Care service inspection report

Transcription

1 Care service inspection report Full inspection Upper Springland Support Service Isla Road Perth Inspection completed on 08 May 2015

2 Service provided by: Capability Scotland Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com page 2 of 29

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 6 Quality of environment 6 Quality of staffing 6 Quality of management and leadership 6 Excellent Excellent Excellent Excellent What the service does well The service has excellent practice and high quality outcomes in involving customers in decision-making about their individual support, planned activities and the leadership of the service. When we spoke to individual customers it was clear that they chose which activities to attend and enjoyed. Customers had made wide-ranging suggestions about activities they wanted put on. Customers were excited about the forthcoming drama production they were involved in. We were impressed with the level of planning and thought that goes into what customers could gain from planned activities. What the service could do better The service is committed to continual and innovative improvement. What the service has done since the last inspection The service met the two requirements made in the last report. page 3 of 29

4 Conclusion Inspection report We found that the management of the service very clearly listened to customers, and systematically involved them in the development of the service, and encouraged staff to contribute to the development of the service too. The service is continually striving to improve and has very high quality outcomes for customers which resulted in excellent practice. page 4 of 29

5 1 About the service we inspected Inspection report Upper Springland is registered by the Care Inspectorate to provide a support service adults who have a physical disability and may also have a learning disability. The service is provided by Capability Scotland, a voluntary sector organisation that provides services to people with disabilities throughout Scotland. On the same site as the support service is the care home of Upper Springland, which provides long-term accommodation and a respite service. The people who use Capability Scotland's services have asked that they be called customers. The support service is registered to provide a service to people in a day care setting and to people in their own homes. The service can provide for up to a 40 people per day, of whom up to ten service users on any day may have a significant learning disability as well as a physical disability. At the time of the inspection about 20 people attended each day, with between 20 to 30 different customers attending over the course of the week. Any customer who stays in the care home can use the day service on a planned and agreed basis. Most customers live in their own homes, or with their families, and travel to the service each day. There were customers from Perth and Kinross, Stirling, and Fife. When customers stay in the respite service which is part of the care home they can use the day service. The service operates Monday to Friday between the hours of 9am and 4pm. Before 1 April 2011 this service was registered with the Care Commission. From 1 April 2011 this service continued its registration under the new body, the Care Inspectorate. Social Care and Social Work Improvement Scotland, also known as the Care Inspectorate regulates care services in Scotland. It awards grades for services based on the findings of inspections. These grades, including any that services were previously awarded by the Care Commission, are available on page 5 of 29

6 Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 6 - Excellent Quality of environment - Grade 6 - Excellent Quality of staffing - Grade 6 - Excellent Quality of management and leadership - Grade 6 - Excellent 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. page 6 of 29

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a 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 This report was written following visits by an inspector and volunteer inspector to the service on two days on 5 and 6 May Feedback was given to the manager and team leader on 8 May. In this inspection evidence was gathered from various sources, including: - personal plans of people who use the service - training records - accident and incident records - minutes of meetings and supervision records - observation of the environment and equipment used. We spoke with: - speaking with nine service users - three relatives - the manager, the team leader, three support and assistant support workers. 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 page 7 of 29

8 Inspection Focus Areas (IFAs) Inspection report 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 page 8 of 29

9 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. A fully completed self assessment was submitted by the service. Taking the views of people using the care service into account The views of the customers we spoke to have been included in the main part of this report. Taking carers' views into account The views of the relatives we spoke to have been included in the main part of this report. page 9 of 29

10 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: 6 - Excellent 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 used several methods to ensure that customers and their relatives had a say in how their service. Customers regularly met in the service and influenced how it operated. The service has an eight week cycle of activities for service users. In the first week the customers and staff jointly in groups and one-to-one meetings activities across the service. There is then a six-week block of the planned activities. Each customer signs up to those activities they want to join in and their individual timetables are developed. Speaking to individual customers it was clear that they chose which activities they attended. In the eighth week the customers and staff jointly how well the activities had gone. We saw several customers involved in a feedback session, giving their views on what activities had taken place. We heard about and saw photographic evidence of the activities that had taken place. The customers had clearly enjoyed these activities which had been designed to give everyone the chance to participate in their own way. page 10 of 29

