1st Class Care Solutions Limited Support Service Ramsey House Fairbairn Place Livingston EH54 6TN Telephone: 01506 412698 Type of inspection: Unannounced Inspection completed on: 20 February 2017 Service provided by: 1st Class Care Solutions Limited Service provider number: SP2013012158 Care service number: CS2013320342
About the service 1st Class Care Solutions is registered with the Care Inspectorate to provide support to people in their own homes. The service is provided to people living in the West Lothian area. The service currently provides support to approximately 80 people. The client support base is older people and a limited number of people with physical disabilities. 1st Class Care state their aim is to 'deliver a 1st class service based on relationships that actively support wellbeing' and 'encourage independent living with dignity, privacy and choice'. What people told us We asked the service to distribute 50 Care Standard Questionnaires (CSQ) and received 36 completed responses. Comments from the CSQ's and from service users and relatives we spoke to included the following; 'I have been very unsettled over the last few months with times not being adhered to'. 'The staff appear to be very overworked working very long hours. Some days they appear to work from 7am until midnight. All the staff are great, do a good job, very helpful and obliging. We appreciate them and how hard they work under difficult circumstances' 'I am very happy with the care my relative gets. She has regular carers and regular times in place' 'Some carers are excellent others can be impatient. The time allocated is half the time in the care plan' 'Because of the changes in staff it is difficult to know all the names of the staff. Some of the staff do not always spend the amount of time stated in the plan, do basic needs and leave' 'I am fortunate that I get the same carer all the time for my relative. I have built up a relationship with them and I am very happy with them. I know this isn't the case for everybody' 'Good communication with care provider, always a prompt response to any issues raised' 'Not always getting a shower, some carers just in and out and not looking at care plan or medication sheet' 'I am very happy with the care my relative receives, don't know what I would do without it' 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 service provider offered a detailed self assessment. This identified areas they thought they did well, some areas for development and any changes they planned. The grading indicated by the provider did not correlate with the grading arrived at following our inspection. The self assessment was completed with relevant information under each statement to describe the service's strengths however, when we looked at a sample of evidence we did not find it always related to the information page 2 of 14
within the self assessment. There was no evidence for service user/family representative involvement in completing the self assessment. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 3 - Adequate 2 - Weak Quality of care and support Findings from the inspection We sampled support plans and found them to be bulky and difficult to navigate through to find relevant information. Carers told us that when they visited a service user they had not visited before, they were not always sure of the specifics of the care and support to be provided and had limited time to read the care plan. The care plans could benefit form having 'one page profiles' which gives a summary of the important things in a person's life that care staff should be aware of whilst providing care and support. We also found that there was inconsistency with how information was recorded within the care plan. The care review minutes we sampled were brief and needed more evaluation of outcomes associated with measuring the effectiveness of support. The manager did not have an overview of when reviews were due or completed. The manager should ensure there is a system in place to ensure reviews are carried out within the required timescales. When we spoke with service users we heard that they felt the care and support was generally good, although sometimes rushed, and they did not always know who was visiting to provide their care and support if regular staff were absent. For some service users this was unsettling and did not offer consistency in their care and support. We looked at medication and found inaccurate information within the care plan regarding whether the medication support was administration or prompting. The service should ensure that a robust assessment has been carried out to determine the level of support required and staff are aware of any changes to service users level of medication support. We also saw that there were double entries for recording medication support, a medication administration record and a medication log. The service should ensure the correct recording format is in place for the appropriate level of support required. The service generally recognised when changes in a persons presentation required intervention from professionals from health and community based agencies, however this was not well documented in the care plan. The service should ensure that known signs and symptoms of changes in health issues are documented to ensure staff are aware of any decline in service users health and how to respond to these changes. We saw that some service users had a diagnosis of dementia or cognitive decline but did not see any evidence that staff had been trained in dementia. Staff should be trained in dementia to ensure they have the skills and knowledge to carry out support to people experiencing dementia, and/or stress and distress situations. page 3 of 14
