The Bungalow Support Service Without Care at Home Ayrshire Central Hospital Kilwinning Road Irvine KA12 8SS Telephone:

Transcription

1 The Bungalow Support Service Without Care at Home Ayrshire Central Hospital Kilwinning Road Irvine KA12 8SS Telephone: Type of inspection: Unannounced Inspection completed on: 30 September 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Alzheimer Scotland - Action on Dementia Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com The Bungalow, page 2 of 24

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 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The Bungalow continues to achieve very good outcomes for service users. The service delivers person centred care in a small and welcoming environment. We observed staff working well as a team and found that staff knew service users and each of their specific circumstances very well. The service continued to place importance in the involvement of service users and relatives/carers and encouraged them to express their views and make suggestions on how the service could be improved. This included daily discussions with service users, quality surveys for relatives/carers, service user meetings, telephone contact and home visits with relative/carers and a newsletter. Service users spoke enthusiastically about their visits to the service and how much they enjoyed meeting other people and the activities available to them. We continued to see very good examples of life story work which had been complied with the involvement of individual service users and their relatives/ carers. These provided very good individual biographies and life histories which helped to inform the type support to be provided by the service. Staff were well supported by the organisation and had access to a range of relevant training to assist in meeting the needs of service users. The Bungalow, page 3 of 24

4 What the service could do better Inspection report continued The provider should consider using independent facilitation to assist service users in the completion of quality surveys and in chairing service user meetings. The provider should consider ways in which more formal participation of relatives/ carers could be achieved. There should be a system in place to evidence that portable electrical equipment used in the delivery of the service has been tested in accordance with Health and Safety guidance. If the organisation carryout the plan to have policies and procedures only accessible via electronic means appropriate resources must be available to enable staff to access these from the Day Care premises. What the service has done since the last inspection Since the last inspection, the provider has now ensured that formal reviews take place at least six monthly. The provider has continued to improve and develop support plans to include person centred information on each individual's support needs and also contain clear direction to staff on how these needs should be met. Conclusion The manager and staff remain committed to achieving very good outcomes for service users and relative/carers and continue to encourage service users to take as active a role as possible in developing the service. The Bungalow, page 4 of 24

5 1 About the service we inspected The Bungalow day care service in Irvine, provides support and stimulation for up to 9 adults with dementia at any one time. The service is managed by the voluntary organisation Alzheimer's Scotland. The stated aim of the service is to "provide personal support and understanding that the person with dementia and their carer need, together with practical care that benefits the person and gives a break to the carer." The service is now deemed registered with Social Care and Social Work Improvement Scotland (SCSWIS) on 01 April 2011 in terms of article 2 of The Public services Reform (Scotland) Act 2010 (Health and Social Care) Savings and Transitional Provisions Order 2011 (SSI 2011/121). The service was formerly registered with the Scottish Commission for the Regulation of Care (the 'Care Commission'). The Care Commission merged on 1 April 2011 with the Social Work Inspection Agency and the section of HMIE responsible for inspecting services to protect children, to form the new scrutiny body SCSWIS'. 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 - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good 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. The Bungalow, page 5 of 24

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 This inspection tool place on 30th September 2014 and was carried out by one inspector. During the inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents including; * evidence from the service's most recent self assessment * care files of people who use the service. * minutes of service user and staff meetings * training records * evidence of supervision and appraisal * risk assessments * newsletter * servicing and maintenance arrangements for equipment used in the service * health and safety systems and procedures * the service's own quality surveys and evaluation * discussions with various people including; day care officer, staff and people who use the service * observing how staff work 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 The Bungalow, page 6 of 24

7 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 The Bungalow, page 7 of 24

8 What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that formal reviews take place at least 6 monthly. This is to comply with Public Services Reform (Scotland) Act 2010 SSI210 Regulation 5 (2) (b) (iii). Timescale for implementation: 6 months from the publication of this report. What the service did to meet the requirement See Quality Theme 1 Statement 1 The requirement is: Met - Within Timescales The requirement The provider must ensure that the quality of personal plans is improved, to clearly show service users' needs and how these needs will be met.personal plans must evidence the involvement of service users and/or their carers. This is in order to comply with: This is in order to comply with SSI 2011/210 Regulation 4 (1) (a) Welfare of Service users. Timescale for implementation: 3 months from the date of publication of this report, What the service did to meet the requirement See Quality Theme 1 Statement 3 The requirement is: Met - Within Timescales 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 The Bungalow, page 8 of 24

