Sense Scotland Respite and Short Breaks Service Care Home Service Adults 5 Fleuchar Street Dundee DD2 2LQ Telephone: 01382 642082 Inspected by: Susan White Type of inspection: Unannounced Inspection completed on: 28 February 2013
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: Sense Scotland Service provider number: SP2003000181 Care service number: CS2005101796 Contact details for the inspector who inspected this service: Susan White Telephone 01382 207200 Email enquiries@careinspectorate.com Sense Scotland Respite and Short Breaks Service, page 2 of 21
Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 6 Excellent Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service is valued by families and people who use the service. Staff have a good knowledge of individual service users and how they like to use their time in the service. Involvement of families and service users in how the service is run is a priority for the manager and staff at Respite. What the service could do better A new approach to focus on outcomes for people who use the service has been started. This should make clear the benefits for service users and their families of using the service at Fleuchar Street. What the service has done since the last inspection Sense is developing the service through an outcomes based support model. Change to new systems was in process at the time of this inspection. Conclusion The respite service supports a lot of local families and is valued by them all. Service users benefit from the sense of independence offered by the service and the help in preparing for a more independent life. Opportunities to explore the local community with assistance from staff helps to develop a good sense of worth and a sense of well being. Staff do this with skill. Sense Scotland Respite and Short Breaks Service, page 3 of 21
Who did this inspection Susan White Sense Scotland Respite and Short Breaks Service, page 4 of 21
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. 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 Inspectorate. Sense Scotland Respite and Short Breaks Service is registered with the Care Inspectorate to provide a care home service for a maximum of three service users with staff support. The service operates at weekends and during the week. The service is provided to people with a learning disability and additional complex needs, including communication and behavioural needs and sensory impairment. The aim of the service is to provide a fun and stimulating service for service users in a relaxed environment. The service provides opportunities for its service users to access a range of activities both within the service and in the wider community, depending on the individual. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 6 - Excellent Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Sense Scotland Respite and Short Breaks Service, page 5 of 21
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. Sense Scotland Respite and Short Breaks Service, page 6 of 21
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This report was written following an unannounced inspection of the service on 23 January 2013. The inspection was carried out by Susan White, Care Inspectorate. The manager of the care service sent us an annual return and a self assessment form. We talked to the manager, staff in the service and service users during the inspection. We sent questionnaires to service users/relatives and received 8 responses which we took into account for this report. We looked at records and documents during the visit. These included - certificate of registration public liability insurance written risk assessments a sample of six care and support plans complaint to the service audits and quality assurance systems information on the office noticeboard. We talked to the manager and senior staff. We reminded the manager about recent changes to legislation - The Public Services Reform (Scotland) Act 2010 and we discussed the need to update policies and procedures in light of these changes. We explained our Regulatory Support Assessment which is part of our preparation for the inspection visit. 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 Sense Scotland Respite and Short Breaks Service, page 7 of 21
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 Sense Scotland Respite and Short Breaks Service, page 8 of 21
The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate 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 heading that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they had planned. The service provider told us how the people who use the care service had taken part in the self assessment process. Taking the views of people using the care service into account 'Always happy to go to the respite house.' 'My son seems happy to go to Respite compared with the previous one whereby he unpacked his holdall and put everything back so he didn't have to go.' 'Excellent respite - fun, interesting, challenging and tailored to me. Couldn't be better.' 'I like coming here and playing with the staff. I like making funny faces at the staff and playing with the wii.' 'I always look forward to my stay at Fleuchar Street. I know staff would help me or speak to Mum if I had a problem.' Taking carers' views into account 'This is an extremely useful service that we feel has helped a great deal throughout the last year. We admire the work the staff do and are always helpful if we ask questions or have any worries.' Sense Scotland Respite and Short Breaks Service, page 9 of 21
