Real Care Agency Housing Support Service Glenburn House 35 Glenburn Road East Kilbride Glasgow G74 5BA Telephone:

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1 Real Care Agency Housing Support Service Glenburn House 35 Glenburn Road East Kilbride Glasgow G74 5BA Telephone: Type of inspection: Unannounced Inspection completed on: 23 June 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 29 5 Summary of grades 30 6 Inspection and grading history 30 Service provided by: Real Care Agency Ltd Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Real Care Agency, page 2 of 32

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 5 Very Good Quality of Management and Leadership 4 Good What the service does well The service involves people in their care and support where possible. Care staff offer good, reliable support to people using the service and the service regularly checks that people using the service are happy. Information received from people using the service is audited and used to improve the service provided. What the service could do better The service could improve the system of supervision and appraisal and how staff are involved in the service. The service could review staff training and development to ensure that staff have the opportunity to further develop their skills. The service could improve how it involves carers in the running of the service. The service could improve how it keeps up to date with the latest developments and initiatives in the care sector. What the service has done since the last inspection The service has made some progress to address the recommendations and requirements from the last inspection.however, some recommendations and requirements remain outstanding. The service has developed opportunities for people using the service to be involved in their care and support, the service has collated this information and taken action where necessary to resolve any issues. The service has introduced new personal support plans for service users, these contain good detail and people using the Real Care Agency, page 3 of 32

4 service had been involved in developing these.regular supervision was taking place and attendance at staff meetings had improved. Conclusion We saw that the service provides people with good quality care and support. People using the service stated that they were happy with the support provided and felt that care staff met their needs well. The provider needs to take appropriate action to address the issues discussed during the inspection and address the recommendations made in this report if the service is to maintain the grades currently awarded. Real Care Agency, page 4 of 32

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 The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. You can find the most up-to-date grades for this service by visiting our website, by calling us on or visiting one of our offices. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Real Care agency is a service, which provides care at home, and housing support services to people who live in their own homes. The service supports people who have a wide range of support needs. The service aims "to provide high quality care to help support people who live at home for as long as possible and is their wish to do so". 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 5 - Very Good Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Real Care Agency, page 5 of 32

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. Real Care Agency, page 6 of 32

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 one Inspector. The inspection took place on Monday 23 June 2014 between 9.45 am and We gave feedback to the manager on 23 June As part of the inspection, we took account of the completed annual return that we asked the provider to complete and submit to us. We sent 50 care standards questionnaires to the manager to distribute to service users and relatives.five service users and six relatives sent us completed questionnaires. We also asked the manager to give out 24 questionnaires to staff and we received five completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: the manager the office manager We looked at: care plans home visit questionnaire staff files training records staff supervision records service user survey summary client feedback summary training matrix Real Care Agency, page 7 of 32

8 training programme training plan staff meeting minutes service user home visit form service user handbook participation strategy contact response form statement of purpose staff supervision policy risk assessments complaints procedure registration certificate employers liability insurance 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 Real Care Agency, page 8 of 32

9 What the service has done to meet any recommendations we made at our last inspection See comments on outstanding recommendations under relevant Quality Theme and Statements. 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 service provider had completed this and with the relevant information they had given us for each of headings that we grade them under. The provider identified what they thought they did well, some areas for development and any changes it had planned. The service 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 We received five completed Care Standard Questionnaires before the inspection. We did not receive any comments from the completed questionnaires. All the respondents strongly agreed or agreed that overall they were happy with the quality of care and support they received from this service. One service user said they did not know about the services complaints procedure and did not know they could also make a complaint to the Care Inspectorate. No other issues were raised in the returned questionnaires. Real Care Agency, page 9 of 32

