Allied Healthcare (Elgin) - Housing Support Service Housing Support Service Unit 3 Southfield Drive Glassgreen Elgin IV30 6GR Telephone: 01343 550074 Inspected by: Elano Ross Type of inspection: Unannounced Inspection completed on: 18 January 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: Allied Healthcare Group Limited Service provider number: SP2003002385 Care service number: CS2010250332 Contact details for the inspector who inspected this service: Elano Ross Telephone 01463 227630 Email enquiries@careinspectorate.com Allied Healthcare (Elgin) - Housing Support Service, 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 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well The service delivers a flexible support service to vulnerable people in their own homes. The manager and staff know their service users well and are able to recognise and respond to changes to service users health and wellbeing needs. The manager and staff have developed effective professional relationships with health and social care agencies within the area. They worked in partnership with a range of agencies to meet service user's individual need, supporting good communication and a responsive service. Staff were knowledgeable in working with a range of issues experienced by service users, carers and care providers. The management team worked diligently to ensure that staff skills were matched to service users needs. Staff are caring and committed to the service. People using the service speak well of the staff who provide the care and support. What the service could do better The provider needed to ensure that the service reviewed individual support plans within statutory timescales and that review meetings were fully recorded. The manager needed to implement the providers participation policy relevant to the needs and wishes of people that use the service in Elgin. Allied Healthcare (Elgin) - Housing Support Service, page 3 of 22
The provider needed to ensure that training and opportunities for professional development were provided to staff in accordance with their own training policy. What the service has done since the last inspection Since the last inspection, the service have continued to provide a consistent level of care and support to their service users during what has been a difficult period for the service. Conclusion Allied Healthcare (Elgin) provides a good level of care and support to people living in their own homes and helps them to remain within their communities. The management team and staff are committed to delivering a high quality service and working to achieve this. Service users are happy with the service provided by Allied Healthcare (Elgin) and have good relationships with their carers. The organisation have good policies and procedures in place, but they needed to fully implement these in this service. The manager is required to make sure that service user's support plans are reviewed within statutory timescales and updated to reflect any changes. Who did this inspection Elano Ross Allied Healthcare (Elgin) - Housing Support Service, page 4 of 22
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.scswis.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Allied Healthcare (Elgin) is part of a multi-national company operating health and social care services across the United Kingdom, Ireland and the United States of America. The company have recently been acquired by Saga Group Ltd. Allied Healthcare (Elgin) provides a combined Housing Support and Care at Home service to people within the local area. Primarily, the service is delivered to older adults and adults with disabilities and significant health issues. Recently the service has diversified and they have begun providing support to children and young people with learning disabilities. The service aims included: To provide a high quality service to people in their own home Allied Healthcare (Elgin) - Housing Support Service, page 5 of 22
To work in partnership with service users and any other healthcare professionals involved To provide a flexible service to meet service users needs and To promote service users independence as far as possible Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate 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. Allied Healthcare (Elgin) - Housing Support Service, 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 report was written following an unannounced inspection carried out by Inspector Elano Ross. The inspection took place between 16-18 January 2013; between the hours of 11:00 and 17:00. Our findings were fed back to the manager of the service by telephone on 18 January 2013. The feedback included the areas for improvement as well as any requirements and recommendations made as a result of this inspection visit. Before the inspection As requested by us the care service sent us an annual return. The service also sent us a self assessment form. The Care Inspectorate issue Care Standards Questionnaires (CSQs) to services and ask them to distribute them to service users and staff who then return them directly to us. We received 16 completed questionnaires from people that use the service or their relatives or carers and seven from staff working in the service. Generally service users are very happy with the service provided from Allied Healthcare. During the inspection We gathered evidence from various sources including: Relevant sections of policies, documents and records Samples from individual support plans Considered information provided in the self assessment document Considered the information provided in the annual return for the service Samples of staff training and supervision records Viewed minutes from meetings, including staff meetings Review documentation Risk assessments Accidents and incidents Registration certificate Insurance documents Considered the information provided by service users and carers in the questionnaires returned to us Allied Healthcare (Elgin) - Housing Support Service, page 7 of 22
