Ark Perth & Arbroath Housing Support and Care at Home Housing Support Service The Gateway North Methven Street Perth PH1 5PP Telephone: 01738 446848 Inspected by: Averil Blair Type of inspection: Unannounced Inspection completed on: 16 December 2013
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: Ark Housing Association Ltd Service provider number: SP2003002578 Care service number: CS2004073962 Contact details for the inspector who inspected this service: Averil Blair Telephone 01382 207200 Email enquiries@careinspectorate.com Ark Perth & Arbroath Housing Support and Care at Home, page 2 of 21
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 was able to react flexibly to the needs of service users, and we could see that the service had worked with both service users and families to ensure that the service met identified needs. What the service could do better The service had made some changes to staff teams and how they were managed and this had impacted on some aspects such as the frequency of team meetings. The Manager confirmed that Team Leaders had recently become supernumerary and this should mean that team meetings returned to their monthly frequency. What the service has done since the last inspection The service which covered the Perth area had recently moved into dedicated premises and this meant that they no longer had to use office space in the Care Home. Conclusion Service users spoken with during the inspection said that they were happy with the service they received. They said that they liked their staff and felt they could speak with them about any problems they had. They knew who their key workers were and were able to describe what was discussed at their six monthly reviews. Ark Perth & Arbroath Housing Support and Care at Home, page 3 of 21
Who did this inspection Averil Blair Ark Perth & Arbroath Housing Support and Care at Home, page 4 of 21
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Ark Housing Association provides a combined Housing Support and Care at Home service to service users living within the Perth and Arbroath areas. Many of these service users have previously lived within the residential services provided by Ark Housing Association in Perth and Arbroath, but this is not an essential criteria for using the service. This is a flexible service, the number of hours provided is based on identified needs of individual service users and is designed to maximise independence. 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 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 Ark Perth & Arbroath Housing Support and Care at Home, page 5 of 21
www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Ark Perth & Arbroath Housing Support and Care at Home, page 6 of 21
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 an unannounced inspection which took place over a number of visits between 1 November and 16 December 2013. We gave feedback to senior staff on 16 December 2013. As requested by us, the service sent us an annual return. The Care Inspectorate wrote to the service to request completion of the self-evaluation form. Care Standard Questionnaires were sent to the service to distribute to service users. In this inspection we gathered evidence from the following sources:- - interviews with staff - interviews with service users - interviews with managers - a sample of personal plans - a variety of records such as training plans, risk assessments and minutes of meetings - relevant policies and procedures. 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. Ark Perth & Arbroath Housing Support and Care at Home, page 7 of 21
Fire safety issues Inspection report continued 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 Ark Perth & Arbroath Housing Support and Care at Home, page 8 of 21
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 fully completed self assessment from the service. We were satisfied with the way they had completed this with relevant information under each heading we grade them under. They identified what they thought they did well, some areas for improvement and any changes they planned. The service included information on how they involve people using the service in improving the quality of the service. Taking the views of people using the care service into account During the inspection we spoke with people who used the service. They told us that they were very happy with the service they received, and said that they felt the staff supported them well. They made comments such as "I like my key worker, and she helps me with my money", "I can ask the staff if they could change the time they support me if I have something on and they can sometimes do this", and "I really appreciate the support I get from staff and it has made a huge difference to me". Taking carers' views into account No carers were available during this inspection. Ark Perth & Arbroath Housing Support and Care at Home, page 9 of 21
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 service was able to provide very good evidence in support of this statement. During the inspection we visited people who used the service in their own homes, and sampled the records kept by the service. These showed that reviews of the service provided were held at appropriate timescales and, in some cases, we could see that changes were made to care packages where it was identified that the needs of people who used the service had changed. A participation strategy was in place, and this gave clear guidelines to staff on how to encourage participation by people who used the service. The provider had employed a Participation Officer who worked across all the provider's services. Their role was to work with staff and people who used the service to encourage them to take part in the development of the service. She had created opportunities for service users across the organisation to get together to discuss issues which affected them. The service had employed a Speak Out worker who was a local member of staff who worked with staff and individual service users, as well as organising meetings to encourage service users to comment on the service they received. Service users of the Arbroath and Perth service had been given the opportunity to attend these meetings which were arranged locally. All service users who we spoke to during the inspection felt they could approach their key worker or other staff for support, and all felt generally supported by staff. They also felt they could make suggestions for changes to their personal support to meet their needs. This meant, for example, that when they had been invited to important events, the times of their support could be changed or staff could accompany them. Ark Perth & Arbroath Housing Support and Care at Home, page 10 of 21
Service users were involved in a regular audit of their own service, which happened on a monthly basis. All service users that we spoke to told us that they thought this was a useful opportunity for them. We could see that where a service user, carer or staff member identified a required change, then this was carried out wherever possible. Service users had in the past been involved in the appointment of staff, and had identified questions they wished potential staff to be asked at interview. At the time of the inspection service users from Perth were attending training to encourage them to take part in this process. All service users had the opportunity to complete an annual questionnaire on the service, which was returned to the organisation's head office in Edinburgh. The service received feedback on returns. Areas for improvement The service had just taken Team Leaders completely off the rota, which meant that they aimed to allocate time to review support plans with service users on a more regular basis. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ark Perth & Arbroath Housing Support and Care at Home, page 11 of 21
