Phoenix Therapy and Care Ltd - Care at Home Support Service Care at Home 1 Lodge Street Haddington EH41 3DX Telephone:

Transcription

1 Phoenix Therapy and Care Ltd - Care at Home Support Service Care at Home 1 Lodge Street Haddington EH41 3DX Telephone: Inspected by: Michelle Deans Type of inspection: Announced (Short Notice) Inspection completed on: 16 September 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 27 5 Summary of grades 28 6 Inspection and grading history 28 Service provided by: Phoenix Therapy and Care Ltd. Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Michelle Deans Telephone enquiries@careinspectorate.com Phoenix Therapy and Care Ltd - Care at Home, page 2 of 30

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 Phoenix Therapy and Care Ltd have continued to provide individually tailored services to meet the specific needs of the people they supported. This included a dedicated staff team for each service user. As part of the day to day running of the service, service users/and /or their parents/ carers were involved in decisions about their support. Specifically the service provided a high standard of direct care to service users with complex medical needs. What the service could do better The manager and case managers should continue to develop and review the documentation used in the service. This would include the format for personal plans, the medication policy and records of review. What the service has done since the last inspection Since the last inspection the provider has recruited a permanent manager for the service. The manager has a background in both home care and in nursing and has brought a range of experience to the post. This has been of benefit and clear improvements have been made since the previous inspection in terms of audits, quality assurance systems and documentation. Phoenix Therapy and Care Ltd - Care at Home, page 3 of 30

4 Conclusion Inspection report continued Phoenix Therapy and Care Ltd provided individualised support to each service user based on their needs and preferences. There was ongoing consultation with the service users/family/carers about the support and how it is delivered. Feedback from two relatives and two service users we spoke with was that the direct care given by the staff teams could not be improved upon and felt the quality of staff support was very good. Who did this inspection Michelle Deans Phoenix Therapy and Care Ltd - Care at Home, page 4 of 30

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. Phoenix Therapy and Care Ltd is a Care at Home service operating from Haddington, East Lothian. The company Phoenix Therapy and Care Ltd was acquired by Care Tech Ltd in However, as this was through share acquisition, the provider legally remains Phoenix Therapy and Care Ltd. The service provides a homecare service to clients in their own homes. At the time of inspection the agency provided support to five service users in their own homes throughout Scotland. Generally service users had complex packages of care which were provided by the agency. The agency employs a case manager and senior support workers to oversee the care on a day to day basis. Some service users were children who were living in the family home and supported by their parents. The service's aims and objectives state that "we aim to provide our clients with a Phoenix Therapy and Care Ltd - Care at Home, page 5 of 30

6 comprehensive service of the highest quality. We strive to offer a flexible, efficient and professional service which is tailored to meet each person's individual needs." 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 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. Phoenix Therapy and Care Ltd - Care at Home, page 6 of 30

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 Inspector Michelle Deans visited the office base of the service and carried out the inspection on 16/09/2013 between the hours of 9.30am and 2.30pm. During inspection evidence was gathered from a number of sources including Quality assurance documentation Staff training records Staff supervision and induction records Policies and procedures, including the medication policy Four service users' personal plans and associated health guidance Audits of records Four service user's daily notes As part of the inspection questionnaires were sent out to all six service users and their families, five were returned, all were anonymous. The manager was asked to contact all service users or their relatives/carers prior to the inspection to give the opportunity for them to share their views with us. We spoke with one service user and one relative by phone and met with one service user and their mother in their family home. 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 Phoenix Therapy and Care Ltd - Care at Home, page 7 of 30

8 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 Phoenix Therapy and Care Ltd - Care at Home, page 8 of 30

9 What the service has done to meet any requirements we made at our last inspection The requirement The provider is required to ensure that an appropriate medication policy is in place and that there are systems in place to support the medication policy. This includes: (i) A medication policy that gives clear instruction to staff on the different levels of administration (ii) Detailed risk assessment where any service users should be assessed as requiring any level of support with medication (iii) Staff training on how medication should be detailed within personal plans and recorded to reflect the level of identified support. This is in order to comply with Scottish Statutory Instrument No 210 Regulation 15(b)(i) a Regulation relating to staff training. Account should also be taken of National Care Standards - care at home Standard 4, Management and staffing arrangements and Standard 7, Keeping well - healthcare. Timescale for implementation: to commence on receipt of this report and be completed within 8 weeks. What the service did to meet the requirement A revised medication policy had been written and all staff had received refresher training on medication. A new risk assessment document was in place which detailed the help required with medication. However further work needed to be considered on the levels of support detailed within the medication policy, we have therefore made a recommendation about this which can be found under statement 1.3, theme 1. The requirement is: Met - Within Timescales The requirement The system to monitor the competency of staff must be reviewed so that training given to staff can be assessed as meeting the individual needs of the service users. To do so there must be written records of competency which link practice (including observed practice) to the assessment framework and to the individually assessed needs of the service users. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) and (b) - a requirement relating to health and welfare of service users and Regulation 15(b)(i) a Phoenix Therapy and Care Ltd - Care at Home, page 9 of 30

