Homecare Support Support Service Care at Home 152a Lower Granton Road Edinburgh EH5 1EY

Homecare Support Support Service Care at Home 152a Lower Granton Road Edinburgh EH5 1EY Type of inspection: Unannounced Inspection completed on: 19 December 2014

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 14 4 Other information 31 5 Summary of grades 32 6 Inspection and grading history 32 Service provided by: The Human Support Group Limited Service provider number: SP2011011650 Care service number: CS2011299339 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 Homecare Support, page 2 of 33

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 3 Adequate Quality of Staffing 4 Good Quality of Management and Leadership 3 Adequate What the service does well Feedback from clients was that the direct care from their regular home care worker was of a good standard and that the carers carried out their work in a caring, competent and professional manner. The service provided a local office with training resources. The manager recognises that staff need to have training to help them in their work and has arranged for staff to undertake a training course to help them understand more about dementia. What the service could do better The service needs to find ways to gather feedback from more clients and tell clients how their ideas have been used to improve the service. Strengthening quality assurance systems could have a significant impact in further improving outcomes for people who use the service. What the service has done since the last inspection Since the last inspection the service continues to improve how it organises and delivers the service. Homecare Support, page 3 of 33

Conclusion Homecare support provides a care at home from committed staff. Inspection report continued In the majority of cases the care is provided to clients by a small team of carers who know their needs well. The service remains committed to building the number of clients slowly to enable them to maintain the standard of service. We found the management team and staff focused on making improvements and were open to ideas and suggestions from clients and staff. We were satisfied that those we saw managing and delivering the service were caring. The service should complete their planned improvements, as well as those we have highlighted in this report, to ensure that good all clients served by the service achieve good outcomes in accordance with their needs and wishes. Homecare Support, page 4 of 33

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate." Homecare Support was registered in February 2012 and is an independent provider of home care based in Lower Granton Road, Edinburgh. Homecare Support is part of The Human Support Group, an established provider of homecare in England. The management team consists of a General Manager, Operations Manager; Recruitment Manager and two co-ordinators. The service currently has 32 staff and delivers approximately 800 hours of care weekly. The aims of the service are to 'foster an atmosphere of care and support which both enables, empowers and encourages service users to live as full, interesting and independent a life style as possible, with the scope and duration of our service provision being kept to a minimum, in line with the agreed plan of care' The services' work is mainly contracted from Edinburgh City Council. The service also provides care and support to service users through Direct payments. Homecare Support, page 5 of 33

Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate 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. Homecare Support, page 6 of 33

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 Inspector made an unannounced visit to the office base of the service in Granton to start the inspection on 1 December 2014 between 3pm and 5.30pm. We made a further office visit on 4 December and on the 19 December 2014 when we gave feedback to the manager and recruitment manager. As part of the inspection we visited six clients in their own homes and met with two carers while they carried out their work. We also sent out 60 care standard questionnaires to people who use the service and received 23 responses. An Inspection volunteer spoke with seven people who use the service by telephone. An Inspection volunteer is a member of the public who volunteers to work alongside the Care Inspectorate Inspector during the inspection. Inspection Volunteers have either used services or have been a carer for someone who has used services. The Inspection Volunteers role is to speak with people using the service and their families to gather their views from the perspective of someone who uses services. During the inspection we spoke with the manager, the recruitment manager, the training manager, the community liaison manager, a co-ordinator and three care staff. We also received six staff questionnaire responses. As part of the inspection we sampled the following: Care files Risk assessment documents Individual contracts/agreements How to make a complaint information for clients Newsletter Customer satisfaction survey procedure Comments, suggestions and complaints procedure Satisfaction survey analysis Employee rotas Medication policy Medication training Homecare Support, page 7 of 33

Medication assessment Medication audit documentation Induction programme Service User guide Safeguarding Vulnerable persons policy Team meeting minutes Staff files A sample of electronic records Local Authority Contract compliance information Inspection report continued 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 Homecare Support, page 8 of 33

