The Richmond Fellowship Scotland - Edinburgh Housing Support Service

The Richmond Fellowship Scotland - Edinburgh Housing Support Service Unit 1 Alderstone Business Park Macmillan Road Livingston EH54 7DF Telephone: 01506 420 910 Type of inspection: Unannounced Inspection completed on: 28 March 2017 Service provided by: The Richmond Fellowship Scotland Limited Service provider number: SP2004006282 Care service number: CS2004077051

About the service The Richmond Fellowship Scotland - Edinburgh is registered as a Housing Support and Care at Home service and provides support to people in their own homes. People will have learning difficulties, mental health difficulties or problems with drug or alcohol misuse. The service is provided to people living in Edinburgh at three locations. At two of these, people share parts of the accommodation. The registered Manager is based in Edinburgh. The provider, the Richmond Fellowship, is a charity which provides community based services for people who require support. They operate services throughout Scotland. The mission of the Richmond Fellowship Scotland is to provide high quality services that promote inclusion and maximise the individual's potential. At the time of this inspection about thirty-eight people were using the service. What people told us We received the following comments from the completed Care Inspectorate Questionnaires returned to us:- "I am happy with the support given to my relative by Richmond Fellowship. The support and supervision have kept my relative out of hospital. It's not all perfect there have been blips, staff not turning up, time allocation cut short, use of agency staff. Long term staff have been great". "We are happy with the way our relative is treated in their residence, always happy and smiling when we visit. The walking aid supplied has made a big difference ". Overall, the four questionnaires returned all agreed or strongly agreed that they were happy with the quality of care and support they received. We spoke with four people who use the service during the inspection and they made the following comments:- "They help me with me with my housing and sort out my benefits. Without them I could not cope. It's hard to find fault and difficult to be negative they support me with emotional, mental and practical help, I'd be lost without them. It would be nice to see the same staff quiet random staff changes. If I had a complaint I would go to the staff or to my social worker". "Overall, happy with the service". "Went to Benidorm last year and I want to go somewhere different this year. I like going to the football and go to Hearts Home games. I am a season ticket holder. I sometimes go to the pub". "I go to the Gyle Centre on the number 28 bus and then go to Starbucks. I am going to the pub tonight". Self assessment 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. page 2 of 13

The service provider identified what they thought they did well, some areas for development and any changes they planned. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 3 - Adequate 3 - Adequate Quality of care and support Findings from the inspection We found that people who used the service were supported to live meaningful life's in the community such as going out shopping, holidays, maintain their tenancy, go to the football, swimming. We found that some service users had an activity planner in place. We were concerned at the last inspection about the use of agency staff. We found that the service has taken steps to address this with a recruitment campaign and an increase in the sessional bank through a campaign in local colleges and universities. We continue to find the service using agency staff, although we acknowledge that this is decreasing. We have been advised that the service plans to cease using agency staff from July 2017, except in exceptional circumstances. We will continue to monitor this at future inspections. We were pleased to see that following our advice at the last inspection that the service has not taken any new referrals. We sampled care plans as part of the inspection. We found the care plans be to overly complicated, unwieldy and repetitive in places. We did not think they would be useful documents for staff to read and understand the care to be given. They were not always written in a person-centred way and were not always outcome focussed. There was still work to be done in having an effective, informative and concise care plan. This was discussed with the manager during the inspection where we gave examples and he acknowledged the need for improvement. The manager acknowledged that the use of language could be better. We thought the outcomes for people using the service was very good, however, this was not reflected in the care plans. Staff were knowledgeable about how they looked after people and were able to describe the strategies which worked to reduce service users distress. However, this level of detail was not reflected in the care plan in a way which was understandable for staff. e.g. bullet points. page 3 of 13

The service manage a number of service users finances. We found that each service user has an individual account with an opening and closing balance and receipts for purchases. Money is kept in a safe. However, there was no financial assessment in place detailing the reasons why the service were managing people's money. (see Recommendation 1) We have repeated a recommendation from the last inspection report in relation to 'Keys to Life' (see Recommendation 2) Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The service should ensure that a financial risk assessment is in place detailing the reasons why they are managing people's finances. (National Care Standards,( NCS ) Housing Support Services, Standard 3: Management and staffing arrangements and Standard 4: Housing support planning, NCS Care at Home, Standard 11:Expressing your views,ncs Care homes for people with learning disabilities, Standard 8:Making choices, Standard 10:Exercising your rights ). 2. The service needs to fully embed Keys to Life within people's care and support planning and delivery. (National Care Standards (NCS), Care at home, Standard 4:Management and staffing, Standard 7:Keeping well - healthcare, NCS, Care homes for people with learning disabilities, Standard 6:Support arrangements, Standard 8:Making choices, Standard 9:Feeling safe and secure, Standard 10:Exercising your rights, Standard 11:Expressing your views, Standard 16:Private life, Standard 17:Daily life ) Grade: 3 - adequate Quality of staffing Findings from the inspection The service should review the system of supervision and appraisal to ensure it is fit for purpose going forward to support staff to maintain their registration with the Scottish Social Services Council ( SSSC ). We emailed the manager the latest best practice publications for information. It was good to see that the manager had re introduced staff meetings and staff said they found these useful. Staff said they had sufficient training to do their job. Staff spoken with, were aware of their responsibilities to report under Adult Support and Protection legislation. Staff had access to a range of elearning modules e.g. medication page 4 of 13

