Sense Scotland Supported Living Glasgow 1 & Surrounding Area Housing Support Service 43 Middlesex Street Kinning Park Glasgow G41 1EE Telephone: 0141 429 0294 Type of inspection: Unannounced Inspection completed on: 20 February 2018 Service provided by: Sense Scotland Service provider number: SP2003000181 Care service number: CS2004061986
About the service Sense Scotland Supported Living Glasgow 1 & Surrounding Area (formerly known as Sense Scotland - West) provides an integrated housing support and care at home service to adults with sensory impairment and other disabilities. The service is provided to people in their own homes and it is currently covers the Craigton, Clydebank, West End, Southside, Gorbals and Bearsden areas of Glasgow. Support offered to service users varies according to assessed need. Most service users receive 24 hour support. The service leaflet states that, "every service is tailor-made for you and designed with your potential and independence in mind." This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. What people told us People receiving the service appeared happy and at ease in the company of staff. When we spoke with individuals, including family carers, the feedback was generally more positive compared with the last inspection. Comments included, "Like living here because I have friends" "They struggle with staff turnover and retention, but they do pull out the stops" "Sense have tried to have core staff... high praise for the locality manager" "Do our own spot checks on staff due to previous issues but no issues for a while" Some relatives continued to make comment about staffing difficulties and use of agency staff. Self assessment The service did not require to submit a self-assessment as part of this inspection process. 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 People should expect to be involved in shaping the care and support they receive. This is important as it ensures the individual's needs, preferences and interests are listened to. Relatives and external agencies gave us various examples of the service providing positive outcomes for people through meaningful involvement. For instance, one relative noted that a weekend rota was changed "so that staff now work the whole day to suit her". page 2 of 12
We shadowed staff and could see that they were person centred in their approach creating a warm and friendly atmosphere which the individual responded positively to. However, we also found that maintaining core teams of staff remained a difficulty for some supported individuals. Concerns continued to be raised by some people regarding the need for stable staffing to give consistency of practice and build trusting relationships. This is an issue as stable staff teams ensure that people receive continuity of care from staff who work well together. We gained the impression that managers were working hard to manage these situations better, for instance, by using regular agency staff who had developed a good working relationship with the person. It is important that services work closely with other interested parties, including health services, so that people's health and social care needs are adequately supported by multi-disciplinary involvement. We found that staff teams worked well with key support agencies, such as learning disability nurses and psychologist, following agreed action plans. For instance, for one person this was leading to greater involvement in the community and environmental adaptions to improve his mood. Support plans should give clear direction to ensure that each person's care and support is delivered in a way that is right for them. In keeping with comments made at the last inspection, we were still not confident that existing care plans contributed to consistent support practices and informed all aspects of the person's care and support. For instance, it was not always clear how up to date support plans were. This could lead to current need or wishes not being consistently met. We were also not able to verify that everyone was receiving regular reviews of their support (See Recommendation 1). Managers have assured us that the recent recruitment of additional supervisors and imminent changes to the management structure would speed up the planned introduction and quality assurance of new support plans. Appropriate staff support and performance systems were only at the point of introduction at the time of inspection. This meant that the service was not yet in a position to promote sustained confidence in all aspects of staff practice. Overall, feedback from people indicated that the service was moving in the right direction and managers were able to tell us about their change strategy to address the issues highlighted in this report. Nevertheless, as many of the issues raised previously showed limited improvement we were not yet able to confirm sustained progress, as reflected in our evaluation of this theme. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Care plans should provide clear guidance to staff about what outcomes people want to achieve and how they can be best supported to achieve them. Consequently: - In order to support staff to maintain clear care plan records management should regularly be auditing Care Plans. - Care plan reviews should involve all relevant parties which should be evidenced in the records. - Support plans should be signed and dated with out of date plans being archived to ensure that staff are following the latest advice. page 3 of 12
