Carr Gomm - Edinburgh Housing Support Service Units 26 & 27 Craigmillar Social Enterprise & Arts Centre 11 Harewood Road Edinburgh EH16 4NT

Transcription

1 Carr Gomm - Edinburgh Housing Support Service Units 26 & 27 Craigmillar Social Enterprise & Arts Centre 11 Harewood Road Edinburgh EH16 4NT Telephone: Inspected by: David Todd Dave Adams Type of inspection: Announced (Short Notice) Inspection completed on: 18 May 2012

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 28 5 Summary of grades 30 6 Inspection and grading history 30 Service provided by: Carr Gomm Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: David Todd Telephone enquiries@scswis.com Carr Gomm - Edinburgh, page 2 of 32

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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well There are still lots of opportunities for people using the services to take part in groups and activities that try to make services better. We saw people using the services had very good relationships with the staff who supported them. What the service could do better The service could make sure that all staff understand what it means to work in peoples' own homes. It should ensure that, in all the ways it works, it gives people dignity and respect. What the service has done since the last inspection At the last inspection we made a requirement that hoist equipment was repaired. The service had replaced the hoists and baths and decorated the bath rooms. The service had reduced the numbers of staff on temporary or casual contracts. However a number of staff had chosen to keep the contract they had. The organisation has decided to look at how it uses its staff in each service. This will mean further staff changes. The service has tried to improve the work it is doing by finding new ways to check how good the support it provides is. Carr Gomm - Edinburgh, page 3 of 32

4 The services have changed how some of the buildings are used to separate people's homes and staff space. Conclusion The service provides a very good standard of care to people. People using the service and relatives we spoke with said they though the help they got from staff was very good. Who did this inspection David Todd Dave Adams Carr Gomm - Edinburgh, page 4 of 32

5 1 About the service we inspected Social Care and Social Work Improvement Scotland (SCSWIS) is the new regulatory body for care services in Scotland. It will award grades for services based on the findings of inspections. The history of grades that services were previously awarded by the Care Commission are also available on the SCSWIS website. Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, SCSWIS, took over the work of the Care Commission, including the registration of services. This means that from 1 April 2011this service continued its registration under the new body, SCSWIS. Carr-Gomm -Edinburgh is registered with SCSWIS to provide a combined housing support and care at home service. Support is provided to adults with a wide range of needs living in their own homes or in shared accommodation. The type of support each person receives is detailed and reviewed through a personal planning process. The number of hours of support people receive varies. There is a 24 hour on call service which people who are assessed as needing this can use. At the time of the inspection 124 people were being supported by the service. There are six staff teams within the service. Some teams provide visiting support services to individuals who live in their own homes. Others provide support services to people who live in shared accommodation or sheltered housing complexes, leased to Carr- Gomm by housing associations or by the National Health Service (NHS). People receiving support have individual tenancy agreements with Carr-Gomm. Each team has a service manager and a local staff base, or is based in the main office. All service managers report to the Operations Manager (the named manager for the service) who also works from the main office base in South Edinburgh. Carr-Gomm is a national provider which has a number of similar services across Scotland. The organisation's headquarters is in Edinburgh. Carr-Gomm states its aims are 'to help people in Scotland live in their own homes, in a safe way, to do things that they want to and try new things'. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Carr Gomm - Edinburgh, page 5 of 32

6 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. Carr Gomm - Edinburgh, page 6 of 32

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 announced (short notice) inspection. The inspection was carried out by Care Inspectorate Inspectors David Todd and Dave Adams. This took place on 25 April 2012, between 9.30am and 5.30pm, on 26 April between 9:30am and 6.30pm and between 9.30am and 6pm on 29 April We told the Managers what we found on 18 May As requested by us the care service sent us an annual return. The service also completed a self assessment form. In this inspection we gathered evidence from various sources including the relevant sections of policies, procedures and other documents including: Sampled support and care plans Reviews of support and care plans Support agreements Communication books and diaries Complaints Incidents records Accidents records Team meeting minutes Staff training Quality assurance information Minutes of meetings for People using the services Discussion with the Senior Operations Manager Discussions with four Service Managers Discussions with eight Support Staff. We visited the services based in Morningside, Merchiston, Muirhouse and Lochend. We were able to watch staff as they carried out their work. Carr Gomm - Edinburgh, page 7 of 32

