Kelty Day Care Service Support Service Without Care at Home 11 Oakfield Street Kelty KY4 0BX Telephone:

Kelty Day Care Service Support Service Without Care at Home 11 Oakfield Street Kelty KY4 0BX Telephone: 01383 720613 Inspected by: Susan White Type of inspection: Announced (Short Notice) Inspection completed on: 7 March 2013

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: Capability Scotland Service provider number: SP2003000203 Care service number: CS2008172531 Contact details for the inspector who inspected this service: Susan White Telephone 01383 841100 Email enquiries@careinspectorate.com Kelty Day Care Service, page 2 of 22

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 6 Excellent Quality of Environment 6 Excellent Quality of Staffing 5 Very Good Quality of Management and Leadership 6 Excellent What the service does well Kelty Day Care Service supports a small group of people with a lot of family involvement in the service. Communication strategies help people make choices and decisions about the care and support they are involved in. A high level of health support is in place and is not allowed to take over from enjoyment in activities. What the service could do better Plans are in place to help staff increase their knowledge and skills in using technology to enable service users to interact more with their own lives. What the service has done since the last inspection There have been changes in the group of service users supported in Kelty and staff have responded to the different support needs of the group. Training for staff and transitional support has helped new service users to settle in well. Conclusion The day care service provides a specialist service for a small group of people with complex support needs. The staff team has developed skills and knowledge to help maintain good health care and balance this with good access to activities. Strategies for communication are excellent and we talked with the manager about developing written records to support non-verbal communication methods used by service users. Kelty Day Care Service, page 3 of 22

Who did this inspection Susan White Kelty Day Care Service, page 4 of 22

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. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Kelty Day Care Service (also known as Oakfield) was registered with the Care Inspectorate in April 2011 and is owned and managed by Capability Scotland. The service operates from a house which has been modified to cater fort he needs for the needs of five service users who are all adults with Learning Disabilities. The house comprises a sitting room, activity/sensory room, kitchen, dining room, utility room, two bedrooms, a large bathroom, an office and various storage cupboards. There is a large enclosed garden area which has a decked area leading from patio doors. The staff/service user ratio is 1:1 at all times. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 6 - Excellent Quality of Environment - Grade 6 - Excellent Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 6 - Excellent This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Kelty Day Care Service, page 5 of 22

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. Kelty Day Care Service, page 6 of 22

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This report was written following an unannounced inspection of the service on 15 February 2013. The inspection was carried out by Susan White, Care Inspectorate. The manager of the care service sent us an annual return and a self assessment form. We talked to the manager, staff in the service and service users during the inspection. We sent questionnaires to service users/relatives and received responses which we took into account for this report. We looked at records and documents during the visit. These included - certificate of registration public liability insurance written risk assessments a sample of three care and support plans audits and quality assurance systems information on the office noticeboard. We talked to the manager and senior staff. We reminded the manager about recent changes to legislation - The Public Services Reform (Scotland) Act 2010 and we discussed the need to update policies and procedures in light of these changes. We explained our Regulatory Support Assessment which is part of our preparation for the inspection visit. 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 Kelty Day Care Service, page 7 of 22

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 consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Kelty Day Care Service, page 8 of 22

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 the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they had planned. The service provider told us how the people who used the care service had taken part in the self assessment process. Taking the views of people using the care service into account The people present on the day of inspection did not use verbal language, but we saw that they were comfortable in the presence of staff and each other. In being involved in activities and choices, the day was different for each of the people attending. Relationships with staff were very important and were seen to be well established and appreciated by service users and by staff. Taking carers' views into account Carers views were very positive about individual staff and the service in general. Kelty Day Care Service, page 9 of 22

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: 6 - Excellent 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 user group do not use verbal communication. All are supported by family or support staff who represent their views at formal meetings. We saw that support files have details about communication strategies for each service user. Likes and interests are noted. We saw that staff use this information in designing day experiences. Service users have a daily diary which goes with them from home and the day service. This written system ensures that all relevant information is shared between home and day support. We saw that staff shared information such as activities enjoyed throughout the day, meals, medication and snack taken, how the person's mood and health have been during the day. Information is also given verbally by staff when they are escorting service users home at the end of the day, but the written version is available for review in the longer term. One of the staff helps service users with the computer system, Big Mac, to enable some service users to be directly involved in making choices and in telling family about their day. The service uses Person Centred Plan (PCP) system. Regular reviews of the plan are arranged in consultation with the service user and the people important to them. Capability hosts local social events for people who use their services. People who use this day service can meet friends at the social events on Wednesdays. Kelty Day Care Service, page 10 of 22

