Falkirk Council Mobile Emergency Care Service Housing Support Service Unit 1 St Johns Sawmills Etna Road Falkirk FK2 9EG Telephone:

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1 Falkirk Council Mobile Emergency Care Service Housing Support Service Unit 1 St Johns Sawmills Etna Road Falkirk FK2 9EG Telephone: Inspected by: Claire Drummond Type of inspection: Unannounced Inspection completed on: 21 June 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Falkirk Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Claire Drummond Telephone enquiries@careinspectorate.com Falkirk Council Mobile Emergency Care Service, page 2 of 22

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 Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well We found that the manager of the service has pro-actively identified gaps in provision and developed the service to meet the needs of people in the Falkirk area. The provider has accessed funding to support these developments and the service has improved the outcomes for people who use the service as a result. Staff we spoke with appeared competent and confident. The service promotes a culture of continuous development and provides very good opportunities for staff to access any learning and development they require in their roles. What the service could do better We found that the management team have made ongoing efforts to involve people who use the service in assessing and evaluating it. They have also sought to involve people in ongoing service development. Responses to this have been limited. The provider should continue to develop the ways in which people who use the service and their relatives or carers are involved in service developments. What the service has done since the last inspection We found that the management team and staff have started to record reflections about training at the service. This was an area for improvement which was identified during the last inspection. The service is currently in the process of re-design and has used this as an opportunity to re-deploy staff to areas of high demand within the service. Falkirk Council Mobile Emergency Care Service, page 3 of 22

4 Conclusion Inspection report continued We found that this service has a highly experienced and knowledgeable staff and management team. Systems and processes are in place to allow for continuous improvement to the quality of the service being provided. Who did this inspection Claire Drummond Lay assessor: Ms Linda Riley Falkirk Council Mobile Emergency Care Service, page 4 of 22

5 1 About the service we inspected Falkirk Council Mobile and Emergency Service (MECS) provides a combined Housing with Support and Care at Home service. The service aims to provide a prompt and appropriate response to crisis situations through an alarm system set up in a service user's home. A central control room responds to calls sending a mobile warden to provide the necessary assistance and support. The service is provided on a 24 hour basis. The service is also involved in researching and introducing new initiatives as a means of encouraging and supporting individuals in maintaining their independence. Examples have included the development of 'tele-care' and 'falls risk management'. 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 This services was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 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 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. Falkirk Council Mobile Emergency Care Service, page 5 of 22

6 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. Falkirk Council Mobile Emergency Care Service, page 6 of 22

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 an unannounced inspection. This was carried out by Care Inspector, Claire Drummond and Lay Assessor, Linda Riley. The inspection took place on Tuesday 21 May 2013 from 9.00am until 4.00pm. The inspection continued on 22 May 2013 from 12pm to 4.00pm and was completed on 20 June 2013 from 9.15am, we gave feedback to the manager from 10.00am to 12.30pm on 21 June As part of the inspection, we took account of the completed annual return and selfassessment form that we asked the provider to complete and send to us. In this inspection we gathered evidence from various sources, including the following: We spoke with: eight people who use the service the manager three mobile operations co coordinators eight wardens We looked at: six service user support plans, risk assessments and records of reviews registration certificate five staff files including supervision minutes, appraisals and training records training matrix notes complaints information newsletters service development plan and workplans service participation information minutes of staff team meetings, trade union liaison meetings and management team meetings service evaluation form Falkirk Council Mobile Emergency Care Service, page 7 of 22

8 Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Falkirk Council Mobile Emergency Care Service, page 8 of 22

9 What the service has done to meet any recommendations we made at our last inspection There were no recommendations made during the last inspection. 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 Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. Taking the views of people using the care service into account The views of people who use the service are contained throughout this report. Taking carers' views into account The views of carers we spoke with are contained throughout this report. Falkirk Council Mobile Emergency Care Service, page 9 of 22

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 At this inspection, we found that the performance of the service was very good for this statement. We looked at the service user involvement and engagement policy, evaluation responses, minutes of review meetings and spoke with people who use the service to assess this statement. The service is currently using a new paperwork procedure. The purpose of this is to increase the amount of information provided to people who use the service and their relatives and carers. This has been introduced in response to comments from people who use the service and their relatives and carers, who stated that having more information available to them after a warden is called out would be useful. This new procedure is being evaluated by the manager, who will assess the impact of the change on the response times people who use the service experience. People who are considering using the service are given an introductory pack which tells them about the service and how it provides support. This also contains information encouraging people to express their views about the service and how to make a complaint if required. Ongoing service evaluation is carried out by the management team. This is done by: -six monthly reviews with people who use the service -a 10% sample of people who have accessed the service within the last four weeks being chosen at random and asked to complete a service evaluation questionnaire. Falkirk Council Mobile Emergency Care Service, page 10 of 22

