Glasgow Area 1 Housing Support Service

Glasgow Area 1 Housing Support Service Community Integrated Care 2000 Academy Park Gower Street Glasgow G51 1PR Telephone: 0141 419 9401 Type of inspection: Unannounced Inspection completed on: 20 December 2016 Service provided by: Community Integrated Care Service provider number: SP2003002599 Care service number: CS2004072162

About the service Glasgow Area 1 is an integrated service for Care at Home and Housing with Support provided by Community Integrated Care, a not-for-profit UK support provider. The Service is provided for adults with a learning disability. Some of the service users also have a physical or sensory impairment. The service provides care and support to 33 people either individually or in small groups of up to four people located across 11 houses in Glasgow and one in Milton of Campsie. The services are supported 24 hours a day with a staff member providing either waking night-time or sleep-over support. The rented accommodation is provided by local housing associations. Each tenant has an individual tenancy agreement. The properties have been adapted to meet the needs of the individuals who live there. The service aims to be tailored to the individual service user's need. The key objective of Community Integrated Care is "putting individuals first". What people told us Feedback from carers was positive about the care and support provided and the difference it had made to their relative: "Having his own house has made a big difference. He's happy therefore I'm happy." "Staff are really good - I can't fault them." "It's made a tremendous difference. I could never see her going into a restaurant, sitting down and having a cup of coffee before." "They help her to make choices to the best of her ability. They make sure that everything in her room is suited to her." "They're very very good at helping her to stay well. She had someone in helping with her diet and her weight improved/went down. They took her to the park for exercise." "We're so confident to leave him there. He gets individual attention. He's like a different person - he always looks happy." "If he gets any hassle when he's outside they help him." "She's a lot more content and happy." "Overall, as a relative/carer we are happy with the quality of care and support given to our loved one." "We don't get to visit a lot but we do phone. He's so well looked after all the time. He's up walking about now." "They find places that are suitable. If he doesn't like things they don't take him back there." "The staff who work with him have done so for a while and they know his needs. They will know when he is unwell as he can't always say." "My son is still enjoying living in his new place with his support staff. I still have great communication with staff." "I want (relative) to do more trips. More music, swimming (if possible)." "There's plenty of staff always on duty and they check on her frequently." "There have been moments when staff have left but stable at the time being." "The manager (service leader) is very approachable - quite new but very good and keeps in contact with me." "Some staff have left recently so I'll be keeping an eye on them." "I don't think we've been informed of the changes to management. I don't know the manager." page 2 of 13

Self assessment The Care Inspectorate received a completed self-assessment from the provider. The provider identified what they did well and what areas had been identified for improvement and showed how the service intended to do this. However the self-assessment lacked detail of how the different practices, policies and procedures had helped to improve outcomes for people. We continue to reiterate that the focus of the self-assessment needs to be on service related outcomes. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 3 - Adequate 3 - Adequate Quality of care and support Findings from the inspection We found staff to be very caring and motivated to provide good care that improved outcomes. We saw that independence and people's rights were promoted in some services. For example, a person was encouraged to manage their own finances, another to check in their own medication and write their own care notes. Enabling access to advocacy services was another example of good practice. The quality of information in care plans varied considerably. However the one page profiles we sampled contained good information that gave the reader a sense of the person and what was important to them. There were some detailed protocols drawn up by health professionals including eating and drinking, epilepsy and stress and distress. The provider was currently reviewing the quality of information in care plans. Input from the Quality and Excellence Partner included the introduction of new outcomes based plans. The manager had attended training for trainers to assist with coaching and mentoring staff in the changeover to the new plans. This work was in the very early stages of implementation and so we were unable to assess its impact. We had concerns about the lack of guidance in care plans in some important areas. These included: - eating and drinking plans we sampled did not specify which foods should inform meal planning that was aimed at minimising the use of medication in bowel management; - a person had an implant to monitor their heart rate. The care plan lacked detail including what staff should look out for and what to do if there were any concerns; - a person with phenylketonuria did not have a treatment plan that was informed by health specialists; - a person with an acquired brain injury did not have a detailed care plan that included reference to rehabilitation. page 3 of 13

The manager needs to now ensure that care plans reflect good practice guidance in order to meet people's specific needs. (See Requirement 1) The service had good links with local health teams. We saw several examples of good partnership working to ensure that people were supported to keep as well as possible. Carers we contacted confirmed that staff responded promptly to any health concerns. We saw good outcomes as a result, such as less frequent visits from health professionals and weight loss. However we found a lack of staff training and knowledge in some specific medical conditions. We have considered this further in the section on quality of staffing below. Hospital passports contained a range of useful information. We noted good practice in one house - an emergency pack with important information was available for each person should they need to be admitted to hospital at short notice. We were concerned about the mix of people living in one house we visited. We concluded that a person's complex needs were having a negative effect on their housemate who displayed behaviours consistent with low mood. Suitable measures should be put in place to reduce the associated risks. In another house we visited we considered that the behaviour of one person during the night had the potential to affect the sleep pattern of others living there. To determine if there is an associated impact on nearby housemates we have asked the manager to complete an appropriate assessment. Some staff had received training in 'Planning Live', an initiative where the staff rota is compiled according to people's budgets and preferred activities. Where this person centred approach had been implemented people had enjoyed a varied programme of activities linked to identified interests. We heard of some good outcomes as a result such as weight loss through regular walking and relaxed mood through swimming activities. However, for some people we felt that there needed to be a more structured programme of activities along with an assessment of the benefits of the activity which would help to establish the meaningfulness of the activity. We have repeated the recommendation we made about this at the last inspection. (See Recommendation 1) page 4 of 13

