Highland Care Agency Ltd Nurse Agency 219 Colinton Road Edinburgh EH14 1DJ

Highland Care Agency Ltd Nurse Agency 219 Colinton Road Edinburgh EH14 1DJ Type of inspection: Unannounced Inspection completed on: 30 April 2015

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 30 5 Summary of grades 31 6 Inspection and grading history 31 Service provided by: Highland Care Agency Ltd Service provider number: SP2010010984 Care service number: CS2010251813 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at enquiries@careinspectorate.com Highland Care Agency Ltd, page 2 of 33

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 Information 3 Adequate Quality of Care and Support 3 Adequate Quality of Staffing 2 Weak Quality of Management and Leadership 3 Adequate What the service does well Highland Care Agency Ltd continue to look at ways of developing their service. Office staff are friendly and helpful. The service asks for feedback from both staff and the clients who use the nurse agency. What the service could do better The service must ensure that: - Robust recruitment procedures have been completed prior to members of staff commencing employment. - All incidents and complaints are appropriately recorded including any investigations and/or follow up action taken. - Where relevant, notifications must be made to the appropriate regulatory bodies and details of these actions clearly documented. The management should continue to review and develop systems to gain feedback from clients about the quality of information and personnel supplied by the nurse agency. Highland Care Agency Ltd, page 3 of 33

What the service has done since the last inspection Inspection report continued The service has recruited additional nurses since the last inspection and developed a larger client group. Conclusion The service's present clients are providers of care home services. Feedback from these clients indicated that they are generally satisfied with the standard of service this nurse agency provides. The management team told us that they are committed to supporting the service to make the necessary improvements. Highland Care Agency Ltd, page 4 of 33

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at: www.careinspectorate.com. This service registered with the Care Inspectorate on 31 October 2011. Highland Care Agency Ltd supplies and/or introduces registered nurses to client groups. The service has three offices. One at the Moffat Centre on Colinton Road, Edinburgh. A new office in St Enoch Square in Glasgow and the main office for day to day administration and recruitment in Salamander Street, Edinburgh. Within the report please note that where the term 'client' is used this can relate to an organisation/another registered care provider that pays for the service or the individual person who pays for the service. At the time of the inspection the nurse agency's clients were providers of care home service's. The service informed us that they currently had 60 nurses registered with them of whom approximately 30 were currently regularly seeking shifts through the service. The service's stated aim and vision on their website was: "We aim to meet the needs of our clients as they require our services and we are particularly proficient at dealing with last minute requirements. With our vision, we wish to make a difference in the nursing recruitment industry. By focusing not only on the needs of our client but mainly on the needs of the vulnerable that depend on our workers on a daily basis. This is why Highland Care Ltd was created to make a difference without the extravagance price attached. Our mission is to help nursing home and residential home achieved their target without the strain of inadequate or understaffing". Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Highland Care Agency Ltd, page 5 of 33

Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Act, its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of Information - Grade 3 - Adequate Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 3 - Adequate Inspection report continued 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 0345 600 9527 or visiting one of our offices. Highland Care Agency Ltd, page 6 of 33

2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following a series of visits to the service's office in Salamander Street, Edinburgh. An unannounced inspection took place on Thursday 23 April 2015 between the hours of 10.20am and 11.30am. A short notice announced visit was made, in order that we could access further records, on Tuesday 28 April 2015 between 10.15am and 3pm. A further announced visit was made on the morning of Thursday 30 April 2015 to gather additional evidence and to give feedback to the service's management team. As part of the inspection, we took account of the completed annual return and self assessment form that we asked the provider to complete and submit to us. During the inspection we gathered evidence from a number of sources. We looked at a range of documentation, including the following: Certificate of Registration. Certificate of Employers Liability Insurance. Staff records. Computer system for recording staff information. Client information pack. Service's website. Complaints log. Complaints procedure. Recruitment procedure. Accident and incident records. Booking sheets. Client feedback forms. We looked round the office and spoke with the service's management team and office staff. We also spoke with clients (care home managers) that had used nurses supplied by the nurse agency and asked for their feedback. We also considered the information in the action plan devised by the service to Highland Care Agency Ltd, page 7 of 33

address the requirements identified at the previous inspection and looked at information we had received about the nurse agency since the last 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 Highland Care Agency Ltd, page 8 of 33

