Handy Services Support Service Care at Home Aldersyde 9 Routine Row Pittenweem Anstruther KY10 2LG Inspected by: Patrick Sweeney Type of inspection: Announced (Short Notice) Inspection completed on: 21 March 2014
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Heather Muir and Anne Stewart a Partnership trading as Handy Services Service provider number: SP2006008198 Care service number: CS2006117062 Contact details for the inspector who inspected this service: Patrick Sweeney Telephone Email enquiries@careinspectorate.com Handy Services, page 2 of 27
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 3 Adequate Quality of Staffing 4 Good Quality of Management and Leadership 3 Adequate What the service does well The service changed how service users were supported when staff found that service users' needs had changed. Staff used their insight into service users' health condition to recognise and anticipate the changing needs these would bring. The service emphasised that service users should have as much independence and support to do the things they feel they can do. What the service could do better The service must review service users' personal plans at least once in every six months. All personal plans must detail service users' needs and preferences and how they will be met. All service users must have a written personal plan. What the service has done since the last inspection The service had met a requirement to improve medication records. The service still needed to improve its quality assurance system. Conclusion Most service users and relatives were overall happy with the service provided. There were limited discussions by the service with service users and relatives about their needs and preferences. Handy Services, page 3 of 27
Who did this inspection Patrick Sweeney Lay assessor: Mrs Winnie Whyte Handy Services, page 4 of 27
1 About the service we inspected Handy Services is registered by the Care Inspectorate since 1 April 2011 to provide a support service - care at home. The service is provided by Heather Muir and Anne Stewart, a partnership trading as Handy Services. The service is available to older people and adults. The service is provided by a staff team across most of east Fife. The services aim include "The service aims to provide quality care to a diverse range of clients requiring assistance in their own homes. The service aims to operate a 24 hour/7 day per week service as and when required." The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. You can find the most up-to-date grades for this service by visiting our website, by calling us on 0845 600 9527 or visiting one of our offices. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Handy Services, page 5 of 27
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate Inspection report continued 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. Handy Services, page 6 of 27
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 This was a short notice inspection with two days' notice to arrange visits to service users' homes. The inspection was carried out by an inspector on 19, 20 and 21 February 2014. A lay assessor contacted some service users and relatives by phone. The management of the service was told the result of the inspection in a meeting on 21 February. Before the inspection the provider had submitted an annual return and self assessment as requested by us. During this inspection we gathered evidence from various sources, including; discussion with the management team, discussion by phone with one people using the service, visits to four service users' homes, discussion with four staff, examining four service users' care plans, examining the services' records of staff induction, supervision meetings and training, accident and incident records. We sent out twelve questionnaires service users and eight were completed and returned to us. 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 Handy Services, page 7 of 27
Inspection Focus Areas (IFAs) Inspection report continued In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Handy Services, page 8 of 27
What the service has done to meet any requirements we made at our last inspection The requirement The service provider must ensure medication is managed in a manner that protects the health, welfare and safety of service users. In order to achieve this the provider must ensure; -- Where handwritten instructions have been added to the MAR sheet these must be signed and dated by the authorising GP or the member of staff who transcribes the doctors instructions. This is in order to comply with Regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) and SSI 2002/114 Regulation 19(3)(j) Timescale: 1 month from receipt of this report. What the service did to meet the requirement Where a service user who was being supported to manage their medicines, there were appropriate records being kept of how the staff were supporting them to take their medicines. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection To help identify areas for improvement and improve the quality of record keeping it is recommended that the service introduce a regular programme of audits.the service shall ensure outcomes of audits and quality assurance systems are shared and taken forward with clients, relatives and staff. National Care Standards, Care at Home, Standard 4 - Management and staffing. We did not find that this practice had been put into place. Overall the service did not have a system to obtain service user and relative feedback, to measure that good outcomes were being achieved for service users, or to give feedback on improvements to service users, relatives and staff. A revised recommendation is made. See Quality of Management and leadership, Statement 4, Recommendation 1. Handy Services, page 9 of 27