10 Taking carers' views into account We received six completed Care Standard Questionnaires before the inspection. All the respondents strongly agreed or agreed that overall they were happy with the quality of care and support they received from this service. We received the following comments from completed questionnaires:- 'Both the carers who work with my relative do a great job with him. My relative has built up a great bond with them and enjoys the time they spend together and my relative trust them completely.that is big thing for my relative.since working with these carers he has shown more progress.it shows how well getting the cares involved has helped us both.i am also a lot more calmer due to the few hours of respite per week'. ' I have first class care,always prompt and treated with respect'. ' More than happy with the care and support given by this service. Thank you'. ' My relative is happy with the care and support received'. Inspection report continued ' Double care is not quite as personal as carers can sometimes talk between themselves rather than to service user. Also work is done quicker and less time is spent with service user'. One relative said they did not not know they could make a complaint to the Care Inspectorate. Another relative said the service did not check regularly that they were meeting their needs and also said the service does not ask their opinion on how it can improve. Real Care Agency, page 10 of 32

11 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths From the evidence we were presented with we concluded that the service was performing at a very good level in areas covered by this statement. The service ensured that service users and carers participated in all aspects of the service. We looked at care plans, in-house summary of questionnaires, participation strategy,returned Care Inspectorate questionnaires,policies and procedures, discussions with the manager and office manager to assess this statement. This statement will include evidence for Quality Statements 2.1, 3.1, and 4.1. Real Care have a number of policies and initiatives which enable service users to participate in the evaluation and development of their services. the organisation has a Participation policy which states that service users and carers should be consulted in all decisions affecting them. We saw good evidence that the organisation values service user and carer participation; we saw that the service had evaluated questionnaires issued in 2014, where they received 26 completed questionnaires from 71 which were issued,form the Real Care Agency, page 11 of 32

12 information we saw all the respondents indicated were happy with the service; we found a very good analysis of the completed questionnaires with details of any issues or concerns raised and we also saw detailed information on the action the service had taken to resolve any concerns; this complemented our own questionnaires which all indicated that service users and their carers were happy with the quality of care and support they received; we found that the care plans contained detailed and informative information on service users likes and dislikes and accurately described how care should be carried out. We thought that the way in which care plans were written and carried out generally contributed to service users quality of life; we saw very good evidence of service users being involved in decisions. e.g. service users were able to influence the times of when care was delivered; we found at this inspection that two service users have agreed to become involved in the recruitment of staff. Areas for improvement The provider should continue to monitor and maintain the very good quality of participation. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. We said previously that the number of people responding to in 'Client Feedback Summary' was relatively small when compared to total number of people who use the service. At this inspection twenty six out of a total of seventy one service users completed an in-house questionnaire. We said previously that the manager was still exploring ways to improve service user and carer involvement. We discussed ways of improving service user involvement and made the following suggestions:- improving the number of respondents to in-house and care inspectorate questionnaires by staff sitting down with service users and completing them on their behalf.improving the quality and detail of the information recorded in 'Field Supervisor Home Visits' and developing service user and relatives meetings. We also suggested the manager set up a programme of visits to all service users homes to get a first hand account of service users views and opinions. Real Care Agency, page 12 of 32

13 We thought that there was still areas where the involvement of service users could be further developed. We found that the service had accessed the publications,'the National Standards for Community Engagement and the Ladder of Participation' as previously signposted for information and guidance. However,it was not clear how the information contained in these publications was being used to inform and improve service users participation. This recommendation was not met and is re-stated. (see Recommendation 1) We previously made a recommendation in relation to service users becoming involved in the recruitment process. The manager has tried to involve service users in the recruitment process with limited success,however,we found at this inspection that two service users have agreed to become involved. This recommendation has been met and will be removed. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should develop the range of ways in which they involve the people who use the service and their carers in all aspects of the service which takes into account all the quality themes and statements. (National Care Standards, Care at Home, Standard 4 Management and Staffing). Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths From the evidence we were presented with we concluded that the service was performing at a good level in areas covered by this statement Real Care Agency, page 13 of 32

