Carewatch - West Central Scotland Housing Support Service Caledonia House Quarrywood Court Livingston EH54 6AX Telephone:

Transcription

1 Carewatch - West Central Scotland Housing Support Service Caledonia House Quarrywood Court Livingston EH54 6AX Telephone: Type of inspection: Announced (Short Notice) Inspection completed on: 23 July 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 30 5 Summary of grades 31 6 Inspection and grading history 31 Service provided by: Carewatch Care Services Ltd Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Carewatch - West Central Scotland, page 2 of 33

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well Overall, customers we spoke with confirmed that they knew the carers who visited them. They told us that (mostly) they had small teams of carers, had no concerns about staff reliability, time keeping or consistency. Customers told us that staff had the skills and approach to support them and meet their care needs. The induction training for new staff continued to be developed to ensure it met the changing needs of the customers and staff team. This was well presented and staff told us that it prepared them for the job. The service were able to show how they used a 'competency based' framework to support staff development and learning. This supported the service in delivering a good standard of care. Customers and their families gave good examples of office based staff responding to their concerns and needs. What the service could do better Areas for improvement are reported on under the relevant themes and statements but include: -The provider still needed to put a plan into place to support all staff to achieve qualifications that will allow them to register with the Scottish Social Services Council. Carewatch - West Central Scotland, page 3 of 33

4 -We could still evidence that some policies and procedures in place did not reflect Scottish legislation. This requires to be a focused area for improvement -Risk assessments and care plans need to be further developed to reflect the complex health and social support that care staff provide -Robust procedures and policy are to be developed and implemented for 'Controlled Medications'. What the service has done since the last inspection Developments since the last inspection are reported on under the relevant themes and statements but included: -The senior staff team had expanded in response to the increase in the size of the service. We could evidence the positive impact this was having upon the service provided to customers and to the support and monitoring of care staff -Carewatch (the provider) were undergoing a significant restructure. The senior team in this branch gave examples of how this was a positive change and was impacting upon the service -Developments in performance management and quality assurance demonstrated that customers' needs were being met more effectively -Documentation was being reviewed and developed and we saw how this could improve the way that customers' needs were assessed and reviewed -The field care supervisors and co-ordinators had been given development opportunities to improve their practice in key responsibilities for their role. Conclusion Customers we spoke with gave positive feedback about the care and support provided. The management team and care staff spoken with demonstrated a good knowledge and understanding of the customers they supported. The West Central Scotland branch of Carewatch welcomed the inspection process and feedback as a means of further developing and improving the service to meet the future needs of customers'. We were pleased to see how the service had responded to recommendations made at last years inspection. The management team felt positive about overall changes in the organisation. We have requested that the service provides regular updates on the progress made in relation to recommendations and requirements made at this inspection. Carewatch - West Central Scotland, page 4 of 33

5 1 About the service we inspected At the time of the inspection, Carewatch West Central Scotland delivered a service to approximately 460 people in their own homes in West Lothian. The organisation was staffed by a general manager, a depute manager, a training officer, three coordinators, six field care supervisors and aproximately 130 frontline care workers. Carewatch (West Central Scotland) provides a care at home and housing support service. The services are provided in a combined way by the same management and staff team. Care and support is provided to people living in their own home in West Lothian, this large area is managed as three distinct geographical areas. The service includes all aspects of personal care, social and emotional support and assistance with housework and shopping. Care and support is provided based on individuals' needs. The service aims to provide care and support to enable individuals to live in their own homes. The service aims and objectives include: 'To live an independent life and be valued for your ethnic background including language, culture and faith. You will be treated equally and live in an environment free from bullying, harassments and discrimination. You must be able to complain effectively without fear of victimisation'. 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 but where failure to do so will not directly result in enforcement. Carewatch - West Central Scotland, page 5 of 33

6 -A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the inspectorate. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Carewatch - West Central Scotland, page 6 of 33

