Ashfield Healthcare Nurse Agency Ashfield House Resolution Road Ashby-de-la-Zouch LE65 1HW

Ashfield Healthcare Nurse Agency Ashfield House Resolution Road Ashby-de-la-Zouch LE65 1HW Inspected by: Amanda Cross Type of inspection: Unannounced Inspection completed on: 27 May 2014

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 27 5 Summary of grades 28 6 Inspection and grading history 28 Service provided by: Ashfield Healthcare Limited Service provider number: SP2010010966 Care service number: CS2010251041 Contact details for the inspector who inspected this service: Amanda Cross Telephone 01294 323920 Email enquiries@careinspectorate.com Ashfield Healthcare, page 2 of 29

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 Information 4 Good Quality of Care and Support 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service provide good support and training for staff to ensure they are appropriately skilled an knowledgeable to undertake their duties. What the service could do better Policies and procedures should make specific reference to Scottish Legislation and best practice guidance to inform, support and direct staff who work in Scotland of their obligations. Six monthly reviews must be carried out on review of service users personal plans. What the service has done since the last inspection The service have reviewed some policies and procedures to reflect Scottish Legislation. An example of this is the Protection of Vulnerable Groups checks to promote the safety of service users. Conclusion Ashfield provides a good personalised service to people in accordance with their identified needs. This is monitored through systems to oversee how client needs are being met. Ashfield Healthcare, page 3 of 29

The manager and staff were committed to ensuring the quality of service is continually improved. This included seeking feedback and updating their knowledge and relevant documents with best practice and legislation changes. Who did this inspection Amanda Cross Ashfield Healthcare, page 4 of 29

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. This service was registered with the Care Inspectorate on 27 May 2011 to provide a nurse agency. 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 a 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 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 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. Ashfield In2focus supplies and/or introduces registered nurses to client groups. Within the report please note that where the term 'client' is used, it can relate to an organisation that pays for the service or the individual person who pays for the service. The care service offices are in Leicester, England. At the time of the inspection a service was being provided to one NHS hospital in Scotland. The nurse agency was working with a pharmaceutical company to deliver and administer specialist medicines. The stated aims of the service were: "Ashfield In2Focus provide high quality healthcare services. The requirements of the hospital and the patients are at the forefront of everything we do". Based on the findings of this inspection this service has been awarded the following grades: Quality of Information - Grade 4 - Good Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good Ashfield Healthcare, page 5 of 29

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. Ashfield Healthcare, page 6 of 29

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 On 14 May, a desk top inspection was initiated through a telephone call to the head office which is based in Ashby-de-la-Zouch. Between 14 May and 26 May information was obtained and received through the use of emails and telephone calls. The registered manager and the nurse who worked in the service attended the Care Inspectorate office to complete the inspection and receive feedback on 27 May between 10:00 and 15:30 hours. We looked at a range of documents throughout the inspection process. These documents included: Registration certificate Certificates of insurance (copy provided and assurance of display in office) Feedback systems Supervision records Induction and training records Minutes of meetings Methods for accident and incident monitoring Risk assessments service user handbook Policies and procedures including: - Recruitment policy - Abuse - Quality Policy - Operations manual and Standard Operating Procedures Self Assessment We spoke with: Service Manager Nurse Unfortunately we were unable to make contact with the people who used the service who had been agreeable to speak with us. Ashfield Healthcare, page 7 of 29

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 report continued Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Ashfield Healthcare, page 8 of 29

What the service has done to meet any requirements we made at our last inspection The requirement The provider is required to have a clear and accessible complaints procedure that is given to each service user. The procedure must include the name and address of the Care Inspectorate and advise people that they may choose to complain directly to the provider or the Care Inspectorate, or both. This is to comply with The Public Services Reform (Scotland) Act 2010 and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210), Regulation 18(6)(a)(b) - Complaints. This also takes into account National Care Standards, Nurse Agencies, Standard 1: Information about the nurse agency. What the service did to meet the requirement The service have reviewed their complaints policy which meets the timescales detailed within the Public Services Reform Act. The complaints procedure provided details of the Care Inspectorate with appropriate contact details. The requirement is: Met - Within Timescales Ashfield Healthcare, page 9 of 29

