Arboretum Outreach Housing Support Service

Transcription

1 Arboretum Outreach Housing Support Service 490 Gorgie Road Edinburgh EH11 3AF Telephone: Type of inspection: Announced (short notice) Inspection completed on: 6 November 2017 Service provided by: Autism Initiatives (UK) Service provider number: SP Care service number: CS

2 About the service Arboretum Outreach (formerly know as No 6 Outreach) is registered with the Care Inspectorate as a combined housing support and care at home service. The service has been re-aligned geographically so that people would receive a more local service and staff would be working closer to the office in Gorgie Road. The service has two teams, Elm and Oak, each with their own team leader. The Elm team includes a university team which supports people attending higher education. The Oak team includes the Blackfriars Street service which offers accommodation and if wanted individual packages of support and evening drop in cover. The service has been registered since January The service has stated aims and objectives that include: 'Individual support workers will support service users as agreed in their individual support plans, based on their agreed assessed need. 'To help people plan and organise their lives, to support people with personal planning and provide guidance and practical help to them. 'To provide support and advice to people with housing, accessing the local community, socialising, health visits, social work visits, benefits issues, personal advice, budgeting, communication and practical independent living skills. 'To help people with their physical and mental health needs. 'To help the development of coping strategies to deal with the impact of the person's Autistic Spectrum Disorder'. At this inspection the service was working with about 70 people. What people told us We sent out 80 care standard questionnaires before the inspection and 25 were returned. Everyone said that staff treated them with respect and that they knew their staffs' names. Most people said that staff had the skills to support them and had enough time to do this. Twenty-one people strongly agreed or agreed with the statement that 'overall, I am happy with the quality of care and support this service gives me' Four people disagreed. We spoke with four relatives who thought that there had been some improvements to the service in the last year. Some said that communication had improved and three said that staff had come up with new ideas for activities to support the person they worked with. Others said that recorded information was not accurate and support plans did not contain the correct information. There were also issues about how support plans and support were used and followed through, especially when staff changed. This meant that support designed to help people in their daily lives was not consistent. Two people also said that staff not being able to drive them about anymore was 'limiting and hard'. Other comments included: page 2 of 10

3 'The service has improved...we are given more information...the manager is very good at replying to queries and in trying to be flexible with support shifts'. 'Overall the provision of hours has settled down and is consistent. Staff turnover means a lack of continuity and no follow through of specific plans...' 'Autism initiatives are just top class...give the best support and they are so excellent'. Self assessment We did not ask for a self-assessment this time. We did look at the service's development and improvement plan to see how they evaluated their work and planned for needed changes. These will be looked at in future inspections and linked to the new Health and Social Care Standards from April From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership Quality of care and support Findings from the inspection Feedback from people using this service and their families suggested that, over all, there had been some improvements in the last six months. Communication had got better and the consistency in staffing had improved. For example, rotas were made up four weeks in advance and this helped with planning support and knowing which staff were providing it. This was very helpful for people receiving support. One person told us that 'the care staff are always ready to adjust to my needs; if a shift needs changing or cancelling they are quick to accommodate this change. They are always respectful'. However, on some occasions people also told us that times of support were changed, different staff came or support times could not be agreed. These difficulties seemed far less than at previous inspections but these must be kept to a minimum. Staff told us that they were sometimes late due to problems getting between people. While they tried to give people notice of this some did not like to hear the worker was going to be late. We thought there was more clarity for staff about what was expected of them regarding recording daily notes of support, evaluating support plans and carrying out reviews of plans. Although this still required further work we saw that most paperwork was being completed and that six month reviews had nearly all been completed within that timescale. This helped show what had worked well, what had been achieved and what the next steps were (recommendation 1). We saw that people using the service were involved in reviewing their own support and were consulted well in most cases, though this could still be better for a few. page 3 of 10

