Key Community Supports - Glasgow South Housing Support Service Unit 33 6 Harmony Row Govan Glasgow G51 3BA Telephone:

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1 Key Community Supports - Glasgow South Housing Support Service Unit 33 6 Harmony Row Govan Glasgow G51 3BA Telephone: Type of inspection: Unannounced Inspection completed on: 30 June 2014

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 26 5 Summary of grades 27 6 Inspection and grading history 27 Service provided by: Key Housing Association 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 Key Community Supports - Glasgow South, page 2 of 29

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service continues to be very good at providing people with person centred support. Carers and service users hold a positive view of the quality of care, staff and local management. Service users had good relations with staff that they trusted and this impacted positively on people's quality of experiences. What the service could do better We have made five recommendations and two requirements in this report. The recommendations relate to developing: the detail in care plans for financial support, reference to medicines used for staff interventions within relevant documentation, staff forums for planned supervision, effective communication and ongoing development, a pro-forma to audit personal plans and mechanisms for stakeholder feedback. The requirements relate to improving the frequency of reviews and recordings for medication administration. What the service has done since the last inspection The last inspection took place in June 2014 and seven recommendations were made from this visit. These related to a review 'summary minute', medicine audit, restraint protocols, evaluating local staff communication, external stakeholder feedback and Key Community Supports - Glasgow South, page 3 of 29

4 developing monitoring of service user finance records. Good progress had been made in some areas and others needed further development. Since the last inspection the service continued to work through the challenges resulting from self-directed support and at the same time strive to provide the best possible care to service users. Feedback from service users and carers showed that the service was doing this well. Conclusion Most of our recommendations and requirements relate to the need to improve aspects of recordings and better evidence of management checks. Key to improving this will be management monitoring and systems that support audit findings and overviews of action needed. Whilst these areas need to be addressed, it is important to note that outcomes for people were generally very good. Overall, Key Community Supports - Glasgow South was found to be performing well across the service with grades ranging from 'good' to 'very good'. Key Community Supports - Glasgow South, page 4 of 29

5 1 About the service we inspected Key Community Supports - Glasgow South is registered with the Care Inspectorate to provide a large 'combined' housing support and care at home service to adults with a disability living in their own homes and in the community. The service is managed by a national organisation, Key Housing Associated Ltd which is a registered charity, of which its head office is based in Glasgow. At the time of the inspection the service was providing support to 94 service users living at home within the south of Glasgow. Most of the people being supported by the service had a learning disability, and a small number of people had alcohol related brain damage or an acquired brain injury. The amount of support people received could vary from a few hours per week up to 24 hours a day for an individual service user. Staff members provided both personal care and housing support to individuals. The overall aim of the service was 'to support individuals in the community and to maximise the opportunities for normal living within the local community'. 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. Key Community Supports - Glasgow South, page 5 of 29

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 We wrote this report following an unannounced inspection carried out by two inspectors and one inspector volunteer who carried out telephone interviews with relatives during the inspection process. The inspection visits took place on the 12, 13 and 20 June between 9.15am and 5.40pm. We gave feedback to the covering manager and external manager on the 30 June As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. We asked the manager to give out 20 questionnaires to staff and we received 11 completed questionnaires. In addition, we received 7 responses from the 30 questionnaires for service users/carers that we provided to the service for distribution. During this inspection process, we gathered evidence from various sources: - we visited 3 service users at their homes - spoke with 6 carers by telephone - met with the covering manager and external manager for the service - met with 4 team leaders - met 3 support workers - met 1 relief support worker. We looked at: - the registration certificates for the housing support and care at home service - the service's self-assessment - participation information to show how the service involved and listened to people - feedback from questionnaires we provided for staff and service users/carers - confirmation of employer's and employees' liability insurance - aims and objectives of the service Key Community Supports - Glasgow South, page 6 of 29

7 - personal planning paperwork and review records - minutes of staff meetings - accident/incident reporting - staff training information - medicine information - finance information and related systems - quality assurance information to see how the service and organisation monitor and assess aspects of the service, such as care, staffing and management. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Key Community Supports - Glasgow South, page 7 of 29

