Maryhill Supported Accommodation Care Home Service Adults Flat 1a & 1b 151 Wyndford Road Maryhill Glasgow G20 8DZ Telephone:

Maryhill Supported Accommodation Care Home Service Adults Flat 1a & 1b 151 Wyndford Road Maryhill Glasgow G20 8DZ Telephone: 0141 945 4085 Inspected by: Jacqueline Young Type of inspection: Unannounced Inspection completed on: 21 November 2011

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Scottish Association For Mental Health Service provider number: SP2003000180 Care service number: CS2003000883 Contact details for the inspector who inspected this service: Jacqueline Young Telephone 0141 843 4230 Email enquiries@scswis.com Maryhill Supported Accommodation, page 2 of 26

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 Care and Support 5 Very Good Quality of Environment Quality of Staffing N/A N/A Quality of Management and Leadership 4 Good What the service does well The service is very good at supporting people to become more confident in day-today life, which in turn helps towards increased independence and better mental health. Service users speak highly of the support they receive from the service. The manager and staff team are strongly motivated to deliver the best possible service to people. What the service could do better Reviews of risk assessments need to be more clearly documented. The staffing establishment needs to also show that staff can participate in other activities relevant to their duties, in addition to providing direct support. Audits on the quality of each person's accommodation need to be more detailed to demonstrate that all rooms/areas are considered. Maryhill Supported Accommodation, page 3 of 26

What the service has done since the last inspection New personal planning paperwork called 'My Outcomes' had been introduced. The aim of this was to demonstrate a more person centred approach to support. The manager continued to work on improving the service to achieve better outcomes for service users. Conclusion The service has many strengths as highlighted in this report. Local management is committed to continuous improvement, and this again reflects another strength of the service. Overall, Maryhill Supported Accommodation provides support that service users view positively. Who did this inspection Jacqueline Young Maryhill Supported Accommodation, page 4 of 26

1 About the service we inspected Social Care and Social Work Improvement Scotland (Care Inspectorate) regulates care services in Scotland. It awards grades for services based on the findings of inspections. These grades, including any that services were previously awarded by the Care Commission, are available on www.scswis.com Maryhill Supported Accommodation is registered as a care home with the Care Inspectorate to provide support to a maximum of 11 adults with mental health problems. The service is managed by SAMH (Scottish Association for Mental Health). Accommodation consists of 10 dispersed flats within the Maryhill area, with the furthest being no more than an eight minute walk from the staff office base. Staffing cover is provided 24 hours a day. At the time of the visit staff started work at 9am and stopped at 11pm, followed by a sleepover shift. Service users were able to contact staff by telephoning the office base or on-call person in between support times if needed. Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (Care Inspectorate), took over the work of the Care Commission, including the registration of care services. This means that from 1 April this service continued its registration under the new body, Care Inspectorate. Below is an extract from the service's aims and objectives: "To provide individualised, holistic and needs-led care packages in partnership with service users and their support networks, promoting hope of recovery. To have a competent, qualified staff team capable of providing a quality service." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - N/A Quality of Staffing - N/A Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Maryhill Supported Accommodation, page 5 of 26

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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Maryhill Supported Accommodation, page 6 of 26

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection. This inspection was carried out by inspector, Jacqueline Young. The inspection visit took place over two days on the 10 and 11 November. Following this visit, we requested further evidence relating to an aspect of the inspection. This allowed us to complete the inspection on the 14 November 2011. During our visit 11 people were receiving support from Maryhill Supported Accommodation. In this inspection we gathered evidence from various sources including the relevant sections of policies, procedures, records and other documents, including: - the self assessment submitted to us by the service - personal planning paperwork and review records - minutes of service user and staff meetings - aims and objectives for the service - staff supervision and appraisal records - audits of the service - observation of staff handover information from sleepover shift - accident/incident reports - questionnaires sent to stakeholders - participation strategy - development plan for the service. Discussions and feedback from various people including: - one to one meetings with three service users - telephone discussions with two service users - meetings with two support workers - the registered manager. Maryhill Supported Accommodation, page 7 of 26

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 report continued 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 Maryhill Supported Accommodation, page 8 of 26

