Perth & Kinross Council - Home Care Housing Support Service Council Buildings 2 High Street Perth PH1 5PH Telephone:

Perth & Kinross Council - Home Care Housing Support Service Council Buildings 2 High Street Perth PH1 5PH Telephone: 01738 476711 Inspected by: Averil Blair Type of inspection: Announced (Short Notice) Inspection completed on: 6 July 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 9 4 Other information 17 5 Summary of grades 18 6 Inspection and grading history 18 Service provided by: Perth & Kinross Council Service provider number: SP2003003370 Care service number: CS2004074754 Contact details for the inspector who inspected this service: Averil Blair Telephone 01382 207200 Email enquiries@careinspectorate.com Perth & Kinross Council - Home Care, page 2 of 20

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 4 Good What the service does well People who use the service told us during the inspection that they felt the individual staff who provided their care were of a high standard and carried out their tasks promptly and efficiently. What the service could do better We found that some people could not always rely on the times that staff would arrive. For some people this was not an issue but for others there appeared to be quite a difference in the time that the care was expected and the time that staff were able to get to them. What the service has done since the last inspection At the last inspection the service had just introduced a Re-ablement service which aimed to support people who used the service to regain as much independence as possible. Over the past year this service has been successful in helping some people become more confident, and for some this has meant that they no longer need the service. For others they have been able to reduce their dependence on the home care service. Conclusion Most of the people we spoke to said that they greatly appreciated the service they received, and they also spoke highly of the staff who provided their service. Perth & Kinross Council - Home Care, page 3 of 20

Who did this inspection Averil Blair Lay assessor: Not Applicable. Perth & Kinross Council - Home Care, page 4 of 20

1 About the service we inspected Before 1st April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland, (SCSWIS), also known as the Care Inspectorate took over the work of the Care Commission, including the registration of care services. This means that from 1st April 2011 this service continued its registration under the new body the Care Inspectorate. Perth and Kinross Council's Home Care service is registered to provide a combined Care at Home and a Housing Support service. The service is provided by Perth and Kinross Council's Social Work Department to people requiring care and housing support services in their own home. The service aims to "recognise the rights of individuals to lead independent lifestyles within their own home". The service is provided to people with many different needs including older people, adults with physical disabilities, enduring mental health difficulties, HIV and drug and alcohol needs. The service can respond to crisis, intermittent needs, short and long term needs. Parts of the service were provided on a 24 hour basis, particularly through the Community Alarm and Crisis Teams, which are registered within the Home Care Service. Also within this registration, the service has developed a Reablement service, which aims to help people who use the service to regain the skills needed to feel confident about living independently at home. 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 4 - 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. Perth & Kinross Council - Home Care, page 5 of 20

2 How we inspected this service The level of inspection we carried out In this service we carried out a high 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 This report was produced following an announced (short notice) inspection which took place between 20 June and 06 July 2012 by Care Inspectorate Inspector Averil Blair at Pullar House, Perth. Visits to people who used the service were carried out on 25 and 26 June, by Averil Blair. Feedback was given to the Management of the service on 06 July at Pullar House, Perth. During the inspection we sampled service user hand held records (HHR), other associated paperwork such as details of actual timings of care provided, and also sampled staff files. Other records such as results of questionnaires were also looked at during the inspection. 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 Perth & Kinross Council - Home Care, page 6 of 20

What the service has done to meet any requirements we made at our last inspection The requirement The provider shall ensure that proper provision is made for the health and welfare of service users, namely that personal plans shall give clear guidelines to staff relating to duties to be carried out on any visit. This is to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 No 210, 4(1) (a) a requirement which makes provision to meet residents health and welfare needs. This also takes account of National Care Standards Care Homes for Older People Standard 5 Management and Staffing and Standard 6 Support arrangements. Timescale: within 12 weeks of receipt of this report. What the service did to meet the requirement Care plans were seen to include details of care to be provided, and this was regularly monitored through the review and auditing process. The requirement is: Met What the service has done to meet any recommendations we made at our last inspection The service had worked on recommendations made at the last inspection. 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 service submitted a self assessment before the inspection as requested by the Care Inspectorate. This identified some of the strengths of the service and also identified some of the areas where the service felt they could improve the quality of care provided. Perth & Kinross Council - Home Care, page 7 of 20

Taking the views of people using the care service into account We visited 14 people as part of this inspection and also received 26 completed Care Standard Questionnaires. People commented that they felt the carers who provided their care were of good quality and carried out their tasks very professionally. They made comments such as "I couldn't manage at home without them", "The staff have hearts of gold and work really hard", and "I am happy with the service I receive". Some commented that the staff didn't always arrive on time and that they weren't always informed of this. Some also said that they felt the office staff could be disorganised and didn't always phone them back. Taking carers' views into account Two carers were available during the inspection and both were pleased with the service they received, although they commented that it had taken some time to get settled into a routine. Perth & Kinross Council - Home Care, page 8 of 20