14 The service generally met the health and welfare needs of service users. We found the service was delivering good quality care resulting in good outcomes for people using the service. people using the service had good support plans that identified a range of care needs; we found that care plans generally reflected individual needs; we saw detailed and informative risk assessments which informed staff on the tasks to be carried out how; we thought that some elements of the car plan were written in a person centred way e.g. 'service user will let you know if she wants to eat in the living room or the kitchen'; we saw good evidence that staff received training in e.g. Moving and Handling, Food Hygiene, dementia and administration of medication; we saw good evidence that advice and assistance continued to be obtained from the community medical and nursing services, as required e.g. Community Nurse,G.P.; the manager is an accredited Moving and Handling trainer. Areas for improvement The provider should continue to monitor and maintain the 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 made a requirement at the last inspection that care plans must be reviewed every six months. We saw a spreadsheet indicating when reviews had taken place and planned dates for reviews going forward. We are satisfied that this requirement has been met and will removed. We found some of the language used in the documents we saw was not person centred e.g.' take into the toilet for a pad change'. This was discussed with the manager during the inspection. ( see Recommendation 1) Real Care Agency, page 14 of 32

15 There was no information in the care plans we looked of the legal status of service users. ( see Requirement 1 ) We signposted the service to the web site to access 'Preventing Infection in Care at Home' for information and guidance. Grade awarded for this statement: 4 - Good Number of requirements: 2 Number of recommendations: 1 Requirements 1. The provider must ensure that where decisions are being made on service users behalf that the person making that decision has legal authority to do so and this is appropriately recorded. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) - a requirement for a provider to make proper provision for the health and welfare of service users; Timescale for Implementation:The provider must do this within 6 months of the publication of this report. National Care Standards care at home Standard 9:Private life and Standard 11:Expressing your views, has been taken into account when making this requirement. Recommendations 1. The provider should ensure that all the language used in care plans is written in a person centered way. ( National Care Standards Care at Home for Standard 3: Your personal plan,standard 5: Management and staffing,standard 9:Private life,standard 11:Expressing your views ). Statement 6 People who use, or would like to use the service, and those who are ceasing the service, are fully informed as to what the service provides. Service strengths This statement focuses on progress made to address recommendations from previous inspections and the information below is included for clarity. We found that this service was performing well in the areas covered by this statement. We concluded this after we: Real Care Agency, page 15 of 32

16 spoke to the manager; the office manager; examined completed questionnaires;and reviewed the information given to people who use the service and their carers; The care service informs the people who use the service and their relatives and carers as to what the service provides in several ways. These included: the service user agreement which included detailed information on the services aims and objectives,code of values,service users rights, tasks that care workers will and will not carry out; the agreement included a timetable of when and on what days care would be provided; we saw that the service user agreement was signed by the service user and by Real Care; we saw a sheet with details of Real Care charges; a client handbook which included detailed information on confidentiality, recruitment, personal finances and key holding, withdrawal of service and how to complain, including the name, address and telephone number of the Care Inspectorate; we saw appropriate policies for managing risk and recording accidents and incidents; we saw the information included contact telephone numbers for the service. Areas for improvement The service is maintaining current very good standards and continuing to improve. They should ensure they are rigorous in identifying any areas for improvement and implementing action plans to address these. We made a recommendation at a previous inspection in relation to the information that we saw did not include the latest inspection report from the Care Inspectorate. We saw at this inspection that the latest Care Inspectorate Inspection Report was included in the information pack. Real Care Agency, page 16 of 32

17 This recommendation is met and will be removed. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Real Care Agency, page 17 of 32

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 See comments under Quality Theme 1.1. Areas for improvement See comments under Quality Theme 1.1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths From the evidence we were presented with we concluded that the service was performing at a very good level in areas covered by this statement. The service have a professional, trained and motivated workforce. from the staff questionnaires returned all of the staff said they have sufficient training to do their job e.g. adult protection,first aid, food hygiene,peg feeding and principles of dementia.staff said, ' I have been given all the training I have asked for'.' Training is offered continually '. Real Care Agency, page 18 of 32