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by Karen Mack, Inspector. The inspection took place over three days between the 24 of June and the 23 of July. We gave feedback to the Registered Manager and Depute Manager on 23 July As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and return to us. During this inspection we gathered evidence from various sources including: -The Participation Strategy for the service (this is the service's plan for how they will involve people who use the service) -Relevant sections of policies/procedures/records/documents -Care plans of people using the service -Staff Records -Training records -Direct observation of staff practice -Questionnaires that had been issued and returned to the care service from people using the service -Questionnaires returned to the Care Inspectorate We met with people including: -Customers and their families -Five experienced front line care staff -Three new front line care staff -Depute Manager -General Manager -Training Officer -Field Care Supervisors -Co-ordinators All of the above information was taken into account during the inspection process and was reported on. For the purpose of this report, people using the care service will be referred to as 'customers' a term promoted within the service inspected. Carewatch - West Central Scotland, page 7 of 33

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 Carewatch - West Central Scotland, page 8 of 33

9 What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that service users personal plans are reviewed at least 6 monthly and evidence how service users and their representatives have been consulted about how the service is meeting service users' health, welfare and safety needs. 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 5(2)(b). Timescale: Within 4 weeks of receipt of this report. What the service did to meet the requirement A key performance indicator (KPI) tool had been introduced. This tool enabled the service to identify when key actions were due to be undertaken. This included customer quality assurance visits and six monthly customer reviews. This was a very positive development and we could evidence that the service had a much greater 'overview' of customers' needs and that six monthly reviews were planned and happening. The requirement is: Met - Within Timescales The requirement The provider must ensure that appropriate risk assessments are in place and fully completed for all service users. This must include: i) Moving and Handling ii)risk of falls 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. Regulation 4 1(a) Welfare of users Carewatch - West Central Scotland, page 9 of 33

10 This is a requirement for providers to make proper provision for the health, welfare and safety of service users. Timescale - Within 6 weeks of receipt of report. What the service did to meet the requirement From the sample of personal care plans assessed we could evidence that the service had moving and handling assessments and falls risk assessments in place. We shared examples with management of ways that some risk assessments could be further developed. A recommendation has been made. The requirement is: Met - Outwith Timescales Inspection report continued The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade the services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The service should continue to develop the self-assessment to include more information on the outcomes for people using the service. Taking the views of people using the care service into account We asked the service to distribute Care Standard Questionnaires to a sample of people using its service. We received 15 completed questionnaires. 100% of respondents agreed that overall they were happy with the quality of care. Other findings were: -100% agreed that staff treated them with respect -100% said they were confident that staff had the skills to support them -87% % agreed that the service checked with them regularly that they were meeting their needs Carewatch - West Central Scotland, page 10 of 33

11 -100% said that staff had enough time to carry out the agreed support -93% agreed they had a personal (support) plan which contained information about their support needs -100% agreed that the service asked them for their opinion about how it could improve -60% of respondents knew how to use the service's complaints procedure Further comments from people we met and spoke with during the inspection are included in the body of the report. Taking carers' views into account We met with relatives during the inspection and spoke with them on the telephone. We also considered the feedback gathered through the Care Standard Questionnaires. We have used the views expressed to us to inform this inspection. Comments are included in the body of the report but include: 'They are all very good' 'Carers have a lot of patience' Further comments from people we met and spoke with during the inspection are included in the body of the report. Carewatch - West Central Scotland, page 11 of 33

12 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths From our inspection of the documents available to us (including care plans, daily recording notes, risk assessments, records of reviews) and the discussions with the customers, relatives and the staff we met, our conclusion was that Carewatch was providing a good service in meeting the care and support needs of its customers. The contract between the local authority and Carewatch states that they are to provide a call within 15 minutes of the agreed visit time. We asked customers about the consistency of the service. Out of the eight telephone calls and three customers we visited, most said that they had regular carers at fairly regular times and that staff stayed the allocated time. Specific feedback was given to management where required, for example one person told us 'I don't know how long they should be here'. The service used computer systems to allocate specific carers to specific customer visits. We selected certain customers' names and checked the schedule for the consistency of named staff and times of visits. Overall, records sampled showed there was an underlying consistent team of staff providing the care. As example, one customer was visited by two carers four times per day - we saw that there were a core group of around six/seven staff. We concluded that the value of people having regular named care staff was recognised by the service. Care Standards Questionnaire results showed that all 93% who responded either strongly agreed or agreed "I know the names of the staff who provide my support and care". Customers we spoke with confirmed they knew all the carers who visited them and were introduced to any new staff. Carewatch - West Central Scotland, page 12 of 33

