Independent Living Services - ILS Ayrshire Housing Support Service Cumbrae House 15A Skye Road Prestwick KA9 2TA Inspected by: Michelle Deans Type of inspection: Announced (Short Notice) Inspection completed on: 18 November 2013
Contents Page No Summary 3 1 About the service we inspected 6 2 How we inspected this service 9 3 The inspection 20 4 Other information 39 5 Summary of grades 40 6 Inspection and grading history 40 Service provided by: Independent Living Services (ILS) Ltd Service provider number: SP2003002216 Care service number: CS2008185120 Contact details for the inspector who inspected this service: Michelle Deans Telephone 0131 653 4100 Email enquiries@careinspectorate.com Independent Living Services - ILS Ayrshire, page 2 of 41
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 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 4 Good What the service does well We saw that there were systems in place to enable service users and relatives give feedback on the service provided. These included reviews of support, visits by the quality officer, quality assurance questionnaires and feedback through phone calls. Service users and their families we spoke with said that in general the direct care and support from the homecare workers was good and that they were happy with the service provided. What the service could do better Although there was a planned approach to completion of reviews these had not been consistently achieved for all service users at the point of inspection, however we could see these were 85% completed. We also found the quality of personal plans were variable with gaps in preferences of support for those service users who needed less help than those people with more complex needs. The quality and content of the personal plans should be consistently achieved for everyone. We found practice issues in medication records for people who had been assessed as requiring prompting with medication. We discussed that in some cases the support the service users received was in line with the definition of administration. We found that issues had not been picked up by the customer care supervisors when the completed medication records were returned to the office. Independent Living Services - ILS Ayrshire, page 3 of 41
We were told by service users and family that consistency in timings of visits could be an issue when the regular carer was off and we could see from looking at homecare staff rotas that there were instances of no travel time allocated between service users. Although the service for North Ayrshire had a call monitoring system in place as part of the contract with the local authority, the South and East Ayrshire services did not. Whilst we saw no evidence of issues with missed visits in the two areas as good practice the call monitoring system should be extended to the whole of the service provided. What the service has done since the last inspection There have been improvements in the format of the personal plan which has meant that when these are completed for all service users any homecare worker would be able to competently support the individual based on the information within the plan. There have been significant improvements in North Ayrshire to prevent the reoccurrence of missed visits as identified in the previous report. The manager and staff team have made a significant effort to carry out nearly 400 courtesy calls since January 2013 on top of the quality assurance surveys sent out to service users. This had evidenced that on the whole service users were happy with the support provided in all three local authority areas. The service has increased the number of office based staff and senior support workers to ensure more consistency in communication, feedback from service users and their families and in the day to day support. The service had also developed a quality team who specifically focused on the information documented within each individual support plan, they worked closely with all service users and their families to ensure that the completed document is personalised with individual agreed outcomes. Regular audits were undertaken within the service and the outcomes of the audits would be overseen by the manager. Where there were issues with reviews of support or personal plans not being completed as expected the assurance manager would oversee these to ensure they were completed Since the last inspection, Independent Living Service (ILS) have been taken over by the Mears Group. Whilst the provider remains ILS at this time, the majority shareholder in the company is Mears. Independent Living Services - ILS Ayrshire, page 4 of 41
Conclusion Inspection report continued Whilst there were still improvements to be made we found that overall the improvement plan put in place at the last inspection had led to better outcomes for service users. The improvements need to be sustained and reviewed to ensure they lead to consistency in support for all service users. However it was clear that a great deal of effort and work had been undertaken since the last inspection to make improvements in the service which would have a positive impact for service users. Who did this inspection Michelle Deans Independent Living Services - ILS Ayrshire, page 5 of 41
