Barony Housing Support Service - Edinburgh Housing Support Service 101 High Riggs Tollcross Edinburgh EH3 9RP

Transcription

1 Barony Housing Support Service - Edinburgh Housing Support Service 101 High Riggs Tollcross Edinburgh EH3 9RP Inspected by: Stephen Ball Type of inspection: Unannounced Inspection completed on: 6 March 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Barony Housing Association Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Stephen Ball Telephone enquiries@careinspectorate.com Barony Housing Support Service - Edinburgh, 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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well Barony Edinburgh provides a high standard of care and support to service users. All of the care and support plans we sampled were outcome focused, supporting the service user to fulfil their goals and aspirations. What the service could do better We identified some gaps in the completion of care and support plan reviews at one of the shared accommodation services we visited. We have highlighted this further within this report. The service should also develop the existing internal quality assurance measures to ensure all documentation is completed in a timely fashion and signed by the relevant people. What the service has done since the last inspection The service has continued to ensure all care and support plans are outcome focused and strived to ensure choice and independence is provided for service users. Conclusion Barony Edinburgh continues to provide good care and support to service users. However, whilst the majority of procedures and systems are being operated to a high Barony Housing Support Service - Edinburgh, page 3 of 24

4 standard, this was not consistent across all services. We have highlighted this within this report. Who did this inspection Stephen Ball Barony Housing Support Service - Edinburgh, page 4 of 24

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to 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 based on best practice or the National Care Standards. - 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 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. About the service we inspected Barony Care at Home Service Edinburgh and Barony Housing Support Service Edinburgh (referred to in the report as "the service") is managed by Barony Housing Association Limited (referred to in the report as "the provider" or "Association"). The service is available each day of the week between the hours of 8am and 10pm. Staff provide an overnight sleepover service as required. Although the Housing Support service and the Care at Home service are separately registered, they operate as a combined service with the staff teams reporting to the same manager. The service is provided by a manager and six staff teams based in Edinburgh. One team operate from an office base while the other five teams operate from community shared houses. Each team is managed by a service manager or team leader who all report to the manager. Barony's vision: Barony Housing Support Service - Edinburgh, page 5 of 24

6 Barony's vision is of a society in which every person is enabled to lead a full and active life and has a good quality, safe and affordable home environment. Barony's values: Barony believes that people are at the centre of everything we do; whether tenant, service user or employee. In our work we will always strive to uphold and promote the following values: * Listening to and involving people in shaping our services. * Respecting people's individual choices. * Treating everyone with equal dignity and respect. * Empowering people to make informed choices, take decisions and achieve their potential. * Recognising and responding to the changing circumstances in people's lives. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued 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. Barony Housing Support Service - Edinburgh, 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 Stephen Ball. 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 out 30 care standards questionnaires to the manager to distribute to service users and their relatives. Fifteen service users and their relatives sent us completed questionnaires. We also asked the manager to give out questionnaires to staff and we received 9 completed questionnaires. We visited three out of the five shared accommodation services and the visiting support service: 1. Mayfield Road shared accommodation service. 2. Mardale Crescent shared accommodation service. 3. Ardmillan Terrace shared accommodation service. 4. The Visiting support service. We also viewed care and support plans and other relevant documents at the following service: 5. Lauriston Place shared accommodation service. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: * The registered service manager of the service 15 Service users (as detailed below) Barony Housing Support Service - Edinburgh, page 7 of 24

8 13 staff (as detailed below) Mayfield Road shared accommodation service * 1 service user * 2 support staff Mardale Crescent shared accommodation service * Service manager * 2 service users * 5 support staff Ardmillan Terrace shared accommodation service * 2 support workers * 6 service users Visiting support service * Service manager * 2 support workers * 5 service users We looked at: Relevant documents as detailed below at the following services: * A sample of 17 care and support plan documents. * A sample of 17 care and support plan reviews. * Service user care and support agreements. * A sample of staff team meeting minutes. * A sample of staff training and development records. * A sample of any incident records made by the service. * Any complaints the service had received since our last inspection. * Quality assurance information. * Any minutes of meetings for people using the services. * The responses from questionnaires issued to service users, carers and relatives. * Collated the responses from questionnaires issued to service users, carers and relatives. 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 Barony Housing Support Service - Edinburgh, page 8 of 24

9 Inspection Focus Areas (IFAs) Inspection report continued 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 Barony Housing Support Service - Edinburgh, page 9 of 24

10 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. We received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We sent out 30 CI Care Standard Questionnaires to people using the service, relatives and carers. Fifteen were returned to us. The majority of questionnaires returned told us they were happy with the service they receive. Positive comments received The majority of the responses we received were positive. "I am delighted with my support." Some raised particular issues Three service users did not know the procedure for making a complaint to the Care Inspectorate. One service user did not know how to make a complaint to the service. Barony Housing Support Service - Edinburgh, page 10 of 24

