Penumbra - West Lothian Supported Living Service Housing Support Service Unit 20 Grampian Court Beveridge Square Livingston EH54 6QF Telephone: 01506

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1 Penumbra - West Lothian Supported Living Service Housing Support Service Unit 20 Grampian Court Beveridge Square Livingston EH54 6QF Telephone: Inspected by: Janet Wilson Pauline Cochrane Type of inspection: Announced (Short Notice) Inspection completed on: 6 March 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Penumbra Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Janet Wilson Telephone enquiries@careinspectorate.com Penumbra - West Lothian Supported Living Service, page 2 of 25

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 2 Weak Quality of Management and Leadership 2 Weak What the service does well The staff team were committed and were aware of the different support needs for the people that used the service. The service had an I.Roc computer system in place which some staff had started using. What the service could do better A requirement regarding the timescales for reviews was made. Recommendations were made regarding staff training, updating policies and procedures and documents. The manager agreed to ensure all documents were signed and dated by the relevant parties. There was no evidence of questionnaires for service users in 2012 and auditing tools were not being utilised. What the service has done since the last inspection The service had started to implement s measuring tool for a person's health and wellbeing, an 'I.Roc' computer system. Conclusion We found the service disorganised with documents either not being available or not fully completed. The service user and staff files were found to be inconsistent in their content. The standard of supervision records was poor. The staff team provided a good level of support and were aware of the health and wellbeing needs of individuals. Penumbra - West Lothian Supported Living Service, page 3 of 25

4 Who did this inspection Janet Wilson Pauline Cochrane Penumbra - West Lothian Supported Living Service, page 4 of 25

5 1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body Social Care and Social Work Improvement Scotland (known as the Care Inspectorate) took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body the Care Inspectorate. The Penumbra West Lothian Supported Living Service is part of Penumbra Limited. The service is based in Livingston West Lothian and covers the West Lothian area. The service provides support to adults in their own homes with the focus on providing mental health support. The service aims to prevent unnecessary evictions by providing support in areas which may put a service user's tenancy at risk. Support is provided Monday to Thursday 9.00am to 5.00pm and Friday 9.00am to 3.45pm. At the time of the inspection the service provided support to 126 people. They were supported by one manager, one assistant manager, one administrator, 17 support workers (both full time, part time and temporary) and five relief workers. The Aims and Objectives of the service stated:- 'Penumbra's Supported Living Service aims to assist Service Users towards living independently in their community and improve the mental health and well being of Services Users in West Lothian.' 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 2 - Weak Quality of Management and Leadership - Grade 2 - Weak 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. Penumbra - West Lothian Supported Living Service, page 5 of 25

6 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 The report was written after a low intensity, short notice inspection on 25 February Feedback took place on 5 March. The inspection was carried out by Care Inspectorate Inspector Janet Wilson and Pauline Cochrane (referred to as the 'Inspector' in this report). The service had submitted an Annual Return and Self-Assessment form as requested by the Care Inspectorate. In this inspection we gathered evidence from various sources, including relevant sections of policies, procedures, records and other documents, including: Evidence of the service's most recent self-assessment Evidence of the service's most recent annual return Files and care plans of people using the service Policies and procedures of the service Staff files and supervision notes Training records Discussions with - the Manager Staff People using the service Carers Consideration of the National Care Standards - Housing Support Service 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 Penumbra - West Lothian Supported Living Service, page 6 of 25

7 Inspection Focus Areas (IFAs) Inspection report continued 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 Penumbra - West Lothian Supported Living Service, page 7 of 25

8 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. We received a fully completed self-assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Penumbra - West Lothian Supported Living Service, page 8 of 25

