Care service inspection report Full inspection Annan Activity & Resource Centre Support Service 15 Ednam Street Annan Inspection completed on 05 May 2016
Service provided by: Dumfries & Galloway Council Service provider number: SP2003003501 Care service number: CS2003010868 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 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 27
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 continues to support the meaningful involvement of the people it supports and their families and to use their views and comments to develop the service. During the inspection, we had the opportunity to speak with people at the service. They commented positively about the care and support provided by the management and staff team at Annan Activity and Resource Centre (ARC). What the service could do better The management team should continue to encourage the staff team to record and report, when completing daily records or care planning activities, in a manner that focuses on individual personal outcomes for the people using the service. The service should encourage input from people using the service in implementing the Charter for Involvement, to monitor, evaluate and measure their performance against the standards it contains. The supervision of staff could be based on some observations of competency, within Dumfries and Galloway Council's procedure for the supervision of staff. page 3 of 27
What the service has done since the last inspection Inspection report There were five recommendations identified at the previous inspection in June 2014. The service has worked hard to meet these recommendations. This has resulted in an increase to the grades awarded by the Care Inspectorate following this inspection. Conclusion The care and support needs of the people who use Annan ARC are managed and met by a caring and skilled staff team. The management team demonstrated a commitment to the continued review, development and improvement of the overall service. The entire staff group demonstrated a commitment to ensure that the ethos of Annan ARC is welcoming and friendly. page 4 of 27
1 About the service we inspected Inspection report Annan Activity and Resource Centre (ARC) is registered to provide a support service to a maximum of 49 people with a learning disability. The provider is Dumfries & Galloway Council. The service is located in an old school building in the centre of Annan and part of the building is shared with other tenants. Owing to the age and design of the building, it does impose some restrictions on the service but several adaptations and improvements have been put in place to maximise the space and to meet the needs of the service users. Transport for members to come to and from the service is provided by a contract hire company or service users make their own way. The service has one bus which is used by members for leisure, social and community activities. Annan ARC provides a wide range of social, leisure, educational and employment training services. Referral to the service is through Dumfries & Galloway Council's Health and Social Services. In addition to the activities provided at the service there is a number of community based initiatives including cooking, fishing, swimming, computer skills, outings to places of interest, art, making DVDs and gardening. Several service users have work placements locally and links are being strengthened with the local colleges. The overall aim of the service is to support and enable people with a learning disability to become as independent as they can and to access local community resources. Each service user is allocated a key worker and they provide a link between the service user, their carers and any other agencies involved in providing that person's support. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. page 5 of 27
From 1 April 2016, the way in which we carry out inspections has changed. We choose which quality themes and statements are inspected for better performing services to be more proportionate and targeted in our work. 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 5 - Very Good Quality of environment - N/A Quality of staffing - Grade 5 - Very Good 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 6 of 27
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 www.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. page 7 of 27
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 compiled this report following an unannounced visit to the service. The inspection was carried out by one inspector over two days - Wednesday 4 May and Thursday 5 May 2016. We gave feedback to the manager on Thursday 5 May 2016. As requested by us, the service sent us an annual return and self assessment form. Prior to the inspection, we sent 15 care standards questionnaires to the manager to distribute to service users, their relatives and carers. Eight completed questionnaires were returned. We also issued five staff questionnaires and received three completed questionnaires from members of the staff team. Comments made by both service users and relatives/carers informed the inspection and are included in the inspection report. During the inspection, we spoke to people who used the service at the centre. We spent time observing how staff supported and interacted with people using the service. We spoke with the manager, day service officers and care assistants. Documents sampled included: - registration certificate - staffing schedule - introductory information - minutes of a range of meetings - accident and incident records - personal plans - risk assessments page 8 of 27
- staff supervision records - training records - records of quality audits. 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 www.firescotland.gov.uk page 9 of 27
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 provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. Taking the views of people using the care service into account We received some comments from people using the service in returned care standards questionnaires. Comments included "I am very pleased with the daily support I receive. The staff are caring and supportive and always take time to check that they have given me all the assistance they can." Taking carers' views into account We did not receive any comments from relatives/carers. page 10 of 27
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: 5 - Very Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths We found that the performance of the service was very good for this statement. The service delivered quality care that resulted in positive outcomes for people using the service. At this inspection, we looked at: - personal plans - records of accidents and incidents - service audits - information on staff training. We also spoke with people using the service and staff. People using the service had very good support plans that identified a range of care needs. We were able to see that these plans reflected individual needs accurately and that support assessments were regularly reviewed and updated according to current need. Some information in personal plans was written in the first person and from the service user's point of view. The outcomes for service users were clearly stated. The personal plans were in a user-friendly format and took account of health and communication needs. page 11 of 27
