Carewatch (Edinburgh, Mid & East Lothian) Housing Support Service 29 Drumsheugh Gardens Edinburgh EH3 7RN Inspected by: Mary Moncur Type of inspection: Announced Inspection completed on: 22 July 2011
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 15 4 Other information 32 5 Summary of grades 33 6 Inspection and grading history 33 Service provided by: Graham Homecare Limited Service provider number: SP2006008172 Care service number: CS2006117162 Contact details for the inspector who inspected this service: Mary Moncur Telephone 0131 653 4100 Email enquiries@scswis.com Carewatch (Edinburgh, Mid & East Lothian), page 2 of 35
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 2 Weak Quality of Staffing 2 Weak Quality of Management and Leadership 2 Weak What the service does well The service provides care and support which enables people to stay in their own homes for as long as they want to. Care staff we spoke to told us that they encouraged people to maintain their independence as much as possible. The new management team has worked hard to improve the service, including working with us and the local authority to improve the quality of care and support provided. What the service could do better We are extending the timescale on the aspects of the Improvement Notice which have not yet been met to give the provider further opportunity to achieve these. These are in relation to monitoring that complaints are dealt with consistently and care improves where complaints are upheld, making sure there are enough regular staff to cover all visits and there is a system in place to make sure visits happen as planned, making sure records of the assistance required with medication are consistent, staff's competence in administering medication has been checked and there is a system in place to monitor that medication is being taken as prescribed. The provider must also make sure the improvements to recruitment, selection and induction of staff and staff supervision, appraisal, training and retention are maintained and built on. What the service has done since the last inspection The service has achieved most of the improvements outlined in the Improvement Notice we issued in March 2011, including improvements to how they deal with complaints, making sure visits take place at the time they should and the number of staff required to visit, medication administration and recording, the on call service and Carewatch (Edinburgh, Mid & East Lothian), page 3 of 35
making sure there are enough suitably competent people working in the service to meet the needs of people using the service. The service has also improved spot checking, supervising and training for staff. Conclusion The managers of the service acknowledge that while a number of improvements have been made there is still a lot of work to do to make sure the service consistently provides the quality of care people using the service should expect. It is our intention to visit the service in three months time to make sure the outstanding improvements have been achieved. Who did this inspection Mary Moncur Lay assessor: Mr David Tares Carewatch (Edinburgh, Mid & East Lothian), page 4 of 35
1 About the service we inspected Social Care and Social Work Improvement Scotland (SCSWIS) regulates care services in Scotland. It awards grades for services based on the findings of inspections. These grades, including any that services were previously awarded by the Care Commission, are available on www.scwis.com Carewatch (Edinburgh, Mid & East Lothian) provides both a care at home and housing support service. The services are provided in a combined way by the same manager and staff team. Until recently Carewatch (Edinburgh, Mid & East Lothian) was a franchise of Carewatch Care Services. The provider, Graham Homecare Ltd, remains the same however the company is now part of Carewatch Care Services Ltd. The service operates in line with their policies and procedures and support is provided by their senior management team. The service provides care and support to adults living in their own home throughout Edinburgh. The level of care and support provided is based on individual need. At the time of inspection 80 people were using the service. Before 1 April 2011 these services were registered with the Care Commission to provide a care at home and a housing support service. 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 registration of care services. This means that from 1 April 2011 these services continued their registrations under the new body, SCSWIS. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 2 - Weak Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 2 - Weak 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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Carewatch (Edinburgh, Mid & East Lothian), page 5 of 35
2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report after an announced inspection of the service. The inspection was carried out by Mary Moncur, SCSWIS inspector and David Tares, lay assessor. It was planned with the manager and carried out between 6 and 15 July 2011. Feedback was given to the manager, operational manager, co-ordinators, supervisor and the senior contracts officer from City of Edinburgh Council on 22 July 2011. As requested by us, the provider sent us an annual return. The provider also sent us a self assessment form. We issued 35 questionnaires to people using the service or their relatives. 14 were returned. We spoke, by phone or during visits, to 20 people using the service and/or their relative. Five of these people had also returned questionnaires. In this inspection we gathered evidence from various sources, including the following the service's most recent self assessment discussion with the manager, the operational manager, trainer and care staff shadow visits with care staff recruitment and induction policy and procedures quality policy sample of records for people using the service, including care plans, comments for care staff, medication administration records, visit records and reviews scheduling information and rota for a sample of people using the service sample of staff records, including recruitment records, spot checks, supervision, appraisal and training manager's audit of staff's spot checks, supervision and appraisal complaints records records of satisfaction monitoring by the service most recent Carewatch quality audit findings from a monitoring visit carried out by us in May 2011 Carewatch (Edinburgh, Mid & East Lothian), page 6 of 35