8 What the service has done to meet any recommendations we made at our last inspection We made seven recommendations in the last inspection report. These related to a review 'summary minute', medicine audit, restraint protocols, evaluating local staff communication, external stakeholder feedback and developing monitoring of service user finance records. Action taken on these recommendations will be referred to under the relevant Quality Statements. 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. All sections of the self-assessment had been completed. Further comment has been made on the self-assessment under various Quality Statements within this report. Taking the views of people using the care service into account We met three service users in their homes during the inspection and met another 3 service users attending an art group. We received responses from 2 service users from questionnaires that we provided. One service user did raise a particular issue that we shared with the management team, and we did offer to meet or talk by telephone with this person. We also considered feedback that the service had collected as part of their own participation methods. Overall, people were positive and some examples of comments made will be reflected throughout this report. Key Community Supports - Glasgow South, page 8 of 29

9 Taking carers' views into account An inspector volunteer carried out telephone interviews with 6 carers/relatives and we received 5 responses from the 30 questionnaires that we provided to people. Overall, carers held a positive view of the service. Comments made by carers are reflected throughout this report. Inspection report continued As part of the inspection we contacted one social work and one health professional to ask for their view of the service. At the time of concluding the inspection we had not yet received a response. Key Community Supports - Glasgow South, page 9 of 29

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 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 We found good performance under this Quality Statement. Key Community Supports as an organisation states that "we are proud to be both a user and carer led organisation". This sets out the organisation's expectation about the involvement of service users and carers in assessing and improving all aspects of the quality of service. During the inspection process we saw that methods in place for service users and carers to influence the quality of care and support. Some of the ways included: - involvement in the process of personal planning - review meetings - house meetings - a named keyworker for each service user - satisfaction survey for service users/carers - local and national service user meetings called 'TAG's' (The Advisory Group) - 'Living a Life' - an organisational course to help people get involved and achieve outcomes - day-to-day interactions between service users and staff - engagement and involvement with the local community. The service continued to demonstrate very good practice on a day-to-day basis that encouraged involvement from people. Personalised and 1:1 support for each service users was key to meaningful involvement. This was evidenced very well when we asked people for their views on the quality of support. Service users and carers said: Key Community Supports - Glasgow South, page 10 of 29

11 "I'm happy with Key, had a review meeting recently and I got a minute of the meeting". "I meet with Key every week to see how things are going, they are good at listening to me". "If there are any changes to support they let me know". We were made aware of a specific support around welfare calls being provided to a service user that went beyond the contracted arrangement. This had been longstanding and provided a degree of assurance to the service user involved. This was an excellent example of the service striving to do the best for people. Since the last inspection new personal plans had been introduced with the aim to of being more outcome based. The organisation was developing more use of pictures as a means of helping people communicate. It was good to see the use of pictures within parts of the new personal plans. We were able to see that the service encouraged relatives and external agencies to be involved in reviews. In between reviews people said that there was regular discussion with staff about support and any other matters that they wished to raise. In the last inspection report we made a recommendation for management to ensure that a 'summary minute' is always recorded when a third party provider has led a review meeting. We were shown communication about taking this forward and a proforma to record a 'summary minute'. Some people chose to have 'house' meetings to meet with their staff team to discuss support arrangements. This was a good option to have for those people who wished to meet with their support staff as a team. All service users/carers had been sent a questionnaire by the service since the last inspection. The purpose of this was to get feedback from people about the quality of service. From questionnaires sent we could see that 38 responses had been received, and that overall people were 'very happy' with the quality of service. We were advised that action was taken on an individual basis from comments that had been highlighted by people for suggested improvement. The manager and external manager said that general feedback was due to be provided to all service users/ carers. Overall, we found that the service valued and took account of service users and carers views. This was natural to the way that staff worked with people, and key to effectively involving people in assessing and improving the quality of care and support. Key Community Supports - Glasgow South, page 11 of 29

