Allied Healthcare (Scottish Borders) Housing Support Service Unit 3 Annfield Business Centre Teviot Crescent Hawick TD9 9RE

Transcription

1 Allied Healthcare (Scottish Borders) Housing Support Service Unit 3 Annfield Business Centre Teviot Crescent Hawick TD9 9RE Type of inspection: Unannounced Inspection completed on: 12 June 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 14 4 Other information 27 5 Summary of grades 28 6 Inspection and grading history 28 Service provided by: Nestor Primecare Services Ltd trading as Allied Healthcare 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 Allied Healthcare (Scottish Borders), page 2 of 29

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 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well The service continues to function best where there are established working relationships and individuals are supported by core teams of staff with whom they have built up a positive rapport. We found some good examples of this in action. We also found examples of good working relationships between staff and relatives to ensure the needs of individuals were being met. We observed staff providing positive care in a range of settings. What the service could do better Whilst recognising the progress made following previous regulatory activity this report makes additional requirements where further improvements are needed. The priority for the service must be to ensure that people are receiving care at the times allocated and staff are able to stay consistently for the length of times identified in assessments of need. The service should ensure that information provided through their "call monitoring" system is audited to identify any problems. This information should be used to correct any shortcomings to ensure people are consistently getting the care they need at the times they need it. The report also refers to improvements which need to be made in accessing "call monitoring" on call records regularly to respond to any missed visits. Improvements are needed in recording incidents. Further improvements are also needed to ensure that support plans consistently provide staff with information on meeting the needs of service users. Allied Healthcare (Scottish Borders), page 3 of 29

4 Service users need to know the names of staff visiting to provide their care. This information should be provided consistently. What the service has done since the last inspection Considerable work has been undertaken to improve support plans. This was reflected in the improved support plans we found in all of the service users homes we visited. The service provider was also continuing to address issues of recruitment and retention. This coupled with improved scheduling had improved the overall standard of the care provided. Conclusion This service is valued by the people who use it and their relatives and we received several positive comments from individuals. The service needs to build on the improvements described in the report. Improved consistency is needed and in particular in the consistency in the timing and lengths of visits. This will be monitored closely at the next inspection. Allied Healthcare (Scottish Borders), page 4 of 29

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at: This service was registered with the Care Inspectorate on 27 March The new registration was needed following the change in ownership of Allied Healthcare. Due to the previous history of weak grades achieved by the Scottish Borders service a condition was placed on the registration certificate requiring the service provider to address any requirements from previous regulatory history. These are referred to in this report. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Allied Healthcare are registered to provide at Care at Home and Housing Support Services to adults and older people. The service is provided to people living in Roxburghshire and Berwickshire. The Scottish Borders service is managed from an office in Hawick. The aims and objectives of the service provider state, "We are able to provide care and support to anyone, people who are elderly and infirm, people who have mental heath problems, people with physical disabilities and also learning disabilities. We work on behalf of Local Authorities, the NHS, the independent and charity sector as well as individuals themselves. Allied Healthcare (Scottish Borders), page 5 of 29

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate 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. Allied Healthcare (Scottish Borders), page 6 of 29

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 We wrote this report following an unannounced inspection. This inspection was carried out by two inspectors. The inspection took place on the 3 and 4 June The inspection involved shadowing staff and visiting service users homes on 3 June This allowed for observation of the service at different times of the day and in different locations. We gave feedback to the manager, their line manager and an internal auditor from the service on 12 June During this inspection process, we gathered evidence from various sources, including the following: We spoke directly with 16 people who use this service. We also spoke with five people who were relatives or friends of people who use this service. This involved both face to face and telephone contact. We spoke with 18 staff including the manager, senior staff direct care staff. This include both face to face and telephone interviews. We issued 59 Care Standards Questionnaires to people who used the service and received 31 completed returns. We issued 12 staff questionnaires and received four returns. We followed up some questionnaires with phone calls to the respondent. Comments made in returned questionnaires are referred to in this report. Documentation sampled included: Personal plans, including risk assessments Daily recording diaries. Significant incident reports. Staffing rotas. Training records. Electronic records recording visit times to service users. Recruitment and selection policy. PVG audit checklist. Allied Healthcare (Scottish Borders), page 7 of 29

8 Staff recruitment records. Staff supervision an appraisal records. Information on the timing and duration of visits held electronically on the services call monitoring system. 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 Allied Healthcare (Scottish Borders), page 8 of 29