All of the above was taken into account at this inspection. 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 Allied Healthcare (Elgin) - Housing Support Service, page 8 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 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 useful self assessment document from the service provider. We were satisfied with the way the provider had completed this and with the relevant information they gave us for each of the headings which we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We received 16 completed Care Standards Questionnaires from people that use the service. They told us that they were very happy with the service provided by Allied Healthcare (Elgin) they said that they had a support plan in place that included their needs and preferences; that staff were skilled, courteous and treated them with respect; and that they were confident that any issue or complaint they might have would be resolved satisfactorily. Comments from people that use the service included: My carers give excellent service I am well taken care of so my family do not worry about me Many thanks to the staff at Allied I value the professional standard of discretion by the staff They make a huge amount of effort to match appropriate staff with clients My carers have supported me through a difficult time with empathy, good humour and encouragement Staff know me very well and can give me the support that I need I cannot fault my carers as they go the extra mile. Thank you all Allied Healthcare (Elgin) - Housing Support Service, page 9 of 22
One service users commented that their support plan had not been reviewed for 11 months. Taking carers' views into account Carers views were not sought as part of this inspection. Allied Healthcare (Elgin) - Housing Support Service, 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: 3 - Adequate 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 the service was performing to an adequate standard. We concluded this after we: Considered the organisation's participation policy Sampled care files and review documentation of people that use the service Spoke with the manager and staff Reviewed the information in the Care Standards Questionnaires returned by people that use the service Allied Healthcare had a good corporate policy on service user participation that aimed to 'enable people to play an active part in the development and improvement of our services' this included a number of ways in which the service would listen to and involve them as partners in the decisions that affect their lives. This included: How health and social needs will be met Supporting service users to take part in selection of staff Seeking the views on the quality of information provided Opportunities to participate in planning groups and Creating user forums From the support plans we sampled it was clear that service users had been involved in the decisions on how the service would support them. Service users were provided with a handbook and a named contact person when they first began to use the Allied Healthcare (Elgin) - Housing Support Service, page 11 of 22
service. This provided good information about the service and what they might expect and included information on how to make a complaint if they were not happy with any aspect of the service. The manager told us that senior support staff visit service users on a regular basis to find their views about the service provided by Allied Healthcare (Elgin). Additionally the organisation, centrally issues questionnaires to a selection of service users seeking their views on the service provided. Areas for improvement In the Self Assessment for the service, the manager acknowledged that attempts to involve service users in focus groups were unsuccessful and that she now needs to look at other methods for involving service users in developing the service provided to them. We found that the corporate policy on participation gives no direct guidance to staff on how they should involve people in developing the service. Questionnaires were issued to a selection of service users centrally from head office and returned to them to be collated. We did not see any evidence that the outcomes from these questionnaires influenced changes in service provision or the delivery of care. In our discussion, the manager of the service was directed to the Care Inspectorate publication 'Involving people' which should provide her with very good guidance on how to develop service user participation and involvement in this service. See Recommendations. One of the main ways in which people can give their views about the service and make suggestions for service improvement is through the review process of their own individual Support Plan. From our sample of service user's files we found that Support Plans were not routinely reviewed with service users every six months as required. We sampled 11 service user care files and noted that there was no statutory review recorded for six service users and four files were for people who had begun to use the service within the last four months so a review of their Support Plan was not yet required. One service user commented that their Support Plan had not been reviewed for 11 months. In two care files we observed written correspondence from service users or their representatives making suggestions and requests for changes to the support they received. We could not evidence that the requests made had been followed up or had resulted in any changes. We found these letters loose in the care files for two different individuals and not held securely within the bound care file. See Requirements. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Inspection report continued Allied Healthcare (Elgin) - Housing Support Service, page 12 of 22