Staff indicated that moral has improved since the appointment of the new manager approximately six months ago. The service was continuing to develop a 'competency based framework' to evaluate staff performance and we would encourage this development. We asked for information on what plans the service had for staff to obtain a qualification to register with SSSC. We were advised that plans were in place, however, the provider was unable to provide evidence as to the numbers and timescale for staff in this service to obtain a qualification. This will be monitored at future inspections. We have repeated a recommendation from the last inspection in relation to staff views (see Recommendation 1) Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service would benefit from collating and reporting on the views of support staff locally, to support the manager in identifying areas of improvement relating to the service. (National Care Standards, Care at Home, Standard 4:Management and staffing). Grade: 3 - adequate Quality of management and leadership Findings from the inspection We were pleased to see that a new manager was in post and was present on a daily basis within the service. We looked at the services system for logging in-house complaints and we looked at a specific example. We were satisfied that complaints were logged appropriately and properly investigated. We suggest that the service ask and record if the complainant is satisfied with the outcome of the investigation. We were pleased to see that the manager had developed a local improvement plan and we look forward to seeing this being fully implemented at future inspections. We were advised that the service was due a 'Quality Assurance' visit in the near future. We look forward to seeing the findings from this audit to take the service forward. page 5 of 13

We found that the service had a 'National Evaluation Tool' which looked at e.g. person-centred planning, continuous learning and development etc. It was not clear how this impacts on local service delivery. We were very pleased that the new manager was fully committed to taking the service forward and we look forward to seeing how this develops at future inspections. We have repeated a recommendation from the last inspection in relation to the services system of audits. (see Recommendation 1) Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service should further develop their quality assurance systems to ensure a robust process is established to monitor and improve the quality of service provided to people. (National Care Standards, Care at Home, Standard 4:Management and staffing). Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service provider must ensure all medication administered to service users is correctly recorded in-line with their relevant policies and procedures. This requirement is to comply with Scottish Statutory Instruments (SSI) 2011. No. 210. The Social Care and Social Work Improvement Scotland (SCSWIS) (Requirements for Care Services) Regulations 2011. Regulation 4 Welfare of Users. Timescale: Immediately on receipt of this inspection report. This requirement was made on 25 April 2016. page 6 of 13

Action taken on previous requirement From the records we sampled we are satisfied that the service has a robust system for the administration of medications. We did, however, find some minor errors which were identified and these were discussed with the manager during the inspection. We found that the service had a robust audit system to identify any errors and these were discussed with the individual staff concerned and at team meetings. We found that the majority of staff had been trained in the administration of medication. The service also had a system to check staff competency by observation and completion of a competency check. However, these were not always completed. We were satisfied that the service had addressed the majority of the issues reported on at the last inspection in relation to this requirement. Met - outwith timescales Requirement 2 The service provider must have an effective management and leadership oversight of the service to ensure the welfare of service users is fully met. This is to comply with the Scottish Statutory Instruments (SSI) 2011, No 210 Welfare of service users. Timescale: Twenty-eight days on receipt of this inspection report. This requirement was made on 25 April 2016. Action taken on previous requirement A new manager has been in post for the last six months and is present in the service every day. Staff have indicated that moral has improved and he has started to make a difference to how the service is performing. We look forward to seeing this improvement at future inspections. We are satisfied that the service has taken reasonable steps to address this requirement. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service would benefit from collating and reporting on the views of service users and carers locally, to support the manager in identifying areas of improvement relating to the service. page 7 of 13

