Allied Healthcare Group Ltd - Dumfries Housing Support Service 1st Floor 22 Castle Street Dumfries DG1 1DR Telephone:

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1 Allied Healthcare Group Ltd - Dumfries Housing Support Service 1st Floor 22 Castle Street Dumfries DG1 1DR Telephone: Inspected by: Linda Wheatley Clive Pegram Type of inspection: Unannounced Inspection completed on: 24 May 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 20 4 Other information 42 5 Summary of grades 43 6 Inspection and grading history 43 Service provided by: Allied Healthcare Group Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Linda Wheatley Telephone Allied Healthcare Group Ltd - Dumfries, page 2 of 45

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 3 Adequate What the service does well Staff have continued to be flexible within their support times to try to meet the needs of service users. Service users told us that staff are very kind and they carry out their support as expected. They told us that staff will attend to the little things and will always make sure they have everything they need before they leave. They are good at responding to any changes in their needs on a daily basis. The service manager and staff are completing new care plans with service users and their relatives to help them to provide more individualised and person centred care. What the service could do better Some service users continued to receive support from staff at different times, and at times which were not allocated on their rotas. Some service users were left feeling unhappy about this as a result. Although the service manager and staff were working hard to complete individualised care plans, some service users did not have these and did not have updated information about the service provided and how they could make a complaint if they were unhappy. The service manager agreed that ensuring service users received support at the correct times remained a priority. She was aiming to complete all care plan updates within the next two months. Allied Healthcare Group Ltd - Dumfries, page 3 of 45

4 What the service has done since the last inspection Inspection report continued The temporary serviced manager and staff have worked hard to address the outstanding 12 Requirements and two Recommendations from the previous inspection. These have all been met or partially met which has resulted in better outcomes for service users increasing in their previous grades to 4 good in all Quality Statements. Conclusion The service is providing a good quality of care and support to service users, with good staffing and adequate management and leadership. The service should continue to remain focused on providing good care and support to service users and ensure they receive person centred support and at times they request. Who did this inspection Linda Wheatley Clive Pegram Allied Healthcare Group Ltd - Dumfries, page 4 of 45

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at Allied Healthcare Group is a national organisation which was registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011 to provide Housing Support and Care at Home services. It also has services throughout England. Allied Healthcare Group is registered to provide a service to a wide range of service users living in Dumfries and surrounding areas including; older people, younger people, people with physical disabilities, mental health problems and learning disabilities to people in their own homes. The providers local office is close to the town centre and is near to local amenities, including shops, and train and bus routes. The services include personal care and support, shopping, day and night sitting service and others in response to service user's requests. Their mission statement is to be a leading and valued partner in UK health and social care. Their aims and objectives are to provide personal and practical care to people in their own homes. To assist service users to achieve and maintain their independence. To provide services of a general nature, which may include specialist provision within the available human resources and the ability of the service users (or representative) to fund such services. During the inspection there were 185 active service users receiving support from the service with a total of 1840 hours per week. These ranged from half an hour each week to 35.5 hours per week. The youngest service user was 16 years old and the oldest service users was 100 years old. 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 Allied Healthcare Group Ltd - Dumfries, page 5 of 45

6 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 the 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 3 - Adequate 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. Allied Healthcare Group Ltd - Dumfries, page 6 of 45

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed that the service may need a more intense inspection. During the inspection we looked mostly at the outstanding Requirements and Recommendations from the previous inspection in May We wrote this report following an unannounced inspection. This was carried out by Inspectors Linda Wheatley and Clive Pegram on Monday 20th May 2013 between the hours of 1.30pm and 4.15pm, Tuesday 21st May 2013 between the hours of 9am and 10pm, Wednesday 22nd May 2013 between the hours of 9am and 3pm, and Friday 24th May 2013 between the hours of 10am and 1.30pm when we gave feedback to the service manager. During the inspection we visited service users and their relatives, and spoke to staff within the Annan and Dumfries areas of the service. As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us. We sent 60 care standard questionnaires to the manager to distribute to relatives and carers. Relatives and carers returned 27 completed questionnaires before the inspection. We also asked the manager to give out 60 questionnaires to staff and we received 10 completed questionnaires. During the inspection process, we gathered evidence from various sources, including the following: We spoke with: Seven service users Two relatives Allied Healthcare Group Ltd - Dumfries, page 7 of 45