Risk assessments covered all aspects of service users' support plans and included reviews and updates, where required. We found very good examples of recording how service users' healthcare needs were being monitored. We observed the practice of staff within Annan ARC and saw examples of very good, person-centred care. Staff worked well throughout the centre and we saw that they had a great rapport with service users. We saw that health and wellbeing changes were quickly picked up on. We examined records of accidents and incidents and noted some had been reported to the Care Inspectorate. Accidents and incidents had been investigated by the service and other agencies were informed or involved, where necessary, with details recorded in the appropriate personal plans. We looked at the staff training schedule and training records and saw evidence of training received in areas such as food hygiene, infection control and adult support and protection. We saw that some training had been completed and some was scheduled for the remainder of the year. The training schedule highlighted training for staff to meet the needs of service users as well as providing development opportunities. We found well-trained, skilled and knowledgeable staff who were able to respond to health issues that affected people using the service. The staff practice we observed was of a high quality and the approach of staff was patient and respectful. Areas for improvement The management team should continue to encourage the staff team to record and report, when completing daily records or care planning activities, in a manner that focuses on individual personal outcomes for the people using the service. We discussed the Talking Points resource and how it could to be used to advise staff. Talking Points is a practical guide to a personal outcomes approach. page 12 of 27
Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 13 of 27
Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths The service performed to a very good standard under this statement. We came to this conclusion after we: - looked at documentation - spoke with people who used the service - observed the practice of staff with the people they supported. We observed very warm and caring relationships between staff and people using the service over the course of the inspection. We saw that when staff worked alongside people there was genuine warmth and appropriate use of touch and body language, to let them know they were cared for and valued as individuals. All staff were aware of their duties and responsibilities to promote independence, safety, choice and to respect all people using the service as individuals. Our discussions with staff about each service user's care and support needs, indicated that staff had built long-term relationships with service users and knew them well. We found that staff were very good at recognising when someone was behaving differently to usual and were quick to pick up on when someone was not happy about something or feeling unwell. The service had developed individual approaches to supporting people to communicate their needs and preferences where they could not communicate verbally. This included recognising and interpreting facial expressions and gestures. It was clear that all staff wanted the best outcomes for the people they supported and reflected on their practice on a regular basis. We found that the service supported people to achieve better health outcomes. We saw that the service worked closely with healthcare professionals such as speech and language therapists. page 14 of 27
We found that support plans were clear, easy to follow and detailed how best to support individuals. We noted that information was up-to-date and reviewed regularly or as needs changed. We saw that health needs, interventions and health updates were well documented and we found examples of positive health outcomes. We noted detailed risk assessments, including choking hazard identification. We found that risk assessments were regularly reviewed. We saw evidence of regular reviews of support plans and noted that relatives, care managers and other stakeholders were involved in planning in advance of the meeting. The reviews were an opportunity to discuss the care and support of people. The communication skills and needs of people using the service were taken into account at the review setting. The minutes we read demonstrated that staff responded effectively to comments from review meetings. We looked at feedback from relatives and found that they were very happy with the way their relatives were supported and the way that staff valued them as individuals and supported them in all aspects of their care. We saw very positive comments about the manner in which their relatives were supported, as well as the openness of the staff team and management in dealing with any questions or concerns they might have. We saw examples of the promotion of a person-centred approach and the choice of activities catered for individual preferences. We found that people's quality of social life was very good and active involvement in the local community was promoted and supported. The service was committed to promoting a human rights agenda through its policies and its participation strategy. We saw that this was underpinned by the training that staff received and was embedded in their practice. We found, consequently, that a positive culture had been cultivated in the service. page 15 of 27
Areas for improvement One of the people using the service was an active member of the National Involvement Network, whose aim is to promote, implement and support ongoing involvement for people who use services in the organisations that provide support for them. It is hoped that people who use services from the network will monitor and evaluate quality standards for user involvement in learning disability services and a National Charter for Involvement has been developed. The service should encourage input from people using the service in implementing the Charter for Involvement, to monitor, evaluate and measure their performance against the standards it contains. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 16 of 27
Quality Theme 2: Quality of Environment Quality theme not assessed page 17 of 27
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths We found that the service performance was very good for this statement. We concluded this after we examined personnel records and had discussions with people using the service. At this inspection, we met with: - the manager - day service officers - care assistants. At the last inspection, we made a recommendation that the manager should consider how service users can provide feedback regarding individual staff practice to the management team and develop and introduce this to the supervision and appraisal process. We found that feedback given by people using the service had been used to inform the supervision process. This recommendation had been met. We found that the service maintained a range of very good methods to support staff. These included: - regular one-to-one supervision - staff appraisal system - regular team meetings - a range of training opportunities. page 18 of 27