National Care Standards (NCS) 3 Care at Home - Your Personal Plan, NCS 4 Care at Home - Management and and NCS 11 Care at Home - Expressing Your Views Grade: 3 - adequate Quality of staffing Findings from the inspection Many relatives we spoke with had nothing but praise for the core teams who supported their relative, describing staff as caring and friendly. This testimony reflected our observations of staff who we met during the inspection. This was reassuring as people should feel confident that staff are meeting particular needs and wishes in a person centred way. We saw several examples of very positive and supportive interactions when staff were supporting people. Care and support is more likely to be consistent and stable when staff feel valued and motivated. We could see that morale was improving for some staff, but this was not everyone's view. We found mixed views from staff regarding the accessibility and approachability of managers. Not everyone described a team approach or felt listened to and energised by management and leadership. This feedback should lead to managers' redoubling their efforts to create an open culture where staff feel valued, are confident in the competency of colleagues and feel empowered to innovate (See Recommendation 1). Families and people receiving care should have the confidence that staff are receiving regular appraisal of their work performance and opportunity to reflect on their practice. This ensures professional support and accountability which promotes people's wellbeing and protection from harm. However, we found slow progress on the development of a staff culture that guaranteed support and accountability. Some staff practice as described to us and also noted through misconduct investigations highlighted the need for managers to continue to promote a better team understanding of safe care and adult support and protection. Importantly, we found that staff were not yet having an opportunity to regularly reflect on how training and best practice guidance was impacting on actual practice. Staff were not receiving regular supervision or direct observation and feedback on their work so that people could always be assured of consistent staff conduct and practice. Managers acknowledged progress in this area has been slow and understood the need to focus on developing the staff culture. (See Requirement 1 and Recommendation 2). We were not able to evidence that all staff had received appropriate training. Training records were not up to date and so it was difficult to track a clear structure of training and the identification of priorities (See Requirement 1 and Recommendation 3). Addressing this would give people confidence that staff could always meet the needs of those individuals they supported. It is important that new staff receive a strong grounding through their induction training to ensure continuity of care for the person receiving support. The induction of new staff had improved in terms of more opportunity to shadow and observe longer standing staff. However, the quality of the induction training in assessing new staff's competency, values and knowledge of the supported person's needs and wishes was an area for further improvement. page 4 of 12
We have noted senior managers' expectations that the recent increase of supervisory staff and a new structure of management should make a positive impact on planned actions to address the issues highlighted under this and other quality themes. Our recommendations and requirement are made with a view to supporting this ongoing work and speeding up the pace of change. Requirements Number of requirements: 1 1. In order to meet the assessed needs of people who use the service, the provider must ensure that staff receive the support required to do their job safely. In order to achieve this the provider must ensure: - Staff have the opportunity to reflect individually and in teams on their work practice and take account of best practice guidance. - Staff supervision must be performed in accordance with the provider's policy and procedures in order to ensure staff are supported to discuss and develop their roles. - Staff have the appropriate training and skill to meet the needs of the individuals they support. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210).Regulation 15(a)(b) (i)(ii) - Timescale: To be fully implemented by 30 April 2018 and ongoing thereafter. Recommendations Number of recommendations: 3 1. Managers should ensure that staff adopt a consistently professorial approach to their role. In order to support this managers should work with staff teams to address any tensions and low morale. NCS 4 Care at Home - Management and 2. People who use the service should be supported in a consistent manner by staff. In order to support this management should ensure that they develop systems for assessing staff competency such as introducing observed practice as a part of their supervision. NCS 4 Care at Home - Management and 3. Management need to develop systems for ensuring staff have understood the training they have received and use these systems to develop their practice. In order to achieve this the management should consider adopting reflective supervision practices to test whether staff have adopted practices discussed in training. NCS 4 Care at Home - Management and Grade: 3 - adequate page 5 of 12
Quality of management and leadership Findings from the inspection We could see that the managers involved with the service were committed to maintaining the best standard of service possible for people living there. However, the findings under all three quality themes under inspection highlighted the need for continued improvement to leadership and action to address the development of stable teams. Full implementation of culture changes has been affected by staffing shortages, management diverted to frontline tasks and responding to internal and external investigations from increased scrutiny of the service. Managers reported that difficulties in management capacity had struggled with not having a full supervisory team. These circumstances had lead to "fire fighting" and reactive management which had affected their ability to carry forward service improvement plans. Good communication with family carers is important to promote confidence in service delivery and so that managers use this feedback as learning to improve the service to people. When we spoke with relatives they could tell us about the positive effect that changes in the management structure was having on improving the service, for instance, by addressing their concerns and encouraging joint working. The locality managers came in for special praise as people could see their dedication and commitment to ensuring people lived the life that was right for them. Our findings also suggested that if the manager was to become more accessible to people and families and supportive of locality managers this would improve people's outcomes by helping foster team dynamics and a safe to challenge culture. Further learning and development opportunities and practice