Highland Homeless Trust Housing Support Service 57 Church Street Inverness IV1 1DR Telephone:

Transcription

1 Highland Homeless Trust Housing Support Service 57 Church Street Inverness IV1 1DR Telephone: Inspected by: Lynn Ellison Type of inspection: Unannounced Inspection completed on: 17 January 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Highland Homeless Trust Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Lynn Ellison Telephone enquiries@careinspectorate.com Highland Homeless Trust, page 2 of 23

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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well We found the following key strengths in the areas inspected: the service offered people a variety of ways to express their views and get involved in service development and improvements; service users had a range of opportunities to take part in sports and other activities to improve their physical health; staff had on a number of occasions made use of a potentially life-saving drug for service users; there was a relevant and varied training programme; the service was committed to ongoing improvement. What the service could do better The service should: introduce a system for managers to check financial records for those people receiving support in this area; improve the quality of incident analysis; ensure that staff receive regular, planned supervision in line with the policy; improve the quality of recording of staff and service user meetings to ensure better communication and accountability. Highland Homeless Trust, page 3 of 23

4 What the service has done since the last inspection The service had continued to review the progress of its development plan and achievement of its aims and objectives. There had been improvements in the way that staff training was recorded, allowing easier monitoring. Conclusion This is a well-performing housing support service. It provides care and support to people with a wide range of needs, many of whom are experiencing significant challenges such as homelessness and chronic addiction. The service is also committed to increasing public awareness of homelessness. Recent management changes and staff sickness have had some impact on continuity and caused additional pressures for the staff group. The service now needs to implement its policy on staff supervision. Who did this inspection Lynn Ellison Highland Homeless Trust, page 4 of 23

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at: This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 01 April Requirements and recommendations If we are concerned about some aspect of a service, or think it could 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, but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Highland Homeless Trust is a housing support service for adults who are homeless or in housing need, including those with alcohol problems and mental health problems. They provide support either to service users living in one of their supported accommodation units as well as those living in their own homes in the community, on an outreach basis. The four accommodation units are located in the Inverness area: Atchcournie offers housing support and accommodation for adults, including those with drug and/or alcohol problems within fifteen self-contained bedsits. It is staffed 24 hours a day; No 45 is a similar unit offering accommodation in 12 self-contained bedsits; Roinn has single room accommodation with communal facilities for six men aged between 16 and 60. It is staffed 24 hours a day; Planefield has accommodation for seven young people aged between 16 and 25 leaving local authority care. It provides en suite bedrooms with a communal kitchen and lounge. Highland Homeless Trust, page 5 of 23

6 In the winter months the service also provides short-term accommodation to people who have no right of access to other accommodation. They do this by using hostels or bed and breakfasts. The service's aims and objectives include: Inspection report continued providing temporary accommodation to those who are homeless or rough sleeping; offering guidance, information and support to vulnerable adults on all aspects of housing; enabling service users to gain the practical skills needed to achieve more independent living; offering information on issues affecting the individual; making referrals to other specialist services; encouraging service user involvement and meaningful participation; working in a non-oppressive way. The service provider is Highland Homeless Trust, a private company limited by guarantee and registered Scottish charity. It is managed by a board of directors. The staff team consists of a manager (who is one of the directors) and senior management team, and three staff team of support workers led by unit managers. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good 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. Highland Homeless Trust, page 6 of 23

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection by Lynn Ellison, Inspector. Visits took place on the following days in 2014: Sunday 12 January between and 15.35; Wednesday 15 January between and 17.00; Thursday 16 January between and 17.00; Friday 17 January between and We visited three of the four accommodation units (Atchcournie, No. 45 and Roinn) as well as the administrative office. We gave feedback to the manager and business manager on Friday 17 January. Also present was NHS Highland's area contracts officer. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: the senior management team, two unit managers and five support workers; seven service users in person. We looked at: policies and procedures on vulnerable adults, child protection, participation, staff development, lone working and whistleblowing; the service's development plan for ; the record of the board's annual general meeting; records of accidents, incidents and complaints; service user's personal plans, assessments and reviews; records of residents' meetings; the employee handbook; Highland Homeless Trust, page 7 of 23

8 staff training records; staff meeting records. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Highland Homeless Trust, page 8 of 23