11 There was a real buzz and everyone was excited about the forthcoming drama production and their involvement in it. When planning the next six-week block the customers were all asked to suggest workshops. The staff considered every suggestion and there was further discussion to make sure that they understood what the customers really wanted and recorded what was said. Customers had been involved in making the plans to redevelop each area of the day service premises, along with specialist advice from the service's occupational therapist. Customers had contributed ideas for facilities they wanted as well as the decoration. This was resulting in improved facilities which service users could make more use of. Each customer had a keyworker, a named staff member who meets with them regularly to ensure their support plan is up to date, and actions are being taken on their individual goals. The customers we spoke to all knew they had a key worker. This is a very important relationship that ensures that the support provided is meeting customers' wishes and goals. Each customer had a support plan were written from their point of view which considered how best to support them individually and consistently. Customer said they were involved in their personal plans with their keyworker and they understood what the plans said. Each customer also had personal goals, called smart goals, to be put into action between the six monthly reviews. The goals were one each from broad categories of; Social, Therapy and Activities, though there was flexibility in how this was put into practice. This encouraged a range of goals to be worked on. Customers were involved to a very high degree in the six monthly reviews of their support plan. Customers made use of a range of communication methods, such as talking mats and slide show presentations including video and photographs, to have their say in these meetings. The relatives said that reviews took place on a regular basis and they were very detailed and individual with digital presentations produced for the reviews. They also commented; "When we visit we see him taking part and giving his opinion. He is comfortable and confident here." There was strong evidence that relatives were involved in assessing the quality of care through review meetings. page 11 of 29

12 The service has three representatives on the Upper Springland community council which meets every two weeks. An independent advocate assisted to the committee to conduct its business and record the outcomes of its discussions for the management. This is the high level of representation of customers' views with regards to the overall management and direction of the service of the care home and day service. The service has excellent practice and high quality outcomes in involving customers in decision-making about their individual support, planned activities and the leadership of the service. Areas for improvement The service is committed to continual and innovative improvement. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 12 of 29

13 Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths We examined the service's practices and outcomes for customer by speaking to service users and relatives, speaking to staff and examining the service's records for customers' support. Customers had access to specialist physical therapy activities are provided in conjunction with the therapies team based at Upper Springland. Customers took part in rebound therapy, hydrotherapy and a walking room therapy as part of individually planned programmes developed by the therapist team. We were able to watch one customer enjoying rebound therapy. A customer waiting on their turn was clearly excited and eager to get onto the trampoline. The staff were following the programme that had been written by the physiotherapist. The staff have had specific training by the therapies team to follow the programmes safely. Customers' personal support plans were written to a very high standard, setting out in comprehensive detail how their needs and wishes were to be met, and encouraging their independence and choices. The support plans were complemented by individual smart plans with a range of goals for customers to work on. page 13 of 29

14 When we spoke to individual customers it was clear that they chose which activities to attend and enjoyed music, art, cooking, swimming, rebound therapy, computer activities and games on a regular basis, and enjoyed and benefited from these. Customers had made wide-ranging suggestions about activities they wanted put on which included; a sports competition, karaoke, jewellery workshop, cane weaving, dog therapy, baking, wine-tasting and fishing. A relative commented that the regular changes in planned activities were beneficial to customers as it prevented boredom and continually refreshed how it met their needs. A relative also told us; "(Our relative) always wants to come to the service each day. When we visit we see him taking part and giving his opinion. He is comfortable and confident here. The staff all have a good knowledge about him and his needs." We were impressed with the level of planning and thought that goes into what customers could gain from planned activities. A staff member who leads a movement group spoke about how it required customer to concentrate on the activity, and that it was relaxing and released physical tension. Also the customers helped each other through the exercises and took turns leading the group. The staff member took advice from the physiotherapist about what are suitable exercises for customers to do and how to then make further progress with them. Customers were excited about the forthcoming drama production and were involved in for example: making and decorating props, singing, operating musical equipment and acting. The service found that customers' skills and confidence were built up through taking part in putting on the play. Also customers received compliments from the audience after the made up of other service users and relatives. The service had made several structured improvements to how the service supported customers; page 14 of 29

15 The service had addressed an issue whereby customers from the care home had not been coming to the activities that had been agreed. Customers from the care home had been encouraged to commit to attending activities they had signed up to benefit from them and the social side of the service. Also the service had liaised with the staff in the care home to ensure that customers going to activities were assisted to be ready in time. This had resulted in customers from the care home using the activities more reliably. In response to an expressed wish by customers in the care home to cook an evening meal the service had set up a The Bistro, on Tuesday and Thursday evenings. The activity was supported by two staff from the day service and a member of the kitchen staff. In The Bistro four or five customers prepared their evening meal in the day service's kitchen. The group was a very popular activity with those service users. We spoke with a customer who had difficulty in joining in other activities but who particularly liked making their own meals. The service had looked for ways to support customers with activities away form the centre building. Two customers had been supported to work as volunteers in a local charity shop, with a staff member in support. The staff member reported that the volunteer work had improved the customers' confidence in dealing with new people and situations. The service was to look at more opportunities for customers to be supported in activities in the community. There were very high quality outcomes for service users' health and wellbeing from the service's practices. Areas for improvement The service is committed to continual and innovative improvement. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 15 of 29

