1st Class Care Solutions Limited Support Service Care at Home Argyll House Quarrywood Court Livingston EH54 6AX Telephone:

Transcription

1 1st Class Care Solutions Limited Support Service Care at Home Argyll House Quarrywood Court Livingston EH54 6AX Telephone: Type of inspection: Unannounced Inspection completed on: 13 March 2015

2 Contents Page No Summary 3 1 About the service we inspected 6 2 How we inspected this service 8 3 The inspection 13 4 Other information 28 5 Summary of grades 29 6 Inspection and grading history 29 Service provided by: 1st Class Care Solutions Limited 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 1st Class Care Solutions Limited, page 2 of 30

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 During our inspection we saw some good interactions between care staff and the people they support. We also heard some positive feed back, from individuals who received support and from family representatives, focusing on the quality of the 1st Class Care staff team and the effectiveness of their care delivery. There were some good examples of how the service responded flexibly and proactively to people's changing care needs and circumstances, initiating assessment for equipment and referring for additional supports from health and social care professionals. We saw some good examples for the service working collaboratively and integrating advice and care guidance from health care professionals into care planning for some of the people they work for, promoting positive health outcomes. We also heard how consistency of staffing in some packages of care had facilitated positive relationship building for some service users, supporting and enabling individuals to access community based networks and resources. The provider has undertaken a commitment to promoting a programme of Scottish Vocational Qualification (SVQ) training for all staff employed in the organisation. We noted that a number of staff had undertaken or completed SVQ courses. 1st Class Care Solutions Limited, page 3 of 30

4 What the service could do better Inspection report continued In the course of the current inspection year, the Care Inspectorate have initiated two separate complaints investigations about 1st Class Care, In one enquiry we made two requirements, focusing on safe recruitment practice and staff induction processes/ training provision. We upheld elements from the second complaint investigation, focusing on a missed visit, a lack of care plan in one service users home and a lack of rota notification for service users around scheduled visits. We did not make any formal recommendation or requirements during this second enquiry. Our inspection showed that the provider has met one of the requirements, developing and implementing a safe recruitment procedure and applying this in respect of all new employees from the time of the complaints investigation. However, they must improve their evidencing of their evaluation of staff competency to carry out essential care tasks and develop a structured staff training schedule that will ensure that staff are equipped to deliver good quality support. We saw that all the care files in the service users properties that we visited had care plans in situ, we noted that service users were given rotas in advance and we did not hear any further concerns around missed visits. The provider should improve its care planning documentation, ensuring that that all care plans adequately describe service users needs and that there are clear and relevant links between the care plans, risk assessment and care review documents used in the service. Care planning documents should place a greater emphasis on goal setting and evidencing outcomes for people who use 1st Class Care services. We have identified areas for improvement around the quality and frequency of care reviews. We observed that some service users had not had a review within the timeframe indicated by statutory regulation. The documentation of care review discussion was very brief and did not adequately describe the complexity of care delivery and the support issues for the individuals concerned. During our inspection we considered the timing of scheduled support visits. When we looked at service users care files, we saw some areas for improvement around adhering to agreed support times. This was confirmed to us through our discussion with service users and family representatives. 1st Class Care Solutions Limited, page 4 of 30

5 The provider must ensure it adheres to regulatory requirement in respect of appropriate levels of notification of accidents and incidents to the Care Inspectorate. What the service has done since the last inspection This is a newly registered service and this report reflects findings from it's first inspection. Conclusion 1st Class Care is a new company, seeking to establish themselves as a care at home provider in the West Lothian area. The evidence from inspection highlighted some areas of good performance, particularly in respect of relationship building with service users and their family carers. We also heard some very positive feed back from service users around the providers flexible and responsive care delivery strategy. We have identified areas for improvement around care planning and the depth and detail of information contained in associated documentation. There are further areas for development in respect of staff training and evidencing service user engagement and participation in assessing the quality of support received. 1st Class Care must build upon areas of existing good practice and ensure that they address areas for improvement outlined in this report. 1st Class Care Solutions Limited, page 5 of 30

