Support Work - Inverness Community Mental Health Service Housing Support Service Inverness Community Mental Health Service The Corbett Centre

Support Work - Inverness Community Mental Health Service Housing Support Service Inverness Community Mental Health Service The Corbett Centre Coronation Park Inverness IV3 8AD Inspected by: Lindsey McWhirter Type of inspection: Announced (Short Notice) Inspection completed on: 11 March 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: NHS Highland Service provider number: SP2012011802 Care service number: CS2012307271 Contact details for the inspector who inspected this service: Lindsey McWhirter Telephone 01463 227630 Email enquiries@careinspectorate.com Support Work - Inverness Community Mental Health 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 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well The staff team have developed good relationships with the people that use the service. Support is provided to people in their own homes from a small established team of support workers. What the service could do better The individual housing support plans need to be more specific about the support that is provided. Housing support plans should be regularly reviewed with the person using the service. An effective system to monitor the quality of the service should be put in place. Staff should have clear guidelines on their roles and responsibilities. The service should continue to look at the ways they get the views of people using the service. What the service has done since the last inspection This was the first inspection of this service under the new provider. Support Work - Inverness Community Mental Health Service, page 3 of 22

Conclusion Inspection report continued The provider was in the process of reviewing the service and ways it can be improved. This was to include clarifying the roles and responsibilities of the housing support workers. Staff have developed good working relationships with the people they provide housing support to. The housing support plans for people using the service and frequency of reviews needs to improve. The service should continue to look at the ways they get the views of people using the service. Who did this inspection Lindsey McWhirter Support Work - Inverness Community Mental Health Service, page 4 of 22

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was registered with the Care Inspectorate on 30 March 2012. All registered care services for adults previously run by Highland Council, were transferred to NHS Highland as part of the integration of health and social care. The Care Inspectorate registered NHS Highland as the new provider of these services in March 2012. From April 2012, the Care Inspectorate further improved its inspection methodology. From this point, all services of are being assessed against 3 or 4 quality themes (care and support; management and leadership and staffing) during inspection. This means that our inspections and application of grading judgements are even more robust, consistent and focused on evidencing the impact of the quality of care on outcomes for people who use services and their carers. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. -A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Support Work - Inverness Community Mental Health Service is registered to provide a housing support service to people living in the wider community with mental health problems. The service is provided by NHS Highland. The aims of the service are: - To provide a support service to adults affected by mental health problems to enable them to live as independently as possible in the community. Support Work - Inverness Community Mental Health Service, page 5 of 22

- To provide a service agreed between those who request the service and those who provide it. - To involve service users and cares in as wide a range of service planning involvement and development as possible. - To provide a service that respects dignity, privacy, choice, safety and which promotes the realisation of potential and recognises equality and diversity. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Support Work - Inverness Community Mental Health 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 We wrote this report following a short notice announced inspection. This was carried out by Inspector Lindsey McWhirter. The inspection took place between 25 February and 7 March 2013. During the inspection visit we visited the service office base at Bruce Gardens Centre and Larche House where the Community Mental Health team were based and some of the housing support service records were held. Feedback was given to the acting manager and district manager for Inverness (East) on 11 March 2013. The feedback included recommendations and areas of improvement made as a result of these visits. As part of the inspection, we took account of the completed annual return and self assessment documents we asked the provider to complete and submit to us. We sent ten Care Standards Questionnaires to the manager to distribute to people using the housing support service. Seven were completed and returned to us. We sent ten questionnaires to be distributed to staff. Four were completed and returned to us. Before the inspection we spoke with people who used the service during an open day held at Bruce Gardens drop in Centre. During the inspection process we gathered evidence from various sources, including the following: We spoke with: * acting manager * senior support worker * support workers * manager and social worker from the community mental health team We looked at: * evidence from the service's most recent self assessment * the service's aims and objectives Support Work - Inverness Community Mental Health Service, page 7 of 22

