The Richmond Fellowship Scotland - Scottish Borders Housing Support Service Units 19 & 20 Tweed Horizons Newtown St. Boswells Melrose TD6 0SG

The Richmond Fellowship Scotland - Scottish Borders Housing Support Service Units 19 & 20 Tweed Horizons Newtown St. Boswells Melrose TD6 0SG Inspected by: Dave Hutchinson Type of inspection: Unannounced Inspection completed on: 25 February 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 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: The Richmond Fellowship Scotland Limited Service provider number: SP2004006282 Care service number: CS2006124804 Contact details for the inspector who inspected this service: Dave Hutchinson Telephone 0131 653 4100 Email enquiries@careinspectorate.com The Richmond Fellowship Scotland - Scottish Borders, page 2 of 22

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 We found very good examples of detailed person centred personal plans. Care was being provided in line with the varied needs and aspirations of service users. Staff were clear on their responsibility to involve service users and families in the planning of care and we found several examples of this being done to produce a range of positive outcomes for service users. What the service could do better The service had identified an area where the regularity of one to one supervision to staff needed to improve. The report also highlights the need to ensure that all personal plan entries are signed and dated. What the service has done since the last inspection The service has expanded since the last inspection. This had been well planned and managed and we continued to find the positive care practice described in previous inspection reports. The Richmond Fellowship Scotland - Scottish Borders, page 3 of 22

Conclusion This continues to be a small focused service which continues to build links with healthcare professionals to meet the needs of a complex and diverse group of service users. The service was continuing to support service users to access activities in their local communities. Who did this inspection Dave Hutchinson The Richmond Fellowship Scotland - Scottish Borders, page 4 of 22

1 About the service we inspected The Scottish Borders Housing Support and Care at Home Service is part of The Richmond Fellowship Scotland services. Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS known as the Care Inspectorate. The service was registered as a Housing Support and Care at Home Service, providing support to service users in their own homes. The service is provided to adults with a learning disability. The aims of the service provider are stated as "Providing high quality community based services for people who require support in their lives. All of our services work in person centred ways to offer choice, promote inclusion and maximise ability. " The Housing Support/Care at Home services operate from an office near to St Boswells in the Central Borders. The service also has office bases in Hawick and Galashiels. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at: www.careinspectorate.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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The Richmond Fellowship Scotland - Scottish Borders, page 5 of 22

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. The Richmond Fellowship Scotland - Scottish Borders, page 6 of 22

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This was an unannounced inspection carried out by Dave Hutchinson, Inspector, Care Inspectorate. The inspection was carried out on 22 and 25 February 2013. The initial visit to the service was unannounced. We provided feedback to the manager on 25 February 2013. Before the inspection the service provided a self assessment. The service also provided an annual return as requested by us. Prior to the inspection we issued six Care Standards Questionnaires, two completed questionnaires were returned one from a service user ad one from a carer. We met and spent time talking with with five service users. We contacted two carers by telephone. We interviewed the manager, two senior care staff and five members of care staff. We also attended a staff meeting and a staff shift handover meeting. We spoke with two healthcare professionals who had close working links with the service. We also spoke to an advocacy worker who supported individual service users. Documents sampled included: Registration certificate. Personal plans, including risk assessments. Medication administration records. Medication policy and records of medication training. Staff supervision plans and records. Training records and training plan. Staff meeting minutes. Daily recording notes. The Richmond Fellowship Scotland - Scottish Borders, page 7 of 22

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 The Richmond Fellowship Scotland - Scottish Borders, page 8 of 22

What the service has done to meet any requirements we made at our last inspection The requirement Requirement: The provider must ensure that medication policy and procedures are adhered to and that all returned medication records are double signed. This in order to comply with the Social Care and Social Work improvement Scotland (requirements for Care Services) Regulations 2011. SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of services users. Timescale: The provider must do this within one week of the report being published. What the service did to meet the requirement This has been actioned The requirement is: Met What the service has done to meet any recommendations we made at our last inspection There were two recommendations made following the last inspection which was carried out in December 2011. Recommendation: Medication practice should be reviewed to ensure that stocks of "as and when required" medication are monitored to ensure that stocks are not allowed to build up. National Care Standards. Care at home. Standard 8. Keeping well -medication. Progress- This had been done. This recommendation had been met. Recommendation: Risk assessments should be reviewed on a regular basis and reviews should be signed and dated. National Care Standards. Standard 4. Management and staffing. Progress- This had been done. This recommendation had been met. The Richmond Fellowship Scotland - Scottish Borders, page 9 of 22

