Community Alarm Service Housing Support Service Merrystone Care Base 10 Blairhill Street Coatbridge ML5 1PG Telephone:

Community Alarm Service Housing Support Service Merrystone Care Base 10 Blairhill Street Coatbridge ML5 1PG Telephone: 01236 622400 Inspected by: Ann Marie Hawthorne Type of inspection: Announced (Short Notice) Inspection completed on: 16 August 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 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: North Lanarkshire Council Service provider number: SP2003000237 Care service number: CS2004071319 Contact details for the inspector who inspected this service: Ann Marie Hawthorne Telephone 01698 897800 Email enquiries@careinspectorate.com Community Alarm Service, page 2 of 23

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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service supports people to remain living in their own homes longer than may otherwise be possible by reducing the potential risks for them doing so. The alarm service works using systems in place throughout the other North Lanarkshire Homecare services; this is to the benefit of service users as it gives them access to more help if they require it. What the service could do better The service should consider ways in which they can review the care needs of service users who have the system installed. The manager needs to ensure that home support workers are being provided with sufficient information to support people from the electronic records that are accessed by response advisors. All staff need to have the necessary information to be able to support people effectively before responding to a call. What the service has done since the last inspection The service had continued to develop through the use of very good quality monitoring systems to ensure it was providing a service that was meeting the needs of those people who used it. The service had also been engaged in an exercise to review the longer term model of care which explored ways in which improvement could be made. They had also been actively recruiting to the service and had met the requirement made at the previous inspection. Community Alarm Service, page 3 of 23

Conclusion Inspection report continued This service continues to put great effort into trying to engage with service users and to give members of the public information about their service by inviting service users to visit and facilitating focus groups to elicit their views on the service being provided. The manager is very commited to quality improvement and has established a range of systems to evaluate and monitor the quality of the service provided. Who did this inspection Ann Marie Hawthorne Community Alarm Service, page 4 of 23

1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS) took over the work of the Care Commission, including the work of registering care services. This means that from April 1st 2011 this service continued its registration under the new body, SCSWIS. The service provides a 24 hour call out alarm service to people in their own homes and tenants in sheltered housing complexes. The service is provided by North Lanarkshire Council across six locality areas. Community alarms can be installed in the home of anyone in Lanarkshire who had reached the age of 75 and had requested or been assed as needing one. Community alarms are also installed in the homes of those who have been assessed as having a range of additional support needs and would benefit from having this system in place. Response advisors are located in Coatbridge. Mobile home support workers are located across the six localities, Wishaw, Motherwell, Bellshill, Cumbernauld, Coatbridge and Airdrie. Response advisors respond to alarm calls from the unit installed in a person's home, via the two way speaker system. They provide advice and reassurance to the caller. The response advisor will then contact a relative, emergency service or ask a mobile support worker to make a visit. The response advisor, when requesting a home support worker to visit a service user, will be able to give them information about the service user from the information stored on the computer system. The system has been developed for some people to incorporate additional technology alerting the call centre to doors being opened, for example where someone with dementia may leave their home durng the night. Initial assessments are carried out by social work staff, the community alarm service then arranges for the installation of the community alarm to be carried out, following this, a further home assessments is carried out. At the time of this inspection the provider was in the process of reviewing this service from assessment to service delivery, we will look at the findings of this proess and the way in which the service has developed as a result of this at the next inspection. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Community Alarm Service, page 5 of 23

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. Community Alarm Service, page 6 of 23

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 after a short notice inspection that took place on 2nd August 2013 between 10am and 3.45pm and again on the 8th August 2013 between 10:30am and 3.30pm. We also visited people who use the service outwith these times and discussed the community alarm service with them, we have reflected their views throughout this inspection report. The inspection was carried out by Ann Marie Hawthorne, Inspector. Feedback was given to the manager team on the 16th of August between 2pm and 3:40pm. As requested by us, the provider sent us an annual return. The provider also sent us a fully completed self assessment form. We sent 200 questionnaires to service users and their relatives/carers. We received 26 completed questionnaires. We also received completed questionnaires from 12 members of staff who worked in the service. During the inspection we spoke with management, we observed response advisors while they responded to calls. We shadowed a home support worker while installing a new alarm and we visited a number of people living in their own homes who have the alarm system installed. During this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents including: evidence from the service's most recent self assessment questionnaires that had been issued by the care inspectorate and and returned by, service users, relatives and staff participation records including support plans, meeting minutes, forms and questionnaires which the provider has distributed to the people who use the service. service users' personal plans including assessments, care plans, risk assessments focus group meeting minutes staff supervision, training and development records staff meeting minutes service information leaflets quality monitoring tools Community Alarm Service, page 7 of 23

accident and incident records complaint policy and log discussions with service users 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 Community Alarm Service, page 8 of 23