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.careinspewctorate.com. 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 Reform (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Order or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. ILS Ayrshire is registered to provide a Care at Home service and a Housing Support service. The service is delivered in a combined way and is therefore regulated as a combined service. The service provides personal care and support to adults with a variety of needs, living in their own homes. The service is generally available 24 hours per day seven days per week to provide flexible packages of care appropriate to service users' needs. The service has an office base in a business park on the outskirts of Prestwick. At the time of the inspection the service provided care and support to about 750 service users and employed the equivalent of approximately 270 staff. The service has a manager, a deputy manager, six customer care supervisors and six co-ordinators as well as a quality team based in the office. The service operates across three local authorities, South, East and North Ayrshire. The service brochure describes the service as: "ILS is a company which provides care and support for people in their own homes, in their communities or in respite." The service states some of its aims to be: "To provide support, advice and partnership to people with personal assistance, requirements or special care needs in order to enable them to live as independently as possible." "To develop and provide a range of responsive and flexible services which are needs led." "To provide a service which emphasises quality of life and assists in maintaining Independent Living Services - ILS Ayrshire, page 6 of 41
people in their own homes." Independent Living Services - ILS Ayrshire, page 7 of 41
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate 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. Independent Living Services - ILS Ayrshire, page 8 of 41
2 How we inspected this service The level of inspection we carried out In this service we carried out a medium 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 Inspector Michelle Deans visited the office base of the service and carried out the inspection on 18th November 2013 between the hours of 8.30am and 5.30pm. Prior to this visit the Inspector had spoken on the phone with twenty service users. We also spoke with ten relatives by phone. Prior to the inspection we sent out 249 questionnaires to the manager to distribute to service users, 98 were returned. We spoke with one service user at the office on the day of the inspection. During inspection evidence was gathered from a number of sources including Supporting evidence from the up to date self assessment Discussions with service users and relatives Staff supervision and training records and team meetings Personal plans for 20 service users Service users guide and written agreements Medication records for service users and the medication policy Quality assurance audits and outcomes Reviews of support Records of contact with service users and their relatives Recruitments records and staff files for 20 staff Discussions with the manager, quality officer, two senior support workers, two customer care supervisors and one co co-ordinator. We also spoke with the senior officer for contracts and commissioning in East Ayrshire Council. 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. Independent Living Services - ILS Ayrshire, page 9 of 41
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 Independent Living Services - ILS Ayrshire, page 10 of 41
What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that its internal systems are effective in following through concerns raised by service users and changes are made to the delivery of care accordingly. This is to comply with The Social Care and Social Work Improvement Scotland(Requirements for Care Services) Regulations 2011, SSI 201. Regulation 4 (1) (a)which is a requirement about welfare of service users. Timescale: within 24 hours of the receipt of this report. What the service did to meet the requirement We could see that where issues were raised there was evidence of follow up. A revised system to record messages from service users has been put in place to ensure that communication is improved. A quality team oversees reviews of support and over 60 % of service users have received a courtesy call in the last 6 months. The requirement is: Met - Within Timescales Independent Living Services - ILS Ayrshire, page 11 of 41
The requirement The provider must review the information about care and support needs recorded in support plans and ensure that this is detailed and reflects the personal preferences and choices of individual service users. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a)which is a requirement about welfare of service users. Timescale: within three months of the receipt of this report. What the service did to meet the requirement Over 85% of service users have had a review of support, however we have made a further requirement under theme 1 statement 1.1 to ensure this is achieved and sustained for all service users. The requirement is: Met - Within Timescales Inspection report continued The requirement The provider must ensure that there are sufficient and effective resources and systems in place so that service user support plans are being reviewed at least 6 monthly or as there are changes. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 5 (b) which is a requirement about personal plans. Timescale: within four weeks of the receipt of this report. What the service did to meet the requirement Over 85% of service users have had a review of support, however we have made a further requirement under theme 1 statement 1.1 to ensure this is achieved and sustained for all service users. The requirement is: Met - Within Timescales The requirement The provider must ensure that staff follow the information in support plans and timetables with respect to the times of visits to service users and that these are recorded accurately and in compliance with internal procedures. This is to comply with The Social Care and Social Work Improvement Scotland Independent Living Services - ILS Ayrshire, page 12 of 41
