Scottish Nursing Guild Nurse Agency 160 Dundee Street Edinburgh EH11 1DQ

Transcription

1 Scottish Nursing Guild Nurse Agency 160 Dundee Street Edinburgh EH11 1DQ Type of inspection: Unannounced Inspection completed on: 21 May 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Independant Clinical Services 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 Scottish Nursing Guild, page 2 of 26

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 Information 5 Very Good Quality of Care and Support 5 Very Good Quality of Staffing 6 Excellent Quality of Management and Leadership 6 Excellent What the service does well The service has a robust recruitment selection process which enables them to ensure that staff they employ have up to date skills and experience for the work they are to undertake on behalf of the agency. The manager and senior staff we spoke with felt that they worked hard to ensure that the right nurse was in the right place and at the right time in accordance with the needs of service users. The electronic systems matching staff skills with the requirements of service users was of a great benefit and ensured that service users were provided with staff who were skilled in the particular area of need. What the service could do better The Scottish Nursing Guild should continue to develop methods to involve service users, staff and stakeholders in assessing and improving the overall quality of the service. The service should continue to develop the information in the service users handbook to make sure that prospective and existing service users are aware of the service to be provided and any limits to this. Scottish Nursing Guild, page 3 of 26

4 The service should continue to develop the quality assurance systems to show the on-going development and improvement made as a result of audits. What the service has done since the last inspection The service had met the requirement we made at the last inspection about the notifying the Care Inspectorate of any issues of staff misconduct. Also see quality theme 4 statement 4. We also saw that they had made progress with the implementation of recommendations we made. These are reported under the relevant statements. Conclusion We saw that Scottish Nursing Guild were committed to providing a very high quality of nursing staff based on matching staff skills and experience with those required by the service user. Scottish Nursing Guild, page 4 of 26

5 1 About the service we inspected The Scottish Nursing Guild is registered as a Nurse Agency and supplies registered nurses and care staff to hospitals, care homes and private clients in their own home. It supplies nurses and carers all over Scotland and the main office is in Edinburgh. The service has been established in Scotland for many years. It was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April The Scottish Nursing Guild also operates a care at home service from the same office. Based on the findings of this inspection this service has been awarded the following grades: Quality of Information - Grade 5 - Very Good Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 6 - Excellent Quality of Management and Leadership - Grade 6 - Excellent 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. Scottish Nursing Guild, page 5 of 26

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We compiled the report following an unannounced inspection. The inspection was carried out by an inspector from Social Care and Social Work Improvement Scotland. This took place on 21 May 2014 between 9:30am and 4:30pm. During this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documentation including evidence from: - The Certificate of Registration - The insurance certificate - The self assessment completed by the service - The annual return (a document completed each year by the service to tell us about aspects of the service) - The service's action plan to address issues from the last inspection - The provider's website - Electronic records of staff training - A sample of three service users' personal support plans - Accident, incident and complaint records - Consideration of audits undertaken by the service - Consideration of the National Care Standards, Nurse Agencies Care at home. Discussion with various people including: - The manager of the service - The business manager - The senior case manager - The sales manager. We spoke directly with the manager of a care service who used The Scottish Nursing Guild (SNG) to provide nursing staff on a regular basis. We also spoke with a service user and three relatives/ carers where nursing and care staff were provided either through the nurse agency or SNG care at home service and two members of nursing staff. Scottish Nursing Guild, page 6 of 26

7 The above information was taken into account during the inspection process and feedback on the outcomes of the inspection was shared with the manager, business manager and senior case manager on conclusion of the inspection on 21 May 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 Scottish Nursing Guild, page 7 of 26

