Care service inspection report

Care service inspection report Full inspection Crossroads Caring Scotland - Stirling/ West Stirling Support Service 14 Buchanan Street Balfron Glasgow Inspection completed on 29 February 2016

Service provided by: Crossroads Caring Scotland Service provider number: SP2007008963 Care service number: CS2014332240 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 25

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 Quality of staffing 3 Quality of management and leadership 3 Good Adequate Adequate What the service does well The service was viewed positively by many people it supported. Staff were seen as having a friendly and caring manner. The manager and other senior staff were known to service users and their carers/family members. What the service could do better The service had some areas to improve in. A couple of main ones were making sure people had regular reviews for their care and support and that staff members had supervision meetings. Steps like these will help make sure the service is providing support to the standard people want. What the service has done since the last inspection This service was previously part of a larger service registration, Crossroads Caring - Central East. It registered as a new service on 4 March 2015. Conclusion The service had seen a lot of change in the last 12 months and we thought in some ways it was still establishing itself following the various changes that had occurred. Overall, we saw the service as having made progress. page 3 of 25

Crossroads Caring - Stirling/West Stirling provided good support to people. All staff members we spoke to had an interest in making sure people got a good level of support. page 4 of 25

1 About the service we inspected Crossroads Caring Scotland - Stirling/West Stirling was registered by the Care Inspectorate in 2015. The service provides a care at home service to people living in their own homes in the Stirlingshire area. Crossroads Caring Scotland, the provider of the service, is a national voluntary organisation, Scottish Charity and a company limited by guarantee. Its head office is in Glasgow. All local services have the same mission and objectives 'to relieve stress on persons or families caring for the elderly or people with physical, mental or sensory impairment who are living at home' and 'to care in appropriate circumstances for the elderly or people with physical, mental or sensory impairment who are living alone'. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. page 5 of 25

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 3 - Adequate Quality of management and leadership - Grade 3 - Adequate This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. page 6 of 25

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. The inspection visit was carried out on Thursday 18, Monday 22, Tuesday 23 and Monday 29 February 2016. We gave feedback to the manager and area manager on 29 February 2016. As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. We sent Care Standards Questionnaires (CSQs) to the manager to distribute to service users and relatives. We received 15 of these back. CSQs for staff members were also given to staff and we received 15 of these back, too. We took account of the feedback when considering the service's care and support provision. In the inspection we gathered information and evidence from a range of sources, including the following: We spoke with: - two service users - four carers/family members - three support workers - a senior support worker - the service manager and the service co-ordinator - the area manager. We looked at: page 7 of 25

- registration certificate - service user care and support plans - service user files - service guide/leaflet - recruitment information - staff induction information - training records - policies and procedures - quality audits and monitoring - health and safety information - accident and incident recording - surveys and feedback information - service development planning information. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may page 8 of 25

consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firescotland.gov.uk page 9 of 25

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the service provider. We were satisfied with the way this was completed. The service provider identified what it thought it did well, areas for development and changes it had planned. Taking the views of people using the care service into account During our visit, we spoke to some people who used the service. We also received some CSQs back that were sent out to people by us. Generally, people reported positively on the support they received from the service and were complementary about the staff members that supported them. Some comments were: - "The service I get...is fantastic". - "The Crossroads ladies are very professional, capable and supportive". Taking carers' views into account Carers/family members we heard from were again, in the main, happy with the service provided. Some comments were: - "...the service has been very good". - "The same carer comes on a regular basis and provides excellent support...". page 10 of 25

