Inverclyde Learning Disability Support & Care at Home Service Housing Support Service CHCP Kirn House Ravenscraig Hospital Inverkip Road Greenock

Inverclyde Learning Disability Support & Care at Home Service Housing Support Service CHCP Kirn House Ravenscraig Hospital Inverkip Road Greenock PA16 9HA Telephone: 01475 714188 Inspected by: Gerry Tonner Type of inspection: Announced (Short Notice) Inspection completed on: 4 February 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 9 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Inverclyde Council Service provider number: SP2003000212 Care service number: CS2004078035 Contact details for the inspector who inspected this service: Gerry Tonner Telephone 0141 843 6840 Email enquiries@careinspectorate.com Inverclyde Learning Disability Support & Care at Home Service, page 2 of 22

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well We found that people who are supported are very happy with the standards of support and care provided by the service. The service has been excellent at ensuring each service user's health and welfare needs are met. We were impressed with the work carried out with service users and staff in relation to health promotion and communication systems used when service users attend hospitals and other appointments. What the service could do better The service should fully implement the quality assurance systems and checks available e.g. monitoring the standards of individual files and ensuring medication audits are completed fully. We thought that the service should develop a clear participation policy at service level which reflects the good range of methods used to hear the views of key people. Staff should receive training on the use of service user questionnaires. What the service has done since the last inspection The service has involved service users with the recruitment of new support staff. Inverclyde Learning Disability Support & Care at Home Service, page 3 of 22

There have been a number of service users from the service who have been involved with various groups e.g. Health Advocacy group who have produced excellent material on health promotion. This has included the production of information packs and presentations to staff and other people with learning disabilities. Conclusion The service continues to adopt a person centred approach to shape the care and support provided to each individual service user. There is an experienced and well trained staff group who deliver support. Who did this inspection Gerry Tonner Inverclyde Learning Disability Support & Care at Home Service, page 4 of 22

1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS) took over the work of the Care Commission, including the work of registering care services. This means that from April 1 2011this service continued its registration under the new body, SCSWIS. Inverclyde Learning Disability Support and Care at Home has been registered with the Care Commission since November 2004. The service provides a Housing Support and Care at Home service to people with a learning disability living in their own homes. There were 50 people using the service at the time of the inspection. The service provides 24 hour support to people living in James Watt Court in Greenock and two houses within the Gibshill area of Inverclyde. The service also has a team of support workers who provide support to people living in their own homes throughout Greenock. The service aims to "provide high quality person centred services that support and encourage people with a learning disability to live valued, fulfilling lifestyles in their own homes, as part of the community." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very 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 www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Inverclyde Learning Disability Support & Care at Home Service, page 5 of 22

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 A short notice inspection was carried out by Inspector Gerry Tonner on 29th and 30th January 2013. The following activities were carried out over the course of the inspection; - * Returned 18 out of 40 returned Care Inspectorate questionnaires issued to service users and relatives * Interviews with 12 service users * Telephone interview with 1 relative * Interview with the Manager, Resource Officer, Team Leader, 2 Senior Support Workers and 3 Support Workers * Reading minutes of meetings * Checking the content of 4 support plans and associated records * Examining 3 staff files * Checking the quality assurance systems used by the organisation Feedback was given to the registered manager, resource officer and team leader on 4th February 13 were the findings and grades awarded were accepted as an accurate reflection of current performance. 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 Inverclyde Learning Disability Support & Care at Home Service, page 6 of 22

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 www.firelawscotland.org Inverclyde Learning Disability Support & Care at Home Service, page 7 of 22

What the service has done to meet any recommendations we made at our last inspection Not applicable. 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 service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each heading that we grade them under. Taking the views of people using the care service into account These are reflected throughout the quality statements. Taking carers' views into account These are reflected throughout the quality statements. Inverclyde Learning Disability Support & Care at Home Service, page 8 of 22

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths Our examination of records, discussion with service users, a relative, staff and the manager supported that the service performs at a very good level in this quality statement. We found that there were regular and planned tenant's meetings. We looked at the minutes of the meetings and found there were good examples of service users being involved with decisions. This meant activities and social events were shaped by the views of service users. The returned Care Inspectorate questionnaires indicated that there were high levels of satisfaction with the service. 12 of the 18 returned strongly agreed with the statement; - "Overall, I am happy with the quality of care and support this service gives me." The remaining 6 agreed with the statement. We heard that a service user had been involved with The Same As You review and roadshow. The service had developed a satisfaction questionnaire. However, at the point of inspection this was being looked at with a member of staff from the organisation's planning section and there were ongoing discussions regarding the format and implementation. Inverclyde Learning Disability Support & Care at Home Service, page 9 of 22