The requirement The provider must have clear adult protection procedures. In order to achieve this the provider must update its adult protection guidance and procedure to include: (i) the definitions described within the Adult Support and Protection (Scotland) Act 2007, Section 3; (ii) information that all adult protection concerns must be reported to the Local Authority where the adult at risk resides; (iii) where in the organisation information on Local Authority contact numbers can be found. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4 (1)(a) Health, welfare and safety of service users. In making this requirement National Care Standards, Nurse Agencies, Standard 4: Management and Staffing Arrangements are taken into account. What the service did to meet the requirement The service have detailed policy on protection of service users in relation to abuse. This policy reflects the Scottish legislation. A recommendation was made to promote ongoing monitoring and development of the ASP policy under quality statement 1.3. The requirement is: Met - Within Timescales Inspection report continued Ashfield Healthcare, page 10 of 29

The requirement The provider must put in place procedures to ensure that they do not employ, in regulated work, a person who is listed in the adults list in the Protection of Vulnerable Groups (Scotland) Act 2007. In order to achieve this the provider must: (i) identify posts within the nurse agency that are eligible for Protection of Vulnerable Groups (PVG) Scheme membership; (ii) ensure that newly recruited staff to these posts are members of the PVG Scheme; iii) develop and implement a timetable for seeking PVG retrospective checks on staff already in post; (iv) take account of the Care Inspectorate Guidance Protecting Vulnerable Groups Implementation Guidance Publication Code: OPS - 1012-195; (v) liaise with other U.K vetting and barring schemes to ensure that nurses whose post is based elsewhere in the UK are not listed in the adults list in the Protection of Vulnerable Groups (Scotland) Act 2007 prior to taking up temporary work in Scotland. Where other U.K vetting and barring schemes are not able to confirm nurses are not on the adults list in the Protection of Vulnerable Groups (Scotland) Act 2007, membership of the PVG Scheme must be sought. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4 (1)(a) Health, welfare and safety of service users. In making this requirement National Care Standards, Nurse Agencies, Standard 4: Management and Staffing Arrangements is taken into account. What the service did to meet the requirement The recruitment policy was updated and appropriate mechanisms have been put in place to ensure appropriate PVG checks are completed for staff prior to commencement of their employment. Further information is provided under quality statement 3.2. The requirement is: Met - Within Timescales Inspection report continued What the service has done to meet any recommendations we made at our last inspection Outstanding recommendations have been discussed within the relevant quality statement throughout the report. 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 Ashfield Healthcare, page 11 of 29

Comments on Self Assessment Inspection report continued 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 completed self assessment which supported the findings of this inspection. Taking the views of people using the care service into account Unfortunately we were unable to make contact with service users during this inspection process. Taking carers' views into account There were no carers involved during this inspection process. Ashfield Healthcare, page 12 of 29

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 0: Quality of Information Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the information provided by the service. Service strengths The grade awarded for this quality statement during the last inspection was 3 - Adequate. The evidence we sampled during this inspection increased the grade to 4 - Good. We reached this decision after we reviewed relevant documents including feedback documents. Referrals were made to the agency through hospital consultants. Information was provided to potential service users in the form of a service user guide. This guide allowed service users to outline the programme to allow people to understand the service available to them. This was then supported by 1:1 discussions to set up an appropriate and agreed plan of care. Feedback forms were provided to service users regularly throughout the duration of the supports provided by Ashfield. Discussions were also facilitated by the visiting nurse. Feedback obtained was used to improve the quality of the care and supports for each individual service user. An example included negotiation of times for visits. We were told how the visits by the service were flexible to accommodate work commitments or school to ensure minimal disruption to people's lives. To promote choice, consent was obtained during initial discussions and reviewed prior to any treatment being provided. Additional methods of consultation were being considered. The service also created documents to capture feedback from health professionals. Ashfield Healthcare, page 13 of 29

A policy for handling of concerns, comments and complaints was implemented to ensure timeous resolution which was in accordance with th Public Services Reform Act (Scotland) 2010. Areas for improvement Whilst we saw that there was review of the clinical needs of service users, the service must ensure that there is a review of the personal plans which detail the needs and preferences of service users on how these needs are to be met. (See requirement 1 of this quality statement) A recommendation was made during the previous inspection which stated: The service should include measures of service users and clients' satisfaction with the information provided by Ashfield Healthcare regarding the nurse agency and the service offered in their quality assurance systems. This information should be used to develop the information provided. Action taken The service regularly reviewed their documents and made amendments to update as necessary. However, the service should consider how this information should be obtained and used specifically to improve the service based within Scotland. This recommendation is not met and will be repeated. Whilst there was some good documents available to provide information on the service, consideration should be given to providing this in a more service user friendly format. (See recommendation 2) Consideration should be given to implementation of an involvement/ participation strategy. This should outline how the service involves all stakeholders and how information received leads to improvements in the service. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements 1. Regulation 5(2)(b) The provider must conduct reviews to focus on service users' needs as required. In order to achieve this, the provider will: (i) put in place a personal plan within one month of a service user first using the Ashfield Healthcare, page 14 of 29

