Angel Care Services (Scotland) Limited Support Service 29 King Street Greenock PA15 1NL Telephone: 07963 937889 Type of inspection: Unannounced Inspection completed on: 28 September 2016 Service provided by: Angel Care Service (Scotland) Limited Service provider number: SP2013012092 Care service number: CS2013318215
About the service Crown Care Day Centre is owned by Angel Care Services and has been registered with the Care Inspectorate since May 2014. It provides a flexible support service for adults and older people in the town centre of Greenock. People who use the service can access a new purpose built, bright, spacious and homely environment, which supported individuals with complex needs including dementia, anxiety and problems with depression. The day care service can be provided for up to 28 people during the day time. At the time of our inspection the service was operating for six hours, on three days of the week and 13 people were using the service. The centre had a welcoming feel as you entered it, the service's literature described the service as being a flexible day care service for adults and older people, providing recreational, social and educational activities, including hairdressing and manicures; a gardening area which includes a sensory garden, with raised beds and ramp access, a spacious and bright dining area and a relaxing quiet zone. People who used the service could engage in various recreational activities comprising of carpet bowls, bingo, music and television quizzes, dominos, live entertainment and arts and crafts. Lunch and evening meals are provided by the service, whilst drinks and snacks are provided by staff throughout the day. The provider encourages people who use the service to be actively involved for maximum participation. What people told us "I enjoy coming here immensely; I would be a mess without this service. I feel I need this service, I would be lonely without." "I enjoy coming here; I don't know what I would do without the service." "I enjoy coming here, I enjoy the company." "Staff are good and help me all the time." "This place is excellent, I have been to other centres and the staff here have a lot more time for you." "I have been coming here for over a year and still enjoy the exercise class, I like the quiet area, and you can watch television in here." "We like the vegetable garden, we pick the veg ourselves and use it in the kitchen." page 2 of 10
Self assessment The Care Inspectorate received a fully completed self assessment document from the provider, although it was later than requested. The provider completed this with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how they will support people who used the service to take part in the self assessment process. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 4 - Good 5 - Very Good 3 - Adequate 3 - Adequate Quality of care and support Findings from the inspection After we reviewed the information we gathered during the inspection process, we decided that the service was performing in this quality theme at a good level. We reviewed the service's participation and involvement strategy which stated they would involve people who use the service in recruitment and selection of staff decisions, shaping the strategy and direction of the organisation, determining as far as possible the detail of service users day to day support, giving an evaluation of the service provided and performance evaluation of staff, where possible and appropriate. Throughout the inspection process we found good evidence of participation and inclusion. When we met and spoke with staff it was clear they promoted a strong culture of involvement and participation, we saw this during the activities we were present at and our discussions with people who used the service. We met and spoke with people who used the service, they told us that the management team are available to them every day and share ideas for activities. We could evidence this from our visit, staff and service users were very much involved with the day to day planning of the service. We reviewed three service users' care and support plans and found them to be mostly appropriate to the needs of the people using the service. Information included one page profiles which detailed who the service user was and what their likes and dislikes where. Care and support plans were reviewed every six months following the initial six week review process; this also included a review of the service user's outcomes and what they had achieved. Since the last inspection the service are now providing meals on site, this included lunch and evening meals, we saw that hot drinks and snacks were available throughout the day. page 3 of 10
Service users told us of the activities they like to be involved in, these included, Reiki, bingo, quizzes and various other therapies to maintain their health and well-being. We found that the service could develop its monitoring of outcomes for service users through its review process; we will monitor this at future inspections. We discussed with the service the need to encourage a wider risk management strategy which would identify the way risks are recorded and managed; see recommendation 1. We concluded that there were many factors which contributed to the people who used the service achieving positive outcomes whilst having their health and wellbeing needs met. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should ensure that care plans record all the health and welfare needs of residents to inform how those needs are to be met by the day care service. There should be specific reference to the following: - Accurate recording of the details of care interventions - risk assessments must reflect all identified risks - records must be regularly updated to reflect change. - Appropriate use of risk assessment tools. Grade: 4 - good Quality of environment Findings from the inspection After we reviewed the information we gathered during the inspection process and our observations of the overall environment, we decided that the service was performing in this quality statement at a very good level and promoted positive outcomes for people who used the service. Throughout the inspection process we saw that service users had access to large activity spaces and smaller intimate quiet rooms, as well as a well laid out dining room. The windows allowed good natural light which kept most of the areas well lit. We found no obvious sources of danger or hazards that would affect the health and safety of the people using the service. We fully appreciated that the service was still part time and that there was adequate staff numbers to meet the needs of service users. page 4 of 10
We met and spoke with service users who told us how they developed the outside space using planters to grow various vegetables and herbs, which they had picked on the day of inspection and used for their meals that night. We found that the centre was secured with security key pads from the outside with easily accessible key pads for exiting the building for service users to use, this meant that service users could feel safe. Service users had access to a therapy room which was used for aromatherapy, reiki, and massages; we found that it also accommodated a hairdressing salon which service users booked when they needed it, this meant that service users had control of how and when particular activities took place. We discussed with the service the need to include any environmental audits it carried out within its quality assurance programme and how they could involve service users; we will review this at future inspections. We concluded that the environment allowed service users to be kept safe, interact with each other and maintain friendships with meaningful conversations taking place in most of the rooms available to them. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of staffing Findings from the inspection After we reviewed the information we gathered during the inspection process, we decided that the service was performing in this quality theme at an adequate level. Throughout the inspection process we reviewed three staff files, two of which were new staff, we found appropriate supervision and support with relevant action planning. The service would benefit from indexing the contents of all staff files in order that there is a consistent approach to managing staff files. New staff that we met with told us of the induction process they underwent, examples of this included: service orientation, moving and assisting and first aid. Although this was mostly acceptable, the service would benefit from including in their staff handbook what training staff could expect in their first year of employment and apply appropriate refresher dates for adult support and protection training. See recommendation 1. Throughout the inspection process we met and spoke with most of the staff team, they appeared motivated and very professional, it was clear that they knew the individual needs of the people who used the service and supported them to achieve their individual outcomes. page 5 of 10
