William Simpson's Care Home Service Adults Main Street Old Plean Stirling FK7 8BQ

Transcription

1 William Simpson's Care Home Service Adults Main Street Old Plean Stirling FK7 8BQ Inspected by: Patsy McDermott Pauline Regan Alfie Frances Type of inspection: Unannounced Inspection completed on: 7 May 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 34 5 Summary of grades 35 6 Inspection and grading history 35 Service provided by: William Simpson's Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Patsy McDermott Telephone enquiries@careinspectorate.com William Simpson's, page 2 of 37

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 2 Weak Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 3 Adequate What the service does well People living in the service spoke very highly of the staff and manager. They told us that they were treated respectfully and their right to make individual choices and decisions were promoted. We saw staff were courteous and caring in their interactions with service users and that this created an ethos of openness and warmth. What the service could do better During this inspection, we saw that the care plans were being developed to focus on person centred planning with very clear outcomes. We feel this work should continue to ensure the rights and needs of the service users remain at the centre of future planning. We also looked at medication systems and healthcare. We felt some improvements needed to be made in these areas and we have made requirements and recommendations in relation to this. William Simpson's, page 3 of 37

4 What the service has done since the last inspection The service now has a full management team who have put into place better systems to support staff and the people who use the service. There has also been many new staff recruited to the service. We saw was a robust induction system as well as clearer plans for staff supervision, team meetings, and an effective training system. There was a recommendation in the last report highlighting the need for a cooker that residents could use to develop and maintain their domestic skills. We saw this has now been installed in the activity room and there are plans to install more cookers in the future. Conclusion The service is undergoing many changes due to the recruitment of new staff; however we felt the service remains committed to an improvement agenda and improving the outcomes for the people using the service. Who did this inspection Patsy McDermott Pauline Regan Alfie Frances Lay assessor: Not applicable. William Simpson's, page 4 of 37

5 1 About the service we inspected It is suggested that this report is read in conjunction with the previous March 2013 report. As highlighted in the last inspection report, a new care home has now replaced the previous building, which has increased the registered number from 44 to 64. It operates from a purpose-built building set within its own mature grounds on the edge of Plean. The new building is on 2 floors, with 4 individual units accommodating 8 people. Each unit is self-contained and include a lounge/dining area and a kitchenette with fridge, kettle, toaster and washing machine, where people are encouraged to be independent. The bedrooms are all single en-suite with shower. Additional facilities are available such as a large café area, also used for shows/entertainment, a games room, a hairdressing salon, a variety of sitting areas on site and a library. A local bus service operates close by. One of the stated aims of the service is: "We aim to provide long-term residential care and support for service users with mental health problems and or under the effects of long-term alcohol misuse through the delivery of a quality social care service taking account of their views and preferences". From speaking with members of the management team and with staff; and examining paperwork, it was clear that the organisational and communication systems have been re-introduced. The management team provided us with an action plan to address recent operational failings. Care plan paperwork, communication systems, clear staff responsibilities, staff meetings and service user participation strategies have been prioritised to meet the long-term improvement agenda. However, at the end of this inspection some time frames for achieving all of these areas are still ongoing, therefore recommendations and requirements which have not yet been fully met, are repeated in this report. We assessed the experience of service users during observations, from records and during discussions with service users, staff and the management team. These findings are contained in the individual quality statements. 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 registered with the Care Inspectorate in May William Simpson's, page 5 of 37

6 Requirements and recommendations: If we are concerned about some aspect of a service, or think it needs to do more to improve, 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 based on best practice or the National Care Standards. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate." The Care Inspectorate (SCSWIS) is the new regulatory body for care services in Scotland. It will award grades for services based on the findings of inspections. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 2 - Weak Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. William Simpson's, page 6 of 37

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by three Care Inspectors and the Professional Advisor - Pharmacy. The inspection took place on Wednesday and Thursday 30 April and 1 May 2014 between 8:30am and 6pm. We gave feedback to the management team on Wednesday 7 May As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us. We did not send any care standards questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: Eight people living in the service. Staff on duty including: The management team board members senior care staff care staff William Simpson's, page 7 of 37