What the service has done to meet any requirements we made at our last inspection The requirement In the last inspection report, dated 26 May 2014, we made four requirements. The service sent us an action plan detailing how these were to be met. 1. The provider is required to have a clear and accessible complaints procedure. The procedure should comply with The Public Services Reform (Scotland) Act 2010 and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210), Regulation 18 Complaints. This also takes into account National Care Standards, Nurse agencies, Standard 1 Information about the nurse agency. Timescale: The service should forward us a copy of their revised complaints procedure within three weeks of receiving this report. What the service did to meet the requirement We have reported on the actions taken toward meeting this requirement under quality statement 0.2, quality of information. This was not fully met and remains. The requirement is: Not Met Highland Care Agency Ltd, page 9 of 33

The requirement 2. The provider must ensure that accurate records are kept to inform of the actions taken in response to complaints and reported incidents and include any preventative action to be implemented. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 4 - Welfare of users and Regulation 18 Complaints. This also takes into account National Care Standards, Nurse agencies, Standard 5 Concerns, comments and complaints. Timescale: We asked the service to implement this immediately. What the service did to meet the requirement We have reported on the actions taken toward meeting this requirement under quality statement 1.1, quality of care and support. This requirement was not met and has been amended to reflect our findings. The requirement is: Not Met Inspection report continued The requirement 3. The service must ensure that its recruitment practices follow their provider's recruitment procedures to evidence that all safe recruitment procedures have been completed. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 15 Staffing. This also takes into account National Care Standards, Nurse agencies, Standard 4 management and staffing arrangements. Timescale: The service should send us details of how it is meeting this requirement within three weeks of receiving this report. What the service did to meet the requirement We have reported on this requirement under quality statement 3.2, quality of staffing. This requirement was not met and has been amended to reflect our findings. The requirement is: Not Met The requirement 4. The provider must ensure that the Care Inspectorate is notified of matters listed in the document 'Guidance on notification reporting'. In order to achieve this, senior staff should be familiar with this notification guidance. Highland Care Agency Ltd, page 10 of 33

This is in order to comply with The Public Services Reform (Scotland) Act 2010 and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This also takes into account National Care Standards, Nurse agencies, Standard 4 Management and staffing arrangements. Timescale: immediately on receipt of this report and on going. What the service did to meet the requirement We have reported on the actions taken toward meeting this requirement under quality statement 4.4, quality of management and leadership. This was not fully met and remains. The requirement is: Not Met 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. The service completed their self assessment form. This gave information relating to each quality theme. The service identified what they thought they did well, gave areas for future development and how they planned to implement changes. Taking the views of people using the care service into account The service's clients are providers of care home service's. We spoke to managers and/or the deputy managers of six care homes who regularly use registered nurses from the agency. They were all generally satisfied with the agency and the service that was provided. They spoke of action taken appropriately if any issues were raised and spoke of good communication with the manager. We have reported further on the feedback received in the main body of the report under the appropriate quality statement. Highland Care Agency Ltd, page 11 of 33

Taking carers' views into account Not applicable for this type of service. Highland Care Agency Ltd, page 12 of 33

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 0: Quality of Information 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 information provided by the service. Service strengths From the evidence we found we concluded that the service continued to perform to an adequate level in the areas covered by this statement. In assessing how the service meets this statement we reviewed the written information the service provides to clients and looked at how the service responded to feedback. The service's website provides a range of information for new and existing clients as well as for staff. It provides contact details and information about the services they can provide. The service has a client information pack which it provides to new and potential clients. We were informed that this was currently being updated. In checking that the new information pack contains all the appropriate details the service should check that it meets all the elements of National Care Standards, Nurse agencies, Standard 1 Information about the nurse agency and Standard 5 Concerns, comments and complaints. The management team told us that they meet with potential clients and maintain contact with established clients to discuss the level of service they wish to receive and to listen to their feedback. The feedback we received from clients was that the manager kept them informed about the actions they had taken in response to their feedback. Highland Care Agency Ltd, page 13 of 33