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 At this inspection, we found the service to be good at ensuring people participated in assessing and improving the care and support. We looked at records of service users' review meetings. These meetings were held to check that the care and support provided by the service was meeting an individual's needs and wishes and to confirm they were happy with the support. We saw that service users could put forward their views at the review meeting and would be listened to. Carers/family members often attended these meetings as well. Some we spoke with said that they were listened to and if they needed some change to be made that usually it would happen. Review meetings were happening on a regular basis and we thought they gave people a good chance to go over the main aspects of their care and support. At reviews the service had a form, called a 'consultation form', that was given to service users or their carer/family member. It asked people what they thought about the quality of the service and the care staff. It was good to see the service also used a form like this to get people's comments and suggestions at reviews. Crossroads Caring had a participation policy. It stated the importance of getting service users' and carers/family members' involvement and views for page 11 of 25

improving the service. Having a policy such as this is positive as it makes it more likely that the service will actively seek people's views. We saw that the service had undertaken a consultation survey with carers and service users in the autumn of 2015. A lot of questions were asked. The manager said the responses and feedback will be used to decide what improvements and actions are required locally in the service. We saw that staff members when newly starting with the service went through induction training. As part of the training they'd learn about person centred approaches to supporting people. This approach emphasises knowing supported people's wishes and listening and acting on the views. When we spoke to and got feedback from service users and carers/family members, many said that staff members were caring and would listen to them and provide support in ways that suited them. If they wanted a change, for example, the support worker to arrive a bit later or earlier then usually this would be arranged by the support worker through contacting the office. Service users said they felt they could get changes made through talking to their usual support worker. The service users and carers/family members told us they knew who the manager and senior support workers were. Most of them had met the manager or spoke to her on the phone. They said they'd contact the office and manager if they had any major concerns about the support provided. They felt confident that changes would be made according to their wishes. Some gave examples of times they'd ask for a matter to be discussed or changes to be made. They were satisfied that they were listened to. Areas for improvement People receiving a service must have their support plans reviewed at least six monthly: regular review meetings for the support ensure the support is meeting a person's needs. At this service, we found review meetings had not always taken place at least six monthly. We have made a requirement for this (see Requirement 1). There were some reports of difficulties contacting the office to talk to the manager or other senior staff members based there. The service should monitor page 12 of 25

this as people using the service should find it easy to contact the office and to speak to staff members based there. Grade 4 - Good Requirements Number of requirements - 1 1. The service user care and support plans must be reviewed at least once every six months. As part of reviewing a person's care and support plan the service should hold a meeting with the service user, or their representative. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) SSI 2011/210 - regulations 5(2)(b)(iii) Personal plans. This requires a provider of a care service to review service user's care plans at least once in every six month period whilst the service user is in receipt of the service. Timescale: within 2 months of receiving this report. Number of recommendations - 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths At this inspection, we found the service to be good at ensuring service users' health and wellbeing needs were met. When beginning to get support from the service a person would meet the service manager, coordinator or senior support worker to discuss their needs. A lot of helpful information about the person's support needs was gathered at page 13 of 25

this initial meeting. A person's carer/family member often attended this initial meeting as well. We found that the service asked about important areas of health and social care needs and were good at making sure that they had enough information to support someone well. We saw that if someone had, for example, epilepsy or dementia then the service carefully considered what this meant for the support they provided. It recognised that each person it supported was different and specific knowledge or guidance would be required for certain conditions people might have. One person's care and support plan we looked at, for instance, detailed their special requirements for eating. It meant that staff members who supported them needed extra training to give appropriate and safe care. We saw that staff members that required this training received it. This helped the person keep comfortable and well. The service was good at listening to carers/family members. It recognised the importance of working in partnership with carers/family members and listening to their views and opinions. A carer/family member could give very specific information about how to support a person and knew a lot about their likes and wishes. The service working closely with carers/family members meant people experienced better, more person centred support. The care and support plans had enough detail in them for support workers to know what support to give. Usually, too, when they were supporting a new person the staff member would be introduced by accompanying a staff member who already knew the person. This again would help a person to get support they were happy with. We saw that staff members were given good practice guidance through their induction and on going training. We saw that the service would have contact with health or social care professionals to discuss a service user's needs. We saw examples of where the service had done this when they had a concern about an individual. This showed that the service aimed to work collaboratively with others to help best meet a person's care and support needs. page 14 of 25

