The Richmond Fellowship Scotland - Perth & Kinross Housing Support Service Perth Area Office Suite 2 South Inch Business Centre Shore Road Perth PH2 8BW Telephone: 01738 440012 Inspected by: Averil Blair Type of inspection: Unannounced Inspection completed on: 30 January 2014
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: The Richmond Fellowship Scotland Limited Service provider number: SP2004006282 Care service number: CS2004061307 Contact details for the inspector who inspected this service: Averil Blair Telephone 01382 207200 Email enquiries@careinspectorate.com The Richmond Fellowship Scotland - Perth & Kinross, page 2 of 21
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 The service works well with individual service users to help them meet personal goals. Service users told us that they got on well with staff and felt that they supported them well. What the service could do better The service had had some changes in the make up of teams which had resulted in the cancellation of team meetings. Although the service appears to have restarted regular team meetings they should make sure that they continue to give staff the opportunity to meet to discuss service user issues and have the opportunity for inhouse training. What the service has done since the last inspection The service said that they would be encouraging staff to create more outcome focussed records, and we could see that this has been successful, although the service still has to arrange training for staff. Conclusion The service works with people with a range of support needs, and people told us that they felt they were well supported by staff. Staff had good knowledge of the needs of the people they supported, and said that they were generally well supported by senior staff. The Richmond Fellowship Scotland - Perth & Kinross, page 3 of 21
Who did this inspection Averil Blair The Richmond Fellowship Scotland - Perth & Kinross, page 4 of 21
1 About the service we inspected 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. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. 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 Care Inspectorate. The Richmond Fellowship Scotland is a charitable organisation providing services for people who have mental health difficulties, learning disabilities, autism, dementia and alcohol related difficulties. The Perth services form part of the North Region. They provide both housing support and support services (care at home) to adults with learning disabilities and mental health difficulties, who may also have autistic spectrum disorders. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Staffing - Grade Quality of Management and Leadership - Grade 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. The Richmond Fellowship Scotland - Perth & Kinross, page 5 of 21
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 that took place over a number of visits between 8 and 30 January 2014. Feedback was given to the Manager and senior staff of the service on 30 January. Prior to the inspection the service submitted a self assessment to the Care Inspectorate. During the inspection we gathered evidence from a range of sources, including the relevant sections of policies, procedures, records and other documents, some of which include: * evidence from the service's recent self assessment * a sample of care plans of service users * a sample of recent staff rotas * risk assessments * minutes of service user meetings * minutes of staff team minutes * audit material * training records. We also visited service users in their homes and met with them at the service's office. 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 The Richmond Fellowship Scotland - Perth & Kinross, page 6 of 21
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 The Richmond Fellowship Scotland - Perth & Kinross, page 7 of 21
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. We received a fully completed self assessment from the service. We were satisfied with the way they had completed this with relevant information under each heading we grade them under. They identified what they thought they did well, some areas for improvement and any changes they planned. The service included information on how they involve people using the service in improving the quality of the service. Taking the views of people using the care service into account During the inspection we spoke to nine service users who were receiving a service from different teams within the service. All told us that they were very happy with the support that they received from the service, and that they liked the staff who supported them. They said that they thought they "were good at their jobs", and that they "usually saw the same staff." They also made comments such as: - "I know I can go to staff at any time and they will help me and let me talk about what is worrying me." - "I like my key worker, and they have helped me a lot." - "My staff member is helping me to try new things." The Richmond Fellowship Scotland - Perth & Kinross, page 8 of 21
Taking carers' views into account During the inspection we spoke with one relative of a service user, and one advocate. They both spoke highly of the staff and said that they felt very involved in the care of their relative. They were invited to comment on the service and felt that if they raised any issues these were looked at seriously by the service and action taken as appropriate. The Richmond Fellowship Scotland - Perth & Kinross, page 9 of 21