The service told us in their self assessment that they intended to increase their client and staff surveys from once a year to twice a year. Areas for improvement Contact details for the service were given on the service's website and a complaint form was provided in the client information pack. However neither resources informed the person of the actions that the service would take in response to receiving a complaint. We have made a requirement about this under quality statement 0.2. When we looked at the complaints log we found that the records available did not evidence the actions that the management team had taken in response to all of those logged. We have reported on this further under quality statement 1.1, quality of care, and made a requirement for the service to improve their record keeping. Where areas for improvement were indicated in the staff evaluation forms returned by clients to the service there was limited written evidence of the action that management had taken in response to this. We have reported on how the service should improve on this under quality statement 1.1, quality of care. We will follow up progress of these areas for development at the next inspection visit. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued Highland Care Agency Ltd, page 14 of 33

Statement 2 We provide full information on the services offered to current and prospective service users. The information will help service users to decide whether our service can meet their individual needs. Service strengths From the evidence we found we concluded that the service was performing to an adequate level in the areas covered by this statement. In reviewing this statement we looked at the progress the service had made to meet the requirement we made under this statement in our last inspection report. This was not met and remains. See areas for development below and requirement 1. We also looked at the information provided to current and prospective clients. Highland Care Agency Ltd provides written information about the services that it provides through their website and in the information packs that it provides to new and potential clients. The information the service provides included: The service's aims and vision. Type of services that can be provided. Contact details and 24 hour contact number. Details of staff training. Staff job description. Registration with the Care Inspectorate. Certificate of Employers Liability Insurance. Staff application and recruitment forms. Complaints procedure. Current and prospective clients were advised to contact the service to discuss their service's requests. This would include information on the particular skills, experience and availability of the staff working for the agency to ensure that the best candidates were matched to the clients' needs. During our visits we heard staff dealing with telephone calls from clients in a professional manner. They demonstrated knowledge of their nurses' availabilities and skills. Highland Care Agency Ltd, page 15 of 33

Areas for improvement At our last inspection visit we had asked that the service should update their complaints procedure to include how people can make a complaint, the name and address of the Care Inspectorate and the procedure including timescales the service will follow in responding to the complaint. The service in their action plan stated that they would send in a revised complaints procedure however this was not submitted to us. The client information pack included a complaints procedure however this referred to the service's domiciliary care. We directed the management team to the Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210), Regulation 18 Complaints which stated the information that the service's complaints procedure should contain. We also discussed with the management team how the complaints procedure for the service's domiciliary care could be amended to provide the appropriate information. We have asked the service to submit to us an updated copy of their complaints procedure. See requirement 1. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. The provider is required to have a clear and accessible complaints procedure. The procedure should comply with The Public Services Reform (Scotland) Act 2010 and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210), Regulation 18 Complaints. This also takes into account National Care Standards, Nurse agencies, Standard 1 Information about the nurse agency. Timescale: The service should forward us a copy of their revised complaints procedure within three weeks of receiving this report. Highland Care Agency Ltd, page 16 of 33

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 From the evidence we found we concluded that the service continued to perform to an adequate level in the areas covered by this statement. As reported in quality statement 0.1, quality of information, the service has systems in place to gain the views of clients and enable them to contribute to the improvement of the service. The service seeks feedback from clients as to the performance of its agency nurses. We saw some returned client feedback forms detailing the performance of individual members of staff. Some of these indicated that the clients were very satisfied with the member of staff that was provided. The service recognised that many of the client feedback forms on individual staff were not returned and found that a telephone call to the care home was often more effective in obtaining feedback about the agency nurses supplied. The clients we spoke with informed us that the manager kept them informed about the actions that they had taken in response to their feedback about the quality of care that the agency nurses provided. Areas for improvement Some of the returned client feedback forms indicated there were some staff whose behaviour and practice could be improved upon, for example poor time keeping. We were informed that these staff had been spoken with and that the management team continued to monitor their performance. However we did not see records of these actions. We discussed with the management team possible ways that this information could be recorded. See requirement 1. At the previous inspection visit when we looked at the complaints log and the incident records we found that information about how the service had responded to these was not always fully documented. We had made a requirement that the service Highland Care Agency Ltd, page 17 of 33

