Banff Day Services Support Service Without Care at Home Colleonard Road Banff AB45 1DZ Telephone:

Transcription

1 Banff Day Services Support Service Without Care at Home Colleonard Road Banff AB45 1DZ Telephone: Inspected by: Paul Whitehouse Type of inspection: Unannounced Inspection completed on: 9 January 2013

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 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Aberdeenshire Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Paul Whitehouse Telephone enquiries@careinspectorate.com Banff Day Services, page 2 of 27

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The staff were motivated, knowledgeable and committed to meeting the needs of the people using the support service. The staff and management are working with the service users, relatives and stakeholders to produce an action plan detailing the future of day services in the area. What the service could do better The provider needs to audit the support plans more regularly and encourage staff to use the National Care Standards in their own practice. What the service has done since the last inspection The provider and staff have continued to work with service users to develop a range of services and activities aimed at meeting the changing needs of service users. The management and staff have worked well to support service users going through any changes to their activity programmes. Banff Day Services, page 3 of 27

4 Conclusion Inspection report continued Banff Day Services provides a support service for service users who have various disabilities. The support service had provided a range of activities and support for service users in a very person-centred way. Activities had clearly been adapted and developed as a result of the ideas and input of service users. Who did this inspection Paul Whitehouse Banff Day Services, page 4 of 27

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a Recommendation or Requirement. A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards. A requirement is a statement which sets out what is required of a care service provider 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. Aberdeenshire Council is the provider of this service and they provide support and day care for 115 adults with a learning disability, mental health issues and/or physical impairment. As well as the day centre, the service has further outreach sites in Macduff, Turriff and Boyndie which provide service users access to activities and also vocational training. The service aims and objectives are: to provide valued opportunities and support to adults with disabilities from Banff, Macduff and surrounding area to offer ordinary life opportunities in work, education and leisure to promote and encourage the RIGHTs of individuals to advocate on their own behalf and on the behalf of others. Based on the findings of this inspection this service has been awarded the following grades: Banff Day Services, page 5 of 27

6 Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued 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. Banff Day Services, page 6 of 27

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, which took place on 7, 8 and 9 January 2013 from 9.20am to 4.30pm. We gave feedback to the manager and deputy manager at the end of this inspection. Paul Whitehouse carried out the inspection. In this inspection, we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents: support plans and associated records care monitoring records service user meeting minutes staff meeting minutes staff training information maintenance records nine questionnaires returned by staff working in the service accidents and incident records examining equipment and the environment observing how service users were cared for. Discussions with various people, including: ervice users the manager the deputy manager three staff We have used their comments in writing this report. There were no requirements or recommendations made at the last inspection. Banff Day Services, page 7 of 27

8 Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection report continued Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Banff Day Services, page 8 of 27

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. Every year all care services must complete a 'Self Assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed Self Assessment document from the service provider. The provider had identified what they thought they did well, some areas for further development and any changes they planned. Taking the views of people using the care service into account We spoke with five individual service users and several other service users throughout the inspection requesting their views on how to improve the care in the service. What service users said helped us assess how well the support service was performing. Throughout the inspection, service users appeared to be happy and content to be using the service. They all reported that they enjoyed coming to the service, and they explained which activities that they attended. Some of the comments from those present during the inspection included: * "I'm always happy" * "I'm happy" * "The staff are fantastic" We saw very good interaction between the service users and the staff. The service users appeared to enjoy the presence of those staff on duty and were encouraged by the staff to make choices in the activities they wanted to pursue. Banff Day Services, page 9 of 27

10 Taking carers' views into account No relatives were available for discussion as part of the inspection. Inspection report continued Banff Day Services, page 10 of 27

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: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found the support service was performing at a very good level in the areas covered by this Statement. Throughout the inspection, we saw service users approach the manager, deputy manager and staff with questions and queries. All of the staff members responded and supported the service users in a manner which was appropriate to the needs of the service user. If the staff were unable to answer any questions they would either direct or guide the service user to the appropriate person. Service users met with their keyworker on a frequent basis or as necessary. In addition, a formal group meeting between service users and their keyworkers took place regularly to discuss issues at the service. Appropriate information from these meetings was included on the agenda for the monthly service users' meeting. The service had regular monthly service user meetings. The service held these on different days to ensure all those using the service had the opportunity to participate. On the last day of our inspection, we attended one of the service user meetings. There was good attendance at the meeting, involving service users from the various groups from outside the centre including Macduff, Kingswells project and Boyndie. Although one of the staff co-ordinated the meeting, a service user was encouraged and supported to chair the meeting. One service user read the previous meeting minutes and these were agreed. With support from staff, service users gave feedback on any issues identified at the previous meeting. The meeting followed the agenda as advertised on the board in the main hallway. Banff Day Services, page 11 of 27