Requirements Number of requirements: 4 1. The provider must demonstrate that personal plans record all risk, health, welfare and safety needs in a coherent manner which identifies how needs are met. In order to do this the provider must: a) ensure that documentation and records are accurate, sufficiently detailed and reflect the care planned or provided b) ensure that the documentation and records reflect the changing needs of individuals with specific conditions and healthcare needs c) demonstrate that managers are involved in monitoring and the audit of records. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: regulation 4(1)(a) - requirement for the health and welfare of service users and regulation 5 (2)(iii) Personal Plans. Timescale; with immediate effect and to be fully implemented by 30 June 2017 2. The provider must ensure that: a) statutory care reviews take place at least once in every six month period whilst the service user is in receipt of the service. a) there is an overview of when care reviews are due, carried out and next review due. c) the review adequately evaluates all aspects of the service provided and the service users identified outcomes. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) 2011 (SSI 2011/210) regulation 4(1)(a) - requirement for the health and welfare of service users and Regulation 5 (2)(iii) Personal Plans. Timescale; with immediate effect and to be fully implemented by 30th June 2017 3. The provider must ensure that all staff are trained in dementia to a level that supports service users who have a diagnosis of dementia or cognitive decline. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) 2011 (SSI 2011/210) regulation 4(1)(a) - requirement for the health and welfare of service users Timescales; with immediate effect and to be fully implemented by 30 June 2017 4. The provider must ensure that; a) medication support assessments are carried out and the level of support recorded within the service users care plan. page 4 of 14
b) medication support is reviewed at the statutory care review, or sooner, and any changes recorded in the care plan c) the system for recorded medication support reflects the level of support required, and states whether support with medication is administration or prompt/assist or self medicating This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) 2011 (SSI 2011/210) regulation 4(1)(a) - requirement for the health and welfare of service users Timescales; with immediate effect and to be fully implemented by 30 June 2017 Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of staffing Findings from the inspection From our observations of staff practice and our discussions it was evident that staff knew the people they worked for well, using their knowledge and insight to deliver positive care outcomes. The staff we met all spoke about their desire to provide effective support to the people they worked for, highlighting their commitment to the individuals receiving support. We heard that there were issues around consistent care delivery. Staff were concerned about the lack of time available for delivery of support due to the number of service users they had to visit, the journey times and the short notice for any changes to the service users to be visited. When we looked at the electronic rota on staffs' phones, we saw on one rota sampled, that there were three visits at the one time. We heard that this happens frequently and that staff have to determine themselves how to work out their rota to ensure they visit all service users. This can often mean running late or shorter visits to service users. Staff told us they are responsible for calling the service user to inform them of any changes or delays. We also heard from service users that although they were happy with the support and the staff delivering the support, they sometimes felt they were rushed and staff did not always have enough time to carry out the support. Looking at staff recruitment procedures we saw that safe practices were being carried out. The provider requested and received two references, carried out Protection of Vulnerable Groups checks and inducted the employees into the service. Staff felt the induction was good and they received relevant information to carry out their role and also had the opportunity to shadow an experienced member of staff. At the last inspection we saw that there was a training manager in post and training was being delivered on a regular basis with 'specific health condition' training in addition to mandatory training and additional training. At this inspection we found that staff were not receiving as much training as previously and, as the service did not now have an appointed trainer, the training was being delivered by an external trainer. We could see training page 5 of 14
certificates in staff files but the manager did not have an overview of training delivered, refresher training due or observed competencies being carried out. We asked staff about supervision and we were told that they were unclear how often it should be taking place but, that they had received supervision although this varied from person to person. We could see that there were dates planned for supervision but it was unclear when it was carried out and how often. We saw from the services' own policy on supervision that timescales for supervision was not being complied with. Requirements Number of requirements: 2 1. The provider must demonstrate proper provision for the safety and welfare of service users is made. In order to achieve this the provider must: a) ensure that at all times suitably qualified, skilled and experienced staff are working in the care service. a) ensure that persons employed in the care service receive training appropriate to the role they are to perform. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of residents and regulation 15(a) (bii) - a requirement about staffing. Timescale; with immediate effect and to fully implemented by 31 July 2017 2. The provider must demonstrate proper provision for the safety and welfare of services users is made. In order to achieve this the provider must: a) ensure that the rota identifies time for staff to travel between care and support visits b) ensure that all service users receive the agreed length of time of support c) ensure that staff have relevant information to enable safe and appropriate support to be carried out when visiting service users This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of residents and regulation 15(a) (bii) - a requirement about staffing. Timescales; with immediate effect and to be fully implemented by 30 May 2017 Recommendations Number of recommendations: 1 1. Staff supervision and annual appraisal must be performed in accordance with the provider's policy and procedures in order to ensure staff are supported to discuss and develop their roles. page 6 of 14
