Carr Gomm - West of Scotland Integrated Services Housing Support Service 1479 Paisley Road West Glasgow G52 1SY

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1 Carr Gomm - West of Scotland Integrated Services Housing Support Service 1479 Paisley Road West Glasgow G52 1SY Inspected by: Moira Agolini Type of inspection: Announced (Short Notice) Inspection completed on: 30 April 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 27 5 Summary of grades 28 6 Inspection and grading history 28 Service provided by: Carr Gomm Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Moira Agolini Telephone enquiries@careinspectorate.com Carr Gomm - West of Scotland Integrated Services, page 2 of 29

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 6 Excellent Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service continued to develop innovative, flexible ways to involve the people they work with. We saw that the culture of the organisation is to genuinely seek and listen to feedback with continued improvement the focus of all participation. The organisation is at the forefront of good practice in involvement processes. Staff delivered support with an approach that is embedded in keeping the individual at the centre of everything they do. What the service could do better We would like to see more evidence of feedback from health and social work professionals and how this informs service improvement. There needs to be improved systems in some of the quality assurance approaches to make sure the relevant submissions are made to the Care Inspectorate within the agreed guidelines. The manager also needs to advise us of any significant events that occur in the service. What the service has done since the last inspection The service had continued to develop an outcomes focused approach to support planning. The organisation had also developed technology which was designed to address some of the developments of self directed support (self directed support allows people to choose how their support is provided to them by giving them as much ongoing control as they want over their individual budget). Carr Gomm - West of Scotland Integrated Services, page 3 of 29

4 Conclusion Inspection report continued Throughout the inspection we saw strong evidence in each of the services we visited of a commitment to providing a high standard of support. There is a strong culture within the service that the meaningful involvement of the people who use the service is the essence of good practice. A review of some of the aspects under quality assurance should be discussed to make sure managers and staff are aware of procedures relating to care inspectorate guidance. Who did this inspection Moira Agolini Lay assessor: Ms Catherine McAvoy Carr Gomm - West of Scotland Integrated Services, page 4 of 29

5 1 About the service we inspected Carr-Gomm - West of Scotland's Integrated Service was registered to provide a combined Housing Support and Care at Home service for people with Mental Health problems. The services are integrated into three Community Health and Care Partnerships (CHCP), which cover the whole of Glasgow to provide social support within three key areas: Community Bridge Building Assertive Outreach Approach Crisis Services The Community Bridge Building aspect of the service is open to people with common mental health problems and people who have a history of finding it difficult to engage with services. The nature of the support provided includes supporting people to access employment, training, education and social opportunities. Also practical assistance such as advice services around housing, dept issues and providing emotional support. The Assertive Outreach element supports people who receive care and treatment from the Community Mental Health teams who have a history of finding it difficult to engage with services and/or maintaining contact with services. The Crisis support element of the service is available to people who are experiencing crisis, with a view to avoiding admission to hospital or facilitating an early discharge. This service is delivered working closely within the multi-disciplinary crisis team. The services are staffed and managed by three teams across Glasgow. Each team has a manager and the whole Glasgow wide service is overseen by the Operations manager. The Carr-Gomm staff and managers work as part of the integrated team with other disciplines, working in mental health across the three CHCPs. "The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. Carr Gomm - West of Scotland Integrated Services, page 5 of 29

6 You can find the most up-to-date grades for this service by visiting our website, by calling us on or visiting one of our offices. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 6 - Excellent Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued 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. Carr Gomm - West of Scotland Integrated Services, page 6 of 29

