HSC Nursing Services Nurse Agency Unit 4, Centrum Business Park Hagmill Road Coatbridge ML5 4TD Telephone:

HSC Nursing Services Nurse Agency Unit 4, Centrum Business Park Hagmill Road Coatbridge ML5 4TD Telephone: 01236 702713 Inspected by: Amanda Cross Type of inspection: Unannounced Inspection completed on: 27 August 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 9 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: HSC Futures Ltd Service provider number: SP2010011254 Care service number: CS2011280841 Contact details for the inspector who inspected this service: Amanda Cross Telephone 01294 323920 Email enquiries@careinspectorate.com HSC Nursing Services, 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 Information 4 Good Quality of Care and Support 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well This is the first inspection since registration for the service. There was evidence of the effectiveness and ongoing development of policies and procedures. The agency provided trained nursing staff and support workers to a range of care homes for the elderly. Staff were safely recruited and completed an induction process prior to working in the services. Staff received good support and were monitored closely by management. What the service could do better The management should continue to develop their systems to obtain formal feedback within their quality assurance systems. A formalised risk assessment process should be appropriately completed and recorded to minimise risk to service users and staff. What the service has done since the last inspection This is the first inspection since registration. The service is still in its infancy and the management continue to develop the systems to support the business. HSC Nursing Services, page 3 of 21

Conclusion Inspection report continued We saw evidence of a good level of satisfaction within the feedback documentation received by the service from both staff and clients. This service had offered a good standard of service to clients through their recruitment procedure and supportive induction process for their staff. Who did this inspection Amanda Cross HSC Nursing Services, page 4 of 21

1 About the service we inspected HSC Nursing Services operates from an office in Coatbridge. The service registered with the Care Inspectorate in September 2012. The mission statement of the agency states it "will provide the highest standard of services to both its Workers and Clients alike in conjunction with the guidelines and parameters set within the Healthcare Profession. On achieving these objectives, we will ensure our position is maintained in order to expand and become a successful Nurse Agency". The aims of the service are "to provide a high quality standard of healthcare to the public and private sector and maintain a successful business within the boundaries set by law". Based on the findings of this inspection this service has been awarded the following grades: Quality of Information - Grade 4 - Good Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. HSC Nursing Services, 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 visited the head office of the organisation HRM in Kilmarnock, of which HSC Nursing Services is part, on 19 August 2013 between 10:50 and 12:30 hours. We visited the office of the agency in Coatbridge on 27 August between 10:30 and 16:15 hrs. We discussed the service with the service manager and co-ordinator at the service office. We also spoke with the managing director. We looked at a variety of documentation including: - Service Brochure - Staff Handbooks - Sample client contracts - Policies and procedures including Adult Support and Protection, Complaints, Recruitment - Personnel files - Staff training records - Client communication files - Client satisfaction questionnaires - Client and staff contact records - Accident and incident records - Complaints file 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 HSC Nursing Services, 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 HSC Nursing Services, 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 which reflected the findings of this inspection. The manager had identified areas for improvement which she has detailed within a service development plan. Taking the views of people using the care service into account The feedback systems currently used are commented on in the main body of the report. Taking carers' views into account Due to the nature of the service and the range of services the agency covers, we were unable to obtain the views of the services during the inspection. HSC Nursing Services, page 8 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 0: Quality of Information Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the information provided by the service. Service strengths The grade awarded for this quality statement from this inspection is 4 - Good. There was a comprehensive service user guide which detailed the level of the services that could be provided which outlined the services aims and objectives, policies and procedures, and the contractual arrangements. This allowed the service a clear understanding of the service and what to do if they were not satisfied. Following the completion of each shift covered by the agency, questionnaires were issued to services to gather their views on each staff members performance. This information is recorded in each staff member's file. This information is then used to form the basis for discussion at supervision. Unsatisfactory feedback would be dealt with immediately in accordance with service policy. This information was monitored regularly by the co-ordinator and any areas of concern were discussed with the manager of the service to ensure appropriate action was taken. The management of the agency made regular contact with services via telephone and, where possible, face to face visits. Staff profiles were forwarded to services before commencement of their shift. This provided another source of effective feedback on the standard of staff support being provided. The frequency of contact depended on the demand for staff. We observed a telephone request for staff by a client. The co-ordinator sought the experience required by the client before deciding on the appropriate member of staff to send to work. This was achieved within the stated ten minute response time as detailed within the contract. HSC Nursing Services, page 9 of 21