6 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was previously registered with the Care Inspectorate in March 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. - 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 Inspectorate. 1st Class Care Solutions are registered with the Care Inspectorate to provide support to people in their own homes. The service is available to people with a range of personal care needs. At the time of the inspection the primary client support base focused on adults aged over 65. The service is provided to people living in the West Lothian area of central Scotland. At the time of this inspection, support was being provided to four people. The staff office is also based in Livingston. Staffing cover is provided between 7am and 11pm, seven days/week. Service users were able to contact staff by telephoning the office base in between support times if needed. The following is an extract from the service's aims and objectives: "1st Class Care Solutions Limited aim to support older people who are in need of care. To live as safely and comfortably within their own homes. We will actively encourage independence, dignity, privacy, choice and wellbeing of all our Service Users. Our objective is to deliver a high quality service. Developing relationships that will actively encourage our Service Users own wellbeing, which we aim to achieve and maintain throughout our service. 1st Class Care Solutions Limited, page 6 of 30

7 Providing a high quality service will give our clients the confidence that 1st Class Care Solutions Limited are a responsible and well structured care Company. We aim to employ a professional Management team and excellent carers, they will assist us with their knowledge, skills and attitudes to become recognised. Their loyalty and commitment to the Company and its Service Users, will ultimately lead us to provide the highest quality care service". 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. 1st Class Care Solutions Limited, page 7 of 30

8 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We took into account information from the annual return, evidence gathering tool and self assessment that we asked the provider to complete and submit to us before inspection. We also considered the details from fourteen service user questionnaires and seven staff questionnaires, which we send out as part of our pre-inspection information gathering. We looked at: - A sample of the service's policies and procedures, including: - Protection of Vulnerable Adults policy - Safer Recruitment Policy - Whistleblowing Policy - Complaints Policy - Medication Policy. We also considered: - Minutes from staff meetings - A sample of the service user care files - Accident/incident reports - Staffing rotas and the staffing schedule - Medication recording procedures - A sample of staff recruitment and training records. We carried out face to face interviews with: - The service manager - The training co-ordinator - Three support workers. 1st Class Care Solutions Limited, page 8 of 30

9 During our inspection we visited the homes of a four service users and observed staff practice during care delivery. We met and discussed service provision with one family representative. We carried out telephone interviews with one carer and two service users. 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 1st Class Care Solutions Limited, page 9 of 30

10 What the service has done to meet any requirements we made at our last inspection The requirement The Provider must ensure that the service is delivered in a manner that meets service users' needs safely. In order to achieve this, the Provider must ensure that staff, at all levels including Managers, are suitably trained for the work they are to do. In order to achieve this, the Provider must maintain a record of each member of staff's training and be able to demonstrate that: - Training has been provided - The training was suitable - Those delivering the training are accredited to do so - Staff have evidenced their knowledge of and can implement the training received. This is in order to comply with Scottish Statutory Instrument (SSI) 2011 No 210, Regulation 4(1(a), Welfare of Users and 15 staffing a regulation which ensures staff are trained for the work they are to perform and that they are competent to provide such care. Timescale for Implementation: The Provider is required to submit to the Care Inspectorate a staff induction and training policy by 16 March What the service did to meet the requirement We saw that the provider had initiated a structured programme of induction for all new staff and that this involved competency to carry out effective care delivery. We noted that the training co-ordinator is now in post and that they have completed an accredited "train the trainer" qualification. The provider submitted a suitable induction and training policy as per requirement. The requirement is: Met - Within Timescales The requirement The Provider must be able to demonstrate that those employed in the care service have been safely recruited to the position they hold. In order to achieve this, the Provider must produce and submit a recruitment policy for 1st Class Care Solutions Limited which outlines the recruitment processes including the interviewing, selection 1st Class Care Solutions Limited, page 10 of 30

11 and checking of references and other documentation for all persons to be employed in the provision of the care service. This is in order to comply with Scottish Statutory Instrument (SSI) 2011 No 210: 9(1) & (2)(b) - Fitness of Employees; Scottish Social Services Council Codes of Practice for Employers of Social Service Workers 1.1; 1.2; 1.3 and 2.1 and Safer Recruitment Through Better Recruitment Scottish Government What the service did to meet the requirement The provider has developed and submitted a suitable recruitment policy to the Care Inspectorate. They have followed regulatory guidance in respect of the recruitment of all staff subsequent to the complaints investigation and it's associated requirement. The requirement is: Met - Within Timescales Inspection report continued What the service has done to meet any recommendations we made at our last inspection Not applicable 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 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. The provider submitted a completed self-assessment, which we considered as part of our information gathering for inspection. We did not see any evidence for service user involvement in compiling the self-assessment. The self-assessment data did not always link directly to the quality statement it related to. We observed that the evidence presented, particularly in relation to service strengths tended to be descriptive, lacking evaluative qualities. Taking the views of people using the care service into account "The carers are good with my husband and very reliable" "Without the staff at 1st Class Care, I wouldn't have been able to stay at home after 1st Class Care Solutions Limited, page 11 of 30

