Dumfries Supported Living Support Service 8 Lincluden Court Lincluden Road Dumfries DG2 1QB Inspected by: (Care Commission Officer) Mala Thomson Type of inspection: Inspection completed on: 3 January 29 1/14
Service Number Service name CS2482189 Dumfries Supported Living Service address 8 Lincluden Court Lincluden Road Dumfries DG2 1QB Provider Number dummy Provider Name SP24566 Milbury Care Services Limited trading as Voyage dummy Inspected By Inspection Type Mala Thomson Care Commission Officer dummy Inspection Completed Period since last inspection 3 January 29 17 months dummy Local Office Address Solway House Dumfries Enterprise Park Tinwald Downs Road DUMFRIES DG1 3SJ dummy 2/14
Introduction Dumfries Supported Living is registered by the Care Commission to provide Housing Support and Care at Home. Owned by Milbury Care Services, The Statement of Aims and Objectives states: We aim to provide high quality, good value services, responsive to the needs and aspirations of individuals and enable people to take part in community life with the full rights and responsibilities of citizenship and to live independently with personalised care and support. Based on the findings of this inspection the service has been awarded the following grades: Quality of Care and Support - 4 - Good Quality of Staffing - 5 - Very Good Quality of Management and Leadership - 4 - Good This inspection report and grades represent the Care Commission s 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. Please refer to the care services register on the Care Commission s website (www.carecommission.com) for the most up-to-date grades for this service. Basis of Report Before the Inspection The Annual Return The service submitted a completed Annual Return as requested by the Care Commission. The Self-Assessment Form The service submitted a self-assessment form as requested by the Care Commission. This was sufficiently detailed and informed this inspection. Views of service users 8 Service Users questionnaires were sent out of which 6 were returned completed. Responses were largely positive and most indicated that they were satisfied or very satisfied with the service they received. During inspection, 1 service user agreed to speak with the Care Commission Officer and all their views are included in the body of this report. Regulation Support Assessment The inspection plan for this service was decided after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. LOW This assessment resulted in this service receiving a low RSA score and so a low intensity inspection was required. The inspection was based on the relevant Inspection Focus Areas and associated National Care Standards, recommendations and requirements from previous 3/14
inspections and complaints or other regulatory activity. This inspection was based upon recommendations made at the last inspection on 8th August 27 During the inspection process Staff at inspection The inspection was completed by Mala Thomson- Care Commission Officer. The inspection was conducted on 29.1.9 at the office base of the service from 9.15 to 5.3 pm and 3.1.9 from 9. to 1.pm. Evidence During the inspection evidence was gathered from a range of sources including: Interview with the following: Depute Manager 2 X support staff 1 X Service User Records Registration certificate Insurance certificate Accident and incident records Medication System Aims & objectives of the service Personal plans & Review minutes x 2 sampled Individual risk assessments Staff Recruitment Staff Rotas Staff Supervision Staff training records Complaints procedure Health and Safety Policy and procedures Protection of Vulnerable Adults (POVA) - policy and procedures- Service User Annual Survey Review & Results Communication and Participation Statement The inspection also took account of The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 22 (SSI 22/114), National Care Standards Housing Support Services and Care at Home. In addition, the Inspection Focus Area regarding notifications to the Care Commission and Scottish Social Services Council were also examined. Inspection Focus Areas and links to Quality Themes and Statements for 28/9 Details of the inspection focus and associated Quality Themes to be used in inspecting each type of care service in 28/9 and supporting inspection guidance, can be found at: http://www.carecommission.com/ Fire Safety Issues The Fire (Scotland) Act 25 introduced new regulatory arrangements in respect of fire safety, on 1 October 26. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the 4/14
area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements since last Inspection There were no requirements in the last inspection report: Comments on Self Assessment The service submitted a self-assessment form as requested by the Care Commission which provided useful information about the service. View of Service Users All service users who submitted questionnaires expressed some degree of satisfaction with the service they received and felt staff had the skills and experience to meet their needs. One service user spoken with confirmed that he was well supported and that staff treated him with respect and dignity. Comments about the service were very positive:- : Support package has changed and since moving to service, has met changed needs well. Service Users confirmed that members of staff were attentive and professional and indicated they thought the service they received met their needs. View of Carers No Carers were available for interview during this inspection. However, 2 questionnaires had been completed by carers which indicated that they were very satisfied with the service. 5/14
