The Richmond Fellowship Scotland - Angus & Dundee Housing Support Service Suite 4 Kirkton Enterprise Centre Sir William Smith Road Arbroath DD11 3RD Telephone: 01738 440012 Inspected by: Timothy Taylor Rosemary Wright Type of inspection: Unannounced Inspection completed on: 7 December 2012
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 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: The Richmond Fellowship Scotland Limited Service provider number: SP2004006282 Care service number: CS2004062784 Contact details for the inspector who inspected this service: Timothy Taylor Telephone 01382 207200 Email enquiries@careinspectorate.com The Richmond Fellowship Scotland - Angus & Dundee, page 2 of 23
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 All parts of the service operate with an ethos of empowerment for service users which is backed by well trained and professional staff. What the service could do better The service needs to ensure that all staff understand and promote the ethos adopted by RFTS. The service also needs to ensure that administration of medication is in line with best practice. What the service has done since the last inspection The service has contiuned to develop its provision of training for staff whereby specific training is given for addressing specific needs of service users. Conclusion This is a high quality service which provides support for people with a broad range of needs. Each person is supported in a person-centred way. Who did this inspection Timothy Taylor Rosemary Wright Lay assessor: Ms Winnie Whyte The Richmond Fellowship Scotland - Angus & Dundee, page 3 of 23
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.scswis.com. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not 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." The Richmond Fellowship Scotland (TRFS) is a charitable organisation providing services for people who have mental health difficulties, learning disabilities, autism, dementia and alcohol-related difficulties. The organisation is divided into eight regions covering the whole of Scotland. The Angus and Dundee service forms part of the North East Region. This service was registered with Social Care and Social Work Improvement Scotland (Care Inspectorate) on 1 April 2011. It provides both housing support and support services (care at home) to adults with a wide range of support needs. The service is subdivided into Angus Supported Living Services (based in Arbroath) and three staff teams in the Dundee area, providing both supported accommodation and outreach support. The Richmond Fellowship Scotland - Angus & Dundee, page 4 of 23
The Richmond Fellowship Scotland's mission is to 'develop and deliver best personal supports that listen to what people want and achieve what matters for the person'. 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. The Richmond Fellowship Scotland - Angus & Dundee, page 5 of 23
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 wrote this report after an announced inspection which took place on 5, 6 and 7 December 2012. As requested by us, the service sent us an annual return. The Care Inspectorate wrote to the service to request completion of the self evaluation form. Forty questionnaires were sent to the service to distribute to service users and staff - 21 completed questionnairesw were returned to the Inspectorate. In this inspection we gathered evidence from the following sources:- Interviews with staff. Interviews with service users. Interviews with managers. Interviews with external stakeholders such as care managers and nurses. Inspection of personal plans. Inspection of records. Inspection of policies and procedures 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 The Richmond Fellowship Scotland - Angus & Dundee, page 6 of 23
Inspection Focus Areas (IFAs) Inspection report continued In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org The Richmond Fellowship Scotland - Angus & Dundee, page 7 of 23
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: No 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. A comprehensive self assessment was received for this service. Taking the views of people using the care service into account Five service users were interviewed on the days of inspection and four were contacted prior to inspection by a lay assessor. 5 care service questionnaires were completed by service users. Here are some quotes that reflect the overwhelmingly positive views expressed:- This service was a life saver for me. I get plenty of input from staff. I now do my own medication. I am quite happy with the service. They help me budget and get a clear picture of where I stand. Yes they do ask me about what I think of the service. They really listen to me and acknowledge my feelings. We do a weekly chat were they ask me about my plans and what i think of the service. They always turn up on time. The staff are good treat me with respect. The staff are all very good to me I know their names and I feel they are very supportive to me and will go out of their way to help in any way they can. I feel safe when I go out with them in the community. They help with my shopping and food preparation I do my own cooking while they support me to do this. The Richmond Fellowship Scotland - Angus & Dundee, page 8 of 23
Taking carers' views into account Inspection report continued No carers were interviewed during this inspection but 3 external care professionals were spoken with and gave their views. Here are some quotes from them:- One of my service users had a history on non-engagement but this service have really help them to communicate and engage. They have a very person centred approach. Staff have a high level of training. They empower people to get their independence back. They communicate really well with my service. They have a good way with people. I have a good working relationship with staff. I am very comfortable with the overall care provided. They have the right balance between allowing self determination and the impact of illness upon a person. The Richmond Fellowship Scotland - Angus & Dundee, page 9 of 23
