Dundee City Council - Social Care Teams (Learning Disabilities, Mental Health, Drug and Alcohol/Blood Borne Viruses) Housing Support Service

Transcription

1 Dundee City Council - Social Care Teams (Learning Disabilities, Mental Health, Drug and Alcohol/Blood Borne Viruses) Housing Support Service Claverhouse Social Work Office Jack Martin Way Claverhouse East Dundee DD4 9FF Inspected by: Susan Barrie Type of inspection: Unannounced Inspection completed on: 14 February 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: Dundee City Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Susan Barrie Telephone enquiries@careinspectorate.com

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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well Staff were very motivated and supported and encouraged service users in a warm, respectful and professional way. They provided flexible support which adapted to meet peoples' changing needs. Staff had good knowledge of local resources and worked well with other professionals to ensure service users received the best possible support. What the service could do better Not all service users had regular reviews of their support. Some staff needed more frequent supervision with their line manager. Changes to the way the council supported service users and staff were being developed but not yet in place. What the service has done since the last inspection Since the last inspection the service have asked people for their views. Managers have visited service users alongside staff to look at the way they work and make sure it is of a high standard. Different ways of involving service users in outcome focused plans have been piloted. Conclusion The staff, in all three teams, provide very good support to service users. They are enthusiastic and motivated to support people to improve their lives. Service users

4 had very positive things to say about the staff who supported them. All of the teams work very well with other professionals to ensure people get the right support. Who did this inspection Susan Barrie

5 1 About the service we inspected The service was provided by Dundee City Council to citizens of Dundee aged between 16 and 65. The service aimed to; "Provide a high quality Housing Support Service and Care at Home Service in a person's own home who either have a learning disability, or who suffer from a severe and enduring mental health difficulty or who are affected by their own, or a significant other's substance misuse and/or blood borne virus. The service aims to facilitate opportunities and lifestyles that enable individuals to achieve their full potential". The services were provided by three distinct staff teams based in three separate locations in Dundee. All three teams were led by a Registered Manager and supported on a day-to-day basis by a Team Manager. The Care Inspectorate regulates care services in Scotland. Information about 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 Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good

6 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.

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 One inspector carried out a short notice inspection of Dundee City Council - Social Care Teams (Learning Disabilities, Mental Health, Drug and Alcohol / Blood Borne Viruses( BBV)) on Wednesday 5th February Further announced visits were made on Tuesday 11th and Friday 14th February Verbal feedback was given to the Manager at the end of the inspection. During the inspection process evidence was gathered from: Discussion with staff and service users Service user case files, including support plans and risk assessments Minutes of staff meetings Questionnaires returned to the Care Inspectorate by staff and service users Notes of the Direct Observation of staff (by their Manager) The self assessment submitted by the service to the Care Inspectorate Questionnaires which the service had asked service users to complete Records of staff training Evidence of staff supervision Information leaflets and the welcome pack 'Folders' (support plans) in people's homes. 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

8 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

9 What the service has done to meet any recommendations we made at our last inspection Recommendations made at the last inspection included the need to develop observation of staff practice and the collation of participation opportunities. These had ben progressed and have been detailed in this report. 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. A comprehensive self assessment had been submitted prior to the inspection. The information submitted provided details of all three teams and informed the inspection process. Taking the views of people using the care service into account Five service users were visited in their own homes. One came to see the inspector in the Organisations Office. Ten returned questionnaires to the Care Inspectorate. The views of service users were very positive. They were observed to have good relationships with the social care officers providing their support and were clearly relaxed and comfortable in their company. In response to the (questionnaire) question " Overall, I am happy with the quality of care and support this service gives me". Nine service users stated they strongly agree and one agreed. Questionnaire responses included: 'Overall my social care officer does a great job, keep up the good work.'

10 'The support I receive from drug, alcohol and BBV team has been invaluable to me as I have very poor sight and their support had helped me to remain independent as they help me with tasks within my house and we go shopping.' Taking carers' views into account N/A

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: 4 - 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 Service users who were spoken with or returned questionnaires stated that they had a good relationship with their support worker (social care officer) and would openly discuss their support needs. Examples were given of support workers being flexible so they could meet the current, and changing support needs of service users. During the inspection the inspector accompanied support workers to visit five service users (and met one in the office). Staff were observed to have warm and encouraging relationships with the people they supported. Verbal feedback and observation confirmed that support was led by service users, helpful and individual to each person. Service users were provided with welcome packs on being introduced to the service. The welcome packs were slightly different across the different services but generally provided information on what the service could offer and useful resources which could be accessed in the wider community. In two of the three services there was evidence that service users were very involved in identifying their support needs from the point of referrral, during an initial assessment and at ongoing reviews. Service users supported by two of the three teams also had support plans in their homes which evidenced their full involvement in identifying their ongoing support needs and how these could be met (see 'areas for improvement'). The Organisation had a User Involvement policy and a customer Charter and Customer Care Sandards. These documents informed people what they could expect from the