8 Nine carers Three senior carers Two service coordinators Administrator Service manager Regional trainer We looked at: Personal plans including: My life my choices Risk assessments Reviews Clients care diaries/ log books Individual clients weekly rotas Service user guide Newsletter Individual staff weekly rotas Team meeting minutes Staff files including: Recruitment and Selection information Protection of Vulnerable Group (PVG) checks Staff disciplinary information Supervision notes Scottish Social Services (SSSC) checks Cold Harbour computer monitoring system including: Client details Clients support dates and times Changes to support dates and times Records of staff in individual clients teams Reviews Changes to personal and support details Staff lone working and availability Staff induction, training and supervision Staff calling in and out system Spot checks Staff training matrix Complaints, Incidents, Accidents Management system Policies and procedures: Complaints Recruitment Supervision Allied Healthcare Group Ltd - Dumfries, page 8 of 45

9 Disciplinary Service user feedback and involvement folder Annual survey questionnaires 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 Allied Healthcare Group Ltd - Dumfries, page 9 of 45

10 What the service has done to meet any requirements we made at our last inspection The requirement The service provider must ensure that it makes proper provision for the health and welfare of service users by ensuring that it communicates essential information to service users/representatives about the service they receive; in such a way that respects their privacy and dignity. In order to do this the service provider must ensure that: * Service users are notified of changes of staff * Service users are informed of who will provide the service, how and when it monitors staff patterns, transport in order to provide consistent staffing. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4(1)(a) Welfare of users and to meet National Care Standards, Care at Home, Standards 4.5: Management and staffing, Standard 3: Your personal plan. Timescale: On receipt of this report. What the service did to meet the requirement This Requirement has been partially met Please refer to quality statement 1.1 for progress on this requirement. The requirement is: Not Met Allied Healthcare Group Ltd - Dumfries, page 10 of 45

11 The requirement The service provider must review and update its complaints procedure to inform the complainant of the outcome of the complaint investigation within 20 working days after the date the complaint was made. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 18(4) Complaints. Timescale: Within four weeks of receipt of this report. What the service did to meet the requirement This Requirement has been met Please refer to quality statement 1.1 for progress on this requirement'. The requirement is: Met Inspection report continued The requirement The service provider must ensure that service users have personal plans in place which includes details of: * personal preferences * their needs and how these will be met. Personal plans must be reviewed: * at least once in every six month period * when there is significant change in a service users needs. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulations 3 Principles, 4(1)(a)(b) and 5 Personal plans (1)(2)(a)(b)(ii)(iii)(c) and (d). Timescale: To commence on receipt of this report and completed within four weeks. What the service did to meet the requirement This Requirement has been met by the target date Please refer to quality statement 1.1 for progress on this requirement' The requirement is: Met Allied Healthcare Group Ltd - Dumfries, page 11 of 45

12 The requirement The service provider must ensure that at all times suitable qualified and competent staff are working in the care service, in such numbers to meet the needs of service users. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 15(a) Staffing and to meet National Care Standards, Care at Home, Standard 4: Management and staffing. Timescale: On receipt of this report. What the service did to meet the requirement This Requirement has been met by the target date Please refer to quality statement 3.3 for progress on this requirement. The requirement is: Met Inspection report continued The requirement The service provider must ensure that care staff are fully aware of and put the following policies and procedures into practice: * complaints * participation policy and strategy * record keeping. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4(1)(a) Welfare of users and to meet National Care Standards, Care at Home, Standard 4.1, 4.2, 4.5: Management and staffing Timescale: Within four weeks of receipt of this report. What the service did to meet the requirement This Requirement has been partially met Please refer to quality statement 3.3 for progress on this requirement. The requirement is: Not Met Allied Healthcare Group Ltd - Dumfries, page 12 of 45

13 The requirement The service manager must inform Social Work Adult Support and Protection of the staff disciplinary and related adult support and protection issues found during the inspection The service manager must also submit a detailed notification to the Care Inspectorate immediately afterwards. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4(1)(a) Welfare of users and to meet National Care Standards, Care at Home Standard 4: Management and staffing Timescale: As soon as possible after inspection feedback was given What the service did to meet the requirement This Requirement has been met Please refer to quality statement 4.4 for progress on this requirement. The requirement is: Met Inspection report continued The requirement The service manager and service provider must ensure staff practice issues are addressed through the supervision process with management input. The service provider must review the staff disciplinary procedures to include this. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4(1 (a) Welfare of users and to meet National Care Standards, Care at Home Standard 4: Management and staffing Timescale: Within four weeks of receipt of this report. What the service did to meet the requirement This Requirement has been met by the target date Please refer to quality statement 3.3 for progress on this requirement. The requirement is: Met Allied Healthcare Group Ltd - Dumfries, page 13 of 45

