Step Up (Housing, Employability & Community Support Services) Housing Support Service Falkirk Business Hub 45 Vicar Street Falkirk FK1 1LL Type of inspection: Unannounced Inspection completed on: 29 July 2014
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Step Up (Housing, Employability & Community Support Services) Ltd Service provider number: SP2013012130 Care service number: CS2013319314 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0845 600 9527 or email us at enquiries@careinspectorate.com Step Up (Housing, Employability & Community Support 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 Care and Support 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service provides individual programs of care and support designed to meet the assessed needs of service users. Service users receive support in ways which enable them to develop skills and work towards independence. Staff are able to provide a mix of advice, guidance and practical assistance. What the service could do better The service should continue to review and develop its record keeping systems. Methods of gathering, storing and sharing information should be monitored to ensure that staff are not engaged in repetitive administrative tasks. What the service has done since the last inspection This was the first inspection of the service. Conclusion Step Up provides good, tailored packages of support to service users who require assistance to maintain their own tenancies. The care for individual young people is designed around their needs and is adapted and developed as those needs change. Step Up (Housing, Employability & Community Support Services), page 3 of 21
Step Up is a new service which has quickly established a range of good practices. Step Up (Housing, Employability & Community Support Services), page 4 of 21
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information in relation to all care services is available on our website at www.careinspectorate.com. 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 condition, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Step Up (Housing, Employability & Community Support Services) was registered by the Care Inspectorate on 23 September 2013 as a combined Housing Support and Care at Home service. Step Up's stated aims are as follows: "Step Up aim to enhance young people's quality of life by providing support that will improve and enhance their life chances, their living environment, and their wellbeing. Our aim is to provide advice, care and support for young people who are at risk of social, economic and educational disadvantage. We aim to reduce their barriers to employment and reduce their experience of social exclusion and poverty by supporting them to living independently with dignity, respect and empowerment for themselves and within the community." This was the service's first inspection. At the time of the inspection the service was not providing Care at Home to any of its service users but were in discussion regarding a range of referrals. The provider was also engaged in expanding the types of support it provided to young people in the local community. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good Step Up (Housing, Employability & Community Support Services), page 5 of 21
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. Step Up (Housing, Employability & Community Support Services), page 6 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 completed this report following an unannounced inspection. The inspection was carried out by an inspector from the Care Inspectorate. The service was visited on 24 and 29 Julu 2014. Feedback was provided to the directors at the end of the visit. In this inspection, we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents, including: - Step Up's self assessment and annual return - young people's personal support plans and risk assessments - records of daily events - accident and incident records - minutes of meetings - two service users were spoken with - three members of staff were formally consulted. 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. Step Up (Housing, Employability & Community Support Services), page 7 of 21
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 Step Up (Housing, Employability & Community Support Services), page 8 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. The self assessment was fully completed and described the service's strengths while identifying areas for development and improvement. Taking the views of people using the care service into account At the time of the inspection, the service had four service users. We spoke with two of them, individually, in the provider's office. The service users both said they were very happy with the service provided by Step Up and felt it fully met their needs. They said that they had developed positive relationships with some of the staff and felt able to discuss a range of issues and needs with them. They also said that they were able to contact staff and managers when they needed to and were confident that they would receive help and support when it was required. Both of the service users we spoke with were aware of the content of their support plan and said that they could suggest changes to it if it didn't meet their needs or preferences. They both said that they knew how to make a complaint if they were unhappy about any aspect of the service but hadn't felt the need to do so. They also said that they would recommend the service to others in similar circumstances to themselves. Taking carers' views into account We did not contact the families of service users for this inspection. Step Up (Housing, Employability & Community Support Services), 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: 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 We saw that the service sought to involve service users in assessing and improving the quality of care it provided. A variety of methods were in place to encourage service users to provide feedback about the support which had been provided and whether it has fully met their needs. When young people started to use the service, they were given a welcome pack which provided them with information about the ways in which the service worked and how they could be involved in commenting on how well it met their needs. The welcome pack contained information on how to make comments and complaints and how these would be dealt with. It also provided