Intermediate Care & Enablement Service (ICES) Housing Support Service Kirklandside Hospital Hurlford Kilmarnock KA1 5LH Telephone: 01563 507955 Type of inspection: Unannounced Inspection completed on: 10 February 2017 Service provided by: East Ayrshire Council Service provider number: SP2003000142 Care service number: CS2003052727
About the service The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. East Ayrshire Health and Social Care Partnership Service is registered to provide a combined Support Service - Care at Home and a Housing Support Service. The service provides short-term multi-agency intensive home care support to aid rehabilitation and recovery following discharge from hospital. Support staff attached to the Integrated Care and Enablement Services (ICES) respond to support people to maximise their independence within their own homes. The service also supports calls for assistance from service users using the community alarm system, which can include delivering aspects of personal care. Support staff had also provided short-term emergency cover for the Partnership's mainstream Home Care Service. The service works with health professional colleagues to ensure that service users immediate health and support needs are quickly assessed and met following discharge from hospital back into the community. The service has continued to expand and now has bases in a variety of locations in East Ayrshire, with the main office within Kirklandside Hospital site. The stated aim of the service is as follows: "Care at Home services are a range of services that assist people who need support in everyday tasks. The main aim of the service is to support individuals and families in their own homes and maintain independence. People may find that there are times when they need additional support, because of illness or disability. The support each individual or family will need will vary, according to the nature and number of the tasks they require." What people told us Most people who provided feedback stated they were happy overall with the Intermediate Care and Enablement Service and spoke positively of the staff who attended to provide their supports. Mixed views were received from service users who used the Community Alarms service. Service users and carers stated they appreciated and valued the service which supported them to live in their own home. Some people felt some of the Community Alarms staff could be more respectful with consideration given to the fact 'where help is requested, there is a reason for it.' page 2 of 14
Self assessment A self-assessment had been completed earlier this year which could have reflected more of the changes which had taken place within the service. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 2 - Weak 3 - Adequate Quality of care and support Findings from the inspection To begin the process of involving service users with the service, a welcome pack including a service user guide should be presented at the start of the service with agreement on the service that will be provided. This information should also be provided in a service user friendly format to be more easily understood by service users who live with cognitive or sensory impairments (see recommendations 1, 2 and requirement 1 in theme 4). Overall, service users were happy with the service Intermediate Care and Enablement Service (ICES) and alongside carers, provided positive feedback to the inspector during home visits and was supported during visits to the service office through thank you cards, letters and some feedback from reviews and courtesy calls. Some feedback was varied on the involvement of reviewing the service. Some service users felt they were quite happy, speaking highly about their supports, whilst others had different experiences and were awaiting some issues to be resolved to improve and enhance their support. To support development of the service, methods to consult with people as part of their quality assurance systems should be enhanced. Implementation of systems, including a participation strategy, to obtain and provide feedback to stakeholders would allow a more effective monitoring cycle to obtain feedback and allow evaluation of the service in accordance with the service aims and objectives. At the commencement of the service, there was a lack of available documentation to introduce service users to what they should expect from the service. As most service agreements were made within the hospital, there was a verbal sharing of information to the initiation of the service. However, as this information was not readily available in written format, the management made commitment to review the necessity of information which would reflect the service to be provided. Staff discuss with service users the length of service they can receive i.e four or six weeks, although no formal agreement was entered into. On review of the care planning documentation, some evidence was provided which outlined the basic needs of service users. We had limited access, as a result of the lack of integrated working between systems between health and social care, to sample the level of detail on outcomes held on service users' care and support. Information was updated on electronic systems specifically for health and an alternate system for social care. Written copies of documents provided to care staff were observed to lack specific detail on agreed interventions and review of interventions to support the reablement process of service users. This had the potential to compromise the care and supports of service users but for the knowledge staff had of service users. page 3 of 14
Some improvement in audit procedures could identify opportunities to minimise such occurrences in the future (see requirement 1 and recommendations 3 and 4 of this quality theme). Promotion of a more cohesive system of working between the health team (including nurses, occupational therapy and physiotherapy) and the social care staff would allow more effective monitoring of outcomes for service users. This included attendance of homecare managers social care staff representatives in meetings, with recording of information to be more readily available to appropriate personnel. Monitoring of the service user's journey whilst they use the ICES team supports could formally assess the development of service user abilities, aiding their transition to more mainstream services where appropriate. Improvements to monitoring of staff training must be undertaken. Some staff training records indicated there was some training out of date. This was discussed during feedback with the registered manager who made a commitment to facilitating a training needs analysis to plan training, where identified as being necessary. Consideration should be given to increasing care staff in providing