(Requirements for Care Services) Regulations 2011, SSI 201. Regulation 4 (1) (a) which is a requirement about welfare of service users. Timescale: within 24 hours of the receipt of this report. What the service did to meet the requirement A revised requirement about timings and monitoring of visits has been made under theme 1 statement 1.3 The requirement is: Not Met Inspection report continued The requirement The provider must review and revise all internal processes and procedures to ensure that the quality of the service provided is consistent across all areas and in line with the national care standards. The provider must also take appropriate actions to improve internal risk management and communication to avoid any recurrence of what took place in North Ayrshire and the resulting poor outcomes for service users and their families in this and other areas. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4(1) (a) which is a requirement about welfare of service users. See also: The Public Services Reform (Scotland) Act 2010, Part 5, section 45 (2). Timescale: within four weeks of the receipt of this report What the service did to meet the requirement We could find no evidence to suggest that actions had not been appropriately taken to ensure that the poor outcomes for service users in North Ayrshire would happen again. We also saw that a call monitoring system had been put in place in this area to monitor all visits to service users. The requirement is: Met - Within Timescales The requirement The provider must ensure that it has carried out all necessary checks to ensure that staff are fit persons to be employed in the service before engaging them in the induction process. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 9 (1) which is a requirement about fitness of employees. Independent Living Services - ILS Ayrshire, page 13 of 41
See also: "Better Recruitment Through Safer Recruitment", Scottish Executive 2007. Timescale: within 24 hours of the receipt of this report What the service did to meet the requirement Inspection report continued We saw that staff do not work with service users until all relevant checks are completed. It is clearly stated to staff in the offer of employment that they attend the induction process as part of recruitment however the offer of employment was subject to appropriate checks being returned. See under theme 3, statement 3.2 where a recommendation has been made about this. The requirement is: Met - Within Timescales The requirement The provider must ensure that it has an effective training plan in place for 2013/14 and that this includes training opportunities linked to issues arising from staff supervision and appraisals. All training delivered must provide staff with the skills and knowledge to meet the needs of the service users. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 15 (d) (i) which is a requirement about Staffing. Timescale: within eight weeks of the receipt of this report. What the service did to meet the requirement This requirement has been carried forward under theme 3,statement 3.3 The requirement is: Met - Within Timescales The requirement The provider must put systems in place to ensure that all staff receive regular and consistent supervision which addresses training and development and measures/ addresses issues of staff competency on a rolling programme basis. It should also be a platform to raise any issues of concern. Supervision sessions must be properly recorded with actions being followed up. This is to comply with The Social Care and Social Work Improvement Scotland(Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a)which is a requirement about welfare of service users. Timescale: within six weeks of the receipt of this report. Independent Living Services - ILS Ayrshire, page 14 of 41
What the service did to meet the requirement A programme of regular supervisions had started in the service, as this was not fully in place for all staff a further recommendation has been made under theme 3,statement 3.3 The requirement is: Met - Within Timescales Inspection report continued The requirement The provider must review its senior staff structure within ILS Ayrshire and take appropriate steps to ensure that adequate resources are in place to effectively manage required improvements and sustain improved quality. The provider must share the outcomes of this review with the Care Inspectorate and prepare an appropriate action plan with timescales. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 15(a) which is a requirement about Staffing. Timescale: within four weeks of the receipt of this report. What the service did to meet the requirement The staff structure has been reviewed and further posts have been created to allow customer care supervisors and co-ordinators be responsible for specific areas. An action plan was submitted to us as part of the inspection process. The requirement is: Met - Within Timescales The requirement The provider must ensure that all notifiable events are reported to the Care Inspectorate as required. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a) which is a requirement about welfare of service users. Timescale: within 24 hours of the receipt of this report. Requirement 11 The provider must ensure that information collected about the quality of the service is used effectively to implement improvements and respond to customer expectations. Independent Living Services - ILS Ayrshire, page 15 of 41
