Carr Gomm Highlands Support Service Care at Home 5 Charles Street Inverness IV2 3AQ

Carr Gomm Highlands Support Service Care at Home 5 Charles Street Inverness IV2 3AQ Inspected by: Shona Smith Type of inspection: Announced (Short Notice) Inspection completed on: 19 July 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Carr Gomm Service provider number: SP2003002607 Care service number: CS2012306141 Contact details for the inspector who inspected this service: Shona Smith Telephone Email enquiries@careinspectorate.com Carr Gomm Highlands, page 2 of 24

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 The organisation use a range of ways to help service users and their families to be involved in the development of the service. Management and staff are friendly and approachable. They provide a highly valued service that helps carers and service users in their own homes. Staff receive a good range of training to support them in their role. Management and staff work hard to provide a service that meets service users and carers needs. Staff use a person centred approach. What the service could do better The support plans should provide enough guidance and information to staff so that they can keep service users safe. It would be good practice for new staff to meet the service user and their carer before their first shift. This would help the service user and carer to have confidence in the staff member and for continuity. Carr Gomm Highlands, page 3 of 24

The new management is working to make sure that all service agreements are reviewed at least at 6 monthly intervals. Also that all service agreements are signed by the service user or a close relative as appropriate. There is a training programme to bring all staff up to date with essential training. What the service has done since the last inspection This is the first inspection of this provider. Conclusion A highly valued service that supports people in their own homes. The management and staff were committed to providing a quality service and to making continuous improvements. Who did this inspection Shona Smith Carr Gomm Highlands, page 4 of 24

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service registered with the Care Inspectorate on 7 September 2012. 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. This was the first inspection of this service. Carr Gomm provides a support service to people living in their own homes. The service is provided throughout the Highlands and on the island of Skye. The service can supports carers by giving them some respite. It also helps people to remain in their own homes. The service is provided to older people, adults with disabilities and children. The main office base is in Inverness. The welcome handbook states: 'Being supported by Carr Gomm means: Having control in your life Being able to make choices Feeling safe and secure Being treated with respect Know that there is someone there - no matter what.' Carr Gomm Highlands, page 5 of 24

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 Inspection report continued 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. Carr Gomm Highlands, page 6 of 24

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 following a short notice, announced inspection. The inspection was carried out by Shona Smith, Care Inspector and took place on 3, 4 and 18 July 2013, between the hours of 9am and 6pm. Feedback was given to the registered manager and service manager on 19 July 2013. The feedback included recommendations and areas of improvement made as a result of these visits. As part of the inspection, we took account of the completed annual return and self assessment form that we asked the provider to complete and submit to us. We sent 90 Care Standards Questionnaires to the service, to be sent to people who use the care at home service and 38 were returned completed. We also sent 30 staff questionnaires and 16 were returned. During the inspection process we gathered evidence from various sources, including the following: We spoke with: * Five people who use the service * Ten relatives/carers of people who use the service * Five care workers * One senior support worker * Two service managers * Registered manager We looked at: * evidence from the service's most recent self assessment * the service's aims and objectives * personal plans of people who use the service * formal care reviews and records * participation information, including Care standard questionnaires Carr Gomm Highlands, page 7 of 24

* accident and incident records * staff training records * staff files * staff meeting minutes * risk assessments * newsletters and notice boards * staff rotas * welcome booklet and other company leaflets * Carr Gomm website Inspection report continued *Consideration of the National Care Standards: Support Services - Care at Home 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 Carr Gomm Highlands, page 8 of 24

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 document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We spoke with five people who used the service. Generally opinions expressed were favourable about the care service and the staff. Comments received included: "We are going out for hot chocolate." "She and I have good chats. She tells me all about what is happening in the area." "We usually go out for a while." "She is good to me." Comments from completed Care Standard Questionnaires received included: 'The service I receive is excellent. The carers are friendly, helpful and treat me with respect.' Carr Gomm Highlands, page 9 of 24