Staff said that they received very good support to carry out their roles and responsibilities and were very positive and complimentary about the service. They expressed a great passion and drive about working with the people who used the service and it was clear that they enjoyed working at the centre. Feedback from staff indicated that supervision sessions occurred. This was checked and we noted that there were supervision notes held on file and these were signed by staff to reflect that these were an accurate account of the session. The supervision was cross-referenced to relevant best practice or legislation, which kept the staff outcome-focused. We found that there were regular planned staff meetings and minutes to reflect the content of the same. We noted that these meetings were used to discuss staff practice, encourage staff to share ideas and assist staff understanding of any changes to the service. A good example included the introduction of outcome-focused care plans. We read that background information was given to staff as to why these were introduced, how they should be completed and how they should shape the day-to-day practices. We received comments from staff which indicated that staff morale was very good, support was provided by management and that there was a culture which encouraged staff to raise any concerns and share ideas on how the service could improve. All staff spoken with during inspection, gave good examples of how they have made suggestions about service users' needs and wishes, and how changes were made as a result of this. Staff shared that they were of the opinion that there was good team work and a shared responsibility for ensuring standards of care were maintained. Staff described a range of positive outcomes that service users had identified and had been supported to achieve. We saw very good evidence that staff responded effectively to comments from the person receiving support. There was evidence that staff were able to participate and shape the service. We looked at staff personnel files and saw that these, and other office-based systems, were well organised to support staff. page 19 of 27
Areas for improvement The manager should direct staff to utilise the SSSC (Scottish Social Services Council) Learning Zone to develop their knowledge and skills. The Learning Zone offers a flexible approach to learning and helps care staff to use learning resources that can contribute to recorded development requirements. We discussed how staff should evaluate the training provided in the service, as this was not evident in training records. We spoke of how the supervision of staff could be based on some observations of competency, within the council's procedure for the supervision of staff. The manager stated she will progress these areas for development and we will monitor this at the next inspection. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 20 of 27
Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths We assessed that the service worked to a very good standard under this statement. We concluded this after we: - reviewed a range of documentation - spoke with staff - observed the interactions of staff with people who used the service. We met with the manager and discussed training received by the staff team. We saw examples of training consistent in underpinning an ethos of respect and safeguarding for people using the service and staff. Examples included equality and diversity and adult support and protection. Staff confirmed they had received appropriate training to assist them to deliver good quality support proportionate to the needs of the people using the service. We observed staff and management and their relationships with people using the service. We found that they were really warm and caring, with an appropriate use of humour. We saw that the demeanour of staff exemplified that they were respectful of each other and of individuals' needs. We could see that people using the service were treated with respect by staff. Staff we spoke with clearly had people's best interests at heart. Staff described some of the activities they liked to support individuals with and knew their individual needs and personalities well. Discussions we had with staff indicated that they considered issues from a service user's perspective. Staff discussed service users' care and support needs in a respectful manner. We found that the language used in the documentation we sampled was appropriate and consistent with what we would expect from a service working with an ethos of respect towards each other. page 21 of 27
We saw very positive comments about the way service users were cared for in the service's feedback questionnaires. Relatives commented that they found staff to be courteous and respectful in all interactions that they had with them. Areas for improvement We discussed with the management team how people using the service and their relatives could be involved in ensuring staff maintained their respectful and caring approach when delivering care and support. We spoke about how this could be part of the supervision process, which could be expanded to include observations of practice and competency, with the involvement of people using the service. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 22 of 27
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 1. The manager should summarise the findings of service user questionnaires to provide evidence of how feedback was evaluated or acted upon to enable service users to contribute to the daily running of the service. This recommendation was made on 02 June 2014 We found that a summary of the findings was included in newsletters received by each person using the service. The recommendation had been met. 2. The manager should develop the service's approach to communicating information to service users with communication difficulties or cognitive impairments. page 23 of 27
This recommendation was made on 02 June 2014 The service had implemented a range of methods to overcome barriers to communication and had developed practical approaches to assist people using the service to give and receive information. The recommendation had been met. 3. The service should assess the areas identified in this report and undertake refurbishments as needed. This recommendation was made on 02 June 2014 The service no longer had responsibility for the areas mentioned in the previous report and they are no longer used by people using the service. The recommendation had been met. 4. The manager should consider how service users can provide feedback regarding individual staff practice to the management team and develop and introduce this to the supervision and appraisal process. This recommendation was made on 02 June 2014 We found that feedback given by people using the service had been used to inform the supervision process. The recommendation had been met. 5. The manager should introduce a quality assurance system which will provide a quality assurance report of how the service is running and how it can be further developed. This recommendation was made on 02 June 2014 Inspection report We found that the management team had devised a system of audit processes which fed into the general Dumfries & Galloway Council quality assurance system. The manager advised us that the processes had identified some areas for improvement and had proven to be a valuable addition to ensuring quality within the service. The recommendation had been met. page 24 of 27
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 25 of 27
9 Inspection and grading history Date Type Gradings 2 Jun 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 8 Mar 2013 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 12 May 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 28 Apr 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good 30 Apr 2008 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate page 26 of 27
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 enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect 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 27 of 27