14 The requirement Inspection report continued The service provider must review their Selection and Recruitment Policies and Procedures to include SSSC and professional register checks. They must include clear detailed information for managers to follow when receiving unsatisfactory references. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 15(a) Staffing and to meet National Care Standards, Care at Home Standard 4: Management and staffing. Timescale: Within four weeks of receipt of this report We signposted the service to the following documentation: Equality Act 2010 Statutory Code of Practice, Employment Statutory Code of Practice, Equality and Human Rights Commission What the service did to meet the requirement This Requirement has been met by the target date. Please refer to quality statement 3.3 for progress on this requirement. The requirement is: Met Allied Healthcare Group Ltd - Dumfries, page 14 of 45

15 The requirement The service provider must implement robust systems to enable them to satisfy themselves that: * the service is consistent and reliable * service users receive the care and support they require, as detailed in their personal plan and at the agreed time * spot checks are carried out to observe staff This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4(1)(a) Welfare of users and to meet National Care Standards, Care at Home, Standards 4.6: Management and staffing, Standard 3: Your personal plan. Timescale: On receipt of this report. What the service did to meet the requirement This Requirement has been partially met Please refer to quality statement 4.4 for progress on this requirement. The requirement is: Met Inspection report continued The requirement The service provider must ensure that all complaints and expressions of dissatisfaction are fully investigated. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 18(3) Complaints. Timescale: With immediate effect. What the service did to meet the requirement This Requirement has been partially met Please refer to quality statement 4.4 for progress on this requirement The requirement is: Met The requirement Allied Healthcare Group Ltd - Dumfries, page 15 of 45

16 The service provider must consider other ways in which to fully inform service users of the service's complaints procedure which must be appropriate for the service users' needs. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 18(2) Complaints. Timescale: With immediate effect. What the service did to meet the requirement Please refer to quality statement 4.4 for progress on this requirement The requirement is: This Requirement has been partially met Inspection report continued The requirement The service manager must ensure she follows the organisations Adult Support and Protection procedures and local guidelines and reports all ASP issues immediately The service manager must ensure she completes all notifications to the Care Inspectorate, including detailed information and updates This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4(1) (a)welfare of users and to meet National Care Standards, Care at Home Standard 1: Informing and deciding Standard 4: Management and staffing What the service did to meet the requirement Please refer to quality statement 4.4 for progress on this requirement This Requirement has been partially met. The requirement is: Met What the service has done to meet any recommendations we made at our last inspection We made the following recommendations and Requirements as a result of the previous inspection Allied Healthcare Group Ltd - Dumfries, page 16 of 45

17 1. The service provider should fully implement its participation policy and strategy and involve service users and their carers in assessing and improving the quality of the service. This is in order to meet National Care Standards, Care at Home, Standard 11: Expressing your views. This Recommendation has been partially met Inspection report continued Please refer to quality statement 1.1 for progress on this Recommendation. 2. The service provider should be able to demonstrate how it has responded to feedback from service users and where appropriate how this has led to improvement in the service. This is in order to meet National Care Standards, Care at Home, Standard 11: Expressing your views. This Recommendation has been partially met Please refer to quality statement 1.1for progress on this Recommendation. 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 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. Taking the views of people using the care service into account For this inspection, we received views from 27 of the people using the service. 20 people gave their views via the care standards questionnaires and we spoke with a further seven people in their own homes. 19 people said they strongly agreed or agreed that overall they were happy with the quality of care and support the service gives them. One person disagreed. Allied Healthcare Group Ltd - Dumfries, page 17 of 45