9 What the service has done to meet any requirements we made at our last inspection The requirement Requirement 1. The service provider must ensure that service users consistently receive care as defined in assessments of need. Care must be provided for the length of times identified and at the time of day identified in assessments of need. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within six weeks of the receipt of this report. What the service did to meet the requirement Work had been carried out to improve scheduling. This had improved the service. However the services records indicated that although over-all improvements had been made some problems persisted. We continued to find examples of visits were considerably earlier or later than planned. We also found examples of visits cut short. While the scale of the problem had reduced this remains a critical issue for the service and is discussed in more detail in Quality Statement 1.3. The requirement is: Not Met Allied Healthcare (Scottish Borders), page 9 of 29

10 The requirement Requirement 2. The service provider must ensure that all personal plans are maintained to a level which ensures that staff are provided with sufficient information to meet the care needs of the service user. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within six weeks of the receipt of this report. What the service did to meet the requirement We found considerable improvements in the quality of personal plans. However some additional work is needed. A further requirement about personal planning is made in Quality Statement 1.3. The requirement is: Not Met Inspection report continued The requirement Requirement 3. The service provider must review how support is planned to individuals to ensure that support is provided consistently by staff who have time to build relationships with service users. This in order to comply with the Social Care and Social Work Scotland (requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within six weeks of the receipt of this report. What the service did to meet the requirement We found that this had continued to improve and the reorganisation of schedules had been beneficial. The requirement is: Met - Within Timescales The requirement Allied Healthcare (Scottish Borders), page 10 of 29

11 Requirement 4. The service provider must ensure that staffing levels are maintained to ensure that sufficient staff are available to meet the service levels that they contract to provide to ensure that the assessed needs of all service users are met. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within six weeks of this report being published. What the service did to meet the requirement Improvements in recruitment had been made and the service provider outlined further steps which had been put into place and which were planned to improve recruitment and retention of staff. The requirement is: Met - Within Timescales The requirement Requirement 5. The service provider must ensure that there is sufficient managerial and supervisory time within the service to ensure time is available for Quality Assurance and practice development. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 15(a) a regulation which states that at all times sufficient suitably qualified and competent persons are working in care services to meet the needs of service users. Timescale: The provider must do this within six weeks of the receipt of this report. What the service did to meet the requirement Some improvements made although a vacancy existed a the time of the inspection. A requirement is made in quality 4.4 about the need to target Quality Assurance on the timings of visits. The requirement is: Not Met What the service has done to meet any recommendations we made at our last inspection In looking at previous regulatory activity we only considered requirements. Allied Healthcare (Scottish Borders), page 11 of 29

12 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: No Inspection report continued 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 self assessment document from the service provider. We were satisfied with the way that the service provider had completed this and with the relevant information that they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes that they had planned. Taking the views of people using the care service into account All service users agreed staff treated them with dignity and respect. None could think of an instance where a visit had been missed - one thought there may have been a missed visit but not sure. Those that had the cognitive ability to remember the names of the staff who visited did so. None thought they had too many staff. Some people who used the service confirmed there were different staff at the weekend and were accepting of that. Several told inspectors there had recently been several weeks when they had not received their weekly schedule. Actual comments made included: "They're doing a grand job" "I have no complaints whatsoever" "Very pleased with the help I get" "All on the ball" "The girls look after me really well" "We couldn't ask for anything better" Allied Healthcare (Scottish Borders), page 12 of 29

13 "Really lovely people and good for my husband" "The carers are all nice ( they treat me like the Queen)" "Great respect from carers." "They always ask if there is anything else I need done." Taking carers' views into account Relatives were generally confident about the care provided and described staff as helpful and willing to listen. One individual described visits being missed. The service had acknowledged and apologised for this. Comments made included: "All staff friendly, efficient and professional." "My relatives carers are good and reliable." "The lassies are brilliant, reliable, trustworthy and caring." "If I ask them to do something in a particular way they always do it." Allied Healthcare (Scottish Borders), page 13 of 29

