Brisbane Supported Accommodation Project Care Home Service

Transcription

1 Brisbane Supported Accommodation Project Care Home Service Brisbane House 165 Hamilton Road Mount Vernon Glasgow G32 9QT Telephone: Type of inspection: Unannounced Inspection completed on: 6 March 2018 Service provided by: Scottish Association For Mental Health Service provider number: SP Care service number: CS

2 About the service The Brisbane Supported Accommodation Project provides a care home service for a maximum of five women with mental health problems. The Scottish Association for Mental Health (SAMH) manages the service. The service is in the East End of Glasgow and has very good transport links and access to local amenities. The service occupies a semi-detached property with spacious garden areas to the front and rear. The service property has two floors with a mezzanine level in-between. Each of the service users has their own bedroom. With the exception of the bedroom on the ground floor that has an en-suite, service users share access to the bathrooms. The communal lounge, dining area and kitchen are situated on the ground floor. Internal stairs access the remaining bedrooms. The service states that its aim is to "provide accommodation to service users assessed as requiring, at times in their daily lives, access to high levels of support. This includes physical care, personal finances and personal and household hygiene. We also aim for service users to resettle within the community". The service was first registered with the Care Commission on the 1st April What people told us Prior to the inspection we received five care standard questionnaires back from people who live in the service. These were positive about the quality of the service. During the inspection we were able to speak with four of the five people who live in the accommodation, again they were positive about the service the received. Comments included: - "I have always been treated and spoken to fairly." - "Then staff treat me well." - "The staff know what I like to do, they take me to exercise classes." - "I've never been unhappy about anything but I think they would do something about it if I was." - "The service support me to have an independent relationship with my family." Self assessment Providers were not asked to submit a self-assessment this year. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support page 2 of 12

3 Findings from the inspection It is important that when someone is in supported accommodation that they are assisted to feel part of their local community. It is part of our human rights to able to be involved in activities that we wish to. People who live in this service told us about going out to college courses, clubs, and advocacy groups as well as going out to local shops and cafes so the home tries to support people to be involved in their communities. People who live in care homes should be supported to be as healthy and active as they can be. Part of the reason someone lives in a care home is because they have a need for additional support to maintain their health. We saw evidence that the service supports people to access community and hospital health resources such as G.P.'s, Opticians, and Chiropodists etc. People also told us that they were supported to attend fitness classes and weight loss classes. We were made aware by an external professional that the service had supported individuals to overcome severe anxieties around attending medical appointments which had very positive outcomes for them. The service should review their aims and objectives with the people who live in the service and the staff who work there so that it is clear what the common goal is. At present there were differing opinions from people about how long someone could live in the supported accommodation and whether they should be aiming to move on or not. (See recommendation one) Similarly care plans should make it clear what outcomes an individual is looking to achieve with the help of the service. Currently care plans are not good at doing this although the provider has introduced a new care plan which considers individual 'Pathways' to support people on. We will review how effective these are at the next inspection. While the service was meeting the agreed staffing schedule at the time of the inspection people told us the service regularly had not met the staffing schedule since the last inspection. We saw that the people who live in the accommodation were agitated by the amount of staff who were on duty with one person asking us why so many staff were on. The provider should review the needs of the people within the supported accommodation and review this against their staffing rotas. When they have done this the provider should submit a variation to the Care Inspectorate for consideration. (See recommendation two.) Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The provider should ensure that everyone living and working within the supported accommodation is aware of the aims and objectives of the service. In order for this to happen staff and residents should be involved in a review of the aims and objectives of the service to ensure that they feel ownership of them and have a shared understanding about them. This is a recommendation against the NCS, Care Homes for People with Mental Health Problems, Standard 1, Informing and deciding. page 3 of 12

