Care service inspection report

Transcription

1 Care service inspection report Full inspection St. Aubins Care Home Service 87 South Anderson Drive Aberdeen Inspection completed on 14 June 2016

2 Service provided by: Aberdeen Association of Social Service, a company limited by guarantee, trading as VSA 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 enquiries@careinspectorate.com 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 5 Quality of environment Quality of staffing 5 Quality of management and leadership Very Good N/A Very Good N/A What the service does well The service provides a personalised service in a homely relaxed environment for the people living there. It works to a recovery focussed model with service users. What the service could do better The service should ensure that timescales are adhered to in relation to recording information. What the service has done since the last inspection The service has established a recovery focussed model of care that is supporting service users to take on responsibility. Conclusion The service is performing to a high standard. They should continue to ensure they maintain this standard and keep up-to-date with current best practice. page 3 of 23

4 1 About the service we inspected St. Aubins is registered to provide accommodation for eight people who have experienced problems with their mental health. Residents either no longer need full-time hospital care and have the potential to move on to more independent community living, or have experienced difficulties managing to live independently in the community and require a period of rehabilitation and assessment. The accommodation is on two floors, with individual bedrooms and spacious communal facilities. The house is two miles from the city centre with a bus route nearby. 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 Quality of environment - N/A page 4 of 23

5 Quality of staffing - Grade 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. 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 An unannounced inspection was commenced on Monday 13 June 2016 and a further visit was made on Tuesday 14 June As part of the inspection we took account of the completed annual return and self assessment forms that we asked the provider to complete and return to us. During the inspection we gathered information from a number of sources, including the following: We spoke with: - four service users - the manager - four members of staff. We looked at a range of documents and records including: - policies and procedures - minutes of service users meetings - minutes of staff meetings - the recovery personal plans - supervision records - accident and incident records - quality assurance records. page 6 of 23

7 Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at page 7 of 23

8 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 self assessment had been completed prior to the inspection. Taking the views of people using the care service into account Four service users were spoken with during the inspection. Taking carers' views into account There were no carers available at the time of the inspection. page 8 of 23

9 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: Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths At this inspection, we found that the performance of the service was very good for this statement. The service met the health and welfare needs of service users very effectively. We looked at personal plans and spoke with staff and service users. Examination of plans indicated that the GP and any other health or social care professionals had been identified and their contact details recorded on the plan. Health issues both mental health and physical health would be identified and recorded. There was evidence of continual assessment and review of these. Service users had been supported to access health services and this support had been recorded. The manager had advised how service users would be supported through the use of recovery focussed care plans which contained information on health, relationships, fun/activities and occupation. In discussions with the manager she advised on the developments within the service in relation to the recovery focussed nature of the work that is now going on. The manager advised that she considered that staff now had a more page 9 of 23

10 proactive approach and knew where they were going with this approach when working with service users. Service users were being encouraged to complete a Wellness Recovery Action Plan (WRAP). This would allow the service user to make a decision about their plan and where they currently saw themselves. Service users would also use a toolbox which encouraged them to look at potential issues they may face and identifying things they would need to do on a daily basis. They would also be identifying what could cause them stress which could result in them becoming unwell. Once all areas had been considered staff and the service user would put an action plan in place. Within the plan there was information on a range of interventions and supports that were available to each service user. This included mindfulness, anchoring, calming place, compassion techniques and smoking cessation. Service users would record if they found a particular intervention helpful. The service had also provided written information on the techniques available. Service users were asked for their comments on how the service had supported them: - "It's been really helpful here". - "It works best when I am working toward goals". - "I want to do something, staff provide me with the choices". - "I have started college, I can now cook, it's a big difference". - "I'm now cooking, that would help if I get my own place". - "I go to the farm, I work in the garden, I'm doing more". Staff were asked for their views on how they considered they were supporting service users: page 10 of 23