14 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: 3 - Adequate 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 We observed examples of good interaction and a positive rapport between staff and people using the service and their relatives in several of the properties we visited. This was particularly strong where working relationships had developed over a period of time, meaning that people using the service had been supported by regular staff. We found some examples of positive "team working" to meet the needs of individuals involving staff and relatives. The quality of personal plans had improved significantly. This had improved the way people were being supported to participate in the planning of their care. Recently completed personal plans contained information about the outcomes to be achieved for people who used the service. Personal plans also included improved recording of the personal histories of the individuals using the service. We found evidence of relatives having been consulted about the plans. We also found evidence of "Customer Quality Review" forms in plans sampled indicating the service was seeking the views of the people who used it. Service user six monthly reviews were also being held. We found the majority of reviews were up to date. Where a review had not taken place there was a reason for this. Following a review being completed a letter was sent out thanking the person using the service and their relative for their participation. This letter included a summary of any concerns raised and a commitment to action any changes identified. Individual relatives said they had been pleased by the prompt reaction of managers when they had asked for a change in staff supporting their relative. Records contained examples of contact with relatives where staff had concerns over a service Allied Healthcare (Scottish Borders), page 14 of 29

15 user's health or well being. We found that staff were supportive of service users being involved in the inspection process. A user satisfaction survey had been completed toward the end of The service had acted on the results which had included the need to ensure people using the service were reminded of the services complaints procedure. Areas for improvement We found examples of schedules not being sent out to people who used the service to inform them of the names of staff who would be providing their care. We were informed this was due to the office being short staffed. Some people who used the service had found the lack of information about who was due to visit to provide their care unsettling. (See recommendation 1) We received some comments from a relative of a service user that, following contact with office based staff, information had not been passed on to care staff. This was about the times of visit needing to be changed to accommodate a service users medical appointments. (See recommendation 2) The recent review of rotas had not involved consultation with service users. While it may not be possible to meet the preferences of all people using the service if these were recorded they could be considered when rotas were being amended. (See recommendation 3) Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 3 Recommendations Inspection report continued 1. People who use the service should consistently receive information on who is scheduled to visit to provide their care. National Care Standards. Care at home. 2. The service should ensure that any communication received from relatives is passed to the relevant member of staff for action. National Care Standards. Care at home. 3. Service user preferences on the timings of visits should be recorded and the views of users on the timings of visits taken into account when the planning of schedules is carried out. National Care Standards. Care at home. Allied Healthcare (Scottish Borders), page 15 of 29

16 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found significant improvements had been made in the area of personal planning. We found personal plans in place for all of the people who used the service who we visited as part of the inspection. The way personal plans were being compiled had led to improvements in the quality of information available to staff. The majority of personal plans sampled were typed which made information more accessible and plans took less time to read. The service was using the "My Life, My Choices." plan we found several examples of personal plan information written in the first person giving a clear message to the reader about what the individual needed. Personal plans contained regular references to the involvement of healthcare professionals. On call records and incident logs evidenced the service was making contact with social care and healthcare professionals where they had concerns about an individual's health or well being. These included references to additional equipment which could potentiality improve the quality of life of a service user. We also found evidence of staff responding well to situations where they have found a health concern which needed to be responded to, staff often staying for longer periods until help arrived. In these circumstances individuals due to be visited were informed that their regular member of staff would be late or alternative care arranged. We also found records of staff responding appropriately when they had identified health and safety concerns. Work had been carried out to improve the scheduling of client visits. An exercise had been carried out during February 2014 to make scheduling more efficient. The manager estimated that appropriately 85% of visits were now scheduled and assigned to individual staff to ensure continuity of working with service users being supported by small teams of regular staff. Both people who used the service and their relatives expressed general satisfaction when we asked about the number of staff who visited them. The trend of reducing the number of missed visits was continuing and we found evidence that where a problem occurred this was recorded and followed up on. We did find one example of this not being done correctly. This is discussed under areas for development. We found evidence of several letters from relatives that acknowledged the positive care provided. Allied Healthcare (Scottish Borders), page 16 of 29