8 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 report continued 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 Carr Gomm - Edinburgh, page 8 of 32

9 What the service has done to meet any requirements we made at our last inspection The requirement The service must ensure that it adheres to its conditions of registration with the Care Commission by ensuring that staff do not use a service user's home as an office base or as a venue for supervision/appraisal or other staff meetings. This is to comply with SSI 210 (2011) Section 4(1)(b) - Welfare of users: Providers shall provide services in a manner which respects the privacy and dignity of service users. It is also in accordance with: National Care Standards - Care at home, Standard 4 - Management and staffing and Standard 9 - Private life, and National Care Standards - Housing support services, Standard 3 - Management and staffing arrangements and Standard 7 - Exercising your rights What the service did to meet the requirement The service had made changes to the locations of staff space in the services. This meant that staff did not hold meetings in the spaces that were part of the homes of people using the service. This also meant staff could use a separate entrance although at feedback, we discussed how staff should do this and how people using the service should be asked about this. We were concerned that some staff said they thought the rooms in peoples' homes could be used for staff meetings. We have asked Managers to ensure staff understand this should not be happening. This was agreed. Overall we thought enough progress had been made and the requirement had been met. The requirement is: Met Carr Gomm - Edinburgh, page 9 of 32

10 The requirement The provider is required to ensure that the hoist equipment used in the bathrooms is in working order and regularly serviced and checked in keeping with Lifting Operations and Lifting Equipment Regulations (LOLER). This is in order to comply with SSI 210 (2011) 4(1)(a) - provision for the health and welfare of service users. Timescale: within one week of receipt of this report. What the service did to meet the requirement This requirement had been met. Please see statement 1.3. The requirement is: Met Inspection report continued The requirement The provider is required to ensure the administration of medicines to service users is appropriately managed and recorded. This is in order to comply with SSI 210 (2011) 4(1)(a) - provision for the health and welfare of service users, and SSI 114 (2002) 19(3)(j) -records -medicines. Timescale: within 24 hours of receipt of this report. What the service did to meet the requirement This requirement had been met. Please see statement 1.3. The requirement is: Met What the service has done to meet any recommendations we made at our last inspection 1. The service should ensure that support plans and reviews are signed by the person using the service and/or their representative. National Care Standards, Care at Home, Standard 2 - The written agreement and National Care Standards, Housing Support Services, Standard 4 - Housing support planning. Please see statement 1.3. Carr Gomm - Edinburgh, page 10 of 32

11 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic 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 the service provider had completed this and with the relevant information 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 they planned. The service provider told us how the people who used the care service had taken part in the self assessment process. Taking the views of people using the care service into account We sent out 60 SCSWIS Care Standards Questionnaires to people using the service and their relatives. 14 were returned by people using the service. Comments included: 'I am happy with my keyworker' 'am not happy here...hope for a move Eight people strongly agreed and seven people agreed that 'overall, I am happy with the quality of care and support this service gives me'. One person disagreed with this statement. We spoke with six people during the inspection. People were very positive about the support they received. Comments included: 'I am happy with my house' 'staff help me with my cooking... better than in hospital' ' very happy with staff '. Carr Gomm - Edinburgh, page 11 of 32

12 Taking carers' views into account We sent out 60 SCSWIS Care Standards Questionnaires to people using the service and their relatives. Two were returned by carers and relatives. Comments included: 'communication could be better' 'staff turnover too high' 'overall good standard of care' Inspection report continued We spoke with relatives who thought that the standard of care and support was good. They said that the opportunities for activities were around but sometimes there didn't seem to be enough staff to get people out. Carr Gomm - Edinburgh, page 12 of 32