Taking carers' views into account We spoke with ten carers/relatives. Opinions expressed were mostly positive about the care staff and the service. Comments received included: "We have no complaints about the service. It gives us some time to do other things and it provides another person in her life" "It is good we have the help twice a week so I can go shopping" "It took a while to get going but it is working out well" "I always know the girls that are coming in, and if anybody's going to be on holiday, or sick, I always get told in plenty time" "Initially my husband had Crossroads in and then all of a sudden we were told we were going over to the new agency. In the beginning they were very disorganised and we did not have the flexibility we had with Crossroads. If we don't use all the hours they don't carry them over, anything we want to change they always say you need to see the social worker" "The care plan has carried over from Crossroads but it hasn't been updated in 18 months." "I've had to phone them up to chew their ear about some things I even lost my temper at one time." "Very very happy with the help that I get." We received 38 completed Care Standard Questionnaires, some of which had been completed by service users. Overall, 97% of respondents were happy with the quality of care provided. Comments received included: Inspection report continued "Both myself and my mother very much appreciate the caring service provided by the ladies at Carr Gomm". "Since Carr Gomm took over from Crossroads, I have not had the same confidence in the management. Also it is now very formal and not as flexible as it was and should be. The staff who actually provide the service do an excellent job but, I perceive, do not receive the support or training they deserve. Unfortunately just recently a number of management have left and rather than advertise the positions they seemed to have been filled from within". Carr Gomm Highlands, page 10 of 24

"Carr Gomm is our life line. The staff provide the highest possible standard of care and make us feel confident and well supported. The needs of our son and family were identified and support has been provided to meet all of our needs and this is reviewed regularly. We receive information about the service often and have opportunities to share our views. We feel very lucky to have this service in our lives". "It is critical that we can have the same carers to avoid extra confusion/upset to our daughter". "Support plan was left with me to fill in. No one from Carr Gomm went through the plan. Since Carr Gomm took over from Crossroads no representative from their office has ever come to visit, or ask if I have any preferences, or of my needs. All of my son's carers are fantastic and are a great support for my son". "I am very happy with the staff who attend weekly but feel communication from the office could improve. If there is an incident there should be more follow up from the office. One member of staff has recently left us and I still have to be told by the office". "Not enough staff to cover sickness or other emergencies in this area - otherwise a wonderful service that makes my life so much easier and safer". "Mum enjoys the time spent with her care worker immensely - she says she makes her laugh! I appreciate Mary's positive approach hugely and we communicate regularly by phone and text. The vitality and energy she brings is the key to the success of her work". "The service in Lochaber was not well run initially with multiple problems. Things have improved significantly over the last 6 months. I now have much more confidence in service". "My worker helps me out a lot. I am pretty happy with the service". Inspection report continued Carr Gomm Highlands, page 11 of 24

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 We found that the service performance in relation to this statement was very good. We concluded this after we: spoke with management and staff spoke with service users and their relatives looked at their involvement strategy and website looked at minutes of meetings looked at results of questionnaires Carr Gomm as an organisation was committed to supporting service users and carers to be involved in developing the service. They had a number of approaches to support this including: They have developed a strategy and promoted this through their website. It was also outlined in the welcome booklet, which was given to all new service users. Booklet stated 'Involvement means opportunities for you to give your views and be heard. Involvement means making a difference and influencing the way your service and others are delivered and planned.' It then outlines the different ways service users can be involved if they wish. Management promote a person centred approach to providing care. Care plans are developed with service user and/or if necessary with a close relative. Care plans are generally reviewed regularly and they aimed for 6 monthly intervals at a minimum. Carr Gomm Highlands, page 12 of 24