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 Inspection report continued 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. We received an appropriately completed self assessment in which the service set out its strengths and areas for improvement. We suggest that to improve the assessment that for each strength or area of improvement that the service has an up to date index of where evidence and example of practice with individual service users and staff can be found during an inspection. Taking the views of people using the care service into account We met four service users in their home and spoke to one service user by phone. The comments that service users gave us in person, by phone or by questionnaires returned to us have been included in this report. We received eight questionnaires back from the 12 we sent to service users and their relatives. The service was rated very highly in the following areas with almost all service users and relatives agreeing or strongly agreeing: I have a personal plan or support plan which contains information about my support needs. My need and preferences have been detailed in the personal plan. I am confident that staff have the skills to support me. Staff have enough time to carry out the agreed support and care. Staff treat me with respect. I know the names of the staff who provide my support and care. Overall, I am happy with the quality of care and support this service gives me. Handy Services, page 10 of 27
The service was rated less strongly with the following areas with three out of eight service users or relatives disagreeing that; The service checks with me regularly that they are meeting my needs. The service asks for my opinions about how it can improve. Taking carers' views into account We got the views of relatives in questionnaires returned to us. The comments relatives gave by questionnaires returned to us have been included in this report. Handy Services, page 11 of 27
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: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found the service had adequate performance in this quality statement. There was limited evidence of discussions by service with service users and relatives about their needs and preferences and how the service had acted on this feedback. Also the service was not holding six monthly reviews with service users and relatives about their care plan. We found that the service did change how supported service users, and updated their care plans, when staff reported that service users' needs had changed. Most service users and relatives told us in our questionnaires they had care plans which contained information about their needs and preferences. We had an example where a service user's choices determined where they went on trips out for shopping and outings with staff. The service user confirmed she chose where to go and enjoyed these trips out. The service had reviews with some service users. A service user told us the service had acted on their views, for example; "I have had a review and they listened and acted promptly, but it's been a long while now." In exceptional circumstances the service has also been flexible in how it helped service users. One service user told us: "they have at times provided me with an emergency service last winter." Handy Services, page 12 of 27
Areas for improvement Inspection report continued There was limited evidence of discussions by service with service users and relatives about their needs and preferences and how the service had acted on this feedback. The service was not routinely holding six monthly reviews of service users' personal plans, as required by regulations, with service users and their representatives. If other agencies are holding reviews then it is sensible for the service to combine their six month review with those agencies. This is also an opportunity to ask for their views on how the service is meeting their needs and preferences and to agree how these will be met. See requirement 1. Service users and relatives told us in our questionnaires about improvements they would like the service to made: "I don't know who is visiting me until they show up. It would be good to have an idea of who is visiting and when." "When a new carer attends I have to show them the ropes. I would expect on a first visit that a new member of staff is accompanied by someone who has cared for my relative previously." Though the service's general practice is to introduce new start staff with an experienced staff member, but even experienced staff need to be introduced to service users they are not familiar with. In our questionnaires three out of eight service users or relatives disagree that; The service checks with them regularly that they are meeting their needs. The service asked for their opinions about how it can improve. The service needs to consult with service users and relatives about how their needs and preferences are met and ask them for suggestions about how the service can improve. See recommendation 1. Handy Services, page 13 of 27
Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must review service users' personal plans in consultation with them and their representatives at least once in every six month period. This is in order to comply with SSI 2010/210, regulation 5(2)(b)(iii). This is a requirement for providers to review the personal plan service users' personal plans in consultation with them and their representatives at least once in every six month period. Timescale for completion. Within six months of the receipt of this report. Recommendations 1. The provider should record the views of service users and relatives about their needs and preferences in reviews and show how these had influenced how the service is provided. National Care Standards, Care at home, Standard 3, Your personal plan. Handy Services, page 14 of 27
