The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk Housing Support Service Office 1 Enterprise House Springkerse Business Park

The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk Housing Support Service Office 1 Enterprise House Springkerse Business Park Stirling FK7 7UF Inspected by: Fiona Stewart Type of inspection: Announced (Short Notice) Inspection completed on: 23 October 2012

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 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: The Richmond Fellowship Scotland Limited Service provider number: SP2004006282 Care service number: CS2004061317 Contact details for the inspector who inspected this service: Fiona Stewart Telephone 01786 406363 Email enquiries@careinspectorate.com The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 2 of 22

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 Staffing 6 Excellent Quality of Management and Leadership 5 Very Good What the service does well Staff know people they support thoroughly. They show respect for their right to have their say about their day to day lives and the support they receive. They take a thorough interest in their health and well being and in working with the person supported and with others to identify the best support to meet their current needs. The organisation and the local service promote a learning culture for the work force through good preparation training for work and ongoing support and training thereafter. The service is open to initiatives to inform improved working practices and managers promote continuous improvement through quality assessment and target setting at team and individual level. What the service could do better The service should continue to evidence through quality assessment the impact of current developments on the care and experiences of people they support. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 3 of 22

What the service has done since the last inspection Improvement continues at a steady pace. Inspection report continued Person centred planning which is more outcome focussed is a major development currently underway. Initiatives to improve the health of staff are, in turn, helping them promote healthy lifestyle for people they are supporting in an informed way. Improved induction is aiming to prepare staff better for supporting the individual needs people have. Conclusion Meeting the needs of people supported through listening to what they have to say about the help they receive and who provides it remains central to the service's day to day work. Assessing how well they are achieving this at team and individual staff level continues to identify where further improvements can be made. Who did this inspection Fiona Stewart Lay assessor: Ms Alice Brown The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 4 of 22

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. This service was previously registered with the Care Commission and transferred it's registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate." The Richmond Fellowship Scotland is a charity providing community-based services for people who require support in their lives. The organisation's aims include working in person-centred ways to offer choice, promote inclusion and enable people to live as independently as possible within their own homes and communities. The service in Stirling, Clackmannanshire and Falkirk provides Housing Support and Care at Home Services for people with learning disabilities and mental health problems. People the service supports may be living alone or in shared accommodation. 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 Staffing - Grade 6 - Excellent Quality of Management and Leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 5 of 22

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 0845 600 9527 or visiting one of our offices. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 6 of 22

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 after an inspection that took place on 10 and 11 October 2012. The inspection was carried out by Care Inspectorate inspector, Fiona Stewart and Lay Assessor, Alice Brown, who spoke with a service user and a parent by telephone. The Care Inspectorate inspector returned to the service on 23 October 2012 to provide inspection feedback. As requested, the provider sent us an annual return and a self assessment form. The following activities during the course of the inspection helped us gather information about the work of the service. - We visited accommodation at Torbrex Road, Stirling and Bruce Street, Bannockburn where people the service supports live. - We followed the experiences of some people being supported by looking at their Personal Support and Development Agreements and talking with staff working with them. - We had discussions with the Area Manager and the three Team Managers for the local service. - We made contact with staff key to current initiatives including "Healthy Working Lives, Positive Behaviour Support and the Induction process for new staff. - We took account of evidence from the service's most recent self assessment and other documentation showing the service consulting with people they support, monitoring and evaluating the work of staff, supporting and developing staff and planning to improve the service. 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. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 7 of 22

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 The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 8 of 22

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 document gives a detailed and relevant account of what the service thinks they currently do well, work they have been developing and areas they think need further development. They tell us how they are involving people using the service in their work. Taking the views of people using the care service into account We received fourteen inspection questionnaires prior to the inspection completed either by people using the service or by staff on their behalf. They all told us they are satisfied overall with the quality of care and support they receive. Two people commented as follows: "Don't know how I would cope without the Richmond's support..always ready to listen when needed". "Living by myself and being supported by carers has given me more confidence and helped me learn new skills and more choices". The person receiving support the Lay assessor spoke with was also satisfied with how staff supported them. Taking carers' views into account Four relatives of people receiving support returned completed inspection questionnaires and the Lay Assessor spoke with one of them by telephone. They were happy overall with the support the service provides. One person said their relative is "well cared for and respected in the house they are living in". The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 9 of 22