7 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 wrote this report following a short announced inspection. This was carried out by one Inspector, Moira Agolini. A lay assessor, Catherine McAvoy spoke by telephone with ten people who use the service. A lay assessor is someone who had direct experience of being a service user or a carer. The comments from those interviews are included in the report. The inspection took place at the main office on Thursday 25th April 2013 between the hours of 9:00 am and 12:00 pm. We then visited the following services between Thursday 25th April and Monday 29th April. During those visits we spent time with people who used the service, looked at relevant paperwork and spoke with staff. Feedback was given on the 10th May Glasgow South Service (Rossdale Resource Centre) - Thursday 25th April 1pm pm Glasgow South Service (Florence Street) - Friday 26th April am - 3pm Glasgow North East Service (Arran Centre) Monday 29th April 9:45-3pm. As part of the inspection process we also shadowed workers and observed their working relationships with people. In addition we visited a community allotment project. Prior to the inspection we took account of the completed annual return that we asked the provider to complete and submit to us. On this occasion the self-assessment was submitted after the agreed timescale and we could not look at it before the inspection. We sent 70 care standards questionnaires to the manager to distribute to people who use the service. We received 25 completed questionnaires. The comments within the questionnaires are included throughout the report. We asked the manager to give out 25 questionnaires to staff and we received 10 completed questionnaires. Carr Gomm - West of Scotland Integrated Services, page 7 of 29

8 During this inspection process we gathered evidence from various sources, including the following: We spoke with: * 14 people who use the service * the registered manager * one service manager * 12 staff members *the involvement manager * the business development manager *the community projects manager * one care manager * two community psychiatric nurses We looked at: * the participation strategy which outlined how the staff team involved people in the service * involvement and community participation plan * minutes of the involvement reference group * support plans/personal agreements of people who use the service * review paperwork * positive experience records * medication policy * staff appraisals * training records * supervision records * organisational business plan * quarterly survey and notes from discussion at involvement reference group * survey results from people who are supported and their families * organisation's newsletter * information about community allotment. * registration certificate * accident/incident records * complaints. 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. Carr Gomm - West of Scotland Integrated Services, page 8 of 29

9 Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Carr Gomm - West of Scotland Integrated Services, page 9 of 29

10 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We did not receive a self-assessment document from the provider until the day after the inspection commenced. Taking the views of people using the care service into account For this inspection we received views from 39 of the people who use the service. Twenty five people gave their views via the care standards questionnaires and we spoke with one person in their home, two in the service office and one at the allotment. Comments in the returned care inspectorate questionnaires were mostly positive and included; "The service are willing to meet my needs and arrange things even at short notice" "Grateful to have been referred, provided with a lot of beneficial supports" "My support workers have been extremely sensitive to my needs and have worked with me to create the best plan" "I have seen a number of carr gomm workers in the last year or so and have found them all to be supportive, helpful and friendly" Other less positive comments included; "Staff often have to leave me after a short time to go and support other people and don't stay for one hour. Always change of staff (personnel) I pay a lot of money for the service and they are not doing it for me". As this person did not leave any contact details we were unable to ask for further details. We spoke with the managers about this comment. We were assured that Carr Gomm - West of Scotland Integrated Services, page 10 of 29

11 there are many ways that people can make a complaint about the service. We saw very good examples of people being supported to make changes in their support agreement that had a positive outcome. Five people responded in the care standard questionnaires that they did not know about the service's complaints procedure. Four people told us that they did not know that they could make a complaint to the care inspectorate. We were satisfied that the service inform people in a number of ways about the complaints process. For example, the information booklet, one-to-one visits and reviews. The Lay Assessor report concluded that people who use the service are very happy with their support. She asked questions about involvement, goal-setting, staff and in what ways had the service changed their lives. Of the ten people she spoke with all said that they were fully involved in their support planning. They told her that life had changed in many positive ways because of the input from staff who many regarded as skilled and competent. Some of the comments from the lay assessor interviews are included in this report. Taking carers' views into account Two of the care inspectorate questionnaires were completed by relatives of people who are supported. Comments included; "The service xxx was first provided for has changed with the consistent cuts. It would be good if you could provide some kind of letter to let him know what he can expect from this service" "Staff try as hard as they can to provide support however they always seem pushed for time. You also need to train new staff better as I prefer the more permanent staff to look after my relative". Please refer to comments above regarding the complaints process. Carr Gomm - West of Scotland Integrated Services, page 11 of 29

12 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: 6 - Excellent 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 We found this service continued to show an excellent performance in the areas covered by this statement. We concluded this after we: * looked at the different ways that people are involved * reviewed support plans and written evidence relating to participation * looked at the ways in which staff helped people to make choices in their daily living. The involvement manager had a key role in making sure that involvement was meaningful and purposeful throughout the organisation. From the evidence we gathered during the inspection we concluded that involving people was an essential part of service processes. The following are some of the ways that people can be involved; * Focus groups * Forums * Support planning * Reviews of support agreement * Newsletter * Annual General Meeting * Recruitment * Staff appraisals * Training. Each service had an involvement champion whose responsibility it was to make sure people are involved in ways they choose. We saw in the sampled support plans we Carr Gomm - West of Scotland Integrated Services, page 12 of 29