9 What the service has done to meet any recommendations we made at our last inspection The service had yet to fully implement the policy on staff supervision. 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. The Care Inspectorate received a fully completed self assessment document from the service. The manager identified what he thought the service did well, some areas for development and any changes that were planned. The self assessment could be improved by the inclusion of more evidence of how the service has achieved positive outcomes and experiences for service users. Taking the views of people using the care service into account We received 10 completed Care Standards Questionnaires (CSQs) from people using the service. In response to the statement 'Overall, I am happy with the quality of care and support this service gives me', five strongly agreed, three agreed, one disagreed and one strongly disagreed. One of the people who was less happy with the service did not want to speak to us when we visited, and the other had completed the questionnaire anonymously so we were unable to discuss the issues further. These service users did not feel that the service checked with them whether they were meeting their needs and said that staff did not have the right skills or treat them with respect. Four people were not aware of how to make a complaint to the service or the Care Inspectorate. Comments included: Highland Homeless Trust, page 9 of 23

10 'The staff are very good at anticipating my needs, they talk to me and to one another about how best to help me. I can see they really do care about me and want to help me all they can'; 'The way we are treated is like little kids, not adults (...) We are viewed with suspicion all the time'; 'The way members of staff speak to us as if we are dirt. They are always pulling us down with smug remarks'. We also spoke to some service users individually when we visited the units. Their comments were largely positive and included: one felt the service was very good. Staff were 'brilliant' and treated him with respect. They knew what they were doing. He felt less isolated. He got good support, agreed with his plan and felt the service was reliable; another felt that in the early period of using the service, the needs of people in the existing group were not properly considered when someone new was coming. This was much better recently. All the staff cared and showed more respect. He had been involved in the sports activities and had also learned some new skills. He felt the service could be improved by more consistent application of the house rules; one rated the service as 'excellent'. Staff were 'brilliant' and showed respect and were competent. He had been involved in the football group. He did not feel the service needed to change; another said this was a good service. It had delivered what it said. He had been involved in some of the sporting activities. Staff showed respect and treated him like an adult. They were good at their jobs; one said the service was good. Most staff showed respect and were 'great'. He felt some staff did not understand drug addiction. The service had made a positive difference to him. He was physically better and had stopped using the drug to which he had been addicted for a long time; another person described the service as 'very good' and staff as 'pretty good'. His situation was improving. He felt that understaffing was a problem sometimes and had affected him. One of the drawbacks of the unit he lived in was the lack of a private room except the staff office. We took these views into account in grading the service. Taking carers' views into account We did not speak to any relatives or carers of people using the service. Highland Homeless Trust, page 10 of 23

11 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: 4 - 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 The service's performance had major strengths and reached a very good standard. We came to this conclusion for the following reasons: when they first started to use the service, service users were taken through an induction to familiarise them with what to expect. They also each had a tenancy agreement detailing their rights and responsibilities. Being wellinformed can help service users to judge the quality of the service they are receiving; service users were fully involved in the process of developing needs and risk assessments and personal plans, and attended reviews. This provided them with regular opportunities to express their views and have personalised plans that catered to their needs; staff sometimes acted as advocates for people using the service, supporting them with other agencies for example; a leaflet called 'Get Involved' explained a range of ways in which people could contribute to making improvements, play a part in service operation, or express their views. Some of the methods used by the service recently included producing a newsletter, being on the activities committee and fundraising events. Two people had attended a training course aimed at helping them to offer others experiencing addiction mutual support towards recovery. Others had taken part in the recruitment and selection process for new staff by sitting on the interview panel; service users had opportunities to influence the wider homelessness agenda. For example, some had attended a homelessness event, met a local Member Highland Homeless Trust, page 11 of 23

12 of the Scottish Parliament, and taken part in a programme to help families struggling financially to have enough food (Food for Families). We met another person using the service who was working on setting up a local homelessness forum with the service's help. There were added benefits to this in that he was gaining additional skills; the service's complaints procedure provided a formal avenue for raising any dissatisfaction; the service had asked service users to complete our questionnaires before we visited, and encouraged them to talk to us during the inspection. Areas for improvement We acknowledge that service users in one or two of the units had had limited interest in attending meetings, and that some difficulties with group dynamics had contributed to these being unpopular. However, given that the service's participation strategy describes them as a primary source of information, we would suggest the service considers alternatives or additional methods for consulting and gathering views. The way in which service users' meetings were recorded made it very difficult to see how the service had responded to comments and requests. A few straightforward changes could improve this and make the process more transparent for service users. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service's performance was good and had important strengths, including: there had been a number of initiatives aimed at promoting better health for people using the service. These included opportunities for getting involved in sports and other fitness activities, and for accessing fresh air. The service also promoted harm reduction in conjunction with health colleagues, and provided support for service users to reduce or cease alcohol and substance misuse. They promoted sexual health by providing free condoms, and basic items essential for ongoing health such as toothpaste and toothbrushes; the service worked effectively and co-operatively with a range of other agencies for the benefit of service users. These included the NHS, the local authority and the voluntary sector; Highland Homeless Trust, page 12 of 23

