Dundee City Council - Social Care Teams (Learning Disabilities, Mental Health, Drug and Alcohol/Blood Borne Viruses) Housing Support Service Social Work Offices Balmerino Road Dundee DD4 8RW Inspected by: Lorna Paton Type of inspection: Announced (Short Notice) Inspection completed on: 13 February 2013
Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 10 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Dundee City Council Service provider number: SP2003004034 Care service number: CS2011286196 Contact details for the inspector who inspected this service: Lorna Paton Telephone 01382 207200 Email enquiries@careinspectorate.com
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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well Staff provided flexible support which adapted to meet peoples' changing needs. Staff worked very well with other healthcare professionals to ensure people stayed safe and well. What the service could do better The provider should continue to build upon participation opportunities to ensure feedback they receive is analysed and used to improve or develop the service. What the service has done since the last inspection This was our first inspection of the service since registration. Conclusion People who completed a questionnaire or who we spoke with during our inspection told us they were happy with the service they received. Who did this inspection Lorna Paton
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. This service was registered with the Care Inspectorate in January 2012. Information in relation to all care services is available on our website at www.careinspectorate.com. If we are concerned about some aspect of a service, or think it needs to do more to improve, 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 based on best practice or the National Care Standards. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The service was provided by Dundee City Council to citizens of Dundee aged between 16 and 65. The service aimed to; "Provide a high quality Housing Support Service and Care at Home Service in a person's own home who either have a learning disability, or who suffer from a severe and enduring mental health difficulty or who are affected by their own, or a significant other's substance misuse and/or blood borne virus. The service aims to facilitate opportunities and lifestyles that enable individuals to achieve their full potential". The services were provided by three distinct staff teams based in three separate locations in Dundee. All three teams were led by a Registered Manager and supported on a day to day basis by a Team Manager. At the time of our inspection, the service was supporting approximately 130 people. The number of people supported by each team was approximately; mental health team - 31 learning disability team - 77 drug and alcohol/blood borne virus team - 22
Inspection report continued Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - 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 www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices.
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 This report was written after a short notice announced inspection of the service which was carried out by Inspector Lorna Paton. We made visits to the service on; Wednesday 23rd January 2013, Monday 4th February 2013, Wednesday 6th February 2013; and Friday 8th February 2013. Feedback was given to the Registered Manager on 13th February 2013. 17 questionnaires were returned to us before our inspection from people who used the service. We also accompanied four Social Care Officers whilst they visited four people. This enabled us to speak directly with people about their experiences of the service. During this inspection we spoke with; Team Managers in the learning disability and mental health service Social Care Workers working in the learning disability and mental health service Senior Social Care worker from the learning disability service Four people who used either the learning disability or mental health service
Inspection report continued We looked at; evidence from the provider's most recent self assessment a sample of information within peoples' personal files. This included risk assessments, personal plans and event recordings questionnaires which the service had asked service users to complete complaints record records of staff training records of staff supervision minutes of staff meetings resources available to staff in relation to services available to meet peoples' health and wellbeing needs questionnaires which the service had asked stakeholders to complete records of direct observations Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org
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: No Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the provider had completed this and with the relevant information they had given us for each of headings that we grade them under. The provider identified what they thought they did well, some areas for development and any changes they had planned. Taking the views of people using the care service into account Before our inspection we asked people to complete a questionnaire. 17 were returned to us before our inspection. When asked about the overall quality of the service; 12 people were very satisfied; 4 people were satisfied; and 1 person did not answer this question "No complaints whatsoever. I am really happy with them. They are really honest with me" "It has really been a god send to me and the women are all great" "Have no complaints about the service"
We accompanied four Social Care Officers to visit four people who used the service during our inspection visit. People spoke highly of the staff with comments including; "I always see (staff member's name). I like it that way as she knows me really well and I trust her. She knows how I like things to be done" "I have no complaints at all about (staff member's name). I am more than happy with the help she gives me. In fact, she's wonderful" "I've never thought about who I would talk to if I wanted to complain. I've never had to think about it as (staff member's name) is so good" Taking carers' views into account No carers were spoken to as part of this inspection.