must ensure that accurate records are kept to inform of the actions taken in response to complaints and reported incidents and include any preventative action to be implemented. At this inspection we saw that the complaints staging form that the service had developed was now put with each new complaint or incident. These were often incomplete and details of planned actions were sometimes written on post it notes stuck onto the complaints staging form. This requirement is not met and has been amended to reflect our findings. See requirement 1. For the majority of the complaints and incidents the management team were able to confirm that actions had been taken and provided us with other supporting records to confirm this. We will follow up progress of these areas for development at the next inspection visit. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements Inspection report continued 1. The provider must ensure that accurate records are kept to inform of the actions taken in response to any client feedback that indicates the need for improvement, complaints and reported incidents. These records should include any preventative action to be implemented. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 4 - Welfare of users and Regulation 18 Complaints. This also takes into account National Care Standards, Nurse agencies, Standard 5 Concerns, comments and complaints. Timescale: We asked the service to implement this immediately for any new concerns or incidents. The service should review their complaints folder, incident folder and client feedback records and inform us of the actions taken to conclude and/or update these records within three weeks of receiving this report. Highland Care Agency Ltd, page 18 of 33

Statement 3 We ensure our service provides care staff who are most suitable to meet individual service user needs. The care and treatment received by the individual service user, is supported by evidence based practice and up to date policies and procedures. These reflect current legislation (where appropriate Scottish legislation). Service strengths From the evidence we found we concluded that the service continued to perform to an adequate level in the areas covered by this statement. In reviewing this statement we looked at how the service matches nurses with clients' requests. We also looked at the feedback clients had given on the nurses supplied. Placement of agency nurses was overseen by the manager or one of the senior members of staff who had a registered nurse qualification. The daily booking sheets indicated that there was good consistency in the same staff being supplied to the same care homes. This was also confirmed in the feedback we received from clients. Clients were encouraged to contact the service to discuss their requirements. As part of the recruitment process training records and certificates were checked and potential recruits complete a written questionnaire to assess their written skills and understanding of practice. All nurses complete a yearly moving and handling update. The service has training facilities which they continue to develop that helps them to assess and train staff. Staff induction records confirmed that staff had read the service's policies and procedures and key. The service follows up the performance of nurses on their placements through the use of client feedback forms, telephone calls and monitoring visits. We saw some of the written feedback the service had received from clients. Areas for improvement The service should continue to develop the methods it uses to obtain feedback particularly on new members of staff when client feedback forms on these individuals have not been returned. The service should ensure that this is appropriately recorded and action taken where indicated. See requirement made under quality statement 1.1. Highland Care Agency Ltd, page 19 of 33

The service's training pack on Protection of Vulnerable Adults included a flow chart which provided information on the contact details reflecting local procedures. This information was not included in the service's policy and procedure on Protection of Vulnerable Adults seen in the service's policy and procedure file. We recommended that the service should update their policy and procedure to reflect this additional information. See recommendation 1. We will follow up progress of these areas for development at the next inspection visit. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. It is recommended that the service updates its Protection of Vulnerable Adults policy and procedure to include contact details reflecting local procedures. This takes account of National Care Standards, Nurse agencies, Standard 4 Management and staffing arrangements. Quality Theme 3: Quality of Staffing Grade awarded for this theme: 2 - Weak Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We acknowledge that the service had some strengths in how it assessed and supported new members of staff. However there were weaknesses in how the service met this statement that caused concern. This resulted in this statement graded as weak. We asked the service to take immediate action to improve on how it meets this statement. In reviewing this statement we looked at the recruitment records of seven members of staff. At the previous inspection on the first day of our visit we had found that some of the new staffs' recruitment information in their files was incomplete. These files were immediately reviewed by the management team and the necessary evidence provided. We had made a requirement that the service should ensure that it Highland Care Agency Ltd, page 20 of 33

consistently follows and evidences that it has completed its recruitment process. Our findings at this inspection indicated that the service had failed to continue to meet this requirement. See areas for improvement below and requirement 1. Our sample of staff recruitment files were selected from new members of staff, staff who the daily booking sheets indicated were currently working for the agency and staff named in the complaints log. Staff files were securely stored with restricted access to ensure confidentiality. The service have a very comprehensive written recruitment policy and procedures. All applicants completed a job application form. Applicants were interviewed by the management team to make sure that they understood the job they were being recruited for and to find out if they had the necessary skills needed for the work. The interview process ensures that prospective employees understand the aims and values of the service. Staff were given written information about the expected standards that the service expect staff to comply with. All new staff have to provide evidence of recent moving and handling training. The service have a moving and handling trainer with a current trainers certificate to train and assess staff. Copies of training and qualification certificates were retained in staff files. Management had signed and dated these to confirm that the original certificate had been seen. The service check with the Nursing and Midwifery Council to see if the applicants are registered with them. Areas for improvement Inspection report continued At this inspection we identified concerns regarding the recruitment of staff. These were discussed with the management at feedback and we asked the service to take immediate action to ensure the service undertakes its legal responsibility to complete safe recruitment procedures before new staff enter the workforce. See requirement 1. From the staff records we saw it was evident that the service had not adhered to good practice guidance with respect to staff recruitment practices. The service use a recruitment checklist to monitor the progress of completion of recruitment checks. There was frequently no start date given or evidence that the manager or acting manager had confirmed that they were satisfied that sufficient evidence had been obtained to confirm that all safe recruitment processes had been complete. All the files we looked at indicated that the Protecting Vulnerable Groups (PVG) Scheme Membership had been obtained or checked, however after checking start Highland Care Agency Ltd, page 21 of 33

