Partners for Inclusion Housing Support Service West Kirk 84 Portland Street Kilmarnock KA3 4AA Telephone:

Transcription

1 Partners for Inclusion Housing Support Service West Kirk 84 Portland Street Kilmarnock KA3 4AA Telephone: Inspected by: Lesley Smith Type of inspection: Unannounced Inspection completed on: 5 October 2012

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 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Partners for Inclusion Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Lesley Smith Telephone enquiries@careinspectorate.com Partners for Inclusion, page 2 of 23

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 6 Excellent What the service does well Partners for Inclusion (known as PFI and referred to throughout the report as PFI) use a person centred support model to provide an individually designed service for each service user they support. The planning is meticulous. The support plan is highly detailed in its initial stage (service design) which feeds into an equally detailed working plan. At each and every stage, service users, their families, significant others who know the service user well and PFI staff were fully involved. There was documented evidence to confirm each service was built round genuine involvement and partnership working, where the service user remains at the centre of the process at all times. Along with extensive documentation, confirmation of the inclusive way PFI works was evidenced in positive statements received from service users and relatives during the inspection process. It was also evidenced in interviews with service users who confirmed their identified outcomes were actually being met, or, were in the process of being met. Robust involvement with service users and families was maintained throughout PFI involvement. This was evidenced in documentation relating to regular reviews and ongoing analysis of the individual service. This was also reflected in the regular documented alterations to the service user's working plan. The service was required to adapt and develop as needs or methodology change. Partners for Inclusion, page 3 of 23

4 PFI impressed as a service with a unique vision, a distinct way of working in terms of a person centred approach and a firm commitment to inclusion. We were impressed with the painstaking attention to detail that was apparent in every aspect of the individual services provided, and also within the company support services. We were also impressed with the shared philosophy, purpose, enthusiasm and energy displayed by staff throughout PFI. PFI stated very clearly that there was always space for improvement and encouraged service users, families, carers and involved personnel to comment on the service provided. This is evidenced in a variety of different means for gathering opinion and suggestions. What the service could do better There were two areas for improvement identified which are detailed in the appropriate quality themes. What the service has done since the last inspection PFI has continued to build on their foundation of solid practice. They continue to work on inclusion and independence with service users and there are many examples of how successful this policy has been. For example, one service user, who is part of a local pub's sports team, is now involved in the social activities attached to this team and has made long term friends with team members, none of whom have a learning disability. Conclusion PFI is an energetic, passionate provider who is determined to maximise service user's potential and independence. They continue to operate at a very high level, whilst including reflection and analysis as an integral part of their development process. Who did this inspection Lesley Smith Partners for Inclusion, page 4 of 23

5 1 About the service we inspected 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 service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011 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. Partners for Inclusion (PFI) are a specialist organisation, registered as a Care at Home and Housing Support Service. They work with people over the age of 16 years who have a learning disability, often physical disabilities and/or mental health issues. It is a relatively small service, who wish to keep within certain size parameters to ensure their philosophical and ethical beliefs are not compromised and they can provide a local service. PFI is service with a personalised approach, a distinct way of working and a commitment to both real social inclusion and partnership working. They offer a bespoke, individualised support service, which for many can be 24 hours per day, 7 days per week. The hopes, wishes and potential of the service user is the basis for the service package. They work toward the person's optimum independence level and through various review and safety processes, the individual packages can reduce over time. Each service user has their own unique team, which includes a team leader and support workers. Professional and business support is provided through the management team based in PFI's headquarters. Each service user has their own home, which is designed around their identified needs. Partners for Inclusion, page 5 of 23

6 PFI's philosophy includes 'personalised support as a way of supporting people with complex and challenging needs, to live their own life, on their own terms, but as active citizens.' It was obvious from observation during the inspection process that staff throughout the organisation share and live this philosophy. 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 6 - Excellent 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. Partners for Inclusion, page 6 of 23

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 A preliminary visit to PFI was undertaken on the 23rd of August 2012 between a.m. and During this time, we met with a number of service user and their teams in their homes. Further visits were made on the 4th of October between and on the 5th of October between and During the Inspection, we met with: Seven service users, one family and had telephone discussions with two other relatives We also met with: One Team Leader, a number of support staff, both within the service users home and within headquarters, two senior service leaders, two directors and a signing interpretor who was used by the service, Together with interviewing service users, relatives and staff we collected evidence by: Reviewing 10 service user's files, including analysing service designs and working policies We also looked at other documentation relating to how PFI carries out reviews, develops and carries through with action plans and outcomes. There were also quarterly progress reports to inform commissioning agencies. We reviewed staff files as well as individual staff training matrix and training department materials and evidence of supervision and appraisals. Partners for Inclusion, page 7 of 23