contact details for the Care Inspectorate and informed service users of different ways of seeking advice, information and different sources of support. In discussion with service users and staff, we learned that support workers took time to check with new service users that they understood the content of the welcome pack. We were told service users were clear about the ways in which they could comment on the service they received and access senior staff or support from outwith the organisation if they wished. Service users were encouraged to express their views about the types of support they required and the ways in which staff could best provide practical help and advice. Service users told us that they had got to know the support workers and felt able to discuss issues arising from their day to day life and ask about different ways in which they could access resources and support. Support plans were seen to include ideas and suggestions from service users and contained some evidence of their involvement in evaluating progress made to meet aims and goals. Step Up (Housing, Employability & Community Support Services), page 10 of 21
Service users were allocated a mentor from the staff team who would be the main person involved in developing and evaluating their individual support plan. This encouraged the development of positive working relationships and sought to provide young people with someone who could be used, where appropriately, as a confidante. As part of the service's ethos and intention to involve service users in all aspects of its operation, young people had been invited to participate in staff recruitment processes. This had been taken up by one of the service users. Areas for improvement The service should consider using different media such as email to provide opportunities for service users to be involved in sharing their views about the content of their support plan. The possible use of twitter as a means of informing service users about the service and any news concerning it was being explored at the time of the inspection. The use of one to one sessions or mentoring sessions should be further developed to help service users make best use of the support and advice provided by allocated mentors. These sessions could be used to identify specific tasks and areas of development for young people and subsequently evaluate progress made. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Step Up (Housing, Employability & Community Support Services), page 11 of 21
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We saw that each service user had a support plan in place which set out their support needs and described how these would be met. Included in support planning were encouragement and guidance to develop links with local relevant health agencies and practitioners. Staff helped young people to register with GPs, dentists and opticians to ensure that they were able to access medical and health assessments and treatment when required. Service users were provided with information and advice on accessing a range of health and wellbeing information and advice. This included access information for agencies who could help with mental health issues, alcohol and substance misuse and sexual health. Notes sampled during the inspection showed that staff had helped young people to attend different appointments and had provided emotional support where this was needed. Part of the assessment process for service users was aimed at evaluating their skills in safely managing their living environment. This looked at how well service users were able to assess risks such as fire safety, security of their home and food hygiene. These assessments were intended to inform the support plan and help to identify areas of potential learning for service users. We saw from notes of day to work with service users which showed that advice and guidance was provided about healthy lifestyle choices. This included information and practical help to make healthy choices about different foods and involved practical help with shopping, menu planning and food preparation. We also heard from young people and staff that advice, encouragement and practical help was given to enable young people to access different sports, hobbies and opportunities for physical exercise. Young people confirmed that they were encouraged to be active and to make use of local facilities. Step Up provided passes to leisure facilities in the local area which service users could access. Areas for improvement We discussed different aspects of the support planning systems with staff and managers. A review of planning and record keeping was being carried out at the time of the inspection. We discussed the need to settle on whether day to day records and planned support would be best recorded in paper files or electronically. Some of the assessments which were carried out on the abilities of individual service users were not clearly linked to support plans and some indications of areas for development in these assessments were not seen to be followed up. (See recommendation 1) Step Up (Housing, Employability & Community Support Services), page 12 of 21
Support plans needed to focus on clear issues and describe what action was required to generate a positive outcome for the service user. Where issues or matters of concern were identified, these needed to be clearly described with timescales for progress to be assessed and discussed. (See recommendation 2) Plans needed to contain evidence that they were being reviewed at appropriate intervals. (See recommendation 3) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. Where areas of concern are identified by individual assessments, these should be included in planned support and followed up as part of the service user's personal support plan. National Care Standards, Housing support services - Standard 4: Housing support planning 2. Support plans should contain clear aims which are described in ways which are understood by service users and have descriptions of how they can be achieved. National Care Standards, Housing support services - Standard 4: Housing support planning 3. Support plans and agreed aims should be reviewed and updated as necessary at least every six months. National Care Standards, Housing support services - Standard 4: Housing support planning Step Up (Housing, Employability & Community Support Services), page 13 of 21