* the service information leaflets * personal plans and care records of people who use the service * formal care reviews and records * response in the care standards questionnaires * staff records Inspection report continued All of the above information was taken into account during the inspection process. 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 consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Support Work - Inverness Community Mental Health 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. We received a completed self assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included under each heading that we grade services under. The provider identified what it thought the service did well and some areas for development it had planned. Taking the views of people using the care service into account We received the views of 11 people using the service via the care standards questionnaires and through speaking to people attending the Bruce Gardens Centre. People we spoke with were happy with the service they received. Responses in the seven questionnaires we received indicated that four people strongly agreed and 3 people agreed that overall, they were happy with the quality of care and support this service gives them. Two people gave additional comments. These included: 'My support worker can no longer drive me in her car.' 'Bruce Gardens Day Centre is a very good service.' 'I have time allocated which is good. I only disagree with question 5 [staff have enough time to carry out the agreed support hours] because time with support work is 2 hours weekly and I have times when I could use some more but I understand that resources and funds are overstretched and I am happy in general with the service.' We have included further comments and views from people using the service throughout the report. Support Work - Inverness Community Mental Health Service, page 9 of 22

Taking carers' views into account We did not receive any views from carers during this inspection. Inspection report continued Support Work - Inverness Community Mental Health Service, page 10 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: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found this service was performing adequately in the areas covered by this quality statement. People using the service had some opportunities to be involved in giving their views and making suggestions about the support provided. An information pack was available for people who used or might use the service. This told people about the service, who would provide it and when and how it would be delivered. The service users guide within the pack provided information about who to raise a concern or make a complaint to if they were not happy with the service. The service user guide had been produced in consultation with people who used the housing support service. A leaflet about the Inverness community mental health service told people that the service welcomed feedback about the services they provide as they believed it will help them to provide and 'Having your say' forms were available from staff. Useful contact numbers were also provided for example Advocacy Highland and HUG (Highland User Group). People using the service spoke with their support workers regularly on the days they received support. This provided a regular opportunity to informally discuss any aspects of the support they received, for example what was working well and what might need to be changed. People using the service could also phone the services office base or drop in when attending the Bruce Gardens Centre if they wished to speak to the senior support worker or support workers out with these times. People using the service were involved from the outset with discussing and agreeing their support plan. They had the opportunity to give their views about the care and support they received during review meetings held by the service and/or multi- Support Work - Inverness Community Mental Health Service, page 11 of 22

disciplinary meetings held by others involved in their care and support. We received seven completed care standards questionnaires from people who used the service, four of who confirmed that the service asks for their opinions about how it can improve. All of the seven responses we received in the care standards questionnaires from service users confirmed the service regularly checked with them that they were meeting their needs. Areas for improvement Inspection report continued The provider should review and update the information pack to ensure the information provided is current and accurate. The provider should further develop the methods and opportunities they use to involve people using the service, and their representatives where applicable in assessing and improving the service. A participation strategy specific to the housing support service should be put in place which sets out the different ways people using the service can be involved in assessing and improving the quality of the service. See recommendations. The use of the Housing Support Service 'Have our say forms' should be fully implemented. The service highlighted in their self assessment included as areas for improvement: the service should continue to develop positive relationships with service users and relatives, which should enable them to positively influence matters that affect them a system is being developed to ensure that more formal reviews involving service users and recording care planning specific to housing support is taking place Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations 1. A participation strategy specific to the housing support service should be put in place which sets out the different ways people using the service can be involved in assessing and improving the quality of the service. National Care Standards - Housing Support Services, Standard 8: Expressing Your Views. Support Work - Inverness Community Mental Health Service, page 12 of 22