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that this service had good practice in this quality statement. The need for improvement to the care planning system prevented a higher grade being awarded. We found good outcomes for service users when they and their relatives told us; "I am more than happy with the care I receive and all the help I receive." "The service is reliable in the times it arrives" "My mother finds the support given and the care staff something to look forward to. My father who is the main carer finds the time he has to himself as a result of the care service to be very valuable." We found other good outcomes in the following instances; Where a service user who was being supported to manage their medicines, there were appropriate records being kept of how the staff were supporting them to take their medicines. A service user told us: "The staff are good at making sure I have the correct medicines." A service user was supported by the service to go on shopping trips and outings. The service user confirmed that she chose where to go and enjoyed these trips out. The service had requested changes to a service user's bed, to a profile bed with an air mattress as their mobility changed. The service had also supplied moving equipment such as a four-way slide to make it easier and more comfortable for the service user to be moved. During a visit to a service user we saw a warm working relationship between the service user and the staff with lots of chat and laughter which the service user was enjoying. Also the care was carried in a calm, practical manner which meant that proper attention was paid to safety during a transfer between a bed and a chair, and when being assisted to take medicines. An example of very good practice was where staff used their knowledge an insight into a service user's health condition whose symptoms were progressive, to recognise and anticipate the changing needs this would bring. As a result the service user's care plan had been updated regularly with these changing needs. Handy Services, page 15 of 27
The service had good processes to ensure good outcomes in care when; A service user's care plans had details of relatives, other emergency contacts and healthcare professionals so staff knew who to contact if they had concerns about service users' welfare. The care plans for service users emphasised that they should have as much independence and support to do the things they feel they can do. An example of this was a plan stated a service user will instruct staff how they want to move about their bedroom and bathroom. One service user confirmed to us: "They do my care in the way I want it." Areas for improvement The care plans we saw were basic in stating the care tasks required such as assistance to get up/wash/dressed, and gave some additional directions such as a service user required assistance with washing their lower half and their hair. The care plans needed to state in some more detail exactly how staff should act to meet service users' needs and preferences. Where a service user can give directions or do some of their care themselves it is better practice to state in detail how staff are to assist the service user and what the service user usually does for themselves. See requirement 1. We found two examples where the service had initially supported one person in a household and was now meeting some support needs of another person in the household because of a change in their needs. The support in itself was at a low level, for example; prompting to take medicines and the service could provide this type of support. However there was no personal plan in place. See requirement 2. Handy Services, page 16 of 27
Grade awarded for this statement: 4 - Good Number of requirements: 2 Number of recommendations: 0 Requirements 1. The provider must ensure that all personal plans are written with a detailed and comprehensive account of service users' needs and preferences, and how staff are to meet these for consistency and safety. This is in order to comply with SSI 210/ 2011, regulation 5(1). This is a requirement for providers prepare a written plan which sets out how service users' health, welfare and safety needs are to be met. Timescale for implementation: Within four weeks of receiving this report. 2. The provider must ensure that all service users have a personal plan prepared setting out how their support needs and preferences will be met by the service. This is in order to comply with SSI 210/2011, regulation 5(1). This is a requirement for providers prepare a written plan which sets out how service users' health, welfare and safety needs are to be met within 28 days of starting to receive a service. Timescale for implementation: Within four weeks of receiving this report. Handy Services, page 17 of 27
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths We found that the service had good practice in this quality statement. We based this on the level of positive comment we received from service users and relatives in questionnaires returned to us. These comments included: "In general I am happy with the staff." "The staff are helpful with the regular ones knowing how I like things to be done, and they do it my way, which I think is a nice touch. I usually have the same care staff, but any new staff are always have a shadow visit with one of the regular staff supporting them." "The staff are very good. They work very well with me. I have a good time with them. I know all their faces." "The care staff are kind, compassionate and efficient." Areas for improvement For improved practice and grades the service would need to demonstrate how service users' and relatives' views had led to improvements in staffing. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Handy Services, page 18 of 27
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service had good practice in this quality statement. There was a thorough staff induction and continuing programme of staff support and development which supported staff in their work with service users. The service has a structured induction programme for new staff, which included specific training sessions for; infection control, techniques for personal care, food handling practice, moving and handling. Senior staff are trained as a trainers in moving and handling and medication administration. Staff were provided with a detailed and comprehensive hand book which provided staff guidance on the service's policies and procedures. The service has a room with moving and handling equipment used for staff training. As a part of the induction period new staff had spot checks to ensure they were putting into practice what they had been taught. We spoke to staff member confirmed that they had an induction by a senior member of staff. Another staff member confirmed senior staff carried out spot checks. We saw supervision records which recorded that care staff were being monitored by senior staff in their performance working with service users and being offered