12 Areas for improvement Whilst it was positive that personal plans had developed to be more outcome based, we found that staff were still at different stages on working this through to completion. It would be good for the service to evaluate the impact of the new personal plans. We were advised that the organisation was developing an outcomes monitoring tool that would assist in evaluating the impact of an individual's personal plan. The service may wish to use a tool for this, such as 'Progress for Providers, Checking your progress in using person centred approaches (Helen Sanderson, July 2011) as part of evaluating personal plans. We were told by service users and carers that they were involved in decisions and reviews about their support arrangements. A provider of a care service must provide evidence of this in the way of carrying out a review of personal plans at least once in every six months. This would include risk assessments which are part of personal plans. When we looked at the frequency of reviews across the service, we found that reviews were not up to date for about 45% of people. Management must improve how it records evidence of reviews in order to meet the required legislation. (See Requirement 1). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. The provider must ensure that personal plans and related risk assessments are reviewed at least once in every six month period. In order to demonstrate this: - a record of the review must be made available - the service must keep a track of reviews to demonstrate the required frequency as being met - in the event that the required frequency for a review is not met, then the reasons explaining this must be recorded along with the next planned review date This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210). Regulation 4 (1) (a) Welfare of users and Regulation 5 (2) (b) (iii) Personal Plans - these are requirements to make proper provision for the health and welfare of service users and to review personal plans at least once in every six month period whilst the service user is in receipt of the service. Timescale: within 2 months upon receipt of the final inspection report. Key Community Supports - Glasgow South, page 12 of 29

13 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We considered support provided to people around their health and wellbeing needs. This included the management of medicines and finances. Based on our findings, we found the service to have good performance. As part of understanding how staff identified and met people's support needs we sampled personal planning paperwork. As mentioned previously personal plans had been developed to be more outcome based. This is said to help focus the work of staff and support effective partnership and planning with people who use services. The approach is consistent with policy priorities to engage people using services, personalisation and enablement. (Talking Points, Joint Improvement Team, June 2012). At the beginning of a personal plan it was good to see 'great things people say about me' that introduced who the person was. Following on from this we could see very good detail in 'my outcomes, personal information, important dates, communication, feeling safe and secure, keeping well and staying healthy'. For example, information on personal care covered key areas such as teeth care and continence management. Communication care plans were well written and 'tip's' on phrases and responses were included. From our visit we observed communication 'tips' to be reflective of staff practice. We were able to see that staff supported people to access key health services. For example, appointments with GPs, community learning disability nurses, opticians, dentists, chiropodist or any other relevant health services were evident. The outcome of these appointments would usually be recorded within personal plans. Weekly planners were in place for people that showed how people were spending their time. We could see people being supported to access and engage with their local communities. For example, from 'What's going on Southside' and support to a service user for a sponsored cycle to take part in the special Olympics. In the previous inspection report we recommended that management should ensure that existing protocols for restraint are re-assessed and reviewed in accordance with good practice guidance 'Rights, Risks and Limits to Freedom' (Mental Welfare Commission, March 2013). We were aware of an incident that demonstrated review of restraint in relation to the use of technology. Restraint interventions would be included and reviewed within Crisis Intervention Support Plans. We were pleased to hear that the provider was progressing the 'PDA Health and Social Care: Administration of Medicine at SCQF level 7'. This Professional Development Award (PDA) is a qualification which has been designed to meet the Key Community Supports - Glasgow South, page 13 of 29