more person centred care. Examples included neurological conditions including Motor Neurone Disease, Multiple Sclerosis and other physical conditions including Diabetes (see requirement 1 of theme 3 and recommendation 5 of this quality theme). Some positive feedback was evidenced during visits to the service office through thank you cards, letters and some feedback from reviews and courtesy calls. Varied feedback was provided from service users and carers during the inspection process on their involvement in processes, including six monthly reviews. Some service users felt they were quite happy, speaking highly about their supports whilst others had different experiences and were awaiting some issues to be resolved to improve and enhance their support. Feedback on recommendations made during previous inspections are evaluated later in this report. Requirements Number of requirements: 1 1. The provider must improve the quality of training for staff to include risk assessments and care planning, including medication administration, for all service users to reflect their current needs and outcomes in accordance with best practice guidance with evidence on how service user needs are being consistently developed through the plan, and is being followed on a daily basis. This is in order to comply with The Public Services Reform (Scotland) Act 2010 (Requirements for Care Services) Order SSI 2011/210 4(1)(a) Welfare of users and 5 (1) (c) Personal Plans Timescale: within three months on publication of this report. Recommendations Number of recommendations: 5 1. The provider should develop an introductory pack with a written agreement in accordance with the national care standards. National Care Standards for care at home - Standard 1: Informing and deciding and Standard 2: The written agreement. page 4 of 14
2. The provider should continue to develop the methods used to consult with people who used the service about the operation of the service and their own personal care and support. National Care Standards for care at home - Standard 11: Expressing your views. 3. The personal plan should reflect details of the current needs and preferences of each service user and clearly set out how they will be met. National Care Standards for care at home - Standard 3: Your personal plan. 4. The service should review referral criteria to ensure appropriate and necessary information is received to support care planning to provide a quality service. Awareness and understanding of best practice guidance from Mental Welfare Commission should be integrated into how staff practice to support service users. This includes awareness of aspects of restraint, Adults with Incapacity, Power of Attorney and appropriate consent. National Care Standards for care at home - Standard 5: Management and staffing. 5. Training relevant to staff practice and individual service user needs including whistleblowing, Adult Support and Protection, nutrition, falls, Promoting Excellence Framework (dementia), diabetes, falls management, neurological conditions, pressure relief should be provided to staff to support outcomes for service users. National Care Standards for care at home - Standard 5: Management and staffing. Grade: 3 - adequate Quality of staffing Findings from the inspection Staff we met with demonstrated a positive value base and described working with a service user led focus to improve the quality of lives for service users. Some differences in how staff practiced were reported throughout the different areas within the service. There was a lack of availability of the staff with background in health to be involved in the inspection process. A confusing approach to team working between health and carers meant staff described some good interactions with health professionals but had no up to date written guidance on current plans of care for service users. With reference to Community Alarms, staff received varying degrees of feedback ranging from positive and supportive to concerns being raised about how some staff conducted themselves when attending to provide supports to some service users where service users felt vulnerable and disrespected. Changes to the management team had an impact on the team who were unclear about their responsibilities This had an impact on staff morale and potentially compromised the provision of care and outcomes for service users (see requirement 1 of this quality theme). A lack of leadership and oversight by management was noticeable throughout the inspection process. Discussions with staff highlighted some differences in team working, lack of support and directional support and attitude towards service users. Some staff described being frustrated at the attitude of their colleagues, poor leadership and directional support and guidance whilst others described good teamworking within ICES carers and spoke of systems to contact each other and share information on SUs. Evidence we sampled since the previous inspection demonstrated the necessity of improvements into the quality of monitoring staff practices to ensure outcomes for service users had a positive impact to enhance their page 5 of 14
lives. An organisation system of supervision and appraisal had been intermittently completed. Supervision could be more linked to the appraisal process to evaluate how staff were performing in their role to achieve their potential, including registration with the regulatory body within relevant timescales (see requirement 1 and recommendations 2, 3,and 4 of this quality theme and requirement 1 of quality theme 4). Staff training, including mandatory training, did not reflect being up to date. Some staff confirmed they had had some training but were unclear on exactly what and when. Lack of training with current best practice had the potential to compromise safe practice when staff provided specific supports to service users. This was discussed with the new registered manager during feedback and is reflected in theme 1 (see requirement 2 and recommendation 5 of this quality theme and requirement 1 of theme 1). Team meetings were facilitated within the area in which staff worked. Minutes should be more reflective of agenda, attendees and their designation, record of discussions that take place and outcomes/actions to be taken forward. We saw minutes which lacked detail on discussions or actions arising. Some minutes were recorded with group supervision written but no evidence on appropriateness or effectiveness of this process. The recording of staff meetings should be improved to ensure discussion is consistently recorded and any actions planned at the meeting are progressed and monitored. The registered manager and HCMs were available to provide advice and guidance. The aim of this was to promote positive communications between the staff and management and encouraged staff to take responsibility for their practice. Feedback on recommendations made during previous inspections are discussed later in this report. Requirements Number of requirements: 2 1. The provider must ensure they address issues with staff morale, communication issues and team working amongst all staff to improve the culture within the ICES team staff and ensure appropriate support and training is implemented and undertaken by staff to improve practice and benefit service users. This is in order to comply with The Public Services Reform (Scotland) Act 2010 (Requirements for Care Services) Order SSI 2011/210 Regulation 4(1)(a) - a provider must make proper provision for the health, welfare and safety of service users; and SSI 2011/210 Regulation 15(b)(i) a requirement to ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform and National Care Standards for care at home - Standard 4: Management and leadership Timescale: within six months on publication of this report. 