about how an individual's medical condition affected them. We also saw some examples of plans and risk assessments requiring to be updated. For example, risk assessments detailing outings as weekly but staff and relatives confirmed they happened more often. Not everyone had their life history recorded and yet, along with the manager, we could see such positive outcomes when people's life histories were detailed well. We shared with the manager some examples where terminology could be improved upon. We often saw the phrase 'I suffer from', it is more appropriate to be factual and record people's diagnosis and the impact that this has for them. Some documents were not completed or dated as they should have been and this is reflected upon under quality theme 4, statement 4. page 16 of 38

17 Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations It is recommended that regular formal reviews of service users' care and support needs are scheduled. Review documents and care plans must evidence how service users and their representatives have been consulted about how the service is meeting service users' health, welfare and safety needs. Care plans and risk assessments should reflect the outcomes from this review process. National Care Standards Care at Home: Standard 3 - Your Personal Plan. page 17 of 38

18 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 Services undertake a self assessment before an inspection. The service evaluated its performance under this statement as adequate. To assess this statement we: - Verified information contained within the service's self assessment - Met with service users in their homes - Spoke with relatives over the telephone - Spoke with the staff team - Assessed documents available to us including the service user guide, written agreement and records of care reviews - Considered how service users' care needs were assessed and evaluated and what the outcomes were. We agreed with the service's evaluation that it was performing at an adequate level in relation to this statement. Most of the people we met had chosen the service through personal recommendations. Some people had become aware of the service through information leaflets provided by other agencies such as The Elderly Forum. Relatives and service users we spoke with confirmed that they met with the manager at the time of the initial assessment. Some stated that the manager spent around 1.5 hours with them and that their assessment was detailed. One person commented: 'They got to know the person through that assessment process, very positive.' page 18 of 38

19 In the files we sampled, the assessment was detailed and overall gave a clear picture of the individual's care and support needs. This included a lot of detail about service users' personal preferences and routines. People told us that they knew the care manager well as they sometimes delivered care and, for them, this meant that they could ask questions and get updates. People we visited had a service user guide in their home. In general, this was a detailed document containing information about Assistance in Care Services Ltd and what people should expect from the service. This guide included the core values and aims and objectives of the service, quality assurance systems and some detail on policy and procedure. Everyone told us that the manager was professional, responsive and available. Service users, relatives and staff confirmed they had quick responses from the office based staff when they contacted them. In the self assessment, management recognised that more frequent reviews of policies and procedures would help them identify where information may be lacking. It was encouraging to see that this process had started. Areas for improvement There remained a lack of formal opportunities for service users and their families to provide feedback on the service. No quality assurance questionnaires had been issued and there had not been any focus group meetings (something the service had planned to do). The manager identified that meeting with service users choosing to leave the service would be good practice, this was not yet in place. We advised at last year's inspection that the provider's website ( be updated. This had not happened. The management team acknowledged this. In people's care plans, we saw written agreements that had not been signed by the service user or relatives/carers. In some instances, the person had received the service for some time. We would expect that these areas be identified through the service's quality assurance systems or review process. page 19 of 38

20 The service user guide would benefit from being reviewed. For example, the contact details for the Care Inspectorate require updating and the guide incorrectly states the service has a training manager. The way that the service records some people's financial management could be improved upon. There were no concerns around staff practice but we shared a specific example with management when recordings in care plans and relevant documents could better support practice and arrangements that were in place. Grade 3 - Adequate Number of requirements - 0 Number of recommendations - 0 page 20 of 38

21 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate 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 Services undertake a self assessment before an inspection. The service evaluated its performance under this statement as good. To assess this statement, we verified information contained within the service's self assessment, spoke with frontline care staff, the management team, examined staff files and evaluated staff induction training. We also spoke with service users and relatives. We concluded that the service was performing at an adequate level in relation to this statement. We sampled four staff files to evaluate the way that staff were recruited, inducted and supported when they joined the service. In general, the files contained: - Recruitment checklists - Application forms - fully completed - Formal interview records - Copies of training records and qualifications - Evidence of employment history - Two references - most contained one from a previous employer - Photographic identify checks. page 21 of 38