13 When carers visited each customer they recorded their time of arrival and departure on the daily care note document. They also recorded a short overview of the support/ care provided including support with medication. Entries we checked in customers' homes were signed by the carer and customers confirmed the visit times reflected practice. The service had recently changed the loose pages of daily care notes to a new care notes booklet. The booklet allowed for the separate recording of communication between the customer, their representative, relevant health professionals and the service. This allowed for all involved in that individuals care and support to communicate with each other effectively (this included health care staff). Additional pages were included to allow for the auditing of information recorded within the booklet. This was a positive development. The service could very clearly identify patterns in the customers' health and well-being and also ensure that staff recordings and understanding of needs was as expected. During the inspection, we sampled a selection of customers' personal plans. We then visited some of these individuals to determine if their plan of care reflected their needs. In general, we found that there was no difficulty in identifying the customers' personal needs and preferences and the tasks that they required support with. All customers and relatives we spoke with confirmed that they had been involved in developing the plan for how the service would meet their needs and that they were reviewed. The majority of care plans did detail the customers' life history and interests meaning staff had more understanding of that individual, their background and interests. This can enhance relationships between staff and customers meaning that the support and care provided is meaningful and effective. The staff training and induction systems Carewatch have in place to ensure staff have the skills, knowledge and ability to promote customers health and well-being are reported on under Theme 3, Statement 2 and Theme 3, Statement 3. Customers told us: 'I am very privileged that I have Carewatch as my provider as I have the same regular carer who is the most polite and understanding person. I can honestly say 100% satisfied with the care I receive' 'Although, in general the attendants arrive at around the agreed time, they are often a bit too early. My mother was cited a time of just after 6 to get ready for bed - which she was not happy about' Carewatch - West Central Scotland, page 13 of 33

14 'The office will phone to update me on the carers and staff will do it when they are in' 'I am quite satisfied' 'I was asked for my thoughts and views on the care plan, it's sufficient to meet my needs' 'The care plan is excellent, the District Nurse and I have been involved in every step' 'My needs are reviewed every 6 months' When asked about regular care staff, customers told us: 'Oh yes, Morning, lunch and evening' 'Yes, I have the same girl' 'The last 2 or 3 weeks I have had someone different each time' 'Yes - morning and nights' 'Yes - apart from holidays' We found the performance of the service was good in relation to this statement. Areas for improvement At last year's inspection, we made a requirement that the service have appropriate Risk Assessments in place. From the evidence sampled, we concluded that this requirement had been met. We did see examples of Risk Assessment tools that were generic and could be more specific and we shared examples of this with management. (See Recommendation 1 below). We discussed the care plans that we sampled with the depute manager. We shared some examples of plans that were very detailed and others that could be improved upon. The service is well placed to continue to improve upon the standard of detail in the plans and we recommend that this develops. (See Recommendation 2 below). Documentation sampled was not always signed and dated - we shared examples of this with the management, for example staff competency assessments - this means it can be difficult to know when staff skills were assessed or plans of care reviewed. Carewatch - West Central Scotland, page 14 of 33

15 The staff currently support many customers with taking their medication. During this inspection we noted that staff were supporting customers with medications classed as 'Controlled'. Controlled medicines are classified by law and as such their management is specific. Through discussion and sampling policies we noted that there were no policies or procedures in place to support this practice. We have shared with the management guidance to support development of policies and procedures and this will be followed up on. (See Requirement 1 below). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements 1. Requirement with reference to Theme 1, Statement 3: The service provider must develop and implement a robust procedure to support staffs practice in relation to Controlled Medications. This is to ensure the health and welfare of Service users. This must include: -A clear medication policy relating to the management of Controlled Medications. This should be regularly reviewed. -Appropriate systems and procedures should be in place to support the medication policy. -Administration of medication should be monitored - including written records kept. -The training needs of staff are reviewed to ensure that all staff responsible for the management and/or administration of medications classed as 'Controlled' have the appropriate knowledge, qualifications, skills and experience necessary to perform this role. -Staff competency should be measured to ensure that they are appropriately trained and can demonstrate their understanding of the Controlled Medication management procedures and policy -Medicine management in care plans should be regularly reviewed and regularly audited. 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 Regulation 4 (1) (a) Welfare of users Regulation 15 (a) (b) Staffing Carewatch - West Central Scotland, page 15 of 33