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 This service provides an excellent level of participation for service users who were routinely involved in assessing and improving care and support within the setting. Here are some of the services strengths in this area:- TRFS has a Participation Policy which outlines that involvement of individuals they support, their carers and families is important and lets them know the many ways they can become involved in the process. It was noted that service users get a chance to feed back on the quality of care they receive when they undertake their 'little chat' or 'keyworker agenda' meetings with their key worker. This meeting takes place between 2 weekly and a monthly depending on which part of the service the person uses. These are meetings to plan and review ongoing care and include questions on quality of care. Support plans are also reviewed on a 3 monthly basis and also give service users and other stakeholders a chance to influence the support given. All service users get information on how to complain and they are reminded of this on a yearly basis. Service users get a newsletter which lets service users know about what the service is doing in relation to participation. One such was reminding service users that a questionnaire had been sent out which was asking for their views. Annual How Are We Doing surveys are sent out and service users return them anonymously. The service then devises action plans as a result of feedback gained. The Richmond Fellowship Scotland - Angus & Dundee, page 10 of 23
When interviewed most service users could recall having been sent a questionnaire for their views on the service. They also felt staff were approachable should they have any issues or comments to make. The ethos of staff interviewed showed they understood what participation meant for service users. Carers are fully involved in support packages and are invited to team meetings so they are fully participating in the support process. Where service users are resident in their own supported tenancy in Dundee they report that families and service users were involved in choices over the decor and furnishings of their flats. Staff members reported that they felt part of a team that listened to and acted on their ideas. This service provides both care at home and housing support which means that different parts of the service do things slightly differently. In relation to participation practice however, there is a lot of consistency. Areas for improvement The service should continue to develop its participation practice. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The service provided an excellent level of care and support for service users. Here are some of its strengths:- Each service user has a support plan outlining what they have agreed with the service. This is recorded using a lot of detail and written from a person centred point of view. These plans gave comprehensive and detailed information on support choices and how things should be done. They contain risk assessments and a signed support agreement. One service user had epilepsy and the support plan had a corresponding risk assessment. The service users reported that the people they worked with were sensitive to their needs and wellbeing. One person said they me choices so I could take control of my life. The Richmond Fellowship Scotland - Angus & Dundee, page 11 of 23
Inspection report continued In the use of a tool called WRAP (wellness recovery action plan) service users are encouraged to find coping mechanisms which help them deal with their mental health problems. This tool is being developed for use with staff and service users. The service has links with other health professionals such as the local community mental health team who are contacted routinely and in crisis situations. Some interviews were undertaken with health professionals who commission services from RFTS felt the service was flexible and effective. One care manager felt the staff were very knowledgeable in relation to addressing service user needs. The service has an effective way of using training to give staff the skills they need to work with people with specific needs. Where a person had autism the staff underwent a lot of training in this area. Where a service user is in crisis the service is flexible enough to allocate extra time to supporting that person. It is clear that the health and wellbeing of service users is at the core of what this service does. This was confirmed by users and staff alike. Outcomes for users are flexible supportive and effective. Areas for improvement When inspecting the service at Pitairlie Crescent in Dundee it was noted that some staff were experiencing difficulty in being sure of how to implement some parts of the support roles for service users where there was a perceived dilemma between promoting choice and promoting their duty of care. This had led to staff being unsure about how to respond to such complex issues around diet, some service users staying in bed during the day and medication. The management for the home were aware of these issues and were pro-actively addressing them. The staff group as a whole are all relatively new as the service has not been in existence very long and it was felt by inspectors that the service needed to work with staff to ensure everyone involved in the service understood their roles, the ethos and had a clear understanding of what was an appropriate level of intervention in people's lives. It was noted however, that interviews with both service users and a mental health nurse who worked closely with the service, that outcomes for people were reported as being very good. See requirement 1 and recommendations 1, and 2 The Richmond Fellowship Scotland - Angus & Dundee, page 12 of 23
Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements 1. Whenever a sedative or tranquilising drug is used to help control restlessness or other emotional/mental health needs, the care plan should contain details of: The person's symptoms of disturbance What is likely to cause/trigger this behaviour in this person How the identified care need is best managed for that person Current medication used to manage the care need and the criteria for its use in that person Any monitoring required of the medication of behaviour When the medication's effectiveness will be reviewed by the prescriber The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 See Welfare of users 4.-(1) A provider must- (a)make proper provision for the health, welfare and safety of service users;. (b)provide services in a manner which respects the privacy and dignity of service users;. (c)ensure that no service user is subject to restraint, unless it is the only practicable means of securing the welfare and safety of that or any other service user and there are exceptional circumstances; and. (d)where necessary, have appropriate procedures for the prevention and control of infection. Recommendations 1. Support plans should not only outline the individual care needs that a person has but should also have a clear outline of what the support is aiming to achieve. This will make it clear to staff what the overall aim of the support is so they have a clearer understanding of why they work in a particular way with service users. NCS 4 Housing Support Services - Housing Support Planning. You will be fully involved in developing your personal plan and in any later reviews. You will receive copies of these that have been signed and dated by the housing support service provider. The Richmond Fellowship Scotland - Angus & Dundee, page 13 of 23
