Avenue Care Services Support Service
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- Jean Cunningham
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1 Avenue Care Services Support Service Unit A Glenruthven Mill Abbey Road Auchterarder PH3 1DP Telephone: Type of inspection: Unannounced Inspection completed on: 10 October 2016 Service provided by: Avenue Scotland Ltd Service provider number: SP Care service number: CS
2 About the service Avenue Care Services was registered in June 2011 and is an independent provider of home care based in Auchterarder. Avenue Care Services is part of Avenue Scotland Recruitment and Consultancy agency which is based in Dunfermline. The service had piloted a palliative care service in Dundee with the local authority, and this had been extended to provide home care to other service user groups. The care division manager is based at the Auchterarder office along with the care manager, senior staff and administrative support staff who have responsibility for work scheduling. Avenue Care Services work is mainly contracted from Fife, Dundee and Perth & Kinross Councils. This means that some service users may have services from Avenue Care, their local council or other providers. The care service also uses a Dunfermline office as a base for the Fife staff where the team manager and support staff are based. The service currently provides support to around 300 clients in Perth and Kinross, Fife and Dundee. The aim of the service is to 'recognise the right of individuals to lead independent lifestyles within their own home, with the appropriate support services, where practicable'. This service registered with the Care Inspectorate on 24 June What people told us During the inspection we visited people in their own homes and asked them what they thought about the service they received from Avenue Care Services. People we spoke to who used the service, or their relatives, told us that they felt happy with the staff who supported them, and said they were caring and competent, and worked hard to support them appropriately. Some people told us that they always knew who would be providing their care and that they were always supported by the same staff, while others reported that they had not been told when support times were changed or when they would be supported by new staff. Service users we spoke with during the inspection told us: "Staff are usually on time, they sometimes get held up for a few minutes but nothing much." "We have had some problems but they seem to have been sorted out and things have gone smoothly recently." "Staff are good, I see the same person all the time and I think she is very good." "Although my relative is happy with the service and likes the staff I have some issues with the office staff who don't always phone back when they say they will or say they have fixed an issue but it happens again!" page 2 of 7
3 Self assessment The Care Inspectorate received an updated self assessment document from the service provider. In the self assessment the provider identified what they thought they did well and some areas for development. The service told us ways that people who use the service have been involved in the self assessment process. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate What the service does well During the inspection we sampled service users plans and we saw some good clear information for staff in care plans relating to how care should be carried out. In most of the files we sampled there was a signed agreement on times care was agreed to be provided. This had been an issue at the previous inspection and the service had taken action on this. Service users we spoke with were happy with the service they received, and generally made positive comments about the quality of staff who supported them. The service had followed recognised good practice in relation to the employment of staff, references were followed up, PVG scheme membership was in place, and where relevant, staff were registered with a relevant professional body. Staff attended a full initial induction, where they had the opportunity to be made aware of a range of relevant policies and procedures, as well as core practical training such as moving and handling. The service had recently appointed a dedicated training manager and this person will be able to provide service specific training and source other external training, therefore reducing the use of training DVDs. Staff we spoke to during the inspection who were undergoing induction told us that they felt confident the induction would provide them with sufficient information and training to allow them to go on to the next part of their training. This was more practical where they shadowed experienced staff, and had the opportunity to attend additional training. Records showed that staff had some opportunity for formal supervision with line managers, and that observation of practice was carried out as per the service's policy. The service had an existing audit process which had been put in place prior to the last inspection which included audits of missed visits, medication and the quality of recordings. The service had recognised that one specific part of the service in Fife had issues in relation to consistency of staffing, missed visits, and quality of general recording. During the period the inspection was carried out the service carried out a restructure of staffing to introduce dedicated teams of staff for particular areas so that consistency of staff providing care would be improved. The service had also carried out a comprehensive audit of all files of service users in the Fife area to identify core issues which required attention, such as care plans, agreements of timings of visits and reviews. They planned to extend this to other areas of the service. This had resulted in a comprehensive action plan where the manager page 3 of 7
4 had clearly identified actions to be carried out and staff responsible for this. In addition a specific member of staff has been given responsibility for quality assurance across the service. What the service could do better In the files we sampled there was a difficulty in confirming that reviews had been carried out - some appeared to be in the form of updated care plans, others in new risk assessments obviously completed following a review of service, however no minutes of reviews were in place. The service had audited care plans and identified where reviews were still outstanding. In some cases we did not always see that care plans were updated following changes to service, for example where support changed from a Stand Aid to a hoist, or where there were substantial changes to the times of care provided. We did not see agreements in relation to providing only male or female staff. The service confirmed that they had had this discussion with local authorities and were clear that they could not guarantee this, but that this information had not always been passed on by local authorities. The service should take steps to ensure that service users were aware of this at the point of accepting the service. Although service users we spoke with were very happy with the service they received, some commented that they did not always know who would be providing their care, and that they did not always see consistent members of staff. This seemed to be primarily focused in one geographical area and the service had taken action on this and had restructured staff teams in an effort to ensure consistent support was provided. Where issues had been identified in relation to staff practice it was not always possible to tell how this had been followed up by the service. Minutes of supervision would have benefited from more detail as some files sampled had little or no detail on practice issues discussed, or at times were difficult to read. Since the last inspection the Care Inspectorate had investigated complaints made about the service, and at the time of inspection two complaints had been upheld which identified that individual service users had received a poor standard of care. We required the service to take action. We will do a further inspection to see what action the service has taken to improve the service. The service should increase the quality and levels of quality assurance processes to identify areas of poor practice before this impacted on the quality of care received by service users. The quality assurance process should include continued monitoring of actions taken as a result of audit. The manager should make use of the findings of quality assurance processes to develop an overall development plan for the service. Requirements Number of requirements: 1 1. The provider to devise, implement and fully embed robust quality assurance arrangements that evidence improving outcomes for service users. This is in order to comply with SSI 2011/210 Regulation 3 - Principles & Regulation 4. 1 (a) Welfare of Users. page 4 of 7
5 We took also account of the National Care Standards Care Homes for People with Learning Disabilities - Standard 5: Management and Arrangements Timescale: Twelve weeks from receipt of this report. Recommendations Number of recommendations: 0 Complaints Please see Care Inspectorate website ( for details of complaints about the service which have been upheld. Inspection and grading history Date Type Gradings 31 Mar 2016 Unannounced Care and support 5 - Very good Management and leadership 29 Jun 2015 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 17 Jul 2014 Unannounced Care and support 5 - Very good Management and leadership 18 Jul 2013 Announced (short notice) Care and support Management and leadership page 5 of 7
6 Date Type Gradings 21 Jun 2012 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate page 6 of 7
7 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 7 of 7
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