12 service, how they can make comments, complaints or suggestions and they response they would get if they did so (see Quality Theme 4, Statement 4). Areas for improvement Two of the three teams had comprehensive support plans which included risk assessment and regular ongoing reviews including the service user. They also ensured that service users had copies of their support plan, shared and signed by them, in their homes. Service users receiving support from the learning disabiity team did not have support plans in their homes and were not always part of the review of their care. The senior member of staff spoken to during the inspection stated that past experience had led to the decision that support plans would only be held in the office. At the previous inspection the issue regarding the requirement for regular reviews had been discussed however, reviews for some service users had still not taken place (see Requirement 1). Some service users had been involved in the recruitment of new staff. This wasan area which could be improved as it was not a consistent approach to the recruitment process. Innovative ways should be considered which will involve service users in the recruitment, or indution process (see Recommendation 1). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider to ensure that all service users personal plans are reviewed at least once in very 6 month period. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, No 210: 5(2)(b)(iii) - A requirement in relation to the revew of personal plans. Timescale: Within 14 days of receipt of this report Recommendations 1. The service should continue to consider ways in which service users can be involved in the recruitment of new staff. National Care Standard 3 - Management and Staffing Arrangements Statement 3 We ensure that service users' health and wellbeing needs are met.

13 Service strengths Service users had support plans which detailed how their support needs would be met (see Quality Theme 1, Statement 1). Support needs were identified at the initial referral and assessment. At this time the other agencies which were involved in supporting the service user were recorded, and service users asked to consent to information sharing between relevant agencies. Staff were therefore able to ensure that significant information was shared between agencies such as Healthcare and Social Work, and advocate on behalf of service users around issues with housing and benefits (however see Recommendation 1). The support plans of service users being supported by the mental health and dugs, alcohol and BBV team contained comprehensive risk assessments. Risk assessments included information about identified risks and a risk management plan. Service users supported by the learning disability team had limted, or no risk assessment unless the service user had the involvement of a care manager, which many do not (see Recommendation 1). Staff had a very good knowledge of resources in the local area. Offices, and welcome packs, also had leaflets and information about services which might be helpful for service users to access for information and support. Staff were able to accompany service users to appointments or to groups which would provide them with support and social opportunities. Event recording sheets demonstrated staff suporting service users to improve their health. Records evidenced staff discussing topics such as harm reduction, the safe disposal of needles and naloxone training. They also documented service users being supported to attend community groups and courses which encouraged healthy living. Staff did not give medication but supported people by discussing their medication and prompting them to take this at the right time. Some of the teams had strong links with local carer and family groups and were able to offer support and advice to the friends and families of service users. When shopping with service users staff encouraged the purchase of healthy options wherever possible. Staff spoken with stated that service users always had the choice to buy anything they wanted but would try to advise about health options within their budget. The drugs, alcohol and BBV team was piloting the use of alcohol stars (an outcome based tool where service users identify their priotity areas and assess their progress in a way which can be easily and visually seen).

14 The alcohol star included self assessment in areas such as physical and emotional health, alcohol and drug use and social relationships. Areas for improvement Service users, supported by the Learning Disability team, did not always have risk assessments, when these would be beneficial to both service users and staff. There was also an example of a service user who had clearly refused their consent to information sharing, despite identified aspects of their support plan requiring this (see Recommendation 1 and 2, and Quality Theme 4, Statement 4). Across all three teams it was clear that the Organisational expectation was to ask service users to consent to information sharing when they first received a service. Consent was not reviewed thereafter. The Organisation should consider a timescale in which service user consent is reviewed to ensure it remains current to their stated wishes (see Recommendation 2). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. Where required, service users should have risk assessments which identify areas of risk and strategies to minimise these. National Care Standard 4 - Housing Support Planning 2. Information should not be shared with other agencies without the consent of the service user. Consideration should be given to the review of this consent to ensure it is the continued wish of the service user. National Care Standard 4 - Housing Support Planning

15 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths See Quality Theme 1, Statement 1. Areas for improvement See Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - 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 Staff spoken with, at the time of the inspection, were all motivated to provide the best possible support to service users. Within the team almost all of the staff were well qualified, or in the process of acquiring relevant qualifications. Staff had completed various training courses and felt training opportunities were good. Training included adult protection, first aid, food hygiene and service specific topics such as mental health, overdose prevention and sexual health. Training courses could be accessed via the council's intranet as well as via external organisations such as STRADA and the NHS. Most of the staff received regular formal supervision and attended regular team meetings. These forums provided opportunities for discussion about best practice, aims and values and training. Team meetings included all members of the team (ie, social workers, social work assistants and social care officers) and encouraged professional dialogue, discussion and information sharing. Social Care Officer meetings also allowed peer support, discussion and planning. Minutes of staff

