Hamilton Supported Living Service - Housing Support Service Housing Support Service Flat 3 5 Raeburn Crescent Hamilton ML3 9QD Telephone: 01698

Hamilton Supported Living Service - Housing Support Service Housing Support Service Flat 3 5 Raeburn Crescent Hamilton ML3 9QD Telephone: 01698 823900 Inspected by: Barbara Montgomery Type of inspection: Announced (Short Notice) Inspection completed on: 17 December 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 8 4 Other information 17 5 Summary of grades 18 6 Inspection and grading history 18 Service provided by: Lanarkshire Association For Mental Health Service provider number: SP2004005810 Care service number: CS2004068390 Contact details for the inspector who inspected this service: Barbara Montgomery Telephone 01698 897800 Email enquiries@careinspectorate.com Hamilton Supported Living Service - Housing Support Service, page 2 of 19

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 People contributed to the development and review of their individual day to day support plans and to their recovery action plan. Hours that staff worked were determined by the needs and preferences of service users. LAMH offered its staff good relevant training. All the service users and all the workers we heard from agreed that staff treated them with respect. The service had some effective ways of monitoring its service and ensuring quality. What the service could do better Logging any complaints that service user voice informally would help identify any trends or patterns to service users concerns. Information in written support plans about day to day support and related risks should be easier to follow. LAMH need to hold their own six monthly in house reviews for every service user. Hamilton Supported Living Service - Housing Support Service, page 3 of 19

To encourage greater accountability all audit paperwork should be signed and dated and responsible staff should record action taken after an audit. Asking health professionals and social work staff to take part in a survey would improve quality assurance. What the service has done since the last inspection LAMH have been developing a service user involvement strategy. Service users had been very involved in the development of new support plan paperwork. Plans were much clearer about the support people needed to maintain good mental health and had an emphasis on recovery Plans we looked at contained good clear detail about how staff would offer service users the day to day support they needed to stay well. Conclusion LAMHs Hamilton Supported Living Service offered people with mental health difficulties the kind of day to day support they needed to live as independently as possible. LAMH had taken action to progress all previous recommendations. Everyone we heard from who used the service and all the staff we heard from spoke highly of it. Recommendations we have made are to improve a service that is already performing consistently well. Who did this inspection Barbara Montgomery Hamilton Supported Living Service - Housing Support Service, page 4 of 19

1 About the service we inspected Lanarkshire Association for Mental Health (LAMH) is a registered charity and provider of a range of services to people with mental health difficulties. This service is for people in South Lanarkshire. At the time of the inspection the services workers were supporting 14 people in their own homes in the Hamilton and Clydesdale areas. LAMHs mission statement says LAMH is ''committed to developing and providing quality support services in partnership with people who experience mental health difficulties their carers and other agencies''. Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body. The Care Inspectorate 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. 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. Hamilton Supported Living Service - Housing Support Service, page 5 of 19

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 One Inspector carried out the inspection which took place in December 2012. We sent 10 questionnaires for distribution to service users and 9 people sent one back. We sent 14 questionnaires for distribution to staff and got six back. We had a meeting with the manager and visited one service user at home. We also looked at a sample of records (please see Quality Statements for note of what these were). 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 Hamilton Supported Living Service - Housing Support Service, page 6 of 19

What the service has done to meet any recommendations we made at our last inspection We made seven recommendations in the last inspection report. The provider has actioned all of these relating to Quality Statement 1.1. Those that were about Quality Statement 1. 6 will be followed up at a future inspection. 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. Completed in full noting strengths and some areas for improvement. Taking the views of people using the care service into account Everyone who sent back a Care Inspectorate questionnaire agreed or strongly agreed that overall they were very happy or happy with the quality of the care and support. We have commented on peoples answers to specific questions in more detail against the relevant quality statement. Overall comments included: ''very happy with service provided/ happy with service provided/ supported on all needs I cannot do/ liked move from hospital to my tenancy sense of relief.'' Taking carers' views into account Please see views of people using this service. Hamilton Supported Living Service - Housing Support Service, page 7 of 19

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 We found that this services performance was very good in the areas covered by this statement. We concluded this after we heard from service users, spoke to the manager and looked at the following: support plans; review paperwork; surveys; minutes of meetings and LAMH newsletter. Participation Strategy LAMH had a mission statement which described their commitment to developing and providing quality support services in partnership with people who experience mental health difficulties their carers and other agencies". We noted that LAMH was managed by a board of directors which includes service users and previous service users or people with an interest in mental health, as well as employees. LAMH have been developing a service user involvement strategy. They offered service users various ways to express their views and be involved in the planning and delivery of their service. Almost everyone who filled in a Care Inspectorate Questionnaire agreed that they were asked for their opinions about how LAMH can improve the serviceone person answered 'don't know'. Surveys and Forums The service had developed several different surveys to get people views which asked straightforward relevant questions about specific topics and about the service overall. Forums for service users included LAMHs advisory group, recent focus groups about service user involvement and a working group which was looking at how best to involve service users. LAMH also had a newsletter for keeping service users informed of events and developments and a helpful website. Hamilton Supported Living Service - Housing Support Service, page 8 of 19