This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a) which is a requirement about welfare of service users. Timescale: within 24 hours of the receipt of this report. What the service did to meet the requirement We have no evidence to suggest that any notifiable events have not been submitted to us. Action taken on requirement 11 We saw an improvement plan was in place and regular weekly audits undertaken to ensure key targets were being achieved. This has been met. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection Three recommendations were made at the previous inspection 1. It is recommended that the provider ensures all future surveys are followed up by an action plan which is fed back to service users and their families as well as to staff. The service should also consider how it might access the views of those who may have a sensory impairment or dementia or whose first language may not be English. National Care Standards. Care at home. Standard 10 - Supporting Communication and Standard 11 - Expressing Your Views. See under theme 1, statement 1.1 where this is discussed 2. It is recommended that the provider ensures communication systems are effective and that service users will be notified in advance of any changes in their usual carer and the timing of visits. National Care Standards. Care at home. Standard 4 - Management and staffing. See under theme 1, statement 1.4 where this is discussed Independent Living Services - ILS Ayrshire, page 16 of 41
3. It is recommended that the provider schedules staff meetings in line with its own internal policy and that these forums are used effectively to discuss issues, enhance communication and share information. National Care Standards. Care at home - Standard 4 - Management and staffing arrangements. See under theme 3, statement 3.3 where this is discussed Inspection report continued 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. Before we carried out our inspection, the manager submitted a self-assessment which contained relevant information about what the service thought they did well. It described how they hoped to bring about the improvements they were planning and reflected our findings at inspection. Taking the views of people using the care service into account As part of this inspection we had spoken with twenty service users by phone. All service users were happy with the direct care and feedback was that the service had improved over the last 6 months with more consistency and better communication with the office staff. No issues were raised by the service users and everyone we spoke with said that whilst there remained issues with inconsistency in homecare workers with annual leave or sickness on the whole they received support from the same homecare workers at the time agreed with them. Prior to the inspection we sent out 249 questionnaires to the manager to distribute to service users, 58 were returned by service users. 95% indicated they were happy with the service provided. The four service users who indicated they were not happy were contacted by us. There were issues raised with regard to communication, the lack of consistent rotas, timings of visits and the scheduling of staff who had to travel greater distances between visits. These were discussed with the manager, customer care supervisors and co-ordinator. All the issues raised reflected the findings for the Independent Living Services - ILS Ayrshire, page 17 of 41
outcome of the recent quality assurance surveys and were being addressed in an action plan. Comments included: "Fantastic carers Carers are all good I am very happy Carers wonderful, I can't praise the service enough Overall I am happy with the care I receive The staff are kind and considerate Couldn't ask for better Everyone is very helpful My workers are competent and helpful I am very happy with the support I get" Inspection report continued I don't receive a weekly rota and therefore I don't know who will be coming I don't always get a rota Needs better scheduling on the rota Not all the carers read the care plans Carers could be better allocated I don't know who is coming as carers are moved or swapped" Taking carers' views into account As part of the inspection we also spoke with ten relatives by phone. All relatives we spoke with felt the service was much better than previously and that they felt on the whole communication had improved. Relatives we spoke with felt the homecare workers competent in their support and that on the whole there was a greater level of consistency with support. Prior to the inspection we sent out 249 questionnaires to the manager to distribute to service users, 40 were returned by relatives. 98 %indicated they were happy with the service provided. Of the two who were unhappy one person said this was not in relation to the service provided by ILS but to a former provider. Comments included: "They take good care of my mother, I am very pleased Excellent carers but communication with the office can be improved The office and carers are very good at keeping me updated Staff are always very polite and helpful Individual carers are very good but office staff are not, staff are not deployed in a logical way My mother looks forward to the carers visits, I feel confident in the service Independent Living Services - ILS Ayrshire, page 18 of 41
It can be very stressful when regular carers are off Care is very good but the service can be disorganised re where staff are sent". Independent Living Services - ILS Ayrshire, page 19 of 41