12 I left hospital" "They don't always answer the phone when I call, nor do they call back when I leave a message" "The office said that they were unaware of a missed visit" "Staff are consistent and reliable, they work effectively and delivered care respectfully." Taking carers' views into account We spoke directly with one carer during our inspection. They were full of praise for the staff team at 1st Class Care, saying that they had done a very good job of supporting her husband, carrying out tasks effectively and delivering support with respect. We spoke with a different carer in a telephone interview. They said that they had some issues with missed support visits and poor communication with the office. The missed visits caused stress and led her to question whether she could depend on the service to visit as agreed. 1st Class Care Solutions Limited, page 12 of 30

13 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 saw that there had been reviews of packages of care provided and noted that the review format supported some comment on the quality of care and support provided by the service. There was evidence to demonstrate that the views of service users and their family representatives were considered during review and we saw some changes to care planning and care delivery as a result of these inputs. We heard some very positive comments from service users and their carers around their participation in the design of their care package. Some of the care plans we looked at showed good evidence for personalisation, in the language of the document and in terms of the care delivery strategies employed to provide effective support. One family carer told us how 1st Class Care staff had helped promote good health outcomes for a family member. They highlighted positive relationship building between service user and care staff as an important contributory factor, going on to praise the consistency of staffing and their professionalism. The carer said that the effectiveness of the support delivered had helped sustain them in their role of primary caregiver. During this discussion we heard that the family representative was closely involved in the design of the care plan and that they had provided a significant level of guidance around care delivery strategies. During our inspection we looked at service evaluation questionnaires, sent to service users and their family representatives. 1st Class Care Solutions Limited, page 13 of 30

14 We saw some very good feedback, focusing on quality of staffing and the flexible approach to care delivery. The service questionnaires used a quality grading system and supported comment on how to improve the quality of care from the people who use the service. The registered manager advised us that they always aspire to working in partnership with people using 1st Class Care. They highlighted an example of this in the quality audit visits they routinely carry out during the initial weeks that followed the commencing of a package of care, seeking service user views on the effectiveness of care delivery and their inputs on how to improve the service provided. During our inspection fieldwork we asked service users and their family representatives if the quality audit visits were useful. We heard evidence which demonstrated their participation in bringing about improvement, particularly in respect of changes to the times of scheduled visits and partnership working around delivering effective care. Areas for improvement When we considered the care planning documentation we saw a number of care plans where the written information did not adequately describe the complexity of the care needs or the challenges associated with providing effective care for the individuals concerned. The provider should ensure that there are clear and relevant links between all documentation used for care planning and service review. We highlighted this during discussion with the registered manager, also referring to the need to emphasise goal setting and outcomes based evaluation in care planning and care review. A focus on an outcomes based appraisal would support the service and service user to evaluate their care inputs and consider the effectiveness of care delivery strategies. We have made a recommendation on this issue. We asked service users and their carers about the consistency of staffing in the service and the reliability of visits times. We heard some concerns about the frequency of late visits and the lack of consistent staff cover when the core care team were not working. When we looked at the times of scheduled visits on care plans and compared this to the entry times in the daily progress notes used to detail care delivery, we saw that 1st Class Care Solutions Limited, page 14 of 30

15 there were some packages of care where there were high levels of late visits and a lack of consistency in staffing. We have made a requirement about this. Whilst we saw that service reviews had taken place in all of the care plan sample we looked at, we noted that there were several examples where reviews had not taken place in accordance within the timeframe indicated in the statutory legislation. We discussed this with the registered manager and we have made a requirement, focusing on the need to hold reviews at intervals not exceeding six months. The service should adequately document the findings from their own quality audit visits to service users, ensuring that they record the views of people who use the service. They should also evidence the sharing of the audit visits findings with them. This is an area we will follow up at our next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 1 Requirements 1. Requirement Inspection report continued The Provider must ensure that the service is provided at the agreed times, and in such a way that meets the identified needs of the service user as recorded in the agreed support plan. This is in order to comply with The Social Care and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Scottish Statutory Instrument 210, Regulation 3, a Regulation relating to the main principles to be promoted by providers and services and Regulation 4(1)(a) a Regulation regarding the welfare of service users. In making this requirement account has been taken of the National Care Standards for Care at Home; Standard 4 (6): Management and staffing. Timescale for implementation: to commence on receipt of this report. 2. The provider must ensure that service reviews are carried out a minimum of six monthly intervals. Reviews must evidence participation and sharing of information with all relevant parties involved in that person care and support. 1st Class Care Solutions Limited, page 15 of 30

