Key Community Supports - Highland (Skye, Lochalsh and Lochaber) Support Service 7 Carsegate Road Inverness IV3 8EX Telephone: 01463 242579 Type of inspection: Unannounced Inspection completed on: 12 June 2017 Service provided by: Key Housing Association Ltd Service provider number: SP2003000173 Care service number: CS2015337672
About the service The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com The service, Key Community Supports - Highland (Skye, Lochalsh and Lochaber), is operated by Key Housing Association Ltd, a registered social landlord that provides accessible housing and support in 15 local authority areas across Scotland. The care at home service provided personal care, support and advice to people with learning disabilities and complex care needs. The service is provided at two sites in the West Highlands; one based in Portree on the Isle of Skye and one based in Fort William in the Lochaber area. The service was registered on 28 July 2015 and operates all year round. Previously the service was inspected jointly with the housing support service also provided by the organisation. However, following a structural review, the provider requested that this service should be regulated as a stand alone service. People who use the service can easily access support in emergencies out with their allocated support times. Overnight support can be provided to individuals that required this level of service. The service aimed to work alongside service users and their family to help them to live life to the full. What people told us During the inspection we spoke with six people who were supported by the service. They told us they were happy with the way they were supported. One person said that they felt their support was really for them to help them do the things they wanted to do. People told us that they were confident in their support staff and could speak to the local service managers if they were not happy. All of the people we spoke with said that they got the support they needed to help them have a good lifestyle. Self assessment The service had not been asked to complete a self assessment in advance of the inspection. We looked at their own improvement plan and quality assurance paperwork. These demonstrated their priorities for development and how they were monitoring of the quality of the provision within the service. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership What the service does well Based on the evidence presented at this inspection and what people told us about the service we evaluated the quality of care and support, staffing and management and leadership as good. People can exercise choice in their daily lives and can direct their support in ways that are important to them. page 2 of 6
When we spoke to people, they told us their support was planned around their individual preferences and could be flexible to accommodate changes in need, circumstances and daily routines. People we spoke to told us that staff knew them well which meant that they were able to recognise changes in wellbeing that may benefit from further advice or support from other professionals. Staff were very clear about their roles and responsibilities and were confident seeking additional support for people. Care files contained brief information about people's lives. The service had developed a new format for documenting the support people needed which focused on achieving good outcomes for people in their daily lives. This highlighted what was important to people now, their needs and aspirations and helped plan care in a more person centred manner. Staff presented as a very motivated and committed group. Regular team meetings helped to maintain a cohesive group. Staff told us that they felt their opinions mattered and they were encouraged to express their views, which would be considered in the overall development of the service. Staff support was good and included a comprehensive induction and regular support for new staff throughout their probationary period. A range of ongoing training was provided and regularly refreshed. Staff identified their own development needs relevant to the people they supported and this had started to inform a training plan for the service. Staff had regular supervision which showed good understanding of their roles in relation to adult support and protection. Staff were confident that their development needs were being met. They told us that the manager was supportive of training events and opportunities that could help to improve their skills and impact positively on outcomes for people who use the service. People we spoke to were generally happy with their care and support and where they had regular staff supporting them, people told us they were satisfied with the quality of support provided. A number of areas for improvement have however been identified through this inspection. We saw that these areas were being addressed which would help to improve the service and provide greater satisfaction and reassurance for people who use the service. What the service could do better The service had experienced some staffing challenges in the more rural areas covered by the service. However, the organisation had been proactive in recruitment offering flexible working patterns to attract applications. It would be a good development to consider developing communication passports to support people with limited verbal skills to have a greater voice and control over their support. Staff should be mindful to ensure that hospital passports for people were fully completed and contained accurate information. We found little information in support plans about people's health needs. This may have been an oversight as the format for writing support plans was new. We discussed this with the manager and she agreed to address this as a priority. Where reviews of support plans were completed, a record should be kept and available to participants. The record should describe the discussions that took place and confirm actions agreed and who would be responsible for progressing said actions. From the care files sampled, we noted that reviews were not happening for one person. There was information in the file about changes in health needs, but the support plan had not updated to reflect this and thus provide further guidance to staff. (See Recommendations) page 3 of 6
The service had access to the orders granting guardianship and we noted that the Mental Welfare Commission guardianship checklist was used to summarise relevant information. However, we found that these were not always fully completed or accurate. The service also needed to ensure that they had obtained signed letters from guardians detailing the responsibilities they had delegated to the service. This served to grant legal authority to the service to act and make decisions on behalf of named guardians. (See Recommendations) Service agreements were in place, but these could be strengthened by adding detail about the allocated support hours agreed for each person and how these hours would be used. We could not evidence that staff training needs analysis had been undertaken. The manager needed to ensure that individual training needs analysis was completed for each member of staff and updated regularly. These are key documents for planning and prioritising staff training and development and should inform the annual training plan for the service. The service should develop a system for regular observations of staff practice. This should inform planned staff supervisions, and performance appraisals and inform the quality assurance processes. This procedure would be particularly useful following competency assessments and serve to offer reassurance to service managers that learning has had a positive influence on staff practice. (See Recommendations) The current system for quality assurance could be strengthened and made more robust by the addition of evidence showing that identified outcomes had been achieved; evaluations of potential improvement in service delivery and the actions needed to achieve improved outcomes for people who experience care, staff and the organisation. The manager should consider how staff can contribute to a service development or improvement plan. A development plan can be a valuable tool to plan and prioritise areas for development and improvement. Requirements Number of requirements: 0 Recommendations Number of recommendations: 4 1. The manager should ensure that each support plan detailed the health needs of people they support and how the service would meet these. National Care Standards, Care at Home: Standard 7 - Keeping Well - Healthcare. 2. The manager should ensure that reviews are completed every six months as a minimum. Information about changes in people's needs must inform and update the support plan. National Care Standards, Care at Home: Standard 3 - Your Personal Plan and Standard 7 - Keeping Well - Healthcare. page 4 of 6
3. The manager should ensure that where guardianship orders are in place for people supported by the service, they must obtain signed and dated records detailing the responsibilities and decisions they have delegated to the service. National Care Standards, Care at Home: Standard 3 - Your Personal Plan, Standard 4 - Management and Staffing and Standard 5 - Lifestyle. 4. The manager should consider regular planned observation of practice to support staff development, inform planning and performance appraisals. National Care Standards, Care at Home: Standard 4 - Management and Staffing. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Inspection and grading history Date Type Gradings 1 Jul 2016 Unannounced Care and support Environment Not assessed Staffing Management and leadership page 5 of 6
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 6 of 6