What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that where deemed appropriate; service users and/or relevant carers are fully consulted and in agreement with all parts of the service users' care plans. In doing so, the service must ensure that there appropriate signatures are in place to evidence this. This is in order to comply with: SSI 2011/210 Regulation 5(2) (b) - Personal Plans. What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of care and support statement 1. The requirement is: Met - Within Timescales The requirement The service must ensure care plans contain adequate and accurate information relating to service users' needs in order for staff to be able to fully meet their needs. This should detail needs and preferences and set out how these will be met in a way that the service user finds acceptable. The provider must also ensure that, risk assessments reflect all relevant and up to date information. Interventions recorded within the support plans should be written clearly to detail the level of support which was provided during the period of support. In doing so, acronyms should not be included unless there is a code depicting what the acronyms represent. This is in order to comply with SSI 2011/210 Regulation 4 (1) (d) - Welfare of users. What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of care and support statement 3. The requirement is: Not Met Homecare Support, page 9 of 33

The requirement The provider must ensure that all staff complete records appropriately in that entries are written at the time of any actions or interventions happening. This is in order to comply with SSI 2011/210 Regulation 15 - Staffing What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of care and support statement 3. The requirement is: Met - Within Timescales Inspection report continued The requirement The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 SSI 2002/114 Regulation 4(1)(b) Providers shall provide services in a manner which respects the privacy and dignity of service users by telling service users about changes to staff providing care. This is in order to comply with SSI 2011/210 Regulation 15 - Staffing Timescale: Within 14 days of receipt of this report. What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of staffing statement 1. The requirement is: Not Met The requirement The service must ensure that where issues have been raised within the reference forms, clear records are kept of what further discussions or investigations took place as a result. This is in order to comply with SSI 2011/210 Regulation 9(1) - Fitness of employees Timescale for implementation: Within 24 hours of receipt of this report What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of staffing statement 2. The requirement is: Not Met The requirement The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 SSI 2002/114 Regulation 4(1)(a) Providers shall make proper provision for the Homecare Support, page 10 of 33

health and welfare of service users by ensuring that they have appropriate quality assurance systems in place. Timescale for implementation: Within 16 weeks of receipt of this report What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of management and leadership statement 4. The requirement is: Not Met Inspection report continued The requirement The provider must ensure that the service is provided at the agreed times, and in such a way that it meets the identified needs of the service user as recorded in the agreed support plan. This is in order to comply with The Social Care and Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Scottish Statutory Instrument 210, Regulation 3, a Regulation relating to the main principles to be promoted by providers and services and Regulation 4(1)(a) a Regulation regarding the welfare of service users. In making this requirement account has been taken of the National Care Standards for Care at Home; Standard 4 (6): Management and staffing. What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of management and leadership statement 4. The requirement is: Not Met The requirement The provider must ensure that there are enough staff on duty at all times to meet the assessed needs of the service users as detailed in their agreed individual support plans. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Scottish Statutory Instrument 210 regulation 15 Staffing - A provider must, having regard for the size and nature of the service, the statement of aims and objectives and the number and needs of service users (a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. Homecare Support, page 11 of 33

What the service did to meet the requirement The providers actions and the evidence for our judgement is described in quality of management and leadership statement 4. The requirement is: Met - Within Timescales Inspection report continued What the service has done to meet any recommendations we made at our last inspection Eight recommendations were made at the last inspection. Five have been met and three have not been met. Our findings at this inspection are explained within this report and a summary is provided below. 1. The service should continue to develop methods of involving service users and relatives in assessing and improving the quality of care and support, staffing and management and leadership within the service. This should include methods to demonstrate how suggestions and concerns raised had resulted in positive outcomes for service users. NOT MET. 2.The service should consider developing a more local survey as a way of capturing peoples' views in a quicker and more relevant manner. MET. 3. Spot check forms for staff should be fully completed in that carers comments should be recorded within the relevant section of the form. MET. 4. A cross-reference of the PVG number should be kept within staffs' locally kept recruitment files. MET 5. Personal development plans for staff should be fully introduced and established to demonstrate how staff performance is assessed and how additional targets and training needs are supported. NOT MET 6. Supervision records should be fully completed to clearly reflect discussions held between the supervisor and supervisee. NOT MET 7. Records should reflect the current good practice of establishing staff competencies during training sessions. MET 8. Staff meetings should reflect names of attendees. The minutes of staff meetings should also reflect engagement by staff during the meetings. MET 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 Homecare Support, page 12 of 33