Further opportunity was given to staff to provide comments at induction, training sessions, any other time by telephone or on-line by using the extranet. Annual appraisals were planned in advance and staff updates ensured that all staff are aware of new policies, procedures and any changes being implemented. Supervision had recently been implemented and the manager was monitoring the effectiveness of the current system. Areas for improvement The service should review the participation strategy as the size of the service develops, to allow development and expansion of their methods. The management identified plans to promote engagement in obtaining feedback through the use of a system like the survey monkey and increasing courtesy calls to the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We provide full information on the services offered to current and prospective service users. The information will help service users to decide whether our service can meet their individual needs. Service strengths The grade awarded for this quality statement is 4 - Good. Face to face visits are made to services following initial enquiry. Information is provided here in the form of the service user guide detailing the level of the services that could be provided with the services aims and objectives, policies and procedures, and the contractual arrangements. This allowed the service a clear understanding of the service and what to do if they were not satisfied. During the visit, the service manager undertook a full assessment of the service required and to determine if HSC could meet the client need. There was evidence that written agreements were in place and reviews of the service delivery were ongoing. There was an information brochure which provided information on the service offered. It Included a copy of the statement of purpose,complaints policy and procedure and service user guide. Additional information is provided which included details on rates charged and policies and procedures. HSC Nursing Services, page 10 of 21

Areas for improvement During the visit after initial contact, the manager should conduct and appropriately record a risk assessment of the client service and requirements. This ensures safety of HSC staff, identifies training needs and promotes a safe working environment. (see requirement 1 of this quality statement). Not all services were consistent in providing feedback on agency staff. As described in Statement 1.1 the agency is looking at alternative ways for this information to be obtained. We will monitor the progress of this at the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider must ensure appropriate recording of risk assessments with dates of review. This is in order to comply with SSI 2011/210 (10)(2)(a) which states premises are not fit to be used unless they are suitable for the purpose of achieving the aims and objectives of the care service as set out in the aims and objectives of the care service. Timescale: within 3 months on receipt of this report. Inspection report continued HSC Nursing Services, page 11 of 21

Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - 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 grade awarded for this statement was 4 - Good. When a new service requested to use the nurse agency the manager had a meeting with the organisation to establish if the agency was able to meet the service's needs. All new clients received a copy of a service user guide. This provided details of costs, insurance details, staff time-sheets, complaints process and cancellation arrangements. This information provided information on the staff competencies required to safely meet the healthcare needs of the people using the service. There was evidence there was consultation with clients where feedback was sought and clients were satisfied with the service level being provided by the service. The service kept a communication log for each client. This showed us that the service manager had regular contact with clients, and that their satisfaction with the quality of the service was measured regularly. Clients were asked to complete worker evaluation forms following each shift covered. We saw procedures on how the service would respond to any issues raised. Fortunately this had not been a significant issue. Client comments were also sought for staff appraisal purposes. Areas for improvement The service had identified a recent improvement in their audit systems. The service should consider how to evaluate the feedback received to use in further improving and developing the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 HSC Nursing Services, page 12 of 21

Statement 3 We ensure our service provides care staff who are most suitable to meet individual service user needs. The care and treatment received by the individual service user, is supported by evidence based practice and up to date policies and procedures. These reflect current legislation (where appropriate Scottish legislation). Service strengths The grade awarded for this quality statement is 4 - Good. There was a range of policies and procedures which were being reviewed and updated to ensure they reflected best practice guidance. These were accessed on-line or in a summarised form in staff handbooks. Further information relevant to health and social care was available through the internet and links to best practice were provided. This provided further up to date information on current best practice for nursing and healthcare staff. Staff had been provided with pocket booklets relating to preventing infection. Nursing journals were also freely available within the agency office environment Each staff member employed by the agency provided details of their previous training and experience. This information was used to establish the experience and training of each staff member. This identified the suitability of each person for a service. Staff received a four day induction programme on joining the agency which were relevant to care practice. This ensured appropriate updates to previous training such as moving and handling and Adult Support and Protection. We saw evidence of robust recruitment practices that ensured that only staff with the necessary skills and experience were recruited, for example for care homes for older people and for palliative care services. There was a staff training plan, and staff had a personal development plan. Two monthly registration checks were made with Nursing Midwifery Council or Scottish Social Services Council to ensure appropriate registration of staff. Areas for improvement Inspection report continued The service should ensure that the Adult Support and Protection policy considers the guidelines for the local authority in which the service is being provided. (see recommendation 1 of this quality statement) The service should promote knowledge and understanding of health and social care documentation. This includes Handling of Medication in Social Care, use of assessment tools and Guidance about medication, personal plans, review, monitoring and record keeping in residential care services. This could be during discussion at team meetings to allow sharing of information and reflection on practice. HSC Nursing Services, page 13 of 21