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found this service was performing adequately in the areas covered by this quality statement. We concluded this after we spoke with staff, examined care and support documentation and review records, questionnaire responses and written information about the service. The service received all the referrals through the community mental health team who they worked closely with. Each person using the service had a basic housing support plan in place. Staff turnover within the service was very low and consequently there was a well-established experienced support team in place who knew the people using the service well. Where appropriate staff were involved in external reviews held by other professionals involved in the care and support of the person using the service. The use of independent advocacy was actively promoted and supported. Where it was appropriate to, staff passed on concerns about a persons mental health to the community mental health team who they worked closely with. We received seven completed care standards questionnaires from people who used the service, 100% of who confirmed that: overall, they were happy with the quality of the care and support the service gave them; they had a support plan which contained information about their support needs; their preferences had been detailed in the support plan; the service checked with them regularly that they were meeting their needs. Five out of the seven people who responded felt staff had enough time to carry out the agreed support. We received four completed questionnaires from staff, all agreed that overall, this service provides good care and support to people who use it. Areas for improvement We found the support plans lacked specific information about the actual support that was to be provided. The housing support plans need to be developed further and should contain clear information about identified needs, expected outcomes and what support is being provided by the service. The service should take steps to ensure the housing support plans and records relating the the housing support service are separate from those held for individual clients by the community mental health team at Larche House. Individual support plans should be in a format that is clear and easily understood for people using the service and staff. Service users should receive a copy of their current personal support plan. This is to ensure that all relevant parties have clear information about the level of support agreed and how and when it will be Support Work - Inverness Community Mental Health Service, page 13 of 22

provided. We found that not all service users had their support plan reviewed every six months and minutes of the review were not available in the care files. Reviews of individual support plans between the service and service users should be carried out at least six monthly. A record of who was present at the review and what had been discussed and agreed should be maintained. Individual support plans should be amended to reflect any resulting change in support needs where this is identified. Accurate records to be maintained. See requirements. The service highlighted in their self assessment included as areas for improvement; that a system is being developed to ensure that more formal reviews involving service users and recording care planning specific to housing support is taking place. The service was registered to provide a housing support service only. At the time of the inspection the service was providing a care at home service to one service user along side the housing support service. We discussed this situation with the interim manager at the time of the inspection. The service must ensure that the support service they deliver is within the conditions of their registration. At the time of the inspection the service proposed to merge with another of the providers support services which was already registered for care at home and housing support. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. Each person using the service must have a support plan that clearly sets out how their health and welfare needs are to be met by the service. A review of their agreed plan of care shall take place at least once every six month period and more frequently when indicated by a change in their needs or circumstances. The provider must put in place systems for regular review of each personal support plan at least once in every six month period, to ensure the way care is planned and provided is current and meets the needs of the person using the service. Accurate records are to be maintained. This is in order to comply with Regulations 5 of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for completion: six months The following National Care Standard was taking in to account when making this requirement: National Care Standards - Housing Support Services, Standard 4: Housing Support Planning. Support Work - Inverness Community Mental Health Service, page 14 of 22

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 See Quality Theme 1, Quality Statement 1. Areas for improvement See Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 3 - Adequate 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 found this service was performing well in the areas covered by this quality statement. We concluded this after we spoke with the acting management, senior support worker and some of the support staff; examined staff files and training information and staff questionnaire responses. The service supported all staff to obtain relevant qualifications to support their application to register with the Scottish Social Services Council (SSSC) when the register becomes open to them. The majority of staff held a relevant Scottish Vocational Qualification (SVQ) level 2, level 3 or other relevant qualification. A senior support worker had recently been seconded from the provider's learning disabilities support service to act as coordinator to cover staff absence. Staff meetings and regular supervision was being re-established. The coordinator had implemented the use of supervision contracts and standing agendas. Staff records were currently being recorded manually. It was confirmed to us that all mandatory training was up to date with the exception of one person needing first aid training which would be arranged. In addition to statutory training, staff had received additional Support Work - Inverness Community Mental Health Service, page 15 of 22

training relevant to the service they provided. Specific training had been accessed through other professionals, for example the Community Mental Health Team. Staff turnover within the service was very low and consequently there was a wellestablished experienced support team in place who knew the people using the service well. Staff had received a copy of the Scottish Social Services Council (SSSC) codes of practice and relevant copies of the National Care Standards were available. We received four completed questionnaires from staff, all of the responses we received confirmed staff had access to the services policies and procedures, received regular supervision and that the service had provided them with opportunities to access education/training in the last 12 months. All these staff felt the service provides good support to service users and that they were confident that they had the skills to support people using the service. Areas for improvement The service highlighted in their self assessment document that not all staff had personal access to the intranet to note details of training opportunities; however they ensured that all development opportunities were made available to staff. They told us this was achieved by ensuring that all training was printed off and discussed at supervision and through the personal development plans. It was highlighted that following integration NHS Highland proposed that all staff would have access to the intranet. The service proposed to have all staff training records streamlined and held electronically. The service should continue to monitor staff training needs, support professional development and provide training which takes account of National Care Standards, legislation and best practice. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Support Work - Inverness Community Mental Health Service, page 16 of 22