18 We received the following comments: "The service does not look at what would improve for me." "My only niggle is morning times, the office tell me I won't get carers coming before 8.45 am, then the next week they come at 8am. The carers are very good, I do appreciate them." "The carers are very good but are always pushed for time. "I feel that half an hour is not enough time." "This is a great service which suits me very well. Carers could not be more helpful." "The carers don't have enough time to get from one client to the next to be on time." Sixteen people said that they had a personal plan containing their needs and personal preferences. Eight people told us that the service did not ask for their opinions about how it can improve and four people disagreed that the service checked with them regularly that their needs were being met. People spoke highly about the staff that supported them and all respondents said that staff were very kind, did their best in the time they had, and always attended to the 'little' things. We have included further comments and views from people using the service throughout the report. Taking carers' views into account Feedback about the service varied, seven relatives returned completed care standards questionnaires. They all strongly agreed or agreed that overall they were happy with the quality of care and support the service gave their relative. We received the following comments: "Care plan is reassessed when required, most staff are compassionate although we have been let down by some individuals." Allied Healthcare Group Ltd - Dumfries, page 18 of 45

19 "Biggest issues are some medications getting missed, I have discussed this with some carers and office staff but they never call back about anything, so issues with office cover are great." "I know regular carers but quite often there are strangers on the rota." "We really like the service at the moment and are getting regular carers at regular times." Four relatives told us they did not know about the service complaints procedure or how to make a complaint to the Care Inspectorate. We received mixed feedback about the level of involvement relatives have in the care and support of their relatives and how the service asks for their opinions to make changes. We had the opportunity to speak with one relative individually during our inspection who told us they were very happy with the care and support their relative received from the service. They told us that the staff were very good, they knew what they were doing, worked well with other agencies involved in their care and always arrived on time. Relatives' comments and references to our questionnaires are included throughout this report. Allied Healthcare Group Ltd - Dumfries, page 19 of 45

20 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 At the last inspection the service received a grade of 2 weak for this Quality Statement. During this inspection they received a grade of 4 good. At the last inspection we asked the service provider to ensure that it makes proper provision for the health and welfare of service users by ensuring that it communicates essential information to service users/representatives about the service they receive; in such a way that respects their privacy and dignity. In order to do this the service provider must ensure that: * Service users are notified of changes of staff * Service users are informed of who will provide the service, how and when it monitors staff patterns, transport in order to provide consistent staffing We gave them a timescale of on receipt of this report to complete this. The service manager told us in her action plan that provision letters would continue to be sent by post to all Service Users weekly with the date/time/carer for each visit. Any staff changes would be notified to service users via telephone, which would be evidenced and logged in the relevant service user notes on their 'Cold Harbour' monitoring system stating who made the call and if the call was witnessed by another staff member. All service users we visited during the inspection had a copy of the letters posted out to them including the date, time and carer for each visit. They told us they received these at the end of every week. We could see that staff were working in smaller Allied Healthcare Group Ltd - Dumfries, page 20 of 45

21 teams and were allocated support times in nearby areas to avoid excessive travel and being late for support. Some service users received support from the staff they had requested as a result of this. Some service users told us that they were contacted by the office staff when care staff were running late. They told us care staff would usually apologise if they were late and ask if they had been informed. We looked at the 'cold harbour' monitoring system and spent time in the office with service coordinators and could see that some service users were contacted when staff changes were being made. Due to recent staff changes service users have had to meet new staff to provide support in their small teams. The service manager told us that she had tried to allocate staff to service users with similar skills and experience and retain staff that already had a rapport with some service users. We could see that service user's preferences or requests not to have support by certain staff were recorded on the 'cold harbour' monitoring system. This would not allow office staff to place carers against service users on the rotas. At the last inspection we also asked the service provider to review and update its complaints procedure to inform the complainant of the outcome of the complaint investigation within 20 working days after the date the complaint was made. We gave them a timescale of within four weeks of receipt of this report to complete this The service manager told us in her action plan that the Complaints procedure had been reviewed, updated and was in place to reflect 20 working days. We read the new complaints procedure and could see that all relevant information had been updated. The policy referred to acknowledging all written complaints within two working days. The policy stated that all written complaints would be investigated and reported on the outcomes to the complainant within 20 working days, with the exception where the nature of the complaint is such that an investigation would take longer. At the last inspection we also asked the service provider to ensure that service users have personal plans in place which includes details of: * Personal preferences * Their needs and how these will be met. Personal plans must be reviewed: * At least once in every six month period Allied Healthcare Group Ltd - Dumfries, page 21 of 45