supervision for the manager may assist in this area (See Recommendation 1). Services need to inform regulatory bodies of notifiable incidents so that people can be assured of and benefit from transparent reporting that reflects quality assurance and continuous improvement. The service had improved overall in making the required notifications to the Care Inspectorate, but we noticed that a few notifiable incidents had been missed. The managers agreed to give this matter renewed attention. Although slow progress, this inspection found some cause for optimism. We were pleased to note various developments which had been initiated to focus on continuous improvement. For instance, the introduction of management's presence at weekend and spot checking of night staff meant improvements in quality assurance. Consequently, we could see that management and staff had reflected on and were actively reviewing practice, policies and procedures to improve outcomes for the people who used the service. The expectation was that improved staffing and supervisor levels would also assist management and leadership. Overall, with the increased resources provided by the organisation the service's capacity to improve must now become a reality with sustained improvements. This will be examined at future inspections. Requirements Number of requirements: 0 page 6 of 12
Recommendations Number of recommendations: 1 1. The provider should ensure that the management team are supported to develop in their role. In order to promote this the provider should offer the manager training and reflective practice opportunities on how to develop a positive service culture and team dynamic. NCS 4 - Management and 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. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Managers should ensure that staff take the time to learn from incidents to reduce medication errors and provide better monitoring of medication procedures so that people are always guaranteed that they will receive their medication as prescribed. National Care Standards (NCS) 3 Care at Home - Your Personal Plan and NCS 8 Care at Home - Keeping Well - Medication This recommendation was now met. page 7 of 12
Recommendation 2 Managers should ensure that care plans, review minutes and risk assessments show that everyone has been involved and agree with what is written. NCS 11 Care at Home - Expressing Your Views This recommendation was not yet met. We refer to support planning in this report and have reworded and restated associated recommendations. Recommendation 3 The manager should review support planning paperwork to ensure that staff can easily locate specific pieces of information about the people they are supporting. National Care Standards (NCS) 4 Care at Home - Management and This recommendation was not yet met. We refer to support planning in this report and have reworded and restated associated recommendations.. Recommendation 4 Managers should ensure staff receive regular supervision and introduce systems that assessed staff competency, for example direct observational support and spot checking, so that people could always be assured of consistent and professional staff conduct and practice. NCS 4 Care at Home - Management and This recommendation was not yet met. We make further comment about this in the report leading to reworded recommendations and a requirement. Recommendation 5 Managers should undertake work with staff teams to address any tensions and low morale and maintain a well motivated and professional workforce. NCS 4 Care at Home - Management and This recommendation was not yet met. This remains an area for attention. page 8 of 12
Recommendation 6 Managers should review staff changes and deployment to ensure that people who use the service receive consistent support from a regular team of experienced staff. NCS 4 Care at Home - Management and This recommendation was partially met. Greater effort was made to provide regular teams of staff and give newer staff a better grounding through induction. However, staffing difficulties still led to unplanned changes which people continued to comment on. Recommendation 7 Managers should ensure that staff have been assessed as having the appropriate competencies, training and skill, particularly in relation to complex needs, to meet the needs of the individuals they support. NCS 4 Care at Home - Management and This remained a work in progress and we make further comment within the report. Recommendation 8 Sense Scotland should evaluate the quality of communication between the service and the families of the people they support and identify means of improving this. NCS 3, Care at Home - Your personal plan and NCS 3, Care at Home - 11.4: Expressing your views Based on the feedback of locality managers and relatives spoken with, we have judged this recommendation to be met. Recommendation 9 The manager should ensure that the Care Inspectorate is informed about all notifiable events. NCS 4 Care at Home - Management and The service had made greater efforts to inform us of notifiable incidents, but we pointed out to managers that this needs constant attention as a few incidents had been missed. page 9 of 12
Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 11 May 2017 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 27 Jun 2016 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 3 - Adequate 25 Jan 2016 Unannounced Care and support Management and leadership 14 Jul 2015 Unannounced Care and support 3 - Adequate 3 - Adequate Management and leadership 4 - Good 7 Jul 2014 Unannounced Care and support 4 - Good 4 - Good Management and leadership 4 - Good page 10 of 12
Date Type Gradings 28 Jun 2013 Announced (short notice) Care and support 4 - Good 4 - Good Management and leadership 3 - Adequate 27 Sep 2012 Announced (short notice) Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 27 Jun 2011 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 4 - Good 8 Oct 2010 Announced Care and support 5 - Very good Management and leadership 5 - Very good 21 Jul 2009 Announced Care and support 4 - Good 4 - Good Management and leadership 4 - Good 12 May 2008 Announced Care and support 4 - Good 4 - Good Management and leadership 4 - Good page 11 of 12
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 12 of 12