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 self assessment contained good information on strengths and areas for improvement. We discussed the opportunity for self assessments to reflect ongoing updates to information and to focus more on outcomes. We also highlighted the need for future self assessments to more clearly capture the process of how grades are reached by involving stakeholders through relevant participation methods. Taking the views of people using the care service into account During the inspection we met with three service users individually and had telephone discussions with another two service users. Overall, feedback from people was very positive about how they viewed the support received from the service. The following are some examples of comments made from the feedback: "Staff good, no complaints... go to user involvement meetings. I have reviews... if I was unhappy about anything I would go to the manager, although I don't have any, I'm happy with the service." "My keyworker's great, she helps me with my housework. I can speak to the manager anytime if I wanted to, she's been to visit me and has been at reviews." "Staff visit me and help with appointments, and see that I take my medicine... since the new manager staff seem to be doing more activities, like the football and trips away." "I'm happy enough, staff visit when they say they will." "I get help with letters, doctor's appointments and really anything I need help with. I think I would like to move on in about a year, but I will need a lot of help to do that. I'm happy enough at the moment." Maryhill Supported Accommodation, page 9 of 26

Taking carers' views into account Inspection report continued We did not have the opportunity to receive comment from carers during this inspection. However, the service had recently sought the views of carers. For further detail please see Quality Theme 1, Statement 1, within this report. Maryhill Supported Accommodation, page 10 of 26

We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. 3 The inspection Quality Theme 1: Quality of Care and Support Overall grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found this service to have a very good performance in the areas covered by this statement. We concluded this after we: - spoke to and received feedback from people who use the service and staff members - reviewed care plans and other written evidence relating to participation. We saw that the service invited comment from people on the quality of care and support delivered to individuals. This was done by: - regular review meetings that showed involvement from people and other agencies, such as care managers and community mental health nurses/psychiatrists - sending questionnaires to service users, carers and external stakeholders such as health and social work - a keyworker to facilitate overall care and a named staff point of contact - monthly service user meetings - day to day discussions between staff and service users - a concerns and complaints procedure. The above methods gave people an opportunity to influence decisions, and give their view on the quality of the service on an individual and group basis. We saw some very good minutes of service user meetings that showed detailed discussions and action taken in response to decisions. Questionnaires referred to above, were due be analysed and feedback would be given to people. From the sample we looked at, responses indicated mostly grades of 'excellent' and 'very good'. We noted that the format of the questionnaires followed the Quality Themes that we inspect against. This approach is helpful in showing how stakeholders are involved in the self assessment. Maryhill Supported Accommodation, page 11 of 26

We suggested that the service captures this good work in better detail in future self assessments. For instance, by showing updated information and how/when feedback is given to people, with examples of what changes as a result of participation. People we spoke with were able to recall discussions at meetings about grades for the service as part of work on the self assessment. Information on advocacy was made available to people, and an advocacy worker was actively involved with a service user. Staff worked well in building relationships with service users. People we spoke with said that staff listened to them and treated them with respect. Since the last inspection new paperwork had been introduced for personal planning called 'My Outcomes'. The aim of this is to reflect a more person centred approach, with service users agreeing and measuring their desired outcomes with staff. We saw some good written entries, and early indications show that this is moving in the right direction. More recently SAMH Participation Framework (November 2011) had been developed. This included a toolkit to be used at local level, and other aspects such as a participation plan and sharing of ideas were in keeping with good practice. The service would be implementing the strategy to enhance current approaches to participation. Overall, evidence we looked at and feedback from service users reflected very positive views of the service. Areas for improvement Sometimes it can be difficult for people to say what they really think, when the service that they receive care from is asking them for their views. Best practice on service user engagement suggests that an independent person/body is also used when asking service users/representatives for their views on a service (see Care Inspectorate website "Guidance for providers of regulated services: 2011/12 Arrangements for the inspection of regulated services, Appendix Grading Criteria Scale"). We saw some review minutes that had very good action plans. However, not all review minutes contained clear action plans. The manager agreed to monitor this so that each review minute contained actions plans that could be clearly measured and monitored. We would expect risk assessments to show evidence of having been considered at the same time of a review of the personal plan. We would ask that written information confirms that risk assessments are part of the overall review process. (See Recommendation 1). Maryhill Supported Accommodation, page 12 of 26

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Written information should indicate more clearly that risk assessments are included in the review process of a person's support. National Care Standards, Care Homes for People with Mental Health Problems, Standard 6: Support Arrangements, Standard 8: Making Choices and Standard 9: Feeling Safe and Secure. Maryhill Supported Accommodation, page 13 of 26

Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths Inspection report continued We found this service to have a very good performance in the areas covered by this statement. We concluded this after we: - spoke to and received feedback from people who use the service and staff members - observed a staff shift handover of information - reviewed care plans. The overall aim of the service is to help people to be as independent as they can be. The service did this by supporting people with health issues, engagement with support services, education/training/work, self-care, shopping and other domestic areas. The new 'My Outcomes' paperwork described in a person's words what their desired goal was, and this was supported by a description of staff responsibilities towards the person to help to reach 'desired outcomes'. We observed a staff handover of information from the sleepover to the 9am shift. Detailed information was delivered and very good examples of promoting good health were discussed. Staff also highlighted triggers for when an individual may becoming unwell, and strategies in place for the team to support the person. Mental health was a primary support need for people. The service had good links with local mental health agencies and resource centres. Good physical health was considered, and people were encouraged to be registered with GPs and dentists, and visit when needed. The service had arranged for staff from a local health group to meet with service users to explain what activities could be provided by the group. Examples of activities on offer, ranged from physical exercise to relaxation techniques to vocational classes. Service staff were keen to promote this resource to people. We looked at how the service supports people with any needs they have around prescribed medication. At the time of the visit staff support did not include administration or managing medications for any service user. The type of support provided to people involved prompts with medicine, either in person or by telephone. We did discuss that support from staff could change to administering or managing medicines if a person's needs changed. The manager fully acknowledged this and we were told that the medicine policy was being developed to provide staff with guidance and training on this. We could see from the draft medicine policy that advice in developing guidance had been taken from the Care Inspectorate's Professional Adviser for Medicines. Maryhill Supported Accommodation, page 14 of 26

The ongoing aim of the service was to enable service users to maintain and improve their health in order to be as independent as possible. This was reflected in the discussions we had with people during our visit. We were advised that a service user was in the process of planning to move on from the service to more independent living. Areas for improvement As referred to under Quality Theme 1, Statement 1, we have asked that written information confirms that risk assessments are part of the overall review process. (See Recommendation 1 made under Quality Theme 1, Statement 1). At the time of our visit, we noted that two service users did not have a care manager allocated to them. Whilst we fully acknowledge that care manager allocation is not the responsibility of the service, we discussed the need to continue to pursue this on behalf of individuals. The manager advised that this matter had been raised with relevant agencies, and it would continue to be raised. Overall information in care plans for medicine and financial support was good. Although we noted that some of the wording in some of these care plans would benefit from being changed to provide clearer descriptions of staff support. The manager agreed to take this forward. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Maryhill Supported Accommodation, page 15 of 26

Quality Theme 2: Quality of Environment - NOT ASSESSED Maryhill Supported Accommodation, page 16 of 26

Quality Theme 3: Quality of Staffing - NOT ASSESSED Maryhill Supported Accommodation, page 17 of 26

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths We found this service to have a very good performance in the areas covered by this statement. We concluded this after we: - spoke to and received feedback from people who use the service and staff members - reviewed care plans and other written evidence relating to participation. People we spoke with knew who the manager was and felt able to approach her to discuss any matters and concerns. The manager regularly attended service user meetings and three monthly review meetings. In addition the manager routinely worked a sleepover shift. This involvement meant service users had good access to the manager, and in turn provided good opportunities for the manager to get to know individuals. Feedback from staff and service users was very positive about the manager and the support and direction she provided. Service users also made positive comment when asked about the overall quality of staff. Staff continued to include service users when health and safety checks were undertaken on an individual's accommodation. People were also able to get involved and influence aspects of organisational decision making. For example, people could attend the SAMH National User Involvement Group. If service users chose not to attend or weren't able to attend this meeting, minutes were distributed by the service to people. In addition, a SAMH Participation Worker was available to service users and was a link to taking forward both project and organisational service user issues and suggestions. A suggestions/comments box was available to people when visiting the office. Keyworkers were able to pass on comments/issues from service users at team meetings as part of 'resident updates'. The manager would gather information from service users by asking for their views on a staff member. This would then be used as part of staff supervision/appraisal. This approach had scope to develop further into 360 degree appraisal, which is very much in keeping with good practice. Maryhill Supported Accommodation, page 18 of 26