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued 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 The evidence we sampled during this inspection attained the grade of 4 - Good. The information contained within statement 1.1 is relevant to this quality statement. Areas for improvement The service should continue to review methods of involving service users and carers in assessing the quality of staff. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths The evidence we sampled during this inspection attained the grade of 4 - Good. The service had a comprehensive recruitment policy and procedure which reflected the guidance on safer recruitment. The policy required applicants to complete an application form which included previous experience, skills, qualifications and references. Candidates had to account for gaps in employment history. We sampled four personnel files of recently recruited staff. We saw evidence that the service had recruited staff safely. Two references and appropriate checks with HSC Nursing Services, page 14 of 21

professional bodies had been undertaken to ensure that staff were appropriately qualified and approved to work with vulnerable adults. All prospective staff had been interviewed as per the providers recruitment policy with competency and scenario based questions which was in keeping with best practice guidance. All new staff underwent a four day organisational induction before working with clients. This induction included essential training including to ensure they could undertake their duties safely. All staff were issued with a staff handbook which detailed the services policies and procedures. All staff were also made aware of the relevant professional codes of practice. Areas for improvement The service should continue to develop their good practice at this time. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The evidence we sampled during this inspection attained the grade of 4 - Good. Staff were asked to provide feedback on their recent work place. This provided support for staff and enabled identification of supervision or training needs. Clients were being asked to complete a staff performance review questionnaire, which the service used to identify areas for improvement and training needs. Staff were being appraised and supervision was informal at present. Inspection report continued The Registered Manager for the service was a nurse, as was the co-ordinator. This ensured the quality of care for the service could be monitored. There was a whistle blowing policy and adult and child protection policies. The service undertakes the appropriate checks with regulatory bodies. Discussion HSC Nursing Services, page 15 of 21

with staff are facilitated during induction relating to Codes of Conduct for Nursing and Midwifery Council and Scottish Social Services Council. Additional training was sought and provided by health professional in th local authority area and relevant bodies. An example shows the liaison with the Resuscitation Council to ensure support to develop nursing skills in accordance with current best practice guidelines. Areas for improvement Whilst the majority of the staff team were recently recruited, the service should ensure supervision is facilitated for staff in accordance with organisational policy. This would allow monitoring of knowledge, practice and development needs. The service should formalise their procedure to evidence discussion with services when feedback being obtained. The service should continue to update its policies and procedures to ensure the reference to legislation and best practice is in line with Scottish law and best practice guidelines. The manager has identified that further staff training opportunities will be developed in accordance with business development. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued HSC Nursing Services, page 16 of 21

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - 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 evidence we sampled during this inspection attained the grade of 4 - Good. The information detailed within statement 1.1 is relevant to this statement. Areas for improvement The service had planned to introduce a system to obtain feedback for interactions with the office staff. Office staff were the manager and co-ordinator. We will review this at the next inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 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 evidence we sampled during this inspection attained the grade of 4 - Good. The service had introduced a logging and monitoring tool to assist in the monitoring of staff and performance feedback. This was new. The current ongoing review of policies and procedures assisted the service to ensure appropriate support and guidance was provided to staff. Policies were more reflective of current legislation and best practice guidance. An example of recent policy review related to the allocation of assignments which details how quality assurance will be measured through the implementation of the actions detailed in the policy. HSC Nursing Services, page 17 of 21

To improve the service, there was a service development plan for the next year. This included various areas within the business to be developed but included Human Resources, training and quality. A fully completed self assessment was submitted in which the service identified areas for development which were consistent with the findings of this inspection. Evidence of consultation with clients demonstrated some attempts to obtain feedback to allow evaluation of the effectiveness of the service. The service followed the guidance as detailed in the document "records that services must keep" and appropriately notified relevant authorities of events or incidents. We considered the information in statement 1.1 as part of this statement. Areas for improvement The service should continue to develop and further improve their systems to monitor and improve quality in the service. This included the ongoing review of policies and procedures in a systematic way. The agency should formalise procedures in liaising with staff and service users to obtain their views and evaluate how these suggestions make improvements on the service provided. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued HSC Nursing Services, 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). HSC Nursing Services, page 19 of 21

5 Summary of grades Quality of Information - 4 - Good Statement 1 Statement 2 4 - Good 4 - Good Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 2 Statement 3 4 - Good 4 - Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. HSC Nursing Services, 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 HSC Nursing Services, page 21 of 21