Helensburgh Addiction Rehabilitation Team Housing Support Unit Housing Support Service 52 West Princess Street Helensburgh G84 8UG Telephone: 01436

Helensburgh Addiction Rehabilitation Team Housing Support Unit Housing Support Service 52 West Princess Street Helensburgh G84 8UG Telephone: 01436 674 653 Type of inspection: Unannounced Inspection completed on: 30 September 2014

Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 10 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Helensburgh Addiction Rehabilitation Team Service provider number: SP2004005446 Care service number: CS2003054289 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 Helensburgh Addiction Rehabilitation Team Housing Support Unit, 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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service has embraced service user participation, involving service users in setting up constitutions for their user groups and helping to write grant applications for projects that they wish the provider to run. What the service could do better The service could improve how it evidences the outcomes for service users as a result of the support the service provides. To help do this the manager informed us that staff will receive training in how to use Outcome Star; this is a tool which can help service users with the help of support staff to identify their own outcomes. What the service has done since the last inspection The provider has improved communication within the service both internally between staff and externally with service users. Conclusion This service is very highly thought of by the people who are supported by it. It has improved greatly over the last year at which time we were concerned about poor communication and low staff morale; these are not concerns anymore. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 3 of 26

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. 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 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 Reform (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. Helensburgh Addiction Rehabilitation Team is registered to provide a housing support service to people who experience alcohol and drug misuse problems. At the time of the inspection there were currently 7 people receiving housing support from the service. They aim to offer a flexible and responsive service to people who have needs relating to their addiction. 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. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 4 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.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 5 of 26

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 The inspection was carried out by one Inspector 30 September 2014 between the hours of 9:45am and 16:30pm. Brief feedback was given to the manager at the end of the day. Prior to the inspection, we sent out 9 Care Standards questionnaires to the service to pass out to service users, of these 4 were completed and returned to us. We also sent out staff questionnaires. These give individuals the chance to contribute to the inspection and to do so anonymously if they wish. During the inspection we had individual discussions with a range of people including: - 4 service users - 1 relative - The registered manager - 1 Councillor - 2 Support Workers. We also carried out a review of a range of policies, procedures, records and other documentation, including the following; - Care plans - Care Standards questionnaires returned from people who use the service - The service's questionnaires; their analysis of them and action plan following them. - service user meeting minutes - Staff training records - Staff meetings - Staff personnel files - Team meeting minutes - Supervision minutes - Complaints folder - Quality assurance policy - Insurance Certificates - Staff development information. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 6 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 Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 7 of 26

What the service has done to meet any requirements we made at our last inspection The requirement The provider must have an effective quality assurance system in place to evaluate what they are doing and to make sure improvements to the service are made. This is in order to comply with SSI 2011/210 Regulation 3 Principles and Regulation 4.(1)(a)(b) Welfare of users. Timescale: This requirement should be met by 1 June 2014. What the service did to meet the requirement The service met this requirement in two ways, firstly the manager is very hands on, he is aware of service users needs as is evidenced in the frequent discussion contained in staff supervision notes. Also the feedback that we received from service users and staff lead us to believe that this approach would pick up and address any areas where standards were not as they should be. Secondly the management team has commissioned a consultant to help develop a quality assurance system based on the ISO 9001 quality assurance system. While this is not fully up and running yet we were able to see the work which had gone into creating the quality assurance system, which looks detailed and staff were able to tell us about what it will mean once it is fully up and running. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection There was one recommendation made in the last inspection report which was for the management team to develop a participation policy which informs service users how they can be involved in the assessment and development of all aspects of the service. The management team has done this. Helensburgh Addiction Rehabilitation Team Housing Support Unit, 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 Inspection report continued 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 Care inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The management team identified what they thought the service did well, some areas for development and any changes it had planned. It could be improved by including more of a focus on what the outcomes have been for the people using the service as a result of the support that they receive and by making it clear how service user and carers have been involved in completing the assessment. Taking the views of people using the care service into account Prior to the inspection 9 care standards questionnaires were sent to the service to be distributed to the people who use the service. 4 were returned. During the inspection we had the opportunity to speak with 3 people who use the service, 2 within the service and 1 in their own home. The comments we received were all positive. We have included comments and views from people using the service throughout the report. Taking carers' views into account We also had the opportunity to speak with the partner of one service user during the inspection. They told us; "We can cut through it all and tell you it's 10 out of 10." Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 9 of 26

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 The service was very good at involving people who use the service in the assessment and development of the service which they receive. We arrived at this conclusion after considering the following information: - Care reviews - Questionnaires sent out by the service to; service users - Minutes from the SUSI group meetings - Care plans and care plan audits - Discussions with service users - Discussions with staff - Care standards questionnaires returned to the Care Inspectorate. The provider set up user groups which are open to everyone who uses any of HART's services. Some people who use the housing support service have joined these groups. The groups decide what projects they would like the provider to set up, they helped set up a committee and write a constitution for their recovery group and several service users went to their local council to observe how decisions are made about awarding grants for projects like theirs. Following this some service users have received training on how to write a grant application. Outcomes from these various initiatives have included the setting up of a walking group and a healthy eating group, groups chosen by the people who use the service. The project has links with other service user groups from other areas and there have been joint meetings supported by the provider where ideas can be shared and Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 10 of 26

friendships developed. Questionnaires ask service users to identify outcomes as well as ask questions about the quality of staff the responses that we saw were positive. 100% of people who returned care standards questionnaires to us agreed with the statement that they had a care plan which detailed their needs and preferences and 100% of people agreed or strongly agreed with the statement that the service regularly checks with them that they are meetings their needs. During the inspection we spoke with people who use the service and read their comments within the questionnaires that they returned to us, what they told us in relation to this statement included: - "The healthy eating group was a revelation and we now have the money to run the group again" - "When the healthy eating group finished one of us suggested we start going for a walk, it's been brilliant" - "I'm on the "Surge" committee, we went to a meeting about how to organise a board, we have agreed on a constitution" - "Sometimes I come in here on a Friday other times my worker visits me" - "They talk to me about how I've been coping and then they come up with a plan about what they can do for me" - "The best thing about the service is they operate a drop in service so you don't feel as if you are intruding if you need to go in and speak to someone." Areas for improvement While we acknowledge people may be reluctant to discuss their past they should be encouraged when participating in developing their care plan to give more of their background. A good care plan should inform staff about who someone is, what is important to them and why. This is a small service and staff verbally could tell us far more than was recorded within care plans, which is more important than what is recorded however records are still important and we feel that there is room for improvement in them. The manager told us that they planned to organise training for support staff on how to use Outcome Star which will assist staff to support service users in identifying their own strengths and areas for development. The management team should consider how they could improve the amount of stakeholder feedback they receive. It is important to seek feedback from external professionals such as; social workers, housing officials, and community nurses as a way of this feedback could lead to development opportunities for the service. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 11 of 26

Daily notes could be signed by service users as well as staff if they are being completed along with the service user. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 12 of 26

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service was good at ensuring service user's health and wellbeing needs are met. We arrived at this conclusion after considering the following information: - Care plans - Risk assessments - Interviews with service users - Interviews with staff - Incidents and Accident folders. We spoke with staff and assessed that they were aware of the health needs of the people that they supported. Staff have a mixture of health related training including, alcohol and drugs studies, adult support and protection, mental health first aid, continence care, preventing infection, Asist, overdose awareness, psychology of addictions. Staff will liaise with other agencies and services on behalf of service users if they wish in order to help support service users holistic needs. For example one person we spoke with was referred onto bereavement counselling. During the inspection we spoke with people who use the service and read their comments within the questionnaires that they returned to us. They provided a lot of examples of how they had achieved good outcomes as a result of using the service, their comments included: - "I feel as if I've moved on and been shown other supports I can make use of" - "The healthy eating group was a revelation" - "They have supported me to get access to my child, I've really turned a corner" - "The staff encourage me to keep my house clean" - "I started getting housing support as I was down on my backside, now I've come off the drink." One relative that we had the opportunity to speak with told us: Inspection report continued - "When X becomes stressed he turns to Y (staff member) as she makes sense of things for him" - "The continuity of care has been important for him as it takes a while for him to build up trust with people." Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 13 of 26