2. It was noted that the service has a 3 monthly system for reviewing service user support plans this was not being done in all cases. The service should ensure that all records of reviews completed by keyworkers are up-to-date. See NCS 4 Housing Support Services - Housing Support Planning. 4 You can be confident the housing support service provider will check with you regularly (within three months of the service starting and at least once a year after that) that the service meets your needs that are identified in your personal plan. The Richmond Fellowship Scotland - Angus & Dundee, page 14 of 23
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 This service provides an excellent level of participation for service users who were routinely involved in assessing and improving care and support within the setting. Here are some of the services strengths in this area:- TRFS has a Participation Policy which outlines that involvement of individuals they support, their carers and families is important and lets them know the many ways they can become involved in the process. It was noted that service users get a chance to feed back on the quality of care they receive when they undertake their 'little chat' or 'keyworker agenda' meetings with their key worker. This meeting takes place between 2 weekly and a monthly depending on which part of the service the person uses. These are meetings to plan and review ongoing care and include questions on quality of care. Support plans are also reviewed on a 3 monthly basis and also give service users and other stakeholders a chance to influence the support given. All service users get information on how to complain and they are reminded of this on a yearly basis. Service users get a newsletter which lets service users know about what the service is doing in relation to participation. One such was reminding service users that a questionnaire had been sent out which was asking for their views. Annual How Are We Doing surveys are sent out and service users return them anonymously. The service then devises action plans as a result of feedback gained. When interviewed most service users could recall having been sent a questionnaire for their views on the service. They also felt staff were approachable should they have any issues or comments to make. The ethos of staff interviewed showed they understood what participation meant for service users. The Richmond Fellowship Scotland - Angus & Dundee, page 15 of 23
Carers are fully involved in support packages and are invited to team meetings so they are fully participating in the support process. Where service users are resident in their own supported tenancy in Dundee they report that families and service users were involved in choices over the decor and furnishings of their flats. Staff members reported that they felt part of a team that listened to and acted on their ideas. This service provides both care at home and housing support which means that different parts of the service do things slightly differently. In relation to participation practice however, there is a lot of consistency. Areas for improvement The service should continue to develop its participation practice. Grade awarded for this statement: 6 - Excellent 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 The service was found to have a highly motivated and well trained workforce. Here are some of its strengths:- Staff at the service have a high level of training. Training records and staff interviews confirmed that all staff had been through an induction programme when they began work and that this included core training (inc carevalues, mental health first aid, food hygiene, reactive approaches to challenging behaviour, adult protection) and issue specific training for when they are working with service users who have specific issues. The service also provided other training such as SVQs. The managers have also received extensive training in her role. It was clear that the staff's confidence was raised by their levels of knowledge. The service ensures the continued quality of their staff through annual appraisal meetings (PRD) to monitor performance and development. There is also regular supervision and regular team meetings. It was noted that supervision was used as an effective tool to explore performance and support in relation to staff. They confirmed it was a supportive experience. New staff get a robust and detailed induction programme which means they are fully familiar with their role prior to working on their own. The Richmond Fellowship Scotland - Angus & Dundee, page 16 of 23
The service has a comprehensive set of policies and procedures which lay out expectations of good practice for staff. The service has all the expected policies and procedures to support good practice. Staff interviewed all had copies of the SSSC codes of practice. Staff attend various support groups i.e. team mangers meetings, Senior support workers meetings. Staff who were interviewed were all enthusiastic about their job and felt that the service listened to their views. Service users who were interviewed were also very enthusiastic about the staff and highlighted their sensitivity, support, friendliness and flexibility. Staff working in the service were confident and motivated which is due to the support and training they get. Areas for improvement It was noted that in the Pitairlie Road service that some staff were not fully understanding their role when it comes to addressing some of the challenges they face with service users. They needed to be clear about when to intervene in a person's life choices and when not. See recommendation 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service should ensure that staff are enabled to be clear about when they should or should not intervene in a person's life. This might be an agenda item in team meetings, supervision and training. This might also mean a more detailed and proactive approach to support planning. See NCS 3 Housing Support Services - Management and Staffing Arrangements: 7 You know that the service has a staff development strategy and an effective yearly training plan for all its staff. See NCS 4 Housing Support Services - Housing Support Planning: 1 Your personal plan will set out the way the service is shaped to meet your needs. The Richmond Fellowship Scotland - Angus & Dundee, page 17 of 23
