Lomond and West Dunbartonshire Brain Injury Project Housing Support Service Council Offices 6-14 Bridge Street Dumbarton G82 1NT Telephone:

Transcription

1 Lomond and West Dunbartonshire Brain Injury Project Housing Support Service Council Offices 6-14 Bridge Street Dumbarton G82 1NT Telephone: Inspected by: Jim McNally Type of inspection: Announced (Short Notice) Inspection completed on: 11 October 2013

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 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: West Dunbartonshire Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Jim McNally Telephone enquiries@careinspectorate.com Lomond and West Dunbartonshire Brain Injury Project, page 2 of 24

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 6 Excellent Quality of Management and Leadership 5 Very Good What the service does well This service is excellent at raising awareness of the needs for people who have an acquired brain injury (ABI). It does this by involving and consulting with service users routinely as part of their individual care and support but also by involving service users and carers in decisions about the development and direction of the service. The future direction and development of the service is also an area where family members and other representatives were encouraged to be involved. People who used the service told us that they are always included in decisions about their care and support. We found that the quality of participation and inclusion demonstrated in the service was excellent and this is a view that was shared by the people we spoke with during our inspection. What the service could do better The service has identified itself that it needs to keep networking with other agencies that work in the field of ABI to ensure that they can influence how effectively resources can be distributed. Any areas for improvement in this report have already been identified by the provider and service users. What the service has done since the last inspection The service has maintained the excellent and very good grades awarded at the last inspection. The plans to turn the booklet "The Journey" into a DVD have been realised. The service continues to be critical and analytical in all that it does in a Lomond and West Dunbartonshire Brain Injury Project, page 3 of 24

4 continuing effort to raise awareness and improve outcomes for people with Acquired Brain Injury. Conclusion The service continues to be very active in local and national groups to promote improving services for people with acquired brain injuries. It is a sector leading service with staff who are well motivated and qualified in the field of Acquired Brain Injury. The service is highly valued by service users and carers who are consistently encouraged to influence how it operates and it's future direction. We concluded that this provider was operating a dynamic, expert service which put people affected by Acquired Brain Injury at the core of what it does. It was also a service that did not stand still but always looked to improve on what it was currently achieving. Who did this inspection Jim McNally Lomond and West Dunbartonshire Brain Injury Project, page 4 of 24

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, Social Care and Social Work Improvement Scotland (SCSWIS) took over the work of the Care Commission, including the work of registering care services. This means that from April this service continued its registration under the new body, SCSWIS. Lomond and West Dunbartonshire Brain Injury Project is a service provided to adults in the West Dunbartonshire area where acquired brain injuries, (ABI), are the primary issues affecting their quality of life. The Acquired Brain Injury Service, as it is usually known, is jointly operated by NHS healthcare staff and social work staff employed by West Dunbartonshire Council. The aim of the service is to provide community based assessment and rehabilitation for individuals who have experienced an acquired brain injury and also to assist their families in this process. A definition of Acquired Brain Injury, (ABI), as used by the service is detailed below to assist readers of this report: Acquired Brain Injury, (ABI), "is a condition which is caused by a non-progressive trauma to someone's brain which occurs when they are aged 5 years or older. Nonprogressive means that the trauma happens once and does not go on causing more injury. Typically, this could be due to damage to brain tissue after an accident - such as a road traffic accident, an assault, a fall, industrial or sporting accidents. It can also happen in other ways, such as poisoning, viral infections to the brain, neurosurgery or damage to the blood vessels in the brain." (The Journey. Acquired brain injury ABI team/outside the Box Development Support. Also can be accessed from mental-health-learning-disability-addictions/). 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 6 - Excellent 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. Lomond and West Dunbartonshire Brain Injury Project, page 5 of 24

6 Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Lomond and West Dunbartonshire Brain Injury Project, page 6 of 24

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by Inspector, Jim McNally. The inspection took place on Wednesday 9 October 2013 between 10.15am and 3.30pm and Friday 11 October between 11am and 2pm. We gave feedback to the service manager on Friday 11 October. As part of the inspection, we took account of the completed annual return and self-assessment forms that we asked the provider to complete and submit to us. We sent 15 care standards questionnaires to the service manager to give to service users to complete. Five service users sent us completed questionnaires back. We also received four completed questionnaires from staff that worked in the service. During this inspection we gathered evidence from various sources, including the following: We spoke with: ten service users the service coordinator one care manager one assistant psychologist one support worker We looked at: the participation strategy. This is the service's plan for how they will involve service users in all areas of the care service. minutes of meetings of the Brain Injury Experience Network (BIEN) and Managed Care Network a dvd about the brain injury service and the experiences of service users a pack called "The Journey" about Acquired Brain Injury Lomond and West Dunbartonshire Brain Injury Project, page 7 of 24