service (ii) review the plan at least once in every six month period (iii) review the service users care plan when asked to do so by the service user or their representative. Timescale: within three months on publication of this report. Recommendations 1. The service should include measures of service users and clients' satisfaction with the information provided by Ashfield regarding the nurse agency offered in their Quality Assurance systems. This information should be used to develop and improve information provided. National Care Standards, Nurse Agencies: Standard 1- Information about the nurse agency. 2. Service users should have information that is provided to them in a manner and format that is easy to understand. National Care Standards, Nurse Agency : Standard 1 - Information about the nurse agency. Statement 2 We provide full information on the services offered to current and prospective service users. The information will help service users to decide whether our service can meet their individual needs. Service strengths The grade awarded for this quality statement during the previous inspection was 4 - Good. The evidence we sampled during this inspection maintained the grade of 4 - Good. We reached this decision after we reviewed appropriate documents containing information provided to service users. A requirement was made during the previous inspection which stated: The provider is required to have a clear and accessible complaints procedure that is given to each service user. The procedure must include the name and address of the Care Inspectorate and advise people that they may choose to complain directly to the provider or the Care Inspectorate or both. Action taken Inspection report continued Ashfield Healthcare, page 15 of 29

We reviewed the complaints procedure which clearly detailed the address of the headquarters of the Care Inspectorate. The timescales for resolution were compliant with the timescales set out in the Public Services Reform Act (Scotland) 2010. This requirement is MET. Information is provided to service users through the service user guide which outlines what people can expect from the service, as mentioned in quality statement 0.1. Treatment plans were in place and discussed between the service users and attending nurse to ensure consent is obtained and the treatment is appropriate. Information is provided on the skills and knowledge of the attending nurse to ensure service users feel supported during their treatments. This includes staff training. A website is available for prospective and current service users to access which provides any additional information on the organisation providing the service. Information is available in different formats including large print and alternative languages to promote understanding of service users. Areas for improvement Whilst we saw that there was a variety of information available to service users, the service must ensure that there is specific guidance with reference to Scottish Legislation and in a manner that is easy to support them to understand. (See requirement 1 in quality statement 4.4 and recommendation 2 in quality statement 0.1) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ashfield Healthcare, page 16 of 29

Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The grade awarded for this quality statement during the previous inspection was 3 - Adequate. The evidence we sampled during this inspection increased the grade to 4 - Good. We reached this decision after we reviewed policies and relevant documents including staff training records and documents used to direct staff to provide care with agreement from service users. Informed consent was obtained during visits by the nurse prior to commencement of the service. This often occurred during visits to service users in the hospital environment before the service was provided within their own environment. The service used feedback forms to gather views and comments. These were provided to service users receiving care in their own environment at the end of the 'field visit. The course of treatment was generally provided in 6-8 week blocks. Organisations and other registered services were asked to complete the feedback form on completion of the assignment the nurse was supplied for. The feedback forms asked questions centred around the staff member providing the care. Feedback was sought on areas including about the care delivered, communication and professionalism of staff. Opportunities to make additional comments and to raise any concerns about the service were also available. We considered this statement alongside information contained within statement 0.1. Areas for improvement The organisation should consider the relevance of the array of information and how to provide this is a service user friendly format. Ashfield Healthcare, page 17 of 29

The service could consider improving methods on how it could keep service users informed about the feedback it receives through reviews, feedback forms, compliments, comments and complaints and improvements they make as a result. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure our service provides care staff who are most suitable to meet individual service user needs. The care and treatment received by the individual service user, is supported by evidence based practice and up to date policies and procedures. These reflect current legislation (where appropriate Scottish legislation). Service strengths The grade awarded for this quality statement during the previous inspection was 3 - Adequate. The evidence we sampled during this inspection increased the grade to 4 - Good. We reached this decision after we reviewed policies and relevant documents including staff training records and documents used to direct staff to provide care with agreement from service users. A requirement was made during the previous inspection which stated: The provider must have clear adult protection procedures. In order to achieve this the provider must update its adult protection guidance and procedure to include: (i) the definitions described within the Adult Support and Protection (Scotland) 2007 Act, section 3; (ii) information that all protection concerns must be reported to the local authority were the adult at risk resides; (iii) where in the organisation information on Local Authority contact numbers can be found. Action taken Inspection report continued We saw that policies and procedures had been updated and were more reflective of Scottish Legislation. This included the Adult protection procedures. The manager had details of local authorities in which they provided the service. This requirement has been met. However, a recommendation is made to ensure that the manager is familiar with the contact details of the Adult Support and Protection co-ordinators in the relevant authorities. Ashfield Healthcare, page 18 of 29