Participation in Support Planning and Reviews Service users had been very involved in the development of new support plan paperwork. People contributed to the development and review of their individual day to day support plans and their recovery action plan. People were encouraged to explore their own hopes and aspirations and identify the outcomes they wanted to achieve as well as the frequency of visits and visit times. While service users could keep a copy of their full plan in their house many preferred not to do that and were happy for that paperwork to be kept in the Hamilton office base. Complaints LAMH has a complaints and suggestions policy and gave all its service users a copy. Almost everyone who filled in a Care Inspectorate Questionnaire said they knew about LAMHs complaints procedure (one person wasn't sure about this) and most knew they could complain to the Care Inspectorate. Areas for improvement Participation Strategy, Surveys Meetings and Events The manager said that service users in Hamilton had historically shown little or no interest in going to meetings or being board members and with the help of advocacy services had been trying to find out if there was anything that might encourage greater interest. Complaints Three people who filled in a Care Inspectorate Questionnaire said they didn't know they could complain to the Care Inspectorate. (see recommendation1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should ensure that everyone is made aware of LAMHs complaints procedure and that of the Care Inspectorate. (National Care Standards Support Service Care at Home Standard 11 Expressing Your Views) Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that this service's performance was very good in the areas covered by this statement. We concluded this after we heard from service users, heard from staff, spoke to the manager and looked at the following: supported living plans; risk assessment; my recovery action plans and review reports. Hamilton Supported Living Service - Housing Support Service, page 9 of 19

Support Plan Format LAMH had done a lot of work since the last inspection on developing and improving the written format for support plans. Everyone who returned Care Inspectorate questionnaire agreed they had a personal plan or support plan which contained information about their support needs and most agreed that it detailed their needs and preferences. Mental health Plans were much clearer about the support people needed to maintain good mental health. They had an emphasis on recovery with service users encouraged to develop their own recovery action plan and personal wellness toolkit. Other health care needs It was clear from plans we looked at that workers were aware of any other health conditions that affected service users day to day lives. Support in some instances meant taking account of things like a hearing impairment, early onset dementia, continence or mobility issues. Daily Life Supported Living Plans we looked at contained good clear detail about how staff would offer service users the day to day support they needed to stay well. This included help to keep medical and other appointments; support with keeping house; support with taking care of yourself and your appearance eg food shopping and meal preparation; support relating to return to work or leisure activities. Direct help with things like taking a bath or shower was very occasionally part of the support. LAMHs used their newsletter to raise awareness of healthy living among service users. Medication LAMH s policy was to prompt rather than administer medication. This policy was currently being reviewed and Care Inspectorate Pharmacy Advisors had offered assistance in signposting to good practice. Risk and Safety Support Plans took account of any safety concerns and included action to minimise risks related to for example poor food hygiene; identified where a joint visit was necessary and encouraged people to avoid things that were unhelpful to their mental health such as stress; excess alcohol; drug use; not taking prescribed medication as well as recognising the signs of becoming unwell such as thoughts of self harm. Out of hours and emergencies The Hamilton service provided an out of hours service at night. Service users could telephone the sleepover worker who was based in the office. Legal Arrangements/ Financial Hamilton Supported Living Service - Housing Support Service, page 10 of 19

Where service users were subject to any statutory order such as a probation order staff worked in partnership with other agencies and criminal justice. Reviews All the service users who filled in a Care Inspectorate Questionnaire agreed that the service checked with them regularly that it was meeting their needs. And we noted copies of review reports in service users files. Reliability and Continuity Because this was a relatively small service workers were familiar with the needs of every service user and had experience of supporting everyone. Hours that staff worked were determined by the needs and preferences of service users and not by set shift patterns. All the service users we heard from agreed that staff had enough time to carry out the support and care. Everyone knew the names of the staff who provided their support and care. Areas for improvement Support to manage money was mainly informal. As part of one support plan the service had been asked by the funding authority/care manager to set up a corporate appointeeship arrangement with LAMH in trust. We understand that this arrangement was short term. We noted that the account in question was not interest bearing. Support Plans Information about risks and action to minimise risks was in a section of the support plan that was separate from all the other information about day to day support. For example in one plan a health risk related to poor food hygiene awareness was described but was not mentioned in the day to day support plan. The manager agreed that it made more sense for this information to be together in the same place and would be easier for a new worker to follow. (see recommendation 1) Reviews We advised the manager that they need to hold their own six monthly in house reviews for every service user regardless of care management review arrangements and drew her attention to amended regulations about reviews: Regulation 5(2)(b)(iii)' which states that ''a provider of a care service must review the personal plan at least once in every six month period whilst the service user is in receipt of the service''. (Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011) Leisure Activities One person said they were fed up being stuck in the house and wanted out more but didn't provide any contact details so were unable to follow this up. Hamilton Supported Living Service - Housing Support Service, page 11 of 19