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: 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 service was able to provide evidence which showed that they had very good performance in relation to this statement. We decided this after we: - spoke with the manager and staff - looked at documents such as surveys and questionnaires completed by residents - sampled care plans and review minutes of people who used the service - talked to people who use the service. We could see that the service encouraged service users to take part in as many aspects of the service as possible. This included regular service user meetings where appropriate, where people who used the service discussed issues which affected everyone. If service users and staff felt this would be useful, the local advocacy service could also support service users. People who used the service told us that they knew who their key worker was and that they liked the staff and found them very supportive and caring. They said that staff were happy to advise and support them if they asked them, and that they would also encourage them to make use of other supports such as Advocacy service or their GP. If residents felt they needed the support, staff would attend appointments, etc with them. Service users had the opportunity to complete a 'How are we doing' satisfaction survey which encouraged them to comment on the service they received. The service identified any actions which they felt would improve the service. Service users we spoke with during the inspection confirmed that staff discussed their individual support needs, and that their views were taken seriously and were clearly documented. Some of the comments we received included: The Richmond Fellowship Scotland - Perth & Kinross, page 10 of 21
"I can speak with my key worker about anything if I want." "My key worker helps me to try new things, and looks for new things for me to do." "I feel staff know me well and listen to me." The service had encouraged people who used the service to be involved in their six monthly reviews and, where appropriate, they had also involved relatives or professionals such as Community Learning Disability Nurses, or Dietitian. We saw records of these reviews in service users' files, and saw that where issues had been identified, the service had taken action. The service had organised opportunities for service users to find out what was happening within the organisation, and to make suggestions or ask questions of senior staff. One outcome from this had been a simplification of paperwork. Where possible, service users were encouraged to take part in regular audits of their service. This identified actions which had to take place within particular timescales, such as when reviews should take place and, where possible, service users signed paperwork to confirm that it had taken place. The Richmond Fellowship Scotland had recognised that it was sometimes difficult for service users who were receiving a housing support service to be involved in group activities, and had made available 'participatory funding'. During the inspection we saw that groups of service users had discussed what would make their life better or more enjoyable and had come up with a range of schemes or activities which they felt would be beneficial. We saw the plans one group of service users had for the purchase of a greenhouse, which was to be considered for funding. Areas for improvement The service had identified in their self assessment that they continued to look for ways of supporting service users who have more complex needs or communication difficulties to comment on the service they received. The organisation was also working on a tool to measure outcomes for people they support. The Richmond Fellowship Scotland - Perth & Kinross, page 11 of 21
Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Perth & Kinross, page 12 of 21
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths During the inspection we spoke with people who used the service and they were very positive about the support they received and the quality of staff who supported them. We saw that people who used the service had been involved in the compilation of comprehensive support plans. Where necessary these were very directive, for example where it was important that staff were consistent in how they managed behaviour etc, and support plans were monitored on an ongoing basis. Associated paperwork which recorded how service users reacted to situations, known as ABC charts, was also completed to a good standard and monitored to identify if changes were required. Some people who the service supported had a range of communication difficulties, and the service used a variety of methods to make communication easier. This included pieces of assistive technology, talking mats, and the use of signing. Graphics were also used to help people remember their weekly plans. Service users were involved in all aspects of their care, including encouraging a health lifestyle. Where appropriate, associated professionals such as Speech and Language Therapists, Dietitians, and Occupational Therapists were also involved and gave guidance to staff and service users. We could see that this guidance was followed up and monitored. Staff worked with service users to look at what has worked in their support and what hasn't been as successful. They took an opportunity to do this on a monthly basis, and made any changes to support plans accordingly. The service had a range of Risk Assessments in place which clearly identified any actions taken to minimise risks, and these clearly related to support plans. This included issues such as vulnerability and risk of falls. Staff members had received a range of training which allowed them to support service users. This included training which staff had to complete such as moving and handling or first aid, and also additional training related to specific needs of service users, such as communication, mental health, substance abuse or nutrition. Areas for improvement Inspection report continued As mentioned in Quality Theme 1.1, the service was concentrating on ensuring that paperwork encouraged staff to focus on positive outcomes for service users. The service had identified in its action plan that staff may require more training on outcome focussed support plans. The Richmond Fellowship Scotland - Perth & Kinross, page 13 of 21