11 - "Recovery is getting better, we are clearer about what we are doing". - "We follow through on what we plan". - "It helps us working with residents, we can see the improvements". - "Residents are far more involved, we can see the changes". - "We have to justify what we do and know why we are doing it, that's good". The service had a policy and procedure in place in relation to adult protection. One member of staff spoke in detail about how he had reacted to concerns he had identified and how he had worked with the social worker in that instance. This was clearly documented in the records. For service users and staff there was a more proactive approach being used within the service. Staff had a clear understanding of the recovery approach and had been provided with training and ongoing support. For service users this meant they were being offered more activities and options and the opportunity to state their views on these options. Areas for improvement While reading notes there were examples where dates had not been met and there was no explanation as to why the date had not been met or the outcome of the intervention. Examples of where this had happened were provided to the manager (see recommendation 1). Grade Number of requirements - 0 Recommendations Number of recommendations That the provider ensures that records are up-to-date and accurately reflect the inputs that staff have with service users. page 11 of 23

12 National Care Standards Care Homes for people with Mental Health problems. Standard 6: Support Arrangements. 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 At this inspection, we found that the performance of the service was excellent for this statement. The service provided a range of information and support for service users moving in and moving on from the service. The manager advised how referrals would be made to the service and then the process of giving a potential service user the opportunity to decide if they wished to live at St Aubins. Prospective service users were invited to visit the service prior to coming to any decision. The manager advised that at these visits they could meet with staff and the other service users. Examination of records indicated that there was a checklist in place for staff to complete as a service user moved into St Aubins. An induction pack was in place that contained information for the service users. This included an information booklet about the service. Within this booklet there was photographs of the service and information as to the local services. Current service users had also provided comments. The latest newsletter was also included to provide service users with information regarding the current activities at the service and the organisation. For service users this meant they had information they could take away and read and they could also see what current service users were saying about their experience of living there. page 12 of 23

13 One service user spoke through the admission process and how he had been supported through it. He advised that he had been given a number of options and had decided following visits and information provided that he wished to stay at St Aubins. The manager advised that they had supported some service users to move on since the last inspection. She explained how this had been done and what supports had been available. This included support to make choices and to compile any questions they may have about the process. It was possible to look at the plan for a service user who had recently moved on. Staff were offering to ask questions on the service users behalf and checking to ensure that all areas of the move had been covered. The service user would identify the timescale and then note the supports they would require for the move. This could include contact with the new service and support to make the move. When a service user moved on they would be asked to give their view on how the move had been and also to reflect on their stay at St Aubins. From speaking with service users and examination of records the service was supporting service users throughout the process of moving on or moving into the service. Areas for improvement The service is currently performing to a high standard in relation to this statement. They should continue to offer flexible support to service users moving and moving on from the service. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 13 of 23

14 Quality Theme 2: Quality of Environment Quality theme not assessed page 14 of 23

15 Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths At this inspection we found that the performance of the service in relation to this statement was very good. The service had a mixture of experienced staff and staff with appropriate life experiences to best support service users. The manager had advised on the various policies and procedures that were in place to support staff and to provide information and guidance. This included training, supervision, personal planning and health and safety. A staff induction pack was in place. This highlighted the responsibility of senior staff to ensure that each area was completed. Employees would sign, and the staff member assisting with the induction would also sign, to confirm it had taken place. The staff induction had recently changed. It was considered that staff were being asked to take in too much in a short period of time. The induction period had been extended. In discussion with one member of staff who had recently joined the service, they spoke positively about the induction process. They felt they had been given time to settle in and work through the induction. A tracking system was in place for supervision and staff spoken with confirmed they were receiving regular supervision and felt supported in their role at the service. The tracking system would also confirm what model of supervision had been used whether formal, informal or group. Comments from staff regarding this included: page 15 of 23

