Care service inspection report Full inspection Sue Ryder Care & Support Service - Housing Support Service Housing Support Service Caiesdykes Road Kincorth Aberdeen Inspection completed on 10 August 2015
Service provided by: Sue Ryder Service provider number: SP2007967940 Care service number: CS2012307685 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and 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. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 23
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 Quality of staffing 5 Quality of management and leadership 5 Very Good Very Good Very Good What the service does well This is a small service, which has a very personal, friendly approach. The support plan is detailed and useful, providing the information that staff need to work in a consistent way and to keep themselves and the person receiving a safe service. The manager and head of care have helped the team leader and staff to support the service user and each other, through what has been a very difficult time. They do regular checks (audits) on the service and have used the information from these to improve the service they provide. What the service could do better This service is doing well, with a great deal of progress since the last inspection. During the inspection a new person was in the process of moving in. This will provide a challenge to meet both people's needs without making compromises. page 3 of 23
What the service has done since the last inspection Inspection report The staff and the person they support have been through a lot since the last inspection, and they have managed to cope well and to improve the service provided. Conclusion The person supported by this service and the staff have come through a difficult few months. They have managed to deal with this very well and the service has continued to develop and offer new opportunities. page 4 of 23
1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. This service registered with the Care Inspectorate on 01 June 2012. Sue Ryder is a large charitable organisation, working across the UK. This service is registered to provide a service to people with complex needs, including learning disabilities, physical and sensory impairments living in their own homes. They are registered to provide both housing support and care at home. These are provided as one service, with the same staff team and management structure. At the time of the inspection, support was being provided to one person who stayed very close to another Sue Ryder service. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. page 5 of 23
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 0345 600 9527 or visiting one of our offices. page 6 of 23
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. This was carried out by one inspector. The inspection took place on Thursday 6 August 2015. It continued the following day, Friday 7 August and concluded on Sunday 9 August with a telephone call to the team leader. We gave feedback to the manager, the regional director and the head of care on Monday 10 August 2015. 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 sent one 'Care Standards Questionnaires' (CSQs) to the manager to distribute to residents. One carer sent us a completed questionnaires on behalf of their relative. We also asked the manager to give out five questionnaires to staff and we received four completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: - one person using the service - the head of care - the manager - the team leader - two support workers - one family member. We looked at a selection of documents, records and policies, including: page 7 of 23
- the participation strategy, which says how people and their families will be involved in running the service - support plan - review minutes - evidence of meetings with outside health professionals - accident and incident records - medication records - finance records - team meeting minutes - staff training records - staff supervision records - staff appraisal records. 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 page 8 of 23
consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firescotland.gov.uk Inspection report page 9 of 23
The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. Taking the views of people using the care service into account We talked with one person receiving a service during the inspection. She told us about some of the things she had done with staff support and trips she had been on. She was enthusiastic about her staff, her house and her garden and we saw photos of some of the activities she had undertaken. Taking carers' views into account We spoke to one family member in the course of the inspection. She was very pleased with the progress her daughter had made in the time she had been supported by the housing support service. page 10 of 23
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 The manager, team leader and staff of this service showed that service users and carers participated in improving the quality of support to a very good level. This was a small personal service, with good communication between the person receiving the service, their relatives and staff. This meant there were regular opportunities to discuss the service and involve people in discussing the support provided. A new person was in the process of moving in during the inspection. The two people concerned already knew each other and the move was taking place slowly, with visits for the people to meet and talk prior to the person moving in. This was a positive way of involving people in a planned way. Reviews gave people an opportunity to comment on the service they were receiving. Some of these were chaired by a care manager, which meant there was an external person to support people to put forward their views. The organisation had a well-developed system for asking for people's views using questionnaires. The results from these questionnaires were collected and used to develop an action plan for the service. We saw that there was an action plan in place and that progress was being made on the areas for improvement page 11 of 23
that had been identified. The team leader had developed an easy-read version of a questionnaire to be used by the people using the service and they intended using that in the future. There was a lot of information available in different formats to make it as accessible as possible to the people using the service. This included use of symbols and pictures. Photos were used in a positive way to provide a talking point about places people had been and activities they had taken part in. Areas for improvement At feedback we discussed how service users and families could be involved in completing the Care Inspectorate self assessment document. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths The inspection showed that staff responded to service users' and carers' support needs using person-centred values to a very good standard. Inspection report This year we are using an 'Inspection Focus Area' (IFA) to identify excellence and to promote and support improvement in care homes and combined housing support and care at home services. We have asked providers to complete a self assessment as well as answering a number of specific questions during the inspection which explore health outcomes for people with a learning disability. The IFA also provides a focus on Human Rights, Safety, Supporting communication and the wider recommendations from the Keys to Life and Winterbourne View findings. Information gathered from our inspection activity in 2015-2016 will provide valuable intelligence at all levels, including a national overview. page 12 of 23
These are our findings: The service was using person-centred support plans, and staff all had training in personalisation. Agreed outcomes that the person wanted had been identified and we saw that the service had been helping the person to work towards achieving these. There was a brief support plan to provide key information for unfamiliar members of staff who needed to fill in at short notice. Risk assessments were in place, both general ones and for specific activities. These were detailed and provided control measures to reduce the risk from the hazards they had identified. The person using the service and members of staff had come through a difficult time, as one person they supported and a member of staff had both died recently. Support had been put in place to help the service user and the staff to cope with their feelings around this. Staff described being conscious of their responsibilities and making it a priority to support the service user, whilst feeling upset themselves. This was an impressive piece of work from a small close-knit staff team, who were dealing with their own emotions at the time. The service had been working on meeting the recommendations in the national strategy 'keys to life'. The person they supported had regular eye tests, and had support from other professionals such as GP, community learning disability nurses and the care manager. There was a hospital plan in place, giving the information needed if the person had to go to hospital. The staff team had discussed the keys to life and had also discussed human rights and how these influenced the service provided. We heard of a situation where the staff team had been concerned about the support provided by another organisation and had advocated on the person's behalf to get a change in how they were supported. page 13 of 23
