Care service inspection report

Care service inspection report Full inspection Teviot Day Service Support Service Howdenbank Hawick Inspection completed on 25 May 2016

Service provided by: Scottish Borders Cares LLP, t/a SB Cares Service provider number: SP2014012415 Care service number: CS2015335095 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 Inspection report page 2 of 26

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 4 Quality of staffing 4 Quality of management and leadership 4 Good Good Good Good What the service does well The service provides a good quality experience for the service users. We observed examples of good practice from staff, whom we assessed as caring and understanding of individual service user needs. We also saw staff working collaboratively and in ways which supported individual service users to experience good outcomes. For example, in providing unobtrusive support to increase a service user's enjoyment and meaningful participation. We noted the staff were responsive, enthusiastic and willing to consider ideas for improving the service delivered. The service moved into new accommodation in the Katharine Elliot Centre in July 2015. The accommodation available to the day centre is spacious and suitable for service users with a variety of complex needs. For example, there are two lounge/activity areas, a dining area and toilets which are all readily accessible for service users with mobility difficulties. page 3 of 26

What the service could do better Inspection report We identified a number of areas where the service would benefit from either more work or from specialist advice. For example, the manner in which the activities were organised and the content of the activities could be reviewed to provide a better experience for service users. The environment required some improvement to make it more accessible to service users with dementia. The care planning could be improved by moving to a more person centred model. For example, a clearer emphasis on what the service user wanted to achieve from attending the day centre and how this could be supported. Daily recording would also benefit from being reviewed. For example, recording the level of service user participation and their reaction to the activities offered. What the service has done since the last inspection The service has moved from its previous location in a local care home to the Katharine Elliot Centre in Hawick in July 2015. The service also came under the umbrella of SBCares which provides care and support for Scottish Borders Council service users. As a result of this organisational change, the service had to re-register with the Care Inspectorate. (A number of Scottish Border Council's service had to be similarly re-registered). Within SBCares, there has been an internal re-organisation and a new registered manager was identified. Moving to a new structure and a new building within a short time frame had proved organisationally challenging. However, both people using the service and staff said the move and the settling in period was now over and the service back to normal. The number of people attending the day centre has reduced from 64 places per week to 26. At each session there are rarely more than 13 attending, which allows staff to support service users in a more personal way. page 4 of 26

Conclusion This is a service which provides a good experience for service users and important respite for their carers. The staff are warm, professional and invest time and effort into providing an enjoyable and beneficial environment for service users. The inspection identified a number of areas where further improvements could be made. Staff had started to work on these areas before the end of the inspection. page 5 of 26

1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at: www.careinspectorate.com This service registered with the Care Inspectorate on 1 April 2015 Teviot Day Service is a day support service which is registered to provide care for up to 15 individuals at each daily session. Service users are either provided with transport to attend the centre or carers assist them. The service is based in the Katharine Elliot Centre in Hawick, which is a day service for people with learning disabilities. 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. page 6 of 26

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 - Grade 4 - Good Quality of staffing - Grade 4 - Good Quality of management and leadership - Grade 4 - Good Inspection report 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 7 of 26

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 carried out an unannounced inspection on 17 and 18 May 2016 and provided feedback to support staff, the day care supervisor, the registered manager and two service managers on 25 May 2016. We talked with nine service users, three members of staff, the day care senior, and the registered manager. We also looked at: A sample of service users' personal plans and risk assessments Minutes of meetings involving service users Minutes of meetings involving staff A sample of the service provider's policies and procedures Accident and incident records One to One supervision records Staff training documentation We also walked round the physical environment. 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 page 8 of 26

Inspection Focus Areas (IFAs) Inspection report 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 26

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 service is working on the self assessment and will submit it within an agreed time frame.. Taking the views of people using the care service into account People using the service told us: 'I like coming'. 'The food is good'. 'Its great to have good company. This is my day out'. 'I don't see many people, so coming here is very important'. 'The atmosphere is always happy and welcoming. Any comments I make about the service are always listened to'. 'I really enjoy going to the day centre and look forward to going every week. Lots of fun and super carers'. 'I'm very happy with this service'. Taking carers' views into account 'My relative enjoys the day care. The staff are respectful and professional - they listen to my relative and never patronise'. page 10 of 26

