QXHA Sheltered Housing Support Service Housing Support Service 45 Firhill Road Maryhill Glasgow G20 7BE Telephone: 0141 945 3003 Inspected by: Roddy MacInnes Type of inspection: Unannounced Inspection completed on: 23 December 2013
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Queens Cross Housing Association Ltd Service provider number: SP2004005471 Care service number: CS2003054944 Contact details for the inspector who inspected this service: Roddy MacInnes Telephone 0141 843 6840 Email enquiries@careinspectorate.com QXHA Sheltered Housing Support Service, page 2 of 23
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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The Management team and staff team listen to the wishes of people using the service and, where possible, act on these. Staff have continued to involve service users in all aspects of service delivery and have very good audits to measure service improvement. What the service could do better The service needs to continue to develop more accessible and relevant ways to share information with service users and clarify service delivery, particularly when they are in very sheltered accommodation due to changing needs. What the service has done since the last inspection The service have continued to effectively involve service users in monitoring the quality of support it offers. The service still has in place an excellent range of methods of involving service users and carers in assessing and improving service quality and influencing grades. Conclusion Overall, we thought that the staff team are very good at supporting and encouraging service users to take positive decisions through the use of individual choices to make sure that individual lifestyles are achieved through the use of person centred methods. QXHA Sheltered Housing Support Service, page 3 of 23
Who did this inspection Roddy MacInnes QXHA Sheltered Housing Support Service, page 4 of 23
1 About the service we inspected QXHA (Queens Cross Housing Association) Sheltered Housing Support Service is registered with the Care Inspectorate to provide eight housing support services under one branch. The Service provides support to tenants residing in the Association's sheltered housing units. These are in Firhill, Kirkland Street, Westercommon, Woodside, Seamore, Windsor Terrace, Cromwell and Hopehill. All of these services are located in the northwest area of Glasgow, primarily Maryhill. Cromwell Court Very Sheltered complex operates from 9am-9pm, 7 days a week. Windsor Terrace and Cromwell Court alarm calls out of hours are responded to by Cordia. From Monday to Friday staff are based, within working hours, at each of the sheltered housing developments to deliver support to service users. At the weekend staff share the cover of services from morning to midday. Outwith these times an alarm system is in situ in each service user's home that is linked to Bield Housing, which in turn is linked to a staff member on-call from the service. The service aims to "Support people in a safe and secure environment to set and reach their future goals. To provide opportunities for people to access training, education and meaningful activities. To inspire and to enable people to lead fulfilling lives in their community". "Together we empower, independently you choose". Requirements and recommendations: If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement. -A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards. -A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The Care Inspectorate (SCSWIS) is the new regulatory body for care services in Scotland. It will award grades for services based on the findings of inspections. QXHA Sheltered Housing Support Service, page 5 of 23
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very 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. QXHA Sheltered Housing Support Service, page 6 of 23
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection that took place over four periods starting on 7/11/13 from 3.00pm to 5.00pm, 30/11/13 from 12.00 noon to 4.00pm, 5/12/13 from 1.15pm to 4.00pm and on 19/12/13 from 3.45pm to 4.40pm with feedback confirming grades to the manager, concluded at 4.00pm on 23/12/13. The inspection was carried out by Care Inspector, Roddy MacInnes. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents including: *evidence from the service's recent self assessment *5 support plans of service users *Yearly review planner *Newsletters *registration certificate *service's internal 2013 questionnaires *6 Workers interviewed *Various focus group minutes *service user meetings *staff training plan 2013 *management meetings 2013 *supervision 2013 dates *rating of services in consultation with service users *staff team meetings *tenant questionnaires for recruitment of new staff *naming the new sheltered housing newsletter with service user consultation *2013 team building day *Sheltered housing service user one to one meetings questions/comments. *supervision dates *the registered manager *Meaningful Activities Survey June 2013 *15 service users *26 service user questionnaires *4 risk assessments QXHA Sheltered Housing Support Service, page 7 of 23
*minutes of key work and review meetings that the service user took part in *Quality assurance system *meetings and questionnaires *Minutes of support staff meetings and service user meetings. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org QXHA Sheltered Housing Support Service, page 8 of 23
What the service has done to meet any recommendations we made at our last inspection There was one recommendation made at the last inspection this has been fully met. All personal plans should ask for information on medical needs as well as other health matters. In addition when a couple is supported, each person should get an individual review minute. National Care Standards, Housing Support Service, Standard 4: Housing support planning, Standard 6: Choice and communication, Standard 7: Exercising your rights and Standard 8: Expressing your views 1. From speaking with staff members, service users, manager and examination of paperwork, this recommendation has been met. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self evaluation for this service which was completed in detail, highlighting much strength within the service and areas which they are currently striving to develop or recognize improvements could be made in the future. QXHA Sheltered Housing Support Service, page 9 of 23
Taking the views of people using the care service into account All people using this service were very complimentary about the staff team, manager and the care provided. These included: "It's good here the staff are great" "The place is lovely" "Staff are fair to middling" "There is something to do most days" "I think it's very good here, very clean and nice and bright" "(The staff) get to know you and what you like" "I can ask to look at my care plan when I like" "On the whole the care and support is good" "It's alright here" "Staff are kind and attentive and answer the buzzer quickly". Taking carers' views into account No carers were spoken with during this inspection. QXHA Sheltered Housing Support Service, page 10 of 23