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 This service provides an excellent level of participation for service users who were routinely involved in assessing and improving care and support within the setting. Here are some of the services strengths in this area:- TRFS has a Participation Policy which outlines that involvement of individuals they support, their carers and families is important and lets them know the many ways they can become involved in the process. It was noted that service users get a chance to feed back on the quality of care they receive when they undertake their 'little chat' or 'keyworker agenda' meetings with their key worker. This meeting takes place between 2 weekly and a monthly depending on which part of the service the person uses. These are meetings to plan and review ongoing care and include questions on quality of care. Support plans are also reviewed on a 3 monthly basis and also give service users and other stakeholders a chance to influence the support given. All service users get information on how to complain and they are reminded of this on a yearly basis. Service users get a newsletter which lets service users know about what the service is doing in relation to participation. One such was reminding service users that a questionnaire had been sent out which was asking for their views. Annual How Are We Doing surveys are sent out and service users return them anonymously. The service then devises action plans as a result of feedback gained. When interviewed most service users could recall having been sent a questionnaire for their views on the service. They also felt staff were approachable should they have any issues or comments to make. The ethos of staff interviewed showed they understood what participation meant for service users. The Richmond Fellowship Scotland - Angus & Dundee, page 18 of 23
Carers are fully involved in support packages and are invited to team meetings so they are fully participating in the support process. Where service users are resident in their own supported tenancy in Dundee they report that families and service users were involved in choices over the decor and furnishings of their flats. Staff members reported that they felt part of a team that listened to and acted on their ideas. This service provides both care at home and housing support which means that different parts of the service do things slightly differently. In relation to participation practice however, there is a lot of consistency. Areas for improvement The service should continue to develop its participation practice. Grade awarded for this statement: 6 - Excellent 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 Inspection report continued The service has a good quality assurance system. Here are some of the strengths:- It is clear that the health and wellbeing of service user is at the core of what this service does. The service has a high level of participation whereby service users, staff and other stakeholders can have an input into what the service delivers. (see 1.1). The service has systems in place to support staff, to develop their skills via training and supervision - they also involve staff in developing the service. (see 3.3) The service has a comprehensive set of policies and procedures. The service has a variety of quality assurance systems and processes all of which can involve supported individuals,carers,staff and stakeholders.these include for stakeholders service reviews,supporting people meetings, stakeholder questionnaires,a National Evaluation Tool and service plans. They have a KPI (key performance indicators) system that is used to monitor complaints ensure that they use this information to acknowledge that they take people's views and opinions seriously and gives them the opportunity to learn from mistakes and continuously improve the quality of the support they provide. The Richmond Fellowship Scotland - Angus & Dundee, page 19 of 23
A strategic plan also details how they intend to improve upon and introduce new systems. Staff make people they support aware of independent advocacy.they act on recommendations from previous Care Inspectorate recommendations.the organisations has been accredited IIP,is a member of quality Scotland,SQA approved and Positive about Disabled People and Age Positive This service has good systems for monitoring its quality and has a very person centred approach to support. Areas for improvement Developmental Issue: The service should continue to be proactive in promoting person centred support and the understanding among some staff of the kind of support they are trying to give. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Richmond Fellowship Scotland - Angus & Dundee, page 20 of 23
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 None 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). The Richmond Fellowship Scotland - Angus & Dundee, page 21 of 23
5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 6 - Excellent 4 - Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 6 - Excellent 4 - Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 6 - Excellent 4 - Good 6 Inspection and grading history Date Type Gradings 25 Jan 2012 Announced Care and support 6 - Excellent Staffing Not Assessed Management and Leadership 5 - Very Good 21 Dec 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 30 Jul 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 5 Jun 2008 Announced Care and support 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. The Richmond Fellowship Scotland - Angus & Dundee, page 22 of 23
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 The Richmond Fellowship Scotland - Angus & Dundee, page 23 of 23