Care service inspection report

Care service inspection report Full inspection 33 Malcolms Mount Care Home Service 33 Malcolms Mount Stonehaven Inspection completed on 02 June 2016

Service provided by: Inspire (Partnership Through Life) Ltd Service provider number: SP2003000031 Care service number: CS2003000323 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 29

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 4 Quality of environment Quality of staffing 4 Quality of management and leadership Good N/A Good N/A What the service does well The staff in the service had worked hard at ensuring that the people who used the service were involved in developing the support provided to meet their individual needs. What the service could do better This service has had a number of changes of manager. Since the last inspection there had been another change. At the time of the inspection the new manager was covering three different services in Stonehaven. The provider needs to ensure that the new manager has enough time to effectively manage the service and to better support staff and the people being supported. The provider needs to ensure that they adhere to the services staffing schedule and to ensure that there are enough staff on duty at all times to meet the assessed needs of the people they support. page 3 of 29

What the service has done since the last inspection Inspection report The staff in the service had worked hard to introduce the new format of support plans with the involvement of the people they supported and where appropriate their families. Conclusion In order to ensure the service provides high quality care and support, the provider needs to ensure that there is effective management oversight in place, that there is enough staff on duty at all times to meet people's assessed needs, and that they are supported to participate in meaningful activities in their local community. page 4 of 29

1 About the service we inspected Inspection report 33 Malcolm's Mount is a small care home providing a service for a maximum of four adults with learning disabilities. The service is situated in a family sized house with four single occupancy rooms, set in a residential area of Stonehaven. The service provider is Inspire (Partnership Through Life) Ltd. The home aims to offer twenty four hour support and opportunities for an excellent quality of life in a relaxed and safe environment, to recognise the individuals' needs for independence, and their right to make informed choices. In addition, they offer people opportunities to participate in leisure and other activities within the local community. At the time of the inspection the manager was also managing another Inspire home and a housing support and care at home service and was not working full time at Malcolms Mount. Inspire state their purpose as: "We support people in a variety of settings, from enabling individuals and their families to plan for current and future support needs using person centred planning, to providing self-directed support to help people achieve their chosen outcomes". The Care Inspectorate regulates care services in Scotland. Information in relation to 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. 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. page 5 of 29

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 environment - N/A Quality of staffing - Grade 4 - 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. 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 6 of 29

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 The service was inspected during an unannounced visit on the 31 May 2016 and two further announced short notice visits on 1 and 2 June 2016. From the 1 April 2016 the way in which we carry out an inspection has changed. We choose which quality themes and statements are inspected for better performing services, to be more proportionate and targeted in our work. In highly performing services, inspections will consider Quality Theme 1: Quality of Care and support, Quality Theme 1, Statement 3 "We ensure that service user's health and wellbeing needs are met" will be considered during all inspections. We will also look at one other quality theme. This service is eligible for this type of inspection and based on our knowledge and intelligence of the service we looked at Quality Theme 1, Statement 5 "We respond to service user's care and support needs using person centred values". We chose this based on our knowledge of the service and the importance of service users being supported in a person centred manner and that staff have a good understanding of this. We also considered Quality Theme 3, Statement 3 "We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice" to follow up on a recommendation made at the last inspection. Statement 4 "We ensure that everyone working within the service has an ethos of respect towards service users and each other" was chosen by taking into account the varying roles of each team member and the importance of collaborative team work to promote positive outcomes for service users. This inspection was carried out by one Care Inspectorate inspector. page 7 of 29

Evidence During the inspection, evidence was gathered from a number of sources including: A review of a range of policies, procedures, records and other documentation, including the following: Examination of a range of documentation which included: - certificate of registration - staffing schedule - aims and objectives of the service - complaints records - individuals care files - accident and incident records - adult protection procedure - medication records and audits - staff training records - training plan - risk assessments. Discussion took place with a range of care staff including: - the manager - support workers - bank staff. Observation of staff practices. Observation of the environment. All of the above information was taken into account and included within the body of the report. Feedback was provided to the manager on 2 June 2016. page 8 of 29

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 www.firescotland.gov.uk page 9 of 29