Other strengths for service user involvement are detailed under Quality Theme 1, Statement 1. Areas for improvement Areas for improvement already made under Quality Theme 1, Statement 1, should be read in conjunction with this statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Maryhill Supported Accommodation, page 19 of 26

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 Inspection report continued We found this service to have a good performance in the areas covered by this statement. We concluded this after we: - spoke to and received feedback from people who use the service and staff members - examined minutes of staff and service user meetings and internal quality audit - service development plan and self assessment. Staff had very good opportunities to communicate with each other and express their views on service and organisational matters. This was through established team meetings and supervision sessions. Daily written and verbal handover of information took place when staff changed shift. Through our discussions with the manager it was clear that she was committed to continuous improvement for the service to ensure better outcomes for individuals. Team meetings covered both business and development agendas which captured the needs of the staff team, service user needs and the direction of the project. Staff said they felt supported by local management and that leadership qualities were displayed by the manager. Staff also said there was a good sense of team work, and described positive changes made by the manager since taking up post. For instance, encouraging staff to reflect more on their practice. The provider held the European Foundation for Quality Management (EFQM) award for Commitment to Excellence. Annual quality audits were carried out on the service by another manager working within the organisation. This approach to 'peer' auditing is in keeping with good practice on quality assurance. We were aware of a lot of very good work being carried out to look at improving the quality of the service. For example, service user participation, seeking comment from other agencies on the service's effectiveness, and internal assessment by audit. However, this was not always captured by measuring and evaluating findings through routine and ongoing formal processes. We suggested that some of this could be achieved by expanding the contents of the current service development plan to routinely include dates and to record ongoing updates. If done, this would demonstrate the full impact of the continuous improvement activities undertaken. Maryhill Supported Accommodation, page 20 of 26

Regular liasion meetings took place with other agencies who worked with the service. These included social work, commissioning, health and local resources. The service promoted the work of the Care Inspectorate with service users, and encouraged people to get involved in the inspection process. Areas for improvement Annual staff appraisals had not been as regular for all staff members. However the manager was able to demonstrate that appraisals for all staff were being taken forward. The manager had sent questionnaires out to stakeholders in August of this year. We discussed that feedback on participation methods ought to take place as quickly as possible, showing people that their comments have been listened to and acted upon. During the inspection we advised the manager of the need to submit a variation to the Care Inspectorate, as information on the current staffing schedule had to change. The manager did this during our visit. We did note that less staff were being used than was detailed on the staffing schedule. Although the staffing establishment had one vacancy, we were able to see that staffing hours were able to meet service users weekly direct support hours. Whilst we acknowledge that the provider has tried to recruit for the staff vacancy, the current staff hours available were tight. By this mean we mean that staff were working extra hours to cover the vacancy, and this had potential to impact on staff participating in other activities relevant to their duties. (See Recommendation 1). During our visit we noted an aspect of a person's accommodation that would benefit from some work being carried out. The manager said that checks would be carried out on all 10 flats by management. (See Recommendation 2). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The provider should demonstrate that the staffing establishment adequately meets the needs of service users and provides staff time to participate in other activities relevant to their duties. National Care Standards, Care Homes for People with Mental Health Problems, Standard 5: Management and Staffing Arrangements. Maryhill Supported Accommodation, page 21 of 26

2. An action plan should be submitted to show that management have audited the quality of each person's accommodation. This should form part of regular management monitoring processes. National Care Standards, Care Homes for People with Mental Health Problems, Standard 4: Your Environment and Standard 5: Management and Staffing Arrangements. Maryhill Supported Accommodation, page 22 of 26

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 The provider was reviewing fire systems for the dispersed flats. We were informed that changes for a 'link up' fire system were planned before the end of March 2012. We advised Fire Rescue Services of this, and that domestic fire systems were in place at the time of our visit. 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Maryhill Supported Accommodation, page 23 of 26

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Environment - Not Assessed Quality of Staffing - Not Assessed Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 5 - Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 11 Jan 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 3 Aug 2010 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 18 Jan 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 10 Jun 2009 Announced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Management and Leadership 5 - Very Good Maryhill Supported Accommodation, page 24 of 26

15 Dec 2008 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing Not Assessed Management and Leadership Not Assessed 21 Jul 2008 Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Maryhill Supported Accommodation, page 25 of 26

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 0845 600 9527. This inspection report is published by SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@scswis.com Web: www.scswis.com Maryhill Supported Accommodation, page 26 of 26