10 requirement relating to staff training. Scottish Social Services Council - Codes of Practice, in particular the Code of Practice for Social Service Workers, in particular paragraph 6.1 and 6.2, accountability of a social service worker should also be taken into account. Timescale for implementation: to commence on receipt of this report and be completed within 8 weeks. What the service did to meet the requirement We saw that competency records were now in place and completed which linked into staff supervision and training and where issues had been identified then action was taken to retrain or offer support to staff. The requirement is: Met - Within Timescales Inspection report continued The requirement The provider must ensure that personal plans clearly describe any specific health needs and how these needs will be met. This is in order to comply with SSI 2011/210 Regulation 4(1) (a) - a regulation regarding the welfare of users and SSI 2011/210 5 (2) (a) and (b), Personal Plans. Account should also be taken of National Care Standards, Care at Home, Standard 3, Your personal plan. Time scale: to commence on receipt of this report and be completed within 4 weeks. What the service did to meet the requirement We saw that all personal plans we sampled had detailed information in them on healthcare tasks, however we found there could be further development of the plans and have made a recommendation about this under statement 1.3, theme 1 The requirement is: Met - Within Timescales The requirement The provider must continue to develop the quality assurance system to ensure that all aspects of the service are improved. In order to do this the provider must (i) Have clear guidance for staff on timescales for audits and the content of these. (ii) Clearly record what required action has been identified as a result of an audit, (ii) Ensure that staff undertaking audits within the service receive appropriate training detailing the expectation of the audit, how to monitor outcomes and record follow up to the actions implemented to make improvements. Phoenix Therapy and Care Ltd - Care at Home, page 10 of 30

11 This is in order to comply with SSI 2011/210 Regulation 4 - Welfare of users and takes account of the National Care Standards Care at Home Standard 4 - Management and staffing arrangements. Timescale for implementation: to commence on receipt of this report and be completed within 8 weeks. What the service did to meet the requirement Inspection report continued We could see that an improved audit system had been introduced for the service and at the point of inspection there was a continuous plan in place to make improvements. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection We made four recommendations at the last inspection, all of which are discussed in the body of this report under the relevant themes 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. We received a fully completed self assessment document from the manager. The manager identified areas they thought they did well, some areas for development and information under each statement to describe the service's strengths. Taking the views of people using the care service into account As part of the inspection questionnaires were sent out to all six service users and their families, five were returned, all five were anonymous. The manager was asked to contact all service users or their relatives/carers prior to the inspection to give the opportunity for them to share their views with us. We spoke with one service user and met with one service user and their mother in their family home. Phoenix Therapy and Care Ltd - Care at Home, page 11 of 30

12 Both service users felt they had a very good staff team supporting them and were happy with the support. As part of the inspection questionnaires were sent out to all five service users or relatives/carers. One questionnaire was returned from a service user. They indicated they were happy with the service provided. Taking carers' views into account We spoke with one relative by phone and met with one service user and their mother in their family home. Both relatives thought the direct care was very good and felt they were involved fully in day to day decisions about support. One relative who had been involved in the service for a number of years felt the new manager would be a positive benefit for the service, saying that there had been communication issues in the past with the provider due to the varied locations of the services. However since meeting the manager they thought this would improve and steps had already been introduced to improve communication. As part of the inspection questionnaires were sent out to all five service users or relatives/carers. Four questionnaires were returned from relatives on service user's behalf. All indicated they were happy with the service provided. Phoenix Therapy and Care Ltd - Care at Home, page 12 of 30