Requirements 1. The provider is required to make sure that individual Support Plans are reviewed with service users and their carers or representatives where appropriate, at least once in each six month period or sooner if there are significant changes in service users circumstances. In order to achieve this the manager must ensure that documentary evidence of the review meeting is retained in service users files detailing who was consulted, a summary of the discussion held and the decisions made as a result of the discussion. Support Plans should be updated to reflect any changes in service delivery. This is in order to comply with SSI 2011/210 Regulation 5(2)(b) - Personal Plans. Timescale for implementation two months from receipt of this report. Recommendations 1. The manager should further develop the statement on how the participation policy will be implemented in this service and include: A number of different ways in which service users can express their views and make suggestions for improvement. How the feedback from service users will be used to improve the service. How service users will be informed about the outcome from their feedback. How and when changes to service provision that result from service user consultation and feedback will be made. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that the service was performing well in the areas covered by this statement. We concluded this after we: Sampled services user's support plans and risk assessments Considered the information provided in the self assessment for the service Spoke with staff Sampled daily recordings for individual service users Viewed medication and financial transaction records for individual service users Reviewed the information provided by service users in the Care Standards Questionnaires returned to us Sampled the information recorded in service users care files Allied Healthcare (Elgin) - Housing Support Service, page 13 of 22
The manager and staff told us that service user's health and wellbeing is considered a priority by the service. We found that individual support plans included communication; washing and dressing; mobility; and hobbies and interests. Service users care files included a medical profile for each individual which covered: Medical history Current health Allergies Fits Medication The files we sampled detailed information on the health issues affecting each service user and provided good guidance for staff on how these would be managed. Risk assessments were in place for mobility and moving people, any risks to staff in the home environmental and the arrangements for managing infections. There was good evidence to support that staff had received training on how to manage service users medicines safely. Staff competence in this area was regularly checked through spot checks and individual discussion at 1:1 staff supervision. There was good evidence that the service had developed effective relationships with local health and social care agencies. This meant that if there were changes in service users health or there were issues affecting their wellbeing, an appropriate response could be put in place quickly to ensure that service users were provided with the appropriate level of care and support required to meet individual needs. Areas for improvement The manager noted in the self assessment for the service that there was a need for further training for staff on specific health and wellbeing issues such as stoma care, PEG feeding, nutrition and oral care. We could not evidence that risk assessments had been reviewed and updated along with Support Plans with service users. See Requirements made in Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Allied Healthcare (Elgin) - Housing Support Service, page 14 of 22
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate 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 for the grade awarded in this statement is included in Quality Theme 1, Statement 1. Areas for improvement The areas for improvement in this statement have been identified in Quality Theme 1, Statement 1. Grade awarded for this statement: 3 - Adequate 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 that the service was performing well in the areas included in this Statement. We concluded this after we; sampled staff training records viewed the induction programme for new employees considered the organisation's training policy spoke with the manager and staff sampled staff meeting minutes considered responses we received from staff and service users to our Care Standards Questionnaires The service had developed a comprehensive induction that was well recorded and included dates for completion. The induction process covered essential information Allied Healthcare (Elgin) - Housing Support Service, page 15 of 22
about the organisation and the policies and procedures the service operated under; the organisation management structure, information on the Scottish Social Services Council (SSSC); National Care Standards and expectations of staff; staff training, communication, recording and lone working. Induction training included practical training delivered in-house or through the e-learning forum and included: Health And Safety Infection Control Food Hygiene Nutrition First Aid Medication Moving and Handling Vulnerable Adults/ Adult Support and Protection Promoting Independence Shadowing opportunities Supervision of staff takes place regularly and is recorded. Supervision evidenced that staff practice was monitored regularly and any issues with regard to practice is discussed and ways forward identified. Staff we spoke with told us that they had access to statutory and non statutory training that equipped them with the knowledge and confidence to deliver the identified support to service users that they cared for. They said that they were expected to identify their own training needs and contribute to the service's training plan. Staff meetings took place regularly and were minuted. Staff told us that they received copies of the meeting minutes if they had not attended the meetings in person. Areas for improvement The manager had identified in the self assessment for the service