8 We looked at: Care Inspectorate questionnaires Staff participation day - minutes and outcomes Team participation day - minutes and outcomes Policies and Procedures including Investigation and Disciplinary Procedure Management Guidelines, Employee handbook (which included a precis of other policies and procedures) Complaints records Accident and incident records Investors in People Report Certificate of Registration Various publications and articles produced on or on behalf of PFI 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 Partners for Inclusion, page 8 of 23

9 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. PFI submitted a detailed, informative and accurate self assessment which provided a really good introduction to the service. It described its aims, ethos and philosophies. It detailed how they would provide the service, who would be involved and the emphasis on social inclusion and increasing independence. PFI discussed various methods on how they could improve their service. Taking the views of people using the care service into account Service users interviewed uniformly described how PFI provided the support to live a satisfying, inclusive life with the opportunity to participate in the same activities other people enjoy. One service user told us she felt 'more in control' and 'more confident' Service users said they liked their support teams and got on well with them. Service users told us that they knew and liked PFI senior management. Most indicated they would feel confident a problem would be listened to and get an appropriate response. However, a small number of other service users seemed unclear about the complaints process. Partners for Inclusion, page 9 of 23

10 Taking carers' views into account A small number of relatives expressed current dissatisfaction with some elements of their relative's care. They were already in discussion with PFI, both formally and informally. Despite their concerns, they considered PFI to be one of the best providers. Another relative told us that PFI 'try their utmost to put the individual's needs and priorities to the forefront no matter what it takes'. Yet another commented that PFI 'was the best service ever'. A relative commented that they felt very anxious at PFI taking over the day to day care and support of their relative, but were pleasantly surprised just how involved they had been in setting up the service, recruiting and interviewing staff. They also said how much their relative was enjoying being 'independent'. Partners for Inclusion, page 10 of 23

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: 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 PFI's approach was to develop and create a bespoke service with each service user and everyone who plays a part in their world. The service was completely individualised, the staff team were recruited specifically and the service user remained in control. This was evidenced in the minutes from service development days, finely detailed service plans and equally detailed working policies. We found it commendable that PFI not only include care and day to day routines in the planning process, but the hopes, wishes and aspirations of the service user and how these would be achieved. PFI regularly reviewed the service, again with the complete involvement of the service user and their circle of supports. The service provided was amended, adapted and added to where necessary, or indeed, where the service user's wishes change. We saw evidence of these processes. PFI exhibited a careful attention to detail in all aspects of their business. This was apparent in the support services within headquarters, where files, documentation, policies and procedures were in very good order and showed evidence of regular review. It was especially apparent in the documentation held within service user files, which were carefully and thoroughly prepared, with signed and dated evidence of regular review. The files represented a live, active document with strong evidence of genuine partnership working. Partners for Inclusion, page 11 of 23

12 PFI told us they have very high standards, but will always strive to do things better. When a situation does not work out as expected, there was evidence in files to confirm that they examined their own practice first to see where they needed to change. As a result of this reflection and willingness to adapt their approach, their records confirmed they have successfully worked with individuals and their families, who other care providers have found challenging. There was tenacity, determination and commitment apparent throughout the whole staff group. Service users appeared confident and relaxed when speaking with the Care Inspectorate. We met seven service users, who all indicated they felt in control of their lives, were listened to, and treated with dignity and respect. All were clear on how they could raise an issue or a problem and were familiar and comfortable with PFI's senior staff and management, referring to them in first name terms. Relatives also confirmed they played an integral and influential role in all aspects of the support provided. Areas for improvement PFI provide support for the service user in their own home. PFI have an organised system of checks and balances to protect all service users, especially those who may not have any language or ability to communicate. PFI use a system of regular 'spot checks' which were carried out unannounced by senior managers. They checked that the service was operating as described in the service user's work plans and practical processes were complied with (finance, medication etc). They do this by observation, checking documentation, talking with relatives and others involved with the service user. These checks were recorded in a variety of documentation in different locations. However, to ensure that all parties know that these checks have been systematically carried out, we suggested that the service should develop a 'check sheet' listing the various checks, detailing who carried out the checks, what the outcomes were and on what date. A copy of this should be contained within the service user's home so families and relatives can be reassured the service is under regular and robust scrutiny. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Partners for Inclusion, page 12 of 23