22 We spoke with several members of the staff team. They participated positively in the inspection process and engaged with us in discussions about their recruitment and practice. Comments included: 'I'm working through the induction booklet but not met with the office staff yet (to look at the book).' 'No other training since I started.' 'Induction was very brief.' 'Had one day shadowing.' 'Not had moving and handling training yet.' 'Managers great, very responsive.' We found that the staff team was committed to the care and support of service users they visited. No service users or relatives had concerns around staff members' manner or approach. One relative did have some concern around staff competence and had raised this with the manager. Areas for improvement We acknowledged that Assistance In Care Service Ltd is a small employer that provides care of a very good standard. However, we were not confident that the service's recruitment and induction process was as robust and safe as it could be. This is reflected in the grade awarded. The staff induction schedule was not standardised. We spoke with staff who had been in their job for around four months and had not completed their induction booklet, had not yet attended moving and handling training and had not had their practice formally assessed. Most staff had shadowed an experienced worker for one day and some staff felt this was brief. Whilst there was a good recruitment checklist in place, in some of the files this was not completed, dated or signed. page 22 of 38

23 In three of the four files we sampled, there was no record in the office base that staff had undergone their Protecting Vulnerable Groups (PVG) checks. This scheme was introduced by the Scottish Government to ensure that those with regular contact with vulnerable people do not have a known history of harmful behaviours and it is an essential element of robust safer recruitment practices. At a later date, the manager was able to confirm these checks had happened. Given the positive outcomes for service users and the manager then being able to confirm PVG checks, on this occasion, a recommendation not a requirement has been made. (See recommendation 1) Grade 3 - Adequate Number of requirements - 0 Recommendations Number of recommendations Records must be improved to demonstrate safer recruitment practice in line with the provider's policy and the Scottish Government's safer recruitment practice. The service must be able to evidence that it has evaluated the skills, knowledge and competence of new start staff as part of their safer recruitment practice. We expect that all staff are appropriately trained in relevant aspects of the health needs of each individual using the service. National Care Standards Care at Home: Standard 4(6) Management and Staffing. page 23 of 38

24 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths Services undertake a self assessment before an inspection. The service evaluated its performance under this statement as good. To assess this statement, we: - Verified information contained within the service's self assessment - Observed staff practice - Spoke with frontline care staff and the management team - Examined six staff files - Evaluated staff training records - Spoke with service users and relatives. We agreed with the service's evaluation that it was performing at a good level in relation to this statement. Service users and families provided positive feedback about staff, their consistent approach and the way that the service was delivered. We recognised that the size of the size was a strength as it meant that there was a flexible and responsive approach to service users' needs. As reported on under quality theme 1, statement 3, service users and relatives were confident in the care and support provided by Assistance In Care Services Ltd. Comments included: 'Fairly young staff.' 'Very good, love them all.' 'No concerns around staff's manner or skill.' page 24 of 38

25 We met with three service users in their homes whilst staff were visiting to provide their support. The service users were relaxed and very comfortable with the staff member who was respectful and caring in their approach. We could see that the staff member knew the individuals well and knew how to reassure and support them. The staff we met and spoke with were considerate and supportive of the service users and families they visited. We concluded that staff were motivated to provide a level of care and support that resulted in a positive quality of life for service users. The staff spoke of the real importance and pleasure of delivering person centred care. Staff we spoke with told us that they enjoyed their work very much. Comments included: 'Fabulous.' 'It's perfect.' 'Totally love it, the manager's outlook is really good.' Inspection report The manager continued to deliver some direct care to service users and this provided them with an opportunity to work alongside the care staff. This meant that the manager knew the staff team and had a good understanding of staff members' manner and approach. Staff confirmed that they had easy access to management for advice and guidance, as needed. In general, we found that staff had a good understanding of their roles and responsibilities. Areas for improvement There were no firm plans in place as yet for frontline staff's required training and registration with the Scottish Social Services Council (SSSC). This register opens for care at home frontline workers in January 2017 and consideration must be given to this. page 25 of 38

26 At last year's inspection, we recommended that the service review its staff training policy. Whilst the policy had some good detail in it, it had not been updated and did not include information about which mandatory training staff required regular updates on. The training manual states that the provider will carry out a training needs analysis for all staff and that the provider would ensure that staff had the minimum level of mandatory training. We were unable to evidence this. We found that whilst staff generally felt supported, there was a lack of evidence to demonstrate how staff's understanding of service users' needs and overall competency were assessed. We sampled six staff files and saw that there was variation in how often formal supervision happened. For example, two staff members had supervision meetings annually (but not within the past 12 months) and some staff had not had formal supervision meetings. The provider had still not developed a staff training plan. This would demonstrate that they are forward planning and taking account of the individual needs of service users. The recommendation we made at last year's inspection remains. (See recommendation 1) The management team should use team meetings and supervision sessions to support staff in exploring best practice guidance or research linked to topics relevant to healthcare. These opportunities would lead to staff having a wider knowledge and understanding about people's health and wellbeing and encourage staff to take a holistic pro-active approach to delivering care and support. (See recommendation 2) The management team should work with staff to encourage them to clearly identify how their training needs are being met. They could, following each training event, identify what individual or team learning points have been and how these will be implemented in practice. This reflective practice would result in staff taking responsibility for their own learning and lead to improved outcomes for people using the service. page 26 of 38