8 five questionnaires from service users four questionnaires from staff three individual support plans The Acquired Brain Injury Training Report 2012 the registration certificate We observed the interactions between staff and service users and also met with service users separately in a focus group. 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 Lomond and West Dunbartonshire Brain Injury Project, page 8 of 24

9 What the service has done to meet any recommendations we made at our last inspection There were no recommendations made as a result of the last inspection. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how the people who used the care service had taken part in the self-assessment process. Taking the views of people using the care service into account For this inspection we received views from 15 people using the service. Five people gave their views via the care standard questionnaires and we spoke with 10 service users in a focus group. Everyone that we received views from was very happy with the quality of the service. They told us that staff treated them with dignity and respect and that the service was "excellent". We have included further comments and views from people using the service throughout the report. Lomond and West Dunbartonshire Brain Injury Project, page 9 of 24

10 Taking carers' views into account There were no carers available to speak with us during the inspection. One carer did complete a questionnaire on behalf of a service user and indicated that they service was very good overall. Lomond and West Dunbartonshire Brain Injury Project, page 10 of 24

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 At this inspection, we found that the performance of the service was excellent for this statement. We concluded this after we spoke with guests and staff, observed practice and examined a range of relevant documentation. When this service was last inspected we found that the service operated to an excellent standard in relation to this statement. The reasons for this still apply this year. In addition to that evidence, this inspection found that the service has further improved the way that service users participate in assessing and developing the service. There was strong evidence of the service liaising with various service user forums and networks to offer the support and type of service that was required to fulfil the needs of service users. Examples viewed were partnership working with social work and health professionals and BIEN (the Brain Injury Experiences Network). BIEN was established as a service user group who described themselves as "survivors not victims". BIEN members provided peer support to people affected by ABI and their families. They also acted as co-trainers in brain injury awareness and carers support training. Support plans were developed via a Specialist Single Shared Assessment. Support plans viewed evidenced that service users led their development through setting their own goals. A "goals" folder was in place for each service user. There was strong evidence throughout all care plans viewed of service users negotiating and discussing how their support would be specifically provided. Support plans were regularly reviewed and there was excellent evidence of support packages being amended as a Lomond and West Dunbartonshire Brain Injury Project, page 11 of 24

12 result of ongoing reviews and input from service users. Service users indicated to us via questionnaires and in a focus group that they were very much aware of their support plans and found them a useful means of agreeing the support they needed. There was staff and service user representation on the West Dunbartonshire Acquired Brain Injury Managed Care Network which was a wide group of stakeholders involved in ABI that had been set up in Key work streams were identified by this group such as training and education to raise public awareness of ABI, looking at care pathways, discussing welfare reform and SDS (Self- directed support) and the impact of this on people with an ABI. It was clear that the provider and service was a key driving force for raising awareness and improving experiences for people with ABI both locally and nationally. Service users and carer involvement was a key part of this process and many ideas about developing the service came first from people with ABI. Service users were heavily involved in raising awareness in the wider community of the effects of brain injury and how quality of life can be improved for individuals and their families after acquiring a brain injury. People that we spoke with described how they had initially been involved in training GPs about ABI and how this had resulted in improved referral practices to the ABI team. Two service users and a carer actively participate in co-training in ABI awareness to a variety of groups and various local and national events. Service users had also been involved in the Scottish Head Injury Forum (SHIF) event. We saw that service had worked effectively in a partnership with BIEN on a number of developments. These included: * the completion of an ABI strategy for West Dunbartonshire. * the development of a resource pack called "The Journey" which has since been produced in DVD format, "getting your Head around Brain Injury." * the development of SIGN11 Guidance for ABI rehabilitation. * membership of the planning committee of the World Brain Injury Conference Building on the training on ABI to GPs that was reported at the last inspection we could see strong evidence of continued service user involvement in this area. Training on ABI had been rolled out to homecare staff in West Dunbartonshire, welfare staff and to other care providers. This demonstrated further that service users views and contributions were valued by the provider. We met with a group of 10 service users in a focus group and everyone that we spoke with agreed that there were frequent opportunities to provide written and verbal feedback about any aspect of the service including the quality of the staff and the management. Comments from service users who ran the BIEN group included: "staff are excellent" "we are at the heart of what they do." Lomond and West Dunbartonshire Brain Injury Project, page 12 of 24

13 "The ABI team has fundamentally turned my life around." Areas for improvement The provider should continue to monitor and maintain the excellent quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Lomond and West Dunbartonshire Brain Injury Project, page 13 of 24