8 We looked at: * Residents' and relative questionnaires * A range of care plan and risk assessments * Accident and incident records * A sample of financial records * A sample of staff supervision minutes and appraisals * A sample of staff inductions and reviews * Maintenance records * Minutes of resident and staff meetings * Minutes keyworker meetings * Training records and Continuous Personal Development Plans (CDP) * Staff rotas * Activity records 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 Care Inspectorate received a fully completed self assessment document from the service provider. In the self assessment the provider identified what they thought they did well and some areas for development. 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 William Simpson's, page 8 of 37

9 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 William Simpson's, page 9 of 37

10 What the service has done to meet any recommendations we made at our last inspection There were 5 recommendations made at the last inspection. Progress has been made in all of the recommendations one had been met and four continued. 1. The service should develop and clearly document the systems in place for service user participation to be more inclusive and wide ranging. This should cover all aspects of the quality themes. This is in accordance with National Care Standards Care Homes for People with Mental Health Problems - Standard 5 Management and Staffing, Standard 8 making choices, Standard 10 exercising your rights. Standard 11 expressing your views, Standard 18 Supporting communication. We saw that the service had begun to develop a participation strategy that detailed some of the current ways they used to involve people in assessing and developing the service. We felt this approach appeared to be inclusive and incorporated a range methods to encourage the participation of the people using the service and their relatives. This document is in the early stages of development therefore this recommendation will continue. 2. The service should continue to find ways of documenting the positive outcomes to meet agreed goals from the care planning process. The service should continue to develop care planning to be more inclusive and person centred. National Care Standards Care Homes for People with Mental Health Problems - Standard 5 Management and Staffing, Standard 10 exercising your rights. We looked at eight personal plans during the inspection and found the files to be in good order. However, further development is required in this area. This recommendation will continue. 3. It is recommended that the service should develop and expand the range of activities available around the needs and interest of the service users. National Care Standards Care Homes for People with Mental Health Problems - Standard 4: Your environment, Standard 5 Management and Staffing. We did not fully assess activity information during the inspection. This recommendation will be carried forward and assessed at the next inspection. William Simpson's, page 10 of 37

11 4. It is recommended that the service consider the installation of cooking facilities in some of the kitchen areas. This would help people who wish to move to their own home the opportunity to learn and develop skills in relation to independent living. National Care Standards Care Homes for People with Mental Health Problems - Standard 4: Your environment Standard 5 Management and Staffing. We saw a new cooker had been installed in the activity room and there were plan to install more in some of the units. This recommendation had been met. Recommendation with reference to Theme 4, Statement 4: 5. Service users should be given more opportunities to assess and improve the quality of leadership and management within the service. National Care Standards Care Homes for People with Mental Health Problems - Standard 5 Management and Staffing. This recommendation had not been met. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. 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 Care Inspectorate received a fully completed self assessment document from the service provider. In the self assessment the provider identified what they thought they did well and some areas for development. Taking the views of people using the care service into account We spoke to a group of service users and four people individually who were all very happy with the quality of care they received. Comments included "I get on fine with staff they look after me." Taking carers' views into account We did not speak to any relatives during the inspection. William Simpson's, page 11 of 37

12 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: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: "Resident Meetings are typically held monthly and in the new home will be in groups of no more than 8 people. SU quality assurance surveys are undertaken leading to service improvement outcomes. SU are also consulted on specific service improvement areas such as ideas for activities, grant aid submissions, what their ideal home would be like or menu reviews. Some SUs have advocates to assist them and some staff have received training in advocacy." From observation of practice, discussion with staff and service users and examination of core documentation we found the service was operating at a good level in this area of practice. We found there had been more progress made by the service involving service users with their care plans. The staff team confirmed that service users were encouraged to contribute to the care planning process and were supported to meet their own identified goals. Regular care reviews take place and we found that records and minutes show a high level of involvement from service users, their family and significant others. This meant the service was able to seek people's views about if the care still met people's needs, quality of staff and any changes that were required. William Simpson's, page 12 of 37