27 Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The provider should: - Review the current training and development policy to ensure that it provides sufficient detail and guidance. This should provide information relating to training, assessment, evaluation and ongoing staff development and mandatory training. - Have a training plan in place to take account of mandatory training and forward planning to consider the needs of service users. This should include adult support and protection and manual handling training. National Care Standards Care at Home: Standard 4 - Management and Staffing. 2. The provider is recommended to make use of management practices such as supervision and appraisal and regular staff meetings to support, develop and guide each staff member in their practice and ensure that each staff member is meeting expected standards of practice. National Care Standards Care at Home: Standard 4 - Management and Staffing. page 27 of 38

28 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 2 - Weak Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service Strengths Services undertake a self assessment before an inspection. The service evaluated its performance under this statement as good. To assess this statement, we: - Verified information contained within the service's self assessment - Spoke with frontline care staff and the management team - Examined relevant staffing documents - Spoke with service users and relatives. We concluded that the service was performing at an adequate level in relation to this statement. The care staff that we met told us that the management team of the service was available, responsive and supportive. As reported under quality theme 3, statement 3, staff very much enjoyed working for Assistance In Care Services Ltd and fully understood the fundamental aims and objectives of the service which included: 'To provide an exemplary service by ensuring each person is treated individually and equally.' Staff could tell us about the values that were important to the management team and we saw that staff shared those values and beliefs. Service users and relatives saw how these values and approaches provided positive outcomes and, for some, this was why the service had been recommended to them. page 28 of 38

29 Areas for improvement In the self assessment, the management team referred to staff's induction process, their training plan and staff appraisal systems as the ways that they involved their workforce in determining the direction and future objectives of the service. As reported under quality theme 3, these formal procedures were not in place in a consistent and structured way. Most staff that we spoke with were not aware of the planned changes to the provider including changes to the legal entity and the structure. The recommendations made under quality theme 3 are relevant to this statement. Grade 3 - Adequate Number of requirements - 0 Number of recommendations - 0 Inspection report page 29 of 38

30 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 Services undertake a self assessment before an inspection. The service evaluated its performance under this statement as good. To assess this statement, we: - Verified information contained within the service's self assessment - Spoke with frontline care staff and the management team - Spoke with service users and relatives - Reviewed a variety of supporting documents including formal reviews of care, staff records, training records and considered the progress within the service which contributed to the auditing and quality assurance process. We concluded that the service was performing at a weak level in relation to this statement. As reported on under quality theme 1 and 3, the size of the service and the way that the care was delivered meant that the service was in a very strong position to gather feedback from service users and relatives. Service users told us that they found the staff and management approachable and responsive. This ensured that there was a high level of satisfaction in the service received. All of the service users had met the manager at the time of their initial assessment (or because the manager had provided their care at some time) and this meant that they knew who to speak with if they had concerns or wanted to raise a complaint. Service users told us that they were confident the manager would respond appropriately. The size of the service enabled the staff team to manage many situations informally and be responsive to service users and families. page 30 of 38

31 Areas for improvement Assistance In Care Services Ltd has been providing a care at home service since 2012 and, at each inspection visit, we have recommended that the provider develop the way in which it formally monitors and evaluates how well the service performs (quality assurance systems). This is particularly relevant as the manager is now delivering less direct care and there could be less opportunity for service users to meet with the manager on a daily basis. We would expect to see regular formal reviews of care needs, evidence of robust recruitment, staff training and staff supervisions. We would also expect to see formal systems in place to allow people to feedback on their experience of using the service. Overall, this was not evident. The management team confirmed that there had been no significant developments since the last inspection. The recommendation we made at previous inspections has been removed and a requirement has been made. (See requirement 1) Record keeping and communication must be improved upon. The management team had contacted the Care Inspectorate regarding a potential change to the provider of the care service; this would require a new application for registration. We were concerned that information had been provided to service users, relatives and staff prematurely and was not open and transparent. This impacted upon the way people were invoiced for the care provided to them. We have discussed this situation in depth with the management team and have asked them to provide us with further information relating to this matter. (See recommendation 1) The lack of progress over the last four years in formal quality assurance systems along with the practice concerns identified in relation to the handling of the proposed changes to the provision of care have resulted in the grade awarded under management and leadership. page 31 of 38

