Living Ambitions Limited, Glasgow North and West Housing Support Service Templeton Business Centre Block 1, Unit B3 62 Templeton Street Glasgow G40 1DA Telephone: 0141 556 3294 Type of inspection: Unannounced Inspection completed on: 9 October 2017 Service provided by: Living Ambitions Ltd Service provider number: SP2003000276 Care service number: CS2004073768
About the service Living Ambitions Limited, Glasgow North and West is a combined service registered to provide housing support and care at home to people with learning disabilities and physical disabilities. Living Ambitions is part of the Lifeways Group. The service assists people with a range of needs to live independently and safely in their own home - supporting them to access the social, leisure, education, training, voluntary work and employment opportunities and activities open to all members of the community. The service comprises senior service managers, service managers, senior support workers and support workers. A new senior service manager who is now the registered manager was recruited during our inspection visit. At the time of this inspection the service was supporting 46 individuals. What people told us The views of people who experienced the service were generally positive. They said that they liked the staff who supported them and felt that staff listened to their views and helped them to take part in activities in the community. Some people we met had limited verbal communication but we could see that staff were sensitive to their needs and wishes. One relative told us that they had not seen their relative's support plan and are not consulted by the service to ask if they are happy with the service. They had concerns about the continuity of staff and staff training and skills to meet the needs of the people who experience the service. The management structure and communication has also been an issue. Comments from people we spoke to included: "I like going to the club and the Karaoke, we go with my friend and staff" "I am going to have a party for my birthday and maybe have a few drinks" "I get on well with my friends who live here and the staff are always around" Self assessment We did not ask the service to complete a self-assessment this year. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership page 2 of 9
Quality of care and support Findings from the inspection We could see that people were being supported by staff in a respectful and person centred way. The majority of staff knew residents' likes and preferences told us how they supported people. Some staff told us that they would like further training for supporting people with complex needs. The management and staff were developing more meaningful activity planners which would enable people to get out and take part in activities, in social groups and individual outings. Unannounced spot checks on the quality of people's support continued on a monthly basis and quality visit reports were completed with action plans. This helped improve staff practice and offered staff more support. Support plans had some good person information that was generally well written in an easy read format. People who used the service told us that staff had gone through their support plan with them and sought their views on ways to improve their support. We sampled several support plans and found some had not been updated for several months which meant some information was out of date and in need of review. Staff told us that there was too much paperwork and they had difficulty in keeping support plans up to date. Generally we found the support plans were too large and repetitive. Some important information, for example medical advice from GP visits, was held at the back of some plans and not readily accessible. We noted that staff were recording information and were unsure for what purpose, Some staff we spoke with said that they had never received any training in writing support plans and that training would improve the quality and content of the support plans. See Recommendation 1. The Regional manager told us that new simplified support plans were soon to be implemented that would reduce the volume of paperwork and duplication. We looked at medication records and spoke to staff about medication practice and procedures. We found that there recently had been issues with medication procedures. Weekly and monthly audits were in place to improve practice. Staff said that they had their practice assessed on a yearly basis and had recent medication refresher training. We noted that the use of 'as required' medication to manage stress and distress was appropriately used and regularly reviewed by medical and nursing staff. Requirements Number of requirements: 0 page 3 of 9
Recommendations Number of recommendations: 1 1. Support staff should receive training in support planning and the use of health assessment tools to ensure people's needs are being met. National Care Standards, Care at home, Standard 4: Management and staffing. Grade: 4 - good Quality of staffing Findings from the inspection We reviewed the files of newly recruited staff and could see that safer recruitment practices were used to ensure that people are not employed who are unsuitable to work with vulnerable adults. The manager told us that they were trying to involve more people who experienced the service in recruitment and saw some questionnaires that people had completed. Newly recruited staff have a two-week induction and shadowing experience. One new staff member we spoke with felt the induction was helpful and helped build their confidence when supporting people. A service in the same organisation is currently the subject of a large scale adult support and protection inquiry arising from a serious incident. Very few staff we spoke with during the inspection were aware of the inquiry and the reasons for it. We viewed this as a missed opportunity by the organisation to use this as a learning experience to improve staff practice. Some said that staff meetings were held infrequently and mostly consisted of a series of management directives with few opportunities for discussion for development that encouraged staff to look at best practice. Whilst there have been some training opportunities, there is no training needs analysis which would help produce a coherent training plan relevant to the role and remit of staff, taking account of the needs of people who staff support. This should include autism and promoting positive behaviour. See Recommendation 1. Training and induction for junior managers was limited and could be improved, for example staff had not received supervision training. We spoke to senior managers regarding this who said that they were in the process of developing a training resource for new managers. See Recommendation 2. Requirements Number of requirements: 0 page 4 of 9
Recommendations Number of recommendations: 2 1. The manager should develop a coherent staff training and development plan which include autism and promoting positive behaviour training to meet the needs of people who use the service. National Care Standards, Care at home, Standard 4: Management and staffing. 2. Junior managers and supervisors should receive training and induction relative to their role including supervision training. This will equip them to offer staff a better level of support. National Care Standards, Care at home, Standard 4: Management and staffing. Grade: 4 - good Quality of management and leadership Findings from the inspection The service had recently recruited two new senior managers and three service managers to improve the supervision and support of people who experienced the service and staff. Staff gave a mixed reaction to the support they received from management. Some staff told us that they had met the new registered manager, felt better supported and that things were improving gradually. The management team was working hard to further develop the communication and quality assurance systems to improve the quality of the service. Audits were taking place on a weekly and monthly basis and we could see that actions were being taken when issues arose, for example medication errors had reduced. Management were aware that seeking the views of people who used the service, their relatives and staff could improve and as a result had made the office more accessible and had commenced monthly service user and relative meetings and had held recent fundraising events. Some staff felt there was a lack of continuity in management and they were not included in any decision making which had a negative outcome for people who experienced the service. For example a persons individual needs and choices were not considered when blanket directives were given by management. Some staff told us that they did not really feel part of the organisation due to several changes in provider and lack of visible management. They felt there was a culture of blame and they were fearful of making mistakes. The service needs to review the arrangements for staff who are on call and require to find staff to cover staff absence. Currently they do not have access to information on individual people's needs and are therefore unable to match the skills required to provide the appropriate support. The service's IT systems should be developed to make this information available. At the time of the inspection the provider was introducing new financial procedures for managing people's money, however staff were feeling anxious about this as they had no training in the new procedures. page 5 of 9
The financial records and held cash arrangements were mostly accountable and regularly audited. We found that some people had large amounts of money in their accounts. The senior manager told us that some people had not been charged correctly for the service and some of this money will be spent on outstanding charges. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations There are no outstanding recommendations. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 6 of 9
Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 9 Nov 2016 Unannounced Care and support Management and leadership 30 Nov 2015 Announced (short notice) Care and support Management and leadership 3 Nov 2014 Announced (short notice) Care and support 3 - Adequate Management and leadership 3 - Adequate 19 Nov 2013 Announced (short notice) Care and support Management and leadership 7 Dec 2012 Announced (short notice) Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 20 Oct 2010 Announced Care and support 5 - Very good Management and leadership page 7 of 9
Date Type Gradings 18 Mar 2010 Announced Care and support 6 - Excellent 5 - Very good Management and leadership 26 Feb 2009 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good page 8 of 9
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 9 of 9