8 What the service has done to meet any requirements we made at our last inspection The requirement The provider must notify the Care Inspectorate of any issues of misconduct.this is to comply with: SSI 2011/210 Regulation 4 (1) (a) Welfare of users. Regulation 9 (1) Fitness of employees. Timescale: from receipt of this report. What the service did to meet the requirement The provider had submitted appropriate notification to the Care Inspectorate which included issues of misconduct. Also see quality theme 4 statement 4. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection We have reported progress with recommendations under the relevant quality statement. 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 comprehensive and detailed self assessment document from the service provider. The service provider identified areas they thought they did well, some areas for development and any changes they planned within given timescales. The self assessment was completed to a good standard with information under each Scottish Nursing Guild, page 8 of 26

9 statement to describe the service's strengths. The grades awarded through the self assessment were generally in accordance with those awarded through this inspection. Taking the views of people using the care service into account We spoke with a representative of a care service where staff were placed by SNG. They told us that nurses provided to their service were excellent and skilled in the work they were to undertake. They knew how to give feedback to the service and were aware of who to contact in the nurse agency if they had any concerns. Taking carers' views into account Where nursing staff were working in private homes we spoke with relatives/carers. Everyone we spoke with considered SNG to provide an excellent service in the quality of staff they provided. They also praised the skills and professionalism of staff. Also see quality theme 0.2. Scottish Nursing Guild, page 9 of 26

10 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 0: Quality of Information Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the information provided by the service. Service strengths The service demonstrated the following strengths in the areas covered by this Quality Statement. We assessed that SNG were performing at an excellent level in the methods they had to assist service users and their relatives/carers to participate in giving their views on the quality of the information provided and the overall quality of the service. To make our assessment we looked at the SNG website, the information available to clients, feedback from users of the service and discussion with the management team. We also spoke with a service user and three relatives/carers where staff were working in private homes and two nurses. There were a variety of ways that service users and carers participated in assessing and improving the quality of the information. This included regular contact with service users through telephone conversations, visits (to private homes) by the senior case manager and feedback to the service through quality assurance questionnaires. We saw that the service made contact with services when a new worker has been placed after their first shift. This enabled SNG to check the competence and skills of the new member of staff and their suitability for the placement. The minimum contact with service users was once a month although they were able to contact the SNG at any time through the service website, quick nurse system and 24 hours phone number. A bespoke survey monkey system had also been put in place whereby service users could complete an anonymous on-line questionnaire. We also Scottish Nursing Guild, page 10 of 26

11 saw that SNG made contact with services when a new worker has been placed after their first shift. This enabled SNG to check the competence and skills of the new member of staff and their suitability for the placement. The client survey covers, all aspects of the service provided including: * Service provided by the duty desk * The clinical skills of the nurse * Complaints * The service user guide * Comments, feedback and suggestions on how the service could improve. The timesheet completed by service users on completion of the nurses shift also gave service users the opportunity to comment on the nurse's performance whilst working in their service. This is an immediate and simple means whereby the service can make their views known and it also directs them to contact the SNG office if needed. At the last inspection we made a recommendation that the service should consider and action plan following feedback from clients that explains how the service intends to develop and improve. At this inspection we saw that an action plan approach was used to identify progress with any areas of improvement as a result of service user feedback including surveys. Outcomes could be shared through personal phone contact, , newsletters and the service website dependent on the nature of the feedback. The national care standards, nurse agencies, standards 1 - Information about the nurse agency, Standard 2 Agreeing the service, Standard 3 Agreeing the service and Standard 5 - Concerns, comments and complaints were met at this inspection. Areas for improvement The service should continue give service users and carers opportunities to participate in assessing and improving the quality of the information provided by the service. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 2 We provide full information on the services offered to current and prospective service users. The information will help service users to decide whether our service can meet their individual needs. Service strengths Inspection report continued The service demonstrated the following strengths in the areas covered by this Quality Statement. Scottish Nursing Guild, page 11 of 26