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. We received a self assessment document from the provider. This was submitted in March 2014. During the inspection we found that some of the changes planned to allow the service to progress with their improvements had been delayed. Although the changes were still planned they had not yet had an effect on outcomes for clients. Taking the views of people using the care service into account Over 100 people use this service. We issued 60 questionnaires and received 23 responses. We tried to telephone 17 clients who had supplied us with their telephone number and we were able to speak with seven. We also spoke with six clients when we made visits with the home carers. Overall most people we spoke with were happy with the service. Some told us how the service could be improved. Some clients said that they were just happy to receive any service because they would have difficulties managing at home without it. One quote from a client illustrates the kind of views expressed to us. 'No, they don't come on time, they are often 15 mins to one hour late, and I am depending on them to get dressed. It disrupts my day but I just have to wait and see if someone is going to come. I rarely get a phone call notifying me of lateness. I am just grateful to get the help, so I just sit and wait until someone comes' We have used the views expressed to us throughout this report. Taking carers' views into account We met one family member during our visits to clients. We spoke with two family members by telephone and noted that some of the care standard questionnaires had been completed by relatives on behalf of clients. We have used the views expressed to us to inform this report. Homecare Support, page 13 of 33

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: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths In order to assess this statement we looked at the services relevant policies and procedures. We also looked at the results of the last customer satisfaction survey and how the comments raised had been responded to. We took into account the information we saw in clients' homes and what people who used the service and their families told us during the inspection. We also listened to the views of staff. We found that the service continued to provide good opportunities for clients and their families to participate in assessing and improving the quality of care and support. We found that these methods suited more able clients. The manager had also recognised this. We have outlined the managers plans below and have made some further suggestions in areas for development. Each client had a service user guide which contained a range of useful information about their rights, the standards and quality of service promised by the service and details about how to make a complaint. This guide also contained contact details, so that people who wished to could contact the managing director of the company and the Care Inspectorate directly. There was clear guidance for staff in how to respond to complaints. We saw that complaints were responded to. We also saw that where positive comments were sent, in the form of cards and letters, that these were shared with staff. The services policy said that customer satisfaction surveys should be sent out twice a year. The most recent survey results available were from April 2014. We found that the results from this survey had been collated. Homecare Support, page 14 of 33

Thirty five clients had responded. The majority of the comments were positive. Each client who gave their details was telephoned by the manager and thanked for taking part. Where clients made suggestions for improvement we saw the action that manager took to address some of these. At the last inspection we had recommended the survey results were collated and actioned locally so that the service was more responsive to comments made. The actions from the April 2014 survey demonstrated to us that this had been carried out and we have met the recommendation. Each client had the opportunity to comment on the service at six monthly care review meetings. This gives clients the opportunity to discuss how the delivery of care and support affects their individual circumstances. We saw that care reviews were carried out and there was a system to alert the coordinator when they were due. In the client files we sampled we saw that the care plan had been signed by the client or their representative. At the last inspection we made a requirement that appropriate signatures should be in place to evidence client consultation and agreement with their care. Our sample indicated that the service had met this requirement. The manager recognised that the current ways for people to make suggestions about the service did not offer all clients the opportunity to comment on the service. This is because some clients cannot fill in questionnaires or access a telephone. A new post had been developed. A community liaison manager would visit clients in their homes and part of the role would be to gain views about the service. At the time of the inspection an appointment had been made for this role but it had not yet been fully established. We will report on the outcome for clients of this appointment at future inspection. The service had sent out a newsletter to clients twice a year but had hoped to increase this to four times a year. This would help to keep clients up to date with changes in the service and feel involved and informed. Quality assurance visits or 'spot checks' were made. These could be used more effectively to offer clients the opportunity to comment on the service they received. Overall we found that the service needs to continue to offer a range of ways for clients to be involved in participating in assessing and improving the quality of care and support provided. These opportunities need to be expanded and developed to ensure all clients can contribute regularly. Areas for improvement While the service user guide available in the office was comprehensive and appropriate, we saw that in some clients' homes the wrong document had been provided. This referred clients to the English regulator and contained incorrect information for Scotland. When we spoke with these clients they said if they had a complaint they would phone the office and had been given contact numbers for this. We have made a recommendation, see recommendation 1. Homecare Support, page 15 of 33