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: 4 - 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 Before our inspection we asked the service to complete a self assessment to tell us how they involved people using the service in assessing and improving quality. We sampled some of this information as part of our inspection. We found the service had developed good opportunities for people to be involved in assessing and improving quality. Questionnaires had been developed for people using the service to give feedback on the quality of the service they received. We looked at these in both the learning disability and mental health service. People were asked for their views in a range of areas. Questions varied between the two services with questions which included; do you feel you have been involved in planning your support do staff listen to your needs do you feel able to speak with your Social Care Officer if you are unhappy Dundee City Council has a complaints procedure. Would you know how to access it How would you rate the level of care that the Social Care Officer service provides you
Inspection report continued The service provided was flexible to meet peoples' preferences and changing needs. Timings of visits were agreed with people to ensure they didn't conflict with their preferences or availability. There was good evidence to show the service was responsive to times where a person may need additional support such as attending important appointments. Staff we spoke with demonstrated person centred values. They were committed to listening to what people told them both informally and formally to make ongoing improvements to the service. People were aware of their right to complain to Dundee City Council. Leaflets were provided detailing this procedure when a person started using the service. People we spoke with told us they would be happy to raise any concerns they had with their Social Care Worker. The mental health service was in the process of developing an "Introductory Pack" for people. The Team Manager informed us that this was to include more details about the Care Inspectorate and National Care Standards. This was being designed to increase peoples' awareness of the standards of care they should expect to receive. We will look at how this has progressed during our future inspections. Dundee City Council had developed a User Involvement Policy. This detailed their commitment to involving people in improving the quality of services and how consultations may take place. The provider demonstrated a commitment to the use of advocacy services for people. We were informed that advocacy is discussed at each review to ensure people are aware of this service and how it can help them in making their views known. Areas for improvement In the self assessment the provider completed prior to our inspection, they identified an area for improvement as; "Development of improved methods of evidencing the involvement of service users and carers". This was particularly in relation to recording how improvements to the service had been made as a result of informal feedback from people using the service. For example, feedback which had been received about a staff member during a telephone call. We will look at how this has progressed during our future inspections. Of the 17 questionnaires which people returned to us before our inspection, seven people were not aware of their right to make a complaint to the Care Inspectorate. As detailed above, the mental health team was looking at ways of raising awareness of the role of the Care Inspectorate with people using the service. It was hoped that this would raise awareness of peoples' right to complain directly to the Care Inspectorate.
Although questionnaires had been returned from people using the service, the results of these had not been collated, analysed and shared. It was recognised that the provider had taken action to make some improvements based on what people said. However, we would expect that the provider would collate the feedback they have received through any participation opportunity and use this information to develop an action plan of improvement. This would detail what actions the service was taking as a result of such feedback and should be shared with people using the service and staff. A recommendation has been made (see recommendation 1). During our sampling of personal plans, we noted some reviews within the learning disability service did not always document the views of the person or, if appropriate, their carer. We spoke with the Senior Social Care worker about this. They told us that this had been identified by the team and new review documentation had been developed to ensure peoples' views were captured. During our inspection we spoke with staff about the support people who used the service received from families and significant people in their life. Some people had significant input from families or friends in supporting them to stay safe and healthy. However, no formal opportunities had been developed to gather the views of families and significant people about their experiences of the service. The provider may wish to consider developing such opportunities as part of their ongoing quality assurance process. This was discussed with the Registered Manager during our feedback. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should ensure that the results of any participation opportunities are collated and analysed. A plan should be produced which details the actions the provider will take based on the feedback they have received. This should be shared with staff, service users and, where appropriate, other stakeholders. National Care Standards: Standard 11, Care at Home - Expressing Your Views
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Before our inspection we asked the service to complete a self assessment to tell us how they ensured peoples' health and wellbeing needs were met. We sampled some of this information as part of our inspection. During our inspection we sampled information within some peoples' personal files. Each person had a plan in place which detailed the support they received from the Social Care Team. We found that these were updated regularly to reflect any changes to the support a person received. Some plans we sampled contained very detailed information about the person and how they preferred their support to be given. A "service use profile" had been completed for each person. These gave detailed accounts of the person which included a life history and information about the person's current situation. From our discussions with staff, sampling of written records and discussions with people who used the service, we found that the support provided was very flexible. This meant that staff could respond to peoples' changing support needs, for example, providing additional support through difficult periods. There was very good evidence to show that staff worked well with other colleagues such as; Psychiatrists, Community