13 Risk assessments were held in peoples' care plans. The detail contained had substantially improved since the last inspection. They were more robust and had clear records held regarding changing needs and increased/decreased risks. We saw that staff received a comprehensive induction that focussed on the need for service users to be fully involved in the planning of their care. Service users had the opportunity to contribute to service developments through resident and keyworker monthly meetings. The service used surveys to ensure service users and their relatives had the chance to give feedback on the service and contribute to future developments. We saw a letter had been sent to service users and their relatives informing them about the results from the survey. Suggestions about more activities and outings and the introduction of the "you said, we did" format for resident meetings had been introduced which helped to improve the outcomes for the residents and their families. We felt the management team were aware of the need to involve people in all aspects of service delivery and were making steady progress in this area therefore we have assessed this statement a good. Areas for improvement In the self assessment submitted by the service the manager had identified the following areas for improvement: "Work towards much more person centred care planning. Developing SU participation e.g. in recruitment. We have encouraged SUs to become Members of the Company." Inspection report continued We felt the management were able to identify the measures required to make the service more inclusive. The work on developing a participation strategy (this is the service's plan for how they will involve service users) and an action plan which timetables the agreed changes should continue. See recommendation 1, quality statement 1.1. William Simpson's, page 13 of 37

14 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should develop and clearly document the systems in place for service user participation to be more inclusive and wide ranging. This should cover all aspects of the quality theme. This is in accordance with National Care Standards Care Homes for People with Mental Health Problems. Standard 5 - Management and Staffing. Standard 8 - Making choices. Standard 10 - exercising your rights. Standard 11 - Expressing your views. Standard 18 - Supporting communication. William Simpson's, page 14 of 37

15 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: "Prior to SUs entering the Home, there is a robust assessment procedure with involves Written Application, Medical Information and full Social Work Assessment. Pre-visiting and / or assessment visits are made to ensure that we have all the appropriate information available. SUs are observed for food and fluid intake levels and if there are concerns, staff will discuss and encourage appropriate dietary intake and discretely record. Dietician advice is sought where there are concerns. Where SUs agree, staff record weights / BMIs to monitor for significant change and seek assistance from the GP or dietician where appropriate." During the inspection we examined some of the evidence presented, we looked at eight personal plans, information in the self assessment and we observed practice. We felt the although the service promoted the health and wellbeing needs of service users there were some areas which needed immediate improvement. We have graded this statement as weak and felt the service was not always meeting the stated aims of the service. We looked at eight personal plans during the inspection. Not all the plans examined contained a review that had been undertaken in the preceding six-month period. Due to the changing health and welfare needs of the residents, these lapses could have a significant impact on the welfare of service users. See areas for improvement below. There was evidence that staff support and encourage service users' health and wellbeing needs through one to one time, discussions, and advice about lifestyle choices and decisions. This included healthy eating advice, support managing finances and the benefits of exercise and physical activity. Health and wellbeing needs had been included in the programme of activities provided in the service. For example, one service user had been volunteering in the garden and this had led to a placement with Stirling Volunteer Agency. Staff had supported the resident throughout this process and he was very proud he could now attend on his own and maintain his independence. William Simpson's, page 15 of 37

16 Risk assessments monitored and evaluated health risk areas and care needs such as nutrition, falls, restraint, pain, behaviour, activity/social interaction and skin care. We felt these were mostly accurate in reducing risks. We saw creative examples of how people are supported to manage their money on a weekly basis, be involved in menu planning and food choices, plan holidays, outings and events. This meant that service users are able to maintain involvement at a level consistent to their wishes and ability. Staff attended a wide variety of training related to health and wellbeing which supported their practice on a day-to-day basis and ensured service users receive the appropriate care. This included, Nutrition, Adult Support and Protection, Administration of medication and Moving and Handling. The provider had a broad range of updated policies and procedures to support service users' health and well-being needs. Areas for improvement In the self assessment submitted by the service the manager had identified the following areas for improvement: "Developing SU participation e.g. in recruitment. We aim to increasingly personalise the model of care with the aim of promoting more use of SUs individual skills in day-to-day living." We saw that the management of the service had done a lot of work to improve the care planning process and the files we sampled were of a good quality, however, further development of personal centred planning should continue. The service should continue to develop its person centred approach to care planning and care delivery further. This recommendation from the last inspection will be carried forward and assessed at the next inspection. See Recommendation 1. It was unclear to us whether some of the resident's healthcare needs had been followed up. For example when someone's weight was decreasing there was no evidence to suggest this had been reported to or actioned by the senior staff. See Recommendation 2. Most of the personal plans we looked at had been reviewed monthly with the service user and the keyworker. However, we saw not all the six monthly reviews had been completed therefore a requirement will be made. William Simpson's, page 16 of 37

