Lifeways Community Care - Glasgow Housing Support Service Munro Business Park Munro Place Kilmarnock KA1 2NP Telephone: 01292 474748 Type of inspection: Unannounced Inspection completed on: 27 June 2017 Service provided by: Lifeways Community Care Ltd Service provider number: SP2004006707 Care service number: CS2004079683
About the service Lifeways Community Care Glasgow provides support to people with a range of complex needs and disabilities. It provides a service covering North and South Lanarkshire, East Renfrewshire and Glasgow. The office for this service is currently in Kilmarnock which makes it very difficult for service users and also staff to access the office, the Provider told us that they were trying to locate more accessible accommodation in the Glasgow area. What people told us Prior to the inspection we sent out 24 care standard questionnaires to gather opinions about the service. We received seven completed questionniares back. During the inspection we visited five people in their own homes and phoned relatives to get their feedback on the quality of the service provided. We received a mixed response, generally people were quite happy with the support workers who visited them on a regular basis and people were happy that they usually received support from a small group of staff. However several people said that staff changes had happened recently and they were not happy losing support staff that they were familiar with. Another remark made by several people was that they had difficulty getting hold someone on the phone if they needed to discuss something. "all in all it's quite good but the support workers have been chopping and changing recently and I'd prefer they didn't." Another relative told us; "I phoned the company to complain (about staff changes) and there was no one I could speak to." Self assessment We did not ask services to complete a self-assessment this year. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 3 - Adequate 3 - Adequate Quality of care and support Findings from the inspection People told us that they were treated with respect by their staff. We saw several people being supported by staff and the staff appeared to have a good understanding and rapport with them. This is possibly an outcome from service users, on the whole, having a core group of staff who get to know them well. We visited five people at short notice and found that people were being supported to live in nice environments which meant staff respected their rights to live in clean and tidy homes. People were also supported to maintain their personal appearances thereby treating them with dignity. page 2 of 12
People told us that their needs had not been reviewed so they were not confident that all staff would be aware of what was important to them. This fitted with what we found, which was that the majority of care plans and care reviews were out of date. Paperwork being out of date is particularly serious when you have new or unfamiliar staff going in to provide support to people. (See requirement one under this theme.) People told us that they were not asked their opinions on the service. While we acknowledge the provider had sent out questionnaires to people who use the service, they need to do more than this to make people feel engaged with the service. They should review their participation methods to give as many people the chance to participate in the development of the service as possible. This should influence the service's self-evaluation and improvement plans. (See recommendation one under this theme.) Although staff have received medication training during their induction into the service, the first complaint investigation found that there were areas around medication which needed to be tightened up on. Particularly, how medication is audited. These areas were not shared with the staff we spoke with and given the lack of supervisions and team meetings we concluded that these were not passed on to other staff either. (see recommendation two under this statement.) The provider has organised training in July and August for a number of staff on how to support positive behaviour. This should increase staff understanding on how to support people with additional behavioural issues. This had been recommended during a recent complaint investigation. Some people we spoke with told us that their right to request changes in the staff who provide their support had been honoured and changes were made to their support teams. However we were also told that when different people organised their rotas, staff who had been removed were placed back on their rotas due to a lack of communication. If the provider used the computer system they have to full capacity it would help ensure that these mistakes did not happen. We spoke with a Director of the company who told us that the Lifeways are looking at this issue. Requirements Number of requirements: 1 1. The Provider must ensure that people they support have the opportunity to discuss their needs and wishes on a regular basis and share any concerns that they have. In order to do this the provider must ensure that care and support plans are reviewed and updated when necessary but at least every six months. Service users and anyone who they feel is important such as family members and or social workers should be involved in this process. Good practice would be that support staff who regularly provide support to service users should also be involved in the care and support reviews. This is in order to comply with SSI 2011/210 5 (2) (b) Personal plans. Timescale: By the 26.10.17 the provider must evidence to the Care Inspectorate that all service users have had reviews within the last six months. page 3 of 12
Recommendations Number of recommendations: 2 1. The provider should encourage and support people who use the service and their representatives to get involved in the development of the service. The provider should look at removing any barriers which may prevent people from doing so. In order to do this the provider should review their participation methods and assess what works well and what has not worked well and what needs to change in order to maximise service user involvement in the review and development of the service. NCS Housing Support Service, Standard 3, Management and Arrangements. 