22 * When there is significant change in a service users needs. We gave them a timescale of: Inspection report continued to commence on receipt of this report and to be completed within four weeks. The service manager told us in her action plan that all service users were divided between staff members to become that service user's allocated reviewer. She told us that all staff will review/update their allocated care plans updating the 'Cold Harbour' electronic monitoring system with the review dates and notes along with the relevant paperwork. She also told us that they were in the process of updating all service users care plans to the new format 'My Life My Choice'. They were updating the service user reviews and spot checks to ensure that their service delivery is appropriate and to the needs of the services users. We could see that the service manager and senior care staff had made good progress with this Requirement. The organisation had developed a new plan called 'My Life My Choices' to look at ways of providing more person centred support, including information from service users and relatives, and provide the right amount of in formation for staff to be able to follow. The service manager was working closely with senior care workers to ensure these were being completed for all service users. We could see that the new personal plans contained more detailed information about the organisation, informing service users about: their aims and objectives, the service provided and how their support needs will be discussed agreed and recorded. Service users were told they would be visited by one of the senior care workers to asses their needs and discuss the type of service they would like. Service users were informed about staff spot checks, and telephone monitoring calls which would take place periodically to assess if their needs were being met. We could also see that the plans included more detailed information about individual service user's specific needs and preferences and how they liked certain support to be carried out. For example where key codes were being used staff knew where they were and individual codes. Staff knew which door to enter the home, where service users would be and how they would like to be addressed. Some service users did not want staff to use their telephones to call in at the start and end of each visit. This was recorded in each personal plan and we observed staff following these requests during the inspection. Days and times of visits were discussed and recorded along with preference of male or female workers, office and out of hour's contacts, and various detailed home and individual risk assessments with care accompanying care plans. Service users were being asked what was important to them and how they wanted to be supported along with what outcomes they wanted to achieve. We could see that one service Allied Healthcare Group Ltd - Dumfries, page 22 of 45

23 user enjoyed listening to music and talking about a book they had written. It was important for them to be able talk to staff about their interests during their support. Six monthly reviews were taking place giving service users the opportunity to discuss their care needs and any changes they would like to make. We saw some good examples of changes being made at service users requests as a result of these. For example: Inspection report continued We could see that one service users support times on staff rotas on the date they requested and agreed. We could see that other service users who requested further help with housework and personal care were being reviewed and reassessed with input from social work. Where service users were unable to receive changes to support we saw some good examples of staff helping individuals access other services for support such as ironing and housework. At the last inspection we also asked the service provider to fully implement its participation policy and strategy and involve service users and their carers in assessing and improving the quality of the service. We also asked them to demonstrate how it has responded to feedback from service users and where appropriate how this has led to improvement in the service. The service manager told us in her action plan that the participation policy would be implemented throughout the following ways: * Service User reviews 6 monthly, * Satisfaction surveys to be undertaken at branch not corporate level going forward * Phone spot checks - 12 per week from branch * Spot checks in own homes * Service User feedback and involvement folder kept in branch, responding to feedback from service users via letter. She also told us that the service User feedback and Involvement folder in the office contained service user feedback response - When a service user calls to request a change in service/time/carer they will respond and confirm in writing what they have done. Service User suggestions were logged in 'Cold Harbour' monitoring system. Telephone Spot Checks proformas had been updated to include action/response taken following spot checks. We could see that the service manager had made some good progress with these Recommendations. We were able to see that she had implemented the policy in the ways she had planned: Allied Healthcare Group Ltd - Dumfries, page 23 of 45

24 Service users were receiving six monthly reviews as previously discussed. We looked at the recent satisfaction surveys which had been completed and sent out to 100 service users of which 30 had been returned. Service users had been asked questions about the type of service they received, rate care staff in terms of their knowledge and skills and abilities to support individuals with specific needs and the overall level of service they received. A copy of the results and the service manager's responses was included in the recent newsletter sent out to all service users. The survey highlighted that some service users were still unhappy with the level of information they received with regards to changes in their workers. The service manager had acknowledged staff changes and the office staff responsibility to keep service users informed and up to date with changes. The service manager had asked service users to inform her with any further concerns. Surveys would be carried out annually for future based on feedback from service users that they were being asked to complete previous questionnaires too frequently. Telephone spot checks and spot checks in homes were taking place and recording any issues and concerns. We could see that some staff issues had been highlighted and were addressed through supervision to monitor individual staff performance to ensure service users received good quality care. We looked at the Service User feedback and involvement folder kept in the branch and saw some good examples of how the service manager had responded to feedback from service users and areas of dissatisfaction in areas such as; changes to support times and missed support, and arranging reviews to discuss dissatisfaction with the service. The service user guide had been reviewed and up dated in January 2013 for service users and people considering using their service. The guide included summarised basic information about the organisation and service provision such as: service aims and objectives, service provided local branch and staff information, complaints procedure, out of hours support, and cover for sickness. Service users were advised to discuss any changes to their support times with their care workers who would discuss these with the branch manager. The guide also highlighted how service users could express their views about the service through satisfaction surveys and visits from branch manager on a regular basis to update their personal plans, as part of their quality assurance processes. Information about telephone monitoring and spot checks to assess staff practice was also included. Allied Healthcare Group Ltd - Dumfries, page 24 of 45