17 The new management team had identified that none of the carers who had been managing and administering medication had a formal qualifications. This has been addressed by the senior staff commencing the SVQ Level 3 qualification (HSC 375/ CHS3(HSC 375/CHS3). However this SVQ qualification is now usually done in conjunction with a higher national unit (F9D9 34) Administration of Medication which is the underpinning knowledge to compliment the more practical SVQ. The outcome of the combined award is Professional Development Award [PDA] Administration of Medication at SCQF level 7. Currently only senior carers administers medicines to be taken by mouth with care staff applying creams and ointments. We felt that all staff needed to have qualifications appropriate any medicines management of administration tasks they were expected to do. As some creams and ointments contain strong medicines such as steroids and antibiotics it important that they are applied correctly and per the prescribers instructions and there is guidance for how long they should be used for. This should be regularly reviewed by the care workers and the prescriber. See recommendation 3. We found several occasions where medicines were out of stock for significant periods of time. Some residents regularly did not take their prescribed medication as they did not want to, however staff had recorded that it had been administered. This was discovered when medication was found in hidden by the resident. Consideration needs to be given about the mental capacity of the resident and their right to refuse their medication. Where people are identified as not taking some of all of their medication it is important to know which medicines are not being taken and why. It would then be appropriate to seek the resident's permission to get medical advice. The medication recording documentation used in the home is designed to provide an audit trail for a 28 day period covering what medicines were received into the home, taken or refused and left at the end of the cycle for disposal or continued use. However staff did not fully understand how to use the documentation so there was no complete audit trail to account for the medication. We found several instances where record stated that more doses were given than had been is stock which suggested records may have been made although the medicines was not given or that borrowing from another person had happened. William Simpson's, page 17 of 37

18 The recording documentation for creams and ointments did not include information like the start date of the treatment, duration of course, when it had to be reviewed and where to be applied. There were two examples of tranquillisers prescribed as "four times a day when required" being given regularly twice every day. It was difficult to determine if this regular use was with the prescriber's authority and if so why did the instruction on the prescription not reflect this. We observed a member of staff handing a resident two tablets, rather than transferring then into a medicines pot to give to the person. This was an example of poor medicines administration practice. Within the care plans we examined it was difficult to find which residents had hospital consultant, community psychiatric nurse, dermatology and contact with other healthcare professionals on input and when they had last been seen by these specialists. It was also unclear when some were last seen by their GP for a level three medication review. The record kept by staff of healthcare professional visits had wording like "seen by GP"; "seen by DN [district nurse], but not naming the professional involved or why they had been seen and the outcome. We gave the manager copies of guidance about medication recording and care plans; the use of monitored dosage systems and NHS Scotland polypharmacy guidelines. Grade awarded for this statement: 2 - Weak Number of requirements: 3 Number of recommendations: 3 Requirements 1. The provider of the care service must ensure - That there is an audit of all residents input from external healthcare professionals to identify those with input from NHS specialists/consultants, community psychiatric nurses, the GP and other members of the primary health team such as dietitians, occupational therapists and other allied professionals. These should be provided to the Care Inspectorate on a monthly basis. This is in order to comply with: SSI 2002/114 Regulation 4 (1)(a) - a requirement to make proper provision for the health and welfare of people, and (b) provide services in a manner which respects the privacy and dignity of service users. SSI 2002/114 Regulation 5(1) - a requirement to have a personal plan which sets out how the service user's health and welfare needs are to be met. Time scale for completion: To commence immediately and to be completed within two months from receipt of this report. William Simpson's, page 18 of 37

19 2. The provider must demonstrate that safe systems are in place for the management and administration. In particular, the provider must: * ensure medication is administered at regular intervals as instructed by the prescriber and in line with the resident's lifestyle and daily routine. * ensure that where a medication is to be given "as required" to manage an emotional or mental health need, that the medication is administered in accordance with a clinical need of the individual. * provide services in a manner which respects the privacy and dignity of service users * ensure that sufficient stock of medicines is available and accessible, and that medicines are stored securely * keep records of medicines for the use of service users which are received This is in order to comply with: SSI 2002/114 Regulation 4 (1)(a) - a requirement to make proper provision for the health and welfare of people, and (b) provide services in a manner which respects the privacy and dignity of service users; SSI 2002/114 Regulation 19(3)(j) - a requirement to keep a record of medicines kept on the premises for service users. SSI 2002/114 Regulation 9(2)(b) - a requirement that a provider shall not employ a person who does not have the qualifications skills and experience necessary for the work that the person is to perform; SSI 2002/114 Regulation 5(1) - a requirement to have a personal plan which sets out how the service user's health and welfare needs are to be met. Time scale for completion: To commence immediately and to be completed within two months from receipt of this report. 3. The Provider must ensure all service users' health and welfare needs are fully reviewed at least every six months or sooner if the service user's care and support needs change. In addition the Provider must be able to evidence these reviews and any changes to a service user's care and support which have taken place. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), regulation 5 (2) (b) Personal Plans and Regulation 4(1) (a). Welfare of Users. Time scale for completion: To commence immediately upon receipt of this report. William Simpson's, page 19 of 37