2. The service should ensure that individuals are supported to safely manage their medication. In order to do this the service should ensure staff receive regular refresher training on medication management and that any areas of learning which come from; medication audits, complaints investigations or new best practice guidance are shared with staff through supervision or team meetings or training updates. NCS Housing Support Services, Standard 4, Housing Support Planning. Grade: 3 - adequate Quality of staffing Findings from the inspection Some of the feedback that we received from people who used the service was that they had positive relationships with staff and they felt that staff cared about them. Some people told us that they had been able to make decisions about their care (how and when it was delivered etc.) and their staff team were supportive of this. Some service users and their relatives however told us that they were unsure if newer staff knew what their needs and wishes were because they had not been involved in recent review meetings and their care plans were out of date. Some people said that communication from the office to both service users and staff wasn't good. Having spoken with several staff and sampled records we concluded that staff were not given the support that they should through; supervision, appraisals and team meetings. We acknowledge that the provider has identified this is an area that the service needs to address and there were indications that this was beginning to improve. (see recommendation one under this statement.) page 4 of 12
People who use the service have in the past been able to take part in the recruitment of staff. An outcome from this was that people felt more confident that they had the right staff in place to support them. However this has not happened recently so the provider should encourage and support people to engage in staff recruitment again. (see recommendation two under this statement.) We sampled the files of staff recruited in the last year and found that the provider has safe recruitment procedures in place to ensure that they do not employ someone assessed as unsuitable to work with vulnerable individuals. The provider could improve this procedure by routinely requesting a third reference from new candidates if either of the first two references offers limited information. The provider should also ensure that relevant managers sign off staff induction procedures as we found gaps in the files we sampled. New staff are put through a standard induction process to allow them to support people safely. In addition the provider has organised for some additional training for particular staff where a need has been identified. How this is captured in training records should be clearer however. Management told us that their computer system could capture all staff training and link this to the needs of service users however the system has not been utilised as yet. The Director we spoke with told us that Lifeways are looking to address this. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The provider should ensure that support staff are kept up-to-date with the needs of service users and of best practice procedures. To do this the service should ensure that staff receive regular supervision and appraisals and have the opportunity to meet together to discuss the needs of the people they support. NCS Housing Support Services, Standard 3, Management and Arrangements. 2. The provider should ensure service users and their relatives are able to influence staff recruitment and development. In order to do this the provider should consider what measures are in place to support service users to have input into staff recruitment, supervisions, appraisals and training. They should also consider how this is evidenced and include this information in any future service evaluations. NCS Housing Support Services, Standard 3, Management and Arrangements. Grade: 3 - adequate Quality of management and leadership page 5 of 12
Findings from the inspection The service has had a number of management changes over the last year and management acknowledge this has affected their ability to take the service forward. An outcome from this is that; services users, their relatives and staff told us that they have limited confidence in the way that the service is managed. However during the inspection some staff and service users told us that their initial impressions of the new management team were positive. We met with the management team and they were enthusiastic about making improvements to the service which was reflected in the feedback we received from staff about management being more visible than before. The management team were open about having conflicting priorities within their roles between following the provider's improvement plan and meeting service user's daily needs. It is essential that the provider meets with managers to review plans to improve the service. (see recommendation one under this theme.) Service users and staff told us that they had difficulty getting hold of someone in the office when they needed to. This was an issue that was raised at the previous inspection. The outcome from this is that people are unsure, that if they have concerns they will be able to get a suitable response. We were also told that team leaders who are in the community as the first line of support for staff do not have mobile phones, meaning staff cannot contact them for advice if they need it. (See requirement one under this theme.) The provider should develop an induction procedure and training plan for team leaders and managers. Managers that we spoke with said that they relied on their colleagues to provide informal support, team leader had not received any training on aspects specific to their role such as supervision. (See recommendation two under this theme.) The provider should review how important information on the people they support is stored so that it can be accessed as necessary by relevant staff. As previously mentioned, there has been significant changes in management over the last year; we found examples where important information had not been passed on to new managers when management changes had been made. Had the service's computer system been fully operational then information would have been there for new managers to access. We were concerned to hear that on-call managers do not have access to essential information with which they can base their advice and decision on. (see requirement two under this theme.) Requirements Number of requirements: 2 1. The provider must ensure that service users and staff are able to contact someone for advice or support during the hours that the service operates. In order to do this the provider must: - Engage with staff and service users to identify when they are experiencing difficulties contacting someone on the phone, put a plan in place for how this can be improved, inform service users and staff what action will be taken, then review opinions to ensure the action taken was effective. - The provider must review the role of team leaders, if they are provide support to staff in the community the provider must provide the means for staff to be able to contact them. page 6 of 12