What the service has done to meet any requirements we made at our last inspection The requirement The provider must establish a minimum staffing level which is reasonable for the demands on the service SSI 114 Regulation 13 Staffing A provider shall, having regard to the size and nature of the service, the statement of aims and objectives and the number and needs of service users (a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health and welfare of service users; What the service did to meet the requirement The provider had reviewed the staffing levels required and had recruited additional staff to the service. Further recruitment was ongoing at the time of this inspection. The requirement is: Met - Within Timescales The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted a fully completed and appropriate self assessment. Taking the views of people using the care service into account The people we spoke to about the service told us that it was excellent. We spoke to one person who had experienced difficulty with the staff who had responded to the alarm call on one occasion, however she told us that she was more than happy with the way in which the situation had been addressed by the service manager. In general, people told us that this service provided them with reassurance and a sense of security. Community Alarm Service, page 9 of 23

Taking carers' views into account Inspection report continued We distributes 200 care standard questionnaires, very few of those returned to us reflected the views of carers, however comments made were positive. We saw a range of letters and cards from families and carers that had been received by the service and these were also very positive, we have reflected the content of these throughout this report. We will focus on obtaining the views of carers in relation to this service at the next inspection. Community Alarm Service, page 10 of 23

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: 5 - Very 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 The manager of this service works hard to ensure that people in a range of settings across the Lanarkshire area are aware of the community alarm service and of their eligibility to have the equipment installed. There is evidence that the manager seeks the views of those who use the service and facilitates meetings and forums to give them the opportunity to influence the development of the service. Response advisors seek the views of the caller where possible to identify the action that they want the service to take when they use the system. On completion of the call the file remains open and the response advisor, where appropriate will call the service user to check that the situation has been resolved for them. We saw that this service operates in a highly participative manner in this respect with both people who use the service and their relative/carer. During the inspection all those we spoke to and those we heard during telephone discussion indicated that they were very happy with the service they had received. Of those who responded to the Care Inspectorate questionnaires 96% stated that they either agreed or strongly agreed with the statement 'Overall, I am happy with the quality of care and support this service gives me'. One person said this question was not applicable. In response to the statement 'The service check with me regularly that they are meeting my needs', 95% agreed or strongly agreed. The service held focus groups with service users and carers to discuss issues connected to the quality of the service. The results of the focus groups have been compiled and an action plan has been drawn up. The minutes and the action plans were viewed. questionnaires had been issued to people who used the service, these had been collated and were very positive. The service had also received a number of Community Alarm Service, page 11 of 23

thank you cards from people who had received support, one person had written the service "makes me feel safe" and another had said "I'd be lost without it". One person wrote "it has to be said that this service really helped an elderly lady get the right help very quickly and also made sure her family were there immediately". Within this quality theme, we saw some very good examples of quality monitoring whereby the views of people who use this service were considered in relation to both staffing and quality of management and leadership. This was done through regular courtesy calls which were recorded and were seen by the inspector. There were a range of documents and leaflets in place in different formats and languages explaining how the service can support people. These include information about how to complain about the service and have information about the care Inspectorate included. Areas for improvement Inspection report continued The system had been installed in the homes of 11,200 people at the time of this inspection. The service had recognised the challenge of ensuring that a review of care for this number of people, many of whom had never used the system but indicated through questionnaires that having it in place gave them peace of mind. Through the ongoing business change review at the time of inspection, the review process was being considered and in discussion with the service manager a range of approaches toward review, including building a review of community alarm services into home support reviews, sheltered housing reviews, social work or day service reviews were discussed. It is important that the service identify a method of ensuring that information they hold for people reflects their needs accurately. We will look at the way in which the service has developed the review process at the next inspection. While we saw some very good examples of participation within the service user forum, and there is a North Lanarkshire Participation strategy in place, the manager recognised that for most people there is no ongoing communication with the service. For example, in discussion with people who have the system installed, we established that some people were unaware that they could use the system to give them confidence that it is in working order or to provide the response advisor with information, for example, a change in circumstances. The manager was considering ways in which communication with people who have the system installed could be improved, for example through introducing newsletters. We will look at how this is achieved at the next inspection.the manager was also considering developing a service specific participation strategy. Some people did not have a plan specific to the community alarm service, staff were given direction from the electronic records. Where people had home support provided, community alarm staff use these personal plans to record their input, where there is no personal plan in place, i.e where there is no home support service in place, the service should consider ways in which they can ensure that people have up Community Alarm Service, page 12 of 23