20 Recommendations Inspection report continued 1. The service should continue to find ways of documenting the positive outcomes to meet agreed goals from the care planning process. The service should continue to develop care planning to be more inclusive and person centred. National Care Standards Care Homes for People with Mental Health Problems - Standard 5 Management and Staffing, Standard 10 exercising your rights. 2. The service should clearly document the actions taken and progress made when residents have identified healthcare needs. This is in accordance with National Care Standards Care Homes for People with Mental Health Problems - Standard 5 Management and Staffing. 3. That management should consider enrolling all staff who are involved in the management and administration of medicines in the Professional Development Award [PDA] Administration of Medication at SCQF level 7. This is in accordance with National Care Standards Care Homes for People with Mental Health Problems - Standard 5 Management and Staffing. William Simpson's, page 20 of 37

21 Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: "Keyworkers hold meetings with SUs monthly at which service development is discussed and their views recorded. We use these views to help us improve the environment. On occasion we ask for specific views and ideas through questionnaires such as when we make grant aid applications, menu changes or seek views on activities." We sampled written evidence, feedback from management, staff and service users, and found this service to have a good performance in relation to this statement. The service users that we talked to were pleased with the environment and the people who use the service told us that they are very happy living there. We spent time sitting with service users to see how staff responded to people and we also spoke to staff about people they support. We found some good examples of staff being attentive and caring to people. Access to advocacy services was promoted and we saw examples of active involvement with service users. This level of involvement offers additional support when making decisions about key aspects of their lives. Overall, we found the service was performing at a good level for this statement. William Simpson's, page 21 of 37

22 Areas for improvement As mentioned in previous reports, some people cannot easily express their opinions on the quality of the environment. The service need to continue to demonstrate that they are meaningfully seeking all people's views in relation to the environment and other quality themes. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 William Simpson's, page 22 of 37

23 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Inspection report continued The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: "Every Service user who remains in residence after their 6 week assessment period has a written contact of residence. During the assessment period, keyworkers help SUs orientate and settle into their surroundings. They also go through key policies and information following a '6 week audit' format a copy of which is kept in the SU personal files once completed. This is normally archived after the initial review to ensure that the working file is kept as current and relevant as possible." There was evidence that environmental audits and maintenance checks were carried out regularly. We saw that the decoration of the environment was of a high standard and the service users we spoke to were very happy with their surroundings. We found that the service had a good level of performance in relation to this statement. Accommodation was provided in smaller living spaces of eight people. This approach reflects good practice and is also viewed as being particularly helpful to people with dementia ('Designing and managing care homes for people with Dementia', Cantley & Wilson, 2002). Each of the flats were found to be very homely in relation to soft furnishings and the layout of lounge/dining areas. The service had measures in place to maintain service users' safety. These included individual risk assessments in service users' personal plans and well documented accident and incident reports. We saw that these were up to date and used to support people safely. The risks to residents were reduced by the implementation of the services policies such as Care of Medicines, Control of substances hazardous to health, Waste management, Food safety, Manual handling, Restraint, Health and Safety and Prevention of abuse. We found that the organisation had all appropriate health and safety policies and procedures in place. William Simpson's, page 23 of 37