In their self assessment, the service stated that they aimed to create more learning activities for service users, such as basic education, confidence building, or assertiveness workshops. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Perth & Kinross, page 14 of 21
Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Evidence in support of this statement can be found in Quality Theme1 Quality Statement 1. Areas for improvement See Quality Theme1 Quality Statement 1. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Perth & Kinross, page 15 of 21
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service was able to provide evidence in support of very good practice in this statement. Staff told us that they were able to attend more regular staff meetings, and records generally confirmed this. This gave them the opportunity to discuss service user specific issues, as well as administrative issues and good practice discussions. Prior to the inspection, the organisation had reviewed the suggested timescales for staff supervision, and both team leaders and staff told us that this was much more manageable and still met individual need for support. Staff completed a comprehensive induction period when appointed to a new post. This included training which the service felt was core to the work they would be doing, such as moving and handling, as well as observed practice. A range of training was available for all staff, such as medication administration, management of epilepsy, mental health first aid, and dealing with challenging behaviour. Records confirmed comments from staff that they were able to access training which helped them provide a good quality support to service users. Staff also told us that if they felt they needed additional training to manage issues then this could be made available to them. All staff we spoke with across the service told us that they felt well supported by their line manager, and by the organisation in general. Areas for improvement Due to changes in staffing and vacancies amongst senior staff, some teams had not been able to hold team meetings as regularly as they wished. They had not been able to access supervision as frequently during this period but said that they would feel comfortable supporting colleagues or seeking support from other senior staff if necessary. Staff told us that this situation had recently been resolved and they hoped to settle into an acceptable pattern of team meetings and supervision, and this was confirmed by their new team manager. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Perth & Kinross, page 16 of 21
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Perth & Kinross, page 17 of 21
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 The service carried out a comprehensive range of audit and monitoring processes as part of the organisation's quality assurance process. The organisation had identified key performance indicators of practice. This gave them a method to check whether they were performing well or whether systems and process needed to be more closely monitored to ensure good quality care was provided. All staff were involved in these processes and, where possible, service users were also encouraged to comment. The Manager was responsible for ensuring that all parts of the service were audited regularly using the National Evaluation Tool, which looked at person centred planning, continuous learning development and planning, policies, procedures and documentation, and health and safety. Any areas for improvement were identified and an overall action plan developed. We could see that the service was working to meet some of the identified actions, such as encouraging staff to complete the staff questionnaire which had recently been distributed. On a local level, the service audited accidents and incidents, as well as any complaints or concerns raised. Where necessary, the service involved other professionals, either externally or in-house team such as the Positive Behaviour Team who could support staff to manage difficult behaviours positively. In assessing this statement we also took into consideration the information found in statements 1.1 and 3.3 in relation to reviews, supervision, and meetings. Areas for improvement The service identified in its self assessment that it was looking at how they could encourage service users to be more involved in the completion of their self assessment for submission to the Care Inspectorate. They were also looking at how the information they gathered as part of this process could be transferred to the self assessment to demonstrate good practice. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Perth & Kinross, page 18 of 21
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 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). The Richmond Fellowship Scotland - Perth & Kinross, page 19 of 21
5 Summary of grades Quality of Care and Support - Statement 1 Statement 3 Quality of Staffing - Statement 1 Statement 3 Quality of Management and Leadership - Statement 1 Statement 4 6 - Excellent 6 Inspection and grading history Date Type Gradings 29 Nov 2012 Announced (Short Notice) Care and support Staffing Management and Leadership 30 Jun 2010 Announced Care and support Staffing Management and Leadership Not Assessed 18 Aug 2009 Announced Care and support Staffing Management and Leadership 9 May 2008 Announced Care and support Staffing 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. The Richmond Fellowship Scotland - Perth & Kinross, page 20 of 21
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 The Richmond Fellowship Scotland - Perth & Kinross, page 21 of 21