Quality Theme 1: Quality of Care and Support Overall CCO Theme Grading: 4 - Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service Strengths Service user's (tenants) were enabled to make their views known at different levels within the care service including involving service users at the initial assessment and as part of the services 'Annual Service Review'. This includes questions about staff and management support. Service Users consulted as part of this inspection said that staff were supportive of them and treated them with dignity and respect. They confirmed that they were asked if they were happy with how their needs were met and were able to influence their care support needs through the review process. A culture of respect was evident in the overall policies, practices and in the records kept by the service relating to service users. There is a "Communication and Participation Statement" which highlights the aims and objectives of the organisation and identifies a variety of ways in which participation occurs at different levels. Effective communication systems were in place with support staff being kept updated about service users needs. There was a keyworker policy and each tenant is allocated a keyworker who has responsibility for managing care needs. In addition, tenants are also allocated 'associate keyworkers' to ensure continuity of care. Service users were aware of the service's comments and complaints procedure and they felt comfortable about discussing any concerns with the manager and staff confirming that staff always responded to their concerns. In addition, service users had access to advocacy services and at the time of inspection, one tenant was using this service. Two previous recommendations to obtain copies of Dumfries and Galloway's inter-agency guidelines for child protection and to obtain Mental Welfare Commission for Scotland good practice guidance - "Rights, Risks and Limits to Freedom and "Safe to Wander" have both been addressed. Areas for Development The Care Commission Officer concurs with the Managers comments in the self assessment that whilst service users questionnaires have been introduced to gain their views, these need to be developed and evaluated in a more meaningful way. Service users are assisted to complete questionnaires by staff and whilst it is acknowledged that service users are consulted, this should be done more routinely and in a manner which facilitates independent engagement to ensure choice, privacy and independence. (See recommendation 1) CCO Grading 4 - Good Number of Requirements 6/14
Number of Recommendations 1 Statement 3: We ensure that service user's health and wellbeing needs are met. Service Strengths There are policies and procedures in place for the administration of medication. Some of the staff have had the opportunity to undertake additional training to assist them in their work with Service Users such as training about epilepsy and autism, diabetes and working with people with brain injuries. Staff worked with other health professionals such as speech and language therapists, dieticians, psychologists and physiotherapists to ensure that service users' physical and mental health needs were not overlooked. In addition, service users are encouraged and enabled to access community-based health resources such as GP's, dentists and optician's. Appropriate accident and incident recording systems are in place. These are evaluated by the Manager for patterns in an effort to protect people and preventative action is taken to protect service users. Wherever possible, independence is promoted and service users are encouraged to manage their medication and cook for themselves. Service user's were involved in menu planning and encouraged to lead healthy lifestyles. Service Users expressed no concerns in relation to their health and wellbeing needs and spoke well of the support they received. Areas for Development Although staff were given training and guidance on the administration of medication, the Care Commission Officer found gaps in entries where staff had administered medication compromising accountability and safety for service users. ( See Recommendation 2) There were two occasions whereby a service user had not been supported for meals due to staff absence despite this being part of a care agreement. (See Recommendation 3) CCO Grading 4 - Good Number of Requirements Number of Recommendations 2 7/14
Quality Theme 2: Quality of Environment Overall CCO Theme Grading: 8/14
Quality Theme 3: Quality of Staffing Overall CCO Theme Grading: 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 for information on how Dumfries Supported Living involved service users and carers in assessing the quality of their service. The service gave individuals the opportunity to comment on the performance of staff through their 'Annual Service Review Questionnaire'. Specific questions about staff and managers were asked in relation to 'support arrangements' and 'expressing your view'. Service users could also raise issues through the complaints procedure if they were unhappy with staff and were encouraged to participate in this inspection. The organisation was in the process of giving consideration to methods by which they could include service users in their recruitment procedures. Areas for Development Staff communication on a daily basis is reported by staff to be effective and it was reported that staff ideas are taken forward through supervision. However, although the Managers attend meetings, staff meetings do not take place, the last one having taken place a year ago. This limits service user's views to be carried forward in a cohesive and consistent manner. (See Recommendation 4) CCO Grading 4 - Good Number of Requirements Number of Recommendations Statement 3: We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths An excellent programme of staff training was in place. Induction training is in place for new, temporary and seconded staff. This incorporates National Care Standards, legislation and best practice. In addition, there is also a programme of mandatory and formal training along with training to assist people in their work with service users. Mandatory training includes Protection of Vulnerable Adults and dealing with challenging behaviour. Formal training consists of undertaking various levels Scottish Vocational Qualification. 9/14