24 We could see that maintenance checks were routinely carried out and weekly and monthly meetings showed that the service was proactive in identifying any health and safety issues. Keeping this under regular review promotes safety measures being maintained only at the level necessary to meet their current needs so that the management of risk does not become a barrier to the experiences the service user. During the inspection we saw that some areas were being repainted. When we asked the maintenance person about this, he advised the building is painted every few months to keep the environment clean and fresh. We observed that the residents had a very high quality environment. When we spoke to service users they all said they were very happy with the decoration of the communal areas and their individual bedrooms. We saw that staff consistently demonstrated appropriate infection control and manual handling procedures which ensured the comfort and safety of the residents. We saw a safe recruitment policy and procedure was in place providing evidence in support of safe recruitment. Staff training records indicated training opportunities in a range of safety topics, including: * Health and Safety * Moving and Handling * Infection control * Food and Nutrition Clear policy and regular training on health, safety and hygiene matters promote staff continuing to follow safe, practice according to legislation and current guidance. Regular training updates on protecting service users promote staff remaining aware of their responsibility to report concerns following standard procedures which are set out in the policies of the service. A valid public liability insurance certificate was displayed in the main entrance of the home. William Simpson's, page 24 of 37

25 Areas for improvement In the self assessment submitted by the service the manager had identified the following areas for improvement. "Our transition plan facilitated a smooth and safe transfer to the new Home. SUs are frequently reminded of the need for care and there is appropriate signage in place without detracting from the homely environment." During an examination of activity information we saw that a photo album had been created and a weekly planner developed. We felt it might be more useful for the service to add a narrative about the photographs and distribute them to the residents involved. It would also be useful to see more information on how activities provided reflect individuals' needs and wishes. This would help in the evaluation of activities for each person. We did not assess this area during the inspection therefore this recommendation will continue and be assessed at the next inspection. See recommendation 1, quality statement 2.2 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. It is recommended that the service should develop and expand the range of activities available around the needs and interest of the service users. National Care Standards Care Homes for People with Mental Health Problems - Standard 4: Your environment, Standard 5 Management and Staffing. William Simpson's, page 25 of 37

26 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as "Service Users participate in the recruitment and selection process. Feedback from service users participation in this process is noted on the applicants documentation. Views of Service Users and Carers are continuously sought by various means. Where required, advocacy can be accessed to provide independent support. When new staff are being recruited, they are often invited do trial shifts or work trials in conjunction with the job centre. This allows us to better assess their suitability for the job and to obtain feedback from Service Users, Carers and colleagues." We sampled written evidence, staff files and feedback from management, staff and service users, this service was found to have a good performance in relation to this statement. An annual organisational training plan was in place. Part of this and local training/ working groups reflected the duties of care staff and the needs of service users. Service users had the opportunity to be involved in recruitment and selection procedures for new staff. The range of methods highlighted in this report in Quality Themes 1 & 2, Statement's 1, Service Strengths are also relevant to how service users and carers can participate in assessing and improving the quality of staffing in the service. William Simpson's, page 26 of 37

27 Areas for improvement In the self assessment submitted by the service the manager had identified the following areas for improvement. "We are always seeking to improve and develop our staffing and cascade information and suggestions or feedback through our Supervision sessions and meetings framework. SUs participate in the recruitment process and we aim to develop appropriate ways of participation through development and implementation of our participation strategy." Please refer to recommendation 1 under Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued William Simpson's, page 27 of 37

28 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: Records of individual staff achievement and training are maintained and staff are required to take responsibility for maintaining their own CPD records also in their own portfolio receiving support as appropriate. If staff leave they are invited to discuss any issues at an exit interview which may be formal or informal. There is a schedule of meetings at all levels within the organisation. There is an ethos of communication throughout the organisation and we ensure that staff are kept appropriately informed through the various meeting forums, training sessions and individual supervision sessions." During the inspection, we saw in written documentation and in discussion with the manager, staff and service users that the staff team were a valuable asset to this service. Staff were confident in talking about their day-to-day role and confirmed that they worked from a strong value base. We felt that the service evidenced a good performance in this area. A range of systems were in place that supported staff learning and development. These included team meetings, supervision, open door management, and on-going training opportunities. Staff meetings were well attended and up to date information about the service and the people who use it was shared. We examined a number of supervision records during the inspection. These confirmed that this was used as an opportunity for reflective discussion on practice as well as providing an opportunity for sharing and updating information on the service. Staff confirmed that they found discussion and review with the manager to be a positive experience. Opportunities for training and continued learning were available to all staff. Courses attended by staff included mental health awareness, dementia awareness, palliative care, adult support and protection and managing diabetes. William Simpson's, page 28 of 37