12 A representative from each of the groups, with support and guidance from staff, gave a short explanation of what they did in their group. The staff supporting the meeting let everyone know that the activities vacancy board was up to date and they could approach their keyworker if they were interested in joining any of the groups. Two service users fed back to the group their experiences of attending the recent Slade/ Sweet concert and an Aberdeen football match. They went as interviewers for the Banff BUZZ, this is the newsletter produced regularly by the service. They passed around photos and stated that the contents of their interviews would be part of the next issue. Care plans for service users provided information about the support that each individual received. The care plans we examined were very person centred. The provider was very good at involving the service users in many aspects of the service. Service users participated in their own care reviews with family members being involved at the request of the service user. We saw in the meeting minutes that service users were given the opportunity to request changes in their activities. Where appropriate, these changes were actioned. During 2012, the provider had carried out an intensive review of day services in the area. The review process known as "IDEA" (Inclusive Day services Enabling Aberdeenshire) was broken down into three tiers throughout the year. Tier 1 This involved the consultation with service users and what they thought about day services and how to make them better. The provider used an outside specialist organisation who talked to service users in groups and as individuals. The provider completed this at the end of March The key points from this forum were to develop more projects and community based activities. Tier 2 This involved the consultation with family and carers. The consultation took place in a local hotel on the 18 April 2012 and over 100 relatives and carers attended. The key points from this forum were to continue with the good foundation of activities and projects and also develop more projects and community based activities Tier 3 This involved the consultation with professionals involved in the service and the provider completed this at the end of The key points from this forum included: Inspection report continued Banff Day Services, page 12 of 27

13 To extend the service provision to include weekends and evenings. Develop links with the local hospital with a view to provide a hospital radio service. Develop a retail shop in Banff town centre to sell crafts made by service users. The strategic planning group had not fully agreed the action plan but was expected to be in place in We spoke to several service users and staff who were aware of the IDEA process and confirmed that they had been part of this process. Further information is available on the Aberdeenshire Council website by using the following link: In addition to the above consultation, another piece of work involving service users, relatives and staff was taking place. One of the projects, Boyndie, was providing activities around crafts, vocational training in catering and land maintenance and was due to transfer ownership over to a trust. The Boyndie project known as Boyndie Trust will separate from Banff Day Services and provide its own service as a vocational provider. The craft element was to move to the Kingswells site in Banff. We saw evidence that the provider had consulted with the service users and staff on choosing where they wanted to continue to work or take part in activities. The manager stated that this had caused considerable stress to both the staff and service users. We spoke to some of the service users and staff who confirmed that the process for changing over had gone well and that they were in transition for the separation. There was evidence that the provider had worked with the service users and staff to reduce the stress for them. The manager also advised that several service users had shown an increased level in their confidence in speaking in groups as part of their involvement in the service users' meetings and a leadership project. The service had lots of useful information set out in a format to make it more accessible for the service users; this included how to make a complaint, the welcome booklet and information using photos on notice boards displayed throughout the service. The provider supported service users in producing regular newsletters and they had a website blog known as Banff Blog. (This can be accessed using link: ). This blog had information and photos on all of the projects that service users and the provider have developed and was a good way to see how service users were involved in the development of these. Banff Day Services, page 13 of 27

14 Areas for improvement Inspection report continued Although the provider had developed, an action plan for addressing any items identified at meetings the plan did not have a 'Date Completed' section. This would ensure that there was a clear record of the date the necessary action was taken. (See Recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should develop their meeting action plans to include a 'Date Completed' section. National Care Standards for Support Services, Standard 2, Management and Staffing Arrangements and Standard 11, Expressing your Views Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found the support service was performing at a very good level in the areas covered by this Statement. In assessing this Statement, we sampled minutes of service user review meetings, medication and two care plans. We also observed staff practice and spoke with five service users and staff. The service held additional reviews as appropriate and at least every six months. The minutes showed that those present had the opportunity to discuss how they could meet the health needs of the service users. In one review minute, we saw evidence that those present had discussed the relevant issues in relation to the service user. There was a suggestion that a potential health issue may need to be assessed. The main care provider had thereafter appropriately referred the service user to the GP. The staff agreed that they would monitor the service user and provide the main care provider with relevant information. We saw evidence that both providers had taken the agreed action and the outcomes for the service user had improved. Care plans included very detailed information about service users' health issues and provided appropriate information on how the staff addressed any issues. In the care plans, we saw that service users continued to have access to a range of other professional people to meet their health and wellbeing needs such as the Speech Therapist. Banff Day Services, page 14 of 27