Areas for improvement During the inspection we discussed ways that the staff within the service could further develop their person-centred plans. This could include using one-page profiles for people using the service and for members of staff, for example. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 14 of 23
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 The inspection showed that service users and their families participated in improving the quality of staffing to a very good standard. The staff in this service had good informal relationships with families and carers. The carer we spoke with said communication was good and they were confident that information would be passed on and they would be informed of any concerns about their family member. Reviews gave an opportunity for people using the service and carers to discuss how members of staff were performing in their role. The team leader had discussed how members of staff were doing with family members, and used this information during the member of staff's supervision. At the last inspection a recommendation was made on involving people using the services and their carers in recruiting members of staff. The team leader had discussed this with a family member, who was willing to take part in interviews. She also asked the family member to provide questions to be asked at interview, based on what they were looking for in a member of staff. This recommendation has been met. Areas for improvement There had only been one member of staff recruited since the last inspection. The family member who had offered to take part was unable to attend at short page 15 of 23
notice. The team leader could continue to try to involve families or people using the service in any further recruitment. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths The inspection showed that everyone working in the service had an ethos of respect towards service users and each other to a very good standard. The staff team had recently had a very difficult period, due to two sudden deaths. They had provided a lot of support for each other and had maintained a focus on supporting the person in the service through this time. This was a very positive example of respecting people, whilst themselves going through difficult circumstances. Sue Ryder had a strong commitment to promoting the organisation's values. They had developed these and produced a booklet laying out what they worked towards and what was expected of staff. This had been circulated to each member of staff, with new staff receiving a copy at induction. Induction and team meetings also covered the National Care Standards, the 'Scottish Social Services Council' (SSSC) code of conduct and human rights. All of this served to make clear to members of staff the values which they were expected to work to. Interactions we saw between members of staff and the people they supported were thoughtful and respectful. Their communication was clear and straightforward, using plain language. page 16 of 23
We made a recommendation at the previous inspection on developing support for staff members. Regular supervision and team meetings were in place at the time of this inspection, so the recommendation has been met. Staff told us that they were happy with the support provided and they also pointed out the role they played in supporting each other. Areas for improvement This is still a relatively new service and could continue to develop its approach towards respecting people's rights. The report on the investigation into 'Winterbourne View' provides useful material for discussion on promoting and maintaining an open respectful culture. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 17 of 23
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 The manager showed that service users and carers contributed to the management of the service to a very good level. There were good informal contacts with the person using the service, their family and the manager, head of care and team leader. The family member we spoke with told us that they felt sure any concerns they raised would be listened to and they felt confident they would be acted upon. Questionnaires provided an opportunity for people to comment on the service, including how it was managed. This information was then used to develop an action plan and improve the service. Reviews also provided an opportunity for people to comment on the management of the service. Areas for improvement The newly developed questionnaires will provide another opportunity for people to give their views on how the service is managed. page 18 of 23
Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service Strengths During the inspection we saw evidence that leadership values were promoted throughout the workforce to a very good standard. Members of staff were regularly lone-working, which meant that they needed to take responsibility for supporting people using the service and for the safety and wellbeing of everyone there. The staff we spoke with recognised the responsibility that went with this, but were also aware of the need to ask for advice or report any issues where they were unsure of the best approach to take. There were regular planned tasks, such as health and safety checks, administering medication and checking medication stocks and records that staff needed to do when they were on-shift. Here again they were conscious of the responsibility involved. They were also responsible for checking petty cash and spending money, and keeping receipts and records for these. Members of staff had a thorough induction, good ongoing training and they had all been supported to undertake a 'Scottish Vocational Qualification', (SVQ) which is a recognised qualification for people working in social care. Staff were responsible for keeping a record of their own training and development. Areas for improvement The team leader had developed her role over the past year and was aware that there were more tasks she could delegate to other people or support other people to do. She saw this as one of her priorities for future development. page 19 of 23
Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The manager to consider ways of involving people who use services and their carers, in recruitment and appraisal of staff. National Care Standards, Care at Home, Standard 11: Expressing your views. This recommendation was made on 10 November 2014 The team leader had discussed this with a family member, who wanted to be involved in interviewing members of staff. The team leader had discussed how members of staff were doing with a family member and was using this information during supervision. This recommendation has been met. page 20 of 23
2. That the manager develops systems and procedures for supporting staff. This to include: - Providing opportunities for individual staff to meet to discuss support and development - Keeping a record of these meetings with actions required. National Care Standards for Care at Home, Standard 4: Management and staffing. Improving front line services, A Framework for Supporting Front Line Staff, wellbeing at work. This document can be found at: http://www.scotland.gov.uk/resource/doc/920/0011802.pdf. This recommendation was made on 14 November 2014 The team leader was now meeting each member of staff individually for supervision. We saw details of this support and it was detailed, with agreed actions for people to follow up and discussion on how people could improve their practice. Staff we spoke with told us that supervision was happening regularly and that they felt well supported. Team meetings were also in place and happening regularly. Staff were often working on their own and these meetings provided an opportunity to support each other and to discuss how they worked to make sure there was a consistent approach. Staff told us that these meetings were valuable and were contributing to more opportunities for the person using the service. This recommendation has now been met. Inspection report 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. page 21 of 23
7 Enforcements We have taken no enforcement action against this care service, since the last inspection. Inspection report 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 10 Nov 2014 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 22 Nov 2013 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good page 22 of 23
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 23 of 23