14 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection, we found that the performance of the service was excellent for this statement. We concluded this after we spoke with guests and staff, observed practice and examined a range of relevant documentation. The service assesses health needs of service users through a single shared assessment. and through regular review processes. There was a holistic approach to supporting an individual who had an ABI. From the sample of support plans that we looked at we could see that a detailed timeline of significant medical events, frequent contact with health and social care services and ongoing reviews of care and support needs. The staff used their expert knowledge and experience to support people with a range of difficulties resulting from their brain injuries. This could include difficulties that were: Physical - such as difficulties walking and speaking Cognitive - such as finding it hard to concentrate or remember things Behavioural - when someone behaves in a different way to before Emotional - such as when someone finds it hard to show affection or gets angry much more easily Social - such as when someone finds it hard to be with groups of people or to make friends We saw that the service had close links with other health professionals and professions allied to medicine such as occupational therapy, physiotherapy, speech therapy and Visibility Scotland. The service team also included a Consultant Neuropsychologist and Assistant Psychologist with specific expertise in ABI.This meant that if difficulties were identified in any of the areas detailed above that timely support and expert assistance could be accessed for service users. Carers health was also looked at as part of the assessment process and separate support plans were completed for carers. The service had close links with the local carers centre and assisted people to access this service along with other resources that they might need. We saw some excellent yet simple examples of how staff and other service users supported individuals with their goals after ABI. For example one person was encouraged to become involved in fishing and attending a woodwork class to help reduce social isolation and boredom. Other service users were supported to reduce Lomond and West Dunbartonshire Brain Injury Project, page 14 of 24

15 their alcohol intake, improve their sleep patterns and become more independent at home and in the community developing life skills such as shopping and cooking. When we spoke with service users in the focus group and looked at the provider's information from service users in the self-assessment it was clear that help with memory loss or impairment was important. Many service users had developed their own strategies to aid their memory such as writing things down, keeping a diary or having a routine. Staff also assisted with this through telephone reminders, 1:1 support when necessary and accessing support from other care providers. Peer support was especially important and much of this was done by the service users who ran the BIEN group. Since the last inspection, the provider has piloted a tool used to measure the extent and effects of disability following brain injury, (Mayo-Portland Adaptability Inventory), a quality of life questionnaire was also being used. These tools assisted staff and service users to identify key needs and to tailor rehabilitation and therapeutic support for each individual. Areas for improvement The provider should continue to monitor and maintain the excellent quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Lomond and West Dunbartonshire Brain Injury Project, page 15 of 24

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths At this inspection, we found that the performance of the service was excellent for this statement. We concluded this after we spoke with guests and staff, observed practice and examined a range of relevant documentation. A training needs analysis was carried out between May and July 2013 and training needs were reviewed and discussed with service users and other stakeholders including care providers. See strengths detailed under Quality Statement 1.1 Areas for improvement The provider should continue to monitor and maintain the excellent quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Lomond and West Dunbartonshire Brain Injury Project, page 16 of 24

17 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection, we found that the performance of the service was excellent for this statement. We concluded this after we spoke with guests and staff, observed practice and examined a range of relevant documentation. The service is part of the social work department in West Dunbartonshire and as such they have an understanding with the duty social work system that any duty calls which have a suggestion that someone may have a brain injury are put straight through to the service. Equally the work and co-training from staff and service users with local GPs has helped to increase their awareness to refer patients to the service for person-centred treatment and rehabilitation The service employs a social worker, a consultant neuropsychologist and an assistant psychologist. When referred, people have a neuropsychological assessment which feeds into the single shared assessment which is completed by the social worker. Initial assessments usually include home visits and interviews with service users, family members and significant others. This comprehensive assessment provides a baseline for future therapeutic work and rehabilitation. We spoke with a sample of staff who worked for the service. All the staff that we spoke with told us that had very good training opportunities, received regular supervision and regular reviews of their personal development plans. We noted that the care manager was studying to become a social work teacher and had a postgraduate ABI rehabilitation qualification, the ABI support worker had an SVQ (Scottish Vocational Qualification) in Care at Level 3 and was currently studying a Visual Impairment course. The service coordinator had a Diploma in Social Work Management, was a qualified practice teacher and practice assessor. The service coordinator was also part of the SIGN group, (Scottish Intercollegiate Guidelines Network) which developed national Acquired Brain Injury guidelines regarding rehabilitation. This means that people are being assessed and supported by professionals with qualifications specific to the job they are being asked to do. This was also demonstrated in the single shared assessments that we viewed during the inspection. All the assessments were individualised with the support being tailored to the individuals needs. There was strong evidence of regular goal setting involving the service users and frequent reviews of care and support needs. On the first day of the inspection we discussed with the social worker, (care manager), and the assistant psychologist the outcome of an initial home visit to a Lomond and West Dunbartonshire Brain Injury Project, page 17 of 24