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: 3 - Adequate 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 There were good opportunities for service users to participate in assessing and improving the standard of care and support. Customer care supervisors and the quality team were responsible for meeting service users to discuss any issues, writing personal plans with service users and facilitating reviews of support. Senior support workers would also carry out direct care and this gave an opportunity to discuss any issues that may not have been fed back under normal circumstances to the office. ILS Ayrshire sends quality assurance questionnaires to every service user who was currently supported by the service once a year. The questionnaires for 2013 were to be sent out in June. The questionnaires sent out reflected the quality themes that the Care Inspectorate use for inspection, quality of care and support, quality of management and staffing and quality of management and leadership. The questionnaires ask about staff practice, support issues and reviews of support. The questionnaires also include a section for any comments or suggestions for improvements in the service. Outcomes from the surveys were fed back to service users through the quarterly newsletter. We saw that the outcomes of the questionnaires sent out reflected our findings at inspection and from speaking with service users and relatives. The main area for improvement was in communication. We saw that action had been taken to address this and an action plan was in place. This showed that where comments were made the manager and staff team had acted to make improvements. In conjunction with this the service users would randomly receive courtesy calls from Independent Living Services - ILS Ayrshire, page 20 of 41
the customer care supervisors to ask about the service they received. At the point of inspection over half of the service users had received a courtesy call in the last 6 months. The results reflected our findings in that the majority of service users were happy with the support provided. We saw that where issues were noted from the call then there was evidence of what action had been taken in response to this. Service users received a six monthly newsletter which gave relevant information on any developments within ILS Ayrshire. This included details of how to contact ILS either to raise an issue, to make a complaint or to find out how to be involved more in the service. One of the outcomes from the returned questionnaires was that service users were unaware how to make a complaint. As a result of this a letter was sent to all service users giving information on this and contact details. As part of the ongoing strategy to involve service users, a survey had been sent to all service users asking if they would like to be involved in induction training, recruitment, policy groups or the newsletter. Whilst there was not a very good response to this, it still shows that there are opportunities to be involved if service users wished to do so. We saw good practice of a service users personal pans being translated into braille to enable them to access this. The service had worked with the RNIB to help do this. We saw that personal plans were being reviewed and there was a planned approach to achieve this for all service users. The format for reviews included who was involved in the review. The quality officer said that for all service users who had a diagnosis of dementia that families or representatives opinion of the service would always be asked for as part of the review process. This was either done by phone or in person. The service had a well written Service User and Carer Participation Strategy. This was written in plain English and was available in different formats. It explained the service's commitment to involving people who were using the service and acknowledged that different levels of participation suit different people. It went on to explain what its aims were, how they would be achieved and by whom. Areas for improvement Since the previous inspection the service has continued to implement the Service User and Carer Participation Strategy. This included evidence of outcomes being fed back to service users, both individually and in general, views being sought from service users and their representatives of the service provided and the continuation of a planned approach to the review of support and personal plans involving relatives as appropriate. At the point of inspection there was still further work to be done to achieve consistency in this. For example whilst actions were identified though courtesy calls often there was a lack of follow up evidenced to ensure the issues had been resolved Independent Living Services - ILS Ayrshire, page 21 of 41
after the action had been taken. Not all service users had a review of their support needs in the last six months or longer in some cases. Although we did recognise that at the point of inspection 85% of service users had a review completed at the point of inspection there remained approximately 90 to complete. Because at this point in time there were further improvements to be made and not all service users had a review of their personal plan in the last six months we have made a requirement and recommendation. (See requirement 1 and recommendation 1) Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must make proper provision for the health, safety and welfare of service users. In order to do so, the provider must put in place a system to ensure that service users are fully involved in developing and reviewing their personal plans at least once in every six month period or when there is a significant change in the service user's health, welfare or safety needs, that this is done in consultation with the service user and, where appropriate, their relative or representative, and that this consultation is recorded. This is in order to comply with SSI 2011/210 Regulation 4(1) (a) - a regulation regarding the welfare of users and SSI 2011/210 5 (2) (a) and (b), Personal Plans Account should also be taken of National Care Standards, Care at Home, Standard 3, your personal plan. Timescale for implementation: to commence on receipt of this report and be completed within 8 weeks. Recommendations Inspection report continued 1. The service should continue to develop and implement the quality assurance systems to encourage people using the service and their relatives to be involved in service development and evidence positive improvements for the service users as a result of consultation. National Care Standards, Care at Home, Standard 4, Management and staffing and Standard 11, Expressing your views. Independent Living Services - ILS Ayrshire, page 22 of 41
