Ark Edinburgh South Housing Support Service

Transcription

1 Ark Edinburgh South Housing Support Service 18 c Southhouse Broadway Edinburgh EH17 8HG Telephone: Type of inspection: Announced (short notice) Inspection completed on: 12 August 2016 Service provided by: Ark Housing Association Ltd Service provider number: SP Care service number: CS

2 About the service Ark Edinburgh South is registered to provide a combined Housing Support and Care at Home service to adults with learning disabilities in their own homes in the south of Edinburgh. The service is delivered by three staff teams at two locations. The service is part of a range of care and support services offered by Ark Housing Association Limited. The service is provided over twenty-four hours and where required, includes waking night or sleepover. The service is designed for each individual, to give them support to live as independently as possible. At the time of this inspection the service was supporting twenty-five people. Literature provided by Ark Housing Association Ltd list the outcomes they offer service users as; "Have choice and control over their own life, develop new friendships and relationships, develop skills and contribute to their community and do things valued by others in the community." What people told us Due to the extent of their cognitive issues, all but one of the service users we met were unable to offer their views on the service. We spoke with one family representative. "Staff have good communication skills" "There is not enough social activity" "I would like more consistency of staffing" "Management are approachable" Self assessment The service had not completed or submitted a self assessment prior to the start of inspection. The Care Inspectorate had previously sent a reminder letter advising that one must be completed. The service had not complied with this request. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 3 - Adequate 2 - Weak page 2 of 13

3 Quality of care and support Findings from the inspection Whilst most service users had also participated in reviews since the time of the previous inspection, the frequency of the reviews did not always comply with the regulatory guidance, therefore the provider did not meet a requirement we made around reviews at our previous inspection. We noted that there was no independent representation at reviews where people lacked family involvement. The provision of advocacy would enhance the meaningfulness of reviews where people could not readily provide their views. This is an area for development that the service should seek to routinely integrate into their participation processes. The review minutes we considered were brief and needed more evaluation of outcomes associated with measuring the effectiveness of support and more detailed discussion around how the service addressed complex care issues. The review minute should also state the role of the participants and be signed by the author and evidence sharing with the supported person or their representative. When we looked care planning documentation we saw some good information on people's routines and preferences, including information on effective communication with people who were unable to indicate their preferences verbally. This helped demonstrate that the service had considered peoples communication abilities and provided guidance which supported the delivery of effective support outcomes. In some files there were examples where documentation had not been updated in line with regulatory guidance or lacked essential information around management of complex support and risk issues. An example of this could be found in the lack of specific guidance for staff around the triggers and preventative measures to be considered before using "as required" medication with a service user with some significant behavioural issues in their presentation. The service must evidence that they are aware of and have fully considered alternative measures before staff use medication in order to manage challenging support situations. In another file we looked at an as required medication protocol was in situ. However, this dated from 2011 and could not be considered as relevant to that persons support needs at the time of inspection,. We also saw files where the service had not provided up to date documentation in respect of external professional inputs around risk and care delivery for nutritional intake, continence, pressure care and repositioning. This led to inconsistent practice, causing tensions amongst the staff team and potentially compromising service user health and well being outcomes. Although files had been audited, we observed that this had not taken place for some significant time. This meant that management had not scrutinised paperwork in order to ensure that it was relevant and up to date. Robust audit would help ensure that all essential documentation was in situ and that documentation evidenced that the service understood complex support issues and managed care with appropriate insight and responses. Another file lacked information around prescribed medication on a plan to be used in event of an unplanned hospital admission. We also noted that an adults with incapacity certificate, known as a section 47, had not been renewed after expiry. AWI certification ensures that the necessary legal authority is in place when health and well being intervention is needed. page 3 of 13

4 We repeated a requirement from our previous inspection, adding elements associated with areas for improvement around care planning documentation and processes we have outlined in this Quality Theme. The service generally recognised when changes in a persons presentation required intervention from professionals from health and community based agencies. We noted that this had involved seeking input from professionals around the provision of aids and equipment, nutritional intake, continence and pressure care management. Although service users were supported to engage with routine health care appointments, access dental treatment, optical appointments and health screening, that this information was difficult to access in some files and we suggested to the team leader that the service could consider implementing a chronology which indicated key contacts with health services and a brief description of the outcomes arising from the intervention. This would make information accessible and help ensure that key issues, such as medication review, and other health and well being interventions were undertaken and readily evidenced. We followed up some key areas for improvement we highlighted at our last inspection, looking at Medication Administration Recording (MAR) sheets and the recordings associated with the maintenance of individuals who had previously presented with significant concerns around their nutrition and continence. Whilst the majority of medication recordings were accurate and completed appropriately, we noted some examples where staff had not indicated why medication was administered by using the index found on the MAR sheet. We also were present when mistakes around medication occurred. This meant that service user did not receive essential medication as prescribed. When we considered training around medication, we saw that some staff had still not undertaken relevant training/refresher training. Some of the staff team we spoke with during inspection told us that they were administering medication with the requisite training. At our previous inspection, we highlighted that some service users lacked care planning around meaningful social and recreational support. We observed one service user who staff advised enjoyed walking and outings, yet this was not reflected in a care plan which addressed the need to offer a structured programme. Her daily task sheets showed significant variation in the level of social activity. Several members of the support team advised us that this variation was due to lack of available staff. Areas for improvement identified in Quality Theme 3 and Quality Theme 4 of this report also apply to Quality Theme 1 Requirements Number of requirements: 1 1. The provider must ensure that: - Service care reviews take place at least once in every six month period whilst the service user is in receipt of the service -Care plans and all associated care planning documentation must be updated at a minimum of six monthly intervals page 4 of 13