4 2. The provider should ensure that the service is staffed appropriately to meet the needs of the people who live in the service. In order to do this. - The provider should carry out a review of the needs of the people who live within the service and review this against their staffing rotas. - The provider should submit a variation request to the Care Inspectorate for its registration certificate to reflect this updated assessment. This is a recommendation against the NCS, Care Homes for People with Mental Health Problems, Standard 5, Management and staffing arrangements. Grade: 3 - adequate Quality of environment Findings from the inspection People have a right to feel safe within their home. People who live in the service told us that they felt safe because staff checked the windows and locks at night and one person told us they liked to lock their own bedroom door at night. In addition the service carries out safety checks of the building and maintenance contracts for essential equipment. People have a right to live in a pleasant environment. The building had been freshly decorated at the time of the inspection. People who live in the service told us that they had chosen the colours for their rooms so they felt they were able to participate in the redecoration. It is important that people who live in supported accommodation are supported to access their community, so their environment is not just about bricks and mortar of the building they live in. The service is close to good transportation links and people told us about all the things that they do in the community. People told us that their privacy was respected. We observed staff knocking and waiting for a response before going into people rooms and people told us that they could lock their own bedroom doors if they wanted to. We looked at the environmental audits which had been carried out by the provider and although they were quite detailed with an action plan attached to them the provider needs to get better at signing off to say when actions have been completed. This is an important part of quality assuring the environment. Requirements Number of requirements: 0 page 4 of 12

5 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection People living in a care setting have a right to be supported in a warm and caring manner. People who use the service told us that the staff were nice and the staff that we observed displayed a compassionate approach towards the people that they supported. Some of the staff that we spoke with and who returned questionnaires to us mentioned a tension present amongst the staff group at times. We were told that this had existed for much of last year which lead to some staff feeling that they had been less supported than they would have liked. At the time of the inspection the provider was in the process of reviewing the management support within the service which will hopefully address this issue. We monitor this at the next inspection. Staff should be supported to carry out their role and part of this is ensuring that they receive regular supervision. The frequency of supervision and appraisals had been reduced last year, the provider should look to address this. (See recommendation one under this theme.) We sampled staff appraisals during the inspection and did not find them to be particularly useful tools. Staff should be encouraged to be reflective in their appraisals and to identify goals which they can work towards the following year. (See recommendation two under this theme.) People who live in the service told us that they were confident that staff had the knowledge required to support them. We looked at staff training records and saw that staff had been offered a broad range of relevant training such as; Calms, Assist, Overdose Awareness, Strada, Rights, Risks and Limits to Freedom, 'My Outcomes.' We also saw that there was a training plan for this coming year in place. We suggested to the manager that the focus of this plan however was on new staff and did not include much development opportunities for established staff. People who live in the service have been offered the opportunity to be involved in the recruitment and selection of staff and they decided at a residents meeting that they wished their Key Workers to change every three months. We spoke with the manager about how they should continue to try to involve service users in the recruitment and appraisal of staff and that they should be innovative in how they did this. page 5 of 12

6 Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. Staff should receive support to enable them to confidently and competently do their jobs. In order to do this the provider should consider implementing a range of supervision techniques including: - Reflective Supervision - Observational monitoring - Group supervisions. This is a recommendation against the NCS, Care Homes for People with Mental Health Problems, Standard 5, Management and staffing arrangements. 2. Staff should be supported to develop in their role. In order to do this the provider should consider making Annual Appraisals more reflective and put in place goals which can be monitored throughout the year as part of a regular supervision plan. This is a recommendation against the NCS, Care Homes for People with Mental Health Problems, Standard 5, Management and staffing arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection The management and leadership of the service has been through changes over the last year. At the end of the inspection the Provider had decided to put a new management structure in place for this service and others run by the provider in the area. We hope this sees a period of stability within the service where plans can be developed and carried out. People that live in the service told us that they were aware of the management team and found them to be an approachable, visible presence around the service. At the time of the inspection the acting manager had only been in position a few weeks. They were able to describe to us some of the areas that they were hoping to improve and they demonstrated a willingness to engage with service users and staff to help develop the service. There will be consistency in the new management arrangements as the current acting manager will be taking up a promoted post so can help to oversee improvements within the service. page 6 of 12