16 This is a requirement for providers to make proper provision for the health, welfare and safety of service users. The following National Care Standards have been taken into account in making this requirement: National Care Standards - Care at Home Standard 4 (Management and Staffing) Standard 8 (Keeping Well - Medication) Timescale for Implementation - 3 months from receipt of report. Recommendations 1. Recommendation with reference to Theme 1, Statement 3: The service should further develop Risk Assessment procedures and assessments and should consider: -appropriate tools which provide a clear, evidence-based, process for assessing and documenting risk. -the process and tools used should provide a more detailed and clinical overview of the care needs and the associated risks. National Care Standards: Care at Home - Standard 4 - Management and Staffing 2. Recommendation with reference to Theme 1, Statement 3: Inspection report continued The service should provide a care plan that can evidence: -Clear assessment information regarding customers needs and the planned interventions by staff to meet these needs -The choices and preferences of customers in relation to meeting these needs -How these needs and risks are evaluated and reviewed National Care Standards: Care at Home - Standard 3 - Your Personal Plan Carewatch - West Central Scotland, page 16 of 33

17 Statement 6 People who use, or would like to use the service, and those who are ceasing the service, are fully informed as to what the service provides. Service strengths Following examination of written information, discussions with management and staff and, information from people using the service, we concluded that this service performed well with regard to this statement. We met in person with one customer who was new to the service and spoke with another three customers who had started using the service within the past eight months. They told us of their experience of Carewatch, including the assessment process, information provided and their involvement in planning how the service would meet their needs. The customer told us that three senior members of staff met with them and their family to discuss what they wanted from the service. In their opinion, these staff were 'easy to speak to and professional' throughout the assessment period. The assessment process centred around what times the visits were required and the support and care. Before the service was provided a moving and handling assessment happened in the house, supported by the training officer. All staff spent time becoming familiar with the equipment that would be used and the best way to provide the care and support to meet that individuals' needs. At this time, the customer informed us that time keeping was 'generally good' and that they were informed of what staff to expect - and that there was a core group of regular staff who provided support - 'plenty of continuity'. They also stated that there was always at least one staff member who had specific training on the equipment used. We asked for feedback about the staff's skills, conduct and the information the service provided: 'Staff are pleasant, we have struck up a good rapport' 'We got an introduction pack, the social worker and someone from Carewatch met with us to discuss care needs' 'The staff are respectful and look after my husband very well. I am happy with the service' 'It's all in the information folder' Inspection report continued Carewatch - West Central Scotland, page 17 of 33

18 'The service is catered to my particular needs' 'They always stay and chat - ask me about my photos and things that interest me' 'They brighten my day' One customer told of their involvement in the plan of care and we talked through this. We could see that there was a good level of detail in the plan, including the specific way that moving and handling should happen to meet that individual's needs and ensure staff safety. The service user's guide and written agreement in the plan were current and provided appropriate information. We found the performance of the service was good in relation to this statement. Areas for improvement The service must ensure that information provided to potential customers on what the customer can expect continually evolves to reflect changes in legislation and expected best practice. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carewatch - West Central Scotland, page 18 of 33

19 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths To assess this statement we met with three new care staff, office based staff, customers and their relatives, examined staff files and evaluated the induction training. We concluded that the service demonstrated a good staff recruitment and induction process which met the standards for safer recruitment in social care. We sampled three staff files and this showed us that the service had followed a robust structure for safe staff recruitment. This process included: -Application forms - fully completed. -Formal interviews, which were recorded. -Copies of relevant qualifications and previous training records. -Evidence of employment history. -Two references - including from a previous employer -Photographic identity checks. -PVG (Protection of Vulnerable Group) checks. -System in place for updating staffs PVG checks. -Equal Opportunities monitoring form. -Evidence of eligibility to work in the United Kingdom. -Recruitment files were audited and 'signed off' when the individual was ready to begin working with customers. During the inspection we met with the training officer who gave us a copy of the training and development programme undertaken at induction. The training was undertaken over five whole days. Training topics delivered at the five day induction training included adult support and protection, duty of care, end of life care, reflective practice, moving and positioning, understanding medication, understanding dementia, food safety, nutrition and hydration, health and safety, first aid awareness and other operational and employment procedures. The induction training was underpinned by an assessment at the end of each training topic to ensure new carers understood what had been taught. Carewatch - West Central Scotland, page 19 of 33