12 We have assessed this service as performing at a very good level. To make our assessment we looked at the provider's website, their information pack and spoke with service users. The provider's website was easy to read gave contact details for the service included, a 24 hour phone number, a call back request, the service address and enquiry form. Written and web site information gives comprehensive information about what the agency and the service it provides. This covered general information about SNG and the range of services which could be provided including specialist nursing skills, staff training, and client information. In the service user guide we saw that information tells readers that SNG is registered with the Care Inspectorate and the regulations and standards which apply to their services. This may give reassurance to people that this service is registered and inspected and reports on the service are available to the public. One relative/carer told us that the initial contact with the sales manager had been of particular benefit as he understood immediately what was required and was able to give appropriate information about the service. They said that the call was then directed to the relevant person who could discuss in detail the particular needs from a clinical perspective. They told us that this had been in direct contrast with another agency who could not give clear information or understand what type of service the caller required for their relative. This caller told us that SNG took time to match staff skills to the service users needs and they provided "joined up services." We also spoke with a representative of an organisation where registered nurses were provided. They told us that they were aware of the range of services SNG provided. At the last inspection we made a recommendation that the service should update the information it gives to clients to ensure all the detail is accurate. At this inspection we saw a draft of the new information pack. This being reviewed and updated to address some of the suggestions we made including the Care Inspectorate details and the complaints procedure. We concluded that as the service provider was addressing this recommendation the recommendation was met. Also see areas for improvement. The national care standards, nurse agencies, standards 1 - Information about the nurse agency, Standard 2 Agreeing the service, Standard 3 Agreeing the service and Standard 5 - Concerns, comments and complaints were met at this inspection. Areas for improvement Inspection report continued As the new information pack was still to be concluded and made available to those with an interest in this service we have awarded a grade of 5 - very good. Scottish Nursing Guild, page 12 of 26

13 A copy of this and the updated staff handbook should be provided to the Care Inspectorate once introduced and available. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Scottish Nursing Guild, page 13 of 26

14 Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The comments made in Quality Theme 0 Statement 1 also apply to this statement. Areas for improvement The areas for development noted in Quality Theme 0 Statement 1 are relevant to this statement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure our service provides care staff who are most suitable to meet individual service user needs. The care and treatment received by the individual service user, is supported by evidence based practice and up to date policies and procedures. These reflect current legislation (where appropriate Scottish legislation). Service strengths The comments in quality theme 0 statement 1 and quality theme 1 statement 7 are also relevant to this statement. Areas for improvement At the last inspection we noted that the service should review the service user guide and nurse handbook to ensure that Scottish legislation is included. At this inspection we saw that this information was in the process of being updated. Also see quality statements 0.1. and 1.7. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Nursing Guild, page 14 of 26

15 Statement 7 We are confident that the quality of service users' care will benefit from regular review of clinical practice within the service. Service strengths The service demonstrated the following strengths in the areas covered by this Quality Statement. To make our assessment we looked at records held in the service, examples of care/ support plans (for people receiving the service in their private home), feedback from users of the service, discussion with the management team, discussion with two nurse and examination of a sample of staff personnel and training records. The service had a computer system which recorded the qualifications, skills, knowledge, experience and training for each member of nursing and care staff. The system also noted the particular needs of service users and enabled staff to match staff skills with the skills required by the service user. We sampled some of the staff training records held on the computer system. We saw that these noted training completed and when any refresher training was due. The sample of records we looked at noted that training deemed necessary was up to date. The service had member of staff who had responsibility for Regulation training and staff compliance. This enabled the service to check that staff had successfully completed any mandatory training including on-line training and to ensure that any training was up to date. We saw that nursing staff (working in private homes) were supported by the senior case manager who met with them on a regular basis. This manager also reviewed and updated care/support plans supervised staff including assessment of competency in specific areas of the care to be provided and to discuss any training needs. Service users considered staff to be trained and competent in the duties they were to undertake and staff told us that training was provided to enable them to keep their practice up to date. The service also had a clinical governance team which had an overview of the service provided including quality, compliance and policies and procedures. We concluded that SNG had excellent systems in place to review clinical practice in the service. Areas for improvement Inspection report continued SNG should continue to regularly review clinical practice with the aim of maintaining and promoting the excellent systems we saw at this inspection. Scottish Nursing Guild, page 15 of 26