16 - "We get regular supervision but everyday is informal supervision". - "It's all been very supportive since coming here". - "I am fully supported and management are always available". - "We are definitely supported and we can phone as well if we need anything". Training information was in place and it was geared toward the needs of service users and staff. Staff spoken with spoke positively about the training that was available for them and how they could access that training. A training record was in place. This indicated that staff had completed training in various areas including medication, new support plans, mental health and adult protection. The manager also explained the training that had been provided in relation to the introduction of the recovery plans. Staff had completed a 4 day course of training. The manager was an accredited trainer and was available to further support staff. Comments from staff regarding training included: - "The recovery training was 4 days over 4 weeks, it covered a lot and we had to work, it was very good". - "We asked for naloxone training and that was arranged". - "The training has been really good, I'm very happy with it". - "We can access a lot of training and we now have E learning as well". Staff meetings continue to take place and minutes were in place for these. The minutes indicated that a range of issues were being discussed. There was also evidence of further training being provided at these meetings and staff being supported with information and advice. page 16 of 23

17 In discussions with staff and the manager they came across as highly motivated to provide a high quality of service and to reflect on their practice. Areas for improvement While it was noted that improvements had been made to the induction process it was also noted that in one case all the induction checks had not been completed within the 3 month period (see recommendation 1). It was also considered that it would be beneficial for staff to be reminded of their role and responsibilities in relation to adult protection to ensure there is a consistent approach to any concerns. Grade Number of requirements - 0 Recommendations Number of recommendations That the provider ensures that inductions are carried out within the recognised timescale and that this is accurately recorded. National Care Standards Care homes for people with mental health problems. Standard 4: Management and staffing arrangements. Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths At this inspection we found that the performance of the service in relation to this statement was excellent. The service had a clear ethos of respect toward the service users who lived there and to the staff. page 17 of 23

18 The manager provided a number of areas of evidence. This included a gold investors in people award, participation policy, dignity at work policy and the supervision and appraisal system that was in place. One of the values of the organisation was. - "We will respect and value our service users, partners, volunteers and staff". Information contained within quality theme 1, statement 3 would also apply to this statement. Service users were being given control of their records and plans and being encouraged to take a lead role in deciding what they wished to do. This demonstrated that their views were being respected. One service user stated "I now have control and my confidence has improved" another comment was "I am fully respected here". In discussions with staff they spoke respectfully about the service users. Staff indicated how they would reflect individually and as a group on their inputs with service users and encourage service users to identify and work toward their goals. Observation of practice indicated staff and service users treating each other with respect. This had contributed to the homely atmosphere at St Aubins and staff and service users were relaxed in each others company. Questionnaires had been issued to service users in February They were being encouraged to share their views and that their answers would be treated in confidence. There was evidence of their comments being followed up and shared with them as to any actions that would be required. A residents meeting took place on a regular basis and minutes were available for this. Any suggestions from service users were being recorded and an identified person listed to follow any suggestions through and report back. The service shared a range of information with service users including the Care Inspectorate's report and the annual report of the organisation. There was also information from the SSSC about what the service users could expect from staff. page 18 of 23

19 In discussions with staff they also indicated that they felt respected in their role. Comments included: - "I can make suggestions and I'm listened to". - "The manager and the organisation are very open with us". The service had demonstrated their ethos of respect by their day-to-day inputs with service users. Staff were prepared to let service users take control and responsibility and respected their right to do this. Areas for improvement The service is currently performing to a high standard. They should continue to ensure that service users views are respected. Grade 6 - Excellent 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 No complaints have been upheld, or partially upheld, since the last inspection. page 20 of 23

21 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 24 Apr 2015 Unannounced Care and support Environment Staffing Management and Leadership 24 Apr 2014 Unannounced Care and support Environment Staffing Management and Leadership 22 May 2013 Unannounced Care and support 4 - Good Environment Staffing Management and Leadership 4 - Good 3 Jul 2012 Unannounced Care and support Environment Staffing Management and Leadership 14 Dec 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed page 21 of 23

22 Management and Leadership Not Assessed 30 Aug 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership 18 Jan 2010 Unannounced Care and support Environment Not Assessed Staffing Management and Leadership Not Assessed 27 Oct 2009 Announced Care and support Environment Not Assessed Staffing Management and Leadership Not Assessed 23 Jan 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Management and Leadership 4 - Good 26 Aug 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 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. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 23 of 23