ACS Care at Home Ltd Support Service Care at Home Lister House 203/207 Lochleven Road Lochore Lochgelly KY5 8HU Telephone: 01592 862162 Inspected by: Karen Mack Louise Curtis Aileen Scobbie Type of inspection: Unannounced Inspection completed on: 20 July 2012
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 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: ACS Care at Home Ltd Service provider number: SP2011011574 Care service number: CS2011288100 Contact details for the inspector who inspected this service: Karen Mack Telephone 01383 841100 Email enquiries@scswis.com ACS Care at Home Ltd, page 2 of 20
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 Service users and their families told us they know who to contact if they have concerns and that the management team are approachable and responsive. The management team have spent time working along side the care staff in the service users' homes and are aware of their situation and their care and support needs. Families commented on the positive and supportive attitudes of the care staff. The service has a full time training officer, as well as regular planned training for all staff; we saw that this enables the service to react immediately to the changing training needs of the staff. What the service could do better The service needs to further develop the ways in which it gathers feedback from those who use the service and their families. The service should continue developing policies and procedures to be more specific as the service expands and develops. What the service has done since the last inspection This was the first Inspection for ACS Care at Home Ltd since registering with the Care Inspectorate in July 2011. ACS Care at Home Ltd, page 3 of 20
Conclusion ACS Care at Home Ltd are a new business who are striving to deliver a high quality care and support service to individuals within their own homes. The management team at ACS are focused and aware of the need for further development of the service. Who did this inspection Karen Mack Louise Curtis Aileen Scobbie ACS Care at Home Ltd, page 4 of 20
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. ACS care at Home Ltd was registered in July 2011 and is a newly established independent provider of home care. ACS Care at Home Ltd is affiliated with Avondale Care Scotland Ltd which also includes Lister House, Benore Care Home and Benore day Care. The four services are sited together in Ballingry. The registered manager of the service is also the general manager for the 3 services and she is supported by a Depute and an Area Co-ordinator. The service currently has 58 service users in Fife. The aims of the service include 'providing service users with a comprehensive service of care of the highest quality within their own home environment' At the time of the inspection all of the service's work is contracted from Fife Council. This means that some service users may have services from ACS and Fife Council. ACS Care at Home Ltd, page 5 of 20
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 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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. ACS Care at Home Ltd, page 6 of 20
2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection This report is based on an unannounced visit to ACS Care at Home Ltd on 12th July. A follow up visit including inspection feedback to the management team, was on the 20th July. Time was spent visiting service users, speaking to service users, staff and relatives/carers on the telephone as a follow up to the Questionnaires that they returned. The inspection focused on 3 Quality Themes this year with 2 or 3 statements under each theme heading. As requested by us, the service submitted a completed Annual Return and a Self Assessment form and this was used in preparation and during the Inspection. One Service User, one relative and two staff completed questionnaires which were returned to us before the Inspection. We were then given permission to visit/contact more service users and staff for further feedback. During this Inspection we gathered evidence from various sources including: Relevant sections of policies/procedures/records/documents Personal care plans of Service Users Minutes of meetings Accident and Incident records Complaints/Comments record Staff Records Training records Questionnaires that had been issued and returned to the care service from Service users, their relatives or advocates We spoke with various people including: Service Users and relatives/carers Management team Care staff All of the above information was taken into account during the inspection process and was reported on. ACS Care at Home Ltd, page 7 of 20
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 report continued 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 ACS Care at Home Ltd, page 8 of 20
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. 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. A fully completed self assessment was returned to us before the inspection. This had been completed to a satisfactory standard and highlighted the services' strengths as well as areas for improvement. The provider should use their self assessment to highlight how the strengths they identified had improved outcomes for service users/residents. Taking the views of people using the care service into account Two questionnaires were completed and returned to us by people who use the service. We then contacted more service users directly. We received some comments as follows: 'The staff genuinely care about me and the support they provide. They are friendly and very helpful. Nothing is too much trouble. We greatly appreciate the help given.' 'They don't make me feel cumbersome; the staff don't talk over me. They are jolly and happy and include my husband in the conversation. I have no complaints.' Taking carers' views into account One questionnaire was returned to us by relatives/carers of those who use the service. And we also spoke to relatives in service user's homes. We received some comments as follows: 'The staff are excellent - there is good communication. The manager has visited - the manager is very responsive. All round - they are great.' ACS Care at Home Ltd, page 9 of 20
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 During Inspection the service detailed the ways in which they aim to gather information from service users and their families. They told us that this included service user reviews, questionnaires and newsletters. The service informed us that this was in the early stages of development. The manager told us that they attended reviews led by Fife Council Social Work Department. After attending these reviews the service amend the care plan and support provided (If required) and meets with the service users to discuss. The service independently reviews the support provided to service users within the first week of the service being in place, then on an ongoing regular basis. This allows the service to review the care needs with the individual and make changes to the care and support provided. The service informs the Social Work department if there are significant changes or concerns following on from the review. The service had developed a questionnaire for service users to complete and had 11 returned at the time of the inspection. The questionnaire allowed for service users to grade the service and provide comments. The service told us that they would collate this information and develop an action plan for the service. ACS Care at Home Ltd, page 10 of 20
Areas for improvement Newsletter - This would enable the service to feedback to service users the outcomes of the information gathered through the questionnaires and would inform service users of changes and developments in the service. Whilst service users had been having their care needs reviewed, this was not being recorded formally. During the course of the Inspection the service was developing a structured review process and this is to be accompanied with a review document that the service user can be more involved with. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. It is recommended that the service continues to develop methods of involving service users and relatives in assessing and improving the quality of care and support, staffing and, management and leadership within the service. This should include methods to demonstrate how suggestions and concerns raised result in positive outcomes for service users. Reference is made to: National Care Standards: Housing Support and Care at Home. Standard 1 Informing and deciding. ACS Care at Home Ltd, page 11 of 20
Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths We looked at a sample of four service users care plans on the second day of inspection. The service has recently changed to a care planning system called 'care sys'. The care plans were written in the 'first person' and provided valuable information about the person's preferences and their 'personal story'. All care plans examined were very detailed and provided good information about dependency and assistance required. These showed good examples of how to support the service user effectively. The care plans provided detailed information about the person's health needs, and we saw an example of individuals' specific wishes for their end of life care. The service users that we met with and spoke to told us that they did not feel rushed by the staff and that they felt that they were informed if care staff were behind schedule 'they are good at communicating - they text or phone if they are running behind'. Areas for improvement The care plans for some service users needed to be reviewed to be more detailed to inform staff of their care needs. This related to care plans that had been in place for a longer period of time. The service should ensure that they provide a care plan that meets the care needs and personal preferences of the service users. Care plans must be specific and detailed in relation to service users' medications and the role of the care staff. During the course of the inspection the service amended the care plans to detail medication prompting and plan to introduce further training for staff. Service users were usually informed of the staff due to visit them but told us that they could not always see a pattern. One service user stated that the timing of her visits could be variable. The service told us that continuity of staff is becoming more established as the service develops. The service must aim to be consistent and reliable in who is giving the care and also in the way and timing of how it is given. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued ACS Care at Home Ltd, page 12 of 20
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The evidence for the grade awarded for this statement is included in Theme 1 Statement 1 Service Strengths. Areas for improvement The evidence for the grade awarded for this statement is included in Theme 1 Statement 1 Areas for Improvement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 ACS Care at Home Ltd, page 13 of 20
Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths Staff files sampled showed us that the service had followed a structure for staff recruitment. These confirmed that PVG (Protection of Vulnerable Group) safety checks were carried out along with formal interviews. Staff do not commence employment until the organisation has received a new PVG. In all staff files sampled, there were 2 references obtained. We received copy of the staff induction programme, which covered key training requirements such as manual handling, palliative care and infection control. The staff that we spoke to commented very positively on the Induction training 'the training was very good; it was tailored to people's experiences and included speakers on Fire Safety and skin care'. All induction training and manual handling training are delivered by the service. The provider has a full time training officer covering ACS Care at Home Ltd as well as the care homes and day care service. The service has a dedicated training room and access to manual handling equipment such as a bed, hoist and slings to allow them to deliver training to staff when it is required. The service told us that this will allow the staff training needs to be managed effectively after being identified, and will result in better outcomes for the service users. The management team and training officer also work with the staff in the service users' home to observe their practice and identify further training needs. Areas for improvement The management team should continue to remain committed to ensuring systems are in place which ensures staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued ACS Care at Home Ltd, page 14 of 20
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service told us that they currently have 3 members of staff on call out of hours and this means that both staff and service users have access to management out of hours. The management team work alongside staff and also directly deliver care to review support provided to service users, monitor staff practice and identify training needs. The training officer also observes staff practice in the service users' home when appropriate. The management team can then discuss practice issues through supervision. Staff told us that they are encouraged to identify further training needs 'the opportunity for training is there and is encouraged' and during inspection we saw that the staff notice board included a suggestion form for further training. The service has a supervision and staff appraisal plan in place. We saw that there is regular supervision, supervision contracts and details of discussions and action plans. Staff we spoke to were aware of the SSSC codes of practice and National Care Standard When assessing this statement we also took into consideration training received by staff. (See Statement 3.2 for further details). Areas for improvement The management team confirmed during discussion that consideration is now being given to the ongoing training needs of the staff as the organisation develops. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued ACS Care at Home Ltd, page 15 of 20
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The evidence for the grade awarded for this statement is included in Theme 1 Statement 1 Service Strengths. Areas for improvement The evidence for the grade awarded for this statement is included in Theme 1 Statement 1 Areas for Improvement Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 ACS Care at Home Ltd, page 16 of 20
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 care staff, service users and management all told us how the management team meet with service users when their service begins and, how care and support plans and timings of visits can then be reviewed to allow the best outcomes for those using the service. All staff members that we spoke to informed us of how responsive the management team were and that they viewed the company highly. 'This is an excellent company to work for, I feel supported at all times. There is a high standard of care delivery and the service users' interest is at the forefront' Staff told us of the 'open door' policy which means that they can access support from the management team easily. We saw that individual staff reviews are carried out every 3 months. This allows staff and management to reflect on the staff member's practice. Newly recruited staff have a review with management at weeks 6 and13. Staff progress would then be summarised at an annual appraisal. The service has a complaints procedure and details of this are provided to service users in a 'Service User Guide' when the service begins. This means that people know how to raise a complaint if they are unhappy with any aspect of the care service. The management have a system in place to record the outcomes of the complaints although none had been received at the time of inspection. Areas for improvement The service should evidence the ways that it monitors the quality of the care and support that the care staff offer to service users. This would allow the service to support, develop and guide each staff member in their practice and ensure that each staff member was meeting expected standards of practice. The service plan to develop an 'End of service Questionnaire' to gather feedback from the service users on their experience of using the service. There was a wide range of policies available to the service and the manager has recognised how the service should develop these policies to be more specific. The service manager is now reviewing these policies, examples being - administration of medication and supervision. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued ACS Care at Home Ltd, page 17 of 20
4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in 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). ACS Care at Home Ltd, page 18 of 20
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 2 Statement 3 4 - Good 5 - Very 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. ACS Care at Home Ltd, page 19 of 20
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 SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.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@scswis.com Web: www.scswis.com ACS Care at Home Ltd, page 20 of 20