East Lothian Council - Domiciliary Care Service - Care at Home Support Service

East Lothian Council - Domiciliary Care Service - Care at Home Support Service 9 Civic Square Tranent EH33 1HU Inspected by: (Care Commission Officer) Julie Tulloch Type of inspection: Inspection completed on: 5 December 2007 1/13

Service Number Service name CS2004078142 East Lothian Council - Domiciliary Care Service - Care at Home Service address 9 Civic Square Tranent EH33 1HU Provider Number dummy Provider Name SP2003002600 East Lothian Council Inspected By dummy Inspection Type Julie Tulloch Care Commission Officer dummy Inspection Completed Period since last inspection 5 December 2007 Nine months dummy Local Office Address Stuart House, Station Road, Eskmills, Musselburgh. EH21 7PB dummy 2/13

Introduction East Lothian Council Domiciliary Care Service is an integrated housing support and care at home service, provided by the local authority to approximately 1000 adults living in their own homes throughout East Lothian. The service was registered with the Care Commission in August 2004. The service is divided into 8 geographical teams managed by 8 Domiciliary Care Organisers. The office base is located in the main square in Tranent, East Lothian. The aims of the service are to "enable clients to remain in the community" and to "support clients and their carers" Basis of Report Before the Inspection The report was written following an announced visit to the Office of the service which took place on Wednesday 5 December 2007, by Care Commission Officers Julie Tulloch and Michelle Deans who will be referred to as the Officers throughout this report. Prior to this a pre-inspection visit was undertaken by the Officers on 23 October 2007 to ascertain the most effective way to ascertain service user views and to meet with the Manager and the Service Manager. Prior to the Inspection the views of staff and service users were sought via questionnaires. The Annual Return The service submitted a completed Annual Return as requested by the Care Commission. The Self-Evaluation Form The service submitted a self-evaluation form as requested by the Care Commission. Views of service users A sample of 94 service users questionnaires were sent to inform this inspection. A response was received from 61 service users and/or their representatives. Some service users asked to be contacted and a sample were contacted. The written and verbal responses of service users have been used to inform this inspection report. Regulation Support Assessment This service was inspected after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers: complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a medium RSA score and so a medium intensity inspection was required as a result. The inspection was then based upon the relevant Inspection Focus Areas and associated National Care Standards for the particular service type and follow up on any recommendations and requirements from previous inspections, complaints or other regulatory activity. During the inspection process 3/13

Staff at inspection During the visit, which took place on the 5 December 2007, the Care Commission Officers spoke with the following: Service Manager Older Peoples Provision Manager Domiciliary Care Services Two Domiciliary Care Organisers As part of the inspection process 100 staff questionnaires were issued and forty three returned prior to the inspection visits. Responses were received from staff who were employed as Home Helps, Domiciliary Care Workers, Locum Domiciliary Care Workers and Domiciliary Care workers who provide care in the Discharge Response Team. Evidence During the inspection, evidence was gathered from a number of sources including: A review of a range of policies, procedures, records and other documentation, including the following: A Draft Induction Programme The Business Continuity Plan Child Protection leaflet Challenging Behaviour Policy Adult Protection/Adult Abuse Policy Intra-agency Adult Protection Guidance Staff Questionnaire results issued by Service Manager Learning and Development Policy Training Programme Staff supervision records Staff Training records Draft supervision recording sheet Care record books Discussion took place with the Service Manager for Older Peoples Provision, the Manager for Domiciliary Care Services and Two Domiciliary Care Organisers. The Officer took all the above onto account and reported on whether the service was meeting a range of relevant National Care Standards for Support Services associated with the Inspection Focus Areas for 2007/2008. Inspection Focus Areas and associated National Care Standards for 2007/08 The main Inspection Focus Areas for this inspection were - Protecting People, which included Adult Protection, Restraint, Child Protection (for visiting children), Staff Training/Training Plans and Quality Assurance. The following National Care Standards for Care at Home/Housing Support were also taken into account during this inspection, though not all aspects were inspected against, only those which supported the IFA and which related to previous requirements or recommendations. Care at Home Standard 1: Informing and Deciding 4/13