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 report continued 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 Carewatch (Edinburgh, Mid & East Lothian), page 7 of 35
What the service has done to meet any requirements we made at our last inspection The requirement In order to meet the health and welfare needs of the service users the provider must ensure care and support plans include the level of detail needed by staff to provide the care required. This includes detailing the catheter care to be provided. What the service did to meet the requirement See Quality Theme 1 Statement 3 for details of action taken. The requirement is: Met The requirement The provider must make sure it continues to follow its procedures for spot checks and make sure it follows its procedures for supervision of staff in a way which makes sure staff are carrying out care outlined in individual's care and support plans. What the service did to meet the requirement See Quality Theme 3 Statement 3 for details of action taken. The requirement is: Met The requirement The provider must ensure that staff have the appropriate training to carry out their duties and that there are adequate systems in place to assess the competence of staff and monitor the quality of care and support being provided. What the service did to meet the requirement See Quality Theme 3 Statement 3 for details of action taken. The requirement is: Met What the service has done to meet any recommendations we made at our last inspection We made the following recommendations at the last inspection 1. The service should continue to follow its procedures for frequency of review depending on the vulnerability of the service user, making sure it involves the service Carewatch (Edinburgh, Mid & East Lothian), page 8 of 35
user's relative or other representative where the service user may find it difficult to express their views. See Quality Theme 1 Statement 1 for details of action taken. This recommendation is not fully met and is continued at this inspection. 2. The service should make sure their plans to improve staff training in the use of special equipment are carried out and staff's competence is checked before they carry out visits on their own and at regular intervals to make sure competence is maintained. See Quality Theme 1 Statement 3 for details of action taken. This recommendation has been met. There were a number of recommendations carried over at our last inspection. That inspection focused on outstanding requirements and we did not follow up on recommendations at that time. 1. The service should make sure it responds to all concerns raised by service users and/ or relatives. See Quality Theme 1 Statement 1 for details of action taken.this recommendation is continued. 2. The service should make sure the provider's procedures for setting up a new care package are followed. See Quality Theme 1 Statement 2 for action taken. This recommendation is continued. 3. The service should improve the induction for new staff who have not had previous care experience. See Quality Theme 3 Statement 2 for details of action taken. We have made a requirement in relation to all new staff completing the improved induction process. 4. The service should make sure the field supervisors are given development opportunities to carry out their role. See Quality Theme 3 Statement 3 for details of action taken. Because new supervisors have recently started this recommendation is continued. 5. The service should consider whether pay and conditions contributes to the high staff turnover and, if so, how this could be improved. Carewatch (Edinburgh, Mid & East Lothian), page 9 of 35
See Quality Theme 3 Statement 3 for details of action taken. This recommendation has been met. 6. The service should make sure staff are dressed appropriately for their task with regard to being in the service user's own home. We saw staff dressed appropriately on shadow visits. Spot checks on staff carried out by the service recorded staff were dressed appropriately. There have been no complaints to the service or to us about the way staff are dressed. This recommendation has been met. 7. The service should respect the service user's preference for the gender of carers wherever possible. See Quality Theme 1 Statement 2 for details of action taken. This recommendation has not been fully met and is continued. 8. To ensure consistency of care the service should make sure regular carers are identified for all service users. See Quality Theme 1 Statement 1 for details of action taken. This recommendation became part of the Improvement Notice issued to the provider in March 2011.This improvement has not been fully met and the timescale for completing this aspect of the Improvement Notice is being extended. 9. The service should consider how care staff can be supported to continue to develop their knowledge and skills in working with people with dementia, through working alongside more experienced carers, reflection on their practice and further training as relevant. See Quality Theme 1 Statement 3 for details of action taken. This recommendation is continued. 10. The service should make sure that staff's practice is supervised regularly, that training is provided relevant to the needs of service users and that any concerns about a member of staff's practice are followed up quickly. See Quality Theme 3 Statement 3 for details of action taken. This recommendation was covered by a requirement made at the last inspection. This requirement has been met. We have made a further requirement at this inspection that the improvements made must be maintained and built on. 11. The service should make sure the on call service records all calls and passes on messages to the manager. Carewatch (Edinburgh, Mid & East Lothian), page 10 of 35