14 requirements of social service workers who are in a job role where they assist or administer medication to individuals. This is a very positive development. Since the last inspection improvements had been made to procedures around financial support provided to people and related checks. Staff were consistent in the expected standard for checks on finances. The aim of the service was very much about enhancing people's lives through day-today support with general health, wellbeing and aspirations. Relatives and service users made comment that reflected how well staff were doing this. For example: "All X's needs are met..very good". "Staff help X with washing, cooking, shopping and spend time with her...they are really good with her". "Staff make sure he takes his medicine, look out for home when he's cooking and help him walk and get out and about". "All my workers are great, they take me where I want to go. I am cared for well and feel safe with them". Overall we were impressed with the knowledge and caring manner that staff and the management team spoke about people they provided support to. It was clear that staff worked hard to provide good outcomes for people. For example, the service had tried hard to support a service user with changing needs to remain living in their own home so that they did not have to move to a care home. This underpins the values of the staff team and quality of support staff strive to deliver. Areas for improvement Inspection report continued In the last inspection report we said that management agreed to monitor that risk assessment dates were in keeping with six monthly reviews of care plans. This continues to be an area for improvement as we have made a requirement about review frequency under Quality Theme 1, Statement 1. An epilepsy protocol showed multi-agency discussion, however review of this was not clearly recorded. This again links to improving the frequency of recording of reviews. We noted an Adults with Incapacity (Part 5) Certificate that had expired. These are in place to support appropriate decision-making for people who have been assessed to lack capacity on health treatments. We were advised that a new certificate was being pursued by the service with the person's GP. The checking of expiry dates on these type of certificates ought to be included in management audits to ensure that enough time is given to take necessary action. Key Community Supports - Glasgow South, page 14 of 29

15 A recommendation was made in the last inspection report for medicine systems, including audit to ensure that all medications received by the service are accurately checked against prescriptions. On this visit we found that staff did not always have a copy of actual prescriptions or other appropriate record of authorisation, to check medicines received against. Therefore, information from the supplying pharmacy was being relied upon in some instances. The management team agreed to explore this with GP's and supplying pharmacists. Care plans for the management of financial support for people needed to include more detail. We have said this because information in a care plan referred to 'X receives full support' and this did not explain what staff need to do. (See Recommendation 1). We noted a CRISP (Crisis Intervention Support Plan) that included very good detail. However, this did not refer to the use of some medications that may be used as part of staff interventions. (See Recommendation 2). During our home visits we sampled medicine adminstration records (MAR's). One of these records showed recording that was not in keeping with good practice. For example, codes were entered without adequate explanation, instead of starting a new MAR sheet when needed entries continued to be made which could not be easily understood and a staff practice for leaving a medicine out for a service user was not recorded within a care plan to support that this was safe practice. (See Requirement 1). Whilst we acknowledge that new personal plans were in the process of being worked through, information was not always up to date and sections in some personal plans were blank without explanation. We also noted that on some occasions personal plans were not readily available in a person's home, when information said this is where they were kept. This is an area that we will refer to in the context of quality assurance under Quality Theme 4, Statement 4. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements Inspection report continued 1. The provider must improve staff recordings related to the administration of medicines. In order to demonstrate this: - care plans must give a clear explanation as to why medication support is needed from staff and the detail of staff support required Key Community Supports - Glasgow South, page 15 of 29

16 - medicine administration records (MAR) must be completed in accordance with good practice, such as 'Guidance about medication, personal plans, review, monitoring and record keeping in residential care services' (Care Inspectorate, July 2012) - the above areas must be monitored by management through audits, observation of staff practice to determine competency and staff supervision processes to show if staff are doing this well or if improvements are needed. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210). Regulation 4 (1) (a) Welfare of users and Regulation 5 (2) (b) Personal plans. A requirement to make proper provision for the health and welfare of service users and to set this out in a written plan. Timescale: within 3 months upon receipt of the final inspection report. Recommendations Inspection report continued 1. Care plans for the management of people's finances need more detail to explain what support is provided by staff. National Care Standards, Housing Support Services, Standard 3: Management and Staffing Arrangements and Standard 4: Housing Support Planning. National Care Standards, Care at Home, Standard 3: Your Personal Plan, Standard 4: Management and Staffing Arrangements and Standard 7: Keeping Well-healthcare. 2. Crisis Intervention Support Plans (CRISP) should refer to medications that may be used as part of staff interventions. National Care Standards, Care at Home, Standard 3: Your Personal Plan; Standard 4: Management and Staffing Arrangements and Standard 8: Keeping Well - Medication. Key Community Supports - Glasgow South, page 16 of 29