9 Taking the views of people using the care service into account Three of the questionnaires returned to us before the inspection had the following comments:- 'Very friendly staff, no issues at all with staff, pleasant and respectful.' 'I am happy with the service.' 'I have found this service beneficial for me and person centred towards my needs.' Generally people were happy with the service provided. One person did not know how to complain if needed. We met with two people during the inspection. Both said how much they valued the support they received, enjoying the different activities and outings they did. Taking carers' views into account We met with one carer during the inspection who said how much he valued the support his wife received. He said the support gave him some time to do some things for himself or just have a break. It also gave him the chance to talk to staff if he had any queries or needed help with something. He was very happy with the support worker for his wife and said they had built up a good, trusting relationship. No other carer's views were taken into account during the inspection. Penumbra - West Lothian Supported Living Service, page 9 of 25

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: 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 Grades within this statement reflect the evidence found at the time of the inspection. The information was gathered by speaking to service users, carers, the manager, staff, and documentation looked at. The service enabled service users and carers to participate in assessing and improving the quality of care and support in a variety of ways: A welcome book and working together book was provided before a service commenced, which provided the service user and carers with the aims and objectives of the service and their policies and procedures which should enable the service users and carers to make an informed assessment of whether the service could meet their needs. A clear complaints policy was available which advised the service user and carers of what to do if they had a complaint and what to expect from the service. We found evidence that complaints were dealt with timeously and sensitively. The service had consulted with service users about their complaints policy and feedback indicated that the service users found it difficult to understand, therefore service users were encouraged and supported by the service to review this and the identified changes were made. One service user stated on the Care Inspectorate's questionnaire that they did not know how to complain. (see areas for improvement) The service provided end of service questionnaires to service users and carers, to gain feedback on the quality of care and support being provided. Some of these questionnaires were available at the time of the inspection. Penumbra - West Lothian Supported Living Service, page 10 of 25

11 Penumbra as a wider organisation held road shows which service users using the West Lothian service and other Penumbra services were invited to in order for the organisation to consult with them about the quality of their care and support amongst other things. The service intends to consult with the service users in reviewing the service user's charter they currently have in place. The service told us that they provided questionnaires to service users and regularly carried out informal reviews of their care and support to ensure it continued to meet the service users. The service users had a support group which was supported by staff but run by the service users themselves. This enabled the service users to discuss the care and support they were being provided and feedback as a group. The group were proactive in fund raising and organising events and days out. The support people received was reviewed by West Lothian Council after 4-6 weeks, by the service after three then six months. There was a joint review with West Lothian Council annually. The manager said the service reviewed people using their I.Roc system every three months after this. A formal review was carried out annually only. During each review or meeting service users and their carers had the opportunity to comment on the quality of their care and support. The I.Roc system was able to highlight when a review was due, overdue or if the review date was near. The system could also record a person's personal details and any issues staff needed to be aware of. As this system was new not all staff were using it. We found the content and quality of information available to very different depending on whether staff were using the electronic or paper system. Areas for improvement Inspection report continued The service told us in their self-assessment that they offered "annual service users questionnaires, referrers questionnaires". On the day of the inspection the questionnaires that we saw were dated Although the manager showed us statistical feedback from service user and carer 2012 questionnaries, the questionnaries for 2012 could not be evidenced. The service should ensure that they offer these questionnaires at more regular intervals, keep the forms and collate the information received in them to plan for future improvements. The service needs to ensure all support plans are formally reviewed at least every six months in line with current legislation and that any changes or no changes are documented. Requirement 1. The manager said she intended to start a carer's focus group to get ideas of what to include in a carers welcome pack. Penumbra - West Lothian Supported Living Service, page 11 of 25

12 We discussed the content and quality of information in files with the manager. She agreed service user files needed to be regularly audited and the information from these needed to be of a consistent quality from all staff. She also agreed that one system is needed rather than the present electronic and paper ones. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider must ensure that personal plans are reviewed at least every six months and revised where appropriate. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulation 2011/2010 Regulation 4 (2). Personal Plans. Timescale: to commence no longer that one month from receipt of this report. Penumbra - West Lothian Supported Living Service, page 12 of 25