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that support was adequate in ensuring that service users' health and wellbeing needs were being met. ILS had appropriate policies and procedures in place to underpin staff practice. These included Adult Support and protection, medication, whistle blowing, health and safety, accident and incident reporting and infection control. All staff had been given training on all the policies as part of their induction and had also completed mandatory training such as moving and handling and food hygiene and medication. Training records were kept for all staff to evidence attendance at the mandatory training. Values and philosophies towards working with service users were part of staff induction to the service. All staff received a copy of the Scottish Social Service Council codes of Conduct (SSSC) codes of conduct for staff when working with service users. Principles of care were discussed at induction training. We sampled 20 personal plans in total. The plans in general contained comprehensive detail about background health needs and preferences as to how the service user would like to be supported. In these plans the level and quality of information was very good however this was not consistently achieved. We saw where risks were identified that some action plans had been put in place to minimise the risk, where the revised newer format for personal plans was used the risk assessment included all aspects of the service users support from the environment to mobility. Where medication was part of the planned support, the service user had a medication risk assessment and medication management plan in place. All staff were trained on the administration of medication in the service as part of their induction. The medication risk assessment included the level of help needed in the administration of medication. We were told that only one area supported medication at level 3. This was where the service user needed full assistance to take any medication. This was in East Ayrshire. We spoke with the senior contract officer for East Ayrshire council who said the ILS Ayrshire team worked jointly with the council to ensure medication administration followed the agreed policy and procedures. This was to include a joint working group to discuss any issues with the procedures and policy. We also saw input from relevant professionals where appropriate such as community nurses, pharmacists and GPs. We saw that where individuals received 24 hour support that small teams of carers Independent Living Services - ILS Ayrshire, page 23 of 41
provided this. We could see that where a service user had specific needs such as mental health issues that staff were trained on these. We also saw that as good practice all office based staff had received an introduction to mental health because the company currently supported 18 people who had specific mental health issues. Service users and families we spoke with felt the direct care given by the homecare workers met the individual assessed needs and in general were happy with the direct care and support provided. Areas for improvement Inspection report continued We were told that the service had to follow East Ayrshire's medication policy as part of the contractual arrangements. We saw that this included an assessment of the level of administration required. However in the other two local authority areas we debated some service user's assessment of only requiring prompting, as they were unable to remember to take the medication and homecare workers had to physically hand medication from the blister pack to them. We discussed that a full review of medication should be undertaken to ensure assessments were correct. We saw that this had led to confusion with regard to record keeping for those service users assessed as only requiring prompting. We discussed that staff should feedback to the office where the plan had stated "prompt" with medication and clearly they were administering this. We also discussed issues of recording of medication that was to be prompted and a specific issue with regard to this with the manager. (See requirement 1) We found that when medication administration sheets were used that there was no system in place to audit these, as observed practices of staff were inconsistent this meant there was no system in place to check that there were no errors in medication out with this being reported by family, the service users or staff. (See recommendation 1) We could see that a great deal of work had been put into the new personal plan format and the ones we saw had detailed information in them about preferences of support. However at the point of inspection not all service users had the new plan in place and the ones in use were variable in quality and content for service users who required less support than those people with more complex needs. We discussed that the quality of information in the plans should be consistently achieved. (See recommendation 2) Although we could see no evidence of missed visits in East or South Ayrshire, as good practice a call monitoring system should be introduced to ensure the safety of more vulnerable service users. At present only the North Ayrshire service users have a system in place. This meant outwith the service users, family or staff notifying the service a visit had been missed or was late there was no way to tell if this happened or not. We saw this as a potential risk to service users. Added to this in these two areas we found that staff did not consistently record the times or length of visits to Independent Living Services - ILS Ayrshire, page 24 of 41
