Flat 5 Oronsay Court Support Service Oronsay Court Portree IV519TL Telephone: 01478 613110 Type of inspection: Unannounced Inspection completed on: 28 September 2016 Service provided by: NHS Highland Service provider number: SP2012011802 Care service number: CS2015338694
About the service The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service registered with the Care Inspectorate on 7 August 2015. The service is operated by NHS Highland, an integrated service incorporating adult social care services and health care services across the Scottish Highlands. This service provides a care at home service for adults with a learning disability in their own homes. The service is located in a residential area in the town of Portree and provides support to people living in the town. The service provides up to 24 hour support based on the needs of the people who use the service. The service aims to support people who have a learning disability to live in the community. What people told us People we spoke with were generally happy with the service, but most supported people were not happy with the constant changes in the staff that supported them. Our observations showed that some people did not get their immediate needs met and this had caused them some frustration. Similar concerns were reflected in the Care Standards Questionnaires returned by relatives. They told us that whilst individual staff were greatly appreciated, they were very concerned about the lack of permanent staff and the use of agency staff to cover shifts. They said that unpredictability in staff rotas was confusing for them and their relatives. At times, this resulted in distress for people when the delivery of support was inconsistent. Relatives expressed concerns that poor staffing levels had sometimes resulted in people having either no support or having to use emergency respite services in order to have their care needs met adequately. Relatives and staff expressed concerns about the lack of management and leadership within the service and said that the service had suffered as a direct result of this. However, they also said that this had started to improve recently when the senior social care worker was able to take on some of the management responsibilities. Self assessment The Care Inspectorate received a self assessment document from the provider. We did not find evidence during our inspection that confirmed the areas of strengths as stated in the document. The provider should accurately identify their own strengths and areas for improvement through the self evaluation process. They should consider how they develop the information submitted to us in the self assessment From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 2 - Weak 2 - Weak 2 - Weak page 2 of 10
Quality of care and support Findings from the inspection We looked at this theme to consider how well the service met the health and wellbeing needs of people who used the service. We found that the service performance in this area was weak. This grade is awarded where, though there may be some strengths, there are important weaknesses which cause concerns which are important enough to have a substantially adverse impact on health, wellbeing and overall experience. We found that there was limited information about individuals in their support plans, risk assessments and review records. Some of the risk assessments we sampled contained good information, but this needed to be supplemented with clear guidance for staff on how they should manage these risks in order to mitigate risk of harm for people. One support plan we sampled recorded good guidance for staff on how to recognise when this person got anxious and how to offer reassurance. However, most were not as detailed as they needed to be. For example, people's medication and money were held in the office located in Flat 5; but there was minimal detail in their support plans about what medications were prescribed or the conditions for which medication was taken. Support plans lacked basic information about the needs of individuals and their ability to manage daily tasks independently. In some support plans, important information about how to support people with their basic needs such as nutrition, oral care or communication was missing. (See Requirements) The lack of written information about people's basic needs and how these would be met exposed people to unnecessary risk which could have significant implications for individual's health and wellbeing. (See Requirements) Most support plans we sampled had not been reviewed. Several were significantly out of date. This means that we could not be sure that the limited information in support plans was accurate or that people were supported appropriately to meet their needs. (See Requirements) Appropriate legal arrangements were in place for people who could not make informed decisions about their welfare and safety. However, the service did not have necessary details of the extent and limits of these orders or information about the responsibilities and decisions that were delegated to the service. (See Recommendations) Overall, we found that the service did not provide people with care and support that enabled their needs to be met adequately or in a person centred way. We have discussed with the provider the need to make significant improvements in this area. Requirements Number of requirements: 3 1. The manager must ensure that each supported person has an up to date personal support plan based on a comprehensive assessment of their health, safety and wellbeing needs and clearly sets out how these will be met. Additionally; the service to further develop support plans by ensuring: a) personal support plans provide an outcome focussed approach b) daily records clearly evidence whether identified goals are being achieved c) personal support plans detail the personal evacuation plan for individuals. page 3 of 10