The service has translated the service standards into a pictorial format to enable service users to be involved in understanding what the service should provide. Areas for improvement The manager said there are plans to extend this as skills in the staff team increase. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We sampled three of the PCP records. We found a detailed record of support needs, risk assessments and procedures for meeting individual needs. For example, in one of the PCP's inspected we saw a copy of health guidelines from the GP for first signs of a chest infection. A note of the commonest signs to look for were detailed and actions expected by staff were clear. The service uses the Disability Distress Assessment Tool (DisDAT). This is a system for identifying signs of discomfort or pain and means that staff can look to make the person comfortable or to use pain relief at an early stage. We saw in one of the PCP's that a service user that a specialist visual assessment had been done. It gave recommendations about using light sources to maximise the person's ability to see. We observed that staff practice followed all of the good practice in the recommendations. All of the people who use the service have specialist support from health professionals. These include dietician, physiotherapist and/or epilepsy nurse. We saw care plans in place for all specialist support, including health care support. We saw staff training records included specific training in specialist support, for example gastrostomy feeding. Such training ensures that people with complex health needs can use the service and that staff can focus on enjoyable activities as they are confident that health is maintained to a good enough level. Areas for improvement We saw that daily recordings noted detailed record of skin condition for one service user, but the language chosen did not reflect the minor nature of the detail. It is acknowledged that staff do well to ensure that detail is noted, but the language should reflect the degree of intervention needed. Kelty Day Care Service, page 11 of 22

Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Kelty Day Care Service, page 12 of 22

Quality Theme 2: Quality of Environment Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The manager described how the layout of the house took account of the ways the service users could best be supported. For example, if someone's health meant that some bed rest was needed, this could be arranged and still provide appropriate support fort he individual and respite for the family. The manager confirmed that preparation for using the service included visits for new service users and their families and social workers. This gives an opportunity for comments about the building and garden. Any modifications to the environment are said to be welcomed by staff. Since the last inspection, changes to the garden have increased access for wheelchair users. Other plans are said to be in hand. The plans take account if the interests of service users and the potential from the current garden layout. The manager said the decor in each of the bedrooms reflected the favourites of the service users. Both rooms are decorated in pastel shades of these favourite colours. Areas for improvement The service should increase the contribution of opinions from service users as they develop their use of technology to help service users respond effectively in demonstrating choice. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Kelty Day Care Service, page 13 of 22

Service strengths The property is owned and managed by Capability Scotland. The manager ensures any requests for repair and adaptation are passed to Capability Scotland as quickly as possible, then acted on promptly. Since the last inspection Capability Scotland has made the planned improvements to the large, flat garden. Access to the garden is now accessible by wheelchair. The house is spacious and there is ample space for movement of several wheelchairs and staff in the space available. The decor of the main rooms took account of the preferences of the people who use the service. We saw that the choice of colour in both of the bedrooms also took account of the preferences of service users. The large kitchen gives privacy for people who use a peg feeding system, or equivalent. Staff said that when a baking session is planned, the kitchen has sufficient space for two service users to work together with staff. At the time of this inspection we saw that the environment was light, bright, clean and tidy. Records were kept to monitor that cleaning had been done as planned. Health and safety checks were done routinely and that large items of equipment were regularly serviced. To support service users, some specialist items of equipment are in place. This includes beds and hoists. Maintenance contracts are in place to ensure that equipment is always serviced and safe for use. The service uses two 'large' buses. All vehicle checks were in place, risk assessments included ensuring the all fuel levels were done daily. Buses are used to bring people to the service and return home at the end of the day. The buses are available for any visits to community resources during the period of support. Areas for improvement The service should continue to ensure the building and furnishings and equipment are suitable to meet the needs of the service user group. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Kelty Day Care Service, page 14 of 22