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The performance for service user involvement under this statement was found to be very good. Key Community Supports as an organisation is committed to involving service users and carers in the processes of staff recruitment and training, The self-assessment gave examples of this at an organisational level and we discussed that the focus ought to be on local examples. For example, we were told about service users being involved in different stages of staff recruitment that was specific to the service. Plans were in place to use a 'matching tool' in order to enhance relationships between service user and worker team, this would include 'gender mix' as well. This is a good development and links to recommendations from 'Keys to Life: Learning Disability Strategy '(Scottish Government, June 2013). Satisfaction surveys sent out to service users/carers invited feedback on aspects of staffing. Overall responses were very good, and comments included: "I like my team and want to have the same people support me". "I think my team are polite and I like good manners. People ask me how I am, I like that". "Workers listen to me, that makes me happy and feel safe". Some areas for improvement were identified in questionnaires and we could see that these were being looked into and that the outcomes would be recorded. In our telephone interviews with carers we asked 'Do you think staff are skilled to meet your needs?''. All responses were very positive. Key Community Supports - Glasgow South, page 17 of 29

18 We also asked service users and carers what they thought about the quality of care workers who deliver direct support. Again responses to this were very positive, and included: "They're excellent, brilliant". "Staff are very good, X is well looked after". "I like Key staff, I am happy with them and how they are with me". Most of the responses from people indicated that staff were reliable and punctual with visits, and they knew in advance what staff would be providing support. Some carers felt they were not always about to comment on this, and we suggested to management that staff punctuality and reliability is discussed as part of reviews. Areas for improvement There is scope to reflect more evidence of service user and carer feedback on the quality of staff through established processes such as team meetings, supervision and observational monitoring of staff practices. Information within the service's self-assessment could be presented more clearly to explain how the grade for this Quality Statement was reached by involving people at a local level. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Key Community Supports - Glasgow South, page 18 of 29

19 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 We considered the performance of the service to be good. We looked at evidence relating to the quality of staff training/education, supervision and team meetings. We also observed staff practices and spoke to staff about their work. During our visits we met mostly long-standing employees and some newer staff members. Staff that we met with continued to impress us with their values and committment to support people well. Turnover of staff across the service was low, and this was an indication of staff satisfaction. A staff survey had been undertaken recently and overall responses were generally positive about their work. The management on-call continued to provide good support to staff. Since the last inspection there had been a shift in approaches to supervision. The aim of this was to capture more of unplanned supervision provided to staff by the management team. A pro-forma for the recording of this had been introduced. We highlighted that this proforma was not always being used by staff, and therefore the evidence of this type of supervision was minimised. Management agreed to look at this. Training opportunities were made available to all staff. This included mandatory and service specific training such as food hygiene, moving and assistance, adult support and protection, child protection, palliative care, use of catheters, finance, personality disorder and dementia. Staff held a positive view of their regional trainer and responses to local need. A member of the local management team was undertaking a masters degree in autism. This would assist in enhancing current staff knowledge and education in this area. The provider had plans in place to introduce e-learning to further support training and education opportunities for staff. Bi-annual appraisals for staff had been introduced with a new proforma to assist in ensuring that the appraisal process was more closely aligned to that of ongoing staff support and supervision. This was an improvement to the previous process. A programme was in place for care staff obtaining suitable qualifications for registration with the SSSC (Scottish Social Services Council). This is in keeping with the need to be registered with a regulatory body. Staff we spoke with had an awareness of the National Care Standards that we inspect Key Community Supports - Glasgow South, page 19 of 29