17 Areas for improvement We did find improvements in scheduling had been made and identified a positive trend with regard to scheduling and allocating of visits. However we continued to find some examples of actual visits which were in practice a lot shorter than scheduled. We also found examples of visits taking place in excess of 30 minutes earlier or later than planned. We found some, albeit more isolated examples, of visits starting over one hour earlier or later than planned. The service needs to improve consistency in this area. This needs to be a priority for the service. Progress will be monitored in future inspection visits. Call monitoring records give a valuable insight into what is actually happening on the ground and auditing these records and responding to any issues identified needs to be a priority for the service to ensure that the needs of service users are being met. Staff also informed us it could be difficult to stick to the times in schedules. Comments made included being rushed and not enough time between visits. Staff noted that rotas had been changed to include more travel time. However some staff reported the times allowed did not always fit with the location of the homes they were visiting. This meant that too much travel time was allocated to properties which were close together while insufficient travel times had been allocated between properties a greater distance apart. (Requirement 1) We had concerns about the consistency of recording in particular the recording of incidents. In one example staff had raised a concern about a vulnerable service user. These concerns had been correctly passed on to Social Work. However this had not been logged as an incident report on the services system to ensure an audit trail of communication was being maintained. Another example which had involved missed visits to a service user on three consecutive days had not been recorded as an incident. A third example involved a medication error which had been responded to i.e. advice had been sought but the incident had not been correctly recorded. All incidents should be correctly recorded and where necessary the Care Inspectorate must be notified in line with published guidance. (See requirement 2) The incident of visits being missed on consecutive days calls into question how the call monitoring system operated by the service was being monitored. Regular checks would have identified the problem. (See requirement 3) Allied Healthcare (Scottish Borders), page 17 of 29

18 The improvements made in the overall standard of personal plans which were available in the homes of service users we visited have been noted earlier in this report. However plans sampled indicated that further work was required to improve the quality of personal planning in particular where service users or staff could be placed at risk. Problems identified at inspection included: A falls risk assessment which indicated a service user was at increased risk of falling however no action plan was in place to guide staff on ways to minimise the risk. One service user identified as someone who had a problem with alcohol whose behaviour could be erratic however no guidance had been put into place to inform staff on how to respond to ensure the safety of the service user and their own safety was being maintained. A lack of detail where a service user was identified as having a diagnosis of dementia. This included the lack of recording specific support needs, how the individual was effected by their dementia and any actions which are required by staff to minimise any identified risks. There were still a small number of handwritten personal plans, staff reported these could be difficult to read. Where new information is provided by a relative improvements were needed in how that information was being recorded in personal plans. We found examples of comments about preferred routines for people living with dementia being recorded on the front of daily record sheets. These comments should be incorporated into the personal plan. (See requirement 4) Grade awarded for this statement: 3 - Adequate Number of requirements: 4 Number of recommendations: 0 Allied Healthcare (Scottish Borders), page 18 of 29

19 Requirements Inspection report continued 1. The service provider must ensure that service users consistently receive care as defined in assessments of need. Care must be provided for the length of times identified and at the time of day identified in assessments of need. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within six weeks of the receipt of this report. 2. The service provider must ensure that all incidents which involve harm or potential harm to service users are fully recorded and the Care Inspectorate are notified in line with published guidance. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within one week of the receipt of this report. 3. The service provider must ensure that their call monitoring records are checked on a regular basis to ensure that if a visit is missed due to an error this is identified and action taken to safeguard service users. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within one week of the receipt of this report. 4. The service provider must ensure that improvements in the consistency of support planning continues and that all plans contain: Actions to minimise risk where a risk has been identified. Guidance to staff on how to respond to service users who have problems relating to alcohol. Details about how dementia effects an individual and guidance to staff on how to meet needs. Allied Healthcare (Scottish Borders), page 19 of 29

20 And that plans are updated as needs change or further guidance is received about the care needs of the individual. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within two weeks of the receipt of this report. Allied Healthcare (Scottish Borders), page 20 of 29

21 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Comments made in Quality Statement 1.1 are also relevant to this Quality Statement. We have also applied the grading of three "Adequate " awarded in Quality Statement 1.1 to this Quality Statement. Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. They should ensure that they are rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Allied Healthcare (Scottish Borders), page 21 of 29