16 Quality Theme 2: Quality of Environment Grade awarded for this theme: 6 - Excellent 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 grade given to Quality of Care and Support, Statement 1 has been to grade this statement. Areas for improvement See above. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 16 of 29

17 Statement 2 We make sure that the environment is safe and service users are protected. Service Strengths We examined services' use of equipment, management systems, staff practices and the involvement of customers in this quality statement. Examples of the service's practices for service user safety included: Repairs identified in the repairs log were promptly attended to by the on-site maintenance team. There was an audit system of health and safety practices. This identified strengths in the system and where there needed to be improvement. Staff from different parts of the Upper Springland Site met to coordinate safety issues. For the day service an assistant support worker was responsible for coordinating health and safety assessments and liaised with the health and safety committee. Equipment used in service users' personal care, such as hoists, were serviced by external specialist companies, and there was an internal monthly visual check of the equipment to catch any developing faults. This ensured that equipment was maintained to the manufacturers' standards and any problems with equipment were detected early. The service had contingency plans for major events such as; fire, flood, and interruptions to gas, electricity. There were individual personal evacuation plans for each customer, which were kept up to date. This ensured that service users' safety during any incidents was protected in a coordinated manner and with reassurance that the incident would be managed safely. We were impressed with the improvements to the safely and the facilities of the service as a result of involving customers at each stage. Examples of this included; page 17 of 29

18 The customers and the service's occupational therapist had been closely involved in the design of a new accessible computer room with suitable control equipment and furniture. The intention is that customers have better access to the service's facilities and take part in more activities, more independently. The customers and occupational therapist were to be consulted on further improvements of other areas in the day service such as the kitchen, and an exercise room and gardens to improve their acts physical access ability to service users. It had been identified that several incidents had occurred when service users were using powered wheelchairs by themselves. The staff involved customers in finding a solution to the problem in the weekly meetings. The customers and staff had agreed to put up reminder signs round the centre so that customers using powered wheelchairs would be more careful round other people. This was very good piece of practice to involve service users in finding solutions to safety issues in the centre. Different customers had made use of the Have Your Say forms to make comments about the environment such as a customer who pointed out the difficulty in getting their wheelchair across an external paved area. This had resulted in the paving being altered and easier access for customers using wheelchairs. Overall service users experienced a safe environment with equipment, management systems and staff practices that protected their welfare. Areas for improvement The service is committed to continual and innovative improvement. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 18 of 29

19 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The grade given to Quality of Care and Support, Statement 1 has been to grade this statement. Areas for improvement See above. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 19 of 29

20 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths We examined how the service supported staff in their work with customers and involved staff in improving outcomes for service users. During the inspection we spoke with the manager, the team leader for the day service, a support worker and two assistant support workers. The manager for the service, is also the manager for the care home, who is registered with the Scottish Social Services Council (SSSC). On a day-to-day basis the service was led by a team leader. There are two support workers and five assistant support workers. There are additional three relief support workers who can be called upon in the absence of someone else in the care team. At this time the SSSC does not have a start date for staff in day services for adults to register. The service supported staff to learn and develop as professional social services workers. Examples of this practice included: The service appropriately delegated responsibilities to staff for different aspects of the service provision. Support workers were responsible as customers' keyworkers for preparing and updating their support plans, risk assessments, six monthly reviews and smart goals plan. The assistant support workers were also co-keyworkers who contributes to the content of the plans and following up on customers' agreed goals. All staff members in the staff team contributed to that information about service users for forthcoming reviews. Staff told us they could readily ask senior staff for advice or assistance. As all three senior staff also provided some direct support to service users they had an insight into service users' needs and could make changes to support arrangements accordingly. page 20 of 29