16 Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Scottish Nursing Guild, page 16 of 26

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The comments made in Quality Theme 0 Statement 1 also apply to this statement. At the last inspection we noted that the staff time sheet was not a very effective way of obtaining meaningful feedback about staff performance and the service user should consider other ways to obtain feedback on individual staff's performance. We made a recommendation about this. At this inspection we saw that other methods were used. We saw that this recommendation was met. Also see quality theme 0 statement 1 and quality theme 1 statement 7. Areas for improvement The areas for development noted in Quality Theme 0 Statement 1 and quality theme 1 statement 7 are relevant to this statement. Grade awarded for this statement: 6 - Excellent 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 The service demonstrated the following strengths in the areas covered by this Quality Statement. The strengths noted under quality statement 1.7 are also relevant to this statement. The service operated a robust recruitment selection system which assisted them to ensure that staff were trained and skilled in the work they were to undertake. In addition to the computer system which was used to record and ensure that staff skills Scottish Nursing Guild, page 17 of 26

18 and training was up to date the system also allowed staff placing nurses with services to check that their Nursing and Midwifery Council (NMC) registration was current and without conditions to ensure that they were 'fit to practice'.. Staff told us that training, supervision and appraisal was in place and that the training met their needs. We saw that some of this training included child protection (for pediatric staff), adult protection, moving and handling, life support skills and infection control. We also saw that the service required nursing staff to complete annual records to confirm that their specific skills and training were up to date. They also required a clinical reference to confirm that staff had attained a new skill and that they were competent in this area of care. We saw that staff practice was also supported by policies and procedures which underpinned the service provided. A staff handbook was provided to all staff which detailed these and other information to support staff in the work they were to undertake. For example, risk assessment, lone working and health and safety. Relatives/carers of service users (receiving the service in private homes) told us that the staff providing the service had the necessary skills to undertake the duties required of them. They also told us that regular contact with the senior case manager enabled them to discuss the quality of the service and the skills and abilities of staff to meet their relatives' needs. A representative of a service where nurses were provided told us that they found the staff to be excellent, and they made particular reference to a nurse who was provided as a block booking. They also told us that they were very satisfied with the quality and skills of the staff provided by SNG. They also told us that SNG had provided the same member of staff on request which assisted their service in offering continuity of care. One relative/carer told us that the initial contact with the sales manager had been of particular benefit as he understood immediately what was required and was able to give information and direct the call to the relevant person. They said that this had been in direct contrast with another agency who could not give clear information or understand what type of service the caller required for their relative. This caller told us that SNG took time to match staff skills to the service users needs and they provided "joined up services." We saw that staff practice was also supported by policies and procedures, regular assessment of competency (where the service was provided in private homes), supervision and appraisal. At the last inspection we noted that the service should review the service user guide and nurse handbook to ensure that Scottish legislation is included. At this inspection we saw that this information was in the process of being updated. Also see quality statements 0.2. and 1.3. Scottish Nursing Guild, page 18 of 26

19 We concluded that there were systems, training and guidance available for staff which promoted a professional approach to service provision. This also enabled the service to ensure that staff practice was up to date, in line with best practice guidance and assisted staff to maintain and develop their skills. Areas for improvement The service should continue to support staff in training to meet the needs of the service users. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Scottish Nursing Guild, page 19 of 26

20 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 6 - Excellent 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 The comments made in Quality Theme 0 Statement 1 also apply to this statement. Areas for improvement The areas for development noted in Quality Theme 0, Statement 1 are relevant to this statement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths The service demonstrated the following strengths in the areas covered by this Quality Statement. We saw that the areas of participation as noted in Quality Theme 0 Statement 1 were also relevant to this statement. We have assessed that the service was performing at an excellent level for this statement. We looked at notifications made to us, the quality of information provided when requested and when necessary by the service, comments of service users and the quality of auditing in the service. We have stated in other statements of this report that the provider actively involved service users and staff working in the service staff working in the service to assess the quality of the service provided. Scottish Nursing Guild, page 20 of 26