9 Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We spoke with two service users individually and a small group consisting of six service users. They spoke very positively about their experience of the service. Some were able to speak about particular activities and outings they had enjoyed. There continued to be evidence of activities and trips being organised for individuals, taking into account their life histories including school, employment and past home life. One service user told us about a trip to the area of a nearby town where they had lived and spoke about the local school and what it was like to be there as a child. We were also told about how they enjoyed quizzes and how some people could be very competitive and 'liked to win'. Service users told us that staff were very attentive and always wanted to know what they enjoyed and what could be better. None of the service users present could think of anything that could be better. Comments included; "I have no complaints what so ever. I am always very well catered for' "There is always someone to talk to and something to do even if it is just a sing song it brightens the day' "I know I have to come here but it's not a chore" Taking carers' views into account No relatives were consulted during this inspection. The Bungalow, page 9 of 24

10 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 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The grade achieved at the last inspection on the 22nd March 2012 was 4 - Good. Elements of the evidence considered for this statement were re-visited and we found performance had improved and the statement was graded 5 - Very Good We concluded this from discussions with the manager, staff and service users. Other sampled evidence included: Support plans Service user reviews Completed quality surveys Newsletters Minutes of service user's meeting. The service continued to place importance in seeking the views of service users and relative/carers in developing and improving the service. This included; daily discussion with service users, regular contact with relative/carers, service user meeting, carer support (both individual and in small groups) quality surveys and newsletters. Service user views were sought on all elements of the service, including their own quality of support, the quality of the environment and what could be better and the quality of staffing and management. There was previous evidence of service users being involved in staff recruitment. Applicants were asked to meet with service users where the quality of engagement and interaction with service users was assessed. Service users' views were sought for The Bungalow, page 10 of 24

11 each of the applicants. We saw throughout the inspection that service users were able to choose how they wished to spend their time in the service. Service user meetings took place and offered service users the opportunity to discuss the choice of activities and suggested outings. Quality surveys were used to seek the views of carers on all aspects of the service. This included the quality of service, the environment, staffing and management. The completed surveys continued to show a very high level of satisfaction with the service provided. The majority of the relative/carers who completed surveys praised the service for the support it provided to enable them to continue in their caring role. 'Excellent service, without this help I would not be able to keep my husband at home.' 'The service is excellent and my mum is well cared for at all times.' 'My mother was not eating well before attending day care. Staff have encouraged her to eat and monitor her weight.' 'Mother looks forward to Day Care'.' 'Very well managed and good lines of communication.' We found that the following requirement made in the last inspection report had been met. The provider must ensure that formal reviews take place at least 6 monthly. This is to comply: Public Services Reform (Scotland) Act 2010 SSI210 Regulation 5 (2) (b) (iii). The provider now ensured that formal reviews of service users care and support needs whilst attending day care were now carried out. The minutes of care reviews were appropriately detailed and recorded service users and relative/carer views and any decisions agreed. Information about how to make a complaint was available to service users in information leaflets and displayed on the notice board. Information was also available on how to access Advocacy services' Areas for improvement The provider should consider providing independent facilitation to support service users, when completing quality surveys or chairing service user meetings. The Bungalow, page 11 of 24

12 The service should consider how more formal contact with relatives/carers can be achieved outwith the review process, to encourage their participation in improving and developing the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The grade achieved at the last inspection on the 22nd March 2012 was 4 - Good. Elements of the evidence considered for this statement were re-visited and we found performance had improved and the statement was graded 5 - Very Good We concluded this from discussions with the manager, staff and service users. Other sampled evidence included: Personal plans Service user reviews Individual risk Assessments Individual preferences and interests Activity records Inspection report continued Each service user had a support plan in place. Initial assessments were carried out following referral to referral to the day centre. Service users and family carers had been consulted to gather relevant information to assist in providing individual, person centred support. We found that the following requirement made in the last inspection report had been met. The provider must ensure that all service users have a care plan and that the quality of care planning is improved to clearly show service users' needs and how these needs will be met. Care plans must evidence the involvement of service users and/or their carers. This is in order to comply with: This is in order to comply with SSI 2011/210 Regulation 4 (1) (a) Welfare of Service users. The quality of support plans had improved since the last inspection. This was specifically the case for service users with more complex needs. We saw that individual needs were appropriately documented and reviewed and that support plans provided clear direction to staff on how these needs should be met. The Bungalow, page 12 of 24