20 Carers we met with explained that their five day induction was 'split' and that they had spent two days in between observing other staff practice. It was recognised by the service how beneficial this was as it enabled the staff to have a greater understanding of their role and the needs of customers. Staff provided very positive feedback about the quality of the induction process: 'Trainer was brilliant, approachable' 'They understand that we all learn differently' 'Surprised at what we managed to cover and our understanding was checked after each unit' 'Training very thorough' As part of the induction process new care staff 'shadowed' a field care supervisor, senior carer or an experienced staff member whilst delivering care. New and experienced staff confirmed that the more experienced care staff would be asked to give the new staff and the managers, feedback on how the 12 hours had gone - and that if they or management felt they needed more time working alongside experienced staff, that this would happen. It was positive that Carewatch had recently agreed to increase the 'shadowing hours' to 20.This meant that staff should not be supporting customers when they felt under confident or did not have the appropriate skills. The training officer had a responsibility for assessing staff competency after induction training. They told us that the service was developing the way they monitored staff during their probationary period. This meant the service could evidence that staff had the skills and knowledge to offer the best support to customers. We could evidence that end of probation review took place on/or around twelve weeks (mostly). Staff were aware that their practice would be monitored by senior staff and managers through 'spot checks' and 'field based observation' and that their on-going development and standards would be discussed through supervision and appraisal. The new staff had been told to contact management with any concerns and felt confident that they could. Another staff member told us: 'As a young carer starting out with Carewatch and having no experience, I feel that the induction training provided me with the knowledge I required to go into the field and confidently do my job. I have received regular support and supervision from my managers and feel totally supported in my role'. We found the performance of the service was very good in relation to this statement. Carewatch - West Central Scotland, page 20 of 33

21 Areas for improvement At last year's inspection, we identified that staff interviews were held by one person. We discussed this with the management team then and did again at this inspection. As the service now has more senior staff, it is advised that they are involved in the interview process. This means that care staff can support the administration staff in matching suitable candidates for certain customers or geographical areas. Two staff being involved with the interview process ensures that there is a clear and accurate recording of the process and the outcomes. The provider had developed the induction booklets used to support and evidence staff learning when they started in the service. We thought that these induction booklets were detailed and covered relevant practice, standards and legislation. As new staff had not yet completed these booklets, we look forward to seeing how these have supported the service in assessing staff knowledge at the next inspection. In Theme 3, Statement 3 we have reported on available learning packages to support staff's dementia awareness. This is also relevant to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carewatch - West Central Scotland, page 21 of 33

22 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 To assess this statement we met with new and experienced staff, met with customers, considered feedback from relatives, examined staff records and evaluated the training systems. From the evidence sampled, we found the performance of the service was good in relation to this statement. At the last inspection, we reported that staff were behind schedule with training updates. This had also been identified by the Carewatch Quality Assurance Team. During this inspection, we could evidence that progress had been made. Care staff now undertake an annual two day training refresher course - 'back to basics'. The course includes health and safety, adult protection, medication awareness, nutrition and hydration, dementia awareness, first aid awareness and moving and positioning. At the end of each training module, a written assessment was carried out to ensure carers understood the training delivered. We looked at completed refresher training records of carers which evidenced that this happened. The Training Officer also gave examples of practical observations and further support/training the service would carry out if concerns over practice/knowledge/conduct were identified. We found the content of the training to be of a good standard and staff provided positive feedback on the way that this training was now delivered. We met with the dedicated training officer for the service and discussed changes in the ways that staff knowledge was assessed. The trainer found the change to the annual two day refresher training had been positive. They confirmed that the service were more confident in meeting expected standards and knew that by meeting carers' training needs the customers' service was improved. The service continued to resource training to meet the specific needs of customers when required. For example, staff were attending training on enteral nutrition and the support and care of PEG feeding systems. Staff had been selected to attend dependent upon their level of experience and knowledge. We saw that the training officer was very resourceful and welcomed the chance to work alongside with other organisations to support staff training and development. For example, NHS staff now attended carers' training regularly to advise on best practice in oral care. This is an area that families provided positive feedback on. The training officer was also liaising with the Huntington's Association about training and literature they could offer - again this was specific to certain customers' needs. Carewatch - West Central Scotland, page 22 of 33