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 We saw that the Teviot Day Centre performed at a good level in this statement. To make this assessment, we looked at a variety of evidence including care and support plans and talked with the people who use the service. We noted that each person attending the day centre had care plans in place and these covered their needs, health issues and basic contact details such as GP and next of kin. When specific health needs were identified, such as continence, we saw good plans in place. The service regularly recorded incidents and information. Throughout the sample of care plans we looked at, we noted conscientious reporting of physical concerns and issues. These were followed through in liaison with families and medical professionals. The evidence confirmed a responsive and professional staff group, who actively worked to make sure the health and wellbeing of each person was maintained. There was good evidence of staff advocating and problem solving with people using the service. For example, one person faced a transport issue, and the notes confirmed the staff liaised and successfully advocated with a number of page 11 of 26

external agencies. This support meant the service user continued to attend the day service, and did so in a way which promoted independence and preserved their dignity. There was evidence of some reviews being carried out. (Reviews provide the opportunity to make sure the service is meeting the person's needs and wishes). In the reviews which did take place, we noted that the service amended the care plans where necessary to better reflect the changing need. Outwith the formal review system, there was evidence of staff responding to changes in the person's physical condition and the care plan being altered to reflect this. For example, a change in mobility. The service provided a training matrix which confirmed that staff had received training in essential areas such as moving and handling, adult support and protection and first aid. Lunch at the service was provided by Borders General Hospital. People using the service told us it was very enjoyable. We noted that staff checked the temperature of the meal to make sure that the food was safe and served at the correct temperature. We took part in some activities during the inspection, including a gentle exercise session. We saw that staff offered a choice to the group and supported the participants to take part as fully as possible. This was managed in a discrete way that encouraged independence, feeling included and personal self confidence. People using the service told us they enjoyed the activities and 'had fun'. Areas for improvement We asked the service to review the care planning process. We could find little information about what the person actually wanted from their attendance at the centre. We also noted there was little information about emotional health and wellbeing and have encouraged the service to include this. The service accepted this advice and work was started before the inspection was completed. We will check on progress at the next inspection. page 12 of 26

The service needed to make sure that reviews for all people using the service were routinely carried out. We will check this at the next inspection. The service was asked to consider how they reported in their regular recordings to better reflect the person's individual response to activities and discussions. We also suggested they could consider how they communicate with people who have a diagnosis of dementia or showing signs of cognitive impairment. We will review progress at the next inspection. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 13 of 26

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 To assess the service's performance in this statement, we looked at the written documentation available and talked with staff. We saw that people wishing to use the service underwent a professional assessment prior to starting. Information was provided at this stage on what the service could offer and when. Having good information gives the individual the opportunity to make an informed decision about whether they wished to attend. On a day to day basis, people were well supported in accessing the service. A good example of this included the service's flexibility in arranging specific transport to meet an individual's needs. When the change in the day centre's location from the care home to the Katharine Elliot Centre was initially raised, we saw evidence to confirm that the people using the service had been kept informed. We saw further confirmation that they were kept informed of the process of moving and what the new premises could offer. Areas for improvement As many of the people using the service have memory impairment and forms of dementia, the service should make sure that information is conveyed in suitable formats for each person. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 14 of 26

Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 2 We make sure that the environment is safe and service users are protected. Service Strengths We concluded the service performed at a good level in this statement. To make this assessment, we looked at the systems in place for maintenance and environmental checks. We reviewed the accommodation which had been set aside for Teviot Day Centre. The new accommodation in the Katharine Elliot Centre was separate from the main access to the building and the Centre itself. The accommodation was spacious, clean, tidy and well kept. There was a regular cleaning programme in place which made sure the environment was safe and hygienic. The accommodation offered three flexible spaces which could be used for individual work and groups. There was adequate space to store equipment such as walking frames in an accessible, but safe way. We noted there was good toilet facilities, which were well maintained. The service had a system in place to record incidents and accidents. We saw that the documentation had been completed and any recommendations for improvement put in place. The environment was audited by the senior worker on a regular basis, which helped to make sure good hygiene and safety standards were maintained throughout the premises. page 15 of 26

Areas for improvement The accommodation available to the Teviot Day Centre was freshly decorated. However, the décor did not assist people using the service who have dementia to find their way around. For example, the colour of the furniture merged into the colour of the walls and floor covering. We provided initial advice and the option of the Care Inspectorate's professional Advisor in Dementia visiting the premises to offer further guidance. We will check on progress at the next inspection. The dining and kitchen areas were seen to be cluttered. However, the service immediately took this on board and improvements were introduced. Some equipment was removed and the layout altered to be more welcoming to people using the service. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 16 of 26