Questionnaires were issued quarterly to those who indicated that they wanted to take part in surveys. We could see that management collated results of questionnaires and followed up all concerns and issues. Survey staff and results were collated and the information representated by charts to inform staff of the results. The service issued suggestion/compliments cards, which can be folded up and confidentially sent by freepost back to the head office. The service provided detailed information in the welcome booklet about what to expect from the service. The booklet also outlined the complaints policy. Senior staff kept in touch with service users and were available by phone and email. Service managers visited service users to review the care plan whenever possible. In the Highlands there had been efforts to bring service users and/or carers together. There had been meetings of a focus group and forums that have had mixed success in attracting attenders. The meetings have discussed aspects of the service and how to improve the situations of service users and carers. The service also encouraged carers to meet up with Connecting Carers, a local group that gives support to carers in a range of ways. The service had put on workshops for carers as well as providing opportunities for trips and outings for carers and service users. During the school holidays the service had tried to help carers and service users by providing a summer activity programme. The organisation employed an involvement manager to promote their involvement strategy. There was also a national involvement reference group made up of service users and staff. This looked at different aspects of the service and how to support participation. It was hoped that the Highland service would take part in the group. Areas for improvement The service was working towards involving service users and carers in the staff appraisal procedure. The service manager was reviewing service agreements and care plans and arranging for them to be signed by service user/carer if in agreement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Inspection report continued Carr Gomm Highlands, page 13 of 24

Service strengths We found that the service performance was good in the areas of this statement. We concluded this after we: spoke with service users and their carers spoke with staff and management looked at support plans and information held about service users looked at policies looked at staff training We found that the majority of the service was provided to adults and children referred through local social work services. Therefore the service usually received a copy of the most up to date single shared assessment. This was used, as well as talking with service users and carers, to create the support plan. The support plan outlined service users' main health and welfare needs and how to meet these needs. The respite service was on average 2-4 hours per week to allow carers to have some free time. The service was provided to older people, adults and children with disabilities. This service had been provided by a different organisation, which was taken over by Carr Gomm in Oct 2011. There have been some changes in management since the take over and the present manager was appointed at the beginning of June. All service users had a copy of the agreed care plan/service agreement in their home and this was updated fairly regularly. Each care plan had a risk assessment called 'keeping me safe and well.' This should guide care staff about any significant risks, for example, in the home environment and health issues and how to keep the risk to a minimum. Care staff kept in contact with the office or senior care workers to let them know of any concerns. Service managers and senior care workers kept a note of conversations with other professionals along with service users' support plans. Staff worked with other professionals including social workers, community nurses, speech and language therapists and occupational therapists. In some cases, where the service user had very complex problems, care workers met health professionals to be shown how to provide care and be able to transfer them. Carr Gomm provided services to help carers including a summer activities programme in some areas, trips out to beach and sightseeing. There have been joy workshops to support carers at the local theatre. The website had some details about activities in the area. Carr Gomm Highlands, page 14 of 24

As far as possible service reviews were usually conducted by a senior worker at the service user's home. Once the care plan was agreed the service user/carer signed to indicate their agreement. Recently care workers had been asked to record on the care plan when they provided care, what they did and any relevant comments. Care workers could access service policies through the internet and via their own computers. Areas for improvement The new manager was working to ensure that all service agreements were put onto their computer system, so that renewal dates could be flagged up. The electronic system would also show whether service user/carer had signed the agreement. There was a traffic light system to inform when documents or signatures needed renewed. We found that some risk assessments did not give enough information to alert staff to the possible risks of the situation. The welcome booklet gives good detail about what might be covered by the risk assessment. See Recommendation 1. Care workers' record sheets should be returned to the office on a regular basis so that they can be monitored. We found from the results of questionnaires, from the conversations with the lay assessor and from our visits that, often care staff attend for a shift without first being introduced to the service user and being made aware of the exact details of the service required. See Recommendation 2. At the time of the inspection the service was in the process of giving each of their care staff a different ID badge holder that could be attached to their upper clothing. This would make it more visible to their service users. The service's self assessment document highlighted that they wish to attend more multi disciplinary reviews of their service users. When appropriate, the actual care worker would attend to learn more about how to provide care needed, especially to service users with complex needs. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Carr Gomm Highlands, page 15 of 24