service users in daily diaries, again this meant there was no overview if service users were getting their support as agreed. Please also read statement 1.4 which is also relevant. (See requirement 2) Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 2 Requirements 1. The provider is required to ensure that all staff follow policy and procedures with regard to the administration of medication and that there are systems in place to support the medication policy. This includes: (i) Detailed information on the specific needs of the individual service user with regard support with medication. (ii) Staff training on how medication should be detailed within personal plans and responsibilities for ensuring support is accurately reflected in the personal plans and information held in the office. (iii) A full review of the level of support service users need with medication should be undertaken by the service. The review would include medication risk assessments which would give detailed information on levels of support required and any associated risks. This is in order to comply with Scottish Statutory Instrument 2011 - No 210 Regulation 15(b)(i) a Regulation relating to staff training. Account should also be taken of National Care Standards - care at home Standard 4, Management and staffing arrangements and Standard 7, Keeping well - healthcare. Timescale for implementation: to commence on receipt of this report and be completed within 8 weeks. 2. The Provider must ensure that the service is provided at the agreed times, and in such a way that it meets the identified needs of the service user as recorded in the agreed support plan. In order to achieve this, the provider must: (i) Show who will be providing the agreed care and that a reliable system is in place to inform service users if carers are running late. (ii) Ensure a system is in place to regularly monitor and audit the quality of the service to ensure service users are receiving support as agreed. This is in order to comply with SSI 2011/210 Regulation 4(1) (a) a regulation regarding the welfare of users Independent Living Services - ILS Ayrshire, page 25 of 41
Account should also be taken of National Care Standards, Care at Home, Standard 2, Your written agreement and Standard 4. Management and staffing. Timescale for implementation: to commence on receipt of this report and be completed within 4 weeks. Recommendations 1. A system to audit medication records should be put in place to ensure that there is an overview of any medication errors or omissions. National Care Standards, Care at Home, Standard 4 - Management and staffing. 2. All personal plans should be of the same quality and have information on the preferences of support for service users within them. National Care Standards, Care at Home, Standard 4 - Management and staffing. Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service strengths We found that communication between service users, homecare workers and the office based staff needed to be improved upon, however service users were given relevant information about the service prior to using the service t of the on-going quality assurance process.. We saw from courtesy calls undertaken to service users that there were only a small number issues identified about the timings of visits which was an improvement from the last inspection. At the point of inspection this was approximately 60% of service users. The service provided all new service users with a welcome pack. The pack contained information on the organisation, how to cancel or end the service, how to make a complaint and a guide to how service users can give feedback about the service. All new service users were also issued with a service user guide. This gives information of the expectations of the service, staff training, personal planning and gives answers to frequently asked questions. Local authority contracts were in use for all service users. The revised personal plan format also included a schedule of support which identified the agreed times of the support. Independent Living Services - ILS Ayrshire, page 26 of 41
ILS has a website which gives information on the organisation and on the services it provides throughout Scotland. When a referral was made the customer care supervisor/quality officer would visit the service user to discuss their specific needs and a personal plan would be completed with full service user involvement. At this time any questions about the service could also be answered. We saw information being passed onto service users through the newsletters which kept them informed of any changes to the service provided. Customer care supervisors said that any new homecare worker would be fully informed of key tasks and relevant information specific to the service users prior to the visit. When homecare staff receive their rotas for the week as to whom they were allocated to support this included some basic detail on support required this was also used to pass on changes