18 person who had just been referred to the ABI service. We heard how individual goals and care would be agreed with the service user and their family following a single shared assessment report and an neuropsychology report. This was a clear example of joint working in a small team of professionals who were motivated to improve outcomes for individuals with acquired brain injuries. From the five completed questionnaires that we received from service users everyone strongly agreed or agreed that they had a personal plan which detailed their support needs and personal preferences. Everyone who responded indicated that they were confident that the staff had the skills to support them and that the service checked with them regularly that their needs were being met. The service offers long-term support to individuals with brain injuries as this is the recognised need. If service users require more intensive support the service will contract other care providers with relevant experience but the manager of this service will meet with the managers of these other services regularly to review the support that they are providing. We received three completed questionnaires from staff and spoke with another staff member by telephone who was on leave when we visited the service. All the staff wo responded indicated that they had access to education and training in the last 12 months that helped them with their job. Everyone who we contacted stated that the service provided good care and support to the people who use it. Additional comments include: "This is a small team which is well integrated and highly motivated to providing personalised supports. Team members meet regularly, including with service users who contribute to the development and service provision." The team has weekly team meetings. Tasks and goal sheets for service users are discussed so that they continue to monitor and record the achievements of service users and develop further opportunities to provide service users with support. Areas for improvement The provider should continue to monitor and maintain the excellent quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Lomond and West Dunbartonshire Brain Injury Project, page 18 of 24

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths At this inspection, we found that the performance of the service was excellent for this statement. We concluded this after we spoke with guests and staff, observed practice and examined a range of relevant documentation. The service has user and carer representation on the Managed Care Network and other forums in place to assess and develop management and evaluate leadership. The Brain Injury Experience Network (BIEN) regularly invited the service cocoordinator to attend their meetings, report on supports and to receive feedback on service-user experiences of the ABI service. The service has local improvement targets which came about through the strategy group which service users were part of. See also strengths detailed under Quality Statement 1.1 Areas for improvement The provider should continue to monitor and maintain the excellent quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Lomond and West Dunbartonshire Brain Injury Project, page 19 of 24

20 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths At this inspection, we found that the performance of the service was very good for this statement. We concluded this after we spoke with service users and staff, observed practice and examined a range of relevant documentation. We were provided with a detailed action plan for the service which outlined key development objectives for 2013 and measured what action had been taken. The provider was looking at key areas such as reviewing and developing more information on ABI for the public, website development and reviewing the West Dunbartonshire ABI strategy. The provider was also measuring outcomes for individual service users and looking at how well the "Goal" folders used with service users were working. There were plans in place to decide with the Managed Care Network and Community Healthcare Partnership the most appropriate way to report outcomes of the service and for service users. This was to be part of a wider service audit. Work had been completed on reviewing care pathways for service users and was in progress, consulting with other stakeholders including service users and other service providers regarding service mapping. The service, staff and service users (through the BIEN group) were also exploring appropriate research topic and projects about ABI. There were plans to develop, undertake and publish this research. There was a clear action plan to make sure that the service complied with all relevant service standards including Codes of Practice for professional regulatory bodies, the National Care Standards, Data protection and care management of records. The service has been recognised by other organisations for its work and innovation. It was a finalist in the Care Accolades (2010) which recognised "achievement, partnership working and innovation. West Dunbartonshire council has also awarded a "star award" for outstanding contributions to council services. COSLA (Convention of Scottish Local Authorities) awarded the service an excellence award in The service and it's work was used and reported as a good practice example in the scrutiny report by the Care Inspectorate of West Dunbartonshire Council Social Work Services in Lomond and West Dunbartonshire Brain Injury Project, page 20 of 24

21 The above information and recognition led us to conclude that this provider was operating a dynamic, expert service which put people affected by Acquired Brain Injury at the core of what it does. It was also a service that did not stand still but always looked to improve on what it was current achieving. Areas for improvement The provider should continue to monitor and maintain the very good quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. We will look at the progress made with Acquired Brain Injury Service Development plan at the next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Lomond and West Dunbartonshire Brain Injury Project, page 21 of 24

22 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). Lomond and West Dunbartonshire Brain Injury Project, page 22 of 24

23 5 Summary of grades Quality of Care and Support Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Staffing Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Management and Leadership Very Good Statement 1 Statement Excellent 5 - Very Good 6 Inspection and grading history Date Type Gradings 31 Aug 2011 Unannounced Care and support 6 - Excellent Staffing Not Assessed Management and Leadership 5 - Very Good 7 May 2009 Announced Care and support 6 - Excellent Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Lomond and West Dunbartonshire Brain Injury Project, page 23 of 24

24 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: Lomond and West Dunbartonshire Brain Injury Project, page 24 of 24