25 Areas for improvement We received mixed feedback from service users and relatives about rota changes. Some service users and relatives told us that they did not receive their letters with support times until Friday or Saturday which left little time to make any changes. Some service users told us that they continued to experience changes to rotas such as staff allocated and staff times without consultation and updates. Some service users told us that they had highlighted concerns to care staff who either do not pass information on to office staff or office staff does not respond. Some service users told us that they do not receive phone calls when staff were running late and they expect staff when they see them. Some service users knew they could phone the office to find out where staff were and others told us when they phoned asking if staff were coming they were not always told who it would be or given a time. As a result some service users were still unhappy with their support times or staff allocated. Recommendation 1 Some of the sections in the personal plans were not always completed and up to date such as 'what is important to me' and 'how I feel about having support'. Some information had not been carried forward from some of the initial assessments into care plans. For example one service users risk assessment stated that they needed support to sit up in bed but this was not recorded in the care plan. Another service users plan stated that they did not need help using the telephone but they told us that they did. Some signatures were missing from some sections within the personal plans. Although care diaries requested signatures from service users we saw very few signatures in place. We received different feedback from staff and service users about when their signatures should be obtained Some service users told us that they could sign and would be happy to sign, others told us they were not asked to sign or would not be interested. There was little evidence to show this had been discussed and agreed with individuals. Although some reviews had taken place and some changes to support had been requested, these were not always recorded in the personal plans. This made it unclear if actions had been carried out and completed. Most of the service users visited during the inspection did not have the new personal plans in place. They did not have any up to date service information and no updated service user guide. Recommendation 2 Inspection report continued Although there were some good systems in place to involve service users and their Allied Healthcare Group Ltd - Dumfries, page 25 of 45

26 carers in assessing and improving the quality of the service, we could see that some service users and relatives were still unaware of these, and were still unhappy with some aspects of their care and support such as: changes to support times, staff changes and staff availability and lateness. Some service users were still receiving support from staff they had requested not to see and some service users had managed without any support when staff had not turned up and they had not been informed. Most of the service users told us they did not like to complain and would not contact the office if support was late or did not turn up. Although the service user guide had been reviewed and contained some good basic information for service users and relatives to follow, these had not been distributed to all service users. Most of the service users we visited during the inspection did not have these in place. They told us they did not know about the up to date information included. They did not know about some of the monitoring systems in place such as telephone and spot checks and why they were taking place. They told us they did not always receive any feedback and were not clear if any changes were made to staff practice or their support as a result. Recommendation 3 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. The service manager should ensure that they communicate essential information to service users/representatives about the service they receive. Service users should be informed of who will provide the service and when. They should be informed of any changes to support times and staff allocated at all times. National Care Standards, Care at Home Standard 1: Informing and deciding Standard 11: Expressing your views 2. The service manager should ensure that all service users have the new up to date 'my life my choices' personal plans in place. They should clearly record discussions held with service users and actions agreed. All sections should be completed, dated and signed by service users and staff. National Care Standards, Care at Home Standard 1: Informing and deciding Inspection report continued Allied Healthcare Group Ltd - Dumfries, page 26 of 45