20 against and the Codes of Practice they have to follow as issued by the Scottish Social Services Council which regulates the workforce. Areas for improvement In the last inspection report we recommended that an evaluation of the effectiveness of current local communication systems should be undertaken with staff in the service. Whilst staff generally felt supported, staff told us that the frequency of supervision and team meetings was not being met as expected. These planned forums were thought to be helpful for communication and ongoing development. This needs to be addressed by the provider. (See Recommendation 1). We recommended in the previous inspection report that staff development include a focus on current best practice, such as guidance on 'Rights, Risks and Limits to Freedom' (Mental Welfare Commission, March 2013). When we asked staff about this and other related best practice, such as 'Keys to Life: Learning Disability Strategy '(Scottish Government, June 2013) there was a mixed response. This further supports the need to look at forums for staff communication and development. In the last inspection report we referred to assessing the quality of staff through observations of practice. This is what we refer to as observational monitoring. Staff and management continued to say that was being done. However, this was not routinely recorded and approaches were ad hoc. It would make sense to include observational monitoring within supervision approaches. This would assist with providing evidence of more regular supervision to staff. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The provider should address the availability of forums that will ensure regular planned supervision, effective communication and ongoing development for staff. This should include discussions about current best practice guidance that is relevant to the needs of service uses. National Care Standards, Housing Support Services, Standard 3: Management and Staffing Arrangements National Care Standards, Care at Home, Standard 4: Management and Staffing Arrangements Key Community Supports - Glasgow South, page 20 of 29

21 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths We found this service to have very good performance in the areas covered by this statement. Service users were able to influence organisational decisions and planning by means of local TAG's (The Advisory Group) that feed into the national TAG. Since the last inspection TAG had achieved status as an independent charity. This could open additional opportunities to the service user led group, which would continue to be supported by Key's Advisory Group. Two service users from the national TAG already sat on KEY's Support Review Group, which was a sub group of KEY's management committee. This provided a further opportunity for service users to influence organisational matters. At a local level questionnaires provided people with opportunities to make comment on the quality of service, which included a question about people's awareness of how to make a complaint. Service users and carers that we spoke with knew who the local manager or team leader was, and felt able to approach her/him to discuss any matters and concerns. In our telephone interviews with carers we asked "Do you know who the manager is?' and 'If you have had to contact the manager was it effectively dealt with?'comments that we received in response to these questions included: "I know who the manager is and would phone manager right away if I had to". "The manager is on maternity leave and I've met the manager who is covering". "I've spoken with the manager, all was fine". Key Community Supports - Glasgow South, page 21 of 29

22 We also asked if people were provided with opportunities to give their views on the service. All responses who had regular involvement said that this happened, and that views were listened to and acted upon by management. We were impressed with the local management team's knowledge of individual service users and their carers. Areas for improvement As mentioned in the previous inspection report, best practice on service user/carer engagement suggests that an independent person/body is used when asking service users/representatives for their views on a service. This ought to be considered by the service. Participation methods could develop to show a specific focus on seeking people's view on the quality of management and leadership within current participation methods. This ought to be reflected in the self-assessment with actual examples. For instance, what people have said, and changes/improvements made as a response to people's feedback. Future evidence relating to participation could be aligned more to the grading that we use. This would help when explaining how grades are reached when completing the self-assessment for the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Key Community Supports - Glasgow South, page 22 of 29

23 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 considered the performance of the service to be good in the areas of quality monitoring, audit and associated reporting. We concluded this after we: - spoke to and received feedback from people who use the service and staff members - reviewed quality assurance processes, such as an internal service audit, staff supervision and participation methods - the service's self-assessment and project development plan - continuous improvement since the last inspection - complaints information - looked at how the provider and local management responded to service issues. The organisation (KEY) was a member of Quality Scotland and used EFQM (European Foundation for Quality Management) as the model for quality assurance. The organisation had policy statement that stated it's approach to quality assurance to 'measure and evaluate practice and service delivery'. This explained systems and tool used to do this, such as expected standards, outcome monitoring, satisfaction questionnaires, complaints procedure, worker support, supervision and appraisal, local management checks, service user involvement groups, operational review, financial audit, serious incident and notification reporting along with external quality monitoring. A local development plan was in place that linked to short and long term service objectives. For example, ASP (Adult Support and Protection) refresher training and electronic system to assist with management monitoring. At an organisational level the operational review, based on internal policies/ procedures and service standards had taken place after the last inspection. The structure of this was aligned to the quality framework that we inspect against. The operational review highlighted some of the areas of improvement that we had identified. For example, the frequency of supervision and reviews. At a local level checks were carried out by different levels of management. These included audits of medicines, personal plans, finances and the environment. In the last inspection report we recommended that when staff are involved in service user financial transactions, a system for regular checks by two staff should be introduced. We were pleased to see that this had been actioned, and that other Key Community Supports - Glasgow South, page 23 of 29