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: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths People using the service had detailed support and care plans and guidance for staff in how they wanted their care provided. Plans were of a high standard. People said they were able to comment on their care and support and agree changes. Examples were given where the timing of the service or staff member was changed to meet individual requests. People therefore had regular opportunities to improve the quality of their support. The evidence showed people using the service and their families were fully involved in discussions about the care they wanted and changes to it. People we spoke to said they were always involved in their reviews. One relative we spoke to said they were invited to review meetings. They said they were pleased that the care given was good. They thought the Manager listened to their views and acted on them. As part of the review people were helped to think about what involvement they wanted in their own care and in influencing the organisation. This was recorded in Personal Involvement Plans. People we spoke to talked about how they were involved in different activities and groups. These included making up questions for interviews, designing the 'perfect support worker' and 'publicising the organisation and its work'. People using the service met regularly with Managers and we saw that these were very good relationships. This meant people were able to comment on and influence the quality of their care, support and staff. This information was used to make changes to the service provided when required. Staff we spoke to were able to describe how they supported people using the services to take part in different group meetings and forums. The organisation had developed many different ways people and their relatives could be involved. These included Carr Gomm - Edinburgh, page 13 of 32

14 * joining in planning and working groups * joining in special groups to comment on specific aspects of work * helping recruit new staff * the annual general meeting * being a member of the organisation's Board * being a member of the organisation, with voting rights The organisation had a clear commitment to ensure peoples' views were heard. If people had difficulty making their views known staff encouraged people using the service to make use of advocates. An advocate is independent of the service and helps a person make their wishes clear. The service had good links with a local advocacy service. This service provided advocates to a large number of people throughout Carr-Gomm services. Sixteen CI Questionnaires were returned by people using the service, their carers and families. Three people strongly agreed, nine people agreed and two people disagreed that 'the service asks for my opinions about how it can improve'. Areas for improvement When we looked at the personal involvement plans it was not clear whether and how these had been reviewed. These were not dated or signed consistently. We discussed this at feedback and the Manager agreed to ensure this happened. The service could consider how it could use external consultancy to help people using the services assess and improve it. This would give a more independent view of how well the services are doing. The service could consider how to demonstrate how people using the services and staff feed into the self-assessment. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths Inspection report continued People using the services had individual care and support plans. These contained detailed information about the health needs each person had, listing which health professional and staff member was responsible for the care. Each person had a key worker who was responsible for ensuring care plans were up to date and that people and their relatives were involved in this process. People we spoke to said relatives were invited to reviews Carr Gomm - Edinburgh, page 14 of 32

15 Plans sampled evidenced how staff helped people using the service to meet their health needs. These included supporting people to make appointments with their GP or other health professionals, attending appointments and supporting people to manage appointments or procedures they found difficult, for example attending hospital. The services showed how they kept supporting people who had to spend time in hospital. Staff we spoke to said they were very familiar with the health needs of people using the service. Staff were able to discuss health problems that had affected people using the service, how they had dealt with these and how they had included the person in the discussion. For example we were told how staff and a specialist team worked together with one person to develop a specific plan to help them cope better. Staff talked about work practices that supported people to develop their skills and abilities. This would mean, for example, some people using the service could choose to move on to less supported settings. Carr Gomm was able to provide a range of services to meet peoples' needs and abilities. People using the service said they thought staff understood their health and wellbeing needs well and supported them to have these met. People using the service were helped with taking medication in different ways. Sometimes they took it themselves. Sometimes staff helped by reminding people. In some services, for some people, staff were responsible for managing the medication. Whenever possible, peoples' medication was stored securely in their own rooms. This meant they could take it in private. The organisation supports staff to carry out their work in this area. It has a medication policy and procedure. It requires staff to complete workbooks. These provide guidance to staff working in care at home and supported living settings to manage medication with the person using the service to meet their needs and when possible, to increase independence. Staff said they were trained to carry out any specific procedures to meet peoples' needs. At the last inspection we saw the bath hoists and condition of bathrooms were no longer adequate to meet the needs of people using the service. We were told people using the service had not been able to use one bath hoist for some time. This meant people were not able to use the bath and their choices in personal care were not fully met. Since then new baths have been installed and one bathroom refurbished. The other room is to be finished shortly. The requirement has been met. Carr Gomm - Edinburgh, page 15 of 32