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Support Plans To make written support plans easier to follow information about about day to day support and information about related risks and action to minimise risks should be closer together. (National Care Standards Support Service Care at Home Standard3 Your Personal Plan) Hamilton Supported Living Service - Housing Support Service, page 12 of 19

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 Please see Quality Statement 1.1 Areas for improvement Please see Quality Statement 1.1 Grade awarded for this statement: 5 - Very 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 We found the performance of this service was very good in the areas covered by this statement. We decided this after we heard from service users and staff, spoke to the manager and looked at: training plans; supervision and appraisal records; and team meeting minutes. Staff Training and Development LAMH had a training policy and procedure. The organisation had developed role specific induction packs for new workers and the service had an annual training plan. Core training included Adult Protection, ASSIST (Applied Suicide Intervention Skills Training) and food hygiene. Other topics have included training related to drug and alcohol awareness; de escalation techniques and 'emotional intelligence' and Healthy Working Lives. Staff could also learn a specific skill needed to meet a service users needs. One example of this was British Sign Language. Staff had access to in house training and local authority courses as well as training from external agencies. Hamilton Supported Living Service - Housing Support Service, page 13 of 19

Individual workers received regular supervision, direct observation of practice and annual appraisal and everyone had a training needs analysis. All staff who sent back Care Inspectorate questionnaires said they got planned supervision. All but two staff now had the appropriate social care qualification required for registration with the SSSC. All workers we heard from confirmed recent opportunities to access relevant training and said they had no training needs directly related to their job that were not being met by the service; they said they felt confident that they had the skills to support people using this service. All the service users who completed Care Inspectorate surveys agreed that staff had the skills and experience to meet their needs. Support The manager held regular minuted team meetings. Staff could also participate in working groups. All staff who sent back Care Inspectorate questionnaires confirmed opportunities to meet with other staff all felt safe at work and considered they had the necessary materials and equipment for their job. Staff we heard from made very positive comments about the organisation as an employer. Conduct All the service users and all the workers who completed Care Inspectorate surveys agreed that staff treated people who use this service with respect. Areas for improvement The service should maintain present high standards. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Hamilton Supported Living Service - Housing Support Service, page 14 of 19

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 Please see Quality Statement 1.1 Areas for improvement Please see Quality Statement 1.1 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 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 We found the performance of this service was very good in the areas covered by this statement. We decided this after spoke to the manager and looked at surveys, minutes of meetings, audit paperwork and personnel records. LAMH had a Quality policy and its aim was to identify if 'customer requirements were being achieved'. The service had some effective ways to monitor the quality of its services. These included the following: Feedback from service users through meetings; surveys and consultation events Feedback from staff at team meeting and in working groups Six monthly Internal Quality Audits which included scrutiny of a sample of support plans Audit of case recording as part of the supervision process Some direct observation of staff practice Hamilton Supported Living Service - Housing Support Service, page 15 of 19

Meeting criteria for the Mental Health Commendation Award and for the Investors in People award use of Scottish Recovery Indicators to audit the service against recovery standards. Areas for improvement At the moment the service gets feedback from stakeholders and other professional through the Social Work evaluating officer or at reviews. LAMH has until now not used questionnaires to directly invite the views of health professionals and social work staff. LAMH should consider doing this as further way to measure quality and satisfaction. (see recommendation 1) The manager should ensure that all audit paperwork is signed and dated. Asking responsible staff to record action taken after an audit would encourage greater accountability. (see recommendation 2) The service did not have a complaints log as there had been no formal complaints. We think It would be useful for staff to log any complaints that service user make informally to help identify any trends. (see recommendation1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Quality Assurance To further improve Quality Assurance LAMH should do the following: introduce surveys for health professionals and social work staff ensure that all audit paperwork is signed and dated ask responsible staff to record and date action taken after an audit log any complaints that service users voice informally to help identify any trends or patterns. (National Care Standards Support Service Care at Home Standard 4 Management and Staffing) Hamilton Supported Living Service - Housing Support Service, page 16 of 19

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 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). Hamilton Supported Living Service - Housing Support Service, page 17 of 19

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 25 Jan 2011 Announced Care and support 4 - Good Staffing Not Assessed Management and Leadership Not Assessed 12 May 2009 Announced (short notice) Care and support Staffing Management and Leadership 4 - Good 5 - Very Good 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Hamilton Supported Living Service - Housing Support Service, page 18 of 19

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 Hamilton Supported Living Service - Housing Support Service, page 19 of 19