Mental Health Nurses, Social Workers, Occupational Therapists and GPs. Where necessary, staff were available to support people to attend important appointments. Any concerns were promptly addressed by Social Care Officers who ensured appropriate people were informed of important changes to a person's health or wellbeing. This meant that the multi-disciplinary team could work together to ensure people received the support they needed. People using the service were supported, whenever possible, by one Social Care Officer. This meant they could establish trusting relationships with staff who knew them well. Staff we spoke with demonstrated an excellent understanding of people they supported. This meant that people were supported with what they needed in the way they preferred and from staff who identified any changes to their wellbeing quickly. Having the same worker visit them was something which people we spoke to told us was important to them. One person told us; "I always see (staff member's name). I like it that way as she knows me really well and I trust her. She knows how I like things to be done"
We looked at the resources available to staff in relation to services available to help people stay healthy and well. Databases had been developed for staff working within the learning disability team to access in relation to local services available for people. This included services such as; welfare advice weight management groups services to support people in gaining employment health screening services healthy living initiatives such as walking groups Staff provided support to people in accessing these services or groups if this was needed. During our inspection we accompanied Social Care Workers on visits they made to four people. Staff worked with people in a way which supported choice and independence. Comments we received through questionnaires which were returned to us included; "I have received care for my mental health problems over my lifetime and have received the best care that could be given. Thank you" "I can't believe the care and help I have received from the drug and alcohol team. They have helped me so much" "I would be lost without the support and care given to me" "Since receiving this service my quality of life has improved. My SCO helps with day to day needs and motivates me to retain my independence and social contact"
Areas for improvement The management team advised us that they were moving towards an outcome focused way of working with people. This would support staff in identifying peoples' goals and aspirations and the support they needed to attain these. The management team recognised that, whilst staff worked with people in a person centred and recovery focused way, this was not always reflected within current care planning tools. From our sampling of files, whilst plans were accurate in reflecting support provided, they did not always fully underpin the knowledge and information staff had gathered about a person. A move towards plans which reflect a person centred and recovery focus will support staff in recording information which may be important to consider in delivering a person's care. We will look at how this has progressed during our future inspections. This was also identified by the provider in the self assessment they completed prior to our inspection which told us; "We require to continue to develop in this area, identifying further opportunities for individuals to recognise and meet their need for wellbeing. A person centred outcome approach will focus on this in greater detail". Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The grade awarded for Quality Theme 1, Statement 1 was accepted for this statement. Areas for improvement The grade awarded for Quality Theme 1, Statement 1 was accepted for this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Before our inspection we asked the service to complete a self assessment to tell us how they ensured they had a professional, trained and motivated workforce. We sampled some of this information as part of our inspection. Staff we spoke with throughout our inspection were committed to providing a high quality service. Staff were aware of the National Care Standards and Scottish Social Services Council (SSSC) Codes of Practice. These codes and standards detail what is expected of social care staff as they carry out their daily work. Staff we spoke with were highly motivated and felt supported by their line managers. All staff received regular one to one supervision with their line manager. We looked at a sample of minutes from such meetings. We noted they provided a very good opportunity for staff to reflect on their practice, discuss concerns and identify future training and personal goals. In addition, staff told us they could approach their manager on an informal basis with an "open door policy" being adopted to make sure senior staff were easily accessible.
Regular meetings supported very good communication amongst the staff team. Minutes of these meetings demonstrated a focus on both individual and service development. Staff were encouraged to make suggestions for improvement and discuss how best to implement any changes to the way they worked. This supported staff to feel confident in using their knowledge and skills to be innovative with how they worked with people. In addition to regular service meetings, staff also had the opportunity to attend monthly social work meetings. This supported good communication amongst the different staff teams. Minutes of these meetings evidenced ongoing discussions on best practice and policy changes. Staff had opportunities to attend regular development days with their social work colleagues. The staff team were encouraged to decide what topics would be the focus of these days. This allowed staff to focus on increasing their knowledge and skills in a particular area of their work. Guest speakers were invited to support their learning and to share good practice in the chosen topic. Staff we spoke to felt they had very good access to training to enable them to carry out their job effectively. We looked at a sample of staff records and noted training had been accessed in; overdose prevention risk management mental health and wellbeing adult support and protection equality and diversity moving and handling first aid substance misuse From questionnaires we received before our inspection and discussions we had during our visits, people told us they felt confident staff were trained to meet their support needs. Areas for improvement In the self assessment the provider completed prior to our inspection they told us; "We have recently replaced the Employee Development Review with a Performance and Development Review - we are currently rolling this out to staff". We spoke with the management team during our inspection about considering ways in which people using the service could contribute to such reviews of staff practice. This was something which the management team were keen to consider further.