National Care Standards; care at home, Standard 4; management and staffing Grade: 3 - adequate Quality of management and leadership Findings from the inspection There were a number of key areas where we felt management and leadership within the service required more focus on compliance with regulatory, quality assurance and best practice standards. We were unable to sample any specific audits being carried out within the service. We would expect to see quality assurance systems and processes to be in place to inform, evaluate and implement actions to ensure good outcomes for service users and ensure the safety and security of service users, staff and service. The service is registered with the Care Inspectorate 'to provide a service to older people and 3 adults with physical disabilities living in their own homes'. From evidence sampled we saw that there were in excess of 15 service users who were not deemed an 'older person'. The provider had submitted a variation to have this condition changed but at this inspection this had not been approved therefore, the provider was not meeting their regulatory requirements with regard to their conditions of registration. Since the last inspection the service has had four different managers. This has created some difficulty in getting systems and processes embedded into the service. When we spoke with service users and their families they told us that they had met the provider and manager and that both were very 'hands on' involved in meetings and carrying out care and support when required. Staff were positive about the management team. We were told that they were approachable and flexible when any personal concerns or issues were raised. Some of the staff we spoke with felt that the management team did not manage the rota system well. Very often staff were given information about changes at the 'last minute' which created difficulties in getting to regular service users on time. Staff also told us they were expected to contact service users about changes to the rota or delays in getting to service users homes rather than the office staff dealing with this. This issue of safe practice was highlighted to us by some staff we spoke with. We were told that they felt the quality of care and safety was sometimes compromised by not having enough time to carry out the required care and support and time to get to each service user as on occasions additional support visits were added to the rota. They also felt they did not get any notice when additional visits or changes to the rota was made. They were only aware of this when they checked their phones and felt they had to constantly check in order to ensure no visits were missed. During our conversations with staff we heard examples where they said they had previously raised these issues with the management team but did not feel anything positive had happened to alleviate their concerns. We highlighted this at feedback to the provider and manager and were told that a new system was being introduced which, would identify travel time and allocation of support visits ensuring agreed time for support was being allocated within the rota. page 7 of 14
We looked at team meetings and saw that the last recorded minute of the meeting was July 2016. We saw agendas for meetings but no record of the meeting. The manager should ensure that where team meetings are taking place there is a record of the meeting. Areas for improvement relevant to Quality Theme 1 and Quality Theme 3 also apply to Quality Theme 4. Requirements Number of requirements: 3 1. The provider must ensure; a) that they are fully compliant with the conditions of registration of the service by the Care Inspectorate. b) that any variation to change the conditions of registration have been approved by the Care Inspectorate and that the provider has formal receipt of the approval to vary the condition prior to implementing any changes. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210). Timescale; with immediate effect 2. The provider must develop and implement internal auditing systems to ensure effective oversight and monitoring of all aspects of the service including all care and support records with particular reference to planning of staff rotas and the covering of all scheduled visits, care planning and care reviews. In order to achieve this the provider must ensure: a) the auditing systems effectively enable areas for improvement to be promptly and accurately identified. b) the outcomes as a result of any audit are clearly recorded. c) where areas for improvement are identified an action plan is developed detailing timescales and the person responsible. d) subsequent action plans are reviewed and updated to completion This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) provider must make proper provision for the health, welfare and safety 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. Timescales; with immediate effect and to be fully implemented by 31 July 2017 3. The Provider must; a) ensure that the service is provided at the agreed times, and in such a way that meets the identified needs of the service user as recorded in the agreed support plan. page 8 of 14