SSI 2011/210 - Regulation 5(1); (2)(a); (3)(a)(iii) personal plans. Timescale for implementation: four months from receipt of this report. 2. The manager must ensure that robust risk assessments are completed for each person supported by the service. Where an assessment of risk is undertaken and action identified to manage risks appropriately, the assessment must: a) identify the hazard b) describe who might be harmed and how c) evaluate the risks and decide on precaution d) record findings and implement them e) review the assessment and update as required. SSI 2011/210 - Regulation 4(1)(a) - welfare of users. Timescale for implementation: one month from receipt of this report. 3. The manager must make sure that personal support plans are reviewed with each person supported by the service and their carers or representative where appropriate, at least once in each six month period to ensure that the care and support provided continues to meet the needs of each individual. The service must keep a record of these meetings and a minute taken. Minutes should contain a summary of the discussion held, decisions made as a result of the discussion and when this will be reviewed again. SSI 2011/210 Regulation 5 - personal plans. Timescale for implementation: three months from receipt of this report. Recommendations Number of recommendations: 3 1. The manager must ensure that where people they support are assessed not to have capacity to make decisions, this is fully documented and supported with signed and dated incapacity certificates and details of who is authorised to make decisions on their behalf. Where supported people were subject to Guardianship Orders, the service should hold copies of the order granting guardianship or at least the details of the content of the order and a letter from the named guardian detailing any decisions they have agreed to be delegated to the service. National Care Standards for Care at Home services; Standard 3 - Your Personal Plan. 2. The service must promote good nutrition and a healthy diet for people taking into account likes, preferences and any allergies or any medical requirements including support to eat and drink safely. National Care Standards for Care at Home services; Standard 6 - Eating Well. 3. The service must be familiar with the way people communicate. Staff should be competent and confident in using any tools and aids that supported people use to help them communicate. page 4 of 10
National Care Standards for Care at Home services; Standard 10 - Supporting Communication. Grade: 2 - weak Quality of staffing Findings from the inspection We looked at this quality theme as it allowed us to consider how well the staffing arrangements met the needs of the people who used the service. We concluded that the service's performance in this area was weak. This gives cause for significant concerns, which have a substantially adverse impact on people's experience. We found little to suggest that the service had robust systems in place to ensure that there were sufficient staff with the skills and experience to deliver good quality care and good outcomes for the people who used the service. The service had experienced considerable staffing challenges with a high turnover of staff and significant difficulties in filling staff vacancies. The situation was exacerbated by the lack of a management presence in the service. We saw that the service was staffed primarily with agency staff who did not ordinarily work together and whose skills and experience in working with people with learning disabilities was limited. This means that consistency and continuity of care and support, which were key to delivering safe care to people, could not be ensured. There were times when planned support could not be delivered because there were insufficient staff on duty and sometimes staff were not aware of what support they should be delivering. We saw that the agency staff we spoke with were not familiar with the needs and wishes of the people they supported. At times, staff were patronising towards the people they supported which resulted in a tense and uncomfortable atmosphere. Agency staff told us that they had very limited information about the care and support needs of people before they started to work with them. We thought that this was unacceptable and presented potential risk to people's health, wellbeing and safety. (See Requirements) The responsibility for ensuring staff were appropriately skilled and trained to carry out the work they do remained with the agency who employ them. However, the provider must ensure that everyone working in the service was knowledgeable and competent to deliver support to meet the welfare and safety needs of people. (See Requirements) Staff employed by the service rather than an agency were expected to complete basic core training on essential issues such as protection of people, infection control and health and safety. However, the training records we sampled showed that not all of these staff had completed this. There was little training available to support staff with issues that concerned the people they were working with. (See Requirements) Staff told us that they felt unsupported in their role and unvalued by the provider. We saw that supervision meetings, which support staff practice and development, had been irregular and infrequent. The provider had made some effort to address the staffing issues and had appointed a permanent member of staff to the role of senior support worker. As a result, staff support through supervision had started to happen. If this was sustained, it would help support staff practice in delivering safer care and better outcomes for people. page 5 of 10