National Care Standards, Care at Home, Standard 11 - Expressing your views. The manager has introduced a 'Peoples Support Event' to obtain the views of service users and plans hold these events frequently going forward. They also plan to introduce independent advocacy in the future. We saw that the views of service users were also sought through in-house questionnaires, however, these had not yet been collated and analysed. We thought the service was taking reasonable steps to address the issues identified in this recommendation. Recommendation 2 The service should keep and maintain records of complaints locally, to allow for easy access for those with a dayto-day responsibility for service delivery. National Care Standards, Care at Home, Standard 4 - Management and staffing. We looked at the services system for logging in-house complaints and we looked at a specific example. We were satisfied that complaints were logged appropriately and properly investigated. We suggest that the service ask and record if the complainant is satisfied with the outcome of the investigation. We thought the service had taken reasonable steps to address the issues identified in this recommendation. Recommendation 3 The service should prioritise their completion of reviewing, planning and agreeing support plans with service users to ensure they are up to date and reflect their needs. National Care Standards, Care at Home, Standard 3 - Your personal plan. We found that care plans were being reviewed within the legal frame-work of at least once every six months. We found that, overall, support plans and risk assessments were up to date. We were advised that care plans were written as directed by 'Head Office'. We have commented on the quality of care plans and improvements we would like to see under Quality of Care and Support. There was still work to be done to improve the quality of care plans. page 8 of 13

Recommendation 4 The service should also have appropriate systems in place to ensure records are reviewed and kept up to date to reflect the care and support needs of those they support. National Care Standards, Care at Home, Standard 4 - Management and staffing. We found that care plans were being reviewed within the legal framework of at least once every six months. There was still work to be done to improve the quality of care plans. Recommendation 5 The service needs to fully embed Keys to Life within people's care and support planning and delivery. National Care Standards, Care at home, Standard 7 - Keeping well - healthcare. The manager had discussed 'The Keys to Life' as part of a staff development day and we saw the principles displayed on posters in the staff room. However, this was not reflected in the use of language that we saw in care plans to evidence that the service was aware of people's rights to make their own decisions and choices. The manager and staff were not aware of any initiatives or strategies from the provider to promote 'The Keys to Life'. This had not yet been embedded in practice. This recommendation is not met and is repeated. Recommendation 6 The service should explore and develop further opportunities for service users to participate in assessing and improving the quality of staffing within the service. National Care Standards, Care at Home, Standard 11 - Expressing your views. We were advised that service users took part in the recruitment process and they planned to obtain service users views as part of the supervision process. page 9 of 13

Recommendation 7 The service would benefit from collating and reporting on the views of support staff locally, to support the manager in identifying areas of improvement relating to the service. National Care Standards, Care at Home, Standard 4 - Management and staffing. The manager has introduced a staff development day which he plans to continue going forward. Staff indicated they felt supported and could take issues to the manager and these would be addressed. We acknowledge the efforts the new manager has taken to obtain the views of staff, however, we feel this is still in it early stages. We will continue to monitor this at future inspections. This recommendation has not been met and will be repeated. Recommendation 8 The service should develop the opportunities for service users and carers to be involved in assessing and improving the quality of management and leadership within the service. National Care Standards, Care at Home, Standard 4 - Management and staffing. The manager has introduced a 'Peoples Support Event' to obtain the views of service users and plans hold these events frequently going forward. They also plan to introduce independent advocacy in the future. We saw that the views of service users were also sought through in-house questionnaires, however, these had not yet been collated and analysed. We thought the service was taking reasonable steps to address the issues identified in this recommendation. Recommendation 9 The service provider should support those who meet the requirements of the Scottish Social Services Council (SSSC) to be registered. National Care Standards, Care at Home, Standard 4 - Management and staffing. This also relates to the codes of conduct of the Scottish Social Services Council. We found that staff who were required to be registered with SSSC were now registered. page 10 of 13

Recommendation 10 The service should further develop their quality assurance systems to ensure a robust process is established to monitor and improve the quality of service provided to people. National Care Standards, Care at Home, Standard 4 - Management and staffing. We were shown the services system of audits and we were advised that the service was due a 'Quality Assurance Audit' assessment soon. We are concerned that the services system of audits was not identifying the issues we found in care plans. We will continue to monitor the system of audits at future inspections. This recommendation has not been met and will be repeated. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 23 Mar 2016 Announced (short notice) Care and support 3 - Adequate 3 - Adequate Management and leadership 2 - Weak 22 Dec 2014 Announced (short notice) Care and support 4 - Good 4 - Good Management and leadership 3 - Adequate page 11 of 13

Date Type Gradings 23 Jan 2014 Announced (short notice) Care and support 4 - Good 4 - Good Management and leadership 3 - Adequate 20 Mar 2013 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 9 Dec 2011 Announced (short notice) Care and support 5 - Very good 5 - Very good Management and leadership 24 Sep 2010 Announced Care and support 5 - Very good 5 - Very good Management and leadership 8 Jul 2009 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 5 Dec 2008 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good page 12 of 13

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 13 of 13