24 aspects of financial checks had been tightened up to protect both service user and staff. Regular reports were provided to social work Commissioners who monitored the service. This included information on complaints, survey results, and significant accidents/incidents. We could see good follow-up to a significant incident that had taken place. Staff continued to feel supported by local management arrangements. Staff were aware of the organisational expected standards of support to be provided to people and their own accountability in doing this. The service continues to work through the challenges resulting from self-directed support and at the same time offer the best possible care to service users. Overall, feedback from service users and carers showed that the service was doing this well. Areas for improvement Inspection report continued Shortly before this inspection the registered manager had retired from his post, and the assistant service manager had retired a few months previously. The latter post had not been replaced as yet due to organisational review. At the time of the inspection the registered manager's post was in the process of being recruited for. Whilst we acknowledge these changes, on this inspection there were indicators that highlighted the need to have better management overviews of some areas of service delivery. For example, monitoring systems ought to provide the current situation on reviews, supervision frequency and the audit findings from personal plans to assist management in action that is needed. We were advised that the organisation was considering an electronic system, part of which would provide a monitoring overview of the areas we have highlighted. During the inspection we noted the need to improve audits of personal plans to demonstrate that all key information was available and that this was kept up to date. The service did not have an audit framework for this. Therefore this could be left to individual interpretation of what constituted a good personal plan. Having such frameworks in place would allow for shared understanding, consistency and show the action needed and follow-up monitoring processes. It would be good to see that personal plans are part of staff supervision discussions. This would assist with ongoing audit. (See Recommendation 1). We saw that each section of the operational review asked for 'evidence that information gathered has been used to improve the service'. It was disappointing to see that no entries had been recorded, therefore this was a missed opportunity to demonstrate continuous improvement. In the previous inspection report we said that the service had systems and records for monitoring missed and late visits to service users. On this visit we discussed that these ought to be developed in keeping with 'Records that all registered service Key Community Supports - Glasgow South, page 24 of 29

25 (except childminding) must keep and notification reporting, February 2012, Care Inspectorate). It may be that audits of personal plans could include some consideration of this. We highlighted the need for the provider to ensure that updated notifications to us were submitted and to provide more evidence of service specific outcomes in their self-assessment. The previous inspection report recommended that the service further develop mechanisms for feedback from stakeholders about the quality of the services. We were informed that this was being looked at the by the organisation. We acknowledge that the service had good liaisons with external agencies, such as health and other bodies/agencies. However, this recommendation has had to be repeated for the service to demonstrate how it reflects the views of external stakeholders within existing quality assurance processes. (See Recommendation 2). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. A pro-forma should be developed to assist staff in improving the audit of personal plans. National Care Standards, Care at Home, Standard 4: Management and Staffing Arrangements National Care Standards, Housing Support Services, Standard 3: Management and Staffing Arrangements 2. The service should further develop mechanisms for feedback from stakeholders about the quality of the services. National Care Standards, Care at Home, Standard 4: Management and Staffing Arrangements National Care Standards, Housing Support Services, Standard 3: Management and Staffing Arrangements Key Community Supports - Glasgow South, page 25 of 29

26 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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Key Community Supports - Glasgow South, page 26 of 29

27 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 4 - Good Quality of Staffing Good Statement 1 Statement Very Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 21 Jun 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 5 - Very Good 5 - Very Good 13 Jun 2012 Unannounced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 16 Jun 2010 Announced Care and support 6 - Excellent Staffing Not Assessed Management and Leadership 5 - Very Good 18 Jun 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership 5 - Very Good 13 Aug 2008 Announced Care and support 5 - Very Good Staffing 5 - Very Good Key Community Supports - Glasgow South, page 27 of 29

28 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. Key Community Supports - Glasgow South, page 28 of 29

29 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: Key Community Supports - Glasgow South, page 29 of 29

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