13 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 The service provided very good opportunities for service users and families to participate in assessing and improving the standard of care and support. Each package of support was individually set up to meet the specific needs of the service users. This meant that service users and their families had an opportunity to be involved in the recruitment of staff, care planning, training and team meetings. Individual allocated teams supported each service user which allowed parents/carers and service users to discuss any issues they may have with the direct care staff. Questionnaires had been sent out in May 2013 to all service users or their parents/ carers to ask their opinions of the service provided. The questionnaires included questions on the quality of staff, support and the service provided. The manager said she planned to send these out twice a year. The questionnaires returned showed that all families and service users were happy with their support. We saw that the outcomes of the questionnaires had been collated and the general feedback had been sent out in a newsletter to service users and families. The newsletter also gave information on how the questionnaires were used to link into audits for the service to ensure expected standards were being met. We also saw that when improvements had been identified through the quality assurance systems such as questionnaires, reviews, discussion with families and service users that there was an action plan with specific timescales in place to meet the improvements identified. Phoenix Therapy and Care Ltd - Care at Home, page 13 of 30

14 The service users and their families were asked to comment on areas for development under each of the quality themes we inspect upon, care and support, management and staffing and management and leadership. Where any comments were returned these would link into the self-assessment we request as part of the inspection. The service had a participation strategy which detailed their systems for gathering views of service users and their relatives. A service user involvement policy was also in place which reflected the National Standards for Community Engagement. This would be used as a tool to audit the success of the current quality assurance system. The service user guide which was given to everyone at the start of their service with Phoenix Therapy and Care Ltd also included a section detailing how to make comments or suggestions about the service provided. The service provided clients with information about how to contact an independent advocacy service and how to make a complaint. All service users had continuous reviews of support through meetings with the case manager, team leader or senior support worker which gave the opportunity to comment on the service provided. Feedback from the people we spoke with was that they were very confident that any areas they discussed as needing improved upon would be listened to and actioned. All felt they were at the heart of the service and fully involved in the day to day decisions about support. Areas for improvement At the previous inspection the manager discussed the service was in the process of developing a website which will give service users and relatives information on organisational changes, future plans and would also ask for comments on improvements which could be made at an organisational level. This was still a work in progress and given the diversity of locations of the service users in Scotland we thought this would be beneficial to share information about the provider and organisational developments. We will follow this up at the next inspection. We discussed with the manager that the guide given to prospective service users about the service needed a small adjustment to say that complaints could be made directly to the Care Inspectorate without first using the provider's complaint procedure. The complaints policy did say this however this had not been transferred accurately to the guide. The manager agreed to update the guide to reflect the complaints policy and re issue this section to service users. Three recommendations were made at the previous inspection Inspection report continued 1. Further development of the quality assurance system would be of benefit to link Phoenix Therapy and Care Ltd - Care at Home, page 14 of 30

15 questionnaires and organisational reviews into overall quality outcomes, to feedback to service users and their families. Feedback to people who use the service should be specific to the developments and improvements made by Phoenix Therapy and Care Ltd. National Care Standards, Care at Home, standard 11, Expressing your views. We saw that an improved quality assurance system was now in place which linked all areas of improvement into an overall plan which was monitored by the manager. The plan had timescales for the improvements and now that newsletters had been introduced for service users and their families this gave a forum to share outcomes and discuss improvements to be made. The manager had in place an effective system to evaluate, monitor and feedback outcomes. 2. Where quality assurance exercises result in feedback from service users and /or their families that there are specific areas to improve upon, this should result in an action plan to improve the quality of the service provided. The action plan should be shared with the service user and their families and become part of the overall quality improvement plan for the service. National Care Standards, Care at Home, standard 11, Expressing your views. There was a clear improvement plan in place as an outcome of the returned quality assurance questionnaires and audits for the service. The action plan for improvements was shared with service users and their families through the newsletters which were sent out twice a year following the return of the questionnaires. 3. There should be clear evidence of who was involved in the review of individual personal plans and how decisions were made to update information within them. National Care Standards, Care at Home, standard 3, Your personal plan. Whilst we saw that service users had reviews of their personal plans as and when needed and as a minimum of six monthly, there were no records to show what discussion had taken place or who was involved in the review. Although we could see there was a document review format for all updated documents to show changes made and who had requested these, we still found a gap in records about a specific 6 monthly review of personal plans. We could see that reviews of information in the plans were updated as changes happened and that there was a planned timescale for the review of the plans however records should show who was involved in the discussion, what was discussed and why the plan was to be updated. We did see this in some case management notes but a more consistent approach to records of discussion at review should be undertaken. We had therefore carried the recommendation made previously forward. (See recommendation 1) Phoenix Therapy and Care Ltd - Care at Home, page 15 of 30