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 manager had submitted a self assessment prior to this inspection. The document contained comprehensive information and identified areas for further development. Taking the views of people using the care service into account Prior to the inspection we received four completed Care Standards Questionnaires (CSQs), three of these indicated that people strongly agreed that they were overall very happy with the care and support that they received, the other one agreed. The people who received support were seen to be happy and relaxed with staff and staff demonstrated that they knew each individuals support needs and how to meet these. We spoke with three people who lived in the care home as part of the inspection. They told us that they liked living there, that staff were nice and friendly and that they were overall very happy. Taking carers' views into account Two relatives were spoken with by telephone as part of this inspection. They told us that they were happy with the care and support provided, that the staff were friendly, professional and approachable. However, one relative spoken with page 10 of 29

raised some concerns about changes to their loved ones keyworker and reduced contact and updates from the service following this. These concerns were discussed with the new manager who agreed to follow up and address these. Another relative was spoken with face to face. They said that they thought the care and support their loved one received was of a high standard, however, they too felt they should have been told or consulted about recent keyworker changes. Comments included: - "I have always been very pleased with the care" - "I am aware there is a new manager" - "Staff appear to know X well and his needs" - "X has regular reviews to which we are invited to and attend". - "If there was anything wrong I would be on the phone in a flash" - "Staff keep me fully informed about X's health and if there are any issues" - "The care and support is generally very good" - "Keyworker has changed, I was told this was company policy, I thought it was important that there was stability" - "Turnover of staff is abysmal" - "I think in all fairness they do a good job, X is very secure and happy" - "I have met the new keyworker, not had much contact with them, previously contact was fantastic" - "X seems to be very happy" Inspection report page 11 of 29

- "They certainly look after and know X well" - "The only thing is they have changed her keyworker which I thought was a shame as they had the previous one for a long time, there will probably be a good reason for this, though I wasn't told". page 12 of 29

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths The manager presented adequate evidence of how they ensured that the health and wellbeing needs of the people who received the service were met. Care files showed that people who use the service had access to a range of other professional people to meet their health and wellbeing needs such as GP, dentist, psychologist, nurse and care management. There was strong evidence of how the staff in the service had developed effective working relationships with members of the multidisciplinary health team and other agencies to ensure that they people they supported had their health needs assessed and met. In addition, staff had worked hard to introduce the providers new format for their support plans, and these were seen to be very person centred and contained relevant and detailed information in relation to people's health and wellbeing needs and how these were to be met. Support plans and care files had been broken down into separate areas such as recording, and medication in order to make the information easier to access, to review and keep current (see areas for improvement). The care files looked at contained information on the support people needed to page 13 of 29

attend medical appointments in relation to their health needs. Inspection report Staff had received specific training to equip them to support people with health conditions such as Diabetes and Autism. People being supported where appropriate had Adults with Incapacity Certificates (AWI) for consent to medical treatment. These were seen to be current. The service had medication administration sheets and audit records. Medication files also included copies of prescriptions so staff could check that prescriptions matched information on medication administration records. The care files also contained 'Admission to Hospital for People with a Learning Disability' documents these provided key information for medical staff to help them to meet the care needs of the individual (see areas for improvement). People being supported were supported to access activities based upon their personal hobbies and interests which included clubs, discos, day centre, car trips, woodcraft, football, movie night, meals out, bowling, church, music club, shopping and holidays (see areas for improvement). Care files contained individual risk assessments for each person for activities that they undertook both inside and outside of the home (see areas for improvement). Where appropriate people had Crisis Intervention Support Plans which detailed how staff could best support individuals where they presented challenging behaviour. The service had maintained records of accidents and incidents. These were reviewed and taken to team meetings by the support manager. In addition they were logged onto the providers database where they were assessed for patterns and to ensure that appropriate actions were taken. There was evidence observed during the inspection through documentation and staff practice of staff being fully aware of each individuals health needs, and page 14 of 29

where appropriate, they worked well with other health professionals to ensure that these were assessed regularly and where necessary to have any issues addressed, however, staff shortages had an impact on the opportunities for people to have their social needs met (see areas for improvement). Relatives spoken with said: - "I have always been very pleased with the care" - "Staff appear to know X well and his needs" - "X has regular reviews to which we are invited to and attend". - "If there was anything wrong I would be on the phone in a flash" - "Staff keep me fully informed about X's health and if there are any issues" - "The care and support is generally very good" - "I think in all fairness they do a good job, X is very secure and happy" - "X seems to be very happy" - "They certainly look after and know X well". Areas for improvement Examination of staff rotas showed that there were numerous times when staff were lone working when there should have been two staff on shift. This was due to staff leaving the service. The impact that this had on the people being supported was that they couldn't be supported to access activities outside of the house unless they all wanted to go. A relative told us: - "Turnover of staff is abysmal". Inspection report It is important to note that staff had worked very hard to be flexible to cover the page 15 of 29