13 looked at that people had individual involvement plans that recorded how people's preferences can be taken forward. For example, people who wished to be involved in recruitment are trained in the interviewing process for new staff using role play or observation. This approach helped staff establish what level of involvement people preferred. We heard of one person who chose to meet people before the interview and then offered feedback to the panel. Others preferred to set questions for candidates. We looked at a total of ten support plans from all the services we inspected. We saw evidence that review meetings took place regularly and actively involved people who use the service. We could see from our visit to an individual's home that staff promoted choices and offered flexible support. We saw excellent examples of people setting goals and being supported to achieve successful outcomes. For example we saw that two people were supported to travel independently. Being unable to do so before limited their life experiences. We saw that others had learned new skills by being involved in the Annual General Meetings or the Forums. These successful outcomes were recorded in people's support plans and they could clearly see the progress they had made. We looked at the minutes from the involvement reference group. This is made up of people who used the services and staff from across the organisation. The group had identified areas for development, one of which was to raise awareness of personalisation* and self-directed support. We saw evidence of meaningful involvement in this process; sampled support plans reflected the organisation's aim of a person-centred approach to all planning in this development. *This is a term that describes a way of meeting the needs of individuals in ways that work best for them. The service was excellent at making sure people knew that their involvement was central to all improvement plans. For example in the notes from an involvement reference group held in April 2013 there was a commitment to look at how the organisation could improve ways that they offered feedback to people. We concluded from this evidence and our discussion with the involvement manager that the service had worked hard to continue the excellent standard of involvement practices. An Involvement and Community Participation plan for clearly identified aims and objectives for continued improvement in the areas covered by this statement. Some of the initiatives identified in this plan are referred to in Quality Theme 1 Statement 3. The people we met in face-to-face meetings told us that they were aware of the complaints policy. All of the people we met told us that it was unlikely they would have to put a complaint in writing because any issues are dealt with appropriately by Carr Gomm - West of Scotland Integrated Services, page 13 of 29

14 staff and the managers. The organisation had developed technology that aimed to assist people to be in direct control of their own support from managing money and measuring outcomes to choosing which worker supports them and at what time. They had won a care accolade for this development. We look forward to seeing examples of how this impacts on people at our next inspection. Areas for improvement We would like to see the excellent practices that were evident for people who use the service extended more effectively to evidence feedback from health and social work professionals. This was not included in the self assessment as an area of improvement and we concluded this is an area for development. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Carr Gomm - West of Scotland Integrated Services, page 14 of 29

15 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that the service had an excellent performance in the areas covered by this statement. We reached this decision after we: * spoke with people who used the service * spoke with managers and staff members * looked at support plans * saw some of the ways in which people can be involved in the community * looked at relevant policies and procedures * spoke with health and social work professionals. The organisation's mission is to be a "person-centred organisation that supports people to lead their lives safely and to do the things they want to do". We concluded that this approach to support planning helped to maintain people's health and wellbeing and took account of the unique circumstances of the individual. Each person had a support agreement that recorded their health and social needs. In the sampled plans we looked at there was excellent information to guide staff on the help that was needed. In the sampled plans we saw evidence of people setting realistic goals within an agreed timescale. Outcomes focussed paperwork showed the progress of these identified goals. There was also an opportunity for people to extend the timescale and go at a rate that better suited them. Each support agreement had a safe and well plan. This recorded an identified risk with an accompanying action plan to make sure people are supported to maintain good mental and physical health. Health professionals were involved in this part of support planning. We spoke with two community psychiatric nurses (CPNs) who told us that the staff team from the Glasgow North East team were very skilled and competent. Both professionals told us that staff were experienced and knowledgeable in risk management. They were confident in their ability to make appropriate assessment of relapse and crisis intervention where necessary. A CPN who works with staff from the Glasgow South team commented, "it is an excellent service". Supported individuals had clear guidelines regarding their medication. In the sampled plans we looked at there was evidence of good practice in medication storage and recording. We saw evidence of life-changing opportunities. We spoke to a man who used the service who told us that the opportunities he had now to participate in community Carr Gomm - West of Scotland Integrated Services, page 15 of 29