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 The service was able to provide good evidence in support of this statement. We could see in some records of people who used the service that they had had their service reviewed, and that they had been able to comment on the service they received. Where appropriate this had sometimes also included relevant people such as social workers, relatives or other professionals. The service had made use of specific surveys where they wished to gather information from service users. For example they had asked people who used the meals service what they thought of the quality of the service. They had also asked service users in one specific area to comment on aspects of the service provided. This information was used to review and make changes to the service where it was thought beneficial. The service had previously sent questionnaires to people who used the service, and outcomes from the 2011 survey were distributed to people who used the service in the newsletter updates sent out by the service. Current questionnaires were distributed with the most recent copy of the Newsletter. The service also sent a Newsletter to independent providers who supported staff on behalf of the service. This newsletter encouraged service providers to make sure they had provided opportunities for service users to comment on the service provided. Independent service providers had the opportunity to meet with Perth and Kinross Homecare to discuss issues, and it was noted at the last meeting that the service had discussed how private providers could encourage the participation of people who use the service. Perth & Kinross Council - Home Care, page 9 of 20

Areas for improvement The service had previously held service user focus groups, but these had been poorly attended and were not a success. The service is now looking at other ways, such as local meetings, to encourage service user participation. While sampling hand held records we noticed that records of reviews were not always signed and dated at or around the time of review, but had been signed as part of the inspection preparation. We would recommend that the service encourages staff and service users to sign and date relevant paperwork as soon as possible. (See recommendation 1.) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Written records, particularly reviews, should be signed and dated as soon as possible after the review. National Care Standards, Care at Home, Standard 6. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Service users who spoke to us during the inspection were generally pleased with the practical care the service provided them with. They spoke highly of individual staff members, and made comments such as "I couldn't manage without them", "They go over and above what they should be doing", and "They help to keep me independent in my own house". People told us that they did not feel that staff were pressured to carry out care quickly, and that they always appeared clean and tidy, wearing protective equipment such as gloves and aprons where appropriate. We looked at a sample of service user files (hand held records) during the inspection, and all files included an assessment of need, and a personal outcomes plan. This identified the support needed by people who used the service. We could see that staff completed the daily record sheet which gave them the chance to record the care they had carried out. Risk assessments relating to the environment and service users risk of falls were also carried out and where appropriate this sometimes led to the completion of a specific care plan to help staff reduce risk. Records showed that where it was appropriate staff contacted relevant healthcare professionals such as GPs and District Nurses, and staff told us they felt comfortable doing this on behalf of people who use the service. Perth & Kinross Council - Home Care, page 10 of 20

Since the last inspection the service has had four upheld or partially upheld complaints made against it. The service submitted action plans to show how they would work to improve the quality of the service they provided and these were followed up at this inspection. The service was seen to have taken appropriate action on some of the identified issues and these have therefore been met. Areas for improvement The service had reviewed and updated its Medication Policy and Procedures, and were in the process of ensuring that all staff were aware of changes. Some training had been carried out to support this but due to proposed national changes it was thought that these may need to be reviewed again. During the inspection we found that there was a lack of consistency in the completion of self medication assessments, for example these may indicate that service users were independent in managing their medication but staff were recording that they had prompted them to take medication. In these instances it appeared that service users did need this prompt to make sure that they remembered to take medication but this was not reflected in assessments. (see recommendation 1). Other risk assessments in particular those relating to the safety of home environment of people who use the service were not always fully completed. (see recommendation 2.) Most service users we spoke to during the inspection said that staff were usually on time for their visits, but some also said that sometimes they were late and that they were not always informed about this. Staff used a system of phoning in to record when they arrived at visits, and also when they left. We looked at these records during the inspection and could see that for some people there was no consistency in these visits, and for some people it also meant that their visits were much later or earlier than they had been informed. It was not possible to check whether service users had been informed of the changes to times of visits. The service should ensure that visits take place on or close to the agreed time, and where this is not possible that they record contact with service users to inform them of the change. (see requirement 1.) Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 2 Requirements Inspection report continued 1. The provider must develop and implement an effective system to ensure that all service users receive their care and support at the times that are agreed in their personal outcomes plan. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Scottish Statutory Instrument 2011/1013: 4 (1) (a) and takes account of the National Care Standards, Care at Home, Standard 4 - Management and staffing. Timescale: from receipt of this report. Perth & Kinross Council - Home Care, page 11 of 20

Recommendations Inspection report continued 1. Assessments which look at whether people who use the service require support to manage their medication should lead to care plans which clearly identify the level of support to be given by staff. National Care Standards - Care at Home, Standard 8. 2. It is recommended that a written procedure is developed to support and guide staff with completing / reviewing the risk assessment document. National Care Standards - Care at Home, Standard 4. Perth & Kinross Council - Home Care, page 12 of 20

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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 4 - 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 The service was able to provide very good evidence in support of this statement. We sampled staff files as part of the inspection and we could see that staff had had access to a range of training to support them in their work. This included training which the service considered to be mandatory, such as Moving and Handling, First Aid, and Administration of Medication, as well as other training to deal with issues such as dementia and palliative care. Staff had access to a comprehensive supervision programme, and this also included one supervised practice session per year and an annual appraisal. Records were kept of these opportunities both on an individual basis and a team basis to allow senior staff to monitor provision of supervision and training. Some staff had taken up the opportunity to experience a more promoted role where they spent a proportion of their working week working alongside Home Care Officers to learn more about their role and to gain experience. During the inspection we spoke with some staff who were either currently experiencing this opportunity or who had previously spent time in this role. They felt it had been a useful experience and that they had learnt about different aspects of the work. Staff told us that it had helped them to decide whether they wished to apply for a promoted post in the future. Perth & Kinross Council - Home Care, page 13 of 20

Senior Staff audited hand held records, and this process identified actions which were required to be carried out by Home Care Officers or Social Care Workers. Team meetings were held for all staff, and the service now ensured that attendance at these meetings were counted as part of staff's working hours. Senior staff told us that they were now monitoring sickness and absence in more detail and this had helped to reduce overall sick time within the service. Areas for improvement The detail of records of supervision very much depended on the ability of staff to record issues discussed, and the service should consider whether staff receive training in taking minutes. Staff had had the opportunity to complete Care Standard Questionnaires, and these were returned to the Care Inspectorate prior to the inspection. Some staff commented that they were concerned about various changes to the service such as the choice of service providers available to people who use the service. Some staff felt that this choice was not available to everyone, and it depended on the area in which they lived. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Perth & Kinross Council - Home Care, page 14 of 20

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - 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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. 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 The service was able to provide very good evidence in support of this statement. People who used the service had regular reviews of their care and this was recorded in their hand held records. This gave them the opportunity to comment on the quality of service they received and to identify any changes required. Team Leaders audited 10-15 files across all areas on a weekly basis. This process identified actions for staff to carry out, and information from these audited could also be used to identify potential need for training. Some of the files we looked at during the inspection had previously been audited, and we could see that they were being followed up to ensure that actions were carried out. The service is also in the process of auditing the number of carers a service user receives over a period of time. As part of the supervision process, all staff receive a supervised practice which allowed senior staff to monitor the quality of care provided. The service had made use of surveys and questionnaires which allowed people who used the service to comment on the quality of the service they received. Results were analysed and information was sent out to people who used the service in a regular Newsletter. Perth & Kinross Council - Home Care, page 15 of 20

The service had developed a private provider forum, where information could be passed on, and providers made aware of the quality of care expected. Recent issues discussed included the administration and recording of medication, recruitment, service user requirements and the logistics of developing geographical 'runs' to make it easier for independent providers to recruit and allocate staff. The service has also been in discussion with the local NHS/Integrated Services to improve the quality of the service. A nurse was employed within the Rapid Response team which provides a single point of access and it was hoped that this would improve communication not only between teams but also healthcare providers. Areas for improvement The service had previously set up Service User Forums, but these had not been well attended and the service was looking at ways to encourage people who used the service to participate in forums. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Perth & Kinross Council - Home Care, page 16 of 20

4 Other information Complaints There were four upheld or partially upheld complaints since the last inspection; The service had taken action on most of the issues but there were still issues relating to late visits, and this requirement remains in place. 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). Perth & Kinross Council - Home Care, page 17 of 20

5 Summary of grades Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 4 - Good 3 - Adequate Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 24 May 2012 Re-grade Care and support 2 - Weak Staffing Not Assessed Management and Leadership Not Assessed 20 Mar 2012 Re-grade Care and support 2 - Weak Staffing Not Assessed Management and Leadership Not Assessed 8 Jul 2011 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 27 Jul 2010 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 31 May 2010 Re-grade Care and support Not Assessed Staffing Not Assessed Perth & Kinross Council - Home Care, page 18 of 20

Management and Leadership 2 - Weak 24 Sep 2009 Announced Care and support 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good 30 Jan 2009 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Perth & Kinross Council - Home Care, page 19 of 20

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 Perth & Kinross Council - Home Care, page 20 of 20