11 Taking carers' views into account We did not gather the views of carers as part of this inspection. Taking account of staff members Staff questionnaires were issued, 9 were returned to us. Positives The majority of responses were positive Inspection report continued Some raised particular issues: One staff member felt their were not enough opportunities to meet as a team and discuss day to day work practices Three staff told us that they did not receive regular support and supervision meetings with their line manager One staff member felt that not all staff show service users respect and dignity at all times. One staff member told us that the staff training was not sufficient in order for her to be fully competent in her role. An example of this was in relation to training on effectively managing challenging behaviour. She felt there was no forward plan for staff training. "Barony Housing Association did not provide training in mental health first aid which would have been really useful for my job." Barony Housing Support Service - Edinburgh, page 11 of 24

12 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths Barony Housing Support and Care at Home Service, Edinburgh provides all service users with comprehensive welcome packs, detailing relevant information about the service available to them. It also includes information on the approach, tools and methods Barony uses to encourage service users to become involved in assessing and improving the quality of the service provided to them. For example, we saw evidence of service users involved in the review of their support packages, service user meetings and annual satisfaction surveys. In addition, a leaflet covering the rights of service users (dignity and respect) and the responsibilities of both service provider and service user were also included. Following our assessment of the completed pre-inspection questionnaires and our discussions with service users, the majority of people were aware on how to make a complaint to the service and the Care Inspectorate. Information on how to make a complaint is made available to service users in a variety of ways, including the service user welcome packs, leaflets and posters displayed on notice boards within the shared accommodation services. Information on external advocacy support services to independently support service users to raise any concerns they may have with the service is also provided. We read some of the service user meetings held at some of the shared accommodation services. Regular meetings were held at 2 out of the 3 shared accommodation services we visited. Regular meeting agenda items included service user involvement, making a suggestion for service improvement, infection control and Barony Housing Support Service - Edinburgh, page 12 of 24

13 staying safe. We saw evidence of support staff encouraging service users to make suggestions for which staff could support them to achieve. Examples included developing a music group, organising trips to the theatre and the purchase of board games. We saw recorded evidence of how suggestions from service users had developed into reality. Each of the services (shared accommodation services and the visiting support service) had their own aims and objectives, individually tailored to the support delivered. Annual questionnaires were issued to service users, to capture their feedback on how the service could be further developed and improved. The most recent survey was completed by Barony at the time of our inspection of the service. The large majority of the findings from the survey undertaken were positive and the service provider had put into place an action plan to take forward the areas identified for improvement. Some of the services had their own newsletters. These were individual to each service and provided information to service users on forthcoming events, quizzes and general service information. We saw this to be a good method of providing feedback to those who engage in making suggestions on how the service could be improved. Areas for improvement Barony Housing Association had recently recruited an involvement manager. The primary role of the involvement manager is to explore meaningful ways of involving service users in the development of the service. We are aware of the forthcoming annual plan of involving service users in assessing and improving the service provided to them. We will follow this up at out next inspection. From our assessment f our pre-inspection questionnaires, three service users told us that they did not know how to make a complaint to the Care Inspectorate. Similarly one service user did not know how to make a complaint to the service. The service provider should ensure that all service users are familiar with the complaints procedures. We are therefore making this a recommendation. Please see recommendation 1. The service provider told us that they had not received any formal complaints since our last inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should ensure that all service users are familiar with the complaints procedures to both the service and the Care Inspectorate. Barony Housing Support Service - Edinburgh, page 13 of 24

14 This is to comply with the National Care Standards, Care at Home, Standard 11, Expressing Your Views. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We sampled a total of 17 care and support plans, reviews and other relevant documents for individuals, including risk assessments across the 5 services we inspected. The assessment tool that Barony use to assess individual support needs is outcome focused, meaning support plans are focused on the goals the service user would like to achieve with support from the service. The assessment of needs develops into an individual care plan for any of the following support areas: * Feels safe and secure. * Live where I want to live. * Daily activities. * Have satisfying things to do. * Maintaining and creating new social contacts. * My support needs are being met. * Staying healthy. In addition to the above assessment of needs headings, the support plans contained relevant background information on each of the service users too, to ensure their needs are fully met. This included: * All about me. * What s important to me. * To achieve in my life. * Any communication support needs. * Dietary needs. * Family and friends involvement in support package. Individualised risk management assessments and action plans were in place for all service users, ensuring appropriate protocols were in place to support service users to fulfil their aspirations and goals. For example, one service user required additional support when undertaking a swimming activity. Protocols were in place to ensure lifeguards at the swimming centre were fully aware of the health needs of the individual. This ensured effective risk management was in place and shared with relevant parties where agreed by the service user. The evidence we sampled told us that the majority of care and support plans, along Barony Housing Support Service - Edinburgh, page 14 of 24