Although the results of the last customer satisfaction questionnaire had been collated and responded to on an individual basis, we thought that more could be done to report back to clients a picture of the overall findings and any emerging themes and actions. We discussed how the service could use their newsletter, as one example, of how to do this. In the services client survey there had been comments made about improving cooking skills and that clients preferred carers who had experience of care work. It was not clear from the action plan whether these had directly influenced staff training or recruitment within the organisation. Using client comments to influence the wider systems and processes within the organisation could improve the services performance in participation. We made a recommendation at the last inspection which we have made again. See recommendation 2. We have made further comment about this in quality of management and leadership statement 4. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. 1. It is recommended that the service check each client has the correct service user guide for Scotland which contains accurate information about complaints and the regulator. This takes account of National Care Standards Care at Home Standard 1 Informing and deciding and Standard 11 Expressing your views. 2. The service should continue to develop methods of involving service users and relatives in assessing and improving the quality of care and support, staffing and management and leadership within the service. This should include methods to demonstrate how suggestions and concerns raised had resulted in positive outcomes for service users. This takes account of National Care Standards Care at Home Standard 1 Informing and deciding. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We did not look at all aspects of health and wellbeing during this inspection. In order to assess this statement we looked at care files in clients' homes, risk assessments and the medication policy. We also visited clients in their homes and listened to what clients said about their care. We also spoke with relatives and staff. The support we saw was carried out in a caring and understanding way. Staff were compassionate and treated clients with respect, checking on health and wellbeing. Homecare Support, page 16 of 33

From the records we viewed we saw that home carers who had concerns with the health and wellbeing of clients sought advice from the office and made referrals to health care professionals. We found there was an electronic call monitoring system in place which allowed the timing and consistency of visits to be monitored. Staff used clients' telephones to log in at the start of a visit and log out on completion of the visit. Alternative arrangements were in place for when clients were using the telephone during the visit. During our inspection we found there was good support from the office base when a client did not answer the door. We sampled Homecare Supports medication policy and found this was used to inform staff practice. All staff had been given medication training during their induction. Staff also completed shadow shifts with a more experienced home care worker to ensure they were competent and confident in providing care and support. Where medication was part of the agreed care and support, there was a medication risk assessment in place. We saw that staff followed the medication policy during our visit to clients' homes. We looked at six care plans and associated documents in clients' homes. We found that the plans we sampled had a comprehensive range of assessment information in place with associated risk assessments. Clients had a written agreement about what was being provided and the times of the agreed visits. Clients had signed their agreements and care plans which suggest they were involved in the assessment. At the last inspection we made a requirement about record keeping. This was because staff recorded their visit in advance of care delivery. At this inspection we saw that this had been addressed and staff completed care records at the end of their visit. This requirement has been met. For the clients we visited we found they were supported by the same small group of carers. The carers knew the clients well and explained who would be supporting them when the carers had days off. In these cases the service worked well. We sent 60 care standard questionnaires as part of the inspection. We received 23 responses. Twenty one of the clients who responded to us said they strongly agreed or agreed that they were overall happy with the quality of care and support this service gives. One person disagreed. Some of the positive comments we received included: 'The carers are very helpful', ' On the whole the standard of care is good, but some carers are quite untidy', 'I am very happy with the care I get when they come to my house, they have time to talk to me and put me at my ease and I am so grateful for that', Homecare Support, page 17 of 33

'I like having my regular carers as they understand my needs. Sometimes I get cover carers and I find it more difficult', 'At times I am happy with (the service), but times of day they call can vary a lot which is not supposed to happen', We also spoke with seven clients or their representative on the telephone. Areas for improvement Inspection report continued Comments from clients to us and in the services own survey were that clients would like to be notified when their carers were changed either because of a planned or due to unplanned sickness or delay. Clients who had different carers regularly made comments that they would like more continuity of carer. Some clients said they would like the carers to come at the time stated. We heard that the service works well for some but not all clients and that unplanned absences could upset the quality of the service being delivered because staff were late or not the usual carer. The service should look at how it could build in contingency for unplanned absence and emergencies when organising and arranging staff rotas. This was subject to a requirement from regulatory activity and is discussed further in quality of management and leadership statement 4. When we visited one clients home we noted that one of their medications, used to relieve pain, had run out and they did not receive it for several days. We saw that the carers had made contact with the relevant G.P. and pharmacist to try to resolve the matter. While this was due to an error in supply, because the carers did not record the quantity of medicines when received and ensure enough was supplied, the error was not identified before the medication had run out. This meant that the client was without essential medicines for several days which affected how easily they could move around. Checking quantities of medication supplied was not specified in the medication policies and procedures. We have made a requirement. See requirement 2. At the last inspection we made a requirement about lack of consistency and clarity in direction given for staff in support plans. Our sample found examples of this remained at this inspection. In one file there were two entries about personal hygiene which contradicted the level of support the client needed. The care plans lacked detail in how the support and interventions should be carried out. Some carers wrote informal notes. These were to assist carers who were not familiar with the client to try to ensure all their needs were met. We discussed care planning with the carers and the management team. At feedback we heard that based on our feedback, steps had already been taken for the carers to provide the individualised and personalised information for care plans on a more formal basis. The manager said that the new community liaison manager role would help to bridge the gap. This is a positive step. We have left the requirement in place and will monitor the outcomes for clients at the next inspection when the system has been fully implemented. See requirement 1. Homecare Support, page 18 of 33

Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 0 Requirements Inspection report continued 1. The provider must ensure care plans contain adequate and accurate information relating to service users' needs in order for staff to be able to fully meet their needs. This should detail needs and preferences and set out how these will be met in a way that the service user finds acceptable. The provider must also ensure that, risk assessments reflect all relevant and up to date information. Interventions recorded within the support plans should be written clearly to detail the level of support which was provided during the period of support. This is in order to comply with SSI 2011/210 Regulation 4 (1) (d) - welfare of users. Timescale: To commence on receipt of this report and be achieved by 30 May 2015. 2. The provider must ensure where they service have taken responsibility for medication that clients receive their medication as prescribed. Staff should be aware of how to check and record that sufficient medication has been supplied. This is in order to comply with SSI 2011/210 Regulation 4 (1) (d) - welfare of users. Timescale: To commence on receipt of this report. Homecare Support, page 19 of 33

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 had developed a number of ways to seek clients and carers' views. These could be used to comment on the quality of staffing. These methods are described under Quality Statement 1.1 Some clients we spoke with who had regular carers said they knew who was coming to deliver their care and were happy with the arrangements made. 'I get the same people all the time, they always come in'. At the last inspection we asked that clients comments about the service should be recorded within the relevant section of the 'spot check' form. We were told that this was completed unless the client had chosen not to make a comment. When this was the case the clients 'wish not to comment' was recorded in the relevant section of the form. We have met this recommendation. We also noted that the development of a community liaison manager role was planned to improve this, and other quality assurance processes. Areas for improvement Some clients made comments to us that they did not always know who would be coming to help them with their personal care. 'Staff just turn up, it is different staff all the time', 'I don't normally know who is coming in, I get lots of different staff all the time', 'I just guess who is coming in or the staff member who is in might tell me who is coming in at the next visit. I do not get any paper format of who is coming on shift', 'I get the same people but if there was sickness I wouldn't know'. One quote from a client illustrates the kind of views expressed to us and why some clients do not make a complaint. 'No, they don't come on time, they are often 15 mins to one hour late, and I am depending on them to get dressed. It disrupts my day but I just have to wait and see Homecare Support, page 20 of 33

if someone is going to come. I rarely get a phone call notifying me of lateness. I am just grateful to get the help, so I just sit and wait until someone comes' Clients we spoke with said they were not routinely informed if a different carer than expected was sent to help them. We made a requirement about this at the last inspection which has not been met and we have made the requirement again but have not reduced the grade at this inspection. This is because the manager told us that planned changes to how the office is run and managed should improve the services capacity to let clients know in advance who will be caring for them. See requirement 1. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 SSI 2002/114 Regulation 4(1)(b) Providers shall provide services in a manner which respects the privacy and dignity of service users by telling service users about changes to staff providing care. This is in order to comply with SSI 2011/210 Regulation 15 - Staffing Timescale: Within 14 days of receipt of this report. Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths Inspection report continued In order to assess this staff recruitment we looked at the recruitment of staff procedure, spoke with the recruitment manager and looked at four staff files including new staff members. Overall we found the service had a good systems and processes for recruiting staff. The service had a recruitment manager who was familiar with the company policies and procedures and had access to specialist human resource and legal advice. The recruitment policy included the completion of an application form and a face- toface interview. This ensures that employers can properly examine the competency, experience, qualifications and attitude of potential staff. Staff are employed on a three-month probationary period to ensure they are suitable for their role. At the last inspection we noted that staff files did not record whether a Protection of Vulnerable Groups (PVG) check had been carried out or the unique reference number Homecare Support, page 21 of 33