Housing Support Standard 3: Managing and Staffing Arrangements Care at Home Standard 7: Keeping Well Housing Support Standard 8: Expressing your views Fire Safety Issues The Fire (Scotland) Act 2005 introduced new regulatory arrangements in respect of fire safety, on 1 October 2006. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements in last Inspection Report There were no requirements made in the previous inspection of this service. Action on the five recommendations made during the last inspection are reported within the relevant standard or in other issues section at the end of this inspection report. Comments on Self-Evaluation A self-evaluation form was received from the service. The service identified an area for development which was to formulate an appropriate induction programme for all staff. View of Service Users Ninety four service user questionnaires were sent out as part of this inspection. The questionnaires 'How satisfied are you with your Care Service?' asked service users and/or carers to respond as to whether they felt very dissatisfied, satisfied or very satisfied with the service in a number of areas. All Fifty four of the service users who responded to this question said that they were satisfied or very satisfied that staff treated them with respect. Fifty two service users were either satisfied or very satisfied that staff have the skills and experience to meet their needs and one service user was dissatisfied with this aspect of care. Fifteen service users responded that they had a written personal plan from the service, twenty one service users responded no to this question and twelve responded that they did not know. When asked if the plan detailed care and support which had been agreed with the service user eighteen responded that it was agreed and twenty five that they did not know. Of the service users who responded forty two said that they get the care and support which has been agreed, two respondents said that they did not know. When asked if they were aware if the service had a complaints procedure, thirty service users were aware of this and twenty two were either unaware or did not know. Of those service users who responded to the question thirty three would feel comfortable about raising a concern or making a complaint about the service if they needed to. Eleven respondents would not feel comfortable and four did not know. Of the service users who had made a complaint in the past one was very dissatisfied with how it was handled, one respondent was dissatisfied, eight were satisfied and two were very satisfied. Nine responded that they did not know. 5/13

When asked about overall satisfaction with the service twenty two respondents said they were satisfied and twenty eight that they were very satisfied with the service they received. One respondent said they were dissatisfied with the service, but made very positive comments about the service which they received. Comments taken from the questionnaires included: My carers...'are now more like dear friends than employees',... 'very happy with carers, except those from the agency, some being very good but others terrible', 'I am very satisfied with the personal care that I have received.', 'I am very happy and satisfied with all the care I get from the girls who look after me. They are all very pleasant and help me in any way I need.' 'I need more hours for home help, have already requested and have been told I am on a list. How does this help me now?' 'I feel that recently there is a lack of continuity. I used to know what girls were coming in but I never know now, there seems to be a lack of staff and a lot of agency workers used.' 'Very satisfied with the carers who provide the service. Frustrated by poor management-not acting appropriately when given cancellation of care due to hospital appointment etc.' 'The service is first class. The service is perfect. My carers are the best.' View of Carers The aforementioned issued questionnaires contained a section for carers views. Of the thirty two carers who responded to the question all thirty two carers said they were satisfied or very satisfied that staff treated their friend or relative with respect. Thirty two carers were satisfied or very satisfied that staff have the skills and experience to meet their friend or relatives needs, one respondent was dissatisfied. Nine respondents were aware of the service user having a support plan, four were not and nineteen responded that they did not know. Twenty eight responded that they were satisfied that their relative gets the agreed care and support, three did not know. Twenty respondents were aware that the service had a complaints procedure, one person did not know and ten responded that they were unsure. Twenty four respondents said that they would feel comfortable about making a complaint or raising a concern if they needed to, six carers would not feel comfortable and one respondent did not know. When asked if they had complaint how satisfied they were with how this was handled one was dissatisfied, three were satisfied and one very satisfied, five did not know. Overall satisfaction with the service was experienced by twenty nine of the respondents who were either satisfied or very satisfied. One respondent said they were dissatisfied with the service, but made very positive comments about the service which they received. Comments included: 'My wife and I are very satisfied with the personal carers that come in and treat my wife with respect.' 'We are extremely satisfied with the standard and the type of care received mainly from council carers. They are extremely professional, caring and kind and we cannot praise them enough.' One carer was unhappy with the communication between the Office and the carers as they informed the office of days when they would not need carers due to hospital appointments 6/13