16 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. There should be clear evidence of who was involved in the review of individual personal plans and how decisions were made to update information within them. National Care Standards, Care at Home, standard 3, Your personal plan. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that there was good evidence to show that staff ensure that service user's health and wellbeing needs were being met. We looked at the personal plans of four service users with specific health needs. In the personal plans sampled there was detailed information on individuals health needs. This included advice and guidelines from relevant professionals such as the physiotherapist and GP. Most of the plans we looked at had detailed medical guidance as part of the complex nature of the support. This included guidance on body temperature changes, ventilation, tracheotomy care and guidance on medication. All personal plans were updated and reviewed a minimum of six monthly, however we saw that care plans were updated when there were any changes to the care and support of the individual service user. The care plans were working documents and reflected the complex needs of the service users. Each service user had a care plan in place which detailed the tasks care staff would be expected to carry out. Where the service user has had a spinal injury a full and comprehensive plan is in place which details the specific injury and how this affects the service user. At the initial stage of using the service, information on service users support needs were gathered through an assessment process. The case manager would meet with the prospective service user to discuss the service and what support could be offered. This ensured that the service was able to meet individual needs. Both the service users and family members, where appropriate were fully involved in this process. Each package of care was tailored to meet the needs of the service users and each service user had their own dedicated staff team to ensure consistency of support. Where service users had specific needs, staff were trained to ensure these needs Phoenix Therapy and Care Ltd - Care at Home, page 16 of 30

17 could be met. All staff as part of their induction and training had to undertake a series of competencies which were assessed by the trained nurse or case manager. The competencies included observed practice in healthcare tasks. Each service user had details of relevant training which staff would need to undertake as part of the daily support. We saw that this was individual to the service user. We also saw that this formed the training plan for the staff member for the coming year. This meant that staff would be trained on the individual needs of the service user as well as mandatory training in moving and handling, medication and infection control. Individual service users had a detailed training manual for staff specific to their needs. This included an explanation of their medical/health need, diagrams to help staff understand the health needs and potential issues they may encounter. We saw that a risk assessment had been introduced to assess what help the individual needed with regard to medication. We also saw details in the personal plan of medication and what it had been prescribed for. This allowed staff to have an understanding of prescribed medication especially since the majority of service users had complex health needs. Areas for improvement We made one recommendation at the previous inspection 1. Where gaps in practice have been identified through audits this should clearly link into an action plan for improvement and should be reflected in supervision records, team meeting minutes and the overall improvement plan for the service. National Care Standards, Care at Home, Standard 4, Management and Staffing We could see that areas for improvement had been discussed both in the staff newsletter and through team meeting minutes. We saw that improvements identified from audits of staff practice resulted in discussion with staff and in monitoring of actions taken. At the previous inspection we discussed that the medication policy should be clearer on the different levels of support with medication, from prompting to administration. We also made a requirement about the medication policy at the last inspection. We found that whilst the medication policy had been reviewed and updated further work should be done to identify the specific levels of help needed with medication and what this means for the staff teams in terms of record keeping. (See recommendation 1) We sampled Phoenix Therapy and Care Ltd's policy on Adult Support and Protection. Whilst the general content of the policy did reflect relevant guidance and legislation, the policy needed updated to include local authority guidance on reporting any issue Phoenix Therapy and Care Ltd - Care at Home, page 17 of 30

18 relevant under Adult Support and Protection. There was also some confusion within the policy on responsibilities under Adult Support and Protection and Whistle blowing. (See recommendation 2) Although we could see from looking at the personal plans that there was good detail in terms of health needs further work needs done to ensure that the plans give information on goals and preferences outwith healthcare, such as interests, hobbies etc. We did see some examples of this however there should be a more consistent approach to this. We also discussed that the format used differs for each person. (See recommendation 3) From looking at daily notes for four service users we saw some issues with regard to the recording of information. This included records not reflecting the agreed plan of care or staff supporting service users with topical medication when not part of the planned care. Whilst in all cases it was the service user who requested staff to do tasks we discussed that the records did not reflect this. The manager had completed an audit in the service with the case manager and found issues in terms of some areas of record keeping. This had been addressed though individual supervision and team meetings and had formed part of the improvement plan for the service. We will therefore follow this up at the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. The medication policy should clearly state the different levels of support available with regard to medication. The policy would also detail the records that staff would be expected to keep which reflected the assessed level of support. National Care Standards - care at home Standard 4, Management and staffing arrangements and Standard 7, Keeping well - healthcare. 2. The Adult Support and Protection policy should be reviewed to include relevant local authority guidance and best practice. National Care Standards - care at home Standard 4, Management and staffing arrangements 3. Further development of the personal plan format should be undertaken to ensure there is information on goals, interests and general preferences outwith specific health issues. Phoenix Therapy and Care Ltd - Care at Home, page 18 of 30