16 Areas for improvement The service said it wanted to make support plans more outcome focused. This would make work done measurable. At feedback we discussed how risk assessments could have this focus as well, to help people and staff work together to reduce risk. At the last inspection we had seen that in a sample of files and medicine records some gaps in recording were noted where there were no explanations. On this visit we did not notice any errors. However when we looked at incident reports we saw that a number of mistakes were still occurring. These were confirmed during visits to the services. However there was evidence services monitored giving medication and staff practice. We saw that staff were asked to think about why the mistakes had happened. We saw further training was given when mistakes were identified. We thought the service had made enough progress since the last inspection and the requirement had been met. We also saw that where medicines given on request were asked for (PRN medicines), when a service user thought they needed it, or when staff thought they did, the reason why it was given was not recorded in the medication record (see recommendation 1). At the last inspection we looked at a sample of personal plans. Some did not have signatures of people using the service or their representatives, to show their agreement to reviews and notes. We again found plans where they were not signed nor an explanation given (see recommendation 2). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The service should ensure that the reasons for giving medication when required (PRN medication) are recorded in the medication administration record. National Care Standards, Care at Home, Standard 4 - Management and staffing and Standard 7 - Keeping well - medication. 2. The service should ensure that support plans and reviews are signed by the person using the service and/or their representative. National Care Standards, Care at Home, Standard 2 - The written agreement and National Care Standards, Housing Support Services, Standard 4 - Housing support planning. Carr Gomm - Edinburgh, page 16 of 32

17 Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service strengths The service was performing at a very good level in this quality statement. We looked at a number of support plans for people using the different services. These were easy to understand. People using the service had active roles in developing their care and support plans. The plans we sampled were well developed and provided detailed information about how the people using the service wanted their needs and wishes met. Where people had difficulty communicating their needs, the service used different methods, related to each person, to identify needs and develop ways to meet these. For example staff had identified and recorded meanings attached to gestures, expressions and behaviours people using the service used. Staff were then able to use this guidance to communicate more effectively with the person. This information also provided guidance for new staff members. When possible people used communication tools like Makaton as well as communication notebooks, picture books, symbols and talking mats. We were told about examples of how different ways had been found to work with people who were not able to say what they wanted. We saw that, in one service we visited, staff gave the people they worked with a lot of attention. By doing this they were able to understand peoples' needs and choices. The service had an introductory pack. This provided information about different Carr- Gomm services and how to apply. This meant people and their relatives were able to read relevant local information. People using the service also had a written agreement. This stated, for example, the number of hours people had support for, the costs and the service's responsibilities. Staff we spoke to said they thought they communicated with each other well. They used a number of ways to do this including; * communication book or diary * work planners * mobile phones * text messages * contact with the Manager for visiting support staff * reading file notes * talking to each other Inspection report continued Carr Gomm - Edinburgh, page 17 of 32

18 * team meetings. These methods helped ensure peoples' needs were met and any changes were known to all staff. Each service had different ways to let people know who was supporting them. Some files we looked at noted how important this was for some people who did not want strangers to come. Some people were given staff rotas in advance. If changes had to be made staff would contact the people concerned to let them know. Communication materials were produced in a number of formats. These included large fonts, picture formats and DVDs and audio. The services were developing other methods to help people communicate Areas for improvement At the last inspection we said the services used communication books to ensure important information was passed between staff, managers and people using the services. We were concerned about the quality of some entries, language used and confidentiality. In this inspection we again, in a few examples, saw some entries containing information that should have been recorded in personal files. We spoke with the Manager about this. They agreed and said they would speak with staff to ensure information is properly recorded. At the last inspection we noted progress was being made to ensure people using the services were supported by smaller teams of workers. Because of staffing changes and the need for flexibility in planning rotas these improvements had not been completed. We were told that the services were trying out a system where people using the service could choose which staff they wanted to work with them each day. This would ensure people using the service knew who was working with them. This would benefit communication and continuity. This work is still in progress and we will monitor how it has progressed at the next inspection. At feedback we discussed the different ways the service could help people manage keeping their property safe in similar ways to how they helped people manage medicines. This would mean that people using a service would not have to come to an office to ask for their things. The service agreed to think about other ways to help people achieve this (see recommendation 1). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Carr Gomm - Edinburgh, page 18 of 32