5 -Care planning documentation addresses all significant areas of support provided, including risk assessment and the administration of as required medication -If the person in their care lacks capacity to decide about his/her medical treatment, a certificate under the Adults with Incapacity (Scotland) Act 2000 Section 47(1) is required in order to authorise treatment. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) 2011 (SSI 2011/210) Regulation 5 (2)(iii) Personal Plans. No 210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale for improvement: To commence upon receipt of this report and be completed within three months. Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of staffing Findings from the inspection From our observations of staff practice and our discussions it was evident that staff knew the people they worked for well, using their knowledge and insight to deliver positive care outcomes. The staff we met all spoke about their desire to provide effective support to the people they worked for, highlighting their commitment to the individuals living at the Southouse project. We heard that there were still issues around consistent care delivery. One person referred to the maintenance of a continence regime associated with maintain skin integrity and personal hygiene for a person with a history of broken skin. We looked at the recordings which documented pad changes, noting that there was some significant variation in the frequency of this essential task. This inconsistent practice caused frustration for staff and we were advised that it potentially compromised service user well being outcomes. We felt that robust management input around care planning and robust monitoring of the quality of service delivery around these issues would help ensure compliance with professional guidance offered on this aspect of support and help minimise tensions identified around inconsistent care delivery. Some staff told us that they lacked essential training around routine and specialist aspects of the service. We spoke with two staff who are routinely employed in one of the properties which offers accommodation to people with Autism. They told us that they had yet to receive any autism specific training. This conflicted with the way the provider promotes the service on their website where they say they offer autism based expertise, with appropriately trained and skilled staff. This was an area for improvement at previous inspections. page 5 of 13

6 Two members of staff said that they had not had training around medication administration, although they did this essential task routinely for several years. Others said they had yet to receive training on adult support and protection. These assertions reflected information provided by the service on staff training provision. We have repeated a requirement around training. The service must develop a training planner and ensure that management have an effective system which provides them with an overview of staff training needs. The provider must ensure that all staff who work in the service receive access to essential training required for the work they undertake. When we spoke with staff we found that people were uncertain as to the content of the Scottish governments "Keys to Life" strategy for improving outcomes for people with learning disabilities. Some people were also unclear about National Care Standards, although when promoted, they were able to identify key values and principles which underpin good practice. Areas for improvement in Quality Theme 1 and Quality Theme 4 also apply to Quality Theme 3. Requirements Number of requirements: 1 1. The provider must demonstrate proper provision for the safety and welfare of services users is made. In order to achieve this the provider must: -ensure that at all times suitably qualified, skilled and experienced staff are working in the care service. -ensure that persons employed in the care service receive training appropriate to they are to perform. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of residents and regulation 15(a) (bii) - a requirement about staffing. Timescale for improvement: to commence on receipt of this report and be completed within 12 weeks. Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of management and leadership Findings from the inspection The service had not completed a self-assessment as requested. This meant that we were unable to consider key information on how support is provided, during inspection and in our inspection planning. page 6 of 13

7 There were a number of key areas where we felt management and leadership within the service required more focus on compliance with regulatory and best practice standards. We sampled from the services accident and incident recordings, observing that there were a number of significant and potentially serious events which had not been reported to the Care Inspectorate, as per statutory requirement. We made a requirement on this issue. Although staff had received supervision since the time of the last inspection, this did not occur in accordance with the providers supervisory procedures, nor had staff had annual appraisal. This was an area for improvement at recent inspection which had not been implemented as previously recommended. Whilst we acknowledge that staff were able to speak with management and engage in discussion around work issues, the service should ensure that staff have access to all the workplace support they require in order to manage their practice effectively in a high intensity service environment. We also considered the induction process for new members of staff. This had been an area for improvement at our most recent inspection. We did not see any significant changes to the way people were inducted into the service. One new member of staff had a workbook which had not been completed, therefore the service could not ensure that the person in question had undertaken the necessary learning required to deliver support. There was no supervision documentation in respect of this person nor was there any documentation around observed practice which would help evidence that they were carrying out their duties competently. We did hear that management were providing informal support via discussion and that new staff shadowed experienced members of the team during their initial work. In order to support staff, document training needs and ensure that induction is robust and relevant to supported people we made a requirement around appraisal, supervision and induction. We considered the providers assessment of required staffing levels and sought to reconcile them with the actual rotas of staff who had been on shift. There were days when the service had not been staffed to levels indicated by their own assessment of required provision. This issue was highlighted to us by some staff we spoke with, who told us that they felt the quality of service user care and safety was sometimes compromised by the absence of sufficient levels of staff on duty. Staff provided with examples where lack of personnel had impinged on service user well being. We were initially aware of staffing level deficits through our own observations from several visits to the flats of multiple occupancy, where we saw staffing ratios did not match the levels of support indicated on the rotas. The flats in question were home to supported people with complex care needs and significant levels of risk in their presentation. In order to ensure service user safety and promote positive care outcomes, the service must ensure that there are adequate levels of staff on duty at all times. We made a requirement on this issue. During our conversations with staff we heard examples where they said they had previously raised poor or unacceptable practice with the management team, but felt that there was no tangible changes as a result of their sharing of concerns. These related to allegations of illegal and potentially dangerous manual handling techniques, resulting in bruising to the person in question. page 7 of 13