Requirements Number of requirements: 3 1. The provider must ensure that all staff, including agency and relief staff have accurate up-to-date information about the health, wellbeing and safety needs of people they are to support and detailed guidance on how to support each person well. SSI 2011/210 Regulation 4(1) - welfare of users. Timescale for implementation: one month from receipt of this report. 2. The provider must ensure that there are suitably qualified and competent staff employed in sufficient numbers to meet the needs of people who use the service. In order to achieve this they should develop systems to enable them to ensure that agency and temporary staff have appropriate qualifications and experience relevant to the needs of people using the service. SSI 2011/210 Regulation 15(a) - staffing. Timescale for implementation: one month from receipt of this report. 3. The provider must ensure that staff are suitably qualified and receive appropriate training to ensure they can deliver service users' care in a safe, respectful and supportive manner. In order to comply the provider must: a) complete a training needs analysis for each member of staff b) implement a written action plan to meet the training needs identified c) ensure that there is an effective system in place to monitor that staff are implementing the care service's policies and procedures and to identify where further training and support is necessary. SSI 2011/210 Regulation 4(1)(a) - welfare of users; Regulation 15(b) - staffing and SSI 2011/28 Regulation 4 - records. Timescale for implementation: six months from receipt of this report. Recommendations Number of recommendations: 0 Grade: 2 - weak Quality of management and leadership Findings from the inspection We looked at this quality theme as it allowed us to consider how well the management and leadership arrangements supported the development and direction of the service and supported a quality service for vulnerable people. We thought that the service's performance in this area was weak. We had significant concerns which impact negatively on the delivery of a safe, high quality service for people. page 6 of 10
The management arrangements at the service consisted of a senior support worker supported by the Integrated Team Leader. Through discussion, we learned that the registered manager for the service did not have day to day contact with the service and did not directly manage the service. We learned that the service had lacked appropriate management and leadership arrangements for a number of years when it had been part of another registered service. The appointment of a member of staff to the role of senior support worker did have some benefit in that staff had a point of contact to go with any concerns and staff supervision meetings were beginning to be established. However, her ability to effect change within the service was very limited. This was due to the heavy reliance on agency staff to deliver basic support to people and an inability to recruit staff to the service. Although families told us that overall, they were satisfied with the quality of the service, they expressed significant concerns about the inconsistent staffing and lack of management and leadership within the service. This was reflected in the completed satisfaction surveys issued by the service and the Care Standards Questionnaires returned to us. Staff we spoke with, and who completed questionnaires for us echoed these concerns. (See Requirements) The service had completed a self assessment in consultation with people who used the service and had developed an action plan to address issues raised. However only few action points identified had been completed. We considered that there were inadequate quality assurance procedures in place and lines of accountability for improving the quality of the service were unclear. (See Requirements) We found that in one of the tenancies the staff sleep in room was used as an office base for staff. It is not acceptable that people's homes were used to hold staff meetings, carry out supervision, training and keep records that don't need to be stored in a service user's home and in our view it is a breach of their rights to privacy and dignity and undermines their status as tenants. The provider must secure alternative office accommodation urgently or consider an alternative category for registration with the Care Inspectorate. (See Requirements) Requirements Number of requirements: 3 1. The provider must take urgent steps to ensure there were adequate management and leadership arrangements in place to support the delivery of the service. In order to achieve this the manager must recruit and appoint a qualified and competent manager for the service who has appropriate authority to make management decisions and take action to direct staff and lead service improvements. SSI 2011/210 Regulation 4(1)(a) - welfare of users and Regulation 15(a) - Staffing. Timescale for implementation: three months from receipt of this report. 2. The provider must develop and implement an accredited and effective quality assurance system. In order to do this, the provider must set baseline standards from which the performance of the service can be measured and develop auditing systems to check actual performance so that gaps can be identified and resolved. The provider must develop and share any action plans that arise from the quality assurance audit with all stakeholders and advise them when progress would again be reviewed. SSI 2011/210 Regulation 3 - principles - a requirement on the provider to provide services in a manner which promotes quality and safety; respects the independence of service users, and affords them choice in the way in page 7 of 10
which the service is provided to them. Timescale for implementation: six months from receipt of this report. 3. The provider must ensure that the service operates in accordance with the principles enshrined in the Public Service Reform (Scotland) Act 2010 and in the National Care Standards that apply to this service. A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. The provider should ensure that people's rights are protected and promoted. In order to achieve this the provider must move the office base and worker base from the service user's home to alternative accommodation or consider registering the service under a different category. SSI 2011/210 Regulation 3 - Principles. The National Care Standards for Care at Home services have been taken into account. Timescale for implementation: within three months of receipt of this report. Recommendations Number of recommendations: 0 Grade: 2 - weak What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations There are no outstanding recommendations. page 8 of 10
Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history This service does not have any prior inspection history or grades. 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