but the message was not always given to the carers. 7/13

Regulations / Principles Regulation : Strengths Areas for Development National Care Standards National Care Standard Number 1: Care at Home - Informing and Deciding Strengths This standard was inspected in relation to progress with a recommendation made at the previous inspection. The previous inspection recommended that the Provider should include the ' Bill of Rights' information in the introductory brochure for the service. This has been carried out but not yet been implemented as the brochures are waiting to be reprinted. This will be followed up at the next inspection Areas for Development Progress in this area for development will be followed up at the next inspection. National Care Standard Number 3: Housing Support Services - Management and Staffing Arrangements Strengths This standard was inspected in relation to the inspection focus areas of protecting people including child protection in adult services, restraint, adult protection, Staff training and quality assurance. The Manager stated that as the service is carried out in service users own homes, staff may have contact with child visitors during the delivery of the service. The Manager said that the local area child protection guidance was used in the event of a child protection incident allegation. A pocket sized guide of this had been distributed to all staff. The service does not have a policy and procedure guide for restraint, however the services policy on challenging behaviour contains a section on physical intervention. The Manager stated that care record books would contain risk assessments on any aspect of anticipated risks. 8/13

In discussion of risk assessments the manager stated that all individual risks are recorded. Risk assessments are initially completed during the first assessment in support plans, however the record of the discussions surrounding the decision reached may not be transferred to the care record book. The domiciliary care service would be involved in the case conference to discuss issues such as use of items which may be considered restrictive such as bed rails. The Manager was confident that the risk assessments would be regularly updated. Key areas of direct and indirect limits to freedom were discussed with the Manager and Service Manager, they were unaware of any of these areas being used within the service currently. If any of these areas were applicable to a service user this would be recorded either in the support assessment or care record book. The Manager stated that direct restraint was not used in the service. The service have a comprehensive policy on adult abuse/protection which covers the range of aspects of protecting vulnerable adults, reporting and responsibilities of staff. The local area inter agency adult protection guidance was available. Adult protection concerns raised within the service since the last inspection had been dealt with appropriately. All staff have received some training in adult protection and have interim written guidance to use whilst awaiting a full training place. There is a protection of vulnerable adults rolling programme of training planned and a place booked for all staff to attend. The service Manager had carried out a training needs analysis of each staff group within the service and identified training needs to meet the aims and objectives of the service. The Officers were able to view identified training needs from staff supervision notes. The training programme covered all the requirements defined in regulation. The Domiciliary care service and care at home service had a learning and development policy. The policy states aims and objectives, considers induction, supervision, continuous development and access to training. Training carried out through East Lothian Council is evaluated by a questionnaire given out at the end of each training session. Any external training is evaluated. Training is discussed at staff supervision and appraisal. Home care organisers observe practice of care workers directly and the service plan to further develop this method of evaluation. The previous inspection report recommended that a formal induction should be implemented for all new staff had been addressed by the Manager and the Service Manager. The Officers viewed the new documentation and the policy was awaiting approval to be implemented. This will be followed up at the next inspection. Although the service have had limited places to offer workers training in Scottish Vocational Qualifications (SVQ) the Manager anticipates the service will meet the deadlines of the Scottish Social Service Council (SSSC) to enable staff to have an appropriate qualification for registration. The service currently do not have a formal quality assurance system in place, however there are plans for a formal participation strategy to be implemented which will include service user evaluation questionnaires which are currently being developed. This will be monitored at future inspection. 9/13

A recommendation from the previous inspection report that the service consistently records the assessment of applicants' medical fitness to practice prior to the commencement of employment had been satisfied through corporate policy. Areas for Development The Manager agreed to provide guidance to staff which would offer information about the general responsibilities of staff in relation to child protection concerns. It was planned that this guidance would be available within the staff induction book. This development will be followed up at future inspections. It is recommended guidance for staff on direct and indirect limits to freedom are included within policy documents (Recommendation 1). It is recommended that the manager obtain and implement best practice guidance including: 'Rights, Risks and Limits to Freedom' and 'Safe To Wander' Mental Welfare Commission Best Practice Guidance and disseminate to all staff for discussion. (Recommendation 2). Feedback from staff questionnaires suggested that there may be some deficits in identifying changes in risk. The Manager acknowledged this finding and was currently implementing a system of supervised visits which may assist staff in obtaining advice from senior staff when urgent reassessment is identified. Progress with this development will be monitored at future inspections. No staff have received training in relation to restraint issues, assessment and recording. (Requirement 1) Although a staff training plan has been identified, staff through questionnaires given by the Care Commission have said there is a lack of training outwith mandatory training to meet the care of individuals with specific needs such as dementia, mental health problems, multiple sclerosis, and especially issues in relation to palliative care. Service users through the Care Commission questionnaires highlighted some deficits especially with new staff and agency staff being trained to meet their needs. (Recommendation 3) There was no formal gift policy for the service to guide staff if the event of being offered a gift from service users. (Recommendation 4) National Care Standard Number 8: Care at Home -Keeping Well - Medication (where help with taking medication is provided as part of the service) Strengths This standard was inspected in relation to one recommendation from the previous inspection report. Areas for Development 10/13