22 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service provider was continuing to progress with additional recruitment to meet the needs of the service. Changes to staff employment conditions had been introduced and further changes were being planned to improve recruitment and retention. At the time of the inspection staffing had improved particularly in the Kelso area. The service was promoting a new "on- boarding" process for staff. Four members of staff had been trained in a mentoring role to support newly in post staff. This was designed to improve the induction process and ensure new staff were not overwhelmed. We found the newly introduced system to be operating well during the inspection. Staff who had recently started working for the service commented positively on the induction they received and said they felt prepared for their role. We received several positive comments from staff when we asked them to describe their experience of the support they received from office based staff when they needed to seek assistance or had a query. Staff commented positively on the availability of training. Training records confirmed mandatory training was being maintained. We saw examples of good training materials being used to assist with staff development. We found a range of examples of staff receiving recognition for good practice for dealing with difficult situations to support and protect service users. Staff had access to a range of policy and procedural guidance including an informative staff handbook. Areas for improvement Inspection report continued Some staff were continuing to have problems meeting their rotas due to the lack of travel time between visits although staff did acknowledge improvements had been made in this area. Additional staff were needed in the Hawick area particularly at weekends. While acknowledging some improvements staff said weekend working could be "hectic" "horrendous" and "jam-packed" with additional work being added to work rotas which were already full. This is related to the requirement made under Quality Statement 1.3. Some staff felt that sometimes office based staff could be short with them when dealing with tense situations although they did understand the pressure office staff could be under. Individual staff said they felt that they were made to feel guilty if they could not take on additional shifts. Communication between managers and staff had Allied Healthcare (Scottish Borders), page 22 of 29

23 been identified as an issue nationally through the service provider's exit interview information gathering system. Communication skills were being included in a range of managerial training to support first line managers in this role. Some staff reported that the notice for staff meetings and one to one supervision sessions could be short with little time for them to prepare. The manager confirmed at feedback that staff would normally receive at least one weeks notice in advance of a staff meeting. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued Allied Healthcare (Scottish Borders), page 23 of 29

24 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 Comments made in Quality Statement 1.1 are also relevant to this Quality Statement. We have also applied the grading of three "Adequate " awarded in Quality Statement 1.1 to this Quality Statement. Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. They should ensure that they are rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Allied Healthcare (Scottish Borders), page 24 of 29

25 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 We found improvements had been made in a number of areas. Supervision and support to the registered manager was now in place to support them further in their role. We found evidence of the work being carried out by the service provider to improve recruitment and retention including changes to employment conditions to support recruitment with additional changes being planned for consultation with staff. Management training including conflict resolution and grievance handling was being provided to office based staff. The service provider was carrying out their own internal audits. These including sampling of personal plans and staff files to confirm that correct information was in place and files were being correctly maintained. Audits included contact with people who used the service. The service was also auditing daily recording records and Medication Administration Records. Areas for improvement Inspection report continued We found on call logs could be difficult to read due to the handwriting of some staff. On call records are important documents which may need to be accessed at a later date and therefore need to be fully legible. In some instances no outcomes had been recorded in the on call log. On call logs recorded instances where service users or their relatives had raised concerns or expressed dissatisfaction however it was not clear in all cases if these had been logged on the services electronic recording system and followed up on. (See requirement 1) The manager and supervisors still occasionally had to cover for shortages on the care rota however we did find the incidence of this had reduced. We discussed at feedback the need for the service to notify the Care Inspectorate where an incident which had the potential to cause harm to a service user. The manager agreed to read the guidance and ensure notifications were being submitted as stipulated. This is included in a requirement made in Quality statement 1.1. While audits were being carried these were not targeted to ensure the service is meeting the assessed needs of service users. Problems with the timing and duration of visits were discussed in Quality Statement 1.3 with a requirement being made. Detailed information is available through the call monitoring records to audit the Allied Healthcare (Scottish Borders), page 25 of 29

26 timings and durations of visits to ensure the service is providing the correct level of support at the required time. Regular auditing of these records with the creation of an action plan to address any issues identified has the potential to be an effective tool in improving care. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. The service provider must ensure that all entries to the on call log are legible. The log must be monitored and any action items recorded to include how the issue was dealt with and resolved. This in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within two weeks of the receipt of this report. Allied Healthcare (Scottish Borders), page 26 of 29

27 4 Other information Complaints There have been no complaints about this service since it registered in March Requirements made following previous regulatory activity are included in this report. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Due to the timing of the registration, the newly registered service was not required to submit an annual return. 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). Allied Healthcare (Scottish Borders), page 27 of 29

28 5 Summary of grades Quality of Care and Support Adequate Statement 1 Statement Adequate 3 - Adequate Quality of Staffing Adequate Statement 1 Statement Adequate 3 - Adequate Quality of Management and Leadership Adequate Statement 1 Statement Adequate 3 - Adequate 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Allied Healthcare (Scottish Borders), page 28 of 29

29 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: Allied Healthcare (Scottish Borders), page 29 of 29