13 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Grades within this statement reflect the evidence found at the time of the inspection. The information was gathered by speaking to the manager, service users, carers, staff, and documentation looked at. Files for people using the service were found to be inconsistent in their content. All service users had a personal support plan. Information in their file included details on a person's health, likes, dislikes and contact details for family members, however these were not reviewed in line with statutory requirements (see areas for improvement). All service users had an agreement signed and up to date, detailing the responsibilities of the service and what they could expect and what their responsibilities as service user were, however the service could not always ensure that they met their agreement (see areas for improvement). Service users had access to a focus support group enabling them to have peer support, and organised outings and activities. Minutes of meetings were evidenced and we spoke to the person who ran the focus group. The service used a measuring tool (I:ROC) to enable them to track service users health and wellbeing. This was regularly reviewed and the results discussed with the service user in order to inform the care plan in place and also review whether they needed an increase or decrease of support (up to 25% of their agreed care package), allowing the service to identify and respond to immediate need. The manager told us the service carried out spot checks which enabled them to discuss the service users care plan and ensure that the service was meeting all of these needs. There was no system to these spot checks however and service users were not guaranteed to be provided this opportunity (see areas for improvement). We spoke to service users and they told us "Penumbra is great and gives me someone to talk to", another said "My worker is great and supports me to make soups and bake and to go out on walks, I am happy". The service told us they liaised closely with carers to ensure that they met service user's health and wellbeing needs and supported carers. They told us they spoke regularly to carers who knew how to contact them. One carer confirmed that this was their experience. Penumbra - West Lothian Supported Living Service, page 13 of 25

14 Some risk assessments had been completed and were in the service users file (see areas for improvements). There is a clear and transparent complaints policy and service users were provided with the contact details of local advocacy services in order to ensure their views were heard. We found evidence of the service working alongside an advocacy service to resolve a complaint. The service followed good accident and incident reporting procedures. The information we evidenced showed documents had been completed appropriately with the outcomes and actions taken following on from an incident recorded. Areas for improvement Service users care plans were not being updated in line with current legislation and best practice. We therefore made a requirement, (see Statement 1.1) Risk assessments were not visible in the files, updated regularly enough or specific enough. The service should review their recording of risk assessments. Risk assessments relating to risks to staff should not be kept in the same place as the ones relating to service users. To ensure the service users health and wellbeing files need to be kept up to date with the information being consistent. The manager agreed to look at a system of how the service can efficiently record information, whether this is in paper or electronic format. Files need to be easy to understand so all staff, including relief staff, know at a glance where to find the information about the service user. Spot checks could be used more effectively and in a more organised way to ensure all service users are given the opportunity to have a face to face discussion with one of the managers of the service about the care they are receiving. Information on the services care plans needs to be more detailed and cover areas such as health, likes, and dislikes, social and emotional needs. It also needs to help support people to make healthy choices regarding meals and exercise. Penumbra - West Lothian Supported Living Service, page 14 of 25

15 All care plans and supporting documents must be signed and dated by all relevant parties. The service needs to ensure its Complaints Procedure and any other relevant documents contain up to date information on the Care Inspectorate. From the feedback we received before the inspection not all service users were aware of how to complain. Although they did say they would generally speak to their support worker. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Penumbra - West Lothian Supported Living Service, page 15 of 25

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Grades within this statement reflect the evidence found at the time of the inspection. The information was gathered by speaking to the manager, staff, and documentation looked at. We found that service users were invited to participate in interviews for staff. They were supported to develop their own questions which they then asked candidates at interview. Following involvements in the interviews we found evaluation forms completed by service users providing feedback of their experience. These forms included comments such as "I really enjoyed the experience and would like to do it again" Managers told us they consulted with service users on their experience of being supported by new staff members on probation and students working in the service. These consultations were used to improve the quality of the staffing for example by informing managers about when permanent contracts should be offered. Areas for improvement The manager agreed to look at more ways of getting feedback on staff from not only service users and carers, but stakeholders as well. The information we looked at during the inspection was found to be very patchy. A more consistent process would benefit how the service regularly gathers information, evidences how this information has been used and what changes to staffing or the service have been made. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Penumbra - West Lothian Supported Living Service, page 16 of 25

