DIAL Network Housing Support Service 9 Queens Terrace Ayr KA7 1DU Telephone:

Transcription

1 DIAL Network Housing Support Service 9 Queens Terrace Ayr KA7 1DU Telephone: Inspected by: Amanda Cross Type of inspection: Unannounced Inspection completed on: 16 July 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Dial Network Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Amanda Cross Telephone enquiries@careinspectorate.com DIAL Network, page 2 of 25

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 4 Good Quality of Management and Leadership 3 Adequate What the service does well Staff were flexible and responsive in their approach to the meet the needs of people who used the service. There were good relationships observed between service users and staff. This provided good support for service users. Staff demonstrated a good knowledge and understanding of the needs of the people who use the service. The service continues to offer a good service to the people they support. What the service could do better The service should review their policies and procedures to ensure they were reflective of best practice guidance and current legislation. Consideration should be given to additional methods to encourage involvement of people who use the service in service development. The service needs to demonstrate how it consults with people using services as part of their quality assurance systems. Feedback obtained through these systems should be used to inform action planning for future service improvement. DIAL Network, page 3 of 25

4 The provider should ensure an appropriate management structure is maintained to allow leadership, monitoring and development of the service. What the service has done since the last inspection There had been some evidence of review and update of policies and procedures. Conclusion The providers and management team are motivated and are committed to making the necessary improvements to improve the quality of the service. We found that a good standard of support is delivered by a motivated and well engaged staff group. The service continued to provide individualised support for service user. Who did this inspection Amanda Cross DIAL Network, page 4 of 25

5 1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS. D.I.A.L. Network has its administration office located in the town centre of Ayr. They provide support for 24 adults with mental health problems and adults with learning difficulties. The service is provided in a house of multiple occupation (HMO) and in independent flats in the community. D.I.A.L. Network's Values and Principles are: "We will offer support to appropriate individuals referred to our service by external professional agencies, and will not discriminate on the grounds of Race, Creed, Colour, Gender, Religion, Age, Disability or Sexual Orientation. We will actively promote independent living skills and support individuals back into mainstream housing. We will be open and honest in all of our dealings with service users, external agencies and families of our service users. We will maintain records to demonstrate that we act in accordance with our values and principles. We will meet nationally and locally imposed standards for Housing Support and where ever possible exceed these standards. We will conduct internal quality monitoring processes over the range of our services and encourage external agency assistance in further monitoring the quality of our service. We will ensure that all managers and staff are vetted and trained as suitable persons to be working with vulnerable people." The HMO is staffed across 24 hours and those service users living independently can access a 24 hour emergency on call videophone service or drop in to the 'Contact Point' located within but separate from the HMO. This 'Contact Point' provides a meeting area for social interaction and advice. DIAL Network, page 5 of 25

6 At the time of this inspection, 9 people were in residence in the HMO and a further 16 were receiving support in the flats. SPACER 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 4 - Good Quality of Management and Leadership - Grade 3 - Adequate 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. DIAL Network, page 6 of 25

7 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 In this service we carried out a low intensity inspection. We wrote this report after an unannounced inspection that took place between 11:00 and 17:10 on 24 June 2013, 11:30 and 17:00 on 25 June 2013 and 11:10 and 13:00 on 11 July Further contact was made via telephone to confirm elements of the inspection on 16 July. The inspection was carried out by Care Inspector, Amanda Cross. As requested by us the service submitted an annual return and a self assessment. During the inspection process we took account of the services own feedback questionnaires. In addition, we issued 25 questionnaires to people who use the service and 12 were returned. Information from the returns is included throughout the main body of the report. We gathered evidence from various sources including the relevant sections of the policies, procedures, records and other documents including: Service user Personal Plans Risk Assessments Minutes of service user meetings. Staff and Management meeting minutes Quality Assurance System Documentation Auditing systems Insurance Certificate Certificate of Registration Previous Inspection Reports Health and Safety Records We also spoke with: 6 Service users 4 Support staff 2 Senior Support Staff DIAL Network, page 7 of 25

8 2 Managers Provider 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 DIAL Network, page 8 of 25

9 What the service has done to meet any requirements we made at our last inspection The requirement Service users personal plans must be reviewed at least once in every six month period whilst the service user is in receipt of a care service. This is to comply with: SSI 20011/210 Regulation 5(1)(b)(iii) Personal plans. Timescale for completion: 30 October What the service did to meet the requirement We saw good evidence of six monthly reviews taking place. There was also evidence of future planning of reviews within the office base and the home of the service user. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection Actions taken on outstanding recommendations are reported within the main body of the report under the relevant Quality 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 completed self assessment which supported the findings of this inspection. DIAL Network, page 9 of 25