that as the service developed and expanded, there was a need to increase the provision of specialised training for staff on issues such as palliative care, autism and other specific conditions. The manager should continue to plan, source and deliver this to the staff who need this. The organisation's policy on staff training requires staff who do not already hold a relevant care qualification to 'register for SVQ level 2 (care) award within three months of joining the company and complete the full award within 2 years.' Staff we spoke with confirmed the statements from staff who completed Care Standards Questionnaires for us that despite requests, the service did not provide them with this training. The Scottish Social Services Council (SSSC) are working towards required registration for everybody working in the field of social work and social care. Currently the managers of Housing Support Services and Care at Home Services who are not currently registered with another regulatory body, must apply for Allied Healthcare (Elgin) - Housing Support Service, page 16 of 22
registration with the SSSC by 31 July 2013. Other staff employed in these services will also be expected to register with the SSSC and will be required to achieve a relevant professional qualification within a specific time frame following registration. The provider should ensure that the service comply with their own training policy to ensure that the qualification requirements for the staff group can be planned for effectively. See Recommendations. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The provider should make sure that the service is compliant in all aspects with the organisational training policy. In order to achieve this the manager for the service should source and secure SVQ training for an agreed number of staff each year until all staff can meet the qualification requirements for registration with SSSC. In making this recommendation the following National Care Standards for Housing Support and Care at Home services have been taken into account; Standard 4 - Management and Staffing (Care at Home Services) and Standard 3 - Management and Staffing Arrangements (Housing Support Services). Allied Healthcare (Elgin) - Housing Support Service, page 17 of 22
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 evidence for the grade awarded in this statement is included in Quality Theme 1, Statement 1. Areas for improvement The areas for improvement in this statement have been identified in Quality Theme 1, Statement 1. Grade awarded for this statement: 3 - Adequate 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 that the service was performing well in the areas covered by this Quality Statement. We concluded this after we; considered the Quality Assurance system for the service viewed service policies including complaint procedures and whistle blowing spoke with the manager and staff considered information provided in the self assessment for the service sampled a number of records and documents including support plans, reviews, risk assessments, letters from service users and minutes from meetings People that used the service confirmed that they knew how to make a complaint to the service and the Care Inspectorate. They were confident that the manager and the provider would listen to their concerns and work quickly to resolve issues. Allied Healthcare (Elgin) - Housing Support Service, page 18 of 22
Accident and incident records were maintained and kept up to date. There was clear evidence that the manager was monitoring occurrences of accidents and incidents as part of the quality assurance for this service. There were regular internal audits which reflect any changes within processes. Audits undertaken by the service manager included spot checks on staff practice and competence and visits to service users to get feedback on the service delivered. Allied Healthcare have a dedicated Quality Assurance manager who visits the service three monthly to complete external audits of the service. The outcomes of theses audits form an action plan for the service. Any identified actions are followed up by the manager, Quality Assurance manager and the Business manager for the service. Areas for improvement We found that the Quality Assurance System policy emphasised the importance of service user feedback and that of their relatives or representatives, however we could find little evidence to support that service users had been involved in assessing the quality of the service. The service had not demonstrated to us how service users had been involved in the self assessment process for this service. The provider needed to make sure that the organisations policy on service user involvement was fully implemented in this service. The manager also needed to develop systems to capture the views of service users about the service and to engage with them in assessing the quality of the service provided and identifying where the service could be improved. See Recommendations in Statement 1 under the Quality Theme for Care and Support. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Allied Healthcare (Elgin) - Housing Support Service, 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 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). Allied Healthcare (Elgin) - Housing Support Service, page 20 of 22
5 Summary of grades Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 3 - Adequate 4 - Good Quality of Staffing - 3 - Adequate Statement 1 Statement 3 3 - Adequate 4 - Good Quality of Management and Leadership - 3 - Adequate Statement 1 Statement 4 3 - Adequate 4 - Good 6 Inspection and grading history Date Type Gradings 10 Jun 2011 Announced (Short Notice) Care and support Staffing Management and Leadership 4 - Good 4 - Good 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Allied Healthcare (Elgin) - Housing Support Service, 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 Allied Healthcare (Elgin) - Housing Support Service, page 22 of 22