Rowan Alba Ltd - Thorntree Street Housing Support Service 19 Thorntree Street Edinburgh EH6 8PU

Transcription

1 Rowan Alba Ltd - Thorntree Street Housing Support Service 19 Thorntree Street Edinburgh EH6 8PU Inspected by: Catriona Maplesden Type of inspection: Announced (Short Notice) Inspection completed on: 21 January 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Rowan Alba Ltd Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Catriona Maplesden Telephone enquiries@careinspectorate.com Rowan Alba Ltd - Thorntree Street, 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 The manager and staff team have worked hard to support service users' involvement in the assessment of the quality of their care and support. Staff work under challenging circumstances but maintain focus on improving the outcomes for service users. They bring communication skills, training and experience to their roles and understand each service user's needs well. The manager promoted the staff team's professional development. Staff receive regular supervision. This gives them the opportunity to discuss practice issues and identify any training suited to the needs of individual service users. We received very positive feedback from service users about the quality of the support they receive and how the service is managed. What the service could do better Staff had completed a survey but had not received feedback about the issues they have raised about lone working and staffing of the service. Staff dealt with behaviours which could be very testing and many indicated that they did not feel safe at their work. Training in capacity and consent issues and further adult protection training was planned for. Training for staff in mental health first aid would be beneficial to them in supporting service users. The input from a psychologist had proved beneficial to the team and the manager was planning to have further involvement so that staff could look at specific issues and situations which they are dealing with on a regular basis. Rowan Alba Ltd - Thorntree Street, page 3 of 22

4 What the service has done since the last inspection Service user involvement was more firmly established with regular house meetings and the introduction of the 'You Said, We Did' system. Staff had worked hard to support service users in accessing support from health professionals and promote service users' rights. The manager had just started at the time of the last inspection and had put a lot of effort into developing and supporting the staff team in their work with service users. Staff training and development was continuous and had included 'Death, Dying and Bereavement' training. Staff had received input from a psychologist to support them in their roles and look at how their input improved outcomes for service users with alcohol dependency. The Cards project (Community Alcohol Related Damage Service) had developed as a result of the work Thorntree Street staff undertake on a daily basis with people with alcohol related brain damage. Volunteers work to build the clients' self-esteem, confidence and social skills, often addressing health and financial issues on the way towards more independence. The service and organisation as a whole were developing the role of volunteers in supporting service users and other people living in the community. We found that the service were committed to continuous improvement and planning ahead to be less reliant on local authority funding in a time of financial cutbacks. Conclusion Staff have knowledge and skills in supporting people who are alcohol dependent. They deal with some challenging situations but have benefited from having regular support from their manager. Various developments such as the computer group and photography project have started as a result of service user involvement and staff were keen to further develop resources. Service users were well supported in their daily lives and outcomes for service users are monitored through regular reports to the local authority. The organisation should continue to monitor the levels of incidents to ensure that staffing arrangements are flexible enough to provide for the changing needs of people using the service. Who did this inspection Catriona Maplesden Rowan Alba Ltd - Thorntree Street, page 4 of 22

5 1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, SCSWIS, took over the work of the Care Commission, including the registration of services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS. Thorntree Street provides secure tenancies to older people (50+) who have had a history of rough sleeping, living in insecure accommodation or homeless hostels and a long-term history of problematic alcohol use. Opened in 2004, in partnership with Bield Housing Association, Rowan Alba provide on-site housing support and care-at-home services centred around individual needs, choices and preferences. There are eight 'bed sit' type flats and four one bedroom flats - all with lift access. The ground floor of the building consists of office accommodation, a large catering kitchen and a spacious lounge with dining area, where service users can meet for shared meals and to socialise. The individual flats are situated on the upper floors and can be accessed by a lift or stairs. There is a small garden to the rear of the property. Bield Housing Association owns the property and leases it to Rowan Alba Ltd. The two parties meet on a regular basis. Tenants have the opportunity to discuss their housing needs with their landlord. The tenants have a Scottish Secure Tenancy which means they have a tenancy for life. Newer tenants have short-term agreements while their housing needs are assessed. The service has a statement of aims and objectives including: "Deliver a service which fully honours service users' rights as defined in the National Care Standards: Dignity, Privacy, Choice, Safety, Realising Potential and Equality and Diversity. Rowan Alba's work is built on the fundamental principle of the right of the individual to make choices about their lives in terms of health, relationships and lifestyle. Tenants are also encouraged to recognise and address the responsibilities that come with these. Rowan Alba support isn't about forcing tenants into services they aren't ready to use as a condition of stay or having to address dependency issues through therapy. The time may come when one of our tenants is ready and motivated to explore change - or it may not.'' Rowan Alba Ltd - Thorntree Street, page 5 of 22