to evidence this. During this inspection we noted that a system had been set up which provided evidence that the appropriate checks were carried out. We have made a further suggestion on how the service could document this to help make the record clearer. We have met this recommendation. Areas for improvement Although the services recruitment procedures were good, we found that staff files varied in the detail with which they were completed. For example employment gaps information was not completed. This was discussed with the manager and recruitment manager. During the inspection we signposted the service to best practice in recruitment by Scottish Government (formerly Scottish Executive 2007) Scottish Safer Recruitment through Better Recruitment: Guidance in Relation to Staff Working in Social Care and Social Work Settings. This will help the employer to not only meet existing standards but move beyond these.the recruitment manager had read the document by the time of our feedback and had agreed to look at the recruitment practices taking into account best practice. At the last inspection we made a requirement that where there were issues from the recruitment process, such as unfavourable or insufficient references that clear records were kept. These should include records of any further discussions and the decisionmaking process which has led to employment. This is because the onus is on the employer to make an assessment of a person's suitability to enter the workforce. When we looked at records we found the recording and evidence of this was still missing. We have reworded this requirement to reflect our findings at this inspection, see requirement 1. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. 1. The service must ensure that where issues have been raised within the reference forms or through the recruitment process, that clear records are kept of what further discussions or investigations took place as a result. This is in order to comply with SSI 2011/210 Regulation 9(1) -Fitness of employees Timescale for implementation: Within 24 hours of receipt of this report. Statement 3 Inspection report continued We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Homecare Support, page 22 of 33

Service strengths Inspection report continued In order to assess this statement we looked at staff files, the induction programme and some training information. We also spoke with staff and used the views expressed to us in the staff questionnaire responses. The service employs 60 staff on a range of contracts. We issued twenty staff questionnaires and received 6 responses. We also spoke with staff who are mostly office based and carers in the field. Staff told us that they had received induction training before working with clients. We saw that all new staff received training which included: Information about the organisation Scottish Social Services Council codes of practice National Care Standards Dress code Understanding the principles of care Care plan and documentation Staff also received training in health & safety, moving and handling, fire procedures and food handling in accordance with their experience. In addition all home carers attended training in medication, first aid, cardiopulmonary resuscitation and adult protection. All six staff who returned questionnaires said they had received training in the last 12 months and some staff said they were provided with opportunities to gain qualifications. The manager told us that she is aware that all staff will need to achieve a suitable qualification, such as a Scottish Vocational Qualification (SVQ), to enable them to register with the Scottish Social Services Council (SSSC). The register will open for workers in care at home services in 2017. We could see that some staff were being supported to achieve a suitable qualification. The service had a dedicated member of staff who organised and delivered staff training. A training room was available at the Granton office base and hoists and other pieces of equipment were available for practical training. We spoke with the manager about the Scottish Government's Promoting Excellence Framework. This is a training programme provided by the NHS and Scottish Government to promote an understanding of dementia in the wider community, but also to ensure that all staff working with social care are trained to an appropriate level in dementia care.the staff trainer had recently completed a facilitators course which would allow her to help staff complete a training course in dementia care. The manager said the course was suitable and all staff would be expected to Homecare Support, page 23 of 33

complete it. The first group of care workers were due to start the course in January 2015. We will monitor the progress with this at future inspection. We saw that there were opportunities for staff to apply for promotion within the company and they were encouraged to develop their skills to enable them to do so. We saw that there had been two group supervision session held in August 2014. This was in relation to a specific issue rather than a staff meeting. From the minutes we saw that attendees were recorded and a record was kept of staff engagement. We have met a recommendation we made about recording meetings at the last inspection. At the last inspection we made a recommendation that records should be kept when staff competencies were checked following training. We looked at the medication training assessment document and spoke with the manager and recruitment coordinator who said this was now in place. The recommendation we made about this at the last inspection is met. We observed two care staff working with clients in their homes. Staff were relaxed and professional in their approach and had a good relationship with clients. Staff demonstrated knowledge and understanding of the clients needs and reported concerns appropriately. The clients spoke highly of the staff and appeared comfortable with them. Areas for improvement Inspection report continued Some staff employed were new to care. In order to support all staff and ensure they were equipped for their role the service had a system for continuous personal development. Its purpose was to extend staff skills, knowledge and understanding and was designed to be part of supervision and appraisal meetings. At the last inspection we made a recommendation that this system should be fully implemented. We sampled four staff files only one had a personal development plan. In this case the plan had not been completed. The manager said staff kept their personal development plan. While we recognise that this ensures staff take responsibility for their personal and professional development, there was no record of how this was being supported by the organisation.this recommendation is carried forward in this report. See recommendation 1. At the last inspection we found staff supervision records lacked detail. Most but not all staff said they received supervision. We viewed staff supervision records which were recorded electronically. We found that 9 staff had received a group supervision in May 2014 and 14 staff in August 2014. Some staff had not received an individual supervision session since January 2014. Supervision sessions were part of the ongoing staff development and appraisal system and were expected to take place regularly. From the 54 electronic records of supervision sessions we viewed there was a one or two-line entry. This did not reflect that a two-way discussions had taken place or Homecare Support, page 24 of 33