19 We saw that staff had regular supervision and this was recorded. We thought that the records we saw contained limited care practice information; we saw that the service had a 'Training and Development Policy'. We saw that some staff had obtained a Scottish Vocational Qualification (SVQ) level II and/or III in Health and Social Care; we saw very good questionnaires completed by staff who had attended training to check understanding and learning e.g. infection control,dementia, food hygiene etc. we saw that copies of training certificates were in staff files; we saw that staff had an individual record of training and an individual training plan in place; staff were aware of whistleblowing,confidentiality and adult protection; staff were familiar with the national care standards and the Scottish Social Services Council (SSSC) codes of practice; we saw that a rolling programme was in place for staff to achieve an SVQ Level II in Health and Social Care, equivalent or above; staff said in Care Inspectorate questionnaires that they had access to training opportunities in the last 12 months and that their training needs were being met. We received the following comment in the completed care inspectorate questionnaires:- 'All compulsory courses offered and many more which are related to a few clients plus others as we can request information on problems we may or have come across'. Areas for improvement The provider should continue to monitor and maintain the very good quality of staff. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. We did not see any annual appraisals in place. We were shown a new ' Appraisal Review and Personal Development Plan' by the manager,however, this has not yet been rolled out. This recommendation is not met and is restated ( see Recommendation 1 ) Inspection report continued The staff files that we saw had an individual training plan,individual personal development plan and had copies of all certificates of training attended. Real Care Agency, page 19 of 32

20 This recommendation is met and will be removed. We made a recommendation at previous inspections that staff should have the opportunity to gain qualifications appropriate to their role as set out by the Scottish Social Services Council ( SSSC ). A significant number of staff do not have a suitable qualification in care.e.g. SVQ Level II/III in care. We found that eleven staff currently hold a qualification to register with SSSC in Three staff are currently completing a qualification and we saw plans for a further five staff to begin this training up to December 2015.The manager plans to undertake SVQ 4 in Management starting in August We saw plans for staff to achieve SVQ qualifications up to December 2015.If the opportunities for staff to obtain a qualification continue at the rate of five a year the service will have approximately 35 out of 54 staff with a qualification to register with SSSC by the end of The manager advised that the availability of SVQ training was limited due to a lack of funding and the numbers proposed was all the service could afford to put forward to achieve SVQ. We were informed that the service had identified an external training provider to undertake SVQ training. We were advised that the staff with the longest service would be put forward first to obtain an SVQ qualification. We did not see any evidence that decisions as to who should be put forward for SVQ training was being made on the basis of individual staffs personal development needs. We are satisfied that the service is doing all it can within the financial limits of the business to provide staff with an opportunity to obtain a qualification to register with SSSC. This recommendation is met and will be removed. We did not see any evidence of training courses attended being discussed and evaluated in supervision with staff to establish if training was effective and had led to a positive impact on service users quality of life. We thought the service would benefit from implementing 'reflective practice' as part of the supervision and appraisal system as detailed in the Scottish Social Services Council (SSSC) publication,'the Framework for Continuous Learning in Social Services' This was still the case. No progress has been made to develop the framework for continuous learning. We signposted the service to the Scottish Social Services Council (SSSC) publication, 'The Framework for Continuous Learning in Social Services' for information and guidance. Real Care Agency, page 20 of 32

21 The benefits of developing and implementing the 'framework' were discussed during the inspection to support staff to maintain their registration with SSSC. We suggested the service contact SSSC to seek advice on the implementation of 'The Framework for Continuous Learning in Social Services'. Following the inspection the manager has written to SSSC for advice and guidance on how to develop and implement the 'framework'. This recommendation has not been met and is restated. ( see Recommendation 2 ) We signposted the service to the Care Inspectorate web site 'The Hub' which provides a 'one-stop-shop' for knowledge, innovation and improvement We signposted the service to the The Knowledge Network, Scottish Social Services Council and NHS Education for Scotland for 'Promoting Excellence'- the education framework for all social services staff working with people with dementia for information and guidance We signposted the service to Social Services Knowledge Scotland for information and guidance. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The manager should ensure that annual appraisals take place for all staff. (National Care Standards, Care at home - Standard 4: Management and Staffing Arrangements,National Care Standards, Housing Support Services - Standard 3: Management and Staffing Arrangements) 2. The provider should evaluate in staff supervision how effective staff training is in improving the quality of life for service users'. The provider should implement the guidance in relation to 'reflective practice' as part of the supervision and appraisal system as detailed in the Scottish Social Services Council (SSSC) publication,'the Framework for Continuous Learning in Social Services'. (National Care Standards - Care at Home; Standard 4: Management and Staffing) Real Care Agency, page 21 of 32