dates we found some staff had started work prior to this information having been received by the agency. We clarified with the service that we would expect scheme membership updates to have been completed and received before staff commenced employment when they already had a PVG Scheme Membership. Recruitment files indicated that two references were obtained. However only one of the seven recruitment files had evidence that appropriate references had been obtained. We would expect that one reference was from the applicants current or last employer. Reasons for accepting an alternative reference were not seen and there was no evidence of following up gaps in career histories. The NMC checks did not include looking to see if there were any conditions on the nurses' registration. This may restrict the areas they are able to work in. We found that one nurse who was currently working for the service had such conditions. This should have been identified at recruitment and on the subsequent check that was carried to ensure that they had re-registered with the NMC. The management team stated that they would ensure all staff involved in recruitment were made fully aware of safe recruitment practices and there would be improved monitoring of this to ensure the requirement was met. Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider must ensure that staff have been recruited safely and in line with Scottish Social Services Council (SSSC) Codes of practice. In order to achieve this the service must ensure that recruitment files evidence that safe recruitment practices have been completed. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 9 (1) which is a requirement about fitness of employees. See also: Safer Recruitment Through Better Recruitment - Scottish Executive 2007 and SSSC Codes of Practice for Social Service Workers and Employers 2011. In making this requirement the following National Care Standards, Nurse Agencies, have been taken into account: Standard 4 Management and staffing arrangements. Timescale: Immediately for new employees. Inspection report continued Highland Care Agency Ltd, page 22 of 33

The provider must review the recruitment files of all nurses who are currently working for the service and ensure all appropriate checks and records are completed by 14 May 2015. Highland Care Agency Ltd, page 23 of 33

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths From the evidence we found we concluded that the service continued to perform to an adequate level in the areas covered by this statement. The service's recruitment procedures check that staff have the appropriate training and experience to work as an agency nurse. The service ensures all nurses maintain their registration with their professional body, the NMC. The service seek feedback from clients so that it is able to monitor staff performance and give additional support when needed. In their self assessment the service recognised that some of the clients and potential clients were seeking nurses with specialist skills and therefore they planned to recruit more nurses with these skills and to arrange training for those staff interested in developing their skills. This included tracheostomy care and administration of enteral feeds. Areas for improvement As reported on under quality statement 3.2, although the service checked to see that staff maintained their registration with the NMC they did not check to see if the nurses had any conditions on their registration which may restrict the areas they are able to work in. The management team are now fully aware of this and will ensure that their checks now include this. As many of the care homes that the service supplies nurses to have a high level of residents who are living with dementia, we would expect the staff to have a sound knowledge and awareness of this condition. The service confirmed that two sessions of dementia training had been carried out by an outside organisation. At the last inspection we directed the management team to the Promoting Excellence Framework which many of their clients are using for staff training. This is a framework for all health and social care staff working with people with dementia, their families and carers. The service had not yet started using this resource but agreed to looking at how they could include this in staff induction and ongoing training. Highland Care Agency Ltd, page 24 of 33

The service should continue to develop the methods it uses to obtain feedback to evidence that it continues to monitor staff practice. The service should improve its record keeping with regard to complaints, incidents and staff files. See requirements made under quality statement 1.1 quality of care, 3.2 quality of staffing and 4.4 quality of management and leadership. We will follow up progress of these areas for development at the next inspection visit. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued Highland Care Agency Ltd, page 25 of 33