6 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. 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. Rowan Alba Ltd - Thorntree Street, 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 Catriona Maplesden, Care inspector carried out a short notice inspection of the service on 14 January, 2014 and returned to the service between 10am and 5pm on 21 January We gave feedback to the manager on this day about our inspection findings. We spoke with the following people: 3 service users The manager 2 members of staff A student on placement We looked at the following documents: Minutes of tenants' meetings Minutes of annual tenants' meeting with landlord and provider 9 returned care standard questionnaires 4 returned staff questionnaires Information displayed on central areas Sample of support plans Supervision and appraisal records Accident and incident log Minutes of staff meetings Complaint policy and log Audit checklists Minutes of staff consultation Public Liability Insurance document Environment checklists Annual Report information in the annual return Information in the service's self assessment Feedback evaluation Learning and development policy Rowan Alba Ltd - Thorntree Street, page 7 of 22

8 Involvement policy Strategic Plan 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 Rowan Alba Ltd - Thorntree Street, page 8 of 22

9 What the service has done to meet any recommendations we made at our last inspection The service had taken action to meet with previous recommendations. Further training for staff was planned for in the areas of tissue viability, alcohol related brain damage and mental health. We have identified in this report that lone working and feeling safe at work is still an issue for staff and needs further attention from higher management following the staff consultation process. 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 self assessment was completed in full. We were satisfied with the detail provided under each quality statement. The assessment demonstrated that the service was continuing to look at how it could improve and planning ahead for this in order to achieve improved outcomes for service users and those supporting them. Taking the views of people using the care service into account We received very positive feedback about the quality of staff and management including: 'Service is fantastic. The staff are caring. I am well looked after.' 'Since I have moved here the staff have been great and I am happy with the things I have here. Staff take the time to help me.' 'It's home for me. I don't want to go anywhere else.' 'I am happy here.' Rowan Alba Ltd - Thorntree Street, page 9 of 22

10 'This place is well managed and the staff are all really good to me.' Taking carers' views into account We did not have contact with any carers during this inspection but received a questionnaire from a relative which 'strongly agreed' that they were happy with the quality of care and support being provided. Rowan Alba Ltd - Thorntree Street, page 10 of 22

11 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 We found that the service had developed a range of methods for involving service users in assessing the quality of care and support. Since the previous inspection the 'You said, we did' system had been further developed. This involved gathering feedback from service users and posting up the improvements that the service had made in response to feedback. The service also promoted involvement in the care inspection through encouraging service users to complete the care standards questionnaires. We had a good return on these (9 out of 12 people completed these) These indicated high satisfaction levels with the overall quality of care and support, quality of staffing and involvement in support planning. They also showed that service users considered that staff treated them with respect and had enough time to provided them with the support they needed. The service complaint policy and other information was on display centrally. The manager held regular 'surgeries' which allowed tenants the opportunity to meet and share their views about the service. Staff had received information about the organisation's involvement strategy. Keyworkers worked closely with service users and recorded any discussions/feedback in their support plan. The service had well established links with the landlord Bield. A housing officer for Bield visited the service monthly. This allowed service users the opportunity to meet with them (and the service manager) to discuss any issues relating to their housing Rowan Alba Ltd - Thorntree Street, page 11 of 22

12 support and the quality of facilities. They could also explore options for moving on from the service and receive housing advice. There was an annual tenants meeting held. These were well documented and showed that tenants had received information about improvements that had been made. They also had the opportunity to ask questions and raise any issues they wanted to. The meetings were usually attended by Rowan Alba's Chief Executive Officer, the Property Officer and a Bield Housing Officer. We saw positive communications between staff and service users. Assistance was given in a polite, clear way when an issue was raised. Staff used alternative methods for communicating with service users who had difficulties with reading and writing and also supported services users with sensory impairments. This meant they took account of individual needs when supporting communications. The service had started up a computer workshop to support service users in learning new skills and other initiatives were being introduced to help people to be involved in the community and take up old interests or explore new ones. The support plans sampled evidenced that service users' support needs were regularly reviewed. Where possible staff asked service users to sign documents and meet regularly with their keyworker. Tenants were invited to attend staff meetings on occasion and had gained a greater understanding of the differences between housing management and housing support. Tenants had their say about what they would like to see on the menu and what activities they would like to take part in, at home and in the community. Areas for improvement The service should continue to build on the excellent practice of regulalry involving service users in assessing the quality of care and support and providing them with feeback about how their views have been used to improve the quality of the service. The service planned to develop the use of volunteers to further improve the quality of experience for people using the service. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Rowan Alba Ltd - Thorntree Street, page 12 of 22