to date information in their house which matches that which is on the computer system and which staff can record outcomes in relation to the service being provided. The service has had one complaint since the last inspection however we would recommend that the service keeps a record of concerns raised by individuals, as many people will stop short of making an official complaint when they pass on a concern, if a record isn't kept of concerns then important issues may get overlooked. In addition, while we were aware that all service users had been provided with the service leaflet outlining the process for complaints, at the time the service commenced, 60% of people completing the care Inspectorate questionnaire indicated that they did not know how to make a complaint (See recommendation 1 under this statement.) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should consider creating a record of issues raised by people who use the service and their carers in addition to re issuing their official complaints procedure to ensure any emerging patterns can be dealt with appropriately. This is a recommendation under the National Care Standards, Housing Support Services, Standard 8; Expressing Your View. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The service is continuing to develop to support people who have a range of complex health and wellbeing needs, the level of technology being introduced is becoming more advanced and can support people more effectively for example use of door alarms. There have been a range of initiatives developed in partnership with, for example Police Scotland. The community alarm service work with them to issue a range of information to keep people secure in their own homes. We saw examples of people being supported while intruders had entered the premises, response advisors were able to intervene through the system and then provided reassurance and support to the service user until additional help was in place. The needs of service users being supported had also increased and staff had been trained to support people who had experienced domestic abuse or those who had difficulties with their mental health. We saw that there was a focus on health and wellbeing at team meetings and best practice was discussed in relation to falls management, domestic abuse, stroke, risk assessment and entering a service users home. we spoke to staff who told us they Community Alarm Service, page 13 of 23

had received training in palliative care which had helped them to respond to people who needed additional support at the end of their lives. We observed response advisors and home support workers engaging with people who used the service in a very dignified and respectful way. The community alarm home support workers continue to be vigilant during visits with service users. They regularly report back to the response advisors who contact various health services that may be required for example: GP, District Nurse, NHS 24 and Ambulance Services as well as identifying if a service user requires input from another support i.e. Occupational Therapy (moving and assistance aids), Home Care (to assist with personal care tasks etc). The service had received expressions of thanks from families about the way in which their input had met the health and wellbeing needs of those who use the service, this reflected our observations during the inspection. One person wrote " I want to express sincere thanks to the community alarm service for all the help received in the late stages of my mum's life, thank you to [name] they were great. Another family member wrote "it gave me peace of mind when mum was on her own". Areas for improvement There is a need to review recording systems to ensure that all relevant documentation is in place in relation to the legal status of individuals using this service, for example adults with incapacity section 47 certificates, power of attorney, guardianship status, identification of those holding legal responsibility (recommendation 1) There is a need to develop a protocol to check the accuracy of information at the point of installation of the alarm system, we observed one situation whereby some significant information was not included within the assessment provided to the community alarm service and there was no prompt to elicit this information or to ensure that the people recorded as key contacts for the person had capacity to operate the system (recommendation 2). Some staff indicated that they are not always provided with relevant information from the response advisors prior to visiting the person, for example, being informed of issues relevant to the persons mental health when they visit to support them after a fall. We discussed this with the manager at feedback and asked that the process is reviewed to ensure that home support workers are aware of all factors that they need to consider to enable them to support the individual effectively. We will look at how this has developed at the next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Inspection report continued Community Alarm Service, page 14 of 23

Recommendations Inspection report continued 1. The provider should review the status of those using the community alarm service and ensure that the relevant information in relation to the legal status of the individual and implications of this on any care recorded within the system, understood and followed by all staff involved in support. National Care Standards 3 Care at Home - Your Personal Plan 2. The provider should review the protocol for gathering information about the service user and take steps to check that it is accurate and includes all appropriate and relevant information about the person receiving the service. National Care Standards 3 Care at Home - Your Personal Plan Community Alarm Service, page 15 of 23