A service level agreement is devised between the Practice Development Manager from Ashfield and the consultant of the service user. This agreement forms the basis of the treatment plan to ensure the needs of service users are met. At the start of the service individuals were provided with terms of business, their care plan and risk assessment. An appropriate induction and subsequent training plan for staff was implemented to ensure staff were appropriately equipped to provide safe and effective care for service users. A validated online learning platform provided additional training for staff and the IT system highlighted when staff training updates were required. We found the service had comprehensive policies and standard operating procedures to inform care delivery. Some of these were available on their website for service users to see. This included ensuring the protection of adults and children. Staff's key skills, qualifications and areas of expertise were logged on the IT system. Organisations and other registered services applying to use the service provided a minimum information form that identified the key skills, qualifications and areas of expertise they required. There was ongoing liaison with NHS staff to ensure the best health outcomes were achieved for service users. Areas for improvement Whilst the organisation has a global spread, information should be provided for service users who reside in Scotland. This includes reference to the Care Inspectorate, best practice guidelines and Scottish legislation. (See requirement 1 of statement 4.4) Whilst the service had policies on how to manage concerns relating to abuse of vulnerable people, the manager should develop a contact resource to identify Scottish Local Authority Adult Support and Protection co-ordinators where the service is provided. (See recommendation 1 of this quality statement) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service should ensure appropriate methods to report concerns for service users are clear. National Care Standards, Nurse Agencies, Standard 4: Management and Staffing arrangements. Ashfield Healthcare, page 19 of 29

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The evidence we sampled during this inspection provided the grade of 4 - Very Good. We reached this decision after we reviewed relevant documents including feedback systems. The service delivers training for staff which is specifically relevant to the needs of individuals they are caring for. Information from feedback forms and contact with people using the service is used in staff supervision and appraisals. This included sharing compliments and addressing any concerns. Areas for improvement The service could consider how people using services could be involved in delivering staff training or staff recruitment. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The grade awarded for this quality statement during the previous inspection was 4 - Good. The evidence we sampled during this inspection maintained the grade of 4 - Good. We reached this decision after we read recruitment file, training records, supervision records and relevant policies and procedures. A requirement was made during the previous inspection under quality statement 3.2 which stated: Ashfield Healthcare, page 20 of 29

The provider must put in place procedures to ensure that they do not employ, in regulated work, a person who is listed in the adults' list in the Protection of Vulnerable Groups (Scotland) Act 2007. Action taken The provider has appropriately undertaken PVG checks for staff working in Scotland. A system has been secured for ongoing checking and monitoring of staff which includes liaising with other UK vetting and barring schemes to ensure that nurses whose post is based elsewhere in the U.K are not listed on the adults' list in the PVG scheme (Scotland). This requirement is met. Inspection report continued A supportive induction period allowed staff to familiarise themselves with organisational policies and receive appropriate training before supporting service users. All staff were assessed during a probationary period to ensure they demonstrated appropriate knowledge and skills The service's IT system required staff to update all mandatory training annually. An online learning system supported staff development and supplemented practical training, including manual handling and differing levels of emergency life support. Staff received notification of training updates to minimise risk of certification being expired. This included training to work with specific service users. Regular observational supervision and 1:1 supervision was provided for staff. This supported reflective practice and identification of development needs to ensure appropriate support was provided to service users. Annual appraisal was facilitated to develop staff through an action plan of development. Team meetings were held with some regularity and allowed sharing of practice and information sharing of organisational developments. An annual national meeting included all staff attending to ensure mandatory training was undertaken to promote safe and up to date practices. A training calendar was available and personal training logs which were updated after additional training had been undertaken. Standard Operating Procedures provided supportive detail on how activities were to be carried out in accordance with best practice. An end of field visit (end of service)was facilitated by the manager. Information obtained was used to monitor the development of staff in accordance with the detail in their personal development plan. Ashfield Healthcare, page 21 of 29