19 Recommendations Inspection report continued 1. The service should develop ways of working to ensure that the privacy and dignity of people using the service is respected. National Care Standards, Care at Home, Standard 4 - Management and staffing and Standard 9 - Private life. Carr Gomm - Edinburgh, page 19 of 32

20 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Please also see statement 1.1. People using the service we spoke to said they had been involved in interviewing new staff. They said they were supported to do this. Peoples' relatives were also involved. Training was given to help people manage this role. The recently appointed Senior Operations Manager said she had been interviewed in this way. People using the services are encouraged to take part in staff training sessions. For example, in its self assessment, the services highlighted that people using the service take part in recovery awareness training and are part of the Wellbeing and Recovery Group. Areas for improvement The service should continue to develop the ways that people they support are involved in recruitment and in training opportunities. Ways should be found to support people to provide consistency in these activities. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Staff said training was very good. They had access to five days formal training each year. This included refresher days for mandatory training as well as training directly relevant to the work they were doing. A wide range of relevant training was offered. This included mental health first aid and adult protection training. Carr Gomm - Edinburgh, page 20 of 32

21 The organisation remained committed to helping staff gain Scottish Vocational Qualifications (SVQs) at levels 2 and 3. The service told us 28% staff had completed the award and another 11% were working towards them. Some staff were waiting for the opportunity to begin the qualification. Staff were encouraged to use the training packs the organisation had. Topics included infection control and medication. Staff discussed how they used the packs for example in team meetings to develop practices. When possible people using the service attended these meetings. This meant they could learn about the topic and give their views about how staff could work with them. Staff said they had joint review meetings with their manager four times each year in line with the organisation's support and supervision policy. They said they found the meetings helpful. One of the four meetings was used as an appraisal. Staff said they would discuss if they had achieved their own objectives from the previous year, set new ones and plan their training for the year. Staff said they could speak to their managers at any time if they had problems or issues. Some managers recorded these meetings. This helped show how support was given (see areas for improvement, statement 4.2). Areas for improvement We saw that while training for staff was very good there were sometimes limits to the training that relief and casual staff were able to attend. The service should ensure that all staff are able to attend training they need to do their work. The service told us that it planned all staff 'attend and refresh their 2-day training in person-centred approaches and that each worker will have their core training assessed and booked on refreshers accordingly'. Core training is training staff must do to ensure they can do their job well. We saw that while most staff were attending joint review meetings and had annual appraisals this was not consistent across all the services. At feedback we were told more appraisals had been completed. The services should ensure this continues (see recommendations, statement 4.2). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Carr Gomm - Edinburgh, page 21 of 32

22 Service strengths 16 SCSWIS Questionnaires were returned by people using the service. Ten people strongly agreed, five people agreed and one person disagreed with the statement that 'staff treat me with respect'. The 'Your Welcome Handbook' said that 'our work is based on a strong value framework, choice, control, interdependence, openness and honesty and respect. The relationships we build with people we support are underpinned by putting our values into practice'. People we spoke with and their relatives said they thought this was how staff worked and that their view were respected. Staff said they were treated with respect in their teams. This meant team meetings were productive, supportive and ideas and views were listened to. This was important to ensure the service was able to offer positive support and understanding to people with different mental health and other needs. Staff and people using the service were able to have discussions in private whenever required. All information was treated in confidence, although the reasons why confidentiality may have to be broken were discussed, for example, when a person was at risk of serious harm. Carr Gomm had staff conduct policies. These reflected the National Care Standards and Scottish Social Services Council codes of practice. Staff we spoke with said respect was a key to their work and that this supported the ethos of the service. Staff we saw in their work were respectful of the people they were supporting, were attentive to them and listened to their views and opinions. Areas for improvement Inspection report continued At the last inspection we continued a requirement that the homes of people using the service should not be used as office space, for team or other staff meetings. Some changes have been made by individual services. These included changes to the layout of premises to remove rooms that had previously been used for staff offices. Overall we were told meetings did not take place in the areas that were peoples' homes. However some information we were given suggested some shared areas could be used for staff meetings. This implied the requirement was not clear for some staff. Managers agreed to raise these issues to ensure all staff were aware of how they needed to work. In addition we were concerned that some practices recreated an office within a service. For example some goods were kept by staff in an office and people using the service had to come to the office to ask for them. This practice contradicted the positive work done for example in ensuring each person had their medication in their room or flat. During feedback Managers discussed some of the reasons for this and Carr Gomm - Edinburgh, page 22 of 32