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths From the evidence we found we concluded that the service was performing to an adequate level in the areas covered by this statement. The service's recruitment process and induction procedure informs staff of the standards of practice that the service expects of them. During these processes staff are directed to the Nursing and Midwifery Council's and the Scottish Social Services Council's guidance and codes of practice. This reminds staff of their professional accountability. Minutes of staff meetings indicated that staff were kept informed of changes and development of the service and the importance of their contribution to its success. Progress was seen celebrated. The service stated in its self assessment that in developing how they met this statement they planned to develop more open communication by networking with other business organisations. Areas for improvement Some of the agency staff had regularly worked for the service for a significant period of time however a system of formal supervision was not in place. Formal supervision helps to make sure that staff have the support they need and the chance to discuss any problems or guidance they might need. This can also support staff to evidence their continued post registration training and development. We recommended that staff receive regular formal supervision appropriate to their development needs. See recommendation 1. Grade awarded for this statement: 3 - Adequate Highland Care Agency Ltd, page 26 of 33

Recommendations Number of requirements: 0 Number of recommendations: 1 Recommendations 1. It is recommended that all staff receive regular formal supervision that reviews the individual staff member's training needs, identifies any support needed and agrees objectives for them to achieve. This takes account of National Care Standards, Nurse Agencies, Standard 4 Management and staffing arrangements. Highland Care Agency Ltd, page 27 of 33

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 From our inspection findings we concluded that the service was performing to an adequate level in the areas covered by this statement. The service should work toward improving this grade. Highland Care Agency Ltd provides written information about the services that it provides. It uses a variety of methods to monitor the quality of service that it provides. This includes having telephone contact and face to face meetings with its clients, as well as using questionnaires and client feedback forms. The management team were seen to take action in response to our findings at this inspection. Areas for improvement At the previous inspection when we looked at the complaints log and incident records we found some events that should have been reported to us. We made a requirement that the service should ensure that the Care Inspectorate is notified of matters listed in the document 'Guidance on notification reporting'. The service told us in their action plan that senior staff were to be made aware of this guidance. We had received a number of notifications from the service since the last inspection however these were not made within the required timescale. Further incidents that we should have been notified about were identified from reviewing the complaints records. This requirement remains. See requirement 1. The four requirements we made at the last inspection were not fully met. Our findings reported under quality statements 0.1, 1.1 and 3.2 indicated that some of the service's quality assurance systems were not consistently or effectively used. We were made aware that there had been periods of time that a temporary manager had been covering the manager's absence. This was likely to have contributed to the lack of oversight of recruitment and following up of concerns raised. The management team had also been involved in setting up a care at home service. The management team gave their commitment to ensuring that the necessary action was taken to meet the requirements, recommendations and areas for improvement detailed in this report. Highland Care Agency Ltd, page 28 of 33

Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider must ensure that the Care Inspectorate is notified of matters listed in the document 'Guidance on notification reporting'. In order to achieve this, senior staff should be familiar with this notification guidance. This is in order to comply with The Public Services Reform (Scotland) Act 2010 and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This also takes into account National Care Standards, Nurse agencies, Standard 4 Management and staffing arrangements. Timescale: immediately on receipt of this report and on going. Inspection report continued Highland Care Agency Ltd, page 29 of 33

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 No 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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Highland Care Agency Ltd, page 30 of 33

5 Summary of grades Quality of Information - 3 - Adequate Statement 1 Statement 2 3 - Adequate 3 - Adequate Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 3 - Adequate 3 - Adequate Quality of Staffing - 2 - Weak Statement 2 Statement 3 2 - Weak 3 - Adequate Quality of Management and Leadership - 3 - Adequate Statement 3 Statement 4 3 - Adequate 3 - Adequate 6 Inspection and grading history Date Type Gradings 16 May 2014 Announced (Short Notice) Information Care and support Staffing Management and Leadership 3 - Adequate 3 - Adequate 3 - Adequate 3 - Adequate 29 Oct 2012 Announced (Short Notice) Information Care and support Staffing Management and Leadership 4 - Good 4 - Good 4 - Good 5 - Very Good 9 Sep 2011 Announced (Short Notice) Information Care and support Staffing Management and Leadership 4 - Good 4 - Good 4 - Good 4 - Good Highland Care Agency Ltd, page 31 of 33

All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Highland Care Agency Ltd, page 32 of 33

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 0345 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 0345 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0345 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Highland Care Agency Ltd, page 33 of 33