17 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued Grades within this statement reflect the evidence found at the time of the inspection. The information was gathered by speaking to the manager, staff, and documentation looked at. We met with a number of staff members who told us that "penumbra was generally good to work for". They told us they were given induction training at the start of their employment and then offered a variety of training throughout the year. They also advised that when they first started there was a core training programme that they had to complete. Two members of staff told us that they were currently undertaking SVQ training and all staff members we spoke with told us they were supported to access training as and when required. They also had an e-learning system in place to support a variety of training methods and opportunities. We saw the staff training calendar from 2011, which offered a variety of training including: Self-directed support, Overdose training, ASIST, WRAP, Emergency First Aid, Stress Management. Lists of training from the Penumbra head office regarding training undertaken was evidenced as was the manager's monthly list of what training staff had completed or needed. Staff and managers told us they received supervision every 4-6 weeks, however we did not find up to date minutes of supervision meetings to support this (see area for improvement). Staff and managers both advised however that there was an open door policy in place and staff could approach managers with concerns at any time. The providers Strategic Plan stated under support and supervision, peer support is 'The sharing of these ideas between peers can offer the opportunity to reflect and develop on an employee's own practice, whilst also helping colleagues.' New workers had a probationary period and at the end of this they were reviewed, this included setting objectives for the next 12 months and offering a permanent contract or extending the probationary period and providing a higher level of support to staff if needed. Penumbra - West Lothian Supported Living Service, page 17 of 25

18 Following consultation with staff the service had set up a rolling programme of team meetings every week with a slightly different focus, week one was a peer team meeting, with no management, week two was a team meeting/information meeting facilitated by management and week three was a training and development team meeting. Staff said this helped with better communication, team building, and an opportunity for staff to identify and discuss training and development issues. Minutes of team meetings were evidenced, each topic had an action plan and who was taking responsibility in completing what was required. Areas discussed were loan working, training and lack of office space. The service had a lone working policy and used mobile phones to ensure the safety of their staff. Areas for improvement Staff files were found to be inconsistent in their content, some of the files contained very little. All documents need to be signed and dated by the appropriate people. We sampled staff training folders which evidenced a wide variety of training offered, however we did not find staff training certificates to be up to date and staff told us that whilst there was a lot of training offered however some of this was repetitive. As with other areas of the service, the training files were found to be inconsistent in content, many having no copies of certificates or ones that were years old. Regular training appraisals would identify training completed, training required and any discrepancies between these. Although the manager showed the Inspectors lists of training from the Penumbra head office regarding training undertaken and the manager had monthly lists, there was no indication of when any training needed to be updated or an overall annual plan of what training would be taking place and for who. Recommendation 1 Supervision should be recorded, signed and dated and a copy should be provided both to the supervisor and supervisee as a record of their areas for development and with any actions agreed on. The quality and content of the supervision records we evidenced was found to be very poor with an inconsistent format or content followed. There was minimal evidence to highlight the professional and personal development needs of staff members, or any areas an individual may work on before the next supervision session. Recommendation 2 Penumbra - West Lothian Supported Living Service, page 18 of 25

19 One member of staff had had an annual appraisal. The manager said due to a new system being introduced centrally no annual appraisals had taken place during The new format was designed to be more competency based, the manager said this had started to be used in February The service needs to evidence the impact of this new system on the development of staff. (See Recommendation 2) We found the environment the staff had to work in to be unsatisfactory. There were not enough computers for the number of staff. As staff used the services e-learning system for training and the service was transferring all service user information onto their I.Roc system, we considered the lack of equipment and physical office space was detrimental to the training and development of staff. This issue was discussed with the manager who said the working environment and tools for staff was under review. Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service needs to have a staff development strategy and an effective yearly training plan for its entire staff team. National Care Standards Housing Support Service - Standard 3.7 Management and Staffing 2. The service needs to develop a format for the content of all staff supervision and appraisal sessions. All records must be legible, signed and dated by all relevant parties, with copies in staff files. This is in line with best practice guidelines for staff development. National Care Standards Housing Support Service - Standard 3 Management and Staffing Penumbra - West Lothian Supported Living Service, page 19 of 25