16 activities had "saved his life". He told us about feeling more confident and being able to do things he "had never thought possible". Another person told us that staff had helped her to "get out and meet people after years of not leaving the house". Someone told us that the support from staff had stopped her from feeling suicidal. All of the people we spoke with told us the most important achievement of working with the service had been the ability to be helped to remain out of hospital. Some told us they had reduced their medication as a result of the input from the service. We heard of people being involved in a range of meaningful community activities including: * gardening * cooking * voluntary work * walking group * yoga classes. We visited the community allotment and spoke with the community projects manager. We were very impressed at how he and his team had developed this initiative. He told us how he had addressed what he regarded as understandable concerns from other allotment users given the often unhelpful stereotypes that people can have about mental ill health. We concluded that his approach had very successfully challenged the stigma that people often experience. We heard from people who used the allotment of the life changing effect this had on their daily routine. One person told us that the shared interest and social interaction had given her the confidence to become involved in other community activities. A participant in the football group expressed a real passion for his involvement in this community initiative. He told us that the group addressed the issues of healthy living. For example regular training offered opportunities for exercise and social interaction. He told us that the members hoped to organise the group without staff support. We particularly liked the practice of positive experience records. These are used to help people identify and reflect on achievements they had made. We saw many records of positive outcomes that had improved people's lives. Overall we saw excellent evidence of a person-centred and flexible approach to support planning. This clearly helped people to achieve a level of independence and community involvement that improved quality of life and addressed social isolation. Areas for improvement Inspection report continued The provider should continue to monitor and maintain the excellent quality of care. The provider should make sure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Carr Gomm - West of Scotland Integrated Services, page 16 of 29

17 Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm - West of Scotland Integrated Services, page 17 of 29

18 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 Please refer to the strengths in Quality Theme 1 Statement 1 which are also relevant to this statement. The involvement reference group had established areas for development including: * involving more people in staff appraisal, probationary reviews and recruitment * explore opportunities for more people to have the ability and confidence to deliver training * involve more people in delivering induction and training courses to staff. People can make comment on their key and co-workers prior to staff appraisal. The comments informed future learning objectives for the worker. Supported people were involved in developing the associated appraisal questionnaire and leaflet. The complaints policy and suggestions and compliments policy allowed people to make direct comments about staff to the managers including the chief executive. A postcard and prepaid envelope is included in the information pack. Annual questionnaires and exit questionnaires included questions on the qualities of staff and suggestions for improvements or changes they may like. Feedback on this issue is published in the newsletter. Comments to the lay assessor about staff included: "Staff are professional, approachable, trustworthy, adaptable. I'm impressed" "Very nice, very friendly and very professional" "They're understanding about what it is I need to work on". Areas for improvement We would hope to see more evidence of these excellent practice initiatives in our next inspection. We acknowledge the often short-term intervention which can impact on Carr Gomm - West of Scotland Integrated Services, page 18 of 29

19 any meaningful engagement with people in this area. However in order to evaluate the effectiveness of these practices we do need to see more examples throughout the services. We noted the objectives of the involvement reference group and would have hoped to also see this noted in the self assessment as an area for improvement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm - West of Scotland Integrated Services, page 19 of 29