11 We found that a monthly report is prepared from the responses from service users. This report is shared with the service manager, wardens, control room and other staff. This gives the service very up-to-date information about the current views of service users. We found that the manager has offered people who use the service the opportunity to be involved in the recruitment of new staff. However, none have recently chosen to take part in recruitment. People who use the service have also been involved in the delivery of training previously, however this has not been the case since the last inspection. We saw a copy of the service newsletter which is sent to people who use the service, social work departments and partner agencies. This is produced on an annual basis to share information about current trends and the future direction of the service. Areas for improvement We saw that the manager has attempted to engage people who use the service in a service users' forum, to provide an additional way for people to express their views. For example, contact has been made on two occasions a random sample of 100 service users to ask them to be involved in a service user forum. The management team is considering other methods of engaging people who use the service and their relatives and carers. This includes seeking the views of a citizens' panel, which the provider is aiming to facilitate. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Falkirk Council Mobile Emergency Care Service, page 11 of 22

12 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued At this inspection, we found that the performance of the service was very good for this statement. We looked at service user plans, minutes of review meetings and spoke with people who use the service and staff to assess this statement. We looked at seven 'personal plans' for people who use the service. We found that these contain information which allows staff to meet the care and support needs of service users when they respond to an emergency call. We saw that general risk assessments have been completed and that these have been used to develop safe practice. Individual risk assessments have also been completed for some of the people who use the service. Where these are required they provide an additional source of information to enable wardens to meet the needs of service users. General risk assessments are referred to for people who use the service who do not require any additional assessments in addition to these. Staff demonstrated a high level of awareness about these generic risk assessments. We asked people who use the service whether they felt that the staff have enough information to be able to meet their care and support needs. We spoke with six people, four of them said 'yes', one had not used the service yet and one relative/ carer said: 'Yes, so far not any problems'. We saw that comprehensive guidance is available to staff about the level of assistance with medication for people who use the service they may provide. This guidance is very clear and leaves no doubt with regard to the medication tasks which staff are able to carry out depending on their training and experience. We found that training in medicine management is provided for staff and that this is complemented with a competency test, which staff complete and are assessed against. We found that the service is pro-actively working with other agencies to reduce the need for people who use the service to experience assessments from several different agencies. For example, the service has been working in partnership with other health and social work agencies to reduce the amount of falls experienced by people in the Falkirk area. This involves assessing service users and making referrals directly to other agencies where required, but also providing technology and information for service users which reduces the need for contact with the emergency services. Scottish Ambulance Service is part of this pilot and have changed the referral pathway used by them to include a contact with Falkirk MECS wardens where a service user has fallen but is not injured. Falkirk Council Mobile Emergency Care Service, page 12 of 22

13 We found that where technology had been inactive for various reasons, wardens performed test calls to ensure that they were actively functioning for service users. Pro-active work is undertaken by staff in the control room team, whom the service provides with a list of people who have not activated their alarm in the previous six months. Contact is made with these service users and they are asked to complete a test call which the control room monitors to ensure that equipment is working effectively. Areas for improvement We found that reviews are not consistently taking place every six months for each person who uses the service. The manager and staff should ensure that reviews are completed as required. We found that records require further development where more than one person living at the same address uses the service. This is because records we checked made it difficult to establish who the service was for in some cases like this. Some of the people who use the service that we spoke with told us that they did not have a telephone number for the MECS office. This will be checked by wardens during review and other visits. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Falkirk Council Mobile Emergency Care Service, page 13 of 22

14 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 At this inspection, we found that the performance of the service was very good for this statement. We looked at the service user involvement and engagement policy, evaluation responses, minutes of review meetings, staff supervision records, team meetings minutes and spoke with people who use the service to assess this statement. We saw evidence that people who use the service have been invited to be involved in the recruitment of several different members of staff, including where internal interviews have been held. Records show that there have not been any service users who have wished to take part in recruitment processes at the service since the last inspection. We found that feedback from people who use the service is shared with staff in a variety of ways. For example, during supervision meetings, information on notice boards, sent to staff via and through discussion at team meetings. Please see Quality Theme 1, Quality Statement 1 for further information about participation. Areas for improvement The manager has attempted to engage people who use the service in a service users' forum to provide an additional way for people to express their views. The management team is considering other methods of engaging people who use the service and their relatives and carers. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Falkirk Council Mobile Emergency Care Service, page 14 of 22