16 meetings demonstrated discussion about best practice and the sharing of best practice documents and research papers. The inspector attended a team meeting with the drugs, alcohol and BBV team. The meeting provided updated information for staff, evidenced multi disciplinary working and staff who were encouraged to attend forums to develop new and best practice. Staff were aware of the relevant National Care Standards and the Scottish Social Service Council (SSSC) codes of practice. These were provided to staff on gaining employment and detail what is expected of staff as they carried out their daily work. One of the teams used some of the time at their team meeting to discuss the National Care Standards and how individual standards related to service users and the support provided. Relevant policies and procedures were in place which staff were expected to work within. Staff had access to all of these via the Dundee City Council intranet. Staff at the service were aware of the importance of inter agency working to ensure service users received the best possible support. This included information sharing (with consent) and informing and encouraging service users to access relevant services in the wider community. Staff stated that working alongside social work and healthcare professionals had been beneficial in sharing knowledge and skills to the benefit of service users. Areas for improvement Staff who were spoken with, and who returned questionnaires, stated that there were supporting more service users with autistic spectrum disorders and that specific training would be beneficial to their understanding. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

17 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - 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 See Quality Theme 1, Statement 1. Areas for improvement See Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - 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 Staff described a very positive working environment where each supported and encouraged the other. They stated that they received a high level of support from peers, colleagues and senior staff, both formally and informally. As stated elsewhere in this report, staff attended regular staff meetings and most staff received regular formal supervision (see 'areas for improvement'). These forums were used to ensure ongoing discussion and planning, an awareness of issues, cascading of information and discussion about continuous professional development. Formal minutes were kept of team meetings and formal supervision. Senior staff had accompanied social care officers on visits to service users. A comprehensive recording tool was used to assess the staff members practice in a number of areas including communication, social work values, documentation, health and safety and discussion about outcomes. The evaluation was then discussed with the social care officer. Direct Observation 'notes' seen at the time of the inspection

18 evidenced comprehensive evaluation and were seen to be signed by the senior/ manager and social care officer evidencing that the information had been shared. Case file auditing was carried out by senior staff of the service and by the staff within the Organisation. Service user files, seen in two of the three teams, evidenced both. Managers also audited written information and reports to ensure they were of the required standard. Questionnaires had been distributed to service users and stakeholders asking for feedback about the service. Questions asked related to areas such as involvement in the assessment process, participation, reviews of care and staff being reliable and respectful. Responses had been discussed at team meetings. Questionnaires seen at the time of the inspection were almost all positive. The service had noted that service users continued to state they were unaware of the complaints procedure (despite this being made available to them in a number of forums) and had considered ways to ensure they knew how to make a complaint. Service users involved with the drugs, alcohol and BBV team had been part of a City wide consultation of services for people involved with drug and alcohol services ('Dundee recovery') and a social work department service user survey ('How well are we doing'). Responses to these would help to develop service provision for people using these services. The Organisation had identified the need to involve carers (or significant adults) in service feedback. A member of staff from the carers centre had been involved in discussion and planning about this. This had not yet been progressed however one of the teams had contacted carers by phone to ask their views. Dundee City Council had a formal complaints procedure ('Your Right to be Heard'). Details of how to complain were provided to service users at the beginning of their support, and were included in the welcome pack. Documentation about how to complain included details of external organisations and the Care Inspectorate. Areas for improvement Staff in the learning disability team did not all receive regular formal supervision. They did receive ongoing informal supervision, and feel well supported however did not receive supervision as often as the Organisation stated they should (see Recommendation 1). At this, and the previous inspection, the Organisation had been 'rolling out' an annual Performance and Development Review, incorporating the Continuous

19 Learning Framework. Services had discussed this within team meetings and supervision and with the intention that this would be introduced from March 2014 (see Recommendation 2). Organisational and managerial case file auditing was in place and should therefore have identified, and remedied, issues such as lack of service user reviews (see Quality Theme 1, Statement 1). At this, and the previous inspection, the service stated they were moving towards an outcome focused way of working with people which would support staff in identifying peoples goals and aspirations and the support they needed to obtain these. This was still the plan however had not progressed significantly across all of the teams. The Organisation had planned to deliver training to staff however this had not yet been delivered (see Recommendation 3). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. Staff should receive regular formal supervision at the frequency expected by the Organisation. National Care Standard 3 - Management and Staffing Arrangements 2. The Organisation should continue to develop their plans to introduce the annual performance development review. National Care Standard 3 - Management and Staffing Arrangements 3. Identified plans to progress an outcome focused way of supporting service users, including staff training, should continue. National Care Standard 3 - Management and Staffing Arrangements

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. 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).

21 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 5 - Very Good Quality of Staffing Good Statement 1 Statement Good 5 - Very Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history Date Type Gradings 13 Feb 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 4 - Good 4 - Good 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission.

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: