The Richmond Fellowship Scotland - Shared Lives Service Adult Placement Service Unit 2 Pickering House Netherton Road Wishaw ML2 0EQ Type of inspection: Unannounced Inspection completed on: 19 February 2015
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 9 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: The Richmond Fellowship Scotland Limited Service provider number: SP2004006282 Care service number: CS2009234408 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at enquiries@careinspectorate.com The Richmond Fellowship Scotland - Shared Lives Service, page 2 of 20
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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The Shared Lives manager and coordinator demonstrated their commitment to providing a flexible package of care to each of the people they support in a way which helped them make their own plans and achieve a good quality of life What the service could do better We have made a recommendation concerned with seeking formal feedback from people supported by the service and other stakeholders. We discussed with the provider the need to change the way some elements of this service are provided in order to fully comply with the relevant legislation. See Additional Information at the end of this report. What the service has done since the last inspection The vacant position of Shared Lives coordinator had recently been filled and the benefits of this appointment were already being experienced in terms of improved monitoring and support of shared lives carers. The Richmond Fellowship Scotland - Shared Lives Service, page 3 of 20
Conclusion People using the service confirmed their satisfaction with the way they are supported and this had clearly enabled them to experience a good quality of life. Now that the position of Shared Lives Co-ordinator had been filled the service manager was now hopeful that the service would now be able to increase the number of people it supports. It will be important to rectify the current discrepancy in the way that one part of the service is registered (see Additional Information). The Richmond Fellowship Scotland - Shared Lives Service, page 4 of 20
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011 but only began to provide the service in September, 2011. Requirements and Recommendations If we are concerned about some aspect of a service, or think it could do more to improve, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - 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 Care Inspectorate. The Shared Lives Service, formerly known as the Lanarkshire Shared Lives Service, is provided by The Richmond Fellowship Scotland (TRFS) and is registered with the Care Inspectorate as an Adult Placement Service. The service arranges for adults, aged 16 years and over, to have support, partially or fully, in the homes of families or individuals. The service is based in offices in Wishaw North Lanarkshire. The service aims to improve the quality of life outcomes for the people they support by offering: flexible support; genuine inclusion within families and communities; a truly personalised approach designed to reduce social isolation; short breaks with people who have common interests; a decrease in the likelihood that people will have to live with others that they would not choose. The Richmond Fellowship Scotland - Shared Lives Service, page 5 of 20
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good 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. 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 0345 600 9527 or visiting one of our offices. The Richmond Fellowship Scotland - Shared Lives Service, page 6 of 20
2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection Before the inspection we looked at the service's self assessment and Annual Return. We made a short-notice announced inspection and visited three service users in their Shared Lives homes together with their carers. We then visited the service base and met with the manager and shared lives coordinator. We examined a range of paperwork including individual support plans, risk assessments and associated records, recruitment files, training records, assessment information and audits for shared carers and selected policies and procedures including the service's statement of aims and objectives and its medications procedure. We provided brief verbal feedback at the end of our visit and followed this up by telephone and e-mail. 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 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 - Shared Lives Service, page 7 of 20
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 service's self-assessment was completed in September 2014, at a time when there had been a long-term vacancy for the post of Shared Lives Coordinator for several months. This self assessment indicated only an adequate standard in each of the areas we looked at in this inspection. Based on the evidence we saw during this inspection a good standard had now been achieved. Taking the views of people using the care service into account We met three people who are currently supported by the service and through conversation and observation ascertained they are happy with the support they receive. Taking carers' views into account Shared Lives carers confirmed they felt very well supported by the provider and compared this favourably with their past experience of other social care providers. The Richmond Fellowship Scotland - Shared Lives Service, page 8 of 20
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: 4 - 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 Based on our findings during this inspection a good standard had been maintained in regard to this Quality Statement. The views, opinions and wishes of people supported by the service were respected by their carers and acted upon whenever this was practicable. Such views were included in reports written by service manager or coordinator, e.g. with a list of "what's important to..." We also saw that carers planned their time around the support needs and interests of the people they support. A written record had been kept by the service of the main details of conversations between people using the service and the manager or coordinator. This included confirmation of their satisfaction with the arrangements for their support. Supported people and their carers were invited to meetings to review their care and support. Where carers had raised any concerns about the needs of the people they support, these had been followed up by the manager and/or coordinator, for example, where concern had been raised about potential trip hazards and falls, a risk assessment had been undertaken by the coordinator. The provider had asked the people they support to complete a "participation leaflet" to indicate whether or not they were interested in getting involved in opportunities for consultation, e.g. quality assurance questionnaires and inspections. The Richmond Fellowship Scotland - Shared Lives Service, page 9 of 20
Areas for improvement The manager and coordinator confirmed that people they support were invited to complete "How well are we doing?" questionnaires but no completed examples were available for us to look at during our visit. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Shared Lives Service, page 10 of 20
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Based on our findings during this inspection a good standard had been maintained. People we met who were supported by the service had been helped to maintain good health and a healthy lifestyle. This included a healthy diet. Support plans we looked ast were person-centred a gave good attention to ways of supporting people using the service to stay healthy. They included clear statements of what was important to the people the service supports together with desired outcomes. Plans addressed both specific and general health needs and indicated strong links with health and social care professionals including, where appropriate, specialist health services. Carers had received training in mental health first aid. Support plans included details of support with budgeting and, where appropriate, carers had maintained a careful record of supported people's finance. The service had a clear policy on the administration of medicines by carers, however all current service users were able to administer their own medicines with the support of carers. Following our last inspection we reported that records for the administration of medicines would be improved with the inclusion of information about possible side-effects or risks. We saw an example of a support plan which included helpful information about possible side-effects of a specific medicine and the need for carers to be mindful of this. The manager and coordinator also confirmed that information leaflets which accompanied medicines were retained so that carers could consult these. Carers had received training in the administration of medicines. A carer described to us a concern they had felt regarding a supported person's internet safety. They had taken appropriate steps to safeguard them. Areas for improvement Where it is anticipated that people supported by the service will eventually move on to more independent living arrangements, it would be helpful for support planning to identify any personal goals/next steps that need to be achieved before this can happen. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Shared Lives Service, page 11 of 20
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Based on our findings in relation to Quality Theme 1, Statement 1, a good standard had been maintained in regard to this Quality Statement. Areas for improvement The service's self-assessment indicated a proposal to carry out 'observation audits' with the permission of the people they support in order to "strengthen" their voice. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Shared Lives Service, page 12 of 20
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 Based on our findings during this inspection the standard achieved for this Quality Statement had improved from adequate to good. Shared Lives carers had been recruited through a robust recruitment process which one carer described as "much more in-depth" than they had experienced with other care service providers. Records we saw of skills assessments undertaken with prospective carers demonstrated a very good focus on carers' competencies. The provider gave carers clear information about expectations and values as well as practical guidance for the role of shared lives carer. The last time we inspected this service there was a vacancy for the post of coordinator and the registered manager was the only person employed for the support of people using the service. A new coordinator had now been appointed and they had made a very good start with getting to know service users and supporting their carers. Carers confirmed to us that they felt well supported by the manager and the newly appointed coordinator and had been encouraged to participate in training opportunities. This had included training in Adult Support and Protection, medication awareness, health and safety awareness and care values. This training took account of individual training needs assessments and was based on a work-book approach which carers undertook at their own pace before being assessed by the manager or coordinator. This approach was now being well-supported by the coordinator through regular support visits to carers. We note that the provider has an Investors in People award. The Richmond Fellowship Scotland - Shared Lives Service, page 13 of 20
Areas for improvement Two of the people currently supported by the service had their own tenancies and received a type of support which the provider referred to as 'kinship care'. Please see our Additional Information heading for further comment on the 'Kinship Care' approach. We note that the service provider offers a wide range of training to their staff, some of which would be suitable for Shared Lives carers. We suggested therefore that the service is more proactive in publicising available training when it is suitable for shared lives carers., e.g.providing copies of the TRFS training calendar. We note that there had been a very long delay in filling the vacancy for a new coordinator, a post which had remained vacant for almost a year following our last inspection. The service provider should ensure that any future vacancies are filled timeously. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Shared Lives Service, page 14 of 20
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 Based on our findings in relation to Quality Theme 1, Statement 1, a good standard had been maintained in regard to this Quality Statement. Areas for improvement The service's self-assessment committed to asking carers to speak to people they support to find out their views about the management and leadership of the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 The Richmond Fellowship Scotland - Shared Lives Service, page 15 of 20
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 Based on our findings during this inspection a good standard had been maintained in relation to this Quality Statement. The provider carried out observational audits approximately every fortnight and scrutiny of support arrangements included an annual audit of any money looked after by carers on behalf of people they support. These included a record of discussions with carers and people they support and any observations of interaction between them. These audits had maintained a good focus on carers' competencies and outcomes for people using the service. Very good attention was given to finding out and responding to service users' views of their own support arrangements. This included six monthly reviews. The service also carried out annual reviews of individual carers and reminded people they support and their relatives of the provider's complaints procedure at least every year. Areas for improvement Inspection report continued We clarified to the manager that the events that should be notified to the Care Inspectorate include accidents and incidents. We would normally consider an accident to be notifiable if it involves the injured person requiring medical attention other than basic first aid, e.g. if a doctor is called or the victim is taken to Accident and Emergency. The service had not recently carried out any formal survey of people they support, carers (including relatives) and other stakeholders to find out their views about the service provided. If such surveys were based on our Quality Themes this would enable the provider to make reference to survey results when they submit their selfassessment to us. Following such surveys, feedback received should be collated and a plan formed of any necessary actions (see Recommendation 1). The Richmond Fellowship Scotland - Shared Lives Service, page 16 of 20
Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should introduce feedback surveys in order to gather the views of service users, carers, staff and stakeholders about the quality of service provided. National Care Standards, adult placement services, Standard 11: Expressing your views. The Richmond Fellowship Scotland - Shared Lives Service, page 17 of 20
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 During the course of carrying out this inspection we found that one of the support options being offered by the provider, i.e. "kinship care" was inconsistent with registration as an adult placement service. Please see also Quality Statement 3.3. We have discussed this with the service manager who is eager to ensure that appropriate steps are taken to work within relevant legislation and guidance. This will be followed up by us with the provider as a separate regulatory process. 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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). The Richmond Fellowship Scotland - Shared Lives Service, page 18 of 20
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 20 Jan 2014 Announced (Short Notice) Care and support Staffing Management and Leadership 4 - Good 3 - Adequate 4 - Good 15 Mar 2012 Unannounced Care and support 4 - Good 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. The Richmond Fellowship Scotland - Shared Lives Service, page 19 of 20
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 0345 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 0345 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0345 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com The Richmond Fellowship Scotland - Shared Lives Service, page 20 of 20