22 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths See comments under Quality Theme 1.1. Areas for improvement See comments under Quality Theme 1.1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths This statement focuses on progress made to address recommendations from previous inspections and the information below is included for clarity. We found this service was performing at a good level in the areas covered by this statement. We concluded this after we: saw some evidence of regular staff meetings taking place with good evidence of staff being able to raise issues for example service user issues; we saw that attendance at staff meetings had improved; the manager has made a start in developing ways in which staff can influence the service through staff meetings; staff indicated that they had access to and received suitable training to do their job; we saw that the service has a supervision procedure in place; Real Care Agency, page 22 of 32

23 staff indicated that management were approachable and they were able to raise any issues or concerns that they had.they said they were confident in management and they addressed any issues raised. Areas for improvement The service is maintaining good standards. The care service should continue to monitor and maintain the standards of quality. They should ensure they are rigorous in identifying any areas for improvement and implementing action plans to address these. We made two recommendations at previous inspections. This was discussed at some length during previous inspections and the manager acknowledged the importance of addressing the outstanding recommendations and has made a firm commitment to do so. We saw at this inspection that limited progress had been made to address the recommendations. We saw at this inspection that attendance at staff meetings had improved,however,the number of staff attending meetings was still below 50%. Staff questionnaires had not been developed. The manager said at this inspection that he thought this was a good idea. This was again discussed at some length during the inspection. We discussed what was management expectations of staff to attend meetings and the SSSC Code of Practice in terms of responsibility. This recommendation is not met and is re-stated (see Recommendation 1) It was not clear how staff were keeping up to date with developments in the care sector. We thought it was good that the service had developed a library which contained good reference documents and DVD's covering various topics e.g. dementia, Parkinson's and epilepsy etc. It was not clear if staff were using the library and there was no information on what staff had learned from using the resource. We signposted the provider to the Social Services Knowledge Scotland website for information and guidance, Real Care Agency, page 23 of 32

24 We signposted the service to the Care Inspectorate web site 'The Hub' which provides a 'one-stop-shop' for knowledge, innovation and improvement This recommendation is not met and is restated. (see Recommendation 2) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The manager should encourage all care staff to attend staff meetings. The service should develop ways to involve staff in the management of the service, for example, staff questionnaires. (National Care Standards, Care at Home, Standard 4 Management and Staffing) 2. The manager should ensure that staff keep up to date with developments in the care sector. (National Care Standards, Care at Home, Standard 4 Management and Staffing) Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths This statement focuses on progress made to address recommendations from previous inspections and the information below is included for clarity. The service was found to be performing at a good standard in this quality statement. We concluded this after: Inspection report continued we saw that staff received thorough induction training which included SSSC codes of practice, working with dementia handbook, the home care workers handbook, emergency first aid and food hygiene handbook; we saw that staff received an induction pack and this was signed by staff to confirm they had read and understood the services policies and procedures; we saw that the service carried out regular spot checks and these were recorded; we saw that staff were skilled in carrying out their duties; Real Care Agency, page 24 of 32

25 staff indicated that they had access to the services policies and procedures and to training opportunities; we saw that the service had clear information on the training staff had received; we saw that staff had a copy of SSSC Codes of Practice; we saw that the service has a supervision procedure in place and supervision had now taken place for the majority of care staff; the majority of staff indicated that their training needs were being met by the service. Areas for improvement The service is maintaining good standards. The care service should continue to monitor and maintain the standards of quality. They should ensure they are rigorous in identifying any areas for improvement and implementing action plans to address these. The implementation of the recommendations made under Quality Theme 3.3 and 4.2 will strengthen performance in this statement. One recommendation was made at a previous inspection. This was discussed at previous inspections and the manager shared some of his ideas to address this recommendation. We thought it was good that the service had developed a library which contained good reference documents and DVD's covering various topics e.g. dementia, Parkinson's and epilepsy etc. It was not clear if staff were using the library and there was no information on what staff had learned from using the resource. The service did not have a culture which encouraged staff to develop and learn. Staff were not proactive in their own individual development, as detailed in the SSSC Codes of Practice for employers and employees. We signposted the provider to the Social Services Knowledge Scotland website for information and guidance, We signposted the service to the Care Inspectorate web site 'The Hub' which provides a 'one-stop-shop' for knowledge, innovation and improvement This recommendation was not met and is restated. (see Recommendation 1) Real Care Agency, page 25 of 32