to support to ensure consistency. From speaking with service users and their relatives we found that they knew how to contact the service, both during day time working hours and out of hours. Where issues were raised by service users or their family we saw that these were dealt with. The outcomes of the returned quality surveys showed there were issues with communication. The manager had put new systems in place to try to resolve the issues where calls from service users were recorded if a person had taken this who did not work in that specific area or know the service user. This had only recently been put in place and it was too soon to evidence improvement. Areas for improvement Inspection report continued The service user guide contained a paragraph stating that whilst regular carers would be allocated to service users, should they be off sick or on holiday then different carers may have to be allocated. However it also said "we will ensure you are fully informed of the change". This was not consistently achieved. When the main carer was on holiday often the service user did not know who would be supporting them. Service users also discussed with us that rotas were not consistent and sometimes when they did get these the times on them differed from the time of support. We discussed rotas with the manager and co-ordinator. They said rotas were only sent to service users who requested them. This meant that not all service users knew what times their support was or who would support them. Whilst we agree that for some people with dementia rotas may cause confusion, service users should be informed of their times of support and who will give this. This also links into requirement 2 under statement 1.3 (See recommendation 1) From sampling staff rotas and speaking with service users the issue of allocated "travel time" came up. We saw that sometimes (but not always) the time of support for a service user ended at exactly the same as the next support should start. There Independent Living Services - ILS Ayrshire, page 27 of 41
was no reference to travel times in the introductory information given to service users this meant there was no clear information given to service users about this and what it meant for their support. (See recommendation 2) An action plan had been put in place to improve communication. We were told by service users and relatives that on some occasions information had not been passed on from office staff to homecare workers. In one example we were told a service user had cancelled their support but a carer still arrived. The co-ordinator told us that unless a family member or the relevant local authority could be contacted to confirm this, they were hesitant to cancel the support if they did not know the service user well. Whilst we could see the benefit of this, this information needs to be passed onto the service users so they are aware of the guidance re this. If this is not consistently done then a decision should be made to adopt it as policy or not. We will follow this up at the next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. Any changes to support must be communicated to service users and reflect the guidance given to service users in the welcome pack and contractual agreements. All service users should be informed of accurate times of support and who will be supporting them. National Care Standards, Care at Home, standard 4, Management and staffing. 2. The service should provide all service users and their relatives with accurate information on what can be provided as part of the agreed support. This would include reference to changes of homecare workers and travel time. National Care Standards, Care at Home, standard 1, Informing and deciding Independent Living Services - ILS Ayrshire, page 28 of 41
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate 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 there were good opportunities for the service users to participate in assessing and improving the quality of staffing in the service. The quality assurance questionnaires asked for feedback with regard to staff practice. For staff who were undertaking Scottish Vocational Qualifications (SVQ) there was an opportunity on occasion for service users to be involved in planned observation of practice during a specific task. At this time service users could be given the opportunity to give feedback to the assessor on staff practice. A letter was sent to service users asking for anyone who was interested in being part of the induction and training for new staff. Service users had also been recently asked to join a recruitment forum. Whilst there was little uptake on service user forums and involvement, should people wish to do so the opportunity was there. The organisation had a reward scheme for staff called 'Living our values'. This meant that every month staff could be nominated for a modest reward if they had done something exceptional. Service users had embraced this scheme and had nominated several staff for the award at the time of the inspection. See under theme1, statement 1.1 for further strengths which are also relevant to this statement. Areas for improvement Whilst some work had been completed in involving service users in assessing and improving the quality of staffing in the service, such as quality assurance surveys, involvement in recruitment and through reviews of support, it was too soon to evidence how this would impact on the development of staff practice. Observed practice has been inconsistent, feedback from service users through staff appraisals and supervisions were also not consistently achieved. (See recommendation 1) Independent Living Services - ILS Ayrshire, page 29 of 41