There is a planned programme of individual supervision for all staff and records indicated that this took place regularly on a 4-6 weekly basis. Staff were encouraged to identify their own learning needs and can request training to assist them in their work with individuals. The service had a suite of policies and procedures which staff were knowledgeable about. As already stated, previous recommendations to obtain a copy of the local inter-agency policy on adult protection had been addressed and the service had information for staff of the Mental Welfare Commissions documents- Rights Risks and Limits to Freedom and Safe to Wander. Staff presented as competent and there was evidence of good team working. The staff said that they felt supported by the management of the service and found them to be very approachable. Staff demonstrated excellent written skills, all records looked at including support plans and incident reporting were completed in a professional and consistent way. Areas for Development None identified. CCO Grading 6 - Excellent Number of Requirements Number of Recommendations 1/14
Quality Theme 4: Quality of Management and Leadership Overall CCO Theme Grading: 4 - Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service Strengths Please see Quality Statement 1.1 for information on how Dumfries Supported Living involved service users and carers in assessing the quality of their service including the management. All service users who took part in this inspection were very complementary about the quality of management and the service which they received. The service had a clear complaints policy in place and service users indicated that they were familiar with this and would feel comfortable raising an issue or a concern. Records confirmed that where service users had raised complaints, these had been dealt with fairly by the Managers. Respondents of the Care Commission's Care Standards questionnaire said that they agreed that staff had the knowledge and skills to support them. They confirmed that staff were supportive, approachable and always available to them as agreed in their care agreement. Risk assessments were undertaken and a previous recommendation to individually risk assess where service users had agreed to have alarms activated at their front door had been implemented. Areas for Development None Identified. CCO Grading 4 - Good Number of Requirements Number of Recommendations 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 Organisation has a Quality Assurance Policy and a Quality Assurance officer has been appointed. The service has a Participation Policy and, as previously mentioned an' Annual Service Review' has been undertaken by the service with a view to eliciting the views of 11/14
service users and their carers about the quality of the service and to identify ways in which it can be improved. The staff were very complementary about the support they receive from Managers. There was an open door policy and staff confirmed that they found Managers to be approachable and that they were able to express their views both informally and through the supervision process. The Managers were knowledgeable about the notification procedure to the Care Commission, Scottish Social Services Council (SSSC) and National Midwifery Council. All staff had access to copies of the SSSC codes of conduct. Areas for Development Whilst consultation does take place, it was not evident that stakeholder views were sought at service user reviews or as part of the monitoring and contracting meetings with other agencies such as the Local Authorities. The Manager should seek to introduce more formal quality assurance systems to evaluate their service delivery which includes views from stakeholders. (see Recommendation 1) CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 12/14
Regulations / Principles National Care Standards 13/14
Enforcement There has been no enforcement action against this service since the last inspection. Other Information None at this time. Requirements None. Recommendations 1. The Manager and staff should consider a variety of ways in which service users and stakeholders are given the opportunity to influence the delivery of the services they receive. This should include independent facilitation of engagement and results should be evaluated and actioned. National Care Standards for housing support - Standard 6 - Housing Support - Choice and Communication. 2. Action should be taken to ensure that all staff are familiar with best practice guidance in the administration of medication to ensure accountability and safety for service users. National Care Standards for care at home - Standard 7.2 - Keeping well-healthcare 3. The service should ensure that where service users are supported in meal preparation, this as carried out as agreed. National Care Standards for care at home - Standard 6 - Eating Well. 4. Staff meetings should take place regularly to enhance communication and ensure that service user's views are brought forward and actioned consistently. National Care Standards for housing support - Standard 6 - Housing Support - Choice and Communication. Mala Thomson Care Commission Officer 14/14