3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service supports up to forty people during the year, mainly supporting adults living with families. The manager maintains regular contact with families and with Dundee City Council Social Work Service who funds the respite care and support. We sampled three care and support plans. We saw that regular reviews of care and support needs are discussed with families. This is discussed before a planned visit for respite stay. At the end of a stay, information is given by letter on how the visit has been, particularly on activities and nutrition on behalf of people who are not able to inform their family. The service has a policy of individual service reviews for families. We discussed the difficulties for families when a service user accesses a number of different services. For example health appointments, day support, care at home service, respite service and social work service. The manager recognises that several meetings add an extra burden on many family carers and works well to minimise the number of formal reviews. The service promotes joint working for reviews with other providers in the care package. Areas for improvement The service should continue to look for ways to include the views of service users and their families in the development and review of the service. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Sense Scotland Respite and Short Breaks Service, page 10 of 21
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service at Sense Respite is a part of a package of care and support for the people who use the service. The manager links with family members in supporting all health needs. For example, where medication is needed, the service keeps records of medication received, medication taken and medication returned home. We saw the system for managing the records of liquid medications. Most receipts of liquids are in sealed bottles and returned home at the end of the stay. Estimates of the volume returned are noted for families. Each of the care and support files inspected had detailed contact information for each of the local health professionals involved in the person's care. For example, speech and language therapist has given advice on communication systems for some individuals and this is noted in files seen. In one of the files inspected we saw how the service prepared for the visit of a person who requires a particular diet. The preparation included identifying likes and dislikes for foods, training for staff in the dietary requirements, shopping for appropriate foodstuffs and preparing meals. The service planning also considered who would be using the respite service at the same time so that the full benefit of the respite experience could be supported for all individuals. One of the benefits for the service user of small group living was that the whole environment could be adjusted to help support this person's dietary needs. Areas for improvement It is acknowledged that the health support for individuals while using a respite service is secondary to the support provided by families. The service should continue to work with families and health professionals to support good health for the people who use the service. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Sense Scotland Respite and Short Breaks Service, page 11 of 21
Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The service supports people with a range of care and support needs. The rooms are spacious and well presented. The decor is plain as this is needed for some of the people who use the service on a regular basis. Service users bring personal items, for example, soft toys which makes the rooms look more 'homely'. Staff confirmed that people can choose the room they want to stay in from visit to visit. For some people, it is important that they stay in the same room for each visit. The service uses a form 'What to do before my stay' in preparing for an individual's arrival. The form notes any requests, likes and dislikes of individuals which can then be considered before their arrival at respite. We saw that all areas of the house were maintained to a very good standard. Families often visit the house at the beginning or end of a respite stay. Any comments about the accommodation have been positive. Areas for improvement The service should continue to seek views and comments on how the environment can continue to be improved and suitable for the needs of the people who use the service. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Sense Scotland Respite and Short Breaks Service, page 12 of 21
Service strengths The service uses risk assessments to maintain a safe environment. Regular checks are recorded and any action needed is then taken. We saw that the management of foods in the fridge meant that staff knew when foods had been bought and that all storage of foods met good practice guidelines. We saw that the storage and management of medication was secure and that staff used safe systems of work around medication. The service has regular maintenance contracts for equipment in use at the service. Staff training includes health and safety training, for example, food hygiene training. We saw procedures in place in each of the support plans inspected for the safe evacuation as part of the fire protection procedure. Areas for improvement The manager plans to continue and update risk assessments. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Sense Scotland Respite and Short Breaks Service, page 13 of 21
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths We saw that the manager matches staff on duty to the personalities and support needs of the people planning their stay at the service. Service users commented to us that 'I have someone to work with me when I come to respite. I can choose who it is sometimes.' A family said 'We admire the work the staff do and are always helpful if we ask any questions or have any worries.' The service gathered views from families as part of their quality assurance system. Feedback to the service confirmed that service users value the skills and support of the staff team. Areas for improvement The service should continue to get feedback from service users and their families on ways of improving the quality of staffing in the service. Grade awarded for this statement: 6 - Excellent 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 The service has a team of staff with little changes over the last year. This means that the service benefits from a trained and experienced workforce. We sent questionnaires to the staff team and had nine responses, including from relief staff. These confirmed that staff felt they had a good understanding of the policies and procedures in the service. Sense Scotland Respite and Short Breaks Service, page 14 of 21