20 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Grades within this statement reflect the evidence found at the time of the inspection. The information was gathered by speaking to the manager, staff, and documentation looked at. The service had good links with the local colleges and they had developed a good clear student handbook. This enabled students to be clear on the aims and objectives before working with the service. Throughout their placement and at the end the service told us the students were provided with evaluation forms to enable them to feedback their experience of the service and give any suggestions/ideas for improvements. Staff had team meetings which were attended and facilitated by the staff themselves without the involvement of the management. This should enable staff to discuss issues with regards to management and leadership and feedback suggestions for improvements. Areas for improvement The manager agreed to discuss with staff and stakeholders how she can get more constructive feedback to help develop the service. Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 0 Penumbra - West Lothian Supported Living Service, page 20 of 25

21 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths Inspection report continued Grades within this statement reflect the evidence found at the time of the inspection. The information was gathered by speaking to the manager, staff, and documentation looked at. The service completed a National Stakeholders survey in 2012, we saw the results of this survey and noted comments by other stakeholders which included:- "The service provided is very helpful to both myself and client group that I work with. There is good communication between Penumbra staff and myself. The staff members working with Penumbra are very committed to delivering an excellent service to clients and will work at the client's pace." "The service is flexible, if clients have appointments and require to be accompanied then staff from Penumbra will always try to vary their times and meet the client's needs where possible.' The organisation have committed to completing this national survey every October. Managers carried out spot checks within the service to provide service users the opportunity to feedback to them the quality of service they are provided with and any issues they may have with the staff members that are supporting them. The provider held an annual staff conference which was open to all Penumbra employees. This gave management the opportunity to speak to staff on the direction of the organisation, and assess the service currently being provided to service users. The results of this were fed back to staff members along with proposed changes. Staff told us that they were also able to attend staff representation groups at the headquarters of the organisation to put forward ideas and suggestions on improving the service. These were held regularly. The service told us that questionnaires were sent out to social workers, service coordinators and other stakeholders in order to gain feedback on the quality of the service. We found evidence that this had taken place but not in recent years. The providers policies and procedures were reviewed and updated centrally. The index noted when a document had been last reviewed, when it was due to be reviewed again and if it was under review. Penumbra - West Lothian Supported Living Service, page 21 of 25

22 Feedback from the staff questionnaire ( ) stated staff needed more time for paperwork, which had been arranged and that there were constant changes within the service. Staff and the manager said the peer support meetings had started to help with staff discussing this. The manager said annual staff questionnaires were sent out locally and centrally. The evaluation of the service users and the carer's survey gave very good statistical results. Areas for improvement The service needs to ensure effective systems are in place to audit its systems and process. Information also needs to be gathered from stakeholders, agencies, other professionals, staff and people using the service. Recommendation 1 The manager needs to evidence what changes have been made to the development of the service from the surveys it sends out. Although the general feedback from the information we evidenced was positive, there was no evidence to show how service users, carers or staff had benefitted from the exercise. The service needs to develop better quality assurance systems and procedures. This is to include the auditing of all service user and staff files, (including files in service users homes). Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service needs to evidence changes made to it from its quality assurance systems. National Care Standards, Housing Support Services, Standard 3 Management and staffing arrangements Penumbra - West Lothian Supported Living Service, page 22 of 25

23 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 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). Penumbra - West Lothian Supported Living Service, page 23 of 25

24 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 4 - Good Quality of Staffing Weak Statement 1 Statement Adequate 2 - Weak Quality of Management and Leadership Weak Statement 1 Statement Weak 2 - Weak 6 Inspection and grading history Date Type Gradings 15 Jan 2010 Announced Care and support 6 - Excellent Staffing 5 - Very Good Management and Leadership 5 - Very Good 10 Nov 2008 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Penumbra - West Lothian Supported Living Service, page 24 of 25

25 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: Penumbra - West Lothian Supported Living Service, page 25 of 25

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