Requirements Number of requirements: 1 1. People supported by the service must have personal support plans which incorporate full and current details of their relevant individual health and welfare needs and of how these are to be met by the service. In order to achieve this, the provider must ensure that: (i) Assessments of the relevant needs of each supported person are consistently undertaken and documented. (ii) Detailed individual care plans are developed and implemented for each person, in consultation with the service user and their personal and professional representatives as appropriate, in respect of any relevant identified needs. (iii) Personal plans are regularly reviewed with service users, and/or their representatives as appropriate, to evaluate how accurately the plans reflect the needs of service users and how well the service is meeting these needs. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: 4(1)(a) - requirement for the health and welfare of service users. Timescale for implementation: assessment of needs to be completed within six weeks and relevant support plans completed within six months of receipt of the draft report Recommendations Number of recommendations: 1 1. The manager should ensure that evaluations of activities provide enough detail to make them meaningful and useful when planning future activities. National Care Standards for Care at Home, Standard 4: Management and staffing Grade: 3 - adequate Quality of staffing Findings from the inspection Carers we contacted were happy with the staff supporting their relative. People who use the service were encouraged to be involved in the recruitment of new staff at a level that suited them and their views were taken into consideration when deciding the successful candidates. A training needs analysis had been carried out and a training plan put in place. page 5 of 13

The service was now on track to ensure that all mandatory training was up to date. We noted that adult support and protection (ASP) training was part of induction for new staff. However a new support worker we spoke to had a poor understanding of the issues around adult protection which showed us a need to assess staff learning and understanding following training. (See Recommendation 1) We found a lack of knowledge of ASP issues and the Keys to Life, the Scottish Government strategy for learning disability, by many of the staff we spoke to, including senior staff. There were plans for existing staff to complete ASP training in the coming months but meanwhile they need to be confident about protection issues and their role should they suspect a person they support is at risk of harm. (See Recommendation 2) Staff had received some training specific to the needs of the people they were supporting such as gastrostomy feeding, dysphagia (swallowing difficulties), catheter care, autism and epilepsy but we found a serious need for specialist training in some areas such as learning disability, acquired brain injury, bipolar disorder, nutrition and communication. Staff had not received infection control training, particularly relevant in services where they were carrying out a high level of personal care. Also assessment of staff competencies in administering medication were overdue. (See Requirement 1) We found that a new support worker with no previous care experience was working in a service for people with very complex disabilities with little more than basic training. We questioned the matching process of staff skills to service user needs during the recruitment process and discussed this with the manager. We identified that, with the changeover to new outcome based support plans, staff would benefit from training in their whole approach to care planning and identifying need so that they understand their role in meeting that need. We noted that a service leader had completed training to train support staff in positive behaviour support and that there were plans for all staff to be trained in MAPA (managing actual and potential aggression). This was a positive development to support people with stress and distress behaviours. Regular group supervisions for service leaders and senior support workers had been held. Recent subjects included adults with incapacity legislation, the Keys to Life, raising concerns, Winterbourne View recommendations and some policies and procedures. They spoke positively of these sessions and described them as a good opportunity to come together and discuss any issues and help to provide consistency across services. We noted that dates for support workers to start similar sessions had been identified. This was a positive development to improve staff knowledge across the service. The provider had introduced a new supervision format, 'You Can!' which gave staff the opportunity to reflect on their practice and set objectives to develop in their role. We found that the quality of recording in supervision notes varied. Because the new format had been introduced very recently we considered that supervisors may need additional support to ensure that it is being used effectively. (See Recommendation 3) We found that not all staff received regular one to one supervision in line with the provider's policy but recognise that there had been many changes at service leader and senior level that may have led to this and so will follow up on frequency of supervision at the next inspection. Team meeting were being held regularly in most services. From the minutes we sampled we saw a range of discussions on staff, service user and organisational issues. page 6 of 13

In some meetings there had been discussions on the Keys to Life, recommendations from the Winterbourne View enquiry and policies such as whistleblowing and medication to develop staff knowledge and understanding. We would encourage this approach along with an ongoing assessment of staff knowledge and competence in these critical areas. Requirements Number of requirements: 1 1. Staff must have the knowledge and skills to ensure they are competent to meet the needs of the service users. In order to achieve this, the provider must ensure that: - a training needs analysis to identify gaps in training which takes account of the aims and objectives of the service and the specific needs of the service users must be undertaken for all staff employed by the service. Particular reference should be made to areas such as learning disability, nutrition, communication and infection control and where appropriate for the assessed needs of service users, areas such as bipolar disorder and acquired brain injury. - a staff development plan to address gaps in training, including timescales and informed by the training needs analysis is developed, documented and implemented - the staff development plan should be forwarded to the Care Inspectorate - full and accurate records of training, including training to meet specific needs, are maintained in a format which permits auditing by management and regulators. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments (SSI) 2011 No.210 Regulation 4 (1) (a) - a requirement to make proper provision for the health, welfare and safety of residents SSI 2011/210. Regulation 15 (a) (b) - Timescale: Six months from receipt of draft report page 7 of 13