15 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued At this inspection, we found that the performance of the service was very good for this statement. We looked at staff files and spoke with people who use the service and staff to assess this statement. The manager has an overview of the training which staff have attended and any training they need to complete. Staff access the providers' training calendar and we saw evidence of the mandatory and additional training courses which staff have attended since the last inspection. For example, staff had received training about end of life care facilitated by Strathcarron Hospice. The purpose of this was to support staff to understand their role in the provision of palliative care for people who use the service and the relatives/carers. We saw that the manager and staff are maintaining training outcomes records to document their expectations of training opportunities. They also reflect on the value of the training and how this will influence their practice at work. Staff are not currently required to be registered with the Scottish Social Services Council, however were aware of codes of practice during discussions with them. We saw evidence that 36 out of 38 staff employed by the service have completed Scottish Vocational Qualifications. The manager has an overview of supervision and Annual Employee Development Review dates for all staff. This means that these are up-to-date and this information is available quickly. We looked at minutes of supervision meetings between the management team and staff members and found that these are comprehensive. A standard agenda is used however, this agenda is added to for each individual worker if required. This means that the management team are able to evidence their good practice in identifying and discussing individual topics with staff. We found that staff are issued with a copy of the Scottish Social Services Council (SSSC) Codes of Practice as part of their induction to the service. These codes of practice also inform the 'values' training which staff receive during their induction period. We saw minutes of staff meetings, management team meetings and trade union liaison meetings. We also saw additional meetings which are undertaken to promote the development of the service.these demonstrate that the meetings are used to share information and communicate between management and staff. Falkirk Council Mobile Emergency Care Service, page 15 of 22

16 When asked whether staff were respectful towards them, people who use the service told us: 'Yes, they are nice, very nice' '9 out of 10. Once, there was a man who came out to take me to the toilet and he was quite sharp' 'Pleasant, yes' A relative/carer told us: 'They are absolutely wonderful'. We looked at five staff files during this inspection and found that these contain information about relevant checks and references, which are used to make sure that staff are appropriate to be working with people who use the service. Records also demonstrate that the induction of staff to the service is comprehensive and adapted to meet the needs of staff in different roles within the service. We saw that staff are mentored by experienced staff as part of their induction training. Records show that new staff must be deemed competent by their mentor, a verifier (member of the management team) and must agree that they deem themselves to be competent before they provide support to service users alone. Areas for improvement We observed a handover taking place between MECS wardens coming off duty and wardens coming on to duty during this inspection. This process appeared to be rushed and lacked structure. Sufficient time should be made available for staff to handover information between shifts. A standard format for handover could be used to ensure that all relevant information is discussed. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Falkirk Council Mobile Emergency Care Service, page 16 of 22

17 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 At this inspection, we found that the performance of the service was very good for this statement. We looked at the service development plan, comments and complaints and service evaluations to assess this statement. We found complaints records which show that the manager responds quickly to complaints. We also saw that where complaints are investigated, complainants are given information about the outcome of their complaint. We found that the manager has very good links with other agencies. For example, sitting on a cross service group with other local authorities and the National Health Service with regards to the future development of the Falls Co-ordinator post within the service. We saw evidence that people who use the service have been involved in auditing various parts of the service, for example, bogus callers and internal alert responses. We also found that a service user satisfaction survey on the Falls Management Project, bogus callers, epilepsy and Global Positioning System (GPS) technology has been completed. Please see Quality Theme 1, Quality Statement 1 for further information about participation. Falkirk Council Mobile Emergency Care Service, page 17 of 22

18 Areas for improvement The manager has attempted to engage people who use the service in a service users' forum to provide an additional way for people to express their views. The management team is considering other methods of engaging people who use the service and their relatives and carers. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Falkirk Council Mobile Emergency Care Service, page 18 of 22

19 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 At this inspection, we found that the performance of the service was very good for this statement. We looked at policies, audit action plans, complaints, an evaluation of the Falls Management Project, service work plan, service development plan and evaluation returns to assess this statement. We found that the service has developed comprehensive, clear policies to provide guidance for staff. These policies are linked to local protocols, which staff demonstrated good knowledge of during this inspection. We saw that the manager attends management meetings with other services which provides an overview of other local services. Response times are reported on and monitored by the manager. This means that a co-ordinated approach can be developed to meet the needs of people who use the service in the Falkirk area. We saw that the service has completed an internal audit to evaluate the delivery of the service since the last inspection. We found that the management team undertake audits of the performance of the service regularly and are pro-active in addressing any issues identified in these. The management team are responsive and reflective about the service and are focused on continual improvement to the service. The manager has an excellent overview of the service and demonstrates a strategic awareness of services which support people locally. They are using this knowledge to continually improve the service received by people in the local area. Areas for improvement The provider and management team should continue to develop the ways in which service users, staff and stakeholders are involved in assessing the quality of service provided. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Falkirk Council Mobile Emergency Care Service, page 19 of 22

20 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 N/A. 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). Falkirk Council Mobile Emergency Care Service, page 20 of 22

21 5 Summary of grades Quality of Care and Support 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 27 Jul 2012 Unannounced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 7 Dec 2010 Announced Care and support 6 - Excellent Staffing Not Assessed Management and Leadership Not Assessed 5 Mar 2010 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 31 Mar 2009 Announced Care and support 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. Falkirk Council Mobile Emergency Care Service, page 21 of 22

22 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: Falkirk Council Mobile Emergency Care Service, page 22 of 22