15 with risk assessments were reviewed on a regular basis. We found that in most cases care plans and reviews were updated on a six monthly basis, more often in many cases when changes to agreed support packages had occurred. We sampled the keyworker meeting notes. These are records of discussions held regularly between the keyworker (allocated member of support staff to oversee delivery of support) and service users. We found the structure of the keywork meetings was to a good standard, detailing matters arising from the last keywork meeting, notes of what was discussed at the current meeting and a summary of the actions taken forward. We found this to be a good practice approach of recording meetings with service users and what had been discussed and agreed. The majority of the keywork meetings recorded were also signed by the service user concerned. We read a sample of the key policies and procedures for all the services. All of the policies and procedures were reviewed on a regular and routine basis at no more than three yearly intervals, or more frequently to reflect any changes in legislation. All of the policies and procedures were clearly dated as to when they were written and last reviewed by the management of the service. Many of the policies and procedures included examples of good and poor practice and what the potential repercussions were for the employer, employee and the individual they are supporting if procedures are not correctly adhered to. We read the adult support and protection policy, detailing the steps support staff should take if they identified any concerns of the wellbeing of service users. This document details the legal requirements, examples of someone's wellbeing not being satisfactory and the staff responsibilities and reporting procedures. It also included information on external agencies like the Police, social work and the Care Inspectorate. We spoke with staff in relation to the whistle blowing procedure, which details the responsibilities placed on staff to report any practice concerns of individuals or the organisation to senior management. All staff we spoke with said that they had confidence in management in raising issues and that the senior management would address in line with their policies and procedures. We sampled the medication administration records used to support service users with taking their medication across all services. All of the records we looked at were recorded to a high standard. In addition, weekly medication audits were undertaken to ensure all medication is accounted for and in date for taking. The service supports some service users with their finances, for example purchasing day to day items and paying for various community activities. The records we looked at were to a good standard, clearly accounting for all money, keeping receipts and Barony Housing Support Service - Edinburgh, page 15 of 24

16 countersigned by the service user and two support staff. This was consistent in the majority of services we visited. Areas for improvement Inspection report continued Whilst we saw evidence of regular reviews of care and support packages being undertaken at the majority of services, this was not so at the Mardale Crescent shared accommodation service. We were advised that this was a work in progress following a move from other premises in September Although evidence showed that reviews were starting to be held for service users, this had not been the case in the past 12 months. We will follow this up at our next inspection of the service. We also identified some gaps in service users receiving monthly keywork meetings with support staff, as per the keyworking procedure in place. For example, one service user had not received a keywork meeting since November 2012 and a further service user had not received a keywork meeting since April We highlighted this concern with the manager of the relevant service. We are therefore making a recommendation that all service users receive regular keywork meetings with their allocated support worker in line with the service's support procedures. Please see recommendation 1. When we sampled the 17 care and support plans across the services we visited, we found that not all of the plans had been signed by the service user. Each service user has an overall care and support plan which contains individual outcome plans for different areas. Therefore, a service user may have up to 12 outcome plans. When sampling the outcome plans across the services, we identified that 13 had not been signed by the service user. We are therefore making the recommendation that all outcome focused plans are signed by service users. Please see recommendation 2. Weekly schedules of when support should be provided are given to service users. Although all service users had schedules in place, many of these were out of date or had not been reviewed. We were unable to assess whether the weekly support schedule is current and meeting the needs of service users. We identified that out of the 17 support files we sampled, 8 had schedules which were out of date. For example one was dated from March The service provider should ensure that weekly schedules of agreed support are kept up to date, discussed and agreed with the service user and reviewed on a regular basis. We are therefore making this a recommendation. Please see recommendation 3. The service had identified the need for service users to be provided with copies of their support agreements. These documents were kept on file at the head office of Barony Housing Association and not within the individual files for service users. The service provider should ensure that all service users have access to the support agreements, which details how the support is to be provided to them. We will therefore follow this up at our next inspection of the service. Barony Housing Support Service - Edinburgh, page 16 of 24

17 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 3 Recommendations Inspection report continued 1. The service provider should ensure that service users meet with their named keyworker on a regular basis and in line with the service's procedures. National Care Standards, Housing Support, Standard 4 - Housing Support Planning. 2. The service provider should ensure that all care and support plans are agreed with the service user (or representative). National Care Standards, Housing Support, Standard 4 - Housing Support Planning. 3. The service provider should ensure that weekly support schedules for service users are up to date and reflect their support needs. National Care Standards, Housing Support, Standard 4 - Housing Support Planning. Barony Housing Support Service - Edinburgh, page 17 of 24