There were effective communication systems which supported staff to have knowledge on the organisation and opportunities arising for ongoing development. Regular checks were carried out with the Nursing and Midwifery Council to ensure staff were appropriately registered and safe to practice. Prompts were provided for the manager vis the IT system 4-8 weeks before the date of renewal for each nurse. A lone working policy was implemented where appropriate procedures for staff to access to of hours support was available. Areas for improvement A recommendation was made during the previous inspection under quality statement 3.2 which stated: The recruitment procedure should describe the actions to take should references for nursing posts contain insufficient detail to assess the candidates suitability for the role they are to undertake. Action taken There had been no further recruitment within Scotland since the last inspection. We discussed the Safer Recruitment best practice guidance document issued by the Scottish Government with the manager. This should be adopted into the recruitment policy. This recommendation requires further monitoring and will be repeated. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The recruitment procedure should describe the actions to take should references for nursing posts contain insufficient detail to assess the candidates suitability for the role they are to undertake. National Care Standards, Nurse Agencies, Standard 4: Management and Staffing arrangements and Nursing and Midwifery Council, Advice and information for employers of nurses and midwives. Ashfield Healthcare, page 22 of 29

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The grade awarded for this quality statement during the previous inspection was 4 - Good. The evidence we sampled during this inspection maintained the grade of 4 - Good. We reached this decision after we reviewed Standard Operating Procedures, feedback mechanisms and audit records. We also spoke with a nurse and the manager. There was good evidence of feedback systems being used to involve service users and other stakeholders in assessing and improving the quality of management within the service. This statement was considered alongside the information within quality statements 0.1, 1.1 and 3.1. Areas for improvement Information should be available for service users on how feedback has made improvements to the service. Information on how best practice guidance and legislation is used to ensure provision of a good quality service should be made available to service users. This would allow for discussion on the service they receive. While the provider had a range of policies and procedures which included involving service users there was no participation plan specific to this service. The service should develop a participation plan to clarify how service users will be involved in assessing and improving the quality of the service. (See recommendation 1 of this quality statement). The information detailed within the areas for improvement under quality statements 0.1, 1.1 and 3.1 are also relevant to this statement. Ashfield Healthcare, page 23 of 29

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should develop a participation strategy to clarify how service users will be involved in assessing and improving the service, including the quality of management and leadership. National Care Standards, Nurse Agencies, Standard 5: Concerns, comments and complaints. Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths The grade awarded for this quality statement during the previous inspection was 4-Good. The evidence we sampled during this inspection maintained the grade of 4 - Good. We reached this decision after we reviewed the Standard Operating Procedures, audits, service website and other relevant documents. We also spoke with a nurse and the manager. The organisation had clearly defined corporate plan with a statement of purpose which detailed aims and objectives to provide a quality service. An effective quality monitoring system was in place. This allowed identification of areas which required attention. This stimulated review of procedures which were often updated to promote safer and easier ways to work. A range of policies and procedures were in place to support staff fulfil their duties in a responsible manner. Dates for ongoing review of these policies were planned in advance. There was appropriate use of the notification procedures for Care Inspectorate. We received a fully completed self assessment. Inspection report continued Complaint activity, accidents and incidents were monitored to identify trends and make improvements to practice and policy. Quality assurance systems are discussed throughout other quality statements in this report. Ashfield Healthcare, page 24 of 29

Areas for improvement The service had some good, positive methods of obtaining feedback from service users and other stakeholders. However, feedback on how information was used to make service improvements should be provided through feedback to all stakeholders as part of ongoing quality assurance. (See recommendation 1 of this quality statement). Policies and procedures had been updated and often included reference to Scottish Legislation. However, the provider must ensure that sufficient and appropriate direction is provided through policies with detail on Scottish Legislation and best practice guidance is available for staff working specifically in Scotland. (See requirement 1 and recommendation 2 of this quality statement). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements 1. The provider must review policies and procedures to reflect National Care Standards, Scottish Legislation and Best practice guidance documents. This is in order to comply with: SSI 2011/210 Regulation 3 - Principles. A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. Timescale: within six months on publication of this report Recommendations Inspection report continued 1. The service should use the information gathered about the quality of the service in their development of an improvement plan and evidence through feedback how planned improvements are being made. National Care Standards, Nurse Agencies, Standard 4: Management and staffing arrangements. 2. The management should ensure appropriate policies and procedures in accordance with Scottish Legislation and best practice guidance. National Care Standards, Nurse Agencies, Standard 4: Management and staffing arrangements. Ashfield Healthcare, page 25 of 29

Ashfield Healthcare, page 26 of 29

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Ashfield Healthcare, page 27 of 29

5 Summary of grades Quality of Information - 4 - Good Statement 1 Statement 2 4 - Good 4 - Good Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 28 Feb 2013 Announced (Short Notice) Information Care and support Staffing Management and Leadership 3 - Adequate 3 - Adequate 3 - Adequate 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Ashfield Healthcare, page 28 of 29

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 Ashfield Healthcare, page 29 of 29