15 The care plans were very person-centred and contained risk assessments, activity plans and guidelines which gave details of how they provided this support. We saw that the care plans had regularly been reviewed and had been signed by either the service user their representative and the keyworker. In one care plan, we found that staff were following the plan and guidelines. As part of the assessment, the service user was to have a 2 to 1 staff ratio which we observed to be in place throughout the two sessions. In the same care plan, a Speech Therapist had identified very specific guidelines to support the service user at mealtimes. We looked at the care plan and found that the staff were following these. These guidelines involved the use of pictorial symbols of cutlery and guiding the service user to be able to feed themself after staff had put food on their cutlery. We spoke to three of the staff supporting the service user during the inspection who were able to evidence their knowledge of the service user's needs and the consistent approach needed for their support. Additional assessments included the most appropriate position for the service user to be in when being transported in the car. We observed the staff following the assessment guidelines when support staff transported the service user to another activity. Care plans for service users also contained important information on: personal care behavioural assessments with various strategies for dealing with these being clearly explained other assessments regarding mobility, diet. In one care plan, it stated that the service user was allergic to milk. This was implemented in practice as staff were aware of this and advised that the service user could have Soya milk instead. We spoke to the cook at the main centre who was aware of the allergy and showed us where they had Soya milk for his use. The support service had developed a range of activities throughout the area which service users attended using either public transport, transport arranged with the service or independently. Appropriate risk assessments were included in the service users' care plans for each of these groups. Areas for improvement When we looked at the risk assessments in one care plan the support service had recorded 'ongoing' in the date for review. We discussed this with the manager and deputy manager who agreed that they would review this and include a review date. Before the end of the inspection, the support service had reviewed the risk assessments and included a specific date to review them. Banff Day Services, page 15 of 27

16 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Banff Day Services, page 16 of 27

17 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths Information in relation to this Statement can be found in Quality Theme 1, Statement 1 and will be used to give the overall grade for this Quality Theme. Areas for improvement Information in relation to this Statement can be found in Quality Theme 1, Statement 1 and will be used to give the overall grade for this Quality Theme. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths In assessing this statement, we sampled care plans, relevant policies, and maintenance records and looked around the support service. We also spoke with service users, staff and observed staff practice. We found the support service was performing at a very good level in the areas covered by this Statement. A tour of the premises showed that the home was safe, clean and adapted to meet the needs of the activity and decorated to a good standard. The manager stated that they were to develop the service to provide a better environment for those service users who had a complex and/or a profound learning disability. We saw evidence that the provider was in the process of developing part of the main building to incorporate a large shower room with a tracking hoist to support service users. Banff Day Services, page 17 of 27

18 There was a range of health and safety procedures in place throughout the support service. These included risk assessments that were reviewed on a regular basis for all activities. We spoke to the staff that had organised the hill walking activity and they were able to explain the planning process and safety measures that were taken into account. The staff had completed an appropriate group risk assessment for the hill walking activity for that day. The service had in place an adult support and protection policy, which incorporated the local interagency guidelines. Most of the staff had recently attended adult support and protection training and they had an understanding of their responsibilities in supporting and protecting adults. We spoke to four service users who all knew who they could go to if they had a concern. A maintenance programme was in place for the regular servicing of hoists and other equipment. We sampled some of the service records and found that the provider had serviced these pieces of equipment in line with their policies and procedures. We looked at the repair log and saw that the provider completed, in good time, any repairs or maintenance. Some service users brought their own medication into the service and either selfmedicated or needed support to take their medication. Detailed information about their medication was included within the care plans. We observed staff administering and recording medicines in line with their policy and procedure. The provider was aware of the need for staff to be mindful of their duties in maintaining a safe environment. We saw that staff received prompts and reminders at team meetings about health issues. We saw that the manager and staff recorded and audited accidents and incidents and where appropriate had been followed up with appropriate action taken. Areas for improvement Inspection report continued The service could consider how service users can become involved in the checks and recordings about the environment, to help raise their awareness and value their participation in the upkeep of their own service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Banff Day Services, page 18 of 27

19 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Information in relation to this Statement can be found in Quality Theme 1, Statement 1 and will be used to give the overall grade for this Quality Theme. Areas for improvement Information in relation to this Statement can be found in Quality Theme 1, Statement 1 and will be used to give the overall grade for this Quality Theme. 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 found the support service was performing at a very good level in the areas covered by this Statement. In assessing this Statement, we looked at staff training records, staff meeting minutes and observed staff practice. We also spoke with service users and staff. The service users we spoke with had very positive comments to make about the staff working in the support service. Some of these included; "No one treats me badly" and "The staff help you". In one staff meeting minute, staff were asked to write down how the changes to the support service were affecting them. These thoughts were shared with the staff group Banff Day Services, page 19 of 27