32 Grade 2 - Weak Requirements Number of requirements Robust systems for quality assurance must be in place to ensure the highest standard of service delivery. To ensure this, the provider must be able to evidence that: - There are formal quality assurance systems in place that can measure and evaluate how the service is performing and evidence outcomes for those involved with the service. This must include formal reviews of care needs and evidence of effective care planning and review. - There is robust recruitment, staff training and staff competency assessments. - They make use of management practices such as supervision and appraisal and regular staff meetings to support, develop and guide each staff member in their practice and ensure that each staff member is meeting expected standards of practice. - They reach a level of quality assurance that involves people using the service, their families/carers, staff and other stakeholders. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations SSI 2011/210. Regulation 4(1) Welfare of Users. Timescale for meeting this requirement: Within four weeks of receiving the final report, the provider must submit evidence to the Care Inspectorate to demonstrate that progress is being made. This requirement should be met within 12 weeks of receipt of the final report. page 32 of 38

33 Recommendations Number of recommendations The provider should ensure that service users have accurate and detailed information to help them decide about choosing, using and ceasing to use the care service. The provider should ensure that all documentation issued contains accurate information and that where invoices or other documents are issued from the provider, that the provider's details are accurately recorded in full. National Care Standards Care at Home: Standard 1 - Informing and Deciding and Standard 4 - Management and Staffing. page 33 of 38

34 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 1. The service should: - Plan to ensure that required members of the staff team are appropriately registered with the relevant body (Scottish Social Services Council (SSSC) within the required timescale. - This should include members of the office based team who have supervisory roles within the service. National Care Standards Care at Home: Standard 5 - Management and Staffing. This recommendation was made on 05 May 2015 The office based staff team was now appropriately registered with the SSSC. 2. The service should: - Review the current training and development policy to ensure that it provides sufficient detail and guidance. This should provide information page 34 of 38

35 relating to training, assessment, evaluation and ongoing staff development and mandatory training. - A training plan should be in place to take account of mandatory training and forward planning to consider the needs of service users. This should include adult support and protection training. National Care Standards Care at Home: Standard 5 - Management and Staffing. This recommendation was made on 05 May 2015 We received a copy of the provider's training policy and manual. Whilst the policy had some good detail in it, it had not been updated and did not include information about which mandatory training staff required regular updates on. Most staff confirmed that adult support and protection training was included in their induction training but that there had been no updates since. The service found it very difficult to evidence which staff had attended formal moving and handling training since our previous inspection visit. The training matrix the service provided did not include details of training that we would expect staff to have to ensure that they have the skills and competence to meet service users' health and wellbeing needs. The training manual stated that the provider will carry out a training needs analysis for all staff and that they would ensure that staff had the minimum level of mandatory training. We were unable to evidence this. This is reported on further under quality theme 3, statement The service should review their quality assurance systems to ensure that: - There are formal quality assurance systems in place, that can measure and evaluate how the service is performing and evidence outcomes for those involved with the service (including staff). - They reach a level of quality assurance that involves people using the service, families/carers, staff and other stakeholders. Inspection report - The service should ensure that staff at all levels become involved in the page 35 of 38

36 service's quality assurance systems, and have a clear understanding of the process of improvement relating to quality. Discussion at team meetings and individual supervision sessions may assist this level of work. National Care Standards Care at Home: Standard 4 - Management and Staffing. This recommendation was made on 05 May 2015 We requested a copy of the provider's quality assurance policy. It included relevant regulatory legislation, information on being a responsive service (what service users should expect) and the complaints process. For the fourth consistent year, there had been no significant developments in the systems used to formally assess and measure the quality of the service. For example, the service could not show us how regularly service users' needs were formally reviewed, when staff had attended required training or how often staff received formal supervision and appraisal meetings. This is reported on further under quality theme 4, statement 4. Inspection report 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. page 36 of 38

37 9 Inspection and grading history Inspection report Date Type Gradings 5 May 2015 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 4 - Good Not Assessed 4 - Good 3 - Adequate 16 Apr 2014 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 4 - Good Not Assessed 4 - Good 3 - Adequate 7 May 2013 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 4 - Good Not Assessed 4 - Good 2 - Weak page 37 of 38

38 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 38 of 38

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