Areas for improvement The manager told us that he hoped to be able to run a food hygiene project with the substance misuse group which some of the housing support service users are part of. Service users will have the opportunity to achieve food hygiene certificates as well as learn some important life skills. The manager told us that he hoped to be able to offer service users who are interested the opportunity to complete walk-leader training. This is a certified course for people who will lead walking groups and involves first aid and basic health and safety training. This will allow service users to lead their own walking group. As mentioned under Quality Theme 1 - Statement 1 the manager told us that the service were looking to buy licenses to introduce Outcome Star; which is an assessment tool that when used properly can help people reflect on the areas of their life they wish help and identify when they have made progress. Using some form of outcome focused tool would strengthen the care plans by capturing the progress that people are making more clearly than the current plans do. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 14 of 26

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 The service was very good at involving people who use the service in assessing and improving the quality of staffing within the service. We considered the following information in grading this statement: - Staff training - Interviews with service users - Interviews with staff - Questionnaires. Questionnaires used by the service to get people's views included questions on the quality of staffing. The responses we saw were positive which matched the responses in the questionnaires which were returned to us. As mentioned under Quality Theme 1 - Statement 1 service users have gone along with staff to view how the local council made decisions about awarding grants for various projects; they have then influenced which projects the service sets up. Some service users have along with staff had training on how to a tender for a grant from the council. Housing support service users who have chosen to take part in other HART run projects have had the opportunity to take part in committee training and write their own constitution for the substance misuse forum. Service user participation has helped shape the service from the individual's point of view but has also influenced the work that staff and the organisation does. Review records showed that people who used the service could give their views about the quality of staff at review meetings. People that we spoke with told us that they received support from regular support workers which offered them consistency and although they were happy with the support that they received they were confident that if they were ever unhappy they could discuss this with the manager. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 15 of 26

For other strengths around participation see Quality Theme 1 - Statement 1. Areas for improvement While the service clearly encourages service users to express their opinions about staff it would be good practice if their views are considered as part of staff appraisals. If the service becomes in a position to recruit new staff the manager told us that service users would be involved in the recruitment process. In addition the management team could also evidence that service user feedback is considered at the end of the staff induction period i.e. before someone is offered the job on a permanent basis there is evidence that service users have been consulted to as to whether the person is a good support worker or not. The service should consider how it can involve service users more directly in the selfassessment process. For general areas of improvement around participation see Quality Theme 1 - Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 16 of 26

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service's performance in the areas covered by this statement was very good. We concluded this after considering the following: - Interviews with management/staff/service users - Staff induction procedure - Samples of staff supervision and appraisal minutes - Staff meeting minutes - Staff training records. Inspection report continued Staff came across as being very positive when we spoke with them about their work. They also told us that they felt valued and well supported by management. Staff told us that morale which had been low last year had improved greatly as there was now good communication between all the staff. Records showed that staff receive an annual Appraisal of their work. This involves staff discussing their performance in relation to core competencies with their line managers. Staff receive a mixture of relevant training, the staff we spoke to and those who returned questionnaires to us stated that they were confident that they had sufficient training to support them in their work. The service has a Staff Supervision and Appraisal Policy which defines what makes a good supervision session and how frequently they should be. Staff told us that they get regular supervision. Supervision records showed that service users' needs were discussed as was staff training opportunities and the service development this is in line with their policy. Staff meetings were held on a regular basis according to the minutes we read. As with supervision, service user needs are discussed as is the service development and some general practice issues. Staff told us they were encouraged to give their opinions at meetings which are taken on board by the management. 100% of the people who returned care standard questionnaires to us agreed or strongly agreed with the statement; 'Staff treat me with respect.' Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 17 of 26