13 staff supported individual service users to keep health appointments, for both primary care and specialist services. They had contacted the emergency services where appropriate; the service was part of the Scottish Naloxone programme. This meant that with training, staff (and some service users) could administer this drug, which can temporarily reverse the effect of opioids by removing it from the receptors, thereby assisting with the restoration of breathing. As a result of their intervention it is likely that they had saved lives or prevented serious illhealth on a number of occasions; there were effective arrangements for protecting vulnerable adults, in line with local and national guidelines. On occasions, the manager had played an advocacy role for those affected in this way, and had been persistent and proactive in trying to effect change; overall, we found clear evidence of an effective risk assessment and management approach to reducing harm; staff discussed health and safety issues at some of their team meetings; the provision of temporary accommodation over the winter months for those who would otherwise be unable to access shelter was a significant contribution to relieving hardship. Their involvement in food provision and distribution was also of note. Areas for improvement There was some scope for personal plans to be more outcome-focussed and specific, which should make it easier for staff and service users to evaluate progress towards agreed goals. We would suggest that out-of-date risk assessments be kept separate from current ones to avoid any confusion. The service did not have a systematic way of checking and auditing records for those people they supported with their finances (see Recommendation 1, Quality Theme 1, Statement 3). Some incident reports, whilst making relevant events clear, lacked analysis of the effectiveness of intervention and the need for any further action (See Recommendation 2, Quality Theme 1, Statement 3). There was an isolated instance where, following an allegation of staff misconduct, prompt contact had not been made with the on-call manager. Whilst we did not feel that this had led to any increase in risk, it is important that staff follow the agreed process for risk assessment and decision-making. Highland Homeless Trust, page 13 of 23

14 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The provider should develop a system for managers to check records of service users' finances where the service is providing support. National Care Standards Housing Support Services: Standard 3 - Management and Staffing Arrangements. 2. The provider should review the quality of incident reports as outlined in this report. National Care Standards Housing Support Services: Standard 3 - Management and Staffing Arrangements. Highland Homeless Trust, page 14 of 23

15 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 We did not inspect this Quality Statement but have included relevant evidence on the quality of participation in Quality Theme 1, Statement 1. Areas for improvement See Quality Theme 1, Statement 1. 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 We concluded that the service's performance had important strengths and reached a good standard. We identified the following strengths: the service supported staff to gain the qualifications needed to register with the Scottish Social Services Council (SSSC) in advance of this part of the register being opened. The manager was already registered; staff had access to an up-to-date handbook with all the service's policies and procedures for ready access; discussions with staff and a review of a sample of records showed that staff had good training opportunities in most relevent areas to allow them to develop the skills and knowledge they needed for the role they performed. There were also some examples of training to meet service users' specific Highland Homeless Trust, page 15 of 23

16 needs. Speakers attending staff meetings was an additional method for learning and development and provided some opportunities for consultation about service users' support needs; there was a system for monitoring staff and responding to concerns about practice. This included observation; overall, there had been a relatively low staff turnover and the service had a stable core of established and experienced staff to promote continuity of care for service users. This had helped to some extent to mitigate the impact of management changes; there were some opportunities for staff to take on additional responsibilities that reflected their skills and interests; the service had completed an analysis of staff training and a draft corporate training plan for the year. In general, the feedback we received from staff in the 14 out of 20 questionnaires we sent was positive. For example, most staff said they had had regular supervision, felt safe at work, had been asked for their opinion on the service, and had been supported to gain relevant qualifications. Areas for improvement Inspection report continued The way in which staff meetings were recorded did not allow the reader to track progress from one meeting to the next, and meant that issues raised were easily lost. Some relatively easy adjustments would put this right and improve accountability. The frequency of staff meetings also varied across the service and constrained their effectiveness as a quality assurance and communication tool. (See Recommendation 1, Quality Theme 3, Statement 3) There were some gaps in training provision in areas such as mental health and looked after children (for specific staff). The service was trying to identify a suitable course for the former and had agreed in principle the delivery of the latter by the local authority. The manager acknowledged that the system for regular supervision of staff, as identified at the last inspection, had not been fully implemented. The responses to our questionnaires reflected this. Planned supervision is an important part of the support and learning and development programme. (See Recommendation 2, Quality Theme 3, Statement 3) Staff commented on the impact on them of recent management changes and absences, which were still being felt. Some of the staff we spoke to described morale as low and felt that communication between management and support staff needed to be more reliable. Some also felt that consultation with staff should also improve. Staff told us that on a number of occasions there had been no 'floating support' available (this is a member of staff over and above the staff allocated to a particular Highland Homeless Trust, page 16 of 23