8 Although, following feed back, the service were able to show us evidence that they had now sought external professional inputs into the moving and handling issues. We were concerned that these issues had been present for some time and that the issue should have been addressed much sooner. There were also concerns about staff being unwilling to share work tasks due to cultural issues and staff not adhering to advice from external professionals in respect of care delivery around nutrition, continence and pressure care. This was corroborated by looking at entries in the communication logs, referring to bruising on one individuals arms or to continence and skin care guidance from visiting professionals. Concerns around this issue had not been reported to the Care Inspectorate and management had not initiated an appropriate level of response to identify where key guidance had not been actioned or best practice guidance ignored. We were also concerned about the lack of specialist input into managing the care of some of the people in the Autism service. This is a high risk environment where there have been some serious accidents and incidents since the last inspection. Whilst this is inherent in respect of the complexity of the support needs of the people, the service must ensure that they respond to these events by initiating contact with specialist community and health based resources in order to provide staff with guidance around the delivery of safe and effective support. Areas for improvement relevant to Quality Theme 1 and Quality Theme 3 also apply to Quality Theme 4. Requirements Number of requirements: 3 1. The Provider must ensure: - All incidents which are detrimental to the health and welfare of service users are thoroughly investigated in a timely manner. - Incident reports are completed in a timely manner and where applicable notification reports are sent to the Care Inspectorate. : This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulation 2011, Scottish Statutory Instrument 2011/210: regulation 4(1) (a) - welfare of service users. Timescale for improvement: To commence immediately upon receipt of this report. 2. The provider must demonstrate proper provision for the safety and welfare of services users is made. In order to achieve this the provider must: -ensure that at all times there is adequate levels of staffing required to deliver effective care and support as appropriate to the health and welfare needs of service users. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of residents and regulation 15(a) (bii) - requirement about staffing. page 8 of 13

9 Timescale for improvement: To commence on receipt of this report. 3. Staff supervision and annual appraisal must be performed in accordance with the provider's policy and procedures in order to ensure staff are supported to discuss and develop their roles. All staff commencing employment in the service must have appropriate induction, including supervision and training, in accordance with the job applied for and their roles and responsibilities.. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210).Regulation 15(a)(b) (i)(ii) - Timescale for improvement: To commence on receipt of this report. Recommendations Number of recommendations: 0 Grade: 2 - weak What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that service care reviews take place at least once in every six month period whilst the service user is in receipt of the service. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) 2011 (SSI 2011/210) Regulation 5 (2)(iii) Personal Plans. Timescale for implementation: To commence upon receipt of this report and be completed within three months. This requirement was made on 15 December Action taken on previous requirement Although service reviews had taken place, they did not occur as per regulatory requirement. Not met page 9 of 13

10 What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should arrange training/resources for staff in healthy eating/nutrition. NCS Care at Home-Management and NCS Care at Home-Eating Well This recommendation was made on 15 December Action taken on previous recommendation Staff still require training around these key issues. Recommendation 2 Staff induction processes should be reviewed and should include a written assessment of each new member of staff's competence to deliver effective care. This evaluation should involve consultation with service users and observed practice by senior care staff. NCS 4 Care at Home - Management and 2. This recommendation was made on 15 December Action taken on previous recommendation This recommendation has not been met. Recommendation 3 Staff should have the knowledge and competence to administer medication following up-to-date best-practice guidance. NCS 4 Care at Home - Management and and NCS 8 Care at Home - Keeping Well - Medication This recommendation was made on 15 December Action taken on previous recommendation Training records showed that whilst training had been provided by the pharmacist around the use of their medication compliance aids, not all staff had participated Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at page 10 of 13

11 Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 27 Oct 2015 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 2 Sep 2014 Unannounced Care and support 5 - Very good 4 - Good Management and leadership 4 - Good 2 Sep 2013 Unannounced Care and support 4 - Good 4 - Good Management and leadership 4 - Good 20 Feb 2013 Unannounced Care and support 4 - Good 3 - Adequate Management and leadership 3 - Adequate 26 Jan 2011 Announced Care and support 5 - Very good Management and leadership 8 Oct 2009 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 29 Sep 2008 Announced Care and support 5 - Very good page 11 of 13

12 Date Type Gradings Management and leadership 4 - Good 4 - Good page 12 of 13

13 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 13 of 13