See Quality Theme 1 Statement 3 for details of action taken. This recommendation became part of the Improvement Notice issued to the provider in March 2011. This improvement has been achieved. 12. The service should make sure people using the service, and their relative where appropriate, are notified in advance of the timing of the care and who the carer will be. See Quality Theme 1 Statement 1 for details of action taken. This recommendation became part of the Improvement Notice issued to the provider in March 2011. This improvement has been achieved. 13. The service should be consistent and reliable in relation to who is giving the care and also in the way and timing of how it is given. Service users should be notified in advance of any necessary changes to the timing of the care and who is the home care worker. See Quality Theme 1 Statement 1 for details of action taken. This recommendation became part of the Improvement Notice issued to the provider in March 2011. This improvement has not been fully met and the timescale for completing this aspect of the Improvement Notice is being extended. 14. The service should review the Written Agreement and agree the times that the service should be delivered. Staff rotas should match these times. See Quality Theme 1 Statement 1 for details of action taken. This recommendation became part of the Improvement Notice issued to the provider in March 2011. This improvement has been achieved. 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. Social Care and Social Work Improvement Scotland received a 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 Carewatch (Edinburgh, Mid & East Lothian), page 11 of 35
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 80 people were using the service at the time of the inspection. We sent 35 care standard questionnaires and 14 were returned. Four were completed by people using the service, one with help from a care worker and 10 were completed by relatives. People using the service told us * they had a personal plan that detailed their needs and preferences * three agreed the service checked regularly that it was meeting their needs and one strongly disagreed * staff treated them with respect * two were confident staff had the skills to support them, two disagreed, one strongly, with this. * three agreed the service asked for their opinion on how it could improve, one strongly disagreed * they knew about the service's complaints procedure * two knew they could make a complaint to Social Care and Social Work Improvement Scotland and two didn't * three agreed they were happy with the service overall and one disagreed strongly We spoke by phone to the person who strongly disagreed the service checks regularly that it is meeting their needs, that staff have the skills to support them and that the service asks for their opinions on how it can improve and said they were dissatisfied with the service overall. They told us they were unhappy because their care plan didn't detail their needs and hadn't been reviewed for some time, the service doesn't tell them when there are staff changes or when they are going to be late. They did also say that they had regular carers who came at the right time. We viewed the scheduling information for a sample week for this person and found 2 of the four visits were covered by a worker who was not a regular carer. There was no care plan in the person's records and the information on the comments on carers rotas was limited and included instruction to prompt medication when this was not part of the care to be provided. There was a record of a review having taken place in February 2011. We discussed this response with the manager, who told us they were aware of issues with providing this care package. They would review arrangements and make any improvements possible. The other person who disagreed that staff had the skills to support them did not give their name so we were unable to follow up their concerns. We spoke to another eight people who use the service, one of whom had also returned a questionnaire. We spoke to four during shadow visits with care staff and Carewatch (Edinburgh, Mid & East Lothian), page 12 of 35