13 Individual risk assessments were completed and progress notes were maintained showing how individuals had chosen to spend their day in the service. Staff continued to demonstrate through discussion that they knew service users well including their specific care needs and how these should be met. Support staff had worked closely with service users and family carers to develop life story books. The examples we saw were completed to a very good standard. We could also see that the information gained in compiling life stories informed the type of support provided to individuals and the very individual activities and outings they participated in. We continued to see from activity records and from the large collection of photographs the types of activities, entertainment and trips service user had the opportunity to participate in. Some of these activities were carried out in small groups and some were on a one to one base specific to an individual's interests and preferences. Service users continued to be assisted with personal care in a discreet manner ensuring their privacy and dignity was respected at all times. The service continued to achieve very good outcomes for the people using the service. Areas for improvement The service should continue to develop current good practice. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Bungalow, page 13 of 24

14 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The areas of strengths outlined in Quality Theme 1 Statement 1 are also relevant to this quality statement. Areas for improvement The areas for improvement outlined in Quality Theme 1 Statement 1 are also relevant to this quality statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We sampled evidence against this quality statement which was graded 5 - Very Good. We concluded this from discussions with the manager, staff and service users Other sampled evidence included: Support plans and risk assessments Maintenance records Generic and COSHH Risk Assessments Maintenance and service arrangements and records Health and safety Checks. Health and safety related training The provider had a comprehensive range of health and safety policies and procedures available to staff to staff in written and electronic format. Staff had completed Health and Safety focussed training such as; moving and The Bungalow, page 14 of 24

15 handling, fire safety, first aid and health and safety. Staff had also completed training in Adult Support and Protection. An evacuation and contingency plan was in place and each service user had a personal evacuation assessment included in their support plan. The Day Care premises was located within the grounds of an NHS hospital and all maintenance and servicing of equipment and utilities was organised and co-ordinated by the NHS Estates Department. A system was in place for reporting maintenance issues and the date of servicing visits were recorded in the service diary. A system of accident and incident reporting was maintained. These records were countersigned by the service manager. General risk assessments had been completed, to support staff in the operation of a range of equipment in the care home and tasks related to their role. Risk assessments for the Control of Substances Hazardous to Health (COSHH) were also available. An environmental/workplace risk assessment had been carried out to be reviewed in March People visiting the service were required to ring the bell to gain entry. The door was appropriately secured and all visitors had to sign in and out. There was also a secure garden area. Areas for improvement We could not evidence that the portable electrical appliances being used in the delivery of the service were checked at the recommended intervals. The provider must establish a system for recording these checks and ensure they are kept up to date. (See Requirement 1 for this quality statement) Grade awarded for this statement: 5 - Very Good Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. The provider must ensure that portable electrical appliances are checked at the required intervals (PAT testing). This is in order to comply with: 4 (1)(a) - a requirement to make proper provision for the health and welfare of people. Timescale for implementation; within 1 month of the publication of this report. The Bungalow, page 15 of 24

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The areas of strengths outlined in Quality Theme 1 Statement 1 are also relevant to this quality statement. Areas for improvement The areas for improvement outlined in Quality Theme 1 Statement 1 are also relevant to this quality statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths This statement was inspected on 22nd March 2012 and achieved the grade of 5 - Very Good. Elements of the evidence considered for this statement were re-visited and we found that the previous performance had been maintained and graded 5 - Very Good We concluded this from discussions with the manager, staff and service users. Other sampled evidence included; Training Records Training evaluations Supervision Records Completed quality surveys Observation of practice Minutes of staff meetings The Bungalow, page 16 of 24