16 This is in order to comply with The Social Care and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Scottish Statutory Instrument 210, Regulation 5 (2) (b), a Regulation relating to Personal Plans. Timescale for implementation: to commence on receipt of this report. Recommendations Inspection report continued 1. Care planning documentation should accurately reflect the support that is provided. There should be meaningful focus on goals and outcomes derived from the service provided. Care plans should link directly to risk assessments and the format used for service review. Service reviews should place some emphasis on establishing the views of the service user as to the effectiveness of care delivery. The National Care Standards-Care at Home, Standard 3-Your Personal Plan. 1st Class Care Solutions Limited, page 16 of 30

17 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We saw evidence which supported the integration of the advice and care guidance from a range of professionals from community and health based services into care plans and care delivery strategies. We saw the implementation of guidance from a speech and language therapist into care delivery for one individual, noting that this advice was reflected in updated care planning documentation and in the daily progress notes held in the working file in the service users home. We noted that the service had pro-actively sought additional care inputs for some people they work for, referring directly for occupational therapy assessment around aids and equipment and seeking District Nursing inputs around health issues for another service user. We also heard from a family representative about helpful information giving, which supported and enabled an individual to access community based services for social and recreational purposes. Several service users spoke warmly about the care team that provides supports for them. We heard how care delivery had enabled one person to keep well, stay safe and remain resident in their own home following an episode of ill-health. We also heard some very positive feedback from a family representative, saying that the delivery of effective support helped alleviate the challenges associated with being a primary care giver to an individual with complex physical and cognitive issues in their presentation. When we looked at care plans we saw some good evidence for support around wider aspects of health and well being. We noted that some people were using the service to facilitate social and recreational outings, accessing resources that required transport and assistance with moving and handling. When we considered information from pre - inspection information gathering questionnaires, we heard some positive feedback around 1st Class Care assisting an individual to attend their General Practitioner and appointments with other health and community based services. 1st Class Care Solutions Limited, page 17 of 30

18 When we looked at the staff training schedule we saw that all staff had training on medication recording and administration, adult support and protection, whistleblowing procedures and infection control and moving and handling. All the staff we spoke to during inspection said they were confident that they could raise any concern around the safety of a service user in respect of safety and adult protection. Areas for improvement When we looked at the services accidents and incidents records, we saw a number issues that had not been notified to the Care Inspectorate. We highlighted to the manager that the service must ensure that they keep an adequate record of accidents/ incidents and provide notifications to the Care Inspectorate, as per regulatory guidance. We have made a requirement around this issue. Prior to our inspection we were aware that the provider had been subject to an enquiry by the Care Inspectorate's Complaints Team, focusing on concerns around safe recruitment and staff induction and training. Part of the complaint was upheld and we made a requirement which focused on recruitment. During this inspection we looked closely at staff recruitment practices. We saw that the provider has now addressed the required areas for improvement. Previously we saw gaps in the uptake of staff references before commencing employment, we also noted that some employees had not completed job applications, albeit that the provider had ensured that all new employees had undertaken Protection of Vulnerable Group checks. We looked closely at all recruitment that had taken place since the time of the complaint's enquiry. We noted that the provider had developed their own safe recruitment policy and that they had adhered to it, follow recruitment based best practice, interviewing and taking up references for all prospective new employees before offering them work. We consider safe recruitment to be an essential element in meeting people's wellbeing needs and our grading under this quality statement took into account the provider previous poor performance around this issue. We shall follow up on safe recruitment as a focus area in our next inspection. 1st Class Care Solutions Limited, page 18 of 30

19 Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements 1. The Provider must ensure: Accident and Incident reports are completed in a timely manner and where applicable, notification reports are sent to the Care Inspectorate. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulation 2011, Scottish Statutory Instrument 2011/210: regulation 4(1) (a) - welfare of service users. Timescale-From receipt of this report Inspection report continued 1st Class Care Solutions Limited, page 19 of 30