Although all staff we spoke with were aware of the National Care Standards, we found understanding of the content of these standards was variable. This had been recognised by staff working within the mental health team. They had agreed to include discussions of National Care Standards within their regular team meetings. This would support staff in increasing their knowledge of the standards whilst providing an additional opportunity for assuring the quality of the service. We spoke with the Registered Manager about this during our feedback. We suggested that other areas of the Social Care Team should consider how to best to raise further awareness of the National Care Standards. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - 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 The grade awarded for Quality Theme 1, Statement 1 was accepted for this statement. Areas for improvement The grade awarded for Quality Theme 1, Statement 1 was accepted for this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths Before our inspection we asked the service to complete a self assessment to tell us how they involved people using the service, staff and other stakeholders in assuring the quality of the service. We sampled some of this information as part of our inspection. Information within Quality Theme 1, Statement 1 was considered when awarding a grade for this statement. As detailed previously, the service had developed good opportunities for people using the service to be involved in assessing and improving quality. This included questionnaires which people had been asked to complete in 2012.
Stakeholder questionnaires had been developed during 2012 which allowed other professionals to feed back their experiences of the services. This included colleagues such as GPs, Psychiatrists, Community Mental Health and Learning Disability Nurses and Occupational Therapists. We looked at a sample of the returned questionnaires and found people had demonstrated a high level of satisfaction about their experiences of the service. People were aware of their right to make a complaint to Dundee City Council. Although no complaints had been received, staff demonstrated a commitment to acting quickly on any concerns which may be raised. People we spoke with told us they felt confident in raising any concerns they may have. The learning disability service had developed a system for directly observing staff practice. This allowed managers of the service to observe how staff worked with people. We looked at how information within peoples' personal plans was audited within the mental health team. This included an audit of information such as risk assessments and care plans. In addition to regular audits, the Team Manager reviewed all event recordings which had been completed by staff. This allowed the Team Manager to ensure that support was being provided in line with the person's agreed support. Staff we spoke with told us that they were regularly asked to complete staff questionnaires from Dundee City Council. This asked staff for their views in a variety of areas such as support, job satisfaction and training. Areas for improvement In the self assessment which was completed prior to our inspection the provider highlighted areas for improvement. This detailed; "As a department we recognise that the area of customer care is an area that we need to continue to develop and we are constantly striving for ways in which our service users can participate and contribute in a meaningful way. Continue to develop independent mechanisms of quality assurance. Pilot the case file audit tool". Although stakeholder questionnaires had been returned, these had not been analysed or collated. Some staff we spoke with were not aware of the feedback which had been received from these questionnaires. Whilst it was recognised that the feedback received from these had been positive, we would expect that the information received was collated and shared with staff to support the ongoing quality assurance of the service. This was also highlighted within Quality Theme 1, Statement 1 in relation to the collation and analysis of questionnaires people using the service had returned. Please refer to this previous statement for further details of the recommendation we have made.
It was not clear to us how results from staff surveys had been shared with all staff. This would include details of how the provider planned to address any identified areas for improvement. This was discussed with the Registered Manager during our feedback. The mental health team did not have a formalised system in place for directly observing staff practice. However, it was recognised that this was carried out informally by the Team Manager during joint visits with Social Care Officers. To ensure such observations support ongoing improvement and development, these should be documented and used to support the quality assurance process. We have also suggested that the Social Care Team consider documenting the views of the person receiving the service during such observations. This would support a more robust system of assuring the quality of staff. A recommendation has been made (see recommendation 1). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should ensure that direct observations of staff practice are documented and used to support quality assurance systems. These observations should, when possible, include the views of the service user. National Care Standards: Standard 4, Care at Home - Management and Staffing
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 The service was not required to submit an annual return to us. 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1).
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission.
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