four by phone. They were all happy with the service overall, particularly with their regular carers. One person told us the service had improved significantly in the past few months. We heard that many of the care staff were students, which meant there was a high turnover at particular times of the year. It was suggested that the service needed to plan their recruitment better to manage this and to make sure inexperienced staff were well trained and inducted, particularly to meet more complex needs. We shared this at feedback and the service intends to take this into account in future. Taking carers' views into account The 10 relatives who returned questionnaires told us * seven people's relative had a personal plan that detailed their needs and preferences, the other three didn't know * four agreed the service checked regularly that it was meeting their relatives needs, three didn't know and one strongly disagreed * staff treated their relative with respect * seven were confident staff had the skills to support their relative, three disagreed with this, one strongly * four agreed the service asked for their opinion on how it could improve, three disagreed, two didn't know and one didn't reply * six knew about the service's complaints procedure and four didn't * four knew they could make a complaint to Social Care and Social Work Improvement Scotland and six didn't * eight agreed, one strongly, they were happy with the service overall and two disagreed "Some of your carers do not know what is needed...i hope you know what I mean. I'm saying the two carers I have at present are excellent." "The carer from Carewatch is very good and he is always polite, helpful & ensures all is ok and medicine is sorted for night dose. He also ensures all meals are taken." "(Name) has good service mon - frid. Sat-Sun is terrible. (Name) could do with much more help as it is too much for me." "Care package does not take account of (name's) medical and physical conditions." We spoke to the person who disagreed that the care plan detailed needs and preferences, that staff had the skills to support their relative and that they were happy with the service overall. The issues were reflected in the comment above that the care package does not take account of the person's medical and physical conditions, particularly their sight impairment. We found that the comments for Carewatch (Edinburgh, Mid & East Lothian), page 13 of 35
carers did note the person's sight impairment and the need return items to the place they were found. The scheduling information indicated that one of three visits was unallocated and the person's social worker told us that the carer who visited while they were there did not know the person, seemed unsure what to do and asked the person what they wanted done. We discussed this response with the manager, who told us there were ongoing issues with providing this care package. They would review arrangements and make any improvements possible. We were unable to contact the other person who said they disagreed that the service checks regularly they are meeting their relatives needs, that staff have the skills to support their relative, that the service asks for their opinion on how it can improve and that they are happy with the service overall. The issues were reflected in the comment above that the service at the weekend is "terrible". We shared this with the manager who said they would arrange to review the care package. The other person who disagreed that staff had the skills to support their relative did not give their name so we were unable to follow up their concerns. Their comments, noted above, indicated the concerns were related to cultural issues and that their current regular carers were "excellent". Carewatch (Edinburgh, Mid & East Lothian), page 14 of 35
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 Overall grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We issued an improvement notice in March 2011 to make sure the service follows their complaints policy, people making complaints are satisfied the issues raised have been properly addressed and improvements made are sustained where complaints have been upheld. We carried out a monitoring visit in May 2011 and found all complaints received had been logged on the electronic system. This allowed central quality auditors to monitor complaints were being concluded in line with the policy and procedure. We viewed the records and found the complaints policy and procedure had been followed. We looked at the complaints log and records at this inspection and found that the service had continued to deal with complaints in line with their complaints procedure. We issued an improvement notice in March 2011 to make sure people using the service receive their care to the appropriate level and at the appropriate time. We carried out a monitoring visit in May 2011 and found the visit scheduling information for the sample of people we looked at matched their contract, care plan and preferences. This continued for the sample of people we looked at during this inspection. We also saw that concerns had been raised about some care staff not turning up for visits when two staff were required. The service had taken action to address these concerns and was continuing with regular spot checks to prevent this re-occurring. The majority of people using the service we spoke to told us they were happy with their service and we saw only one example where there had been a missed visit. This was a significant improvement since the last inspection. The service had procedures in place for care and support planning and review. Records sampled showed that people had been involved in planning and reviewing their own care. The majority of people using the service told us they had a care plan that detailed their needs and preferences. Carewatch (Edinburgh, Mid & East Lothian), page 15 of 35