20 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 We heard from the service manager that she meets and discusses care delivery and staffing with all prospective service users prior to commencing any package of support. One service user advised us that they had been introduced to the core staff who made up the care team and she was invited to speak directly about care issues and how to deliver effective support. Several service users told us that they found 1st Class Care responsive to their verbal feed back. They were able to raise issues directly with care staff at the point of care delivery. They were also confident about contacting the service manager by telephone and discussing any issues or concerns with them. We heard how the provider is approachable and amenable to these informal inputs and we were advised of changes to visit times or personnel that had arisen from this type of discussion. We have discussed other relevant areas of strength in Quality Theme 1 - Statement 1 of this report. Areas for improvement We highlighted areas for development where the provider could promote greater levels of service user participation in improving the quality of staffing at 1st Class Care. One area for consideration would be for service users or their carers to be directly engaged in the recruitment of new staff, perhaps by taking part at an appropriate stage of the interviews of prospective new employees. 1st Class Care Solutions Limited, page 20 of 30

21 If there is a reluctance from service users or their carers to participate directly in the interview process, the provider might consider facilitating an exercise which elicited service users' questions for use at interviews. These questions could perhaps include a focus on the qualities and attributes required for care staff. Although we heard from the registered manager that they value approachable and accessible systems for service users to feed back and improve the quality of staffing at 1st Class Care, we did not see evidence to support the importance of the verbal dialogue. We would suggest that the provider records the main detail of these discussions and effectively demonstrates how this involvement dialogue results in improved outcomes around service user participation in improving the quality of staffing in the service. The provider should consider ways in which they can promote the involvement of service users in respect of staff training, One area for consideration would be to support direct participation in staff training by people who use the service and their family representatives. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued 1st Class Care Solutions Limited, page 21 of 30

22 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths During our inspection we saw evidence which demonstrated that the provider was investing resources in staff training. They had recently recruited a member of staff to the post of training co-ordinator. The person concerned had previously been employed in a care setting and they have undertaken an accredited "Train the Trainer" qualification. The training co-ordinator is now closely involved in planning and delivering all staff induction and refresher training. We saw that the provider has invested in creating a dedicated training resource at their main office base. This room has been equipped with a range of recently purchased equipment, including hoists and hospital style beds. The service has devised a new induction programme which is part of mandatory training for all new recruits and this should ensure that all employees are assessed as competent to carry out essential care delivery tasks. We looked at induction training structure and saw that it comprised of a mixture of practical and theoretical assessment. The provider used a mixture of visual and written resources to deliver elements of the training schedule, with written examinations around each key area of practice. Staff were required to have shown understanding of the issues and pass all the written work before being considered as competent to deliver care. The practical training schedule included assessment of competency around moving and handling, use of aids and equipment and medication administration. We saw evidence which demonstrated that the provider had shown commitment to its staff's wider training needs. The training policy highlighted their aspiration that all staff would be qualified to a minimum of SVQ level 2 and we noted that there were a significant number of staff undertaking this course at the time of inspection. We saw this as a positive development, one which will help ensure that staff practice is underpinned by a strong knowledge base. 1st Class Care Solutions Limited, page 22 of 30

23 When we observed staff practice during care delivery visits, we saw that they worked with respect and a clear awareness of the support needs of the individual person they were providing care to. Staff used appropriate language and good communication skills during these engagements. Areas for improvement Inspection report continued Earlier in this report (Quality Theme 1 - Statement 3) we highlighted how the Care Inspectorate had investigated and upheld a complaint about safe recruitment practices and the efficacy of staff training. We have detailed the requirement we made around training in the relevant section of this quality statement. Whilst we have described improved performance around this requirement and now consider the provider to be currently meeting its commitment to achieve acceptable performance in this area, we will consider this closely at our next inspection. We would suggest that 1st Class Care place a greater emphasis on evidencing their staff induction competency documentation, providing clear evaluation of new recruits abilities to put the training into practice effectively during care delivery. Whilst we saw evidence to support that competency evaluation was taking place during the staff induction process, the analysis and recording would benefit from a greater depth of detail. The provider should ensure that they sustain current adequate levels of performance and meet their aspiration for very good practice in this area. When we looked at staff supervision and appraisal records we saw that the provider had not always adhered to their own policy of offering 1:1 supervision on at intervals not exceeding eight weeks or of providing all staff with an annual appraisal. We consider 1:1 supervision to be an essential element in promoting good staff practice, offering a platform for reflective and practical discussion around care delivery issues and in supporting the identification of training and other developmental needs. We have made a recommendation that supervision and appraisal is offered at time intervals in line with the providers own policy and associated best practice guidance. Although we saw that there had been some staff meetings, these had not taken place at regular intervals. Staff meetings provide a forum through which staff can offer their views on service development and improvement. highlight challenges in their own work and share good practice. 1st Class Care Solutions Limited, page 23 of 30