29 All staff demonstrated a sound understanding of the importance of monitoring dietary and fluid intake and knew when to report concerns to senior staff or ask the GP to attend. They had also received training in the use of restraint measures such as use of bedrails and postural support belts. They demonstrated a good understanding of the legal issues surrounding restraint and of guidance such as Rights/Limits/ Freedoms, related to people who did not have the mental capacity to consent to such measures. These processes assisted the manager to monitor and further develop staff understanding of their role and the expected standards of care. It also contributed to the development of the yearly training plan and the training requirements of the staff team. We felt the service was proactive in identifying staff training that would enhance the knowledge and skills of the staff to help people using the service meet their personal outcomes. Areas for improvement In the self assessment submitted by the service the manager had identified the following areas for improvement: "We have a pay structure for Care Staff which rewards loyalty and achievement. Policies and procedures need to be reviewed on an on-going basis. We have a new model of care in our new Home which is still in the settling in process." In some of the staff files we examined we noted there was a gap of around three months when not all supervisions or training had been undertaken. The management advised this was due to a lack of senior staff some of whom had recently left the service. These post were currently being recruited to and we saw supervisions and training had resumed. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 William Simpson's, page 29 of 37

30 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: "We embrace the concept of continuous improvement and promote this throughout the service. SUs meetings are delegated to keyworkers to promote 'ownership'. They offer a supportive and trust building forum which facilitates an open expression of views. There is clear evidence that Service Users or Staff have no fear in expressing their views about any matters relating to the running of the service." We looked at a sample of written evidence, and feedback from management, staff and service users, this service was found to have an adequate performance in relation to this statement. Questionnaires offered opportunities for stakeholders to comment and give views on service improvement. Service user review meetings allowed for discussion on all aspects of care and support and service delivery. A written report is provided in conjunction with the service user which includes a note of their satisfaction with the quality of service provision. Other stakeholders such as relatives, social workers and health professionals are invited to attend these meeting and a member of service management is always present allowing for discussion of any relevant management or service issues to be addressed directly. William Simpson's, page 30 of 37

31 The Manager has a hands-on approach and valued people's input on any issues regarding the service. This means that service users saw management as a positive part of their care package. The range of methods highlighted in this report in Quality Themes 1, 2 & 3, Statement's 1, Service Strengths also have relevance to how service users and carers can participate in assessing and improving the quality of the management and leadership of the service. Areas for improvement In the self assessment submitted by the service the manager had identified the following areas for improvement: "We aim to continue to develop ways of enabling Stakeholders to participate in the running of the Service through our participation policy. We have invited individual SUs to attend meetings of Members / Directors with a view to becoming members of the Company." We saw that service user meetings were held on a regular basis. This provided an opportunity for the service to get feedback and develop action plans around suggested changes. We also noted residents were beginning to attend team meetings and training events. These responses should provide clear evidence of service user participation. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued William Simpson's, page 31 of 37

32 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths The service's self assessment told us about most of the ways they supported people to participate in assessing and improving quality. When asked to grade themselves on this statement, the service told us they were very good in this area. The service identified some of their strengths as: "Accounts are produced monthly for monitoring purposes by Management and the Board and there is a Business / Development committee specifically geared to ensure the sound financial direction and management of the Organisation. Our Aims and Objectives promote the rights and potential of service users through core values, support and recognition of individuality. We have a Quality Assurance Policy and Procedures. Inspection report continued Feedback is received from sources such as regulatory visits, Questionnaires, the review process, supervision process, service audits, in-house audits and through discussion at meetings. Appropriate reporting is made to the relevant committees by managers who are subject to questioning." We examined a wide range of documentation and policies to confirm that the service was using an inclusive approach in shared quality assurance systems. We spoke to service users and staff, looked at the evidence presented and information from the self assessment and found the service was operating at an adequate level. During the inspection, we saw that the service had systems and procedures in place that ensured service users' needs were being met. This included regular checks of support plans by the senior staff, collation of feedback, review of any complaints, accidents, or incidents and ensuring staff supervision was up to date. Monthly team meetings provided opportunities for staff to participate in practice reflection and to contribute to the development of the services. Staff spoken with had a good knowledge of the methods used to enable service users to participate in assessing and improving the service and an ethos of respect and equality was demonstrated by the staff during the inspection. William Simpson's, page 32 of 37