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service was able to provide good evidence in support of this statement. We sampled some service users' support plans and could see that they contained comprehensive support plans. This gave staff the necessary information to allow them to support service users appropriately. This included detailed information for staff on more complex issues, such as behaviour or health management. Where this was the case, we could also see that the service had worked closely with associated professionals such as District Nurses, Community Learning Disability Nurses or Psychology staff. Where risk issues were identified, staff carried out risk assessments and we could see that this fed into the completion of support plans. Support plans used graphics and pictures as appropriate to make them more accessible for service users. Support plans were evaluated and monitored on a monthly basis, at which time service users had the opportunity to speak with their key worker. As part of the inspection we visited some of the people who used the service. All were sure that they received a good level of support from the service. They said that staff were always on time, but that if they wished to change the time they received their care, perhaps because they wanted support to go to a social occasion, this was usually possible. Service users showed us their personal plans and these showed that the service supported them to attend to their physical health such as supporting them to attend their GP or District Nurse. They also said that staff encouraged them to live as healthy a life as possible, for example encouraging them to follow a healthy eating programme. Most people we spoke to said that they took their own medication with the help of staff. This might include staff reminding them to take their medication, or helping them to get repeat prescriptions. Staff completed an assessment of service users' ability to self medicate, and staff supported service users wherever possible to be as independent as possible regarding their medication. Records in personal plans showed that all relevant information relating to health and medication was appropriately recorded by staff. Areas for improvement In the service's self assessment which was submitted to the Care Inspectorate prior to the inspection, the service identified that due to staff changes, it had not always been possible to have team meetings. This may have impacted on services, although staff commented that this was improving. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ark Perth & Arbroath Housing Support and Care at Home, page 12 of 21
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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Ark Perth & Arbroath Housing Support and Care at Home, page 13 of 21
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service was able to provide very good evidence in support of this statement, which confirmed the service's own assessment. Staff had a clear vision of the aims and objectives of the service, and demonstrated a good knowledge of individual service users' support needs. Personal plans were seen to contain frequent, regular, good quality updates from staff, plus communication logs were used to pass on general information, for example relating to repairs or activities. Staff told us that they felt they were kept up to date with any changes to service delivery. Staff confirmed that they had opportunities to discuss issues at staff meetings, and this included discussions on the provider's recent reorganisation. Staff also confirmed that they had access to training, particularly relating to the support needs of people who used the service. Staff felt that they were well supported, and received supervision from senior staff. The manager was able to confirm that the service had just introduced a new system for the management of performance, which included the use of objective setting and appraisal as part of the supervision process. Support was provided from four teams, three in Arbroath and one in Perth, and an on call system was in place for out of hours support. This meant that there was always a senior member of staff available to allow staff to discuss any emergency issues or concerns. A record was kept of training completed, and a central record of training organised or planned by the provider. Training included good practice issues such as value based training, plus specific training related to service users' needs; for example, dementia, autism, epilepsy and moving and handling. The organisation had recently been credited as autism friendly by the Scottish Autism Society. Areas for improvement Inspection report continued Although staff were happy with the frequency of staff team meetings, these were irregular and some teams had not had a team meeting for some time. Based on some of the minutes of team meetings we saw during the inspection, staff would benefit from training in recording minutes of team meetings. Some documents were not dated, for example performance management review dates or team meetings and staff are encouraged to ensure that all documents are appropriately dated. Ark Perth & Arbroath Housing Support and Care at Home, page 14 of 21
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ark Perth & Arbroath Housing Support and Care at Home, page 15 of 21
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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Ark Perth & Arbroath Housing Support and Care at Home, page 16 of 21
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 Evidence discussed in Quality Theme 1 Quality Statement 1 is also relevant to this statement and was considered as part of the inspection process. The provider had appointed a Quality Assurance Manager, whose role was to encourage staff and people who use the service to be involved in making comment on the service they provide and receive. This involved the sampling of service user files, including risk assessments and reviews, and followed through a sample of actions carried out as a result of these processes. Where appropriate, this also included the audit of financial records. Staff carried out a monthly housing support service audit of personal plans along with service users. These were referred to as monthly chats. This looked at whether personal plans were still relevant and whether service users felt there should be any changes made. The service carried out a range of audits, and this included six monthly audits carried out by Team Leaders. This audit included a review of all service user paperwork such as risk assessments, personal plans and all other records held. The Manager sampled these audits to ensure identified actions were carried out. The provider had previously been awarded the Investors in People award, and achieved gold standard in 2012. Areas for improvement The service should continue to monitor the quality of service it provides, and ensure that all audits are appropriately signed and dated by the responsible person. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ark Perth & Arbroath Housing Support and Care at Home, page 17 of 21
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). Ark Perth & Arbroath Housing Support and Care at Home, page 18 of 21
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 1 Nov 2012 Announced (Short Notice) Care and support Staffing Management and Leadership 4 - Good 5 - Very Good 4 - Good 29 Jul 2011 Unannounced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 18 Oct 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 20 Aug 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership 3 - Adequate 22 Jan 2009 Announced Care and support 4 - Good Staffing 4 - Good Ark Perth & Arbroath Housing Support and Care at Home, page 19 of 21
Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Ark Perth & Arbroath Housing Support and Care at Home, page 20 of 21
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 Ark Perth & Arbroath Housing Support and Care at Home, page 21 of 21