gaps in staffing, however, that these shortages still led to reduced opportunities for the people being supported (see Requirement 1). This was discussed with the manager during feedback who agreed to take action to address these concerns and to employ agency staff where shifts could not be covered within the team. Following the visits to the service we received an email confirming this had been done. In addition, the manager advised that they were conducting interviews in the very near future with potential candidates with the aim of boosting the number of staff employed in the service. We found that support plans and care files contained a lot of detailed information, particularly in relation to people's health and wellbeing needs, and that staff had worked hard to keep these current. In order to make these better, the manager and staff should ensure that: - Hospital passports contain details of any significant risks identified for the person such as choking. - Risk profiles should be signed and dated by all those involved in the assessment. Grade 3 - Adequate Requirements Number of requirements - 1 Inspection report 1. In order to meet the assessed needs of service users the provider must ensure that there are enough staff with the appropriate skills and experience on duty at all times. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011/210 - Regulation 15 (a) ensure that at all times suitably qualified and competent persons are page 16 of 29

working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. Timescale for implementation: Immediate upon receipt of this report. Number of recommendations - 0 Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths The manager presented very good evidence of how they responded to service users care and support needs using person centred values. Support plans and care files were set out in a person centred format, and there was very strong evidence of how the people being supported, and where their appropriate their families were involved in developing and reviewing these. Staff received training in person centred planning, and staff spoken with were very knowledgeable about the people they supported and their individual needs. People's rooms and décor were seen to reflect their personalities and individual choices. People's likes and dislikes were clearly recorded in their support plans and importantly what staff needed to know about them individually in order to be able to support them effectively. Examples of this included the activities that people were supported to access which were based upon their own interests and wishes which they enjoyed and got a lot out of (see also areas for improvement, quality theme 1, statement 3). Staff throughout the inspection were seen to work hard to engage, interact and involve the people they supported in making their own choices and decisions by providing information, and by actively listening and respecting them as page 17 of 29

individuals. Six monthly reviews were very important opportunities for the people being supported and their families to discuss the care and support provided, explore individual objectives, and to have a say on what is working well and what isn't. The service had information in a format to make it accessible for the people being supported such as "How to respect each other in our house". Another way that staff showed they respected the views of people using the service was people we support meetings which were opportunities for people to discuss and to have their say on things like activities, parties, shopping, fire evacuation, visiting family, holidays, positive people meetings, and trips and outings to places like Aberdeen and Edinburgh. The service had a welcome pack which gave provided information to people who wished to use the service on things like the providers mission and vision statements, service users charter, confidentiality of personal information, accommodation agreement, statement of purpose, risk taking with service users, policy on recording accidents and near misses, complaints, local policy on visitors, Inspire annual report, Care Inspectorate report, advocacy information and role, and what we expect of each other (see areas for improvement). Examination of support plans, discussion with staff, and observation of practice showed how all of the processes detailed above were used to support people in a person centred way. Staff working in the service knew the individuals they supported and worked very hard in partnership with them and their families to help them have their needs met. Relatives spoken with said: - "Staff appear to know X well and his needs" - "The care and support is generally very good" page 18 of 29

- "I think in all fairness they do a good job, X is very secure and happy" - "X seems to be very happy" - "They certainly look after and know X well". Areas for improvement The manager and staff to continue to work with the people they support identifying new opportunities to be involved in meaningful activities and to engage with their local and wider communities. The provider and manager to review the information contained in the services welcome pack to ensure that this is current and up to date. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 19 of 29

Quality Theme 2: Quality of Environment Quality theme not assessed page 20 of 29

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths The manager provided good evidence that they have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Staff were registered with the Scottish Social Services Council (SSSC). Staff were also supported to access relevant Scottish Vocational Qualifications (SVQ) for their roles. The services training plan was available via the provider's intranet to staff. There was flexibility in the courses provided so as not only to meet the core training requirements, but also to allow staff to access relevant training to meet the changing needs of the people they supported, for example, partners in communication. Courses available in the training programme included moving and handling, first aid, introduction to autism, induction to Inspire, infection control, administration of medication, person centred planning, personal and sexual relationships, health and safety, proactive possibilities, food hygiene, caring for smiles, equality and diversity, and adult support and protection. This was confirmed by training records examined (see areas for improvement). Staff said that they thought that the quality of training was good and helped to equip them for their roles. They also said they were encouraged to discuss their training needs during supervision. page 21 of 29