27 Standard 3: your personal plan Standard 11: Expressing your views 3. The service manager should fully implement the participation policy and strategy and involve service users and their carers in assessing and improving the quality of the service. They should also demonstrate how it has responded to feedback from service users and where appropriate how this has led to improvement in the service. National Care Standards, Care at Home Standard 1: Informing and deciding Standard 11: Expressing your views Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths During this inspection the service received a grade of 4 good for this Quality Statement We found some good evidence to show how the service was ensuring service users' health and wellbeing needs were being met: New personal plans included comprehensive and detailed risk assessments looking at safety of the homes environment, moving and handling, pressure area care, food hygiene, medication, financial safeguarding and accidents and incidents. Each assessment included a checklist for service users and staff to follow and tick as yes or no. Each risk assessment had a total score which highlighted of the risk was high medium or low. Where risks had been identified staff recorded how to carry out each task safely. For example we could see that moving and handling risk assessments recorded specific information about which aids and adaptations should be used such as bed raisers, height adjustable beds, Zimmer frames and hoists. They also recorded detailed information about when the aid was purchased, when it was serviced and when the next service was due. This would ensure that all equipment used would remain checked and safe to use. Pressure area care risk assessments included a picture of a body (body map) which allowed staff to highlight specific pressure areas on the back or front of the service user's body. This gave staff a clear indication of where the exact pressure areas would be. We saw a good risk assessment in place for staff to follow when supporting a service user with cleaning using a bleach based solution. The assessment showed some risks of burns to the service user and staff and referred to specific healthy and safety Allied Healthcare Group Ltd - Dumfries, page 27 of 45

28 guidelines to follow. We could see that some risk assessments were being discussed with service users as part of their initial assessment with senior carers and would be up dated as part of their six monthly reviews. Accident/incident report forms were kept in each service user's personal file for staff to complete at the time of each occurrence. This information would then be given to the service manager and head office for review and audit. All service users had a Care worker visit report log kept in their homes. Staff were responsible for recording events of importance and relevance relaying to service users conditions and state of health. All staff were expected to look for changes in service users' health and complete the diary at the end of each visit, recording any identified changes and actions taken. Any significant changes in service users health needs were reported to the office or relevant specialists such as GPs, pharmacy and Community nurses. During our visits to service users with staff we saw some good examples of care staff discussing and recording changes in service users physical health and medication, and checking if medications were being delivered on time. We observed staff following best practice when supporting service users with food hygiene, and attending to personal care needs. Staff wore gloves and aprons and washed their hands after each task. Areas for improvement Although there were detailed risk assessments in place staff were still learning how to complete these and were not providing details of specific training needed or guidelines to follow. For example one of the risk assessments referred to health and safety guidelines for staff to follow but did not include a copy of the guidelines. Another risk assessment referred to staff needing specific training but the exact training was not recorded. We discussed this with the service manager who agreed that risk assessment information would be reviewed and monitored for effectiveness. Recommendation 1 Although staff had a good understanding of level C medication and their responsibilities to administer these, we observed some poor staff practice during the inspection. We observed staff leaving one tablet out for service users to take after they had gone, even though they had signed to say it had been given. We could also see that some changes had been made to service user's medication which had not been recorded appropriately within the personal plans and had not been updated by the GP. Allied Healthcare Group Ltd - Dumfries, page 28 of 45

29 Recommendation 2 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service manager should ensure that risk assessments in personal plans are reviewed and up to date including all relevant information such as guidelines to follow and specific training needs of staff. National Care Standards, Care at Home Standard 1: Informing and deciding Standard 3: Your personal plan Standard 4: management and staffing 2. The service manager should ensure that all staff follow policies and procedures and best practice guidelines when supporting service users to take their medication. Any changes to individual service users needs should be discussed with GPs, recorded in personal plans and reviewed and updated. Standard 3: Your personal plan Standard 4: management and staffing Standard 8: keeping well-medication Allied Healthcare Group Ltd - Dumfries, page 29 of 45

30 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 During this inspection the servcie received a grade of 4 good for this Quality Statement. The service strengths have been discussed in Quality statement 1. Areas for improvement The service areas for improvement have been discussed in Quality statement 1.1. 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 At the last inspection the service received a grade of 3 Adequate for this Quality Statement. During this inspection the service received a grade of 4 good. At the last inspection we asked the service provider to ensure that at all times suitable qualified and competent staff are working in the care service, in such numbers to meet the needs of service users. We also asked the service provider to review their Selection and Recruitment Policies and Procedures to include Scottish Social Services Council (SSSC) and professional register checks. They must include clear detailed information for managers to follow when receiving unsatisfactory references. We gave them a timescale of on receipt of this report and within four weeks of Allied Healthcare Group Ltd - Dumfries, page 30 of 45

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