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 strengths noted in Quality Statement 1.1, also apply to this Quality Statement. Service users we spoke to said they were able to discuss any issues connected to staff or staffing with managers at Step Up. Areas for improvement The service should continue to encourage young people to participate in staff recruitment processes. Where they don't wish to be involved directly they may like to contribute interview questions or discuss the qualities and abilities they feel are important for potential staff members to have. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Step Up (Housing, Employability & Community Support Services), page 14 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 staff team contained individuals with a range of qualifications and experience within the care industry. All staff had been recruited through a comprehensive process which involved taking up appropriate references and ensuring that they were not excluded from working with vulnerable people. Relevant qualification certificates had been seen with copies made and kept by the provider. The provider had operated its recruitment systems in line with best practice guidance and staff files provided evidence of this. A staff induction system was in place and those we spoke to confirmed that it was properly used. New staff underwent a period where they read policies and procedures as well as any relevant training documents. They then worked shadow shifts to familiarise them with the provider's expected level of practice and to introduce them to service users. Staff we spoke with told us they were encouraged to attend relevant training and the provider maintained training records which indicated when any refresher courses were due. We saw information about training opportunities from national organisations in the staff office. Staff team meetings were held and the minutes of these were available for all staff to read. Areas for improvement The quality of record keeping was variable, with some being difficult to follow and fully understand. Some descriptions of work undertaken by staff tended to be jargonbased rather than giving clear descriptions of what had actually happened. Other entries in 'contact notes' tended to describe what the support worker had done rather than the service user. Some notes were formulaic and didn't describe the purpose of the visit to the service user or any outcome from it. Staff should be aware that young people may wish to read their records and they should be written so that they can be easily understood by them. (See recommendation 1) Minutes of staff meetings were emailed to all staff who were then expected to sign to say they had read them. This seems repetitive, as the provider already had evidence they had been sent to each member of staff who were accountable for reading them. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Step Up (Housing, Employability & Community Support Services), page 15 of 21
Recommendations 1. Staff should maintain records which are clear, easy to understand and which have a purpose. The content of these records should be informative and linked to planned care. National Care Standards, Housing support services - Standard 3 Management and staffing arrangements. Staff should also take into account the Scottish Social Services Council code of practice, code 6: As a social service worker, you must be accountable for the quality of your work and take responsibility for maintaining and improving your knowledge and skills. This includes; 6.2 Maintaining clear and accurate records as required by procedures established for your work. Step Up (Housing, Employability & Community Support 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 strengths noted in Quality Statement 1.1 also apply to this Quality Statement. We saw that the manager was available to service users who were aware of who he was and what his role was. The young people we spoke to said they could speak to him about any issues they might have. Areas for improvement The service should continue to look at ways of involving service users in developing all aspects of the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Step Up (Housing, Employability & Community Support Services), 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 provider had a range of methods of assessing the quality of the service being provided. The directors of the service were experienced managers who understood the principles of the National Care Standards and how they should be applied within the provision of support to young people working towards independence. This meant that they were developing a range of working systems and practices which enabled staff to properly meet the needs of the service users. The care of service users was reviewed and these meetings included representatives of the commissioning authority, as well as others who were involved in the overall care of the young people. This provided opportunities for independent assessment of the quality of care being provided by Step Up. The provider used questionnaires and surveys to gather feedback from service users, family members where appropriate and other stakeholders. Responses were used to inform practice and to assist in developing action plans to improve the service. Staff received formal supervision in line with the provider's policy. This allowed senior staff to monitor the performance of members of the staff team and link them to training events which would enhance their skills. Areas for improvement The service should continue to gather feedback from all service users and stakeholders to be used to plan and inform the ways in which the needs of individual service users can best be met. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Step Up (Housing, Employability & Community Support Services), page 18 of 21
4 Other information Complaints No complaints have been upheld, or partially upheld, since registration. Enforcements We have taken no enforcement action against this care service since registration. 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). Step Up (Housing, Employability & Community Support Services), page 19 of 21
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 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. Step Up (Housing, Employability & Community Support 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 Step Up (Housing, Employability & Community Support Services), page 21 of 21