ACS Care at Home Ltd Support Service Lister House 203/207 Lochleven Road Lochore Lochgelly KY5 8HU Telephone: 01592 862164 Type of inspection: Unannounced Inspection completed on: 21 April 2017 Service provided by: ACS Care at Home Ltd Service provider number: SP2011011574 Care service number: CS2011288100
About the service ACS Care at Home Ltd (ACS) is an established independent care provider offering people care and support in their own homes. ACS is part of Avondale Care Services. The service manager for ACS is supported by, three care coordinators, a training officer and administration support. Currently, over 90 people across Fife use the care at home service. At the time of the inspection, most of the service's work is contracted from Fife Council. This means that some people may have services from ACS, other independent care providers and Fife Council. The aims of the service include 'providing service users with a comprehensive service of care of the highest quality within their own home environment'. What people told us At this inspection we shadowed staff and visited nine people in their own homes. We spoke with three relatives and seven people receiving care and support. We also observed the interactions between carers and the people they supported who were unable to express their views. Some of the comments from service users and relatives included: - The carers do a lovely job caring for my relative. - I'm very happy with the service, sometimes there are different carers but it's not a problem. It doesn't happen very often. - I like the carers coming in, they are good company and I have a laugh with them. - They do a very good job for my relative. I feel I can trust them with my relative even when I am not here. - Overall the care is good. I have had a couple of wee niggles but I got them sorted. I know how to contact the manager or the office if I need anything. - I had an initial review for my relative about six - eight weeks after we started receiving care and I have a review coming up again. So far I am happy with the service - There is good communication, I always know what's happening and I get the same carers. They do change every couple of weeks but that's the shifts they work and it's fine. - The staff seem very knowledgeable so I think they must get good training. - Very happy, don't know what I would do without them. - Sometimes they can run a bit late but, these things happen it's not a problem. I've never missed a visit from them. - I am delighted with the care given. they treat me as a person and not a number. Staff are always so thoughtful in so many ways. Helps me to cope each day. page 2 of 10
100% of respondents from the Care Standard Questionnaires were either happy or very happy with the quality of care and support provided by ACS Care at Home service. Self assessment The Care Inspectorate received a fully completed self-assessment document from the service. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade the services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 5 - Very Good Quality of care and support Findings from the inspection We observed staff as they carried out care and support and saw that they checked the care plan when they entered the persons home. The staff were kind and friendly towards the client and demonstrated good knowledge and understanding of the care to be provided. People using the service told us that they received regular visits from staff and that this had improved. They knew the staff who were visiting and said they had a regular team of staff visiting them. We looked at care plans and found that they were limited in the amount of information they contained. The care plans should be more reflective of the service users wishes, choices, needs and care to be provided. At the previous inspection it was highlighted that the times and frequency of visits should be recorded in the care plan. At this inspection we did not see evidence of this within the care plan. A requirement has been made (requirement 1) Care review notes were sampled and we found them to contain good detail within them. Information from the care review should be recorded within the care and updated accordingly. We observed staff carrying out medication support. We saw medication support being carried out safely but, in some cases the appropriate level of support being carried out was not in accordance with information within the care plan or the policy for medication support. We suggested to the manager to ensure medication assessment is carried out with all persons receiving a service to determine the appropriate level of support. The care plan should then reflect the information in terms of risk assessment, level of support and how that support should be provided. A requirement has been made (requirement 2) page 3 of 10
Daily communication logs contained relevant information with records made at each visit. We would suggest having a separate 'medication log' to ensure there is a clear oversight of when medication support is being offered. During our observations of staff visits, we saw that staff attended homes on time, carried out appropriate personal protection measures and ensured all care was given as required. Staff always asked if there was anything else they could do for the person before leaving. Requirements Number of requirements: 2 1. The provider must make proper provision for the health, welfare and safety of people using their services. In order to do so, the provider must ensure that: - all care plans contain relevant, personalised information about the person receiving support. - all care plans should record the length of time of the support, risk assessments and any additional information to ensure the support is outcome focused and meets individual assessed needs This is in order to comply with: SSI 2011/110 Regulation 4(1) (a) - Welfare of users Reference is made to: National Care Standards - Care Homes for Older People: Standard 5; Your personal plan Timescale: with immediate effect and to be fully implemented by 1 August 2017 2. The provider must make proper provision for the health, welfare and safety of people using their services. In order to do so, the provider must put in place a system to ensure that: - all persons receiving medication support are assessed to ensure the correct level of support is being provided and that a medication risk assessment is in place if required. - care plans should reflect the assessed medication support required and details of how the person receiving medication support would like, or need, assistance to be carried out. - medication support should be reviewed regularly and documented within the care plan. This is in order to comply with: SSI 2011/110 Regulation 4(1) (a) - Welfare of users Reference is made to: National Care Standards - Care Homes for Older People: Standard 5; Your personal plan and Standard 8; keeping well - medication Timescale: with immediate effect and to be fully implemented by 1 August 2017 page 4 of 10
Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection We sampled a range of documents and saw that robust recruitment procedures were in place. Protection of Vulnerable Groups (PVG) and Scottish Social Services Council (SSSC) checks were carried out. The staff files held information relating to the recruitment procedure and were informative and well documented. There were also additional staff files which contained information about supervision sessions, training and personal development. staff received a five day induction course and online module learning. In addition to the induction there should be on-going observed competencies carried out. This will ensure staff are developing their knowledge and are carrying out care and support in accordance with best practice. A requirement has been made ( requirement 1) When we spoke with staff they told us they felt well supported through their induction and we saw examples of induction workbook and training carried out at induction. staff told us they received regular supervision and were invited to attend tem meetings. Not all staff agreed that they had the opportunity to meet with other staff members. The manager should consider how peer support within the staff team could be developed to ensure staff have the opportunity to discuss practice concerns and best practice. Staff were enthusiastic about their jobs and the people they supported. We observed very good interactions between staff and service users. We discussed the requirements for staff to register with the SSSC and heard from staff how they have been informed about registration. We were also told how staff will receive support from the management team to register when the registration date for Care at Home workers opens. Requirements Number of requirements: 1 1. The provider must make proper provision for the health, welfare and safety of people using their services. In order to do so, the provider must put in place a system to ensure that: - individual competency assessment frameworks to satisfy themselves that induction and on-going training which has been delivered to staff is being applied in practice and resulting in positive outcomes for people using the service. - observational competencies should include, but not exclusive to; moving and handling and medication support This is in order to comply with: SSI 2011/110 Regulation 4(1) (a) - Welfare of users page 5 of 10
Reference is made to: National Care Standards - Care Homes for Older People: Standard 4; Management and staffing Timescale: with immediate effect and to be fully implemented by 1 August 2017 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection Staff spoke highly of the manager and co-ordinators. We heard that they were approachable and supportive. Staff told us if they had any concerns, they were dealt with quickly with good contact from the office staff. We heard how staff felt that they are listened to by management team and feel reassured that their concerns will be dealt appropriately and timely. We saw that regular supervision and appraisals were being carried out, with actions and outcomes identified and recorded. Although we saw that staff underwent 'spot checks' these could be more robust and specific areas identified such as medication and moving and handling. The manager has worked well since coming into post to ensure quality assurance and areas for audit have been improved and implemented. We sampled audit files and found them to be up to date with areas for action and outcomes identified. The structure of the management team has changed and there are now co-ordinators who assist the manager with the day to day running of the service. This ensures there is very good oversight of the rota. Staff feel that there has been an improvement in this area with the hours being worked and the visits they make more regular and consistent. Looking at notifications to the Care Inspectorate we saw that in general they were being made appropriately, however there were occasions where there were some days delay between the accident or incident occurring and reporting this to the Care Inspectorate. We discussed ways in which the reporting from staff to the office and then to the Care Inspectorate could take place to ensure any reportable events are carried out in accordance with the reporting guidance and timeline. Requirements Number of requirements: 0 page 6 of 10
Recommendations Number of recommendations: 0 Grade: 5 - very good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must make proper provision for the health, welfare and safety of people using their services. In order to do so, the provider must put in place a system to ensure that: - People receive their care and support at the times that are agreed in their care plan and service agreement. - Staffing must be organised and scheduled in a way which ensures all people are, in the main, receiving consistent support from people they have had time to form a working relationship with, who have the skills and competence to meet their health and well-being needs. - Staffing schedules must be further developed to ensure staff can meet the timings and duration of allocated visits. This is in order to comply with: SSI 2011/110 Regulation 4(1) (a) - Welfare of users Reference is made to: National Care Standards - Care Homes for Older People: Standard 5 Management and Staffing Arrangements. Timescale: Evidence must be provided through action plans at weeks eight and 16 after receipt of the final inspection report. This requirement must be met 20 weeks after receipt of the final inspection report. This requirement was made on 2 June 2016. Action taken on previous requirement The staff rota has been changed and co-ordinators organise the schedule of visits. The staff are divided into teams and geographical areas. We saw and heard from people using the service that they received support from the same staff and had changes when staff were off or on annual leave. Travel time was also scheduled into the rota. Met - within timescales page 7 of 10
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 We expect providers of care at home services to consider the need for and the benefits of continuity. We would expect to see staff's induction being managed so that it supports staff's learning and allows them to have a positive relationship with the people they will be supporting. People using the service should be consulted about new staff being introduced in their homes. We expect that all new staff are competent in relevant aspects of the health needs of each individual using the service. National Care Standards - Care at Home - Standard 4: Management and Staffing Arrangements. This recommendation was made on 2 June 2016. Action taken on previous recommendation Staff receive a week long classroom induction in addition to the online learning for additional mandatory training. A robust training and induction programme is in place with oversight from the training manager who highlights to the manager when training, refresher and updates are required. In addition there is also a system for new staff to shadow experienced staff. Recommendation 2 The service is recommended to further develop their competency assessment framework to satisfy themselves that induction and on-going training which has been delivered to staff is being applied in practice and resulting in positive outcomes for people using the service. This should incorporate observational monitoring of practice and could for example, be included as part of the supervision process. This recommendation was made on 2 June 2016. Action taken on previous recommendation The service has systems in place to monitor the competencies of staff post training, post induction and ongoing. There is no separate observed competencies for medication support or moving and handling. The monitoring is a general overall monitoring system. A requirement has been made for specific observational competencies under care and support. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 8 of 10
Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 2 Jun 2016 Announced (short notice) Care and support 3 - Adequate Environment Not assessed Staffing Management and leadership 9 Jun 2015 Announced (short notice) Care and support Environment Not assessed Staffing Management and leadership 28 May 2014 Unannounced Care and support Environment Not assessed Staffing Management and leadership 31 May 2013 Unannounced Care and support Environment Not assessed Staffing Management and leadership 20 Jul 2012 Unannounced Care and support Environment Not assessed Staffing Management and leadership page 9 of 10
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can 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. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @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 cànain eile ma nithear iarrtas. page 10 of 10