During the inspection we spoke with people who use the service and read their comments within the questionnaires that they returned to us, what they told us in relation to this statement included: - "X (staff) has been brilliant with me" - "I find them friendly enough I can sit and talk to them" - "X (staff) is so enthusiastic and bloody good at what she does" - "The staff are all respectful and very much look as if they have been well trained." Areas for improvement The management team each year have a struggle to forward plan training opportunities for staff as the service has to identify separate funding streams to provide training opportunities. While we acknowledge that the small staff group that works in the service is experienced and has been given good training opportunities previously; the lack of a training budget could become a problem if a new less experienced worker ever started within the service. (See recommendation one under this statement.) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should factor in a percentage for training costs into any funding application. NCS 3 Housing Support Services - Management and Staffing Arrangements. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 18 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 The service was very good at ensuring that service users and carers participated in assessing and improving the quality of management and leadership of the service. We considered the following information in grading this statement: - Discussions with service users and relatives - Interviews with management and staff - Development plans - Returned questionnaires. The returned care standard questionnaires which we viewed agreed or strongly agreed with the statement that 'the service checks with them regularly that it is meeting their needs.' As has been previously mentioned the management team have involved service users in; forming a committee for the 'Surge group' (for which it provided training,) and applying for project funding (for which training is also being sought.) Service users are asked within questionnaires what their opinions of the management and leadership of the service are. The responses we viewed were positive. The people we spoke with spoke highly about all aspects of the service they received. Comments made in relation to management and leadership included: - "Since X (manager) and Y (councillor) started it makes you want to get out your Kip" - "Since last year it has picked up, it was a bit dry previously" - "I met the manager when I was first introduced to HART." For other strengths around participation see Quality Theme 1 - Statement 1. Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 19 of 26

Areas for improvement The manager told us that he hopes to involve service users in interviewing staff if any vacancies arise and also develop the opportunities for service users to do some voluntary work within the service and attend training events. For general areas of improvement around participation see Quality Theme 1 - Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 20 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 The service was good in relation to this statement. We considered the following information in grading this statement: - Care standards questionnaires returned from service users - Quality Assurance Policy - Interviews with people who use the service and their relatives - Care plans - Staff supervision - Staff meeting minutes. Inspection report continued Staff stated they were well supported and minutes from supervision and team meetings would support this. The management team have managed to significantly improve the communication between staff over the last year, which had been a problem 12 months ago. The service's quality assurance policy has been adapted from the ISO9001 quality assurance system. This places an importance on ensuring that communication is improved within services by having up to date systems which can be easily accessed by all staff working within the service. When this is fully up and running this should improve the communication further between the housing support staff and other aspects of HART such as the SUSI group (service user group) and the counselling services. 100% of the people who returned care standards questionnaires to us agreed or strongly agreed with the statement that 'overall I am happy with the quality of care and support the service gives me.' We viewed the feedback from questionnaires given out by the service's themselves and overall their response was very positive. Care plans we looked at were kept up to date, as were care reviews. During the inspection we spoke with people who use the service and read their comments within the questionnaires that they returned to us, what they told us in relation to this statement included: - "I couldn't live without X (staff) as I couldn't attend appointments without her" - "X (staff) has been great for me" - "It's been brilliant" - "X (support worker) and Y (the manager) have been great." Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 21 of 26

One relative we had the chance to speak to told us; - "We can cut through it all and tell you it's 10 out of 10." Areas for improvement The management team should develop its self-assessment which it sends to the Care Inspectorate prior each year. Under each heading they should highlight what outcomes service users have been supported to achieve. While the manager told us that service users had been involved in this process their input could be more clearly identified in the report. (See recommendation 1 under this statement.) As part of a quality assurance process the management team should consider how effective the service's participation strategy has been. We discussed with the manager during the inspection certain tools that could be used by managers to measure how successful an organisation has become at delivering and outcome focused approach; such as "Progress for Provider" by Helen Sanderson Associates. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The management team should ensure that the service's new quality assurance policy is fully rolled out, its effectiveness is reviewed over the next year. NCS 3 Housing Support Services - Management and Staffing Arrangements Helensburgh Addiction Rehabilitation Team Housing Support Unit, 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 No additional information recorded. 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). Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 23 of 26

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 5 - Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 19 Mar 2014 Unannounced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 16 Oct 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 3 - Adequate 2 - Weak 2 - Weak 4 Jun 2012 Unannounced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 14 Oct 2011 Unannounced Care and support 2 - Weak Staffing 2 - Weak Management and Leadership 2 - Weak 22 Apr 2011 Unannounced Care and support 2 - Weak Staffing 2 - Weak Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 24 of 26

Management and Leadership 2 - Weak 8 Jun 2010 Announced Care and support 2 - Weak Staffing Not Assessed Management and Leadership 2 - Weak 27 Oct 2009 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 7 Aug 2008 Announced Care and support 4 - Good Staffing 3 - Adequate Management and Leadership 2 - Weak All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Helensburgh Addiction Rehabilitation Team Housing Support Unit, 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 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 Helensburgh Addiction Rehabilitation Team Housing Support Unit, page 26 of 26