Recommendations Number of recommendations: 3 1. The manager should ensure that staff have attained the required level of knowledge and understanding from induction and other training they have attended. National Care Standards for Care at Home, Standard 4: Management and staffing 2. Staff should be given regular opportunities to discuss adult protection issues to refresh their understanding of their role in keeping people safe. National Care Standards for Care at Home, Standard 4: Management and staffing 3. Senior staff who carry out one to one supervision should receive training in the use of the new supervision format to ensure it is used effectively. National Care Standards for Care at Home, Standard 4: Management and staffing Grade: 3 - adequate Quality of management and leadership Findings from the inspection Carers we contacted told us that managers were approachable and that they were satisfied with the level of communication from services. They had opportunities to give their views at regular reviews. The family forum had recently been reinstated to include carers in the development of the service. Since the last inspection there had been significant changes to the management structure in Scotland which meant that a stronger infrastructure of support services had been created locally and issues could be addressed locally. We noted the proactive approach taken by the newly registered manager in addressing issues of poor practice or inappropriate staff conduct resulting in improved outcomes for people who use the service. All staff we met spoke positively of their new management teams and the general feeling was that recent changes were for the better. Senior support workers said they now felt part of the management team and received good support from service leaders. We saw a considerable input into training and development at service leader and senior level but this had not yet filtered down to service level in any significant way. We found a lack of management training for some senior support workers who need to be able to deputise when the service leader is not available. We were informed that service leaders would be starting management training in January 2017. The quality monitoring tool (SQAT) was under review by the provider to link it with the new care standards, the Keys to Life and the SSSC codes of practice. page 8 of 13

This meant there was currently no comprehensive means of auditing all areas of the service, for example the quality of recording, such as in daily progress records, which we found to be poor. We will consider the revised monitoring tool at the next inspection but the provider meanwhile needs to ensure that there is effective auditing of key areas such as care plans, staff training to meet specific needs and meaningful activity. (Requirement 1) We acknowledge that considerable work is being put into developing a professional and effective management team to change the culture of the service and that it will take time for this to have an impact at service level. We also recognise that the service has started to address some of the issues we have raised at this inspection which could potentially have resulted in poor outcomes for people who use the service. Requirements Number of requirements: 1 1. The provider must ensure that quality assurance for the service is carried out effectively. In order to demonstrate this: - routine and regular monitoring of the quality of care and support, staffing and management and leadership must be provided - quality audits relating to the above areas must be accurate, kept up to date and ensure they lead to any necessary action to achieve improvements without unnecessary delay - a service development plan must be made available to show how and when improvements will be made. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments (SSI) 2011 No.210 Regulation 4 (1) (a) - a requirement to make proper provision for the health, welfare and safety of residents Timescale: Three months from receipt of the draft report Recommendations Number of recommendations: 0 Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. page 9 of 13

What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Where advice has been sought from healthcare professionals the manager should ensure that it is incorporated into support plans. National Care Standards for Care at Home, Standard 7: Keeping well - healthcare This recommendation was made on 9 February 2016. Action taken on previous recommendation This recommendation has been met. Where advice has been sought it is included in care plans. Recommendation 2 The manager should ensure that evaluations of activities provide enough detail to make them meaningful and useful when planning future activities. National Care Standards for Care at Home, Standard 4: Management and staffing This recommendation was made on 9 February 2016. Action taken on previous recommendation This recommendation has not been met and is repeated in this report. Recommendation 3 The manager should ensure that actions raised by staff in supervision are actioned and staff are informed of the outcome. National Care Standards for Care at Home, Standard 4: Management and staffing This recommendation was made on 9 February 2016. Action taken on previous recommendation We saw from the supervision records we sampled that this recommendation has been met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 10 of 13

Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 14 Jan 2016 Unannounced Care and support 4 - Good 5 - Very good Management and leadership 4 - Good 28 Nov 2014 Unannounced Care and support 4 - Good 5 - Very good Management and leadership 5 - Very good 21 Jan 2014 Announced (short notice) Care and support 5 - Very good 4 - Good Management and leadership 5 - Very good 7 Jan 2013 Announced (short notice) Care and support 4 - Good 5 - Very good Management and leadership 5 - Very good 22 Dec 2011 Unannounced Care and support 5 - Very good 4 - Good Management and leadership 13 Jul 2010 Announced Care and support 4 - Good Management and leadership 5 - Very good 22 Feb 2010 Announced Care and support 5 - Very good page 11 of 13

Date Type Gradings Management and leadership 4 - Good 30 Mar 2009 Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good page 12 of 13

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 13 of 13