We saw records of each person using the service, or their relative or other representative being contacted during the last month, either during spot check visits or by phone. The questionnaire used was comprehensive and the majority of people said they were satisfied with the service. The manager gave us examples of action that had been taken where people had raised concerns. The service carried out client satisfaction surveys by questionnaire, with the next one planned to be sent out during August. Areas for improvement Inspection report continued The operations manager told us that she checks the electronic complaints records on a weekly basis to make sure that any complaints that have been closed have been completed satisfactorily and any ongoing are progressing or the complainant has been informed if there is a delay. There were no records to evidence this and we discussed the need for evidence that monitoring was taking place. The timescale for completion of this aspect of the Improvement Notice will be extended. At the monitoring visit in May 2011 we saw that the number of unscheduled visit hours had reduced from around 200 hours at the last inspection to 18.15 hours. These are the visits where no regular carer is allocated, however the service tries to cover these visits with a carer the person knows. The manager told us at this inspection that this was now 24 hours, having increased recently because of staff changes. This would be resolved in the next few weeks as new staff completed their induction, which was underway. We are extending the timescale of this aspect of the Improvement Notice to make sure the visit scheduling system includes sufficient regular staff to cover all visits. At our monitoring visit in May 2011 it was reported to us that there continues to be some visits late or missed, which the office is not aware of unless the person using the service or their relative informs the office. We were told the service uses carer timesheets to check that visits have taken place, however there were no records to evidence this. We discussed that the sample of visit records we looked at included records which had not been returned to the office since February this year which meant these could not have been audited. Discrepancies in recent records could not be easily explained, indicating that these had not been audited. We are extending the timescale for completion of this aspect of the Improvement Notice to make sure there is a system in place check visits have taken place as planned. At the last inspection we made a recommendation that the service should continue to follow its procedures for frequency of review depending on the vulnerability of the person using the service, making sure they involve the person's relative or other representative where they may find it difficult to express their views. We found that reviews had taken place less frequently than the procedure stated, but within a month in most cases. We also saw at least one example of a review taking place with the person alone, when records indicated their relative should be included. We are therefore continuing this recommendation at this inspection (see recommendation 1). Carewatch (Edinburgh, Mid & East Lothian), page 16 of 35
The service had appointed an additional supervisor in order that this can be achieved. We previously made a recommendation that the service should respond to all concerns raised by service users and/or their relatives. We heard a number of positive comments about the service's response to concerns. However, we also heard that some people had been dissatisfied. The manager told us that they intended to make better use of the electronic systems to monitor concerns. We are continuing this recommendation at this inspection (see recommendation 2). The service intends to continue monthly monitoring to check satisfaction with each person's care. This will be used to prompt an earlier review if concerns are raised and action to address any issues. They may want to consider recording the action taken on the monitoring forms. Carewatch also intends to carry out telephone monitoring centrally to allow people to express concerns if they would find it difficult to do this with local staff. In their self assessment, the service said they planned to introduce meetings for people using the service. Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service should continue to follow its procedures for frequency of review depending on the vulnerability of the service user, making sure it involves the service user's relative or other representative where the service user may find it difficult to express their views. National Care Standards Housing Support Services Standard 4 Housing support planning National Care Standards Care at Home Standard 3 Your personal plan 2. The service should make sure it responds to all concerns raised by service users and/ or relatives. National Care Standards Housing Support Services Standard 8 Expressing your views National Care Standards Care at Home Standard 11 Expressing your views Statement 2 Inspection report continued We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Carewatch (Edinburgh, Mid & East Lothian), page 17 of 35
Service strengths As noted under Quality Theme 1 Statement 1 the service had procedures in place for care and support plan reviewing. All of the records we sampled included a needs assessment and recent review. The service also included comments on care staff's rotas to highlight particular needs and preferences. The majority of people using the service told us they had a care plan that detailed their needs and preferences. Induction training included person centred working and all staff had completed refresher training since our last inspection. We were told by staff that the content and delivery of all training had been improved. Care staff we spoke to told us that they encouraged people to maintain their independence as much as possible. They found out what people could do for themselves and encouraged them to continue to do these things, offering them the support they needed and only doing things for them if necessary. On shadow visits, we saw care staff work with people in a way that encouraged their independence. The service aimed to provide care and support to enable people to live in their own home as long as they wanted to. A number