Areas for improvement Whilst we saw good examples of support plans, we discussed with the manager how at times the information could be improved. Sometimes we found the guidance in a service user's support plan lacked detail, it wasn't person centred enough. One example was using a word like regularly for, say, how often someone would like to do something. It would be better to be more exact in an example like this. Another discussion we had with the manager was around making sure the information, made clear, how to support individuals in a way that would assist them to maintain or improve their ability. This would help make sure that the support provided had an enabling focus and would assist individuals remaining as independent as much as possible. Occasionally, the service had no support worker available to visit a service user for their planned support. The service recognised the difficulties it had experienced in organising staff rotas and ensuring all visits were covered. The service was introducing improvement to how it organised staff rotas. When we read through some service user files, we sometimes found that they were disorganised. Some of the information could be placed in the wrong section for example. We thought this, generally, made it difficult to find the correct information and could lead to be more serious problems in providing care and support. We advised the manager that the records in files should be better organised. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 15 of 25

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths At this inspection, we found the service to be good at ensuring service users and carers/family members participated in assessing and improving staffing. Comments made in Quality Theme 1 - Statement 1, are of relevance here, also. The survey questionnaire the service sent to service users and carers/family members had a section that asked about staffing matters. This provided an opportunity to confirm everything was okay or to make suggestions for improvements or changes. The review meeting talked about how well the care and support was helping the person. Again staffing matters could be discussed at this meeting. Areas for improvement We found there was not much involvement of service users or carers/family members in staffing matters. We discussed this with the manager and we talked about the different ways people could participate. Some of the areas we discussed were consultation groups, input into staff appraisal and involvement in recruitment. We thought the service should explore ways to get more participation of service users and carers/family members in assessing and improving the staffing (see Recommendation 1). page 16 of 25

Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The service should have a more planned approach to service user and carer/ family member participation in assessing and improving the staffing. National Care Standards care at home. Standard 11: expressing your views. Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths At this inspection, we found the service to be adequate at ensuring the workforce was professional, trained and motivated. The service had an established induction for new staff members to undertake. It provided clear information and guidance for them. It covered the standards and responsibilities expected of staff members in social care. We looked through the information in the guidance pack that was issued to all new staff. It included a lot useful information for someone working as a support worker. Staff members told us they felt well supported when they first started. Some told us how they shadowed more experienced staff members to learn about how people liked to be supported. Staff members were given the Scottish Social Services Council (SSSC) code of conduct for employees in social care. This code made clear the importance of values such as respecting individuals and their views. page 17 of 25

We found the service followed safe and appropriate recruitment practices. They interviewed candidates for jobs. They carried out background checks as required and made sure they got references for new employees. This helped make sure that staff members were suitable for working in a caring profession. People reported staff members had a kind and caring attitude. We saw that the service had set training it aimed for staff members to do. Also when, to meet a person needs, more specific or specialist training was required, we saw the service identified this and made sure staff would undertake it. This meant people's support was provided by people who had the knowledge and confidence to do it well. Most staff members who we got feedback from or spoke to were positive about the support they provided and expressed a real interest in supporting people well. Overall, too, they felt supported by their seniors. Service users and carers were complimentary about staff members. They told us that they thought their staff members were very able and friendly. It seemed like they trusted the staff members that supported them to be professional and caring. Areas for improvement When we checked how often staff members were getting supervision we found that there were some gaps in the records. Staff members weren't attending supervision as often as they should be. This meant they could miss out, for instance, in being able to discuss the support they provided fully, discussing how to improve the support and their training needs. We have made a recommendation that the service should make sure all staff members have regular supervision (see Recommendation 1). We discussed with the service manager team meetings and other meetings for groups of staff. We found that there were not many team meetings at the service. We talked about the purpose of team meetings and options the service could explore regarding getting staff members to discuss service users' support needs. We have made a recommendation (see Recommendation 2). page 18 of 25