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very 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 service recruitment policy means that service users, their families or representatives are invited to be involved in the choice of new staff. This is achieved by direct involvement in the interview process or may be in designing a question to be asked during the interview process. Staff training takes account of the health needs of individual service users. Training for specific care needs is delivered for that person's support. Such training is delivered by a health professional, for example, dietician for nutritional support or physiotherapist for respiratory support. This training is person specific and staff competence is assessed as part of the training programme. Areas for improvement The manager agreed that most of the training relates to health support. The service uses the skills of staff in designing the activity programme but there is scope for further development of using, for example, Clicker 5 system to increase engagement of individual service users in their day to day life. Grade awarded for this statement: 5 - Very 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 We saw that staff on duty on the day of inspection had a good understanding of the individual needs of the service users. Kelty Day Care Service, page 15 of 22

The service has focused on staff achieving the qualifications to enable them to register with the Scottish Social Services Council (SSSC). At the time of this inspection the service was on track for all staff to have the appropriate qualification to be registered with SSSC in 2014. We saw staff training records which showed that training since the last inspection has included updates on epilepsy awareness, medication administration,health and safety for managers, gastrostomy feeding,clicker 5, food hygiene, MIDAS training. Staff said they found the refresher training useful in keeping up their skills. Staff were aware of the National Care Standards and the in-house standards for Capability. These standards have been translated into a pictorial format and staff review them with service users. The manager has a record of supervision meetings with individual staff. These meetings are used to identify any training needs and to deal with any practice questions. Although the manager did say that because it is a small team working mainly in one location, questions are answered at the time they are raised. The level of skill in the staff team in communications with the service users is very good. Communication passports have been well used in understanding the interests and preferences of service users. The use of CLICKER 5 helps service users in direct communication with staff and family. The service has active relationships with health professionals and can call on them for any queries about health for an individual. This gives staff confidence in carrying out specific support. Areas for improvement The service plans to develop the use of CLICKER 5 system to increase the direct communication for more of the service users. We found that the written information in support plans was open to interpretation. An example is given in statement 1.3. Staff meetings and monitoring of each other's recording should address this problem. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Kelty Day Care Service, page 16 of 22

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 6 - Excellent 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 manager said that they benefit from having staff escort on the bus to pick up service users at the beginning of the day and again at the end of the day. This means that families and other carers can speak with staff twice a day. In addition phone calls are used to update on any urgent issues. The service has a management team of two people, with the registered manager available in the service but often based in Dunfermline and the Kelty manager who has a daily presence in Kelty. Capability uses questionnaires to families to help identify improvements to the service. Action plans to address improvements were seen to be acted on. Families told us that they are very happy with the quality of the service at Kelty Day Care. Views of families are very important to the service and these are regularly sought. Families told us that they felt staff took their views into account. Areas for improvement The service should continue to take the views of representatives into account. Increasing skills to help service users to express views directly is an excellent way forward. Grade awarded for this statement: 6 - Excellent 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 Kelty Day Care Service, page 17 of 22

Service strengths The care service has an established auditing system for quality assurance. This includes personal plans, reviews, complaints, accidents, incidents, medication, risk assessments, health and safety and the environment. These audits are validated by the manager. Policies and procedures, staff awareness and record keeping are also subject to audit by Capability's auditors. Managers meetings are used to discuss any current issues or concerns. This ensures that decisions are fully considered and that managers have an opportunity to learn as a group. This strengthens the decision making process. Staff told us they feel part of a close team. Being part of the audit process has helped staff understand how their practice is viewed and of how it can continue to be improved. Areas for improvement The service is preparing for the next accreditation dates and will look to include the representatives and service users views where they can. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Kelty Day Care Service, page 18 of 22

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 Not applicable. 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Kelty Day Care Service, page 19 of 22

5 Summary of grades Quality of Care and Support - 6 - Excellent Statement 1 Statement 3 6 - Excellent 6 - Excellent Quality of Environment - 6 - Excellent Statement 1 Statement 2 6 - Excellent 6 - Excellent Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 6 - Excellent Statement 1 Statement 4 6 - Excellent 6 - Excellent 6 Inspection and grading history Date Type Gradings 24 Aug 2010 Announced Care and support 6 - Excellent Environment Not Assessed Staffing Not Assessed Management and Leadership 6 - Excellent 8 Sep 2009 Announced Care and support 6 - Excellent Environment 6 - Excellent Staffing 5 - Very Good Management and Leadership 5 - Very Good 27 Jan 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good Kelty Day Care Service, page 20 of 22

All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Kelty Day Care Service, page 21 of 22

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 Kelty Day Care Service, page 22 of 22