13 Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths PFI held planning meetings to design the individual service provided. The service user, their families and relatives, and others who play a significant role in the service user's life were all actively involved. Senior management from PFI participate and organise this stage of planning, which meant that the management team have a thorough,working knowledge of each service user and have formed a relationship with all involved. The service had put together a very detailed statement of all aspects of the service user's development, how things are currently and how the service user would like to live. This included the type and location of housing, medical details, significant influences and people, hopes, aspirations and personal gifts. Service users were also encouraged and enabled to analyse what kind of support they would benefit from and what personal attributes were needed in their support team to provide this. The service design additionally included a comprehensive life history. PFI state 'as a mark of respect, it is important we understand how people have become who they are today'. Everyone involved was encouraged to contribute. There was evidence of this throughout the documentation and from questionnaires completed by relatives. The service design documents viewed during the inspection process were of a uniformly high standard and provided an excellent 'snapshot' of the service user as a unique individual. This was confirmed when the inspection team met with service users. We were told or shown that their preferences and choices were the backbone of the their service. The service design led to the working policy, which was a minutely detailed description of each element of the care package. Again, it was evident that relatives, service users and significant others had actively participated. This was evidenced in the documentation and in conversations with families. As each support team was recruited for a specific service user, there was evidence that service users and their families were fully involved. The interviewing process included direct involvement between the service user and the applicant, using a variety of methods to gauge compatibility or 'matching'. This meant that the service user was actively involved in deciding who would be delivering their care. Partners for Inclusion, page 13 of 23

14 PFI had policy of reviewing the plans at team meetings and at meetings with service users and families. There was an annual planning day which was a significant event in the reviewing process. The planning day revisited the year, the accomplishments, achievements, the progress and what goals they were aiming for in the next year. A document was produced with photographs and drawings recording the content of this meeting. This not only acted as a formal review document but also as a living record of each year of the service user's life. In order for the service user to be able to contribute as fully as possible, and to be able to articulate their needs and wishes, PFI used a variety of communication techniques. We saw evidence of daily planning which involved symbols and pictures. The service user decided on the programme for the day which linked in with regular activities and was displayed pictorially on a board. We met with a service user with a hearing impairment and a signing interpretor who was booked to assist with meetings and significant events. It was clear they had a positive relationship as the service user was comfortable, confident and relaxed and very able to express their views through the interpretor. The interpretor confirmed their service was used regularly to assist both service users and staff with hearing impairments to contribute and participate. The design of this service user's plan included staff in their team who sign, however, a relative did comment that the staff skills levels were variable. See areas for improvement. PFI have service users who have no speech. The service had accessed training for staff in 'intensive interaction' which was a method designed to teach the pre-speech basics of communication to children and adults who have severe learning difficulties and/or autism. This assisted support staff to interpret behaviours, movements and sounds made by the service user and to be able to 'talk' back. PFI have also developed alternative, more accessible documentation. They have produced service design documents in a variety of formats to meet the needs of the service user e.g. DVD, collage etc. Areas for improvement The service should continue to maintain their extensive participation and inclusion policies and their current excellent work practices. They should continue to research, access and train staff in a variety of communication tools and methods. PFI should ensure that staff who need specific communication skills receive regular training to an effective standard. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Partners for Inclusion, page 14 of 23

15 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 see Quality Theme 1 Statement 1 for a general assessment on how service users and carers are involved and enabled to participate. Because PFI had a detailed and informative service design based on the service user's needs, conditions and wishes, they were able to provide person specific training. This training was tailored to meet each service user's individual needs and conditions. This was run in tandem with the usual company induction process and mandatory training. According to senior managers, induction involving the service user and their team can take up to 70 hours, with the possibility of a further 35 hours if required. This was carried out prior to the service actually starting. We confirmed this via the individual staff training matrix viewed during the inspection. Staff also told us that if they identified a subsequent training need, PFI were consistently good at both providing funding and time. New staff have a six month probationary period to ensure that they are competent and the service user can work with them. When there was an issue or unease either on the part of the service user, relative or staff group, there was a mechanism to make alterations to the staffing. In consultation with all involved, the staff member may go forward for matching with a different service user and a new member of the team was then recruited. Therefore, the quality of the service user's experience was maintained and outcomes met in terms of feeling safe and supported. Communication channels were described in the service user's working document. There were communication logs and diaries for each service user where support staff record routines, activities, visitors and issues on a daily basis. This ensured that staff providing support have a full and detailed knowledge of previous shifts. This provided continuity of care, consistency and evidence that the working policy is being complied with. These were checked by a senior team leader under the quality assurance system and any training issues identified were then discussed through the supervision and appraisal systems. However, relatives have raised an issue about the quality and authenticity of the daily diary. Please see areas for improvement. Partners for Inclusion, page 15 of 23

16 It was apparent, through minutes available, that individual teams have regular meetings, team leaders meet together, teams have annual days (separate from the planning day with the service user) and the company have sessions in headquarters,on an annual basis, with each team. There was a clear structure for communicating views, challenges and suggestions. This was evidenced in reports made available during the inspection. Areas for improvement Staff did appreciate the availability of training and PFI's commitment to meeting regularly with staff in a variety of forms. However, some staff did comment that they missed previous opportunities to meet with colleagues on a more informal basis to share issues. This may be something PFI would consider re-introducing. A relative raised the issue of the quality and accuracy of the daily recordings. Senior staff stated they make regular checks and these checks are recorded. However, we suggested that PFI introduce a formal 'check sheet' with a copy kept in the service user's home to reassure family members that checks are regular and rigorous. PFI should also consider regular training for all staff on effective and accurate recording. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Partners for Inclusion, page 16 of 23