training opportunities and opportunities to undertake vocational qualifications. Staff are encouraged to obtain vocational qualifications and a senior staff member is a workplace verifier and has supported staff to obtain their qualifications. A staff member confirmed they comments from senior staff about how well they were doing in their work. She felt able to ask questions if there was anything she did not understand. The service was looking to develop the role of senior care staff to assist the management team to ensure the quality of care for service users through; spot checks while care was being provided, ensuring care plans were up to date and accurate and relevant records of care were being maintained and to give staff advice and support. Areas for improvement The service needed to ensure that it demonstrated a consistent use of its supervision system with staff. A sample of supervision records did not include dates of the meetings supervision meeting were no dated which made it hard to track the frequency of supervision meetings. See recommendation 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Inspection report continued Handy Services, page 19 of 27
Recommendations Inspection report continued 1. The service should ensure that it records when staff supervision sessions have taken place as part of its policy on regular staff supervision. Standard 1, Management and staffing. Handy Services, page 20 of 27
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 grade for this statement is based upon the findings reported in Quality of Care and Support, Statement 1. Areas for improvement Areas for improvement have been identified under Quality of Care and Support, Statement 1 to improve how it involves service users and their relatives in assessing and improving the quality of the service. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Handy Services, page 21 of 27
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 The service had adequate practice in this quality statement. While there was some involvement of staff in assuring the quality of the service, this did not include service users or relatives. For better practice the service needs to develop its quality assurance system. We found good practice when the service involved staff in improving the service in the following ways; Staff meetings were held with senior staff and care staff to promote consistency of practice and adherence to the services' policies. In a meeting there was evidence that the service had acted comments from service users that staff were running late on their visits, by doing spot checks and supervising those staff not adhering to expected visiting times. Staff who worked with the same service users met with a senior member of staff to discuss how well each service user's needs were being met and if there needed to alter the support provided in response to changing needs. Areas for improvement There was adequate practice in this quality statement. The service had asked service users or relatives for feedback on the quality of the service and for suggestions about how it could improve. Responses from service users and relatives should be part of the service's quality assurance system. Further there had been a recommendation from the last inspection that the service user regular audits to help identify areas for improvement and share the outcomes of audits with service users, relatives and staff. We did not find that this practice had been put into place. Overall the service did not have a system to obtain service user and relative feedback, to measure that good outcomes were being achieved for service users, or to give feedback on improvements to service users, relatives and staff. An example of a good outcome for service users is are they happy with the number of different staff who visit them. This is based on the comment made by a relative we reported in Quality of Care and Support. See recommendation 1. Handy Services, page 22 of 27
It was not easy to get an overview of the whole personal plan for each service user. The service's care plan system was divided between two systems. A care planning software package produced all service users' plans, and rotas for staff, was reported to be inflexible when writing about service users' needs as the service would want to. The service was supplementing the basic plan produced by the package with additional documents, but not for all service users, and not cross referenced with the basic care plan. See recommendation 2. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The provider should show how its quality assurance system ensures it; acts on feedback from service users, relatives and staff uses measures to ensure good quality outcomes were being achieved for service users show above feedback and measures contribute to plans for continuous improvement. Standard 4, Management and leadership. 2. The provider should ensure that any document detailing each service user's needs is identified as part of their personal plan. Standard 3, Your personal plan and Standard 4, Management and staffing. Handy Services, page 23 of 27
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 No additional information. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Handy Services, page 24 of 27
5 Summary of grades Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 3 - Adequate 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Management and Leadership - 3 - Adequate Statement 1 Statement 4 3 - Adequate 3 - Adequate 6 Inspection and grading history Date Type Gradings 30 Aug 2012 Announced (Short Notice) Care and support Staffing Management and Leadership 4 - Good 4 - Good 4 - Good 20 Sep 2011 Announced (Short Notice) Care and support Staffing Management and Leadership 3 - Adequate 4 - Good 3 - Adequate 28 Apr 2010 Announced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 2 Jul 2009 Announced Care and support 3 - Adequate Staffing 2 - Weak Management and Leadership 3 - Adequate 11 Apr 2008 Announced Care and support 4 - Good Staffing 4 - Good Handy Services, page 25 of 27
Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Handy Services, page 26 of 27
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 Handy Services, page 27 of 27