We examined the service staff training records and plans. We found that it was not easy to identify if all staff members were up to date with training. The manager talked through the records with us and we discussed together how these could be made clearer and simpler to follow. Grade 3 - Adequate Number of requirements - 0 Recommendations Number of recommendations - 2 1. All staff should have regular supervision. Scottish Social Service Council's code of practice for employers 2.2. National Care Standards care at home. Standard 4: management and staffing. 2. All staff should have the opportunity to attend team meetings or other group meetings to support them and to help improve service provision. Scottish Social Service Council's code of practice for employers 1.4. National Care Standards care at home. Standard 4: management and staffing. page 19 of 25

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 At this inspection, we found the service to be good at ensuring service users and carers/family members participated in assessing and improving the management and leadership. Comments made in Quality Theme 1 - Statement 1, are of relevance here, too. The senior staff and the manager were seen as approachable by service users and carers/family members. People told us they felt they could phone the service's office and discuss matters about their care and support. This was important as most people would, in the first instance, look to sort out matters through a phone call to the manager. The returned survey questionnaires sent out by the service to service users and carers/family members would be examined by the manager. It would inform her planning about what service improvements were required. People we spoke said they were aware that if they had a major concern they could formally make a complaint. When they first started with the service they were given information on how to do this. page 20 of 25

Areas for improvement Whilst the service had some methods for involving service users and carers/ family members in assessing and improvement management and leadership these could be developed more. Currently there were only a few opportunities for people to directly influence management and service wide decisions. Grade 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 At this inspection, we found the service had adequate quality assurance systems and processes. The review meetings that the service held with service users and carers/family members was the main way that it checked that people were satisfied with the care and support provided. We saw that the service would change support arrangements if required following these meetings. People told us they felt they were encouraged to put across their views at the review meetings. This meant service users and carers/family members had a say and could help make sure the service met their needs. Staff members completed a brief report on the how a service user was getting on and any issues to do with the care provided. They could alert the management team to any concerns or any changes required. The manager said it helped her keep track of how well the service provided was meeting people's needs. Generally, service users, family members and staff members said the management was approachable. They felt comfortable contacting the office and page 21 of 25

talking to the manager. It's important that the manager is seen as contactable and approachable as this leads to any concerns being brought to her attention sooner. The service had a survey questionnaire that service users and carers/family members completed. There was also a separate one for staff members to complete. That the service consulted people like this is important. It allows the service to hear people's opinions and to get ideas for change or improvements. It helps the service judge how well it is providing support. The service had its own internal audit tool called Crossroads quality assurance scheme (CROQAS). This gathered a lot of information on the service's performance, including health and safety matters, how well service users' records were completed and staff training. It covered a wide range of the service's activities and we could see that it helped the service decide if it was meeting its own standards and targets. We discussed with the manager planning for the future and we saw that the service had begun to make a number of plans to ensure it continued to meet people's needs and grow and develop positively. Areas for improvement We discussed with the manager that the Care Inspectorate must be notified of certain events that occur in a social care service. There is guidance on this for services and we talked with the manager the types of events that it would be necessary to inform us about. We have made a requirement for this (see Requirement 1). As part of quality assurance it is important a service has regular meetings with staff members such as supervision, team meetings or team forums. We found that meetings such as these were not taking place regularly. We reported on this under Quality Theme 3. It can be important for a service to get feedback from external stakeholders (for example, local health or social care professionals) to allow it to gain information on its performance and possible areas for improvements. The service had page 22 of 25

not done this in the last year and we encouraged the manager to consider how the service could do this. Whilst the CROQAS was a good way to monitor activity and check if standards were being achieved, the service was still to state detailed actions it would take in response to its CROQAS report. Grade 3 - Adequate Requirements Number of requirements - 1 1. The provider must ensure that the Care Inspectorate is informed of all events which require notification in line with legal requirements. This is in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/28) regulation 4(1)(b) - a requirement concerning records, notifications and returns. Timescale: immediately on receipt of this report. Number of recommendations - 0 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. page 23 of 25

5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information There is no additional information. 9 Inspection and grading history This service does not have any prior inspection history or grades. page 24 of 25

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 25 of 25