24 Team meetings may also be used to promote staff knowledge of the National Care Standards and other relevant guidance and information. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements 1. The Provider must ensure that the service is delivered in a manner that meets service users needs safely. In order to do this, the Provider must ensure that staff, at all levels including Managers, are suitably trained for the work they are to do. The Provider must also maintain a record of each member of staff's training and be able to demonstrate that - Training has been provided - The training was suitable Inspection report continued This is in order to comply with Scottish Statutory Instrument (SSI 2011, 210, Regulation 4 (1) (a), Welfare of Users and 15, Staffing-a regulation which ensures that staff are trained for the work they are to perform and that they are competent to provide such care. Timescale for Implementation-to commence upon receipt of this report and to be met within three months thereafter. 1st Class Care Solutions Limited, page 24 of 30

25 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 During inspection we heard that the service manager takes an active role in care delivery. They take a direct role in care delivery. They said that this allowed them insight into challenges associated with care delivery, supported evaluation of staff practice and the efficacy of training and it also helped build relationships with service users and carers, providing another means of them offering their views on the quality of management and leadership in the service. Further issues around service strengths in relation to this quality statement have already been discussed in Quality Theme 1 - Statements 1 and Quality Theme 3 - Statement 1. Areas for improvement The provider should ensure that it develops a system for recording and tracking any care related incidents or issues raised by service users and their representatives, delegating responsibility to a named member of staff for following up any action point and feeding back to the service user concerned. We have discussed this with the registered manager and we will follow up the progress made at our next inspection. We have highlighted areas for improvement relevant to this Quality Theme 1 - Statement 1 and Quality Theme 3 - Statement 1 of this report. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 1st Class Care Solutions Limited, page 25 of 30

26 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 saw that 1st Class Care have an appropriate complaints procedure, with complaint response time and individual responsibilities and accountability for any required actions clearly delegated and outlined. We noted that service user care files and support agreements had information on how to raise a complaint, with the provider directly or to the Care Inspectorate. We heard from the registered manager that they were developing a system of audit in respect of the care planning documentation and daily progress notes. This internal audit will include discussion with stakeholders as to the quality of support provided and ways in which it can be improved. The audits will take place in between care reviews and should help ensure that people who use the service have a voice outwith the review process. Areas for improvement We suggested to the registered manager that the service should seek to develop and expand their current strategies for involving stakeholders in quality assurance processes. This is particularly relevant in respect of evidencing the views of the professional they have contact with. Whilst we did see some quality assurance evaluation from service users and their carers, there were none from external professionals or service commissioners. We suggested that the provider ensures that quality assurance based questionnaires are sent to all agencies that provide care inputs for the people they work for and that 1st Class Care evidence that they have sought the views and opinions of all stakeholders. The provider should consider developing a system for obtaining feed back on the quality of service provided, from its own staff group. A questionnaire would provide a useful format for this, particularly if responses could be anonymous. One area for consideration would be to develop areas of the providers website. This is a potentially valuable resource and 1st Class Care could embed a quality assurance questionnaire or "survey monkey" for completion by any stakeholder. This would support a system of continuous feed back around the quality of the service. 1st Class Care Solutions Limited, page 26 of 30

27 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued 1st Class Care Solutions Limited, page 27 of 30

28 4 Other information Complaints The Care Inspectorate investigated and upheld a complaint in relation to safe recruitment procedures and staff induction and training. There are two requirements from the complaints enquiry and we have detailed these in this report. We saw from our inspection that the provider has met the one of the requirements. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information No additional information recorded. 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). 1st Class Care Solutions Limited, page 28 of 30

29 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. 1st Class Care Solutions Limited, page 29 of 30

30 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: 1st Class Care Solutions Limited, page 30 of 30