2. The provider must ensure that all staff receive the appropriate level of induction, refresher and developmental training to provide them with the skills to meet the needs of service users. This training must link to staff supervision and appraisal and address but should not be limited to: - Health and safety - Moving and handling training - Adult support and protection training - Infection control - Food hygiene page 6 of 14
- Lone working - Care planning and record keeping - Medication. This is in order to comply with The Public Services Reform (Scotland) Act 2010 (Requirements for Care Services) Order SSI 2011/210 Regulation 4(1)(a) - a provider must make proper provision for the health, welfare and safety of service users; and Regulation 15(a) - a requirement to ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users; and SSI 2011/210 Regulation 15(b)(i) - a requirement to ensure that persons employed in the provision of the care service receive appropriate training appropriate to the work they are to perform and National Care Standards for care at home - Standard 4: Management and leadership. Timescale: within six months on publication of this report. Recommendations Number of recommendations: 5 1. Use of appropriate best practice guidance relating to recruitment should be implemented and followed within the recruitment policy. National Care Standards for care at home - Standard 4: Management and staffing. 2. Staff should receive regular planned supervision which is reflective of practice to continue to improve outcomes for service users. This supervision should evidence that staff practice is being monitored and how it links to individual training and development plans. National Care Standards for care at home - Standard 4: Management and staffing. 3. The staff and management team should address matters hindering teamwork to ensure that the service continues to be delivered by a well motivated, professional and cohesive team. National Care Standards for care at home - Standard 4: Management and staffing arrangements. 4. Staff should ensure that they submit applications to register as professional workers at the appropriate time with the Scottish Social Services Council (SSSC). The manager should collate information of eligibility to register and monitor that staff undertake this process as required. National Care Standards for care at home - Standard 4: Management and staffing arrangements. 5. The provider should use the Promoting Excellence framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia. This should include training at skilled and enhanced level for all staff working directly with residents. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangement, and Promoting Excellence framework, Scottish Government 2011. Grade: 2 - weak page 7 of 14
Quality of management and leadership Findings from the inspection A new management team had been appointed following the retirement of the previous manager. An increasing awareness was being highlighted to the new management; following ongoing discussion with the management team throughout the inspection process. A service development plan had been created and meetings were facilitated with staff to demonstrate their commitment and intent to improve the quality of the service through improvement in outcomes for service users, carers and staff. As a result, plans were put in place to address many of the findings described throughout this report, which had resulted in lack of evidence of monitoring and evaluation of quality assurance under each of the three quality themes since the previous inspection. We will support the development of the service through providing monitoring visits to the service throughout the year. Previous feedback systems including meetings, complaints, audits, supervisions, appraisals, training used to improve service had not been provided for consideration of evidence during this inspection process. To minimise confusion to service users and staff, clarity should be provided on remit of social care and health professionals working within the ICES team. This could possibly be clarified on the service brochure which is yet to be fully developed to provide written information to service users. A review of the mainstream supports provided by ICES social care staff to assist mainstream homecare should be reviewed to negate confusion on the purpose and remit of the ICES service. There was evidence to demonstrate how providing routine supports to mainstream homecare services had compromised ability of Community Alarms to undertake their duties such as equipment checks including fire alarms, call alarms and pendants for service users (see recommendation 1 of this quality theme). Some systems were in place for quality assurance through organisational systems. Senior carers/home care managers conducted spot checks, observation and courtesy calls were carried out by co-ordinators for feedback on staff practice. Amendments to documents could be more effectively used to obtain feedback from service users on care and support received. A lack of evaluation of audits or monitoring for trends evident or any action plans created to enhance and develop the service (see requirement 1 of this quality theme). Some verbal feedback indicated a high degree of satisfaction with the carers who attended to provide supports (ICES) whilst other people commented on the fact they were unhappy at the negative attitude of some staff who attended them (community alarms). A minimal response to feedback questionnaires for inspection purposes was received whilst there had been no surveys conducted b the service to obtain feedback since the last inspection. On-call arrangements were in place to support staff outwith office hours.the management should continue to promote staff knowledge of the procedure for contacting on-call management. Feedback on recommendations made during previous inspections are discussed later in this report. Requirements Number of requirements: 1 1. The provider must review quality assurance systems and processes to ensure management and leadership within the service is improved to enhance the quality of this service. Managers and seniors must have a clear overview of the different elements of the service and ensure that staff are aware of their roles and responsibilities, that systems and routines are person-centred, efficient and effective and there are strong page 8 of 14