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 See Quality Theme 1, Quality Statement 1. Areas for improvement See Quality Theme 1, Quality Statement 1. Grade awarded for this statement: 3 - Adequate 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 We found that the performance of the service was adequate for this statement. The service had some processes in place which contributed to the way they assessed the quality of the service they provided. These included for example, staff supervision, appraisal and reviews carried out by other health or social care professionals involved with the care and support of people using the service. The service had a complaints procedure in place. Information was available about independent advocacy and people using the service could be supported to access an independent advocate. Five out of seven people using the service who returned questionnaires to us knew about the service's complaints procedure. There were arrangements in place for staff appraisal and supervision. This provided the opportunity to support staff and to discuss individual development and training needs. All four staff who returned questionnaires agreed they had regular individual supervision with their manager and that they were given the opportunity to meet up with other staff and talk about their day-to-day work. Support Work - Inverness Community Mental Health Service, page 17 of 22

Areas for improvement The service should fully implement the 'Have Your Say form' to gain the views of people using the service. Three out of seven people using the service who returned questionnaires to us agreed that the service asks for their opinions about how it can improve. The provider should further develop the methods and opportunities they use to involve people using the service, and their representatives where applicable in assessing and improving the service. Part of the supervision process involved monitoring record keeping, support plans and risk assessment through discussion with staff. This should continue to be developed further. It was difficult to evidence what quality assurance arrangements the provider had in place in this service and how or who was responsible for carrying them out. The service highlighted in their self assessment document they planned to complete the Scottish Recovery Indicators (SRI) to evaluate the current service provision to include feedback from service users, carers and staff. The service worked closely with the Community Mental Health Team. We noted during the inspection there was a lack of clear guidance for the housing support staff where recordings relating to the housing support service should be recorded and where the records should be held. There was a lack of clarity in relation to the housing support staff roles and responsibilities. At the time of the inspection the management, staffing arrangements and location of office bases and records was currently being reviewed. Appropriate arrangements should be established and monitored by the provider, NHS Highland. Two of the four staff who returned questionnaires disagreed that the service asks for their opinion on how it can improve. The provider should ensure that there are effective quality assurance systems and processes in place to assess and improve the quality of service they provide. All relevant parties should be aware of the quality assurance systems which should involve service users, relevant representatives, staff and stakeholders. See recommendations. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The provider should ensure that there are effective quality assurance systems and processes in place to assess and improve the quality of service they provide. All Support Work - Inverness Community Mental Health Service, page 18 of 22

relevant parties should be aware of the quality assurance systems which should involve service users, relevant representatives, staff and stakeholders. National Care Standards - Housing Support Services, Standard 1: Informing and Deciding. National Care Standards - Housing Support Services, Standard 3: Management and Staffing Arrangements. Support Work - Inverness Community Mental Health Service, page 19 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 It was highlighted through the inspection that the roles and responsibilities of the housing support workers in relation to the community mental health team and Bruce Gardens Day Centre drop in service were not clearly defined. At the time of the inspection the management, staffing arrangements and office base location of this service and the providers other support service was under review. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Support Work - Inverness Community Mental Health Service, page 20 of 22

5 Summary of grades Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 3 - Adequate 3 - Adequate Quality of Staffing - 3 - Adequate Statement 1 Statement 3 3 - Adequate 4 - Good Quality of Management and Leadership - 3 - Adequate Statement 1 Statement 4 3 - Adequate 3 - Adequate 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. Support Work - Inverness Community Mental Health 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 Support Work - Inverness Community Mental Health Service, page 22 of 22