10 Taking the views of people using the care service into account Overall, all service users told us they were happy with the quality of care and support provided by the service. Some stated they were unsure of having their needs and preferences detailed within their personal plan. Feedback comments included: "I get on well with staff and very happy with staff as they have been looking after me for 18 years". "I have no comments". "I'm happy with my support. I do not want things to change". "The service I receive is great and I am happy". "staff are good, they go out of their way to help you - no two ways about it". "staff do almost everything for me". "can't find any fault with the staff. They go out of their way to help you sometimes". Taking carers' views into account We did not consult with carers as part of this inspection process due to the client group. DIAL Network, page 10 of 25

11 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The grade awarded for this Quality Statement at the previous inspection on 22 June 2012 was 5 - Very Good. The evidence that we sampled at this inspection reduced the grade to 4 - Good. We reached this decision after we read documents on the effectiveness of participation and saw evidence of how it was implemented, read service user records, and examined questionnaire returns. We also had discussions with service users on their involvement in influencing the care and service they received. We saw that the service had an active participation strategy which they used to involve service users in their supports and the service. Staff told us of their role within this and how they encouraged service users to be involved. Consultation methods included: Questionnaires Service user committees Service user meetings Six monthly reviews Personal plan documentation including housing support agreements Complaints procedure Quality Monitoring visits by management Within the office base, there was a facility to make comments and suggestions. Service users told us they "don't write much in this as they just tell the staff or the manager". They stated "if they wanted to make a change in anything they only had to DIAL Network, page 11 of 25

12 ask". Service users told us they were happy enough with the involvement they had in "sorting out their careplans". There was positive encouragement for service users to participate in the inspection process. Service users attended the office base to meet with the inspector and were receptive to home visits. Keyworkers played an important role within the lives of service users. Through the development of trust with their keyworker, service users told us they felt more confident and felt able to make suggestions. Service users stated they were treated with dignity and respect. Information relating to resources within the local area were freely available to service users and were displayed within the drop-in centre which they attended. Some service users told us they went to local clubs which kept them busy and they made friends there. Advocacy services were also available and had been used in some instances. Areas for improvement There were minutes of meetings which had been held regularly and well attended. However, the minutes did not reflect outcomes from discussion or areas for development with timescales or responsible persons. The manager should review the current method of recording to ensure feedback can be monitored and evaluated. In order to obtain a less general response in feedback, the service should review their questionnaires, making questions themed or more specific in areas of service provision. This would allow them to use this feedback more effectively to improve service delivery as part of their quality assurance system. The service should consider the benefits of further developing their participation strategy. This would allow a more directive process for ensuring feedback is used to inform future developments in their quality assurance processes. This is reiterated in statement 4.4. The service should ensure that all service users know how to make a complaint. Three service users said within Care Inspectorate questionnaire that they did not know how to make a complaint to the Care Inspectorate. (See recommendation 1 of this quality statement). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 DIAL Network, page 12 of 25

13 Recommendations 1. The service should ensure that all service users know how to make a complaint using the organisational process. National Care Standards Housing Support Services, Standard 8: Expressing your views. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The grade awarded for this Quality Statement at the last inspection on 22 June 2012 was 5 - Very Good. The evidence we sampled during this inspection process reduced the grade to 4 - Good. We reached this decision after we had spoken with the management, staff and service users. We also reviewed a number of relevant documents including support plans. A requirement was made during the last inspection relating to consistency of six monthly reviews taking place. The requirement stated "Service users personal plans must be reviewed at least once in every six month period whilst the service user is in receipt of a care service." Action taken We saw good evidence of six monthly reviews taking place. There was also evidence of future planning of reviews within the office base and the home of the service user. This requirement has been MET. Staff provided assistance to ensure service users were registered with health professionals which allowed health needs to be addressed or monitored. Staff also had good liaison with agencies including Community Mental Health Team, pharmacies and Social Work. To promote the attendance of service users at appointments for health professionals or other agencies, support staff reminded them of the appointment by text. Service users felt this was beneficial and improved their attendance. During discussion with staff, they demonstrated a very good understanding of service users for whom they were keyworker and how they provided support to ensure their needs were met. Support plans identified some areas of assistance where service users needed support with their health and wellbeing. This included prompting and assistance to ensure DIAL Network, page 13 of 25