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: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths An examination of relevant documents and feedback from service users, staff and managers indicated a very good performance by the service in relation to this statement. Questionnaires used by the service contained positive comments about the service from service users. For example, they thought the general staff attitudes were very good. They thought that there was good communication between staff and they were treated with fairness and respect. Comments held by the service from their recent satisfaction survey included: "100%" "They always answer my questions" "Very good" "Fantastic" "Whenever I need their help, they always listen" "Always Brilliant" "Staff can't do enough for you - excellent" The service have adopted an excellent proactive approach to gaining feedback from both service users and carers outside of the review process. Service users were fully involved in developing and implementing the service to be provided. Service users are also represented on the Board of Management and area committees. QXHA Sheltered Housing Support Service, page 11 of 23
This was evidenced when Support Plans were audited and seen to contain Service Reviews which, amongst other matters, asked how service development and improvement could be encouraged and enhanced. Reviews evidenced that the wishes of aspirations of service users were listened to. Tenants clearly were at the heart of planning, delivery and reviewing their day-to-day care and longer term support needs. They were also provided with a range of opportunities to participate in developing the service through meetings and satisfaction questionnaires. Personal plans sampled were up-to-date and well laid out. They demonstrated good levels of partnership working with tenants, advocates and significant others. Areas for improvement The service needs to continue developing the methods and opportunities for stakeholders, service users and their families/carers to give their views about all areas of the service - including quality of care, staffing and management and leadership. Greater understanding regarding what the service provide and what areas are not covered should continue to be explored with service users. For example, some comments made during the course of this inspection included: "the needs of clinical sick are not covered in the plan" "seizures have been ignored as every week they occur" Although there are very good participation methods used between staff and service users, the service needs to better evidence how service users are involved in informing the grading system. The questionnaires should be more focussed in relation to the Quality Themes and document the grades being considered. (See Recommendation 1 below). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Recommendation with reference to Theme 1, Statement 1: Consideration should be given to evidence more explicitly the involvement of service users or advocates, where appropriate, in the completion of the self inspection grading. This is in accordance with National Care Standards, Housing Support Standard 3: - Management and Staffing QXHA Sheltered Housing Support Service, page 12 of 23
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Following consideration of sampled written evidence and feedback from management, staff and service users, this service has a very good performance in relation to this statement. There were personal plans in place for all service users. The personal plans examined by the inspector contained a good range of information in respect of the service users' social needs. The service users spoken with over the course of the inspection expressed that they were aware that they could raise any issue or concern with the manager. Support plans clearly outlined individual needs and wishes and there was clear evidence that these shaped the day-to-day support offered by staff. In discussion staff displayed a detailed knowledge of service users' preferences and needs. Sampled support plan information, including risk assessments, had been signed and dated by the person completing the information and clearly indicated the involvement of the service user and clear strategies to reduce the likelihood of a similar situation re-occurring. In conversation staff displayed a strong commitment to maximising individual service user potential. The service was able to demonstrate that they were able to identify service users' health and social care needs and undertook appropriate support, e.g. supporting people to contact and attend their GP. Regular, six monthly, reviews were undertaken with those using the service. At these, service users and appropriate others could discuss the service being provided and, if required, change it to meet developing support needs. There was evidence to demonstrate that staff aimed to promote a person centred approach to support and care for service users. We saw samples of records about activities which showed that there was a range of activities available. We saw lots of photographs of outings and activities which people had clearly enjoyed. There was also a good level of detail about activities enjoyed by people. Staff and service users confirmed that service users' wishes and choices were known and respected. Areas for improvement The service may wish to examine ways in which they can influence more user friendly paperwork to help encourage and evidence greater user consultation. Health checks should be incorporated more effectively into the review process. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued QXHA Sheltered Housing Support Service, page 13 of 23
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 Following consideration of sampled written evidence and feedback from management, staff and service users, this service has a very good performance in relation to this statement. In addition to the strengths highlighted under Theme 1, Statement 1. From looking at documentation and speaking to service users there was very good evidence that people were asked their views about all aspects of the service being provided. Service users interviewed felt that their views were valued and that staff took into account what they said. Service users were very complimentary about the staff team that provided them with support. All staff spoken with confirmed that they felt valued and advised that staff worked hard to ensure communication was effective. All staff were clear regarding the services aims and objectives and how they contributed towards meeting these. Staff had been provided with training in, and were aware of their responsibilities regarding adult and child protection. Prior to working with service users staff were provided with Induction Training and undertook a period of 'shadow working' to ensure they were aware of the services expectations. The quality of Induction was monitored via an 'Induction Follow-up' form which asked staff about their experience of induction and any improvements they feel could be made. Areas for improvement The service should continue to seek the views of other organisations about the quality of the service they provide. Mixed views regarding the newsletters issued were made. Some people felt that although it looked professional, they preferred when each complex produced their own. QXHA Sheltered Housing Support Service, page 14 of 23