The previous inspection report recommended that a comprehensive medication policy should be written giving clear guidance and advice on policies and procedures regarding the administration of medication. Medication administration was discussed and the Manager and service manager who stated that the domiciliary care workers role is for prompting with medication only. Home helps do not prompt or administer medication. Staff were still unclear about their responsibilities in relation to administering topical medication and eye drops. This recommendation is carried forward in this inspection report. (Recommendation 5) National Care Standard Number 8: Housing Support Services - Expressing Your Views Strengths The Manager and Service Manager were currently exploring ways to obtain feedback about the service from service users and carers. The proposed quality assurance system will include facility for consultation with unpaid carers and service users' representatives. Most of the service users completing the Care Commission questionnaire were aware that they could make a complaint or comment to the service and would feel comfortable about doing so. The service had information about independent advocacy services which could be accessed by service users and were encouraged to do so. The service had provided all information requested to assist the participation of service users in the Care Commission inspection. Views and feedback from staff were obtained through questionnaires in regard to training, through staff supervision records and team meetings. The Manager acknowledged the difficulties staff face gaining updated information and were taking steps to address this. A system is being introduced to observe practice at least twice a year. This would provide an opportunity for unannounced visits too. The proposal includes that Home Care coordinators would observe the practice of care workers and a proforma has been produced to consistently record this visit which will be discussed as part of staff supervision. Areas for Development The previous inspection report recommended that as good practice a review of care should be undertaken for all service users at least once in a 12 month period. Currently home care organisers are not able to consistently visit service users, to review care and directly observe staff practice, unless a concern has been raised. This recommendation is carried forward in this inspection report. (Recommendation 6). 11/13

Enforcement There has been no enforcement action against this service since the last inspection. Other Information Two issues were discussed under other issues. 1. Domiciliary Care Staff through the Care Commission Questionnaires identified a need for mobile telephone contact with their supervisors. The Service Manager acknowledged these comments and said that although budgetary limitations prevent issuing all domiciliary care workers with mobile telephones consideration would be given to how to address communication issues and risk management of individual situations. 2. The role and remit of the Discharge response team was discussed as part of this inspection. The discharge response team are responsible for care at home for the first six weeks after discharge from hospital, they also have a rehabilitation remit. The service have separate aims and objectives and are managed by a separate Manager. This will be followed up through separate correspondence and reported in the next inspection report. Requirements 1. Staff must receive appropriate training, assessment and record keeping associated with restraint and the wider aspects of this such as indirect limits to freedom. This is in order to comply with SSI 2002/114 Regulation 13 - a requirement that a provider shall having regard for the size and nature of the service, the statement of aims and objectives and the umber and needs of the service and ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform. This also takes into account National Care Standards Housing Support Services: Standard 3 Management and Staffing arrangements Recommendations 1.It is recommended guidance for staff on direct and indirect limits to freedom are included within policy documents. This takes into account National Care Standards Housing Spurt Services: Standard 3 Management and Staffing arrangements 2. It is recommended that the manager obtain and implement best practice guidance including: 'Rights, Risks and Limits to Freedom' and 'Safe To Wander' Mental Welfare Commission Best Practice Guidance and disseminate to all staff for discussion. This takes into account National Care Standards Housing Support Services: Standard 3 Management and Staffing arrangements 3. It is recommended that the non mandatory training needs identified by individual members of staff inform the training needs analysis and a programme of training to address these is developed and implemented. This takes into account National Care Standards Housing Support Services: Standard 3 Management and Staffing arrangements. 4. It is recommended the service formulate and implement a formal gift policy to provide staff with guidance should they need to refer to it. This takes into account National Care Standards for Housing Support Standard 4: Management and Staffing arrangements 5. It is recommended that a comprehensive medication policy should be written giving clear guidance and advice on the policies and procedures regarding the administration of medication including the administration of topical medication and eye drops. This takes into 12/13

account National Care Standards Care at Home: Standard 8 Medication. 6. It is recommend that a system to ensure regular direct observation of staff practice should be developed and implemented. This takes into account National Care Standards Housing Support Services Standard 2 Management and Staffing Arrangements. Julie Tulloch Care Commission Officer 13/13