of people we spoke to commented that they or their spouse would not be able to continue living in their own home without the care they received from Carewatch. Areas for improvement Inspection report continued We made a recommendation at our inspection in August 2010 that the service should make sure the provider's procedures for setting up a new care package are followed. The service had not started any new care packages since our inspection in March 2011 while working on making the improvements required. We are therefore continuing this recommendation at this inspection (see recommendation 1). We had made a recommendation following a complaint that the service should respect the service user's preference for the gender of carers wherever possible. There had been some concerns recently that male carers had been sent when the person's relative had said they did not want this. We did not see evidence of this request having been made and we saw that the service said they would not provide a male carer to carry out personal care where this request was made. Another person told us that they had requested that at least one of their two carers was female but on occasion recently both carers were male. This caused embarrassment both for them and the carer. We discussed this and agreed that the service should continue to improve how it checks and records people's preferences for gender of carer. We are continuing this recommendation at this inspection (see recommendation 2). We saw that some care plans were very detailed and written in a person centred way while others had limited detail and the comments for carers included with their rotas included more detail. One relative told us they had requested a copy of the comments for carers in order that they could check they were up to date and accurate but had not received this. We discussed this with the service and agreed we would Carewatch (Edinburgh, Mid & East Lothian), page 18 of 35
recommend that the service improves consistency in care planning in a way that the makes the information available for people using the service (see recommendation 3). Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 3 Recommendations 1. The service should make sure the provider's procedures for setting up a new care package are followed. National Care Standards Care at home Standard 4 Management and staffing National Care Standards Housing support Standard 3 Management and staffing arrangements 2. The service should respect the service user's preference for the gender of carers wherever possible. National Care Standards Care at home Standard 4 Management and staffing National Care Standards Housing support Standard 3 Management and staffing arrangements 3. The service should improve the consistency of care plans and make sure the full care plan is available to the person using the service and/or their relative. National Care Standards Housing Support Services Standard 4 Housing support planning National Care Standards Care at Home Standard 3 Your personal plan Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths Inspection report continued We issued an improvement notice in March 2011 to ensure that, where assistance with medication is part of the care to be provided, staff make sure the person actually takes the medication. We carried out a monitoring visit in May 2011. The records we sampled included details of support required with medication, the current prescription and medication recording sheets. The care staff we spoke to told us medication administration had been discussed at a staff meeting and that they had recently had or would have in depth training about medication administration. They all described appropriate methods of administering medication and knew what to do if there had been an error or the person had refused to take the medication. At this inspection all staff had attended training in medication administration and those we met spoke knowledgeably about the medication administration procedures. We saw medication prescription and recording sheets for a sample of people the service administered Carewatch (Edinburgh, Mid & East Lothian), page 19 of 35
medication to. We saw that staff recorded when medication had been prompted and that they observed it had been taken on visit recording sheets. There have been no complaints to the service or us about medication administration since April 2011. People we spoke to were happy with the way the service helped them with their medication. One person said the carer had adapted the way they gave their relatives medication as their relative had been refusing to take this. We issued an improvement notice in March 2011 to ensure that the person taking out of hours calls had the information required to manage in all situations, including emergencies. The service had changed to a local out of hours service from being London based. We carried out a monitoring visit in May 2011. We viewed records of a telephone monitoring survey carried out by the provider during the week commencing 5 April 2011 which showed people were happy with the change to a local out of hours service. We spoke to six people, who did not raise any concerns about the out of hours service. One person said it was much easier to talk to someone local and you know who they are. The records we saw of each person using the service, or their relative or other representative being contacted by the service during the last month included a question about the out of hours service. There were no concerns raised by people who had used this service. There have been no complaints to the service or us about the out of hours service since our last inspection. There were no concerns raised about the out of hours service by the people we spoke to