23 The Training Officer gave positive examples of change within the overall provider 'Carewatch, this included more specialised development and learning for the training officers and other office based staff. Through last year's inspection, we recommended that the service make use of management practices, such as supervision, appraisal and regular staff meetings to support, develop and guide each staff member in their practice and ensure that each staff member was meeting expected standards of practice. From meeting with staff, sampling of staff records and the performance management report we could see that the service was making good progress in this area. The service planned seven annual points of contact with care staff. This included two 1:1 office based supervision meetings, four field based practice observations and one annual performance appraisal. Additional spot checks of staff were carried out when required. In the files we sampled, we could evidence around five points of contact for each carer, a significant improvement. Carers we met with during the inspection confirmed their training needs were being met and the regularity of the 1:1 supervisions, field practice observations and appraisals. Staff told us: 'Great place to work, always make sure that my training is up to date, never been put in a situation where I feel I am untrained and can't deal with it. During my time with Carewatch I have progressed and been promoted' 'I strongly agree that we provide good care to each individual customer. I have also had excellent training and great support from office staff' 'Happy in my workplace and have found office staff very helpful with any concerns I contact them about' 'The support I get from all office staff and the training is excellent. I feel very confident out in the field as we always have support at the end of the phone' 'I have been spot checked by training and manager. I know the importance of this for myself and the company. I also do training every year which I find beneficial as something new crops up every time. I feel I am well supported in all aspects of my job' 'I enjoy working for Carewatch and believe they have improved as a service in the last couple of years' Carewatch - West Central Scotland, page 23 of 33

24 Customers told us: 'Staff are sociable and I get on well with them' '2 or 3 carers are exceptional. They are efficient and engage me in conversations' which are very important to me' 'They (staff) are very good, no complaints' We found the performance of the service was good in relation to this statement. Areas for improvement We spent time discussing 'best practice' in dementia care with the staff team including the Training Officer and management. There are several ways that staff can update their knowledge and follow best practice. Learning resources such as the 'promoting excellence framework' does not cost the service and enables staff to study and work through levels of the framework within the service, supported by colleagues. The service recognised the importance of developing staff awareness in this area. This will be followed through at further Inspections. The Requirement made under theme 1, statement 3 in relation to the management of Controlled Medication refers to the training, development and support of care staff. The Scottish Qualification Authority offer a Professional Development Award (Health and Social Care) Administration of Medicine at SCQF level 7. This is recognised as best practice and the service should consider the benefits of senior staff including field based supervisors gaining this qualification. The Scottish Social Services Council (SSSC) register opened in June 2014 for supervisors to commence registration. This would include the field care supervisors and co-ordinators at Carewatch. These staff members should now be applying for registration. There was no evidence that the provider had a plan in place to support all staff to achieve qualifications that will allow them to register with the Scottish Social Services Council (SSSC). (See Requirement 1 below). Carewatch - West Central Scotland, page 24 of 33

25 Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. Requirement with reference to Theme 3, Statement 3: The provider must: -Ensure the branch manager has a professional development plan to develop their knowledge and skills in leading and managing the service and make sure support is provided to meet their learning needs. The development plan must include providing access to qualification courses for the manager to achieve qualifications that will support their registration with the Scottish Social Services Council. -Ensure that supervisory staff are supported and enabled to commence registration with the Scottish Social Services Council -Identify and secure appropriate qualification courses to ensure supervisory staff can be registered with the Scottish Social Services Council. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210, regulation 15 Staffing. Timescale for implementation: The organisation must provide the Care Inspectorate with monthly updates on progress made. Progress will be formally evaluated in 6 months. Carewatch - West Central Scotland, page 25 of 33

26 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths From our inspection of the documents available to us and the discussions with the customers, relatives and the staff we met, our conclusion was that the service had a good range of methods in place to invite comment from the people using/involved in the service on the quality of the service provided and the management. We could evidence that people using Carewatch, their relatives and community health care professionals contributed to decisions being made. The service had a detailed participation strategy which stated how they will involve people who use the service and their families, to participate and influence the development of the service. This included annual surveys, reviews, involvement in audits, inspections, meetings and staff recruitment and training. We saw that aspects of this policy were followed in practice and that the service responded to customers'/ relatives' suggestions and comments. The 'Service User Guide' was available for all people using the service and has been developed to include visual and audio formats, 'easy read' documents, relevant language translations, and Braille. This guide set the expectations of the service and the values that it operated under. This included what customers could expect in care plans and time scales for reviews. In general, people we met with and documentation we considered confirmed that the service had made good progress in formally reviewing customers' care and support needs. The number of Field Care Supervisors (who carry out the assessments and six week reviews) had increased and they gave examples of the frequency and circumstances under which they would meet with customers. This included when 'spot checking staff's time-keeping and observing staff practice. The aim of the reviews is to seek the views of customers and their relatives about the quality of their care and what changes, if any, they may wish to see in their support plans. This should enable those using Carewatch to feel confident that the service is meeting their needs and is responsive. Carewatch - West Central Scotland, page 26 of 33