20 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found this service to have a very good performance in the areas covered by this statement. We concluded this after we: * spoke to staff members * looked at staff appraisals * examined support plans/training records/supervision records * looked at minutes of staff team meetings. Inspection report continued The new staff we spoke with told us that the induction offered very relevant training opportunities. They told us it gave them a good knowledge of both the organisations aims and objectives and their role within the organisation. Staff we met described good team relations with opportunities to share practice. They told us the management team are "supportive and approachable". The minutes of the team meetings we sampled showed a good standard of discussion with core agenda items including learning and development, health and safety and team work. We saw from the minutes that National Care Standards are discussed within the context of practice issues. This helped inform staff practice on a daily basis. The service had very good policies and procedures to make sure there is safe and robust recruitment of staff. This included criminal record checks through Disclosure Scotland, seeking two references and appropriate medical checks. We saw evidence throughout the inspection process that staff understood the people who used the service. This was also clear in the observed interactions between staff and service users. The recordings within the support plan also reflected staff motivation to help an individual to achieve good quality outcomes in the identified areas. Supervision is aimed at looking at personal development and reflecting on support issues and practice. The staff we spoke with told us that this forum is an opportunity to openly discuss any concerns, identify training needs and generally reflect on their practice. Annual appraisals aim to assist the worker to reflect on progress on individual objectives and agreed training and development needs. Staff told us how they valued this opportunity to reflect on their practice and discuss learning objectives. Carr Gomm - West of Scotland Integrated Services, page 20 of 29

21 We were provided with a copy of the training calendar for 2013 that identified training topics. The system also identified when refresher training was required. The topics covered in the training calendar were relevant to the needs of the people who used the service. Staff told us of the value of the training from the Positive Behaviour Support Team (PBST). They told us that this approach had helped them to develop skills that could avoid crisis. We received 10 completed staff questionnaires and the comments were largely positive about the organisation. We concluded that staff morale was very good and all the staff we spoke with presented as being committed to the aims of the organisation. Areas for improvement We did not receive an action plan for the recommendations that had been made at the last inspection for this statement. We discussed this with the manager and reminded her of the obligation to submit an action plan within a specific timescale. The manager advised that they had progressed the recommendations. From the 10 returned staff questionnaires 5 people told us that the whistle-blowing, complaints, equal opportunities and restraint policies were not fully implemented in the service. We followed this up with some staff for further clarification. We then spoke with managers and suggested that these policies and procedures are re-visited at team meetings to make sure staff feel confident in their purpose. This could also be discussed at supervision. (See recommendation 1) One staff member made comment that the SVQ 1 and 11 that was offered was inadequate for their role. They felt that an SVQ 111 qualification would be more appropriate. The operations manager later advised us in writing that "Carr-Gomm supports staff through SVQ 111 for those at support worker level and SVQ11 for support assistants". We concluded that learning and development areas that staff have should be taken forward within the local management structure. Some staff told us that there were few opportunities for progression within the organisation, although there was acknowledgement that this was not unique to Carr Gomm and was indicative of the wider financial climate. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Carr Gomm - West of Scotland Integrated Services, page 21 of 29

22 Recommendations Inspection report continued 1. Service managers should develop ways to make sure that all staff have an understanding of how policies and procedures inform their practice. We would like to see, for example, evidence of discussions within team meetings and supervision. This is particularly, although not exclusively, relevant for whistle-blowing and complaints policies. NCS Housing Support Service Standard 3 and Care at Home Standard 4. Carr Gomm - West of Scotland Integrated Services, page 22 of 29

23 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 Please refer to the strengths in Quality Theme 1 Statement 1 which are also relevant to this statement. The registered manager is very visible within the service. We were impressed with the knowledge she had of individuals throughout the service. The people we met could name her, understood her role in the organisation and spoke very highly of her. Questions in the annual and exit questionnaire address the quality of management and leadership. There was evidence that the management had good systems in place that show the managers listen and respond to people. For example, information and views gathered at forums are recorded and fed back with actions in the next published newsletter. We noted a comment made by the assessor for the Investors in People (IiP) award about the management and leadership of the service; "People have confidence in the leadership of the organisation and have a great respect for the MD". IiP is a nationally recognised framework that gives people the assurance that they are working for an organisation that cares about improving performance. Areas for improvement We would like to see the excellent practices that were evident for people who use the service extended more effectively to evidence feedback from health and social work professionals in all the services. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Carr Gomm - West of Scotland Integrated Services, page 23 of 29