21 At the last inspection we made a requirement that the provider should notify the Care Inspectorate of any issues of misconduct. At this inspection we followed up on an issue of misconduct notified to us by SNG. We saw that full information was made known to the Care Inspectorate. We also saw from personnel records that advice had been sought from their human resource department and other professional services before the situation was concluded. These actions were and the outcomes and decisions made as a result of investigation were recorded. We saw from these records that SNG were taking responsible and supportive steps to ensure that the staff member was safe to practice. This requirement was met. We also saw that the service used safer recruitment practices to ensure staff were fit to practice. This was also supported by staff competency assessment for all community staff and annual records from registered nurse to confirm that their specific skills and training were up to date. At the last inspection we made two recommendations. On related to the complaint policy and ensuring the provider undertook a detailed complaint investigation. We followed this up and saw that the service undertook a full investigation had taken place about a staff practice issue. Also see statement above in regard to staff misconduct. This recommendation was met. We also made a recommendation that the service put in place a more robust audit system to assist the service to improve and develop. At this inspection we saw that audit had been established in the service including quality assurance surveys and service user feedback. Information from these was used to assess and evaluate aspects of the service in order to develop and improve the overall quality of the service provided. In addition the service was also subject of bi annual clinical governance audits to ensure compliance with the service quality assurance systems. This recommendation was met. Comments suggestions and complaints and accidents and incidents were in recorded and followed up through the service computer based record system (DATIX). Where complaints accidents and incidents were recorded the information included the details of the event including actions taken by the service. We saw that the outcome of quality assurance questionnaires and surveys included the use of an action plan to address any issues which had been identified. This helped to show that the service was responsive to gaining and responding to the views and needs of service users. Service users said that they felt comfortable to raise any concerns or issues with the service and told us they knew who to contact if necessary. No one we spoke with had any concerns or complaints about the service they received at this time. Scottish Nursing Guild, page 21 of 26

22 We concluded that these systems and checks helped to show that the service was responsive to gaining and responding to the views and needs of service users. Senior staff were aware of their responsibilities to report events to the Care Inspectorate and the SSSC of stipulated events and did so promptly. From discussion with the senior staff team we concluded that they were keen to develop the service and to evidence that SNG provided a high standard of service. Areas for improvement The service should continue to develop quality assurance systems. It may also be beneficial if the outcomes of audits were made known to service users, staff and those with an interest in the service through a consistent method, for example, a newsletter. This may encourage people to comment and make suggestions for the on-going development and improvement of the service. We will follow up progress with quality audit systems at the next inspection. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Scottish Nursing Guild, page 22 of 26

23 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 No 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). Scottish Nursing Guild, page 23 of 26

24 5 Summary of grades Quality of Information Very Good Statement 1 Statement Excellent 5 - Very Good Quality of Care and Support Very Good Statement 1 Statement 3 Statement Excellent 5 - Very Good 6 - Excellent Quality of Staffing Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Management and Leadership Excellent Statement 1 Statement Excellent 6 - Excellent 6 Inspection and grading history Date Type Gradings 27 Mar 2013 Announced (Short Notice) Information Care and support Staffing Management and Leadership 4 - Good 4 - Good 4 - Good 3 - Adequate 22 Feb 2010 Announced Information 6 - Excellent Care and support 5 - Very Good Staffing 6 - Excellent Management and Leadership Not Assessed 31 Mar 2009 Announced Information 5 - Very Good Care and support 5 - Very Good Staffing 5 - Very Good Scottish Nursing Guild, page 24 of 26

25 Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Scottish Nursing Guild, page 25 of 26

26 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: Scottish Nursing Guild, page 26 of 26