what actions had been taken by the supervisee as a result of the meeting. We have made the same recommendation again. See recommendation 2. Staff meetings were scheduled to be held every six months. Staff said staff meetings had not been happening recently. Staff meetings are an important way for staff to share information and raise matters with their employer. See recommendation 3. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations Inspection report continued 1. Personal development plans for staff should be fully introduced and established to demonstrate how staff performance is assessed and how additional training needs are supported and targeted. This takes account of National Care Standards Care at Home Standard 4 Management and Staffing. 2. Supervision records should be fully completed to clearly reflect discussions held between supervisor and suprervisee. Records should clearly demonstrate what action has been taken as a result of the supervision meeting. This takes account of National Care Standards Care at Home Standard 4 Management and Staffing. 3. Staff meetings should be held regularly and staff should be able to contribute to the agenda. This takes account of National Care Standards Care at Home Standard 4 Management and Staffing. Homecare Support, page 25 of 33

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 had developed a number of ways to seek clients and carers' views. These could be used to comment on the quality of management and leadership. These methods are described under Quality Statement 1.1 The planned service user forum had not been established. The manager was looking at other ways to gain the views of clients and their families. It was hoped that the community liaison manager role would give an opportunity for clients and families to say directly how they felt the service was run. We look forward to reporting on the outcome of this at future inspection. Areas for improvement The areas for development identified in quality of care and support statement 1 are also relevant for management and leadership. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 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 In order to grade this statement we took into account all of the ways that clients, families and staff can assess the quality of the service. We also looked at how feedback from other stakeholders was used. We used all of our other findings and our feedback from clients. We found that the service continued to perform at an adequate level. We found that the strengths we identified, such as where consistent carers were provided and care Homecare Support, page 26 of 33

packages were well established, there was a positive impact on the quality of the service. However the quality assurance methods currently in place are not being fully implemented and this is constraining the overall performance of the service. We found that the service are subject to compliance monitoring from the local authority, City of Edinburgh Council, who contract their services. We made contact with the contract department. There was evidence that Homecare support responded positively to enquiries and opportunities to make improvements for clients which were suggested and the contracts department had no concerns at the time of our enquiry. Records were kept of accidents and incidents and we could see that the manager had oversight of these. Notifications of particular events were made to the Care Inspectorate by the manager as they are required to do by law. An electronic reminder system was in place to remind the co-ordinators when care reviews were due. This ensures that the service regularly checks that clients needs are being met. Spot check visits were carried out by senior staff as a way of ensuring a quality service was being delivered. We noted that these focused on for example, the appearance of care staff, and did not fully use the opportunity to get feedback from clients about their outcomes of care. Staff said they did not take place as frequently as they would prefer. Currently senior staff fit spot checks in where they have space to do so. The manager said that the community liaison manager would be able to improve the quality assurance systems because this would make up the primary function of the role. Following a complaint made to us in 2013 we made two requirements, The provider must ensure that there are enough staff on duty at all times to meet the assessed needs of the service users as detailed in their agreed individual support plans. This was in relation to one carer being provided when two were needed to provide appropriate care and support.from our sample and our discussions with clients and staff we did not find other occasions when this had happened. During our inspection we saw that coordinators would arrange for staff, or support care staff themselves, where two carers were needed in the event of unplanned staff absence. This requirement is met. The second requirement is described in areas for development. Homecare Support, page 27 of 33