Capability Scotland - Community Living and Family Support Services (Dundee) - Care at Home Support Service Care at Home Anton House Ogilvie Centre 5 Forthill Road Broughty Ferry Dundee DD5 2JT Telephone: 01382 737238 Inspected by: Karen Penman Type of inspection: Unannounced Inspection completed on: 6 May 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 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Capability Scotland Service provider number: SP2003000203 Care service number: CS2004076834 Contact details for the inspector who inspected this service: Karen Penman Telephone 01382 207200 Email enquiries@careinspectorate.com
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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well This service continues to provide high quality support for people who use it. Staff appear highly motivated and work in partnership with people who use the service and their families to agree personalised plans of care and support. What the service could do better The manager should ensure that the results of any consultation are shared with people who use the service their families and stakeholders. What the service has done since the last inspection The management team have developed their procedure for observing staff practice. This now included observation of staff supporting people during activities in the local community. Conclusion The manager and their staff team are committed to the ongoing development and improvement of the service. It was clear during our inspection that the service puts the person first when planning care and support. Choices and changes to support were constantly monitored in order to provide person centred support. Who did this inspection Karen Penman
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. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards. - 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 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Capability Scotland - Community Living and Family Support Services (Dundee) provides a Care at Home service. The service is available for children and adults with physical and/or learning disability living in their own homes and in accessing community facilities. The aim of the service is that adults who have physical and/or learning disabilities should be fully included within society. They should have the opportunity and support through skills and services to maximise their independence and choice. The values underpinning the aims and objectives of the service are clearly laid out in the vision, values and mission statement of the organisation. We were informed that people using the service wished to be addressed as customers. We have respected this choice within our inspection report. At the time of our inspection the service was supporting 69 customers. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good
This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices.
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We compiled this report following an unannounced inspection. The inspection was carried out on 28 April, 01 and 02 May 2014. Feedback was provided to the manager of the service on 06 May 2014. During the inspection we gathered evidence from a variety of sources including; We spoke with the manager and two team leaders. We also spoke to two Community Living Assistants. We observed other staff supporting people who use the service. We spent time talking to three people who used the service and two family members. Prior to our inspection we received thirteen completed Care Standard Questionnaires from people who used the service and their families. we also received five questionnaires from staff. We looked at a range of documents and records including; Ten Personal plans and relevant risk assessments, protocols and guidelines. Minutes of reviews Customer meetings (People who use the service) Accident and Incident Records Activity recording sheets Customer feedback forms Minutes of staff supervision meetings and annual appraisals Minutes of staff meetings Staff training Records of various audits Contract monitoring meeting minutes Results of consultation exercises.
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
What the service has done to meet any recommendations we made at our last inspection We made one recommendation at our previous inspection in relation to developing the procedure for staff observation. The manager provided evidence that this had been addressed. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The 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 provider identified what it thought the service did well, some areas for improvement and any changes it had planned. Taking the views of people using the care service into account We spoke with a number of people who used the service during our inspection. People told us that they were happy with the support they received. Some of the comments we received included; 'I very much like going out with CLA's' 'I know many people through using the service' 'I know how to make a complaint. ' 'I attend customer meetings where myself and fellow customers can "have our say"' 'I can change my hours of support if I want.' 'I have pictures to help me understand information.'
Taking carers' views into account Inspection report continued We spoke with some carers during our inspection. We also received feedback from carers through our care standard questionnaires. Some of the comments we received were; 'Capability is a life saver for us and our children. Because of their support we can have time with our other children.' 'Our (relative) loves going to capability and looks forward to it every week' 'The service has always been excellent.' 'Staff know my (relative) well and are tuned into their moods and feelings.'
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: 5 - Very 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 We considered a range of evidence presented in relation to this statement. We assessed the service to be operating at a very good level of performance. The Provider had a range of methods that it used to consult with people. Some of the methods we saw were; - The Provider had a Service User Involvement procedure. This described how Capability Scotland will gather views of people who use their services. The procedure says that they will check how services are performing every two years. The last consultation had taken place in 2011. The manager had realised the delay in a further consultation. As a result, the manager had developed a questionnaire for people who used the service and their families which had been sent to people in October 2013. The results were being collated into a report which would be sent to people who responded so that they could see what people said about the service and what actions had been considered. - Personal plans had been developed which reflected the views and opinions of people who used the service and their families. We saw that the annual review of personal plans recorded what people liked about their support and what they might like to change. We saw examples where people who used the service discussed their care and support with a staff member in preparation for their review meeting. This helped people to prepare for their meetings to make sure that their opinion was considered.