13 Service strengths The service was operating at an excellent level in relation to this quality statement. We saw that support plans and risk assessments were regularly reviewed and service users had regular opportunities to meet with their keyworkers to discuss their health and wellbeing needs. The service had well established links with the local GP practices and details of involved health professionals were recorded on each individual support plans. The service involved a range of health services and supported service users in having their individual health needs addressed. The service had taken action to meet with a previous recommendation regarding having service users' needs reassessed and accessing specialist equipment for them. We found that the service had continued to request input from health professionals, such as physiotherapists and occupational therapists to have service users' needs reassessed when staff noted changes in their condition. Additional funding had also been sought to provide further staff support for service users whose health and support needs had increased. The service maintained clear records of accidents and incidents and carried out three monthly reviews of the support plans. Service users were involved in menu planning and were given the opportunity to attend a cookery group. Feedback we received from service users in the 9 returned care standard questionnaires indicated that all service users were involved in planning their support. All respondents agreed that their needs and preferences were detailed on their plans and that the service regularly checked with them that their needs were being met. Areas for improvement Training in capacity and consent issues was planned for. This will be beneficial to the staff team who are regularly dealing with complex support issues. Mental health first aid training would also be beneficial for staff. The new induction process will involve staff being trained in adult support and protection at an earlier stage. The service should continue to build on the very good standard of practice achieved to date in relation to this quality statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Rowan Alba Ltd - Thorntree Street, 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 The strengths identified under 1.1 also apply to this quality statement. The service had continued to promote service user involvement in assessing the quality of staffing and had encouraged service users to be involved in staff recruitment. They also had the opportunity to raise any issues about staffing with the manager who was accessible to them on a regular basis. We observed open communication between staff and service users and staff actively encouraged service users to express their views. Areas for improvement The areas for development identified under 1.1 also apply to this quality statement. The service should continue with the very good progress made in supporting service users to express their views and influence the quality of staffing. 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 The manager had put a lot of effort into developing effective supervision, appraisal and support systems for staff who often manage conflict and challenging situations. The team had received recent input from a psychologist in looking at the work they do in supporting people with alcohol dependency. Staff we spoke with during reported that this had been very useful to them in reflecting on their practice and seeing the positive things in the support they provide. Outcomes for service users were often hard to measure and it was important for staff to see the value in what they do on a daily basis. Further support sessions were planned for the team. A staff survey had been undertaken and a staff forum had been held. This had involved staff Rowan Alba Ltd - Thorntree Street, page 14 of 22

15 feeding back to higher management their views of the support they provide and looking at improvements which could be made to staffing at the service. The service had taken action to meet with a previous recommendation in sourcing information about tissue viability issues and identifying risk factors which could lead to skin breakage and pressure sores. Staff were supported in their professional development and were knowledgeable about the service's aims and objectives and policies and procedures. Staff we consulted confirmed that they received mandatory training such as in First Aid, Conflict Management, Fire Safety, Food Hygiene, Health and Safety and Moving and Handling. Some staff had previously attended motivational interviewing training and a member of staff had undertaken training in addiction counselling and another had received training in understanding alcohol related brain damage. Staff had the opportunity to be involved in joint training with other services and were kept informed of training opportunities at staff meetings and through individual supervision with their line manager. The manager had developed a staff training plan. We found improved recording of training undertaken and planned for since the previous inspection. Staff had the opportunity to be involved in joint training with other services and were kept informed of training opportunities at staff meetings and through individual supervision with their line manager. Staff had previously participated in the Stress Management Network Support Programme delivered by the Scottish Centre for Healthy Working Lives and individual counselling was available to staff should they want this. Staff who completed the staff questionnaires confirmed that they received regular supervision and were supported in their training. One member of staff commented that training was constructed around the needs of service users so that staff acquired the necessary skills and knowledge to support people effectively. All staff confirmed that they had the opportunity to meet as a team. Areas for improvement Changes were due to be made to the rota to improve the time staff had to communicate information during handovers between shifts. Staff safety at work is an issue that has been consistently raised by the staff team and it was expressed that staff did not feel safe while lone working. The staff team had not received the results of the survey at the time of inspection or the actions that were being taken to address issues raised. We were informed that there were going to be changes to the staff rota to provide more support to staff in supporting service users. The service should continue to monitor lone working arrangements to ensure that Rowan Alba Ltd - Thorntree Street, page 15 of 22