and a number commented on the improvement since the service had moved from London. This aspect of the Improvement Notice has been achieved. At the last inspection we continued a requirement that the provider must make sure care and support plans include the level of detail needed by staff to provide the care required. This included detailing the catheter care to be provided. The records we sampled included the detail required between the care plan and comments on staff rotas. This included the catheter care required where relevant. The majority of people using the service told us they had a care plan that detailed their needs and preferences. We made a recommendation that the service should make sure their plans to improve staff training in the use of special equipment are carried out and staff's competence is checked before they carry out visits on their own and at regular intervals to make sure competence is maintained. All staff had completed refresher training in manual handling including the use of hoists. Staff we spoke to told us that the training content and delivery had improved, with much more discussion and practical examples included, rather than watching DVDs. We were told that before a care worker worked alone with someone who used special equipment they would completed shadow visits with an experienced worker. We saw examples where staff's competence in using special equipment had been checked during spot checks and we saw care staff using special equipment competently and confidently on shadow visits. There have been no complaints to the service or us about staff's competence in using special equipment. Carewatch (Edinburgh, Mid & East Lothian), page 20 of 35
Areas for improvement We saw examples where there were discrepancies between the instructions for staff on the level of support required with medication between the contract, care plan and comments on staff rotas. The manager checked these and made corrections during the inspection. The sample of staff spot checks we looked at did not include medication administration having been observed. We are extending the timescale on the aspects of the Improvement Notice to review and update the records for all service users who require assistance with medication to make sure the level of assistance is clearly identified and to make sure and record staff demonstrate competence in medication administration through regular spot checks, in line with the medication policy. We found that the service was in the process of introducing a system to audit medication administration records to ensure medication had been administered as prescribed. This had not been fully implemented and we are extending the timescale for completing this aspect of the Improvement Notice. The main concerns expressed by people using the service and/or their relatives were the lack of regular carers, carers not having the skills gained through experience to meet more complex needs (including use of equipment), some carers seeming to lack "common sense", difficulties with carers at the weekend and timing when two carers were required. Some people commented that carers travel across the city to visits which can cause them to be late. These issues affect how effective the service is in meeting individual's health and wellbeing needs. We discussed this at feedback and agreed the provider must continue with the improvements made to make sure enough competent staff are available to meet the needs of people using the service (see requirement 1). The recommendation made under Quality Theme 1 Statement 2 relating to consistency of care plans is also relevant to this statement. We were told by the trainer that now all staff have completed refresher training in core topics they will continue to attend refreshers on a regular basis. She is also developing the training programme to include training on a range of topics relevant to individuals' health needs, including input from other specialists. We previously made a recommendation that the service should consider how care staff can be supported to continue to develop their knowledge and skills in working with people with dementia. We are continuing that recommendation at this inspection (see recommendation 1). Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 1 Inspection report continued Carewatch (Edinburgh, Mid & East Lothian), page 21 of 35
Requirements 1. The provider must maintain and continue to build on the improvements made to make sure there are enough suitably competent people working in the care service to meet the health and welfare needs of people using the service. This includes improvements to recruitment, selection and induction and staff supervision, appraisal, training and retention. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210, regulation 15(a) - Staffing. Timescale: by end March 2012. Recommendations Inspection report continued 1. The service should consider how care staff can be supported to continue to develop their knowledge and skills in working with people with dementia, through working alongside more experienced carers, reflection on their practice and further training as relevant. National Care Standards Care at home Standard 4 Management and staffing National Care Standards Housing support Standard 3 Management and staffing arrangements Carewatch (Edinburgh, Mid & East Lothian), page 22 of 35