19 National Care Standards, Care at Home, Standard 3, Your personal plan. Phoenix Therapy and Care Ltd - Care at Home, page 19 of 30

20 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 We found there were very good opportunities for service users and families to participate in assessing and improving the quality of management in the service. Questionnaires sent out to relatives and service users reflected their opinion was sought in regard to the service provided. The questionnaires sent to service users also asked them to comment on staff practice. Staff were recruited specifically to provide care to individual service users. Service users and their families were involved in the recruitment of staff. All staff were asked to give signed permission to allow parents and service users to look at their applications. Relatives and service users were given the opportunity to be involved in training where appropriate, either to attend training sessions or to deliver training to staff. We also saw that as part of the supervision of staff, relatives and service users were asked to comment on the staff members practice. The manager had visited service users and their families to introduce themselves and to discuss any issues they may have had about the service. See comments under Theme 1, statement 1.1 which are also relevant to this statement. Areas for improvement See comments and recommendations under Theme 1, statement 1.1 which are also relevant to this statement. Phoenix Therapy and Care Ltd - Care at Home, page 20 of 30

21 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 Inspection report continued We found that the service had professional and motivated staff who worked to the National Care Standards. The care workers practice was supported by a range of policies and procedures. We sampled Phoenix Therapy and Care Ltd's policies and procedures and found these were used to underpin staff practice. Policies sampled included, Medication, Accident and Incident Reporting, Adult Support and Protection and Staff supervision and Development. All staff had been given training on all the policies and had also completed mandatory training such as Moving and Handling and Food Hygiene. When polices were updated all staff had to sign to say they had read and understood the revised policy. Each package of care was tailored to meet the needs of the service users and each service user had their own dedicated staff team to ensure consistency of support. Where service users had specific needs, staff were trained to ensure these needs could be met. All staff as part of their induction and training had to undertake a series of competencies which were assessed by the case manager, team leader or senior support worker. All staff were given an induction to the specific service they worked in and to Phoenix Therapy and Care Ltd. Induction included passing a series of competencies. Each individual staff member completed mandatory training and this was highlighted through a computer system of dates when refresher training was due. We saw a yearly training plan in place for all staff which reflected the individual needs of the service users they supported. All training was evaluated by the staff member as to if it was beneficial to them, should there be any comments for improvements to the training then this would be listened to and the training would be revised. Since the previous inspection a staff survey had been completed, this asked about training and what staff preferred, face to face training or e learning. As the outcomes was a mix of the two, both have been used based on the preferences of staff. All staff received an employee handbook which gave details of relevant policies, procedures and expectations of the staff member. Phoenix Therapy and Care Ltd - Care at Home, page 21 of 30

22 A staff newsletter had also been introduced since the previous inspection. This enabled information to be shared about developments, practice and outcomes of questionnaires. The newsletter was put in place as an outcome of the staff survey where staff felt communication could be improved. Team meetings were in place within each service, we sampled minutes from two meetings. These gave the opportunity for staff to raise any issues and discuss policy/ guidance. Team meetings were held monthly at a local venue near where the individual service users were supported. There were also monthly operations meetings for the office based staff. We saw that relevant policy and developments were discussed at all meetings as well as any practice issues. Staff were given three monthly supervision by either the case manager, team leader or senior support worker. We saw from sampling records that practice was discussed on an ongoing basis and where training had been identified as part of supervision or appraisal then we could see that this had either been planned or achieved. Areas for improvement Comments under areas of improvement for theme1 statement 1.3 are also relevant. At previous inspection it had been discussed that there was a programme in place for staff to achieve a relevant qualification to enable registration with the Scottish Social Service Council (SSSC). However this was yet to be fully introduced for staff. Whilst we could see all staff received relevant training to their posts and some staff did hold a qualification, a planned approach to all staff achieving a relevant qualification should be implemented. The manager said this had been discussed at an organisational level with the shareholding company Care Tech. Training would start to be rolled out as soon as funding could be secured and a relevant assessment centre involved for SVQ. (See recommendation 1) We found that the ratings for the competency framework within supervision was 1 to 4 and noted that there was some ambiguity within the rating scale. We saw that a rating of 3 stated good/adequate, which could be two quite different ratings. We also saw when this was used there was no reason as to why the rating was given in some cases. We discussed as an area for improvement thought should be given to a review of the grading scale. This was also discussed at the previous inspection. We will follow this up again at the next inspection. Phoenix Therapy and Care Ltd - Care at Home, page 22 of 30