Recommendations 1. It is recommended that risk assessments are fully completed to give staff adequate guidance about the service user and the environment and to be able to reduce any significant risk. National Care Standards - care at home services. 2. It is recommended that new care staff be introduced to the service user and to be made aware of the service user's needs before providing a service. This helps to reduce the anxieties of the service user and carers and helps to provide good continuity. National Care Standards - care at home services. Inspection report continued Carr Gomm Highlands, page 16 of 24

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 We found that the service performance was very good in the areas of this statement. The evidence in statement 1.1 is valid here. Areas for improvement See statement 1.1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found that the service performance was good in the areas of this statement. From talking to staff and looking at training records there was good evidence that staff have a range of core training to support them in their role. Training included person handling and risk assessment, first aid and infection control. All care staff were being asked to complete five modules on-line: equality and diversity, adult support and protection, falls in older people, food safety and hygiene, data protection and confidentiality. At the end of the modules, staff had to complete a short assessment which they needed to pass to show understanding of the course. If staff were not able to complete the courses on-line there were paper alternatives. We found that staff were aware of their role and responsibilities about service user protection. Staff confirmed that they got in touch with their line manager when they had concerns. Carr Gomm Highlands, page 17 of 24

Staff records showed that the majority of staff had been employed by the previous company and had a wide range of training. We found that the service tried to match staff skills and aptitudes to service users' needs and interests, for example, a care worker with quilting experience was assigned to a service user who used to do this. We found that the service user enjoyed talking about quilting and being involved in related activities. The organisation was supporting staff to obtain relevant Scottish Vocational Qualifications.The manager was registered with Scottish Social Services Council (SSSC). Staff confirmed that induction included information about the National Care Standards and role of SSSC. The service followed a safer recruitment procedure, which included obtaining two references, one being from their most recent employer. New staff would not commence before a suitable criminal check had been obtained. There was a system in place for staff to have individual supervision and to be appraised. Care staff had opportunities to access service specific training, for example, about autism. The new management was progressing staff meetings in all areas. The minutes examined showed that there were discussions about individual service users to ensure consistency of approach. Staff thought the meetings useful and they were encouraged to contribute to the agenda and discussion. There was a 'policy of the month' which helped staff to get to know the content and its relevance to their work. Areas for improvement Management were working to ensure that all staff had essential core training and that it was up to date. It was the service policy that all care staff should have regular people handling training. We found that there were some staff who had not had this training for some time. Staff indicated in the past that they were interviewed and recruited by one person. The manager stated that now there would always be a panel of at least two to interview, as guided by best practice. Joint reviews/supervision and appraisals were gradually being provided for all staff. Carr Gomm Highlands, page 18 of 24

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm Highlands, page 19 of 24

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 We found that the service performance was very good in the areas of this statement. The evidence in statement 1.1 is valid here. Areas for improvement See statement 1.1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths We found that the service performance was good in the areas of this statement. The organisation used various strategies to try and ensure the quality of the service. The service had been accredited by 'Investors in People'. Management was also working towards the service being endorsed by the Autistic Society. There were various audits carried out by management including reviews, service agreements and quality of care plans and notes. Information about Key Performance Indicators was collated. The balance scorecard system was used to provide a framework to define how the service was performing. Gaps or weaknesses were easily identified. Carr Gomm Highlands, page 20 of 24

The service regularly used surveys of service users, relatives and staff to obtain feedback about the quality of the service. Focus groups had been created to bring service users/carers together to discuss aspects of the service and their situations and how to improve them. Manager was involved in national working groups which looked in depth at different issues in order to improve standards. Areas for improvement Management planned to implement spot checks and to observe practice of care staff. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Carr Gomm Highlands, page 21 of 24

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). Carr Gomm Highlands, page 22 of 24

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 5 - Very 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. Carr Gomm Highlands, page 23 of 24

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 Carr Gomm Highlands, page 24 of 24