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Please see Quality Theme 1 statement 1 Areas for improvement Please see Quality Theme 1 statement 1 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service review that was ongoing at the time of inspection included a review of staffing to better support the needs of the people who use the service. Active recruitment was ongoing, new staff had been appointed since the previous inspection. It is recognised that the service is small and that at times when 2:1 support is needed for an individual assistance has to be sought from the home support services in the area or from community alarm home support from another locality. From the analysis of response times it was evident that in May 2013, 91% of calls were responded to in less than 45 minutes and in June 2013, 93% of calls were responded to in less than 45 minutes. We observed calls coming into the response advisor and being concluded with assistance of a community alarm home support worker within eight minutes. Staff induction included mandatory training such as; moving and handling, health and safety, National Care Standards, Infection Control, practice guidelines, medication procedures and financial guidelines. Community Alarm Service, page 16 of 23

The service has policies and procedures as laid down in the National Care Standards, such as; recruitment, whistle-blowing, Adult support and Protection. These areas were discussed in team meetings and staff supervision. Senior staff listened to recordings of interaction between staff and service users and used a reflective approach to identify strengths and weaknesses and had evidence of follow-up discussion to address areas for improvement. Staff supervision was taking place annually, new staff received supervision 4-6 weekly. The quality of supervision was good and identified training needs linked to practice experience. Staff that we spoke to said that while at work they were in frequent contact with the office and that the managers operated an open door policy and were very approachable. We saw that response advisors were continually aware of staff locations and availability. Staff meetings continue to be held every month. At these meetings staff were provided with information. These meetings provided opportunity for a two-way process between managers and staff to discuss issues, seek clarification, raise concerns. We saw evidence that practice issues were discussed, for example infection control, quality of gloves, falls. Many team members for the Community Alarm Service have completed or are currently progressing their SVQ 2 in Social Care with 83% of staff eligible for registration with the Scottish Social Council. Comments which came back from service users in our care standards questionnaires are referred to throughout this report and are very positive, 100% of those who completed the care standard questionnaires answered positively to the statement, "Do staff treat you with respect?". Areas for improvement While the senior staff within this service had identified training needs through supervision, the training had not taken place. There was no training matrix in place and the service did not have an up to date analysis of what training was required. There was no evidence of training in, for example dementia, skin care, child protection, some respondents to staff questionnaires indicated a need for training in moving and handling (Requirement 1). Grade awarded for this statement: 5 - Very Good Number of requirements: 1 Number of recommendations: 0 Inspection report continued Community Alarm Service, page 17 of 23

Requirements Inspection report continued 1. The provider must review the way in which staff training is managed within this service, as part of this they must: carry out a training needs analysis which enables them to identify what training staff need develop an action plan with timescales indicating when training will take place through supervision, evidence that the outcome of training is being considered as part of assessment of staff competence and that ongoing learning is being addressed. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210), regulation 15 (a). Timescale: Within 6 months of receipt of this report. Community Alarm Service, page 18 of 23

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Please see Quality Theme 1 statement 1 Areas for improvement Please see Quality Theme 1 statement 1 Grade awarded for this statement: 5 - Very Good 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 this service had performed to a very good standard in the areas covered by this statement. The manager had implemented a broad range of quality systems and had a quality monitoring checklist. Senior staff carry out courtesy calls to people who have used the service to assess their satisfaction, they listen to the recorded call and reflect on the quality of the service provided and take action to address any areas of improvement. Statistics were being gathered and was being used to inform the business change review. The manager knew the service very well. We saw that a number of areas for development had been identified by the service as part of this process and we will look at how this is taken forward at the next inspection. The service has a history of taking actions to meet recommendation made by the Care Inspectorate and also trying to meet the areas for improvement included in these reports. Community Alarm Service, page 19 of 23

The service demonstrated a commitment to enabling service users to be as independent as possible within their own home and the Community Alarm service has a major role in supporting this. The service continues to have close links with other team such as the Community Older People's Team, Hospital Discharge Team, Police Scotland, ambulance services etc. All complaints and compliments were logged electronically, with details of the complaint and action taken. Service users who make complaints about the service are given written details of the outcome of any investigations. We spoke to one person who had complained about the service she received and we were told that she was very impressed with the way in which the manager addressed her concerns. Incidents and accidents were recorded, analysed and followed through, where action needed to be taken this was recorded. Areas for improvement As recommended earlier in this report the service should consider recording any concerns that service users have and not just if the person makes their concern an official complaint. This could improve the service's quality assurance as it may highlight issues before they become complaints and can reveal patterns which management should be aware of. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Community Alarm Service, page 20 of 23

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 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). Community Alarm Service, page 21 of 23

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 24 Aug 2012 Unannounced Care and support 4 - Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 10 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 22 Jan 2010 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership Not Assessed 19 Dec 2008 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Community Alarm Service, page 22 of 23

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 Community Alarm Service, page 23 of 23