23 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. A planned approach for all staff to achieve a relevant qualification within the agreed timescale with the SSSC should be implemented. National Care Standards, Care at Home, Standard 4, Management and Staffing Phoenix Therapy and Care Ltd - Care at Home, page 23 of 30

24 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 We found there were very good opportunities for service users and families to participate in assessing and improving the quality of management in the service. Questionnaires sent out to relatives and service users reflected their opinion was sought in regard to the service provided. Staff were recruited specifically to provide care to individual service users. The training reflected the needs of the individual service users. Relatives and service users were given the opportunity to be involved in training where appropriate, either to attend training sessions or to deliver training to staff. Senior care staff within each individual team liaises with the relatives and service users where appropriate on staff practice. Staff practice was observed as part of the day to day service and any issues could be discussed with either the senior care worker or the manager. See comments under Theme 1, statement 1.1 and Theme 3,statement 3.1 which are also relevant to this statement. Areas for improvement See under Theme 1 statement 1:1 and theme 3, statement 1.3 for further areas of improvement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Phoenix Therapy and Care Ltd - Care at Home, page 24 of 30

25 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 We found there were good opportunities for the involvement of service users, relatives, staff and stakeholders in assessing the service provided. The service had a participation strategy which detailed the systems for gathering views of service users and their relatives. A service user involvement policy was also in place which reflected the National Standards for Community Engagement. This would be used as a tool to audit the success of the current quality assurance system. All service packages had undertaken audits relevant to individual service needs; these could include equipment checks, cleaning audits and medication audits. We saw that some audits had been undertaken outwith the service staff such as the audit of clinical records. An external health and safety audit had been completed in 2012 and this included audits to ensure that staff were following health and safety guidance and risk assessment. Exit interviews were held for all staff when leaving the service. The exit interviews included a question about the quality of support from the direct line manager and any improvements which could be made in regard to job satisfaction. Service users and their relatives were involved in making day to day decisions about their service and were involved in all aspects of commenting on the direct support from staff. This also included involvement in staff training, supervision and recruitment. Since the last inspection both service users and family newsletters and staff newsletters have been introduced. This was as a direct result of quality assurance exercises where the outcomes were highlighted as improved communication within the service. We also saw that a revised quality assurance system had been put in place to enable audits to lead to improvements through a detailed action plan with set timescales. Since the last inspection a full audit had been completed by the manager and an improvement plan was in place which was regularly monitored by the manager. Monthly reports from the case manager and team leader would link into the monitored improvement plan. We also saw that when service users had raised concerns or complaints about the Phoenix Therapy and Care Ltd - Care at Home, page 25 of 30

26 service actions were taken to improve it. Service users and relatives felt there was an open and honest approach from the manager and staff in their support team should they raise any issues. See under theme1, statement 1.1, theme 3, statement 3.1 and theme 4, statement 4.1 for further strengths which are also relevant to this statement. Areas for improvement At the last inspection we made a requirement about the audit process and evaluating if improvements had been made as an outcome of these. We could see that an audit system had been introduced for the service and at the point of inspection there was a continuous plan in place to make improvements. However as this had only been completed in May 2013 it was too soon to evidence if the audits would lead to sustained improvements and outcomes. The manager could consider ways of gaining feedback from stakeholders in the service, for example relevant professionals who have contact with the service users and family members. We discussed with the manager that there could also be further development of the service user involvement policy. This could include more specific examples of how feedback was given as the outcome of audits and questionnaires relevant to the service. See under theme1, statement 1.1, theme 3, statement 3.1 and theme 4, statement 4.1 for further areas of improvement which are also relevant to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Phoenix Therapy and Care Ltd - Care at Home, page 26 of 30

27 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 None 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). Phoenix Therapy and Care Ltd - Care at Home, page 27 of 30

28 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Good Statement 1 Statement Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 5 Sep 2012 Unannounced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 27 Jun 2011 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 21 Jun 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 10 Feb 2010 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 31 Jul 2008 Announced Care and support 4 - Good Staffing 4 - Good Phoenix Therapy and Care Ltd - Care at Home, page 28 of 30

29 Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Phoenix Therapy and Care Ltd - Care at Home, page 29 of 30

30 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: Phoenix Therapy and Care Ltd - Care at Home, page 30 of 30