7 The service should ensure that they can evidence increased service user and staff involvement within their improvement plans. This is to ensure that there is a shared understanding of how the service should be progressing and that service user's views are an essential component of it. While there has been a lot of good work started by the acting manager over the last few weeks we have not increased the grade for this theme at this inspection because it is early days in terms of seeing the outcomes from the changes. We how to see a more complete picture by our next inspection. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that quality assurance for the service is carried out effectively. In order to demonstrate this: - regular and routine management monitoring of the quality of care and support, staffing and management and leadership must be provided - quality audits relating to the above areas must be accurate, kept up to date and ensure they lead to any necessary action to achieve improvements or change without unnecessary delay - a service development plan must be made available to show how and when improvements will be made. This is to comply with SS1 2011/210 Regulation 4 (1) (a) - a requirement to make proper provision for the health and welfare of service users. Timescale: within one month of receipt of the final inspection report. This requirement was made on 28 November Action taken on previous requirement There was a service development plan completed following the last inspection. The problem was however that the development plan was not carried out fully and this was not initially picked up by the provider. The provider has changed the management structure recently to try to ensure that quality assurance is carried out with page 7 of 12

8 greater checks being put in place to ensure that it has been. We will comment on the progress of this at the next inspection. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should develop individual oral healthcare plans that are informed by best practice guidance. NCS - Care homes for people with mental health problems - Standard 5 - Management and staffing arrangements This recommendation was made on 28 November Action taken on previous recommendation Evidence that this has been completed were found within individuals care plans. Recommendation 2 The manager should develop an environmental risk assessment that regularly records and updates areas of the home and other hazards that may compromise the safety of individuals. NCS - Care homes for people with mental health problems - Standard 5 - Management and staffing arrangements This recommendation was made on 28 November Action taken on previous recommendation al risk assessments were in place the management just need to ensure that identified action points are signed off so that it is clear when actions have been completed. Recommendation 3 All staff should be assessed on their knowledge and understanding of the Mental Welfare Commission document, Rights, Risks and Limits to Freedom. This should ensure that they are competent and confident in the processes that are required when decisions are made to use restraint to reduce risk to the individual concerned. NCS - Care homes for people with mental health problems - Standard 5 - Management and staffing arrangements This recommendation was made on 28 November Action taken on previous recommendation Staff we spoke with were aware of the content of these documents. page 8 of 12

9 Recommendation 4 Staff supervisions should continue to be held in a protected and comfortable environment, away from Brisbane and should be uninterrupted (except in emergency ) allowing staff and line manager time to discuss all necessary issues for an appropriate length of time. Observational monitoring processes should inform supervision meetings. NCS - Care homes for people with mental health problems - Standard 5 - Management and staffing arrangements This recommendation was made on 28 November Action taken on previous recommendation Staff supervisions have been held away from Brisbane so that they are not interrupted. However this does not happen on every occasion and staff told us that supervision had not taken place as frequently they expected and recording of observational monitoring had stopped taking place. We comment on this under theme three in this report. Recommendation 5 Staff appraisals should be completed and be inclusive of individual objectives set in collaboration between the staff and supervisor. These should be measurable targets which can be revisited at regular intervals throughout the year to chart progress made at any particular time. NCS - Care homes for people with mental health problems - Standard 5 - Management and staffing arrangements This recommendation was made on 28 November Action taken on previous recommendation Records showed that supervisions and appraisals had taken place less frequently than at the last inspection so a recommendation around supervision and appraisals is made again under theme three in this report. Recommendation 6 The service manager should be more creative when planning the annual staff training schedule. The manager should review staff training and develop improvements in how staff can be assured that their learning and development is consistent with the requirements of their professional registration and with the developing needs of the people they support. Learning and development portfolios should be developed by each staff member with opportunities for self-directed learning through the links we discussed at our feedback meeting. NCS - Care homes for people with mental health problems - Standard 5 - Management and staffing arrangements This recommendation was made on 28 November Action taken on previous recommendation While there is an annual training and development plan this almost exclusively targets new starts and offers few learning and development opportunities for established staff. This is also commented on under theme three in this report. page 9 of 12

10 Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 13 Oct 2016 Unannounced Care and support 15 Mar 2016 Unannounced Care and support 11 Mar 2015 Unannounced Care and support 22 Oct 2014 Unannounced Care and support 29 Jan 2014 Unannounced Care and support page 10 of 12

11 Date Type Gradings 28 Feb 2013 Unannounced Care and support 25 Nov 2010 Unannounced Care and support Not assessed Not assessed 29 Jun 2010 Announced Care and support Not assessed 25 Mar 2010 Unannounced Care and support 22 Jul 2009 Announced Care and support 2 - Weak 24 Mar 2009 Unannounced Care and support 13 Jun 2008 Announced Care and support page 11 of 12

12 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 12 of 12