17 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service strengths Respect and dignity were keystones in the service PFI offers. A strong adherence to these values was very evident when observing staff attitudes and responses to service users, families and colleagues. Service users confirmed they were treated 'well', 'listened to' and their opinions, thoughts and wishes were respected at all times. Written recordings reflected this. The recordings were composed respectfully, in appropriate language and used correct, dignified terminology. In observation of various conversations between support staff and service users, staff impressed as being understanding and patient. They were observed sensitively supporting service users to communicate their wishes, preferences and opinions effectively via a variety of tools and methods. Staff were observed, on all occasions, working at the service user's pace. PFI were committed to partnership working and families and carers were given their rightful place in the service user's world. PFI openly stated there were times when there were issues of conflict or disagreement between themselves and relatives. They aimed to resolve problems by open discussion, whilst trying to be sensitive to relatives views and fears. They were open that this often proved difficult when trying to support a service user to achieve maximum independence. Areas for improvement PFI should maintain their current high standards and attitudes. They should maintain their excellent communication links with all parties involved in the service user's life. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Partners for Inclusion, page 17 of 23

18 Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths Families and relatives were invited into headquarters on an annual basis to meet with staff including the chief executive and directors. This was an opportunity to influence service provision. Regular newsletters and magazines were issued about the company and the service, inviting comment and responses from all interested parties. The newspaper (partners paper), also gave current updates on government policies and decisions that will effect service users. This provides families and relatives with an opportunity to respond internally within PFI, both locally and nationally. PFI have relative representation on its Board. Service users, their families, significant others and staff meet at the (personal) annual planning day. This was again an opportunity to make suggestions and influence policy. For example, this has led to developments in opportunities for service users to meet and socialise. We reviewed the company's complaints procedures and their complaints file for the previous calendar year. We noted that PFI had evidence to confirm they took complaints seriously, dealt with them thoroughly and the complainants were kept informed. There was also evidence that complaints investigations have influenced practice. Areas for improvement PFI should continue to work to their current high standards. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Partners for Inclusion, page 18 of 23

19 Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths PFI have a system of regular meetings for staff to discuss general service provision. One support worker told us that 'the whole company work hand in hand to provide a better life for service users and staff.' Supervision and team meetings are held on a regular basis, evidenced by documentation. These were identified forums to discuss both specific and company wide issues and ideas. Service leaders attend local team meetings as a communication and support link between headquarters and teams in the community. These meetings were held on a four to six weekly basis The company used a survey dated November 2011 to influence planning. We saw documentation on the survey and its outcomes. Support workers have specific days, twice yearly, which include discussions with the directors. The discussions were recorded, then a feedback sheet was issued. We saw evidence of this process. All teams go individually into headquarters for an 'annual planning session'. This included meetings with health and safety, various trainers and senior staff. New polices and procedures were also discussed. There was also a session with the directors where a representative from every team is asked what the Company's priorities should be in the next year. These suggestions are then incorporated into the Company's strategic plan. When there are changes in behaviour or response with an individual service user or there is an incident, teams regularly hold 'debrief sessions' This can involve senior staff from headquarters. Debrief was not always specifically about the service user or the service, it could be a company wide issue. Individual teams were regularly in touch with outside agencies. This could be a commissioning agency or an involved professional. Information and advice, both specific and generic, were passed on helping to influence policy and development. Again there was documentation to confirm this. One staff member described how a local team needed to adapt their work practice around the shift handover periods. This was because the individual service user did not care for the staff spending time on hand over and responded accordingly. The staff team agreed with management that hand overs could be managed by text. This was a good example of the company being influenced by the support team and agreeing to a more flexible, person centred approach to a mandatory activity. Partners for Inclusion, page 19 of 23

20 Areas for improvement PFI should continue with their current high standard of work. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Partners for Inclusion, page 20 of 23

21 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information not applicable at this inspection. 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Partners for Inclusion, page 21 of 23

22 5 Summary of grades Quality of Care and Support Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Excellent Statement 1 Statement Excellent 6 - Excellent 6 Inspection and grading history Date Type Gradings 12 Jan 2011 Announced Care and support 6 - Excellent Staffing Not Assessed Management and Leadership Not Assessed 15 Dec 2009 Announced Care and support 6 - Excellent Staffing 6 - Excellent Management and Leadership 5 - Very Good 18 Dec 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. Partners for Inclusion, page 22 of 23

23 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: Partners for Inclusion, page 23 of 23