23 agreed to speak with people using the services to find other ways to help them look after their possessions (please see recommendations, statement 1.4). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm - Edinburgh, page 23 of 32

24 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths People were supported to attend a range of Forum meetings. Forums are where people using the service, relatives, staff and people from other agencies meet together with a particular purpose. The meetings cover different topics and have included issues such as 'direct payments'. Staff encourage people to get information and comment on how they are affected. People are also asked to say whether the meeting worked well for them. If not meetings formats are adjusted to make them better in the future. We spoke with people who had taken part in the Forums. They said they had got a lot from them and found them 'helpful and informative'. At the last inspection we said a number of people using services have chosen 'direct payments' to manage their support and give them more control. The organisation had appointed a Manager to develop how these services are given and to encourage and support people who wanted to take on this responsibility for themselves. The organisation has an Involvement Manager. It is their job to encourage people to participate in assessing and improving the services, at all levels. We saw that people using the service took part in different groups and their views were fed into the organisation. We were told how the manager had used different methods to help people who found it difficult to give their views. Areas for improvement The service should continue to develop the ways that people they support are involved in improving how each service is managed. Ways should be found to support people to provide consistency in these activities. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We involve our workforce in determining the direction and future objectives of the service. Carr Gomm - Edinburgh, page 24 of 32

25 Service strengths Staff said they had joint review meetings with their manager four times each year in line with the organisation's support and supervision policy. They said they found the meetings helpful. One of the four meetings was used as an appraisal. Staff said they would discuss if they had achieved their own objectives from the previous year, set new ones and plan their training for the year. Staff said they could speak to their managers at any time if they had problems or issues. Some managers recorded these informal meetings. This helped show how support was given. The service gave us an annual return. We saw that there had been a number of staff changes. We also noted the services still used a high number of casual or relief staff and, in some services, agency staff. Staff and relatives commented about how this affected the consistency of service, especially where a person wanted to have the same staff. Managers we spoke with said the organisation was responding to peoples need for this. It was planned to make posts permanent and use fewer relief and casual staff. The reasons for this included * improving the service for people using it * greater consistency * less need to use agency staff * better flexibility for each service * improving employment practices. These changes continue to happen. We looked at the minutes of team meetings in some of the services we visited. These showed that meetings took place regularly in most services and that staff were able to attend. Staff we spoke with said they could talk about any issues affecting their work and that their views were welcomed. Areas for improvement Inspection report continued We spoke to staff about how they had been involved in the self assessment of the services that was completed for the Care Inspectorate before this inspection. Staff did not think they were involved. The service could consider how to improve staff involvement in this. We looked at a number of joint review notes from each of the teams we visited. Sometimes we found that meetings had not taken place for some months. We were told that one reason for this was that staff had been moved between teams. We were told Managers were trying to complete appraisal meetings. It is however important that these meetings take place consistently (see recommendation 1). When we spoke with staff we were told that, as part of team re-structuring, some were being offered the chance to leave the organisation. They said this was creating more uncertainty for them, although they also said they thought the service to Carr Gomm - Edinburgh, page 25 of 32