We thought that it was good practice that the service has links with the Carer's Centre. Through reading associated minutes we found that the Local Area Coordinator and Senior Nurse of the Community Learning Disability Team had been heading up these meetings. We thought that ongoing supports provided to carers in these meetings were very good. These supports included providing training to carers (relatives) and providing easy access to key professionals and "experts" in the field. We found that there was strong evidence that ongoing progress of these meeting were monitored. The Health Advocacy meetings included a number of service users from the service. These service users had been involved in developing a presentation on bowel screening which will be used to help other service users' understanding of the reasons why these are offered. The Local Area Coordinator and Community Learning Disability Nurse had also sought feedback from service users on the bowel screening project and the information pack developed by the Health Advocacy group. Service users interviewed also commented on their involvement with this area; - "We've been involved with bowel screening and went to see a play about this. We think that we could do this better to help people understand what to do." We noted that there were a number of other health promotion areas which service users had been involved in e.g. breast care and men's health improvement. We noted that the service had good inter-agency links and this included work with the Scottish Consortium for Learning Disability. There were plans in place for staff to facilitate workshops involving service users. Areas for improvement We found that the service has used a range of methods to capture the views of service users however, did not have a local participation strategy or policy which details the methods that are used to hear the views of people who use the service. We would like to see the service develop this. We thought that the minutes from the Tenant's meetings should be made into easy read style to help service users understand the content. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inverclyde Learning Disability Support & Care at Home Service, page 10 of 22

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Our examination of records, discussion with service users, a relative, staff and the manager supported that the service performs at an excellent level in this quality statement. We found the aims of the Health Advocacy group clearly reflected how service users would be involved in educating health professionals and people with learning disabilities. Our findings supported that these aims were put into practice. We examined 4 support plans and associated records. We found very good person centred information recorded. We thought that information relating to reviews was of a high standard; these reflected the progress that had been made between review meetings and changes made to supports as a result of changes in circumstances or the priorities of individual service users. We thought that there had been some excellent worked carried out by staff and service users to help communications in relation to health appointments and hospital admissions. This included the development of a G.P. booklet, production of hospital passports and staff using pictorial images in advance of appointments to help individual service users understand where they would be going and what they could expect to happen. We could see that relatives and other key people were routinely invited to review meetings as well as care managers and advocacy workers when appropriate. Service users also confirmed that they are asked their views about the support they receive at review meetings. We thought that it was good practice that the service uses monthly summaries. We found these to be well structured to ensure that important areas such as health, leisure/social activities, expenditure and current issues are considered. From examining records we could see that staff were pro-active in involving external professionals when they had concerns in relation to any health or welfare needs of individual service users. This was supported by comments we received from the relative interviewed; - "The staff took my relative to a hospital appointment. They are good at picking up on things relating to her health for example they have had a psychiatrist involved and also ophthalmologist due to changes that they noticed." Inverclyde Learning Disability Support & Care at Home Service, page 11 of 22

We found corresponding records in relation to the involvement from the range of external professionals. We thought that it was good practice that there were written protocols held with individual service user's files and that these linked to current risk assessments. The service also has a "drop in" service available for service users to use to gain advice in relation to health needs. Comments received from service users highlighted that they had in some cases become more independent, acquired new skills and felt more confident when undertaking activities of daily living; - "The support has helped me get better at budgeting." "I go to college now." "I get support to buy things like furniture and clothes. This is good. I now manage to go out and get my own shopping." Service users and the relative spoken with also confirmed that the social and recreational needs of each person are taken into account and appropriate supports are provided to meet these needs. Several service users are currently involved in the Get Up and Go group. We found that several service users were involved in voluntary placement or work placements. We found that a number of service users had gone on short breaks and holidays accompanied by staff. Areas for improvement Continue with the excellent practices identified above. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inverclyde Learning Disability Support & Care at Home Service, page 12 of 22

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Our examination of records, discussion with service users, a relative, staff and the manager supported that the service performs at a very good level in this quality statement. See comments in Strengths of Quality Statement 1.1. Service users shared that they have positive working relationships with staff; - "The staff are all good. They always try their best." All of the returned Care Inspectorate questionnaires indicated that there were high levels of satisfaction with the staff that provide support. Service users had recently been directly involved with the recruitment of new support staff. This meant that service users had the opportunity to meet with the candidates and share their views with the interview panel. We thought that it was good practice that the pre- review meetings give each service user an opportunity to discuss how they feel about the staff who provide their support. We noted that these meetings are carried out with the line manager of support staff. The service uses a keyworker system and service users and the relative interviewed confirmed that they knew all of the staff who provide support. Staff use communication books to facilitate a consistent approach and provide continuity of care when working with service users. Areas for improvement See comments in relation to developing a participation strategy in Areas of Improvement in quality statement 1.1. Inverclyde Learning Disability Support & Care at Home Service, page 13 of 22