We took account of all feedback to help us reach our inspection conclusions. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 10 of 22

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 1: Quality of Care and Support 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 In this section of the report, we consider the service's approach in enabling people they support and, where applicable, their family having a say about the care and support staff provide. Policy promotes this involvement as the approach expected by the organisation. Inclusion training aims to equip staff to involve every service user in the way which best fits their needs and preferences. Routine informal and formal opportunities to voice views, ideas and concerns are offered to promote ongoing choice of how to participate and to enable people using the service to have their say as matters needing discussion occur. Each person the service supports has on file a decision making profile outlining arrangements to enable them to have their say. This helps staff follow a consistent approach which takes account of the needs, wishes and support to participate required by each individual. People receiving support/their families are consulted at local and national levels to indicate whether they are satisfied with how the service is involving them. We found evidence of staff using observation to pick up on the views of people they are supporting who are not able to communicate verbally, hearing the views of people who are able to speak in day to day conversation, through regular planned meetings and service reviews and through written means including e-mail, service user's contributions to daily running notes and to periodical service review summaries. Some people receiving support may also have others advocating on their behalf. Those wishing to raise concerns formally may do so through the complaints procedure. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 11 of 22

This flexible approach promotes each person having a say in the way they are able to and prefer. This is a well established approach which is regularly evaluated to identify improvements needed at individual level. We therefore conclude that the service's participation practice is improving from very good towards excellence. Areas for improvement The service identifies in the inspection self assessment that they wish to encourage greater input from local advocacy services. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 12 of 22

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The service takes a rounded approach to promoting the health and well being of people they support. Detailed information about each person's health needs is available from support setup and this helps with planning the support required and identifying specific training for staff. Contact with community health professionals is maintained to provide continuity of health monitoring and treatment and to provide ongoing advice and guidance for staff. Staff training in topics including protecting adults, safer handling, infection control, administration of medicines and food safety guide staff in current good practice. Monitoring processes to check staff understanding and practice help identify if further support and training is required to keep service users safe and well. These thorough, well established practices lead us to conclude that the service demonstrates an excellent approach to promoting the health and well being of people they support. We witnessed an outstanding example of this during our inspection. The concentrated efforts of staff at the Bruce Street accommodation to meet the complex health needs of one person supported and their thorough approach to get the detail and treatment right for the person was a commendable example of dedication within the team and of partnership working with community health professionals. Initiatives currently being implemented are also further enhancing the outcomes for people supported. These include the current work on person centred planning with its greater focus on the outcomes of support for each person as working targets, "Healthy Working Lives" which is helping staff promote healthy lifestyle in an informed way and by example and the work of the Positive Behaviour Support team which helps service users develop strategies for maintaining positive behaviour and, in turn, potentially enhances their quality of life experience and relationships with others. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 13 of 22

Areas for improvement The service identifies in the inspection self assessment that they wish to continue to build links with health professionals to maintain a multi-disciplinary approach as new service users are supported. We encourage the service to continue with implementation of the revised person centred planning for each person supported. They should show through quality monitoring and evaluation the impact of this and their other current initiatives on outcomes for people supported. We will consider this evidence through future routine inspection. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 14 of 22

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths In Quality Theme 1, Statement 1, Service Strengths we outlined the service's flexible approach to enabling people they support having their say about the care and support they receive. The service offers the same choice of ways for people to comment on staffing if they so wish. However, there are also a number of direct opportunities they routinely give people they support to influence choice of staff who work with them. These include contributing to the recruitment of new staff by taking part in interview processes themselves or by contributing interview questions. Staff deployment decisions also now involve matching staff profiles to service users' observed or expressed preferences regarding desired qualities in staff supporting them. Furthermore, people the service supports are able to give feedback for staff appraisals which, in turn, has the potential to influence practice development and training decisions. These are commendable practices which enable people the service supports to have an active and regular influence on staff working with them. We conclude, therefore, that the service's performance in this area of work is currently of an excellent standard. Areas for improvement Self Evaluation - The service should continue to evidence how each person they support influences staff recruitment, deployment and development decisions. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 15 of 22