27 When we visited people in their homes we asked about how responsive and flexible the service was. One family shared with us the very complex care and support needs that they had. They explained that they had certainly 'had their problems' with the service but that the service had worked hard to understand their needs and how these must be met. They went on to say that they now had great confidence in the service - 'If there are problems they will sort it out' - they gave examples of how responsive and understanding the depute manager was. People we met with and spoke to on the telephone generally felt involved in their care and support. Customers were aware that their care and support plan should be reviewed on a regular basis and agreed that this happened. We found the performance of the service was good in relation to this statement. Areas for improvement The service had a "Service User Involvement Policy" which identified that customers could be involved in a number of different ways, including taking part in quality audits, consultations, policy and procedure development and in the recruitment of staff. We could see that this was not fully implemented in the service. Some of the questionnaires, surveys and newsletters were managed nationally - the service should continue to explore avenues for involving people to give feedback that is very specific to their local service and own experience. For example, the service told us that telephone monitoring (where customers are called and asked about the quality of the service) was to be a focus area of the national provider, with a target of speaking with 10% of customers monthly. The service did state that they would remain committed to supporting this monitoring with local telephone monitoring at least annually. By being carried out locally the management team could see how this would enable them to have more direct feedback from their customers and allow them to respond appropriately. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Carewatch - West Central Scotland, page 27 of 33

28 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 We found Carewatch to evidence a good performance against this Quality Statement. We concluded this after we reviewed supporting records, met with managers, customers, staff and relatives and considered the progress within the service which contributed to the auditing and quality assurance process. On a daily basis staff and customers are encouraged to feedback any concerns or comments about the service. Customers and staff gave examples of managers meeting with them and responding quickly to concerns - 'I asked that one staff member did not return, this has been kept'. The strengths reported on under Theme 4, Statement 1 are relevant to this statement. Most of the senior staff (including managers) deliver care on a regular basis, this meant that they had regular contact with customers and could easily get feedback about the quality of the service provided. It was positive to see that senior staff saw being involved in care delivery as essential and we could evidence how this enabled them to have a greater understanding of both customers' and staff's needs. A new key performance indicator (KPI) tool had been developed. This tool enabled the service to identify when key actions were due to be undertaken. This included undertaking customer quality assurance visits, six monthly customer reviews, mandatory and refresher staff training, staff supervision, field observations and appraisals. This was a very positive development and we could evidence that the service had a much greater 'overview' of customers' and staff's needs - and that this tool was supporting the service to plan in meeting those needs. The Carewatch Head Office Quality Team had carried out an annual audit of the service in June When we considered the outcome of the audit - there was evidence of the progress made by the service since the last inspection. An improvement action plan was then produced by the auditor for the branch managers to progress, this supported the service in identifying and developing areas for improvement which will then impact upon the quality of the service and support provided to customers and staff. We found the performance of the service was good in relation to this statement. Carewatch - West Central Scotland, page 28 of 33

29 Areas for improvement We signposted the manager to guidance document, 'Records that all registered care services (except childminding) must keep a guidance on notification reporting V.3'. This document details the information that the Care Inspectorate require under legislation to be notified of, with timescales for notification. It was apparent that notifications were not being made within timescales. We discussed ways that this could improve and suggested that the depute manager takes responsibility for this reporting within the required timescales. This will be monitored. At last year's inspection we reported that some of the documents examined (including policies/procedures) referred to english standards and legislation. We found that there had been some progress in this area but could still identify policies and procedures that needed to be reviewed and updated to clearly reflect up-to-date good practice guidance and current Scottish legislation. For example, the medication policy. We have discussed this with the management who have confirmed that Carewatch's senior management are reviewing practices in line with Scottish legislation. This will be further monitored through the regular updates the service will be asked to provide. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Carewatch - West Central Scotland, page 29 of 33