14 medication was taken as prescribed through the self medication agreement. Staff assisted service users at mealtimes to ensure regular meals were made in agreement with the detail in the support plans. To promote assistance to service users during food preparation, training for staff included food hygiene, infection control and some guidance on healthy eating. We saw how staff responded to changes in the behaviour of the service users by contacting relevant health professionals. This promoted safety for service users through previous completion of consent forms to share information. A team working approach provided trust between service users, staff and health professionals to ensure service users obtained treatment timeously which promoted their positive mental health and wellbeing. Areas for improvement Personal plans should be developed to ensure completion of appropriate assessment tools. This would allow a more individualised and person centred reflection of each service user in their support plan, specific to their identified support needs. (see recommendation 1 of this quality statement). Risk assessments should be completed to ensure the health, safety and wellbeing of service users and staff during support times. (see requirement 1 of this quality statement) To promote health, safety and wellbeing of service users, the service should ensure that a planned staff training schedule is in place. (see recommendation 1 of this quality statement). To ensure the service continues to meet the needs of service users through use of assessment tools, additional training providers to facilitate ongoing and relevant training for staff should be sourced. This would assist staff to respond to the changing needs of service users. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 1 Requirements Inspection report continued 1. The provider of the service must ensure that regular assessments of service user needs and risk assessments are conducted to ensure appropriate provision of service user support and safety of staff. This is to comply with: SSI 2011/210 Regulation 4(1)(a) - a regulation concerning welfare and safety of service users. DIAL Network, page 14 of 25

15 Recommendations Inspection report continued 1. Care plans should be person centred and reflect the goals and wishes of residents in order to meet their needs, with regular review to ensure appropriate support delivery. National Care Standards, Housing Support Services, Standard 4: Housing Support Planning. DIAL Network, page 15 of 25

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The grade awarded for this Quality Theme at the previous inspection on 22 June 2012 was 4 - Good. The evidence we sampled during this inspection reduced the grade to 4 - Good. We reached this decision after we had spoken with management, staff and service users. We also reviewed a number of relevant documents and records. The service sought feedback on quality of staffing through questionnaires. Service users told us how they could request gender specific workers which allowed the formation of therapeutic relationships. The strengths for this statement already include those already mentioned in Statements 1.1. Areas for improvement Feedback obtained from service users on staffing should be evaluated to assess and improve the quality of service. Grade awarded for this statement: 4 - 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. DIAL Network, page 16 of 25

17 Service strengths The grade awarded for this Quality Theme during the previous inspection of 22 June 2012 was 4 - Good. The evidence we sampled during this inspection maintained the grade of 4 - Good. We reached this decision after we had spoken with management, staff and service users. We also reviewed a number of relevant documents and records. The service had begun to introduce some e-learning opportunities for staff. This included access to infection control and food hygiene modules which staff can complete at their own pace. Staff described a supportive working environment which allowed them to advocate on behalf of their service users to ensure their needs were met. We reviewed staff meeting minutes which reflected good attendance and evidence of discussion. Support monitoring sheets were completed by the management during quality assurance visits. Feedback obtained by use of these documents was included for discussion at supervision. Teamworking between the staff team was evident. There was good communication between staff to ensure the promotion of the quality of support for service users. Staff training records detailed mandatory training staff had attended. The manager had begun to create a training plan to ensure training was pre-planned and ongoing to ensure best practice guidance was being used. A formal programme of SVQ training was ongoing. This ensured staff could register with the Scottish Social Services Council (SSSC) within the designated timescales. A high percentage of staff had completed their SVQ training. The Manager and the Assistant Manager were undertaking the appropriate Managers Award. Staff knew of the requirement to register, and the purpose. Staff spoke of the safeguarding vulnerable adults as the main reason for the register in accordance with Codes of Conduct. We found staff had some understanding about key legislation and National Care Standards. Areas for improvement A recommendation made during the last inspection stated: "A planned programme of regular individual supervision should be implemented for all staff". Action taken Inspection report continued DIAL Network, page 17 of 25

18 There was a staff supervision policy in place; however, this was not being facilitated in accordance with policy for all staff. Staff interviewed felt that supervision was a positive activity and were confident in raising service, management and training issues at these meetings. This recommendation is NOT MET and will be repeated. (see recommendation 1 of this quality statement) We found that although staff had undertaken their SVQ qualification, there was a lack of support through supervision to identify further training needs. The manager should consider methods to improve motivation for further development of skills and knowledge. Staff meeting minutes could be more outcome focussed with action planning with timescales and responsible persons identified. This would allow monitoring and evaluation of actions taken and outcomes to benefit service users. The service should identify any additional developmental training needs for staff. This could assist in the identification and provision of support in any specific support needs for service users. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. A planned programme of regular individual supervision should be implemented for all staff. National Care Standards - Housing Support Services- Standard 3: Management and Staffing arrangements DIAL Network, page 18 of 25