4 This meant people were active in planning their support and what they wanted help with. A checklist in each file helped staff keep to a timescale to ensure work was completed. The service plans to make files easier to use, more relevant to daily work, and user-friendly. At feedback we discussed the need to ensure that when goals and outcomes were achieved then it was also clear what work needed to be done to sustain these. The service plans to add outcomes into the 'About Me' document. We suggested that tasks that needed carried forward were highlighted in ways that reminded staff of the need to support people in their daily living. This might be prompting practical tasks that help people sustain their tenancy or more complex work. This will help ensure that all staff are aware of what they need to do to support the person well, consistently and that goals and outcomes are followed through (recommendation 2). Where needed, we saw a variety of methods in use to help people and their workers communicate with each other and other services. We saw that there was good work being done with other services, to share information and come to agreed ways of working together. In particular, the service tried to help staff in other agencies understand autistic thinking and ways to work with people. This sometimes involved advocating on behalf of a service user. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The service should ensure that all paperwork is completed and signed and that support plans are evaluated consistently. National Care Standards, Housing Support Services - Standard 3: Management and staffing. 2. The service should ensure that peoples' daily living needs are adequately identified in the 'About Me' so that staff help people meet these consistently. National Care Standards, Housing Support Services - Standard 3: Management and staffing. Grade: 4 - good Quality of staffing Findings from the inspection There had been a number of changes to the structure of this service in the last year. This means that staffing has been more consistent and there has not been the turnover in staff we had seen before. Sleepovers in one part of the service have also stopped. This has allowed staff to support people more consistently, with less need to plug gaps at the last minute. There are still of course some issues, to cover holidays and sickness, in both Arboretum and other parts of the organisation, but staff are now better prepared to do this work. page 4 of 10

5 Most people told us that they were happy with their staff and that they had the skills and training to work well with them. Some feedback does suggest that a few people using the service still need better consistency in how they are supported, but having the same group of staff using an improved working file should help ensure greater consistency is achieved. Staff 1:1 support and supervision meetings are now taking place consistently, every three months. Some staff felt this was enough but others thought more frequent meetings would be better (and some did meet a team leader more often). We suggested that in an outreach service it is helpful to have more regular contact to ensure that managers are aware of what is being done and any concerns staff have. Staff did however, tell us they felt able to contact their team leader at any time for support, as well as each other in the team. We saw that some informal meetings were recorded and added to supervision notes. Sometimes these were where people raised a concern a concern. At other times where a concern about staff was being followed up. It was positive to see these issues being managed and recorded, often in very good detail. Training is regular and we saw staff had completed (or were about to) ASIST, which helps staff work with people who have suicidal thinking. Staff said they found this training very helpful. We had talked about this training at an earlier inspection and it was good to hear that it had happened. Staff again raised concerns about how to work well with people who also had mental health problems. Mental health awareness training had not happened. The Manager agreed to help access suitable training that would consider how to support people with autism and aspergers (recommendation 1). Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service should ensure that all staff training needs are met, including relevant and specific mental health awareness training. National Care Standards, Housing Support Services, Standard 3 - Management and staffing. Grade: 4 - good Quality of management and leadership Findings from the inspection We saw that there was more auditing being completed for the working files, helping ensure these were up to date, that daily reports were present and that support plans were evaluated. Much of this is done by the key worker and monitored by the team leader. We saw that efforts were being made to have consistency and that all page 5 of 10