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The strengths noted under Quality Theme 1 Statement 1 are also relevant to this statement. The service asks questions which are relevant to the quality of staffing at review, during telephone monitoring and in surveys. Areas for improvement The areas for improvement noted under Quality Theme 1 Statement 1 are also relevant to this statement. The service could consider how it could involve people using the service in staff recruitment, training and appraisal of individual's performance. Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 0 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths The service had a recruitment and selection policy and procedure in place, which included application forms, interview, checking identification, taking up references, use of the protecting vulnerable groups scheme and checking qualifications. It was acknowledged that it had been necessary to improve selection procedures to make sure staff appointed had the necessary skills for the role. We sampled records for people recruited since the last inspection and found that the procedure had been followed in most cases. Concerns had been raised in the past about care staff's ability to speak and understand English. The service had introduced checks on applicants' understanding of written English and a record that the person's spoken English was adequate. Carewatch (Edinburgh, Mid & East Lothian), page 23 of 35
The recruitment and selection policy and procedure also included arrangements for induction of new staff. We made a recommendation at our inspection in August 2010 that the service should improve the induction for new staff who have not had previous care experience. The service had developed the induction training and this would now be provided over four days. The service had also increased the number of shadow visits a new member of staff would complete in order that they could demonstrate their competence and confidence with the range of care tasks before working alone. We were told additional shadow visits could also be arranged when necessary. Areas for improvement One of the records we sampled included two satisfactory references; however one of these was not from the person's most recent employer. This had been an oversight and references were requested from the most recent employer. One applicant had said they had a relevant qualification, SVQ at Level 2. However there was no copy of their qualification in the file. The applicant had been requested to provide this. There was a comprehensive recruitment checklist in place. However these were only partly completed. The service should make sure the checklist is used fully in order to make sure all relevant checks are made (see recommendation 1). Two internal applicants had been appointed to promoted posts. References had not been received and enhanced disclosure information had not been rechecked. The manager checked the procedure to be followed for internal applicants and disclosure checks were being processed. The recruitment and selection policy and procedure should be reviewed to include the checks to be completed for internal applicants to promoted posts (see recommendation 2). The recruitment and selection policy and procedure did not include how applicants' health would be checked, although we did see a health questionnaire having been completed and a record that the applicant was fit to carry out the role. The policy and procedure did not include the checking of professional registers. The recruitment and selection policy and procedure should be reviewed to include how applicants' health would be checked and the checking of professional registers (see recommendation 2). The first group of new staff were due to start since the improvements to the induction process had been put in place. The service must make sure that all staff complete the induction process and demonstrate their competence prior to working alone with people using the service (see requirement 1). Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 2 Inspection report continued Carewatch (Edinburgh, Mid & East Lothian), page 24 of 35
Requirements 1. The provider must make sure that all new staff complete the improved induction, including the four day induction training and shadow visits to demonstrate their competence before working alone with people using the service. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210, regulation 15(b)(i) - Staffing. Timescale: by end March 2012 Recommendations 1. The service should fully complete the recruitment checklist to make sure all checks have been satisfactorily completed. National Care Standards Care at home Standard 4 Management and staffing National Care Standards Housing support Standard 3 Management and staffing arrangements 2. The service should review the recruitment and selection policy and procedures to include the checking of applicants' health, the checking of professional registers and the checks to be carried out for internal applicants to promoted posts. National Care Standards Care at home Standard 4 Management and staffing National Care Standards Housing support Standard 3 Management and staffing arrangements Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We made a requirement that the provider must make sure it continues to follow its procedures for spot checks and make sure it follows its procedures for supervision of staff in a way which makes sure staff are carrying out care outlined in individual's care and support plans. Care staff we spoke to told us that they were spot checked regularly and that more recently they had had office based supervision. This was confirmed in the records we sampled. Records also included a probationary review or appraisal of performance completed in the last year or planned in the near future. We made a requirement that the provider must ensure that staff have the appropriate training to carry out their duties and that there are adequate systems in place to assess the competence of staff and monitor the quality of care and support being Carewatch (Edinburgh, Mid & East Lothian), page 25 of 35