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 grade awarded for this Quality Statement at the previous inspection on 22 June 2012 was 4 - Good. The evidence that we sampled at this inspection reduced the grade to 3 - Adequate. We reached this decision after we read documents on the effectiveness of participation and saw evidence of how it was implemented, read service user records and examined questionnaire returns. We also had discussions with service users on their involvement in influencing the care and service they received. Feedback is requested through the provision of questionnaires. The strengths for this statement already include those already mentioned in Statements 1.1, Areas for improvement Action plans should be devised from the evaluation of feedback to improve the quality of management and leadership of the service. A recommendation was repeated during the last inspection which stated :" The service should demonstrate implementation of its Participation Strategy and formalise their approach to quality assurance". Action taken There was a lack of evidence to demonstrate how feedback from service users had been used to improve the quality of the service. We saw some evidence of how the provider had improved the quality assurance system however this remained a work in progress. This recommendation is NOT MET and will be repeated. DIAL Network, page 19 of 25

20 (See recommendation 1 of this quality statement). The service should continue to explore ways in which service users may contribute to assessing and improving the quality of management and leadership. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should demonstrate implementation of its Participation Strategy and formalise their approach to quality assurance. National Care Standards, Housing Support Services Standard 3: Management and Staffing. 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 grade awarded for this Quality Statement at the previous inspection on 22 June 2012 was 4 - Good. The evidence that we sampled at this inspection reduced the grade to 3 - Adequate. We reached this decision after we read documents on the effectiveness of participation and saw evidence of how it was implemented, read service user records, and examined questionnaire returns. We also had discussions with service users on their involvement in influencing the care and service they received. The service had a quality assurance system in place. For example, feedback was sought through questionnaires, service user reviews and meetings. The service completed a self assessment which partially reflected the findings of this inspection. A monthly summary of service provision for service users is provided to funding authority. Areas for improvement Whilst we saw some evidence of review of policies and procedures there remained some policies out of date and did not reflect best practice guidance. There remained reference to the predecessor organisation of the Care Inspectorate and previous legislation. (see requirement 1 of this quality statement) DIAL Network, page 20 of 25

21 Where processes should be used yo promote the improvement of support delivery, there was a lack of outcomes from audits of the service being implemented through action planning. Accidents and incidents were recorded and audited however they should also be evaluated to promote the safety of residents, visitors and staff. (see recommendation 1 of this quality statement) The service should re-familiarise themselves with the notification guidance issued by SCSWIS to ensure appropriate and timely submission of notifications as is required. Information on how to access further resources on the website was shared during the inspection. We found that some recording systems used language which was judgemental and did not promote values towards working with residents. The service should review these systems and ensure the language used is reflective of the value base as described in their mission statement and objectives of the service. The service should continue to consult with people as part of their quality assurance systems and utilise the feedback to improve service delivery. The service should develop action plans based on feedback and act on issues raised. Evaluation of actions taken should also be conveyed to service users and other relevant persons. Whilst we saw some evidence of review of policies and procedures there remained some policies out of date and did not reflect best practice guidance. There was a lack of outcomes from audits of the service being implemented through action planning. There remained reference to the predecessor organisation of the Care Inspectorate and previous legislation. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must review quality assurance systems and processes to monitor and support the effectiveness of the service being provided. This includes ongoing review and update of policies and procedures in accordance with best practice and current legislation and the practices of regular auditing and evaluation. All documentation should be updated to reflect the Care Inspectorate and not the predecessor organisation. This is in order to comply with: SSI 2011/210 Regulation 3 - Principles. A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the DIAL Network, page 21 of 25

22 independence of service users and affords them choice in the way in which the service is provided to them. Recommendations Inspection report continued 1. The manager should ensure that accident/incident records are consistently followed up and detail information about follow-up actions to minimise risk of reoccurrence. National Care Standards for Housing Support Services: Standard 3 - Management and Staffing Arrangements DIAL Network, page 22 of 25

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 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). DIAL Network, page 23 of 25

24 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 4 - Good Quality of Staffing Good Statement 1 Statement Good 4 - Good Quality of Management and Leadership Adequate Statement 1 Statement Adequate 3 - Adequate 6 Inspection and grading history Date Type Gradings 22 Jun 2011 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 10 Jun 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 21 Oct 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership Not Assessed 24 Dec 2008 Announced Care and support 5 - Very Good Staffing 4 - Good 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. DIAL Network, page 24 of 25

25 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: DIAL Network, page 25 of 25