Staff received training in adult support and protection and all staff spoken with were fully aware of their responsibilities and what they should do if they were to have any concerns. The provider had an adult protection policy which also set out guidance for staff about what they should do. Staff were aware of the providers whistleblowing policy and were aware of the Winterbourne View report. Team meetings were held regularly and topics such as the people they support, health and safety, activities and events, training, support plans, medication procedures and errors, risk assessments, delegated tasks for staff, new staff and rotas were discussed. Staff spoken with thought that the team meetings were helpful as it gave them an opportunity to share information and discuss issues with the management of the home and their colleagues. Staff spoken with also identified formal supervision which they received regularly as a very useful format for them to discuss any issues and for seeking guidance, but also said that there were lots of opportunities for informal supervision. Staff also told the inspector that they had recently had an appraisal (see areas for improvement). A list of important information had been identified for discussion at team meetings. Staff took turns to provide a summary of the relevant topic to help facilitate these discussions. Topics identified included Winterbourne View, Keys to Life, Death by Indifference, Reducing the Risk of Choking, Orchid View Serious Case Enquiry, SSSC Codes of Practice and the providers Whistleblowing procedure. Staff were seen to be motivated and knowledgeable about people's individual needs and how these were to be met. All staff spoken with said that although they had some concerns that they really enjoyed their jobs (see areas for improvement). Areas for improvement Staff spoken with during the inspection raised concerns about the recent change in manager for the service saying that this again raises worries about page 22 of 29

stability and consistency of the support they receive because the service has undergone several changes in managers over recent years. The manager was responsible for three different services at the time of the inspection meaning they could only spend one dedicated day per week at the service raising concerns that the support processes instigated by the previous manager such as regular supervision, appraisals, team meetings and observed practice could be put at risk. The provider needs to ensure that staff receive the necessary support to undertake their roles effectively. To further develop the knowledge of staff and to meet the assessed needs of individuals using the service the provider should ensure that staff have access to caring for smiles training and attend an eating and swallowing workshop. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths The manager provided very good evidence that everyone working in the service has an ethos of respect towards the people who they support and to each other. Staff spoken with said that they felt they were fully involved in making decisions and developing support in partnership with the people they supported and their families. We observed people being supported during their morning routines and when they had come home from activities they had attended during the day. We saw that people appeared to be happy and relaxed. There was a lot conversation between staff and the people they supported, and staff showed warmth and page 23 of 29

respect to them. We also observed during the inspection that people were being supported in a way that was friendly and respectful. Staff asked for people's input in decisions and respected these. Staff knew the people they supported well and this contributed to the relaxed atmosphere and the quality of the interactions. There were support processes and checks in place like regular supervision, appraisals and team meetings in place. These processes were vital for assessing things like attitudes and values and addressing concerns. People being supported were given their opportunity to give their views on staff (see areas for improvement quality theme 3, statement 3). Staff spoken with felt they were part of a good team who worked well together, were respectful of each other and who listened to each other. Staff were very clear that they were able to make suggestions, give their opinions (see also areas for improvement quality theme 3, statement 3). There was evidence that staff observed, and staff spoken with were motivated and committed to meeting the needs of the people they support despite some of the issues such as staffing shortages. They were seen to be warm, caring and respectful not only to the people they supported but in their interactions with each other. This ethos of respect had a direct and positive impact of on how people using the service felt about the support that was provided to them. Areas for improvement The provider and new manager to ensure that staff continue to have access to the support processes of regular supervision, appraisals, team meetings and training. A discussion was held with the new manager about other training resources which were available to staff such as "Steps into Leadership" available via the SSSC website and human rights training available via careaboutrights.com. page 24 of 29

The provider and manager to provide regular updates on the progress being made in recruiting new staff and ensuring that there is effective management support in place for the service. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 25 of 29

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 26 of 29

7 Enforcements We have taken no enforcement action against this care service since the last inspection. Inspection report 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 27 May 2015 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 5 Jun 2014 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 4 - Good 6 Jun 2013 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 21 Jun 2012 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good 20 Oct 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed page 27 of 29

Management and Leadership 5 - Very Good 2 Nov 2010 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 20 May 2010 Announced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Management and Leadership Not Assessed 11 Nov 2009 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 19 May 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 3 Feb 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and Leadership 3 - Adequate 15 Sep 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and Leadership 3 - Adequate page 28 of 29

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 29 of 29