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued QXHA Sheltered Housing Support Service, page 15 of 23
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Following consideration of sampled written evidence, and feedback from management, staff, carers and service users, this service has a very good performance in relation to this statement. From the questionnaires, observation and discussion it was evident that there were good relationships between staff and service users. Service users confirmed that staff promote equality and treated them as individuals. Comments included: "Excellent service, very helpful and understanding staff". "Very kind, courteous, polite and helpful". "feel that all staff treat tenants well" "In bad weather if you can't go out they are happy to help" "they are very happy to listen to what you have to say" A training plan was also in place which supported staff. The staff team advised that they were accessing quality training. All staff were aware of the training requirements of registration with the Scottish Social Services Council. Staff had undertaken training events related to inclusion and communication. Those spoken with were clear about their role in ensuring Tenant participation. The service consistently provided action plans in response to any inspections. They had information about their responsibilities in respect of SSSC codes of practice. Service users were confident that if they had a complaint about staff this would be taken seriously as evidenced by records sampled. The inspector was advised that the service had proactively encouraged tenant participation in staff team meetings and all aspects of service delivery. People spoke freely about staffing arrangements and comments were positive. A clear complaints procedure was in place. Staff supervision was in place and a system of staff appraisal is operated. Staff said that they were well supported by the Manager, describing her management style as supportive and encouraging. In conversation staff presented as being dedicated to their role, having a very high level of motivation, enthusiasm and direction. Areas for improvement Inspection report continued On-going training in dementia care is essential to equip care staff to continue to provide a consistent standard of care based on latest evidence based research. (See recommendation 1) This should incorporate medical information made available to inform the staff team of illnesses which may increase the likelihood of pain or changes in behaviours. QXHA Sheltered Housing Support Service, page 16 of 23
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Recommendation with reference to Theme 3, Statement 3: The service should further develop their practice and commitment to evidencing that all members of the staff team are systematically involved in progressing formally through best practice dementia modules. This is to act in accordance with National Care Standards, This is in accordance with National Care Standards, Housing Support Standard 3: - Management and Staffing QXHA Sheltered Housing Support Service, page 17 of 23
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 An examination of relevant documents and feedback from service users, staff and managers indicated a very good performance by the service in relation to this statement. In addition to the strengths highlighted under Theme 1, Statement 1. The service users we spoke with told us that staff were good at keeping them up-todate with any changes of the service. All staff have had a comprehensive induction which included the aims and values of the service. We noted that staff had an individual approach to service users and that the care was person centred. Staff members confirmed that the service continue to offer training appropriate for registration with the Scottish Social Service's Council and were aware of its Code of Conduct. The service had copies of good practice guidance from the Mental Welfare Commission- 'Rights, Risk and Limits to Freedom' (2006) and 'Safe to Wander' (2003). On receipt of a service clients were provided with an Introductory pack which included details of the service's complaints procedure, Client Charter of Rights, recent inspection report and service contact details. Service users confirmed that the information supplied was seen to work well. Service users in each of the buildings visited during this inspection were seen to be at ease in the office and with their relationship with staff. The service was committed to fully involve service users in its development, growth and grading. This was evidenced in the use of 'Quality Improvement Questionnaires' and the approach adopted by the Service Co-ordinator and staff. Areas for improvement The provider should continue to maintain and develop the strengths identified in relation to this quality statement. The service are in the process of developing a more robust quality assurance system and are intending to continue using staff and service users' views. QXHA Sheltered Housing Support Service, page 18 of 23
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued QXHA Sheltered Housing Support Service, page 19 of 23
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 An examination of relevant documents and feedback from service users, staff and managers indicated a very good performance by the service in relation to this statement. The induction and on-going learning and development of staff were given appropriate priority. Staff received regular supervision and annual appraisal. Those spoken with found these support mechanisms worthwhile and helpful. There was evidence that managers had carried out their responsibilities in respect of notifications. Service users and staff found the manager fair and approachable. There was a good range of experience and skills within the staff and management team. Care management systems were organised and accessible. Supervision systems were in place and effectively used. Staff confirmed that they were well supported and managed. The Officer observed friendly and supportive interactions between staff and tenants. Areas for improvement The service should consider capturing more views from visiting professionals. The service should consider if independent facilitation of groups or committees could be used to gain further feedback about how the service is changing. Management and staff should seek further ways in which service users can be involved in the assessment of the quality of management and leadership using where appropriate external supports. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued QXHA Sheltered Housing Support Service, page 20 of 23
4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. You can find information about complaints that have been upheld or partially upheld on our website www.scswis.com. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information All information has been included within the body of this report. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). QXHA Sheltered Housing Support Service, page 21 of 23
5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 14 Jan 2011 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. QXHA Sheltered Housing Support Service, page 22 of 23
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 QXHA Sheltered Housing Support Service, page 23 of 23