20 so that others could understand the stress involved in the changes. In another staff meeting minute, we saw that the staff group discussed 'respect' and its implications for service users and staff. We looked at the training needs analysis for 2013/14 completed by the manager which had requested training for all of the staff in "Managing change" to help with the transition to a more community based services. We spoke to four staff, all were aware of the providers' policy and procedures for staff supervision. They also stated that they had received supervision in line with the timescales of the policy. All spoke very positively about the supervision process and supervision received. They stated that at supervision they discussed activity groups, any one to one work and any training completed and/or required The service had a training plan which identified training for staff. There was flexibility in the courses provided so as not only to meet the core training requirements, but also to allow staff to meet the changing needs of the service users. Staff told us that they had accessed training in moving and handling, first aid, health and safety, infection control, food hygiene, fire safety, adult support and protection, Epilepsy and medication. Training records examined confirmed this. We saw evidence that the provider had regular team meetings. Staff spoken with stated that these were well attended and held as stated. Minutes of these meetings recorded what actions staff should complete and when the actions were completed. They also said that the team meetings were helpful as it gave them an opportunity to share information and discuss issues with the management of the support service and their colleagues. The manager confirmed that he had registered with the Scottish Social Services Council (SSSC). We looked at the SSSC register and confirmed this. The manager was aware that although the remaining staff were not expected to register with SSSC, the provider was aware that staff will be expected to register when the SSSC have set a date for those staff working in support services. A Scottish Vocational Qualification (SVQ) training programme was also in place. We spoke to five staff, the deputy manager had an SVQ 4, one staff had an SVQ 3 and HNC qualification in care, and one had a Professional development award in Autism. The two others were waiting to start an SVQ qualification. The staff member with the Autism award was working directly to support groups of service users with Autism. From the remaining 20 staff one had an SVQ 4 in care; two had an SVQ 3 and one had a SVQ 2 in care. The training records confirmed this. The manager stated that they retain a copy of any SVQ qualifications at the provider's human resources department. Staff were seen to be motivated throughout the inspection and were very knowledgeable about the needs of the service users. Staff spoken with said that they were involved in making decisions and developing support in partnership with the service users they worked with. Staff stated they enjoyed their job and liked working Banff Day Services, page 20 of 27

21 in the support service. Areas for improvement We spoke to four staff who demonstrated some knowledge of the National Care Standards (NCS). The staff confirmed that they had a copy of the NCS given to them and had used them when completing their SVQ qualification. The provider should consider how they could encourage staff to use the NCS in further improving staff practice. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Banff Day Services, page 21 of 27

22 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Information in relation to this Statement can be found in Quality Theme 1, Statement 1 and will be used to give the overall grade for this Quality Theme. Areas for improvement Information in relation to this Statement can be found in Quality Theme 1, Statement 1 and will be used to give the overall grade for this Quality Theme. 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 We found the care home was performing at a very good level in the areas covered by this Statement. We spoke to staff who confirmed that the management in place was consistent and that they were happy with the support they received through regular supervision. Staff identified formal supervision as a very useful tool for them to discuss any issues and for seeking guidance. The manager provided very good evidence that they have quality assurance systems and processes, which involve those using the service, carers to assess the quality of service provided. Banff Day Services, page 22 of 27

23 The provider's quality assurance processes look at the following areas: The involvement of those using the service in reviews Access to service user meetings Health and safety inspection checklist Electrical appliance checks Maintenance checks First aid box checks Medication audits Complaints procedure Accident and incident reviewing process The staff completed the quality assurance processes and any issues identified were effectively resolved. We saw throughout the inspection how the manager and deputy manager monitored and identified any issues and appropriately address these as they arose. Areas for improvement Although the provider had been auditing care plans, the provider had not audited the care plans recently. We discussed this with the manager and deputy manager who agreed to audit the plans regularly. (See Recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should review the process of how often support plans are audited. National Care Standards for Support Services, Standard 2, Management and Staffing Arrangements and Standard 16, Keeping well Banff Day Services, page 23 of 27

24 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information None. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Banff Day Services, page 24 of 27

25 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Environment Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 1 Dec 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 18 Jan 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 4 - Good 30 Mar 2009 Announced (short notice) Care and support Environment Staffing Management and Leadership 5 - Very Good 5 - Very Good 4 - Good 3 - Adequate Banff Day Services, page 25 of 27

26 All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Banff Day Services, page 26 of 27

27 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: Banff Day Services, page 27 of 27