- Following each activity, staff used 'Activity report' sheets to record their contact with people who used the service. This information was shared with families and carers who were asked to sign to confirm that they agreed with the information. This provided an opportunity for people to express their views and opinions about the support provided and to make suggestions for future support. - Capability Scotland continued to promote a 'Have your Say' (HYS) forum where people who used the service could make suggestions for improvements and developments. Some people attended regular meetings with representatives from other Capability Scotland services. This gave people the opportunity to hear what was happening in other areas and take this back to their own service to consider. People could also complete or be supported to complete a 'Have your say' request form. One person told us that they had used this format to request that a handrail be fitted in the lift in the office base. They told us that this had happened quickly and this was a big help to them and to others that used the service. - An Investigation Request System (IRS) was another example of how people who used the service, staff and stakeholders could make suggestions for improvements or developments. An IRS form could also be completed in response to suggestions and comments from stakeholders, staff and families. We saw that this format had been used to initiate reviews of policies and procedures as well as improving services for people who use them. For example, a staff member supporting someone to the local swimming pool, noticed that the only alert that wave machines were starting was a verbal announcement. This may present a problem for people who have a hearing impairment. Capability Scotland raised this with the local swimming pool and a flashing light alert was installed. This was a very good outcome for people who used the service and for people living in the wider community. - A local advocacy group had facilitated meetings with people who used the service. This had provided a forum for people to discuss the service without staff present. The manager had reviewed this method recently and had identified that people who used the service were more comfortable speaking to their regular staff who they knew well. Advocacy services continued to be available to people, however the manager was developing further methods for people to have their say and meetings continued to be facilitated by staff.
- People who used the service were asked to tell the staff what hours of support they would like. This information was asked for every four weeks so that the team leaders could arrange staff rotas to accommodate requests as far as possible. At this time, people who used the service were also given the opportunity to make suggestions for improvements or developments and to make comment about staff. Nominations for CLA (Community Living Assistant) of the month came through this format. It was good to see that various staff had been nominated and that people had explained why they thought staff deserved this recognition. For example, some staff had been nominated for the following reasons; 'customer focus and enthusiasm' 'good communication skills and being very helpful' 'supporting and developing communication methods' Areas for improvement Personal plans had been reviewed at least once in every six months. In some examples it was difficult to see how peoples views had been considered and recorded. We discussed this with the manager during our inspection and they identified how this could be developed and improved by creating a standard approach to the reviews of personal plans. The format that is used to ask people what hours of support they would like asks people for any suggestions they may have to develop and improve the service. It isn't clear from the information on the form that this format could be used to review personal plans. The manager planned to review this form to make this clearer. The results of the consultation in October 2013 was being collated by head office. We discussed the length of time that this had taken and the manager told us that they planned to write to people to give them feedback about what people had said and any improvements that had taken place as a result. We also suggested that the letter could provide further information about the many methods that were available to people to express their views and opinions Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We considered a range of evidence presented in relation to this statement. We assessed the service to be operating at an excellent level of performance. The service had a strong customer focus and it was evident that the people who used the service were central to the planning of their care and support as well as the development of the service. We thought this because; - Personal plans had been developed with people and their families that were reflective of what was important to them. Goals and outcomes were agreed that supported people to pursue their interests and hobbies, participate in appropriate exercise and enjoy volunteering and educational opportunities. One person we spoke to volunteered in a shop, supported by staff. They told us that this 'made them feel good'. - Risk assessments and care plans had been developed to support the personal plan and helped to ensure that risks were assessed and steps taken to minimise any harm to people. This helped people to maintain their independence and to develop new skills. - People who used the service enjoyed a range of activities and opportunities. For example we observed a zumba activity during our inspection. This was a regular event and was attended by many people who used the service as well as people from the wider community. This provided an opportunity for people to meet friends regularly. We observed a lively session which people who used the service and staff appeared to be enjoying. - A range of talks and visits from other agencies were arranged by the staff to provide information and advice for people who used the service. For example, the fire service were presenting a talk on fire safety at home. People we spoke to during our inspection were looking forward to this and told our inspector how this would help them in their homes. - We saw that some people who use the service had attended an event on Adult support and protection. Some of the feedback following this event included; 'It was telling you how to stick up to bullies...it was brilliant.' 'It was about people being nasty and that is wrong.' 'people should report this right away.' Inspection report continued
We thought that this had been an excellent opportunity for people who used the service and had been presented in a way that people could understand what should be reported and where they could go for further advice and support and being safe and protected from harm. - The staff team had received a range of training which included mandatory training such as health and safety, risk assessment, valuing people and adult support and protection. Further training was arranged to ensure that staff had the appropriate skills and knowledge to support people who used the service. For example Makaton and Autism awareness. - The service also provided a range of information for people who used the service and their families. For example information about activities organised by the service and in the local community, information about benefits advice and links to specialist advice and support such as autism awareness was all available from the service. - We spoke with a number of people during our inspection who told us that they liked being supported by the service. We also received completed questionnaires from family members prior to our inspection. We received comments such as; 'I very much like going out with CLA's (Community Living Assistants).' 'I can ask staff to come at different times.' 'I can speak to (staff member) if I am worried or upset.' - Family members told us that; 'The service has always been excellent... can't fault Capability Scotland.' 'Capability is a lifesaver for us and our children. Because of their support we have time with our other children.' 'Staff listen well to us' 'Staff understand (my relatives) needs really well.' Areas for improvement The manager and staff teams were committed to developing the service further in response to the needs of the people they support. In order to do this, they planned to review and develop further methods of consultation and involvement so that people could continue to tell them how they could improve the service. Some risk assessments had three or six monthly review dates specified. Not all of these had been achieved although reviews had taken place within appropriate time scales. We discussed with the manager that staff should consider the frequency set for reviewing risk assessments to ensure that timescales are achievable and appropriate.
Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very 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 evidence considered in relation to this statement is reported under Theme 1 Statement 1. Areas for improvement See Theme 1 Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued We considered a range of evidence presented in relation to this statement. We assessed the service to be operating at an excellent level of performance. - All new staff undertake a comprehensive induction to the service. This includes an introduction to the service, policies and procedures, mandatory training and shadowing other staff. How people progress through the induction programme is regularly discussed and reviewed with team leaders. Staff are aware of the standards they need to meet to pass their probationary period and extra supports were discussed and provided where appropriate. - A range of training and development opportunities were available to staff. This included mandatory training in a range of topics relevant to their job roles. Areas such as safer assistance (moving and handling) and medication awareness are regularly updated. - Staff had received supervision with their line manager regularly. We saw that these meetings were used to discuss a range of topics such as policies and procedures, staff training and any practice issues that had arisen. Additional supervision meetings were arranged to ensure that staff had support when they needed it. - Annual appraisals helped staff and line managers to identify any training needs which were used to inform the service training plan. - Team meetings had taken place regularly and were well attended. Any staff ho were not able to attend were encouraged to fill in a form to suggest any items that they felt needed discussed as a team. We saw from minutes of meetings that policy updates, development opportunities and service developments were all included regularly on the agenda. SSSC Codes of conduct were also a regular topic and staff had been encouraged to consider what the codes meant to them. A written piece of work was completed and discussed through supervision. Staff were also encouraged to consider case studies to discuss as a staff team. This was a good way for staff to share experiences and to give and receive support from their colleagues.
- Observation of practice. The manager told us that a minimum of two observations would be carried out with staff each year. The standard observations were for safer assistance activities and medication. In the past year, team leaders had also carried out observations during activities supported within the local community. This had led to improved outcomes for people who used the service. For example, staff had requested support to review an activity that they did not feel was providing good outcomes for the customer. The team leader had accompanied the staff member and customer and agreed that the activity provided very little opportunity for the customer to meet and interact with others. The team leader and staff were considering an alternative where the customer would have greater opportunities to meet and interact with others with similar interests, likes and dislikes. We spoke with people who used the service and some family members during our inspection. The feedback we received was very positive. (See 1.3) Areas for improvement The manager has developed the staff observations to included activities in the community. We suggested that an area for development would be to agree the frequency of observations other than safer assistance and medication to ensure that the full scope of staff practice is reflected. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very 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 evidence we considered in relation to this statement is reported under Theme 1 Statement 1. Areas for improvement See Theme 1 Statement 1. Grade awarded for this statement: 5 - Very 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 We considered a range of evidence presented in relation to this statement. We assessed the service to be operating at a very good level of performance. Some of the strengths we saw included; Inspection report continued - Capability Scotland have an overall quality assurance plan which provides a plan of audit and inspection activity that will take place across all services that it provides. The frequency of audit activity is influenced by a number of factors including past audits information, inspection outcomes, complaints and health and safety. This helps to ensure that improvement is on going and that services receive the support they require to continually develop. - Capability Scotland in Dundee had recently had an audit in Infection Control and Risk assessments which was carried out by the Providers Health and Safety manager. This highlighted areas for improvement which were planned and completed. A 'Customer Outcome Audit' had also been completed by the Providers Customer Satisfaction Co-Ordinator. The result of this audit highlighted areas of good practice such as the development of visual timetables for people who used the service. There was also the opportunity to suggest areas for improvement which had not been necessary in this audit activity. - The provider had developed a number of ways for people to make suggestions for improvements in the service. Have Your Say and IRS were two methods that were regularly used. Examples of outcomes are described under Theme 1 statement 1. - The manager had also developed and carried out audits of customers files. This had lapsed recently however, we saw that this audit was used to check the accuracy of information in customers files, review dates were being adhered and that the language used within files was person centred and respectful. - The manager met regularly with people who used the service to ask their views about the service. People were encouraged to make suggestions for developments and improvements. - The manager met regularly with the contract monitoring team with the local authority. Minutes from these meetings showed that each hours of support were considered, what the hours were used for and any financial information. Any actions were agreed and followed up at the next meeting.
- Staff recorded accidents and incidents which were reviewed by the management team. This information was recorded on an electronic database and collated by the health and safety manager. We saw from the system that trends were identified and actions required identified to reduce the risk of reoccurrences. Areas for improvement The managers audits had started to identify areas for improvement in customers files. We discussed similar issues highlighted during this inspection such as accuracy of information, review dates being missed. We recommended that these audits be reintroduced to continue to capture this information and improve the quality of records maintained. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued
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 noted. 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).
5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 6 - Excellent Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 6 - Excellent Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 9 May 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 5 - Very Good 5 - Very Good 27 Nov 2012 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 10 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission.
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 0845 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 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com