24 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 Inspection report continued The organisation had quality assurance systems and processes in place. The following are some of the systems that we sampled from the services we visited: * minutes from focus group meetings * minutes from involvement reference group meetings * annual questionnaires * staff surveys * internal and external monitoring systems such as Investors in People (IiP). Systems were in place to assess the quality of care, staffing and aspects of management and leadership. For example; Staff performance systems included supervision, appraisals, team meetings and audits on staff practice, such as medications and health risk areas. This helped managers to identify any issues and put in place the necessary action. For example we saw from the supervision notes of one of the staff members that measures had been put in place to monitor an area of practice that was regarded as needing additional learning. The operations manager carried out internal audits in each service. These audits included checking support plans, the quality of the recordings, financial records and medication recording sheets. Focus groups are attended by the registered manager. Any feedback from those forums is used to inform an action plan that would progress any planned improvement. Each service had an improvement plan which identified areas for team development. We saw plans for Glasgow South and North East Integrated teams. Forums and Annual General Meetings were open to people who used the service, relatives and stakeholders. We saw evidence from minutes and newsletter articles that these meetings are a way for people to contribute to service development. We looked at the organisation's business plan for and saw their commitment to continued improvement. For example, we saw that requests made through focus groups to organise summer events and involving people who use the service in the planning were successfully achieved. We saw from the business plan a commitment to developing a positive workforce. Carr Gomm - West of Scotland Integrated Services, page 24 of 29

25 External quality assurance measures such as Investors in People award (IiP) were also an indicator of the organisation's business aim to be "efficient and effective in all our organisational processes. There was an emphasis on achieving common objectives through the effective encouragement and development of their workers. Areas for improvement Particular aspects that we look for in this statement were unmet. For example, the self assessment was not returned to us within the agreed timescale, nor was the action plan. An action plan is required from a service when an inspector has made recommendations and/or requirements. Two recommendations had been made for Quality Theme 3 Statement 3 in the last inspection. We therefore expected an action plan that outlined how the service would meet those recommendations. The manager advised that she had progressed the action plan. The self assessment was provided the day after the inspection began and we did look at the areas for improvement that the manager had identified. We noted that despite the internal file audit system a number of documents in support plans had not been signed and dated. This was most evident in the files from the Rossdale service. As this issue was identified at the previous inspection we would like to see improved audit of the plans to make sure quality assurance processes are meeting their objectives. We looked at a sampled minute of a team meeting and noted that a member of staff had been dismissed for gross misconduct. The manager did not send, as required, a notification to the Care Inspectorate. By law all services must tell us immediately if certain events take place including allegation of misconduct by a provider or any person employed in care services. We would refer the manager to Care Inspectorate guidance, 'Records that all registered care services (except childminding) must keep and guidance on notification reporting'. (See requirement 1) We have referred to an absence of any substantial formal feedback from stakeholders such as health professionals and care managers throughout the report. This is an area where we feel there should be more development and which we would be looking for at our next inspection. Overall we concluded that the areas covered by this statement did not meet the high standards we found in other areas of planning and development in this service. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Carr Gomm - West of Scotland Integrated Services, page 25 of 29

26 Requirements Inspection report continued 1. The provider must notify the Care Inspectorate of any significant accident and incidents including those involving a person who uses the service and all allegations of misconduct by a provider or any employed person. (SSI 2002/114), regulation 21 (2) (b) and (c) Notification of death, illness and other events (2) A provider of a care home service shall give notice to the Commission without delay of the occurrence of - (b) any serious injury to a service user; (c) any allegation of misconduct by the provider or any person who is employed in the care service Carr Gomm - West of Scotland Integrated Services, page 26 of 29

27 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 No additional information recorded. 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). Carr Gomm - West of Scotland Integrated Services, page 27 of 29

28 5 Summary of grades Quality of Care and Support Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Staffing Very Good Statement 1 Statement Excellent 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Excellent 4 - Good 6 Inspection and grading history Date Type Gradings 17 May 2012 Unannounced Care and support 6 - Excellent Staffing 5 - Very Good Management and Leadership 6 - Excellent 30 Aug 2010 Announced Care and support 6 - Excellent Staffing 5 - Very Good Management and Leadership Not Assessed 24 Nov 2009 Announced Care and support 6 - Excellent Staffing 5 - Very Good Management and Leadership 5 - Very Good 6 Jan 2009 Announced Care and support 6 - Excellent 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. Carr Gomm - West of Scotland Integrated Services, page 28 of 29

29 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: Carr Gomm - West of Scotland Integrated Services, page 29 of 29

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