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Inverclyde Learning Disability Support & Care at Home Service, page 14 of 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 Our examination of records, discussion with service users, a relative, staff and the manager supported that the service performs at a very good level in this quality statement. We found that there were regular planned staff meetings. These are used to discuss the current support arrangements and if there requires to be any changes. Staff were encouraged to sign that they had read the associated minutes. Through examining these minutes we saw that these meetings are used to encourage staff to reflect on their practice, improve standards or have a specific focus e.g. promote healthy eating. We found that staff are of the opinion that they receive good supports by their line managers through a challenging period of time. Staff communicated that they are encouraged to share their views and feel comfortable in doing so. We checked 3 staff files and found overall there was good structure to supervision sessions. These sessions were used to discuss the current issues and needs of each service user who was in receipt of support. We found that there were Performance Appraisals in place in the 3 staff files sampled. These are used to check that staff are achieving core competencies and identify ongoing development and training needs. We thought that it was encouraging that these sessions are also used to provide positive feedback on performance. We found that all staff employed within the service had either SVQ or HNC qualifications necessary for registration with SSSC. We found that there was a range of training provided to staff relevant to meeting the needs of people who they support. Examples included dementia and people with learning disabilities. We found that there were records held within staff files relating to training undertaken and qualifications achieved. We were informed that a training programme is issued by the training section of the organisation which covers core training. However we would like the service to develop a training plan which is reflected of the identified development needs of each staff member. Inverclyde Learning Disability Support & Care at Home Service, page 15 of 22

We thought that it was good that the service "taps in" to specific or tailor made training by professionals in order to enhance the care and support provided e.g. behaviour management. Staff also have access to e-learning. We found that there was a very well structured induction programme for new recruits and this is enhanced by "shadowing" experienced staff members and working supernumerary to the rota of staff on shift. Areas for improvement There were some examples of file monitoring being carried out by line managers with individual staff. We would like to see this be implemented fully. We found that there had been issues with the sickness levels of staff employed within the service since the last inspection. However, this was an area that there had been recent improvements. We highlighted in the previous inspection that staff should receive training on the use of service user questionnaires. We found that this is an area that requires to be progressed. We think that the appraisals systems used with staff could be developed further by including more feedback from service users and or relatives. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inverclyde Learning Disability Support & Care at Home Service, page 16 of 22

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Our examination of records, discussion with service users, a relative, staff and the manager supported that the service performs at a very good level in this quality statement. See comments in Strengths in quality statement 1.1. We noted that the Manager had been directly involved with transitional visits with service users first moving into the service. This direct involvement by the Manager was found to be helpful for assessing and planning support needs with individual service users and their families and professionals. The Manager oversees the minutes of meetings held with service users and responds to issues raised which relate to management. We found that the Manager of the service has had direct communications with relatives and has attended some review meetings with individual service users. The Manager attends senior staff and staff meetings. Staff interviewed communicated that they find the manager approachable. Areas for improvement The service should detail within the participation policy the methods that will be used to assess the quality of management and leadership. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inverclyde Learning Disability Support & Care at Home Service, page 17 of 22

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 Our examination of records, discussion with service users, a relative, staff and the manager supported that the service performs at a very good level in this quality statement. We sampled minutes of meetings (November 12 and January 13) between the Assistant Service Manager and senior staff. We thought that it was good that these are used to discuss staff practice and identify areas of improvement and development throughout the service. We found that there had previously been a Best Value review carried out with the service. We found that this included analysing responses made by staff through returned questionnaires. This also asked staff for suggestions on how the service could improve. The service has now very recently produced a Development Plan 2012-2013 incorporating this feedback. There has been work carried out by the Manager with the Human Resources section. This included carrying out a pilot on examining patterns of non attendance by staff. Staff attendance within the service has subsequently improved. The service records and forwards accident and incident records to the health and safety section of the organisation. These are categorised, analysed and further follow up actions identified when needed. We found that the service has a system in place to ensure key assessments and reviews are carried out within specified timescales. Areas for improvement The CHCP development plan which link to individual client groups at the point of inspection was still in draft form. We found that there could be improvements made to the medication audits carried out by the service. The service responded to this whilst the inspection was being carried out. Further monitoring shall be carried out in future inspections. See comments under areas of improvement in quality statement 3.3 relating to file monitoring, staff training and improving staff appraisals. Inverclyde Learning Disability Support & Care at Home Service, page 18 of 22

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Inverclyde Learning Disability Support & Care at Home Service, page 19 of 22

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Inverclyde Learning Disability Support & Care at Home Service, page 20 of 22

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 6 - Excellent Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 28 Sep 2011 Unannounced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 27 Jan 2011 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 26 Jan 2010 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 19 Feb 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Inverclyde Learning Disability Support & Care at Home Service, page 21 of 22

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 0845 600 9527. 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: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Inverclyde Learning Disability Support & Care at Home Service, page 22 of 22