18 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Statement 1.1 has been taken into account for this statement. Areas for improvement Statement 1.1 has been taken into account for this statement. The service provider would benefit from involving the feedback obtained by service users into the annual appraisal and training analysis for support staff to ensure their care and support needs are continuously met. We will follow this up at our next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We read the Barony policy and procedure for staff in relation to receiving regular support and supervision meetings with their line manager. The procedure stated that the meetings would be held on a regular basis, no more than 10 weeks apart. The above procedure also detailed the process for staff to receive their annual appraisal of their work and make plans for the forthcoming year in terms of their ongoing learning and development training. The majority of the support staff we met with told us that they met with their line manager on a monthly or six weekly basis. Staff felt supported within their roles and felt able to approach senor management if they had any concerns and would feel Barony Housing Support Service - Edinburgh, page 18 of 24

19 supported in doing so. One support worker told us of a working issue XXX highlighted with their line manager and felt very supported during the process and the outcome. We read a sample of staff meeting notes for all 4 services we visited. These meetings discussed service delivery and development and any changes in policies and procedures. Staff meetings were regular at the Mardale Crescent, Ardmillan Terrace and Mayfield Road accommodation services. We looked at the staff training and development records made available to us. We could see that the support staff were well trained and cover a wide range of core training areas. For example, Infection control, adult support and protection, boundaries and confidentiality and challenging behaviour protocols, to name just a few. The staff we spoke with were familiar with how to deliver the relevant procedures following their training, and received ongoing re-fresher training to ensure they continue to stay up to date with relevant. Areas for improvement Three out the nine support staff who completed and returned our inspection questionnaires told us that they did not receive regular support and supervision meetings with their line manager. One support worker also told us that although they saw their line manager during the course of their day to day work, they did not meet for formal support and supervision on a regular basis. The service provider should ensure that regular support and supervision meetings are held on a regular basis and in line with Barony's own procedure. We are therefore making this a recommendation. Please see recommendation 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should ensure that regular support and supervision meetings are held on a regular basis and in-line with Barony's own procedure. National Care Standards, Housing Support, Standard 3 - Management and Staffing Arrangements. Barony Housing Support Service - Edinburgh, page 19 of 24

20 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 Statements 1.1 and 3.1 have been taken into account for this statement. Areas for improvement Statements 1.1 and 3.1 have been taken into account for this statement. The service should further develop ways of involving service users and carers in assessing and improving the quality of management and leadership in the service. We are therefore making this a recommendation. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths Barony Housing Association (the provider) has held the Investors in People accreditation since This is recognition from an external body of the staff training and development in place for its workforce. Barony is also a member of Quality Scotland and holds a Committed to Excellence Award for their management systems. The service provider had file audits in place for all service user support files. This system allows for management to undertake regular checks of relevant documentation like support plans and risk assessments to ensure the documentation is correct and kept up to date. The evidence we saw told us that these file audits were being done on a regular basis at three out of the five services we inspected. These file Barony Housing Support Service - Edinburgh, page 20 of 24

21 checks enabled service management to identify and highlight any gaps in the documentation with support staff. In addition to the regular service user satisfaction surveys, Barony also asked stakeholders to provide valuable feedback on the service too. The stakeholders included family members and social workers. The response we saw was positive and an action plan for further improvement had been put into place. The service supports some service users with their finances, for example purchasing day to day items and paying for various community activities. The records we looked at were to a good standard, clearly accounting for all money, keeping receipts and countersigned by the service user and two support staff. This was consistent in the majority of services we visited. Areas for improvement Although the service provider had a number of internal audit systems in place to check relevant work is being recorded, we are aware that the service provider is yet to implement a quality assurance policy. This would be a document which details all the methods and tools to be used to assess and improve the quality of the service being provided. We are therefore making this a recommendation. Please see recommendation 1. Whilst file audits are in place for all five services we inspected, we identified that the audits were not being undertaken on a regular basis at the Mardale Crescent service. Records available showed us that the last time file audits had been undertaken was in October The service would benefit from undertaking file audits on a more regular basis to quickly identify and address any gaps in relevant documentation. We highlighted this with the registered manager for the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should develop a quality assurance policy, detailing the tools and methods used to quality assess the service provided. National Care Standards, Care at Home, Standard 4 - Management and Staffing. Barony Housing Support Service - Edinburgh, 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Barony Housing Support Service - Edinburgh, page 22 of 24

23 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 28 Feb 2012 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good Not Assessed 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Barony Housing Support Service - Edinburgh, 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: Barony Housing Support Service - Edinburgh, page 24 of 24