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued Evidence of a range of exemplary practices has led us to conclude that the service is following an excellent approach to providing a professional, trained and motivated workforce. Revised induction training is helping prepare staff better for employment and in a more person centred way with service specific training before they begin supporting service users. Checks on knowledge gained through induction is helping in early identification of further support and training required through probationary stages of employment. Ongoing work thereafter at area level and service level to raise staff awareness and understanding of legislation, national care standards and practice guidance is further promoting staff having a sound basis on which to build their practice. Performance monitoring and assessment by team managers and senior staff based in each service is contributing to setting of improvement targets for teams and individuals which are then promoted and tracked through supervision. Coaching and mentoring at service level or further training is available to support staff achieve development targets. Persistent areas of performance concern may lead to a Performance Improvement Plan being put in place with potential disciplinary consequences for non-compliance. This is a robust framework which promotes a consistent approach to professional development and performance management across the whole service in a supportive manner. Also noteworthy is the organisation's promotion of the workforce keeping well through following initiatives such as WRAP (Wellness Recovery Action Planning) which gives staff opportunity to learn about managing their own health and well-being and Healthy Working Lives which promotes staff good health through having health checks and following a healthy lifestyle. This organisational interest is potentially motivating for staff as it contributes to them feeling valued and supported. Additionally, equipping staff with knowledge of how to keep themselves well also potentially helps them be better informed to support others effectively. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 16 of 22

Areas for improvement As the revised Induction process and the health promotion initiatives bed in, the service should evidence the impact they are having for staff. We will continue to monitor this through routine inspection. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 17 of 22

Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths It is clear from the discussions we had that people the service supports and, where applicable, their families continue to have opportunity to influence the "management" of their individual service through the range of means at local service level which we outlined in Quality Theme 1, Statement 1, Service Strengths. The Richmond Fellowship also carries out periodic surveys and interviews with people using the service to gather further information about how management and leadership could be improved. People the service supports are also encouraged to complete our inspection questionnaires and this continues to provide further means to have their say about what the service could do better. For these reasons, we conclude the service's performance in this area of work continues to be very good. Areas for improvement While it is clear that the views of people the service supports influence the development and delivery of the individual service they receive day to day, it is less clear how local staff routinely capture and take forward their feedback to influence the review and development of the Richmond Fellowship's approach at corporate level. We recognise that there may be communication challenges to meaningful consultation with some service users about issues which are more removed than their day to day care and support. However, it is important that people using the service play whatever part they are able to in shaping wider level policy, systems and development planning. As a consequence, we encourage the service to ensure their participation systems capture all service user/parent contributions to feed into service and organisation wide management developments. (See recommendation 1) The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 18 of 22

This could include topic focused evaluation of policy, processes and systems staff regulary use. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should ensure their participation systems capture all parent/service user contributions to feed into service and organisation wide management developments. National Care Standards Care at Home Standard 11: Expressing Your Views; National Care Standards Housing Support Services Standard 8: Expressing Your Views The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 19 of 22

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 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). The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 20 of 22

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 6 - Excellent Quality of Staffing - 6 - Excellent Statement 1 Statement 3 6 - Excellent 6 - Excellent Quality of Management and Leadership - 5 - Very Good Statement 1 5 - Very Good 6 Inspection and grading history Date Type Gradings 14 Jun 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 30 Oct 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 3 Nov 2008 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 21 of 22

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 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 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@careinspectorate.com Web: www.careinspectorate.com The Richmond Fellowship Scotland - Stirling, Clackmannanshire and Falkirk, page 22 of 22