26 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should promote leadership values throughout the workforce as detailed in SSSC codes of practice. (National Care Standards, Care at Home, Standard 4 Management and Staffing) SSSC Codes of Practice Employers of Social Services Workers : Training and Development. SSSC Codes of Practice Social Service Workers : Improving Knowledge and Skills. 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 Inspection report continued From the evidence we were presented with we concluded that the service was performing at a good level in areas covered by this statement We found this service was performing at a good level in the areas covered by this statement. We concluded this after we saw: The Manager was now aware of the services responsibility to report to Scottish Social Services Council (SSSC) any staff dismissed on the grounds of misconduct; The Manager was also aware that the service must provide SSSC information it may require about members of staff; we saw that the service had copies of the Care Inspectorate Notification Guidance and the Manager knew of her responsibility to notify the Care Inspectorate of matters of misconduct including theft; the service obtained feedback from service users, carers, staff and other stakeholders through questionnaires and visits; we saw that regular meetings were held with staff and these were minuted; we saw that relative/carers questionnaires had been issued; Staff said they received regular supervision and this was recorded; Staff participated in regular training; Real Care Agency, page 26 of 32

27 we saw that the service had an appropriate complaints procedure which complied with current legislation; the service had a process to advise service users if their were any changes to their care package. Areas for improvement The care service should continue to monitor and maintain the standards of quality. They should ensure they are rigorous in identifying any areas for improvement and implementing action plans to address these. How staff, service users, carers and other stakeholders are involved in assessing the quality of the service could be further developed. We saw limited progress on how staff, service users, carers and other stakeholders views were sought to inform improvement in the quality of the service. This recommendation is not met and is restated (see Recommendation 1) We made a recommendation at the last inspection that the service could improve how it records what action it has taken to address concerns raised. We found that the service was now recording the action it has taken as a result of issues/concerns raised. This recommendation has been met and will be removed. (see Recommendation 2) We made a requirement at the last inspection in relation to the timescale to resolve complaints. We saw that the complaints procedure had been updated to reflect current legislation. This requirement has been met and will be removed. The inspector stressed the importance to the manager of addressing the recommendations made throughout the report as some recommendations have been repeated over several inspections and the lack of progress is a cause of concern. The manager has made a committment to address the issues and recommendations discussed and reported on at this inspection and we expect to see significant progress being made at the next inspection. Real Care Agency, page 27 of 32

28 We suggested the manager draft a development plan to identify how the service plans to take these matters forward. ( see Recommendation 2 ) We signposted the service to the Care Inspectorate web site to access the updated ' Records that all registered care services must keep and guidance on notification reporting'. The provider should check the above guidance to ensure that all pertinent notifications are being made to the Care Inspectorate. The inspector was advised of a couple of matters of which the Care Inspectorate may require to be notified. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The provider should develop ways to demonstrate that staff, service users, carers and other stakeholders are involved in the quality assurance process and identify issues which are raised and how these are addressed. (National Care Standards, Care at Home - Standard 11: Expressing Your Views, National Care Standards, Housing Support Services - Standard 8: Expressing Your Views) 2. The provider should draft a 'development plan' to demonstrate how the service intends to take forward the issues discussed throughout this inspection. (National Care Standards, Care at Home, Standard 4 Management and Staffing) Real Care Agency, page 28 of 32

29 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). Real Care Agency, page 29 of 32

30 5 Summary of grades Quality of Care and Support Good Statement 1 Statement 3 Statement Very Good 4 - Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Good Statement 1 Statement 2 Statement 3 Statement Very Good 4 - Good 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 24 Aug 2012 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 21 Jul 2011 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 5 Nov 2010 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 15 Sep 2009 Announced Care and support 4 - Good Staffing 3 - Adequate Real Care Agency, page 30 of 32

31 Management and Leadership 4 - Good 28 Nov 2008 Announced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Real Care Agency, page 31 of 32

32 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: Real Care Agency, page 32 of 32