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 Inspection report continued 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 assessment document from the service provider. We were satisfied with the way that the service provider had completed this and with the relevant information that they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes that they had planned. Taking the views of people using the care service into account Comments made by service users included "I'm happy here I feel I'm building up trust with the staff I'm happy with the way that they support me." "Its OK living here the staff know what they are doing." "It's good I like it here." "If you have a problem there is always someone you can speak to, the staff are OK they listen." Taking carers' views into account Comments made by carers included "The staff know my relative well and are able to provide the level of care and support that they need." "I would have no hesitation in phoning the staff they are always very helpful." "I'm happy with the way that things are going." "The staff are excellent and I'm confident my relative is safe." The Richmond Fellowship Scotland - Scottish Borders, page 10 of 22

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 Service users described their satisfaction with the way staff supported them describing feeling listened to. One service user said "You can talk to the staff about anything and they listen. If I have a problem I speak to the staff." This comment was typical of comments made by other service users. Staff expressed a commitment to working in a way which encouraged service users to make choices and to be involved in planning how they would receive support. We also found evidence of this planning in personal plans and other documents sampled. We found examples of very good personal planning. Personal plans were written in a person centred way and contained detailed information on the likes dislikes and general preferences and interests of service users. Personal plans were written in a way which stressed the individuality of service users. They described the aspirations of service users along with their needs. This included very detailed recording, for example the food preferences of service users. Staff were knowledgeable about the people they supported and the information provided by staff was consistent with information recorded in personal plans. Personal plans also described in detail the communication needs of individuals and how these needs could be supported. Staff spoken with were clear on their role to work in a way which encouraged and promoted family involvement. Staff gave examples of promoting and supporting family involvement. The healthcare professionals we spoke with felt the service had a positive attitude toward promoting family involvement. The Richmond Fellowship Scotland - Scottish Borders, page 11 of 22

Staff were able to describe a range of good outcomes for service users. These included service users being supported to access a number of different activities in their local community. We also found a range of examples of service users being supported to learn and maintain skills which promoted their independence. Service users were provided with information on the availability of local advocacy services. We spoke to an advocacy worker involved with service users. The worker described the service as having a positive attitude toward independent advocacy. They said that any issues raised with the service were taken seriously and responded to in full for the benefit of service users. The service was described as listening and responsive. Areas for improvement While discussing working with families some staff spoken with indicated that training in working with families would be helpful to support them in this role. (See recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should provide staff with training to support them in their role of encouraging family involvement. National Care Standards. Care at home. Standard 4. Management and staffing. The Richmond Fellowship Scotland - Scottish Borders, page 12 of 22

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found a range of very good methods in place to support service users to maintain health and well being. Carers also expressed high levels of confidence in the service to maintain the health and safety of individuals. We found good recording of the healthcare needs of individuals. There was a clear record of the involvement of healthcare professionals along with any follow up actions required to be carried out by staff. Where an individual had a specific healthcare need we found detailed recording to guide staff on how the service user needed to be supported. This level of recording and planning was also applied were an individual needed specific support with behaviour or communication. Clear guidance was available to staff to support service users to maintain positive behaviour. Healthcare professionals described positive open working relationships with the service and expressed confidence that where appropriate their opinion was sought their advice was followed. We observed positive working relationships during the inspection. Personal plans recorded the regular involvement of healthcare professionals. We also found examples of good working links with other agencies involved in supporting individual service users. Healthcare professionals had also been involved in staff training. Staff gave a range of examples of training relating to the healthcare and well being of service users that they had accessed in the previous twelve months. This was also evidenced in training records sampled. Personal plans sampled evidenced that regular reviews including multidisciplinary reviews had taken place. Risk assessments were being well maintained to ensure that service users were being supported to access a range of activities in their local communities while still remaining safe. We found good examples of staff encouraging healthy eating while also ensuring that service users retained choice, independence and adulthood. Medication records sampled were being correctly maintained. "As and when required" medication guidance sampled was also being correctly maintained. We found good examples of incident recording including a structured recording method to ensure that any actions required to reduce the likelihood of a similar incident being repeated were identified. The Richmond Fellowship Scotland - Scottish Borders, page 13 of 22