b) ensure that at all times there is adequate levels of staffing required to deliver effective care and support as appropriate to the health and welfare needs of service users. c) ensure visit lengths are within the designated time duration which has been assessed as necessary to meet those needs d) ensure there is an effective system in place to inform the service and service users if staff are going to be late or not able to attend a service user This is in order to comply with the Social Care and Social Work Scotland (Requirements for Care Services) Regulations 2011. SS12011/210 4 (1) (a) regulation which states that a provider must make proper provision for the health and welfare of service users and regulation 15(a) (bii) - a requirement about staffing. In making this requirement account has been taken of the National Care Standards for Care at Home; Standard 4 (6): Management and staffing. Timescale; with immediate effect and to be fully implemented by 30 May 2017 Recommendations Number of recommendations: 1 1. It is recommended that team meetings are carried out regularly in line with providers policy and there is; - forward planning for dates of team meetings and staff are aware of the planned dates - a record of the meeting including; agenda, record of the discussion, action points and responsibilities - a copy of the meeting record is available for all staff to access National Care Standards; Care at home; Standard 4 Management and Staffing Grade: 2 - weak page 9 of 14
What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that service reviews are carried out a minimum of six monthly intervals. Reviews must evidence participation and sharing of information with all relevant parties involved in that persons' care and support. 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 5 (2) (b), a Regulation relating to Personal Plans. Timescale: with immediate effect. This requirement was made on 15 March 2016. Action taken on previous requirement We saw some evidence that care reviews are being carried out but it was difficult to see if they were carried out in line with statutory guidance as the manager did not have an overview of care review. This requirement has been reinstated. Not met Requirement 2 The provider must ensure that medication is managed in a manner that protects the health and wellbeing of service users. In order to do this the provider must: - ensure that the services' medication policy reflects best practice for the administration of medication. - ensure that service users are assessed in order to have the most appropriate level of administration of medication in place and that comprehensive guidance on the details of the administration are recorded in the service users' personal file. - ensure that Medication Administration Records are audited on a regular basis in line with the services' medication policy. - ensure that all prescribed creams and lotions applied by care staff are recorded on the Medication Administration Record. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of service users In making this requirement account has also been taken of the National Care Standards for Care at Home; Standard 8(1), (2) and (3): Keeping well - medication Timescale: with immediate effect and to be fully in place by 30 April 2016. page 10 of 14
This requirement was made on 15 March 2016. Action taken on previous requirement Medication information was held within the care plan but the information was not always accurate regarding the type of medication support required. The policy for medication was not an accurate reflection of the policy for this type of service as it had information within it about care homes and controlled medication administration. This requirement has been reinstated. Not met Requirement 3 The provider should ensure the safety and health and well being of the service user. In order to do the provider must: - keep a record of all missed or late visits. - assess the impact a late or missed visit has on the service user. - report any significant missed or late visits to the Care Inspectorate. - carry out a regular audit of missed or late visits. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of service users. In making this requirement account has been taken of the National Care Standard for Care at Home Standard 4 (6): Management and staffing. Timescale: with immediate effect and to be fully in place by 30 April 2016. This requirement was made on 15 March 2016. Action taken on previous requirement There were very few missed visits and where these occurred they were recorded. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 It is recommended that all documents held within the staff files should be signed and dated by the appropriate person in relation to the type of document being held or produced. This will ensure that the responsible person is identified and that the service keeps accurate, up to date records. page 11 of 14
This is to meet National Care Standard 4 Care at Home - Management and Staffing. This recommendation was made on 15 March 2016. Action taken on previous recommendation All documents within the staff files were signed appropriately Recommendation 2 It is recommended that staff receive regular supervision sessions. The supervision sessions should be offered at time intervals in line with the providers own policy and best practice guidance. This is to meet National Care Standard 4 Care at Home - Management and Staffing. This recommendation was made on 15 March 2016. Action taken on previous recommendation This recommendation has not been met. This recommendation has been reinstated Recommendation 3 It is recommended that the provider reviews and updates the policies and procedures for the service. The manager should ensure that the content of the policy is reflective of the service delivery and the procedures within the policy are achievable. This is to meet National Care Standard 4 Care at Home - Management and Staffing. This recommendation was made on 15 March 2016. Action taken on previous recommendation Policies now reflect the service delivery at a local level and have realistic achievable procedures. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. page 12 of 14
Inspection and grading history Date Type Gradings 6 Jan 2016 Unannounced Care and support 4 - Good Environment Not assessed Staffing 4 - Good Management and leadership 3 - Adequate 13 Mar 2015 Unannounced Care and support 3 - Adequate Environment Not assessed Staffing 3 - Adequate Management and leadership 3 - Adequate page 13 of 14
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 14 of 14