Statement 3 The environment allows service users to have as positive a quality of life as possible. Service Strengths We concluded that the premises were spacious, with three flexible areas that could be used. This gave people using the service genuine choice on where they wanted to sit, choose whether they wished to join in group activities or have individual time with a support worker. The new accommodation was seen to be purpose built, with wide corridors and accessible toilet areas. Individuals could choose to use the facilities safely and independently. We considered this encouraged and maintained independence, choice and dignity. The service benefitted from having good kitchen areas, which provided opportunities for individuals to assist staff. For example, setting tables and washing dishes. This had positive outcomes in terms of feeling included and self worth. The kitchen facilities also increased potential activity choices. For example, flower arranging which can aid upper body mobility and fine motor control. Areas for improvement The available rooms should be reviewed in terms of décor. We talked about the lack of definition between areas in a room in Statement 2 above. When this is addressed, it will help people using the service who have a memory issues or a sensory impairment to access all areas more safely, maximising their independence. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 17 of 26

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 We concluded that the staff team performed at a good level in this statement. To make this assessment, we checked training records, observed the staff team working alongside people using the service and also talked with staff. We observed staff working with individuals and groups in a skilled, knowledgeable and confident manner. For example, we saw staff responding to people in an empathetic, sensitive way, providing support discretely and making sure that the individual's dignity was respected throughout. This was particularly apparent in a gentle exercise session where individuals were encouraged and enabled to join in. We looked at the staff training matrix and noted that mandatory courses had been updated within the time frame set by the service provider. For example, moving and handling, food hygiene and adult support and protection. We considered the training had been beneficial to the staff and had positively impacted on their practice. An example of this would include the good standard of moving and handling practice observed. Staff were seen to have a good awareness and understanding of the National Care Standards and the Scottish Social Services Council (SSSC) Codes of Practice. We saw this in their practice and in the service documentation. Good examples would include staff working at the individual's pace, behaving towards people with dignity and respect, viewing each person as an individual in their own right and appropriate recording within support plans. page 18 of 26

There was evidence to confirm that staff received one to one supervision and attended team meetings. Within the minutes of these sessions, we could see there had been wide ranging discussions about the service and issues identified had been addressed. Overall, we observed a professional group of staff who were skilled, knowledgeable and anxious to continuously improve the service. Areas for improvement The staff team told us the people who were using the service now have critical need and more frequently have a diagnosis of dementia. We suggest they continue to develop systems and process for communicating with people whose ability to communicate their needs and wishes have diminished over time. We will check on progress with this at the next inspection. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 19 of 26

Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths We concluded that the service was performing at a good level in this statement. To decide this, we looked at supervision and team meeting minutes, talked with staff, read the documentation relating to the service and observed their practice. We saw that the staff team consistently worked in partnership with each person, providing opportunities and choices which were meaningful to the individual. For example, some members of the group liked to walk and we saw staff supporting them to go for short walk. The individuals later confirmed how much they enjoyed the walk in the good weather and the company of the staff member. There were good outcomes for them in terms of choice and independence. People using the service on the days of the inspection had very different needs and health issues. Group activities were seen to be generic, but individuals were supported to take part to their capability and ability level. We noted that staff did this in a sensitive way and we concluded that their practice had good outcomes relating to inclusion and emotional wellbeing. We looked at a variety of documentation from the care planning through to the general recordings relating to individuals. These were respectfully written, showed a good understanding of the individual's needs and a professional determination to make sure the person received the services they required. Areas for improvement The service should continue to work in this sensitive and respectful way. page 20 of 26

Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 21 of 26

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service Strengths We found that the service was good at involving its workforce in the organisation of the service. We spoke to some staff who felt they were encouraged to plan and develop the day to day activities and events. This was done through discussion with the senior, through one to one supervision and through the meetings held within the service. We were told the senior was approachable, accessible and responsive to improvement suggestions made by staff. We noted that staff received one to one supervision, where practice and personal issues could be raised. This formal meeting also provided a forum for service development and improvement suggestions to be discussed. Areas for improvement The service should continue to work in this inclusive way. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 22 of 26

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 We assessed the service as performing at a good level in this statement. We came to this decision by looking at the systems in place for reviewing the impact of the service, discussing and deciding on improvements. We noted that regular meetings were held with people who use the service. We could see that discussions were varied and that actions identified, were carried out. Staff meetings were also held and one to one supervision sessions. Again, minutes confirmed that service delivery and service improvement were on the agenda. There was evidence to confirm that staff were confident about raising issues. We noted that the senior carried out regular audits - for example in care planning. They also provided a weekly report to the service manager. The service provider had a complaints policy and procedure in place and there was a full range of other policies in place to support and guide staff practice. Areas for improvement In line with other areas for improvement within this report, we advised the service to work on methods to involve people attending the service who have experienced communication difficulties. This would support them in being able to contribute to the improvement agenda. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 23 of 26

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. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. page 24 of 26

8 Additional Information There is no additional information. Inspection report 9 Inspection and grading history This service does not have any prior inspection history or grades. page 25 of 26

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 26 of 26