Staff were clear on their responsibilities to report on any concerns about the health of service users and gave examples of doing this. Areas for improvement Some personal plan information did not record the date of the entry or the name of the person making the entry. (See recommendation 1). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. All personal plan information should be signed and dated. National Care Standards. Standard 3. Your personal plan. Inspection report continued The Richmond Fellowship Scotland - Scottish Borders, page 14 of 22

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 Comments made in Quality Statement 1.1 are also relevant to this Quality Statement. We have also applied the grading of five - "very good" awarded in Quality Statement 1.1 to this Quality Statement. Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. They should ensure that they are rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Scottish Borders, page 15 of 22

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued All staff described the support that they received to carry out their roles and responsibilities in positive terms. The terms "Excellent support" and "Very supportive" were typical of descriptions given by staff when asked to comment on the how they were supported to carry out their responsibilities. Mangers and senior staff were seen as approachable and responsive and all staff said that they were satisfied with the quality of the "day to day" support they received. We observed good clear open communication between staff at "hand over" and staff meetings with positive working relationships between managers and staff. Staff also described positive peer support and morale was described in generally positive terms. Staff described regular staff meetings were helpful and informative. Staff felt that they were encouraged to contribute to meetings and be involved in solving problems or planning care. Staff commented that one to one supervision was helpful and offered the opportunity to discuss the work that they were undertaking and identify any training needs. We found that a range of policy and procedural guidance was in place to ensure staff were working in a planned and consistent manner. Staff confirmed that they had access to this guidance and that any changes were discussed with them to ensure that they were up to date with any developments. Records indicated that staff had regular access to training including Adult Support and Protection and "Inclusion and Community Connecting." Staff described receiving regular training and being encouraged to identify any training needs. Staff who were recently in post commented on the quality of the induction training provided and how useful this had been in preparing them for their role. We found evidence of regular appraisals and feedback to staff included information from healthcare and other professionals who have regular contact with the service. The Richmond Fellowship Scotland - Scottish Borders, page 16 of 22

Areas for improvement The need to provide more regular one to one supervision to staff had been identified by managers in one area of the service. We saw evidence that steps were being taken to address this. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Scottish Borders, page 17 of 22

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 Comments made in Quality Statement 1.1 are also relevant to this Quality Statement. We have also applied the grading of four - "good" awarded in Quality Statement 1.1 to this Quality Statement. Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. They should ensure that they are rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Scottish Borders, page 18 of 22

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 healthcare professionals and other professional that we spoke with said they found the service was very open to receiving and responding to their independent viewpoint and they were asked to comment on how staff supported service users. Staff said that managers knew how they worked because they worked alongside them and they had regular contact. Staff said that they received feedback and that this was helpful. Feedback included staff describing receiving positive feedback where good practice had been identified as well as areas here they needed to look at other ways of approaching an issue. Staff said that they felt this promoted good morale in the service. Managers and senior staff described how they worked alongside direct care staff. This enabled them to observe how individual staff worked. They were also able to confirm that staff were working consistently and in line with the personal plans for the individuals they were supporting. Managers also carry out spot checks and regular audits. Audits including medication recording and storage, finance and personal plans. Staff were aware of the checks that were in place and described these as useful in ensuring that care and support was being provided consistently. We found evidence of audits being undertaken including action points being identified. Managers also have the responsibility to ensure that Key Performance Indicators (KPIs) including regular one to one supervision and regular staff meetings are being met. Areas for improvement The care service should continue to monitor and work to build on, and improve on, the standard achieved in this area. They should ensure that they are rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Scottish Borders, page 19 of 22

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 The service gave us an appropriate action plan on 13 January 2012. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). The Richmond Fellowship Scotland - Scottish Borders, page 20 of 22

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 23 Dec 2011 Unannounced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 24 Sep 2010 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 17 Jul 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 18 Sep 2008 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. The Richmond Fellowship Scotland - Scottish Borders, page 21 of 22

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 The Richmond Fellowship Scotland - Scottish Borders, page 22 of 22