16 sufficient practical supports are in place when staff are dealing with challenging situations. A recommendation was made in relation to monitoring lone working arrangements at the previous inspection. While this had been carried out, we heard that there were still staffing issues that needed addressed. (See recommendation 1) The service should continue to build on the very good standard of practice achieved to date in relation to this quality statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. We recommend that the staff team are provided with feedback following the staff survey and consultation exercise and the corresponding action plan to address issues raised. National Standards for Housing Support and Care at Home. Standard 4. Management and Staffing. Rowan Alba Ltd - Thorntree Street, 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 The strengths identified in Quality Statement 1.1 also apply to this quality statement. We saw that service users had direct access to the manager and could raise concerns with her and were also given the opportunity to meet with the chief executive and the landlord at the annual tenants meeting. The service had a complaint procedure which was displayed and feedback we received confirmed that people understood how to make a complaint or raise a concern. We saw that clear records were maintained of any complaints raised and that service users had the opportunity to contact the chief executive if they were unhappy with the outcome of the complaint investigation. The organisation involved advocacy services when there were any conflicts of interests and in situations where service users might need someone representing their views. Feedback we received about the manager of the service was very positive. All respondents to the Care Inspectorate questionnaires were confident that staff had the skills to support them and that the service asked for their opinions on how it could improve. Areas for improvement Further opportunities for service users to meet with board members and participate in decision making processes about policy development and improvement planning could be offered. The service identified in its self assessment that it would like to build upon the progress made in clear information about service improvements made as a result of their views and suggestions being heard. The service planned to update the tenants' handbook and other information for service users to keep in their homes for reference. This had been discussed at a recent meeting with tenants and a service user had shown interest in being part of this project. Rowan Alba Ltd - Thorntree Street, page 17 of 22

18 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 The strengths identified in quality statement 1.1. also apply to this quality theme. We found that the service were committed to involving people who receive support in improving the quality of the service and having their views and suggestions heard. The service had a range of methods in place to involve service users and other involved parties in their quality assurance systems. There were clear auditing systems in place. The service reported to the local authority each month on performance targets and the manager forwarded a monthly audit to the chief executive. Quarterly meetings were held with service commissioners who took account of data from the ECCO (the system City of Edinburgh Council use to monitor outcomes for people being supported). Feedback from staff was strongly supportive of the manager who had worked hard to develop and improve the service through regular consultation with service users and staff. Long term staff were being encouraged to take up training opportunities in management and leadership. The manager was about to complete an award in management and leadership and met with the chief executive on a regular basis. The manager had clear systems in place to check that support plans and medical records were regularly audited. The service maintained night-time disturbance logs and monitored the level of accidents and incidents occurring. This information had been taken forward and staff had been involved in a consultation process about how the staffing at the service could be restructured to achieve improved outcomes for service users and staff. The annual review report had provided a thorough overview of service delivery and had highlighted strengths and areas for service improvement. The Card project had been developed in recognition of a need on the community for people with alcohol dependence to have people to visit and support them. This was being rolled out at the time of inspection and there were plans to develop the role of volunteers in improving outcomes for service users. Rowan Alba Ltd - Thorntree Street, page 18 of 22

19 Areas for improvement Staff were waiting to hear back from the chief executive about how the outcomes of the staff consultation process and how this would impact upon staffing arrangements at the service. An action plan from the most recent annual review was due to be developed and we will monitor progress on this at future inspections. The staff team had long-term experience and skills in supporting people with alcohol dependence and related issues. They expressed that they felt well supported at a local level but would like to be informed more quickly about decisions reached at higher management level. Increased consultation with the chief executive and the Board of Management is an identified area for supporting staff and service user involvement in decision-making processes. The organisation has a strategic plan in place which identified achieving external quality assurance awards such as Investors in People and Investors in Volunteers. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Rowan Alba Ltd - Thorntree Street, 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 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). Rowan Alba Ltd - Thorntree Street, page 20 of 22

21 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Excellent 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 13 Dec 2012 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 14 Dec 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 18 Nov 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 9 Jul 2008 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. Rowan Alba Ltd - Thorntree Street, 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: Rowan Alba Ltd - Thorntree Street, page 22 of 22