leadership values promoted throughout the staff group. This includes but is not limited to review and monitoring and auditing of care plans, medication audits, feedback systems, review of staff practice, supervisions and training, feedback monitoring systems, action planning and risk assessments. This is in order to comply with: The Public Services Reform (Scotland) Act 2010 (Requirements for Care Services) Order and SSI 2011/210 Regulation 3 - Principles. A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them and SSI 2011/210 Regulation 4 (1) (a) welfare of service users. Timescale for implementation: within six months on publication of this report. Recommendations Number of recommendations: 1 1. Appropriate information should be available to support staff in how to perform their duties to promote the safety and wellbeing of residents. National Care Standards for care at home - Standard 4: Management and staffing arrangements. Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should develop an introductory pack with a written agreement in accordance with the National Care Standards. page 9 of 14
National Care Standards for care at home - Standard 1: Informing and deciding and Standard 2: The written agreement. This had not yet been completed. This recommendation is repeated. Recommendation 2 The personal plan should reflect details of the current needs and preferences of each resident and clearly set out how they will be met. National Care Standards for care at home - Standard 3: Your personal plan. Personal plans did not reflect ongoing assessment and review of personal plans with lack of detail on how supports were to be provided with consideration to service user preferences and choices. Information held relating to service user care was recorded on computerised systems which were not clearly discussed or agreed with service users. This recommendation is repeated. Recommendation 3 Use of appropriate best practice guidance relating to recruitment should be implemented and followed within the recruitment policy. National Care Standards for care at home - Standard 4: Management and staffing. Some improvements had been made to the implementation of the recruitment policy. However, we saw some practices which had not yet fully evolved into the consistent use of the up to date best practice guidance. This recommendation is repeated. Recommendation 4 The staff and management team should address matters hindering teamwork to ensure that the service continues to be delivered by a well motivated, professional and cohesive team. National Care Standards for care at home - Standard 4: Management and staffing arrangements. page 10 of 14
There was a marked difference on effectiveness of teamworking which was related to specific elements of the three social care teams under different home care managers and the team leader for health. We discussed concerns that arose during the inspection with the management who are taking action to improve outcomes and minimise the impact on service users and staff. This recommendation is repeated. Recommendation 5 Staff should ensure that they submit applications to register as professional workers at the appropriate time with the Scottish Social Services Council (SSSC). The manager should collate information of eligibility to register and monitor that staff undertake this process as required. National Care Standards for care at home - Standard 4: Management and staffing arrangements. This process was being considered for implementation to ensure all staff submit their applications to register within the specified timeframe. This recommendation is repeated. Recommendation 6 The provider should use the Promoting Excellence framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia. This should include training at skilled and enhanced level for all staff working directly with residents. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangement, and Promoting Excellence framework, Scottish Government 2011. Promoting Excellence Training had not yet been undertaken by all staff to develop their skills and knowledge to improve how they support service users who live with dementia. This recommendation is repeated. Recommendation 7 Appropriate information should be available to support staff in how to perform their duties to promote the safety and wellbeing of residents. National Care Standards for care at home - Standard 4: Management and staffing arrangements. Policies and procedures were updated within organisational timeframes but were not necessarily shared with staff. Induction for staff who joined the service should be reviewed to ensure staff receive appropriate page 11 of 14
information to support them in their role. Training should be available to staff on a regular basis to allow them to provide appropriate care and support using best practice guidance. This recommendation is repeated. Recommendation 8 Review of the registration certificate should be undertaken as part of the quality assurance monitoring. National Care Standards for care at home - Standard 4: Management and staffing. The registration certificate was amended as discussed during the previous inspection to reflect the service provision. This recommendation is met and discontinued. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 3 Feb 2016 Unannounced Care and support 5 - Very good 4 - Good Management and leadership 4 - Good 21 Nov 2014 Unannounced Care and support 5 - Very good 5 - Very good page 12 of 14
Date Type Gradings Management and leadership 6 - Excellent 29 Oct 2013 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 22 Jan 2013 Unannounced Care and support 4 - Good 4 - Good Management and leadership 3 - Adequate 16 Mar 2012 Unannounced Care and support 4 - Good 4 - Good Management and leadership 1 Sep 2010 Announced Care and support 3 - Adequate 4 - Good Management and leadership 9 Sep 2009 Announced Care and support 4 - Good 4 - Good Management and leadership 4 - Good 23 Sep 2008 Announced Care and support 4 - Good 4 - Good Management and leadership 4 - Good page 13 of 14
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 www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect 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 14 of 14