17 As previously stated staff had access to policies and procedures which included those related to training and development. Training records showed that staff had completed training in; moving and handling up dates, personalisation, parkinsons and dementia, palliative care life story work, sexuality and dementia, activities, carer awareness - rights and legislation and leadership and development. All staff had completed the Promoting Excellence Dementia Training. Staff were trained to the Skilled or Enhanced level based on their designation and role within the service. All staff were qualified to at least SVQ levels 2 with a number achieving SVQ3 and other relevant qualifications. Training records were maintained for each member of staff. Completed training and planned training was also recorded in each individual member of staff's Personal Development Review. Staff who attended specific training were required to complete a training evaluation form and also expected to provide feedback on the training at staff meetings. We saw from records that staff supervisions and appraisals were carried out at the frequency stated in the provider's policies and procedures. There was evidence that supervision and appraisal systems were linked to individual's training and development. Staff continued to work well as a team and interacted very positively with service users. Staff met informally each morning to discuss the service users who would be attending, their specific needs and any plans for the day. Formal staff meetings took place approximately monthly. These meeting provided information on organisation and service wide developments including reviews of policies and procedures. Staff training needs and forthcoming training events were also discussed and how the attendance of staff would be facilitated. We noted form Staff continued to tell us that they had the opportunity on an ongoing basis both at formal meetings and in day-to-day discussion to make suggestions on how to continually improve the service. Staff also had the opportunity, when completing the organisation's annual staff survey to express their views on the quality of service provided and how it could be improved. The annual service development plan included sections on staff training and development. We received seven completed quality surveys from staff. It was clear from the The Bungalow, page 17 of 24

18 responses made in the surveys that staff found work within the service to be a positive and rewarding experience. Additional comments made included; 'After working in the care sector for many years I feel that working with Alzheimers' is a very rewarding job.' 'I feel Alzeihmers Scotland gives their staff every opportunity to be up to date with their training and at supervision we get the chance to ask if we can do other training which we feel will help us in our role.' Areas for improvement We were informed that organisational policies and procedures will be held electronically in each service. Although this was the case at the time of this inspection, there were also paper copies available. The provider must ensure that the service has the appropriate resources available to allow staff to have easy access to electronically held information. The organisation's training department was undergoing a review and re-structuring at the time of this inspection, which had caused some disruption to the organisation's training plan. However, we were informed that the aim of the review was to improve the accessibility and quality of the training provided across the organisation. We look forward to seeing how these improvements will impact at service level at our next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Bungalow, page 18 of 24

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The areas of strengths outlined in Quality Theme 1 Statement 1 are also relevant to this quality statement. Areas for improvement The areas for improvement outlined in Quality Theme 1 Statement 1 are also relevant to this quality statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 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 sampled evidence against this quality statement which was graded 5 - Very Good. e concluded this from discussions with the manager, staff and service users. Other sampled evidence included; The self-assessment for this inspection Action Plan Complaints procedure Service user and relative participation methods Managements reports and Audits The service had very good Quality Assurance systems, which allowed the provider to assess the quality of service provided, areas where improvements could be made and how these would be actioned. The Bungalow, page 19 of 24

20 The service participation methods contributed to the Quality Assurance processes. The manager of the service completed an Annual Service Report which linked to the organisation's strategic plan. This included the following areas of consideration; sustaining and developing the local service, increasing reach and local presence, improving practice and service quality, investing in our people and developing innovations and creating new opportunities. A Service Audit was carried out by an external manager which assessed all elements of service delivery. Audits and spot checks are carried out at service levels on the quality of support planning and accompanying assessment documentation. The manager of the service ensured that staff supervisions took place on the scheduled dates and copies of supervision records were maintained. Service users and relative/carers were informed about the provider's complaints procedures in the service leaflet and displayed in notice boards in the service. No complaints had been made to the service. Areas for improvement The provider should continue to develop Quality Assurance processes. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Bungalow, page 20 of 24

21 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). The Bungalow, page 21 of 24

22 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Environment Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 22 Mar 2012 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 16 Dec 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 16 Feb 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed The Bungalow, page 22 of 24

23 4 Aug 2008 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. The Bungalow, page 23 of 24

24 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: The Bungalow, page 24 of 24