21 Staff had access to a range of training that supported their day-to-day practice. This included core training such as medication and food hygiene which was renewed on a regular basis. The service set high standard for staff knowledge and competence in medication training. Staff had to complete learning workbooks, knowledge tests and practice observations to a high standard before they could administer medicines. The staff have had specific training by the therapies team to follow therapy programmes safely with customers. The service monitored when each staff member's training required to be renewed and the training was arranged through the provider's on-going training programme. Staff had regular one-to-one supervision meetings with their line managers staff to reflect on their practice for improvement. We were impressed with the service approach to reflecting on practice and developing staff skills and competence and delegating responsibility and approach to person centred practice and outcomes for service users as demonstrated in the records for supervision. Staff were supported to work as a team to meet service users' needs. In team meetings for each unit staff contributed to discussions on how they could improve support to service users. There was also a detailed agenda and minutes of discussions and decisions made. We were impressed with the depth and range of the discussions and the contributions made by all staff to the decisions made in these meetings. One staff member told us: "I like it here. There is a good team. Senior staff have helped the service to develop a lot. The activities are always being kept fresh and the feeling in the service is up beat." Overall the range of learning and support provided to staff has a positive impact on the quality of care and support that is planned and delivered. Areas for improvement The service is committed to continual and innovative improvement. Inspection report page 21 of 29

22 Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 22 of 29

23 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 6 - Excellent 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 grade given to Quality of Care and Support, Statement 1 has been to grade this statement. Areas for improvement See above. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 23 of 29

24 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service Strengths We examined how the service used feedback on its performance to make improvements. The service made use of internal and external monitoring to identify strengths in its practice and areas for improvement it needed to take action on. Examples of this practice included; The service's provider organisation quality assurance system set internal standards for good practice, and audited whether the practice was being carried out and if there were areas for improvement. The use of the quality assurance system by the service contributed to a high standard of service and outcomes for service users with an emphasis on further improvement. There was regular feedback from and involvement by customers with the service to plan and review the range of activities in the service, supported by very good use of communication aids and an easy to understand recording of decisions made. There was a very high level of customer involvement in the preparation of their personal support plans, and individual smart goals with their keyworker, and the review of these plans. Customers had been involved in finding solutions to safety issues in the centre. Customers had an active community council to represent their views about further improvement at Upper Springland to which the management responded constructively. page 24 of 29

25 The service had developed and improved the service for customers in response to their needs and interest, such as; The Bistro group and voluntary work placements. We were impressed with the service approach to reflecting on practice and developing staff skills and competence and delegating responsibility and approach to person centred practice and outcomes for service users. Staff feel able to contribute to the development of the service such as volunteering opportunities for customers. Customers had been involved in an annual review and planning meeting, recorded in an easy to ready format, which looked at what had and not worked in the previous year, and the goals for the forthcoming year. This would be looked at again at the end of the current year. We found that the management of the service very clearly listened to customers, and systematically involved them in the development of the service., and encouraged staff to contribute to the development of the service too. The service is continually striving to improve and has very high quality outcomes for customers which resulted in excellent practice. Areas for improvement The service is committed to continual and innovative improvement. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 25 of 29

26 4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must ensure the health and welfare of service users. To do this they must ensure: (i)that there is clear guidance/ protocols in place for the use of as required medications. In particular pain relief medication. (ii) That MARS sheets where handwritten are signed, dated and cross referenced. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011/210 Regulation 4(1)(a) The following good practice guidance was taken into consideration when making this requirement. The Handling of Medicines in Social Care. (The Royal Pharmaceutical Society for Great Britain 2007) National Care Standards - Care Homes for people with physical and sensory impairment - Standard 15 -Keeping Well Medication. Timescale:- Within 2 weeks of receipt of report. This requirement was made on 25 June 2012 The service had improved practice in supporting customer to meet this requirement. Met - Within Timescales 2. The provider must implement medication audits which monitor both quantity of medication and the quality of medication administration and practices. To ensure medication quality assurance systems and processes are effective, the provider must; - ensure that key staff are provided with training to make them fully aware of their roles and responsibilities in relation to quality assurance processes and procedures. page 26 of 29

27 - ensure that staff are appropriately using quality assurance systems as these are necessary in their practice for the health, welfare and safety of service users. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations Scottish Statutory Instrument 210 Regulation 4 (1)(a) Welfare of Users and 15 (b)(i) Staffing Timescale: To be implemented within 6 weeks of receipt of this report. This requirement was made on 25 June 2012 The service had implemented audits to meet this requirement. Met - Within Timescales Inspection report 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. page 27 of 29

28 8 Additional Information There is no additional information. Inspection report 9 Inspection and grading history Date Type Gradings 25 Jun 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 23 Nov 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 29 Mar 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 2 Jun 2008 Announced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good page 28 of 29

29 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 29 of 29