17 unit, who offers support in the event of difficulties and also calls at each of the units over the course of a shift). Neither was the provision of a second staff member on some shifts reliable. More detailed information about this was not available at the time of the inspection. (See Requirement 1, Quality Theme 3, Statement 3) The service was about to consult staff on the draft training plan for Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations Inspection report continued 1. The provider should ensure that: (i) staff meetings take place regularly; (ii) records of staff meetings allow effective tracking of progress. National Care Standards Housing Support Services: Standard 3 - Management and Staffing Arrangements. 2. The provider should give staff regular opportunities for planned supervision. National Care Standards Housing Support Services: Standard 3 - Management and Staffing Arrangements. 3. The provider should establish whether the provision of floating staff support and a second staff member on specified shifts is taking place consistently to ensure that there are sufficient staff to meet service users' needs. National Care Standards Housing Support Services: Standard 3 - Management and Staffing Arrangements. Highland Homeless Trust, page 17 of 23

18 Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths We did not inspect this Quality Statement but have included relevant evidence on the quality of participation in Quality Theme 1, Statement 1. Areas for improvement See Quality Theme 1, Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 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 reached a good performance with important strengths. There was a clear commitment to continuous improvement and development in line with the corporate aims and objectives. These strengths included: the service had a development plan for , which had been recently updated. This identified a range of strategic objectives, each of which had an action plan with review dates; the service had identified a range of objectives for people using the service. These were clearly focused on improving outcomes and experiences, for example better nutrition, improved social contacts and greater independence; as part of the preparation for inspection, the service completed a self assessment of its performance in each of the quality themes and statements; Highland Homeless Trust, page 18 of 23

19 the service notified us of any significant events such as serious incidents and allegations of staff misconduct, and had provided additional information when requested; there were some opportunities for staff to contribute to self-evaluation, for example in relation to participation; the board considered the outcome of inspections as part of its corporate oversight of performance; the service had an 'Investors in People' award, an accredited framework for staff management and improvement which was subject to external evaluation; the senior management team regularly liaised with its key business partners such as NHS Scotland, the local authority housing department and voluntary agencies to review progress. Areas for improvement The service development plan was largely strategic and high-level. We felt that an additional focus on lower- or unit-level improvements, making use of national guidance such as the National Care Standards, would be beneficial and a way of promoting greater involvement of staff in wider service evaluation, improvement and development. There was limited management and corporate analysis of incidents (see Recommendation 1, Quality Theme 4, Statement 4). It was difficult to judge the extent to which the board played a part in monitoring the progress of the service's development plan. This should include for example, considering service users' views on a regular basis. There was limited involvement of stakeholders in quality assurance (See Recommendation 2, Quality Theme 4, Statement 4). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The provider should undertake a regular analysis of incidents. National Care Standards Housing Support Services: Standard 3: Management and Staffing Arrangements. 2. The provider should develop methods for consulting stakeholders about service quality. Highland Homeless Trust, page 19 of 23

20 National Care Standards Housing Support Services: Standard 3: Management and Staffing Arrangements. Highland Homeless Trust, page 20 of 23

21 4 Other information Complaints No complaints have been upheld since the last inspection. 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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Highland Homeless Trust, page 21 of 23

22 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Staffing Good Statement 1 Statement Very Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 16 Mar 2012 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 12 Oct 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership Not Assessed 2 Dec 2008 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Highland Homeless Trust, page 22 of 23

23 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Highland Homeless Trust, page 23 of 23