This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No. 210 Regulation 4 (1) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: By 13.09.07 2. The provider must introduce safe and secure systems for on call staff to retrieve the information that they need to be able to carry out their role effectively. This must take into account the underpinning principles of legislation and good practice for the management of confidential information. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No. 210 Regulation 4 (1) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: By 13.09.07 Recommendations Number of recommendations: 2 1. The provider should ensure that improvement plans have local management input to ensure that they focus on the areas of highest need with achievable targets. In order to do this the provider has to meet with local management to review current improvement plans. NCS 3 Housing Support Services - Management and Arrangements 2. The provider should ensure that managers and team leaders are supported to gain the skills, knowledge and confidence to carry out their role. In order to do this the provider should review their induction procedures for managers and team leaders and ensure they can evidence that inductions have been completed. NCS 3 Housing Support Services - Management and Arrangements Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. page 7 of 12
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should provide outcome focused care plan training to support workers to enable them to assist in the development of care plans. NCS 3 Housing Support Services - Management and Arrangements This recommendation was made on 31 October 2016. So many care plans that we looked at were out of date that this recommendation can not have been met. On top of this staff had not been part of any training to do with care planning. This recommendation will be reiterated in this report. Recommendation 2 The provider should use a recognised tool to assess how successful their participation strategies have been. NCS 3 Housing Support Services - Management and Arrangements. This recommendation was made on 31 October 2016. Given most people of the people that we spoke with felt that communication could be improved between the office and the services this recommendation has not been tackled in any meaningful way. Recommendation 3 The provider should ensure that staff receive supervisions at regular intervals and in line with the providers supervision policy. This should be monitored. This recommendation was made on 31 October 2016. Supervision may have been monitored however so many staff told us that they have not had supervision for a long time, if ever, that monitoring supervision appears to make no positive difference to the current situation. This is discussed again under theme three in this report. Recommendation 4 The provider must ensure that staff who have managerial responsibilities are allocated enough time to carry these responsibilities out, once this has been reviewed the provider should monitor this to ensure this time is protected and not used to cover care and support duties. NCS 3 Housing Support Services - Management and Arrangements. page 8 of 12
This recommendation was made on 31 October 2016. Managerial tasks are not being completed on time and in line with the expectations of the provider organisation. Work needs done to review the priorities of the service. We will discuss this more under theme four in this report. Recommendation 5 The service provider should ensure that the support planning procedure gives clear direction to staff on how to meet service user's needs, and promotes good outcomes for service users. NCS 3, Care at Home - Your personal plan This recommendation was made on 30 March 2017. Support plans were not being kept up to date so they were not a useful guide for staff supporting service users. There was some evidence that the service provider was trying to address this, but more work need to be done in this area. This is reflected in requirement one under theme one in this report. Recommendation 6 The service provider should ensure that all staff are aware of and implement the policy in relation to positive behaviour support. NCS 4.2 and 4.5, Care at Home - management and Arrangements This recommendation was made on 30 March 2017. Since this recommendation was made there have been very few team meetings or supervision sessions involving staff so we are unclear as to how this recommendation could be met. The registered manager told us that there has been training organised for some staff in July and August on positive behavioural support. Recommendation 7 The service provider should ensure that all staff are following the procedures for incident reporting. This recommendation was made on 30 March 2017. While we have had some notifications made to us appropriately there have been other notifiable incidents which we have not been notified about. More work needs done under this area which we discussed with managers during this inspection. Recommendation 8 The service provider needs to improve medication management within the service. This includes: - Assess all staff competency in medication management and record supervision records. - Where there are any gaps in knowledge provide staff with medication training. - Ensure all staff and management are aware of and implement the service audit procedures for medication management. page 9 of 12
NCS 8, Care at Home, Keeping Well This recommendation was made on 7 March 2017. We looked at medication procedures within the houses we visited and found them to be adequate, however since the recommendation was made there has not been additional medication training or refresher training identified for staff. So this recommendation remains unmet and is reiterated in recommendation two under theme one in this report. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 31 Oct 2016 Announced (short notice) Care and support 4 - Good Management and leadership 4 - Good 26 Feb 2016 Unannounced Care and support 4 - Good 4 - Good Management and leadership 4 - Good 19 Mar 2015 Unannounced Care and support 4 - Good 4 - Good Management and leadership 4 - Good page 10 of 12
Date Type Gradings 18 Jun 2013 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 25 Jun 2012 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 20 Jun 2011 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 10 Nov 2010 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 24 Jul 2009 Announced Care and support 5 - Very good 4 - Good Management and leadership 5 - Very good 14 May 2008 Announced Care and support 4 - Good 4 - Good Management and leadership 4 - Good page 11 of 12
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 12 of 12