6 files were audited to a good standard. We saw that some staff had been asked to ensure evaluations and audits were up to date. Complaints are documented better now and there is a clearer sense of how these are investigated. At this inspection the complaints we looked at had been dealt with informally and resolved, with any investigation needed recorded. We did suggest that a more formal approach is adopted to acknowledge that a complaint has been received. However, we agreed that corresponding by suited many of the people using the service too. An internal audit of the work of the service is carried out by managers from other teams in the organisation. This helps the service identify good practice and what could be improved. We saw that an action plan had been completed, identifying issues raised and what the service planned to do. Completing these tasks will help sustain improvements in the service. At feedback we discussed how staff are nurtured in this service. Team meetings are monthly but staff may only attend every other one. Formal 1:1 meetings are three monthly. Informal support is available. However, there appears to be little time given to working as a team and its development. We saw that time is tight and mainly used to provide support to people using the service, but staff also need the opportunities as a group to meet, discuss the work they do and how this should develop. The manager agreed to consider how this could be built into the training programme (recommendation 1). The service is carrying out a review of guardianship orders, to assess whether the proper legal powers are in place if a service user does not have capacity as defined in the Adults with Incapacity Act. They will also ask for copies of orders from families to help understand the powers the family member holds. This will also help the service act properly. We will follow this up at the next inspection. The service records support times in the daily notes as the overall number of hours, though these may not always be used. We suggested that the actual times of support are also recorded. This will help the service monitor how time is used and provide accurate information when needed. We looked at risk assessments and saw that, while these were adapted to meet needs following incidents, the stated date for review was often missed. It was also not clear how the risk was evaluated when reviewed, or what work had been done, by staff or the person themselves, to minimise the risk. This was in contrast to the evaluations done with other documents such as positive interventions support plans (recommendation 2). At the last inspection, we said that the provider should continue to monitor the senior role and assess whether current arrangements are adequate. The new senior arrangements had just been implemented before the May 2017 inspection and we were not able to speak to either of the seniors on this occasion. It was not possible to assess the impact of this on the smooth running of the service. We will follow-up on the senior support worker role at the next inspection to check how effective this arrangement is. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The service should consider different ways to enable team members to meet together, discuss their work and consider how the service should develop. page 6 of 10

7 National Care Standards, Housing Support Services, Standard 3: Management and staffing. 2. The service should ensure that risk assessments are reviewed within the timescale set. It should be clear how the effectiveness of these are evaluated. National Care Standards, Housing Support Services, Standard 3: Management and staffing. Grade: 4 - good 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 support plans and risk assessments are reviewed and evaluated on a regular basis, at least six monthly, and when there is a significant change in a service user's health and welfare needs. This is in order to comply with Scottish Statutory Instruments (SS1 2011/210 Regulation 5 (1) and (2) a regulation regarding personal plans. Timescale: The provider must ensure that all support plans and risk assessments are reviewed within eight weeks upon receipt of this report. This requirement was made on 11 May Action taken on previous requirement The provider had continued to make positive progress in addressing this requirement, with most reviews completed within the necessary timescales. An audit system was in use to regularly check that support plans and risk assessments were being kept up-to-date. A 'review matrix' was being used to record when each service user's review had been held, when one was due and a note to be added onto the records if for any reason a review meeting hadn't taken place (for example, if a service user hadn't turned up or the review had to be postponed for any reason). An audit check list was kept at the front of each service file so it was clear if there were any updates or amendments required. For example, adding more detail into a person's 'About Me', evaluating the support plans and checking review minutes were in the file. s were being sent to keyworkers after the audits were complete and a keyworker action plan had been developed to give staff clear guidance in what they needed, to update or amend and also to reflect on how they have involved the service user in their support planning. page 7 of 10

8 The audit showed that the majority of review meetings were in date or had been planned. It was less clear how risk assessments were reviewed and we have made a recommendation about this in Theme 4. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations There are no outstanding recommendations. 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 11 May 2017 Announced (short notice) Care and support Management and leadership 26 May 2017 Re-grade Care and support 3 - Adequate Management and leadership page 8 of 10

9 Date Type Gradings 23 Nov 2016 Announced (short notice) Care and support 2 - Weak 3 - Adequate Management and leadership 2 - Weak 4 Dec 2015 Announced (short notice) Care and support Management and leadership 3 - Adequate 10 Oct 2014 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 1 Oct 2013 Announced (short notice) Care and support Management and leadership 11 Jan 2011 Announced Care and support 5 - Very good Management and leadership 16 Sep 2009 Announced Care and support 5 - Very good Management and leadership 11 Nov 2008 Announced Care and support Management and leadership 3 - Adequate page 9 of 10

10 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 10 of 10