We discussed with the service that they should follow their own policy and guidance in respect of safer recruitment processes as the service were accepting of previous employers Protecting Vulnerable Groups (PVG) checks, the service should carry out their own checks in order to be in a position in the future to carry out retrospective checking. In order to do this the service must undertake the following in order to make proper provision for the health, welfare and safety needs of service users. Review their policy and procedure for recruiting staff safely referenced to best practice guidance from the Scottish Government 'Safer Recruitment through Better Recruitment'. See requirement 1. Requirements Number of requirements: 1 1. The provider must adhere to best practice regarding the safe recruitment of staff. Obtain appropriate references prior to recruitment decisions about employment in the service being made. Apply for and receive verification of applicant's membership of the Protection of Vulnerable Adults scheme from Disclosure Scotland prior to recruitment decisions about employment in the service being made. Evidence interviews of applicants and how decisions to employ are made. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulations 4(1)a. Timescale - The provider must meet this requirement within three months of receipt of this report. Recommendations Number of recommendations: 1 1. The service should ensure that all staff receives refresher training in respect of adult support and protection as part of their on going training and development. National Care Standards Care at Home - Standard 4, Management and Staffing Arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection After we reviewed the information we gathered during the inspection process, we decided that the service was performing in this quality theme at an adequate level. Throughout the inspection process we found that the management team continued to develop their quality assurance programme, we found that it still had areas for improvement and had re-instated a previous recommendation to fully develop the services quality assurance programme. See recommendation 1. page 6 of 10
We discussed examples of audits which the service could use in order to feed into their quality assurance programme, examples of these included: Staff supervision and appraisal. Staff training matrix and training needs analysis. All maintenance audits. Recruitment and retention audits. Care Inspectorate obligations. We reviewed the service's participation strategy and found that this allowed service users to fully participate in the daily management of the service, examples of this included: times of the service provision and daily activities. Staff that we met and spoke with told us that the management team were very approachable and always opened to ideas to improve the service. Staff were confident in discussing any issues with their line manager and felt that they were listened to. One staff member told us "I am relatively new to the service and I am very pleased with how the management team accept our ideas to improve the service." We concluded that the culture of leadership and management within the Crown Care Centre continued to be very open. Staff felt that they could approach the management team with any difficulty or idea that they had which would improve outcomes for people using the service. Throughout the inspection process we found that the service would have benefited from closer working relationships with external professionals in order to measure quality and performance. We felt that this would provide external analysis of the service's quality assurance and support them to continually improve. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider should further develop quality assurance processes to ensure there are robust systems to identify areas of good and poor practice and are responsive to improving the centre's performance. The systems must be focused on outcomes for service users: and must include the involvement of all key stakeholders including staff. National Care Standards for Support Services - Standard 2 - Management and Staffing Arrangements. Grade: 3 - adequate page 7 of 10
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 The provider should ensure that care plans record all the health and welfare needs of residents to inform how those needs are to be met by the day care service. There should be specific reference to the following: - Accurate recording of the details of care interventions - risk assessments must reflect all identified risks - records must be regularly updated to reflect change. - Appropriate use of risk assessment tools. This recommendation was made on 19 January 2015. Action taken on previous recommendation The service had developed a new care plan approach which included the monitoring and recording of desired outcomes, mobility, health, nutrition and hydration, personal care, mental health, medication management and risk assessment. Following this most recent inspection we felt that the service should further develop its management and recording of any risk and have re-instated this recommendation under theme one, quality of care and support. Recommendation 2 The provider should develop quality assurance processes to ensure there are robust systems to identify areas of good and poor practice and are responsive to improving the performance of the service. The systems must be focused on outcomes for service users: and must include the involvement of all key stakeholders including staff. This recommendation was made on 19 January 2015. Action taken on previous recommendation The service had still to develop a quality assurance process which was robust and inclusive. The service had developed quality assurance and audit tools for involving service users, although this was still to be tested. Following this most recent inspection we felt that the service still had areas for improvement within its quality assurance programme, we have re-instated this recommendation under theme four, quality of management and leadership. page 8 of 10
Recommendation 3 The service should develop a robust training and induction programme for new staff to ensure that service users are protected and safe. National Care Standards for Support Services - Standard 2 - Management and Staffing Arrangements. This recommendation was made on 1 October 2015. Action taken on previous recommendation The service had developed an induction programme for new staff, we felt that it was not robust enough, in particular with adult support and protection training and refreshers, please see recommendation under theme three - staffing. 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 25 Sep 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and leadership 4 - Good 19 Jan 2015 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and leadership 3 - Adequate page 9 of 10
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 10 of 10