This means that they felt they had the skills and knowledge to meet all the care and support needs of the people who use the service. Staff also said they have had all of the regular training courses needed. Where some of the needs of service users are changing, or new people start to use the service, staff said that training was given. We spoke to two staff on duty on the day of inspection. Staff confirmed that they have the qualifications for registration with the Scottish Social Services Council. This is the body that all staff will need to be registered with to be employed to work in social care. Staff said they have worked at respite for a few years and enjoy their work. One person said 'The best bit of the job is when you feel you have made a difference in someone's life.' Areas for improvement Some of the questionnaires returned to us said they are supervised by senior staff but not always regularly. It is appreciated that for relief staff, it can be tricky to manage meetings with their manager or senior. But these meetings are important for staff to feel they are as up to date as they should be to deliver support to individuals. The manager said that there are plans for additional group supervision meetings. This will help support the whole staff team. It is planned that discussions on the care and support needs and plans are understood by all staff and that any good practice in supporting challenging needs are shared as a matter of good practice. The organisation plans to adapt the titles of roles in the service to mirror the roles defined by the Scottish Social Services Council (SSSC). This will help understand the qualifications and responsibilities of individual staff. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Sense Scotland Respite and Short Breaks Service, page 15 of 21
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Managers at the service are in regular contact with families before and after a respite stay. This means that families can take account of the respite experience as part of the whole package of care. As an organisation, Sense Scotland aims to include families in all aspects of the organisation. This is supported by a dedicated officer who meets with families on request. Quality of service is regularly monitored by the service and by the organisation. Results from such surveys are regularly very positive about the quality and value of the service here. Areas for improvement The service plans to continue to encourage service users and carers to express their views. Grade awarded for this statement: 6 - Excellent 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 The respite service is an established part of all of the care and support plans for people who use the service. The service has responded to families need for information about how the respite stay has been for each person. Sense Scotland Respite and Short Breaks Service, page 16 of 21
Some service users do not want to personally 'report back' to families, so the service now can send a detailed letter informing carers of the activities undertaken during their stay. Other relevant information is included in the letter such as the service users sleep pattern. The manager said that the letter does not replace face to face conversations or telephone calls but can help families recall information which may not be important at the time but may be useful a bit later. As an organisation, Sense Scotland has achieved the Quality Scotland 'Committed to Excellence Award'. This is a measure of the organisation's commitment to organisational excellence and continuous improvement. We received questionnaire responses from 11 families. All said they were happy or very happy with the quality of the service provided at Fleuchar Street. Areas for improvement The organisation is developing audits of each service to highlight how areas are planning to improve. For example, the organisation, Sense, has bought in to Quality Scotland Auditing system. At the time of this inspection, Quality Scotland system is being piloted in another local service. It is planned that the Respite service will use the system at a later date. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Sense Scotland Respite and Short Breaks Service, page 17 of 21
4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Not applicable. 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). Sense Scotland Respite and Short Breaks Service, page 18 of 21
5 Summary of grades Quality of Care and Support - 6 - Excellent Statement 1 Statement 3 6 - Excellent 6 - Excellent Quality of Environment - 5 - Very Good Statement 1 Statement 2 6 - Excellent 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 6 - Excellent 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 6 - Excellent 5 - Very Good 6 Inspection and grading history Date Type Gradings 11 Jan 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 8 Nov 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 2 Sep 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed Sense Scotland Respite and Short Breaks Service, page 19 of 21
13 Jan 2010 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 23 Sep 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 10 Mar 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 16 Sep 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Sense Scotland Respite and Short Breaks Service, page 20 of 21
To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Sense Scotland Respite and Short Breaks Service, page 21 of 21