26 individual people was not affected. However this would mean some staff would move between teams and that would mean another change for people using the services. We saw that in one service attendances at team meetings were small. Although minutes of the meetings could be passed on to those who were not there, discussions were limited by this. We thought each service should try to find ways to increase participation. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should ensure that joint review sessions and annual appraisals take place for all staff, in line with the policy of the organisation. National Care Standards, Care at Home, Standard 4 - Management and staffing. Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths Inspection report continued Please also see statements and 4.1 for other relevant information. The organisation has a commitment to providing quality services. The Business Plan for identified a number of methods to monitor the quality and effectiveness of service delivery, staffing, management and systems in use. These ranged from people using the service appraising staff to monitoring by the local authority. We saw there was an increased emphasis on measuring outcomes. The Edinburgh services have identified specific service objectives. These include increasing the opportunities for people using services to 'hear/share information about their service, the organisation and external strategic issues that impact on their lives'. This action followed requests from people using the service. Service Managers and staff were able to identify monitoring systems within teams. These included the monitoring of financial and medication records daily, weekly or monthly. Actions had been taken where issues were identified. In addition the Operations Manager carried out financial checks in each service quarterly. We spoke to the Managers in each service we visited. We asked them how they knew that the service they were providing was good enough. They said they knew the people using the service well and that they talked with people often. As they knew Carr Gomm - Edinburgh, page 26 of 32

27 people well they became quickly aware if anything was wrong and take action as necessary. As we went round the different services we saw that Managers had built up good relationships with the people using the service. Issues identified locally are recorded in a computerised information management system. The system is called Carista. Managers are required to record monitoring information, including: * incidents and accidents * complaints * support agreements and reviews * statistical information about numbers of people supported and hours used * staff issues, including grievance and disciplinary information. This information was checked by senior Managers. The self assessment sent to us by the service stated 'any issues that are highlighted are collated into action plans'. These feed into National, Edinburgh Management Team and business planning. Areas for improvement We were shown examples of the new outcomes care plans that were being tried. We saw staff were recording notes that showed how outcomes were being met. We saw that people using the service could say what they thought and that this was also written down on a monthly basis. We were told that this information would be used to show how far the plans each person had made had been met. This would mean the reasons for changes to care and support plans would be recorded. The organisation plans that more people using the services have an 'outcomes' plan in the coming year. We will monitor their progress at the next inspection. The organisation should continue to develop how it monitors each aspect of each services work. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm - Edinburgh, page 27 of 32

28 4 Other information Complaints There has been one complaint about the service since the last inspection. We made one requirement: The provider must ensure that all service users have access to an up to date copy of their support plan. This is to comply with The Social Care and Social Work Improvement (requirements for care services) Regulations 2011/210 5(2)(d) - Personal plans - subject to paragraph (3) a provider of a care service must notify the service user and any representative consulted under paragraph (2)(c) of any such revision. This is also in accordance with the National Care Standards - Housing support services, Standard 4 - Housing support planning. Time scale: This requirement should be completed within four weeks of receipt of this letter. We looked at care plans and spoke with Managers and staff. We also spoke with people using the services. We saw that people were aware of the review of care plans and that a copy of the plan was given to the person. A copy of the plan was also kept at the office when the service visited people in their own homes. The requirement has been met. We made one recommendation: It is recommended that support staff consult service users' support plans thoroughly when supporting them so that they are fully aware of how the service users would like to be assisted. National Care Standards, Housing Support Services, Standard 3 - Management and staffing arrangements. Staff said they knew about peoples' support needs and that they could contact the on-call Manager if problems arose. Managers told us they tried to ensure people were visited by regular staff and that people using the service had a choice in this. In future people using the services, in particular the visiting service, will choose which staff are coming to support them. These staff will form part of a small team who regularly Carr Gomm - Edinburgh, page 28 of 32

29 support the person and have good knowledge about them. Staff are told to ensure plans and notes are up to date. The recommendation has been met. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Carr Gomm - Edinburgh, page 29 of 32

30 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement 3 Statement Very Good 5 - Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement 3 Statement Very Good 5 - Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement 2 Statement Very Good 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 16 Jun 2011 Unannounced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 4 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 30 Sep 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 5 Mar 2009 Announced Care and support 6 - Excellent Staffing 5 - Very Good Carr Gomm - Edinburgh, page 30 of 32

31 Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Carr Gomm - Edinburgh, page 31 of 32

32 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 SCSWIS. 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@scswis.com Web: Carr Gomm - Edinburgh, page 32 of 32