Homecare by Hera Limited Housing Support Service 201a Whitletts Road Glenmuir Square Ayr KA8 0JZ

Homecare by Hera Limited Housing Support Service 201a Whitletts Road Glenmuir Square Ayr KA8 0JZ Inspected by: Mala Thomson N/A Type of inspection: Unannounced Inspection completed on: 4 March 2014

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 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Homecare by Hera Limited Service provider number: SP2012011933 Care service number: CS2012313801 Contact details for the inspector who inspected this service: Mala Thomson Telephone 01294 323920 Email enquiries@careinspectorate.com Homecare by Hera Limited, 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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The manager and staff at Homecare by Hera Limited (Hera Homecare) provide a good level of support to people who use their service. The service provides good individualised support packages to service users. The service is flexible and responsive to the needs of the service users. The manager and staff are dedicated to providing a high level of support to people who use their service to maintain independence in the community. Staff presented as being caring and it was evident that they knew their service users well. Service users spoke highly of staff and acknowledged that staff are approachable and very supportive. Service users we met and communicated with were happy with the quality of care and support they received. What the service could do better The service offers a good service to the people they support. We found that service users' views were taken into account about service delivery. What the service has done since the last inspection This is the services initial inspection since registration was granted by the Care Inspectorate on 26 February 2013. Homecare by Hera Limited, page 3 of 23

Conclusion Inspection report continued The service has a small stable staff team who are caring and have a good knowledge of the people who use the service. People using the service told us that the service provided is "very good." The service has implemented its formal participation strategy and a quality assurance system to evaluate and improve service delivery. The service is in the early stages of development and progressing well. Staff offer people a level of care and support which they value. The feedback we received told us that staff members are highly regarded for their sense of care, friendliness and attention to detail. Who did this inspection Mala Thomson N/A Homecare by Hera Limited, page 4 of 23

1 About the service we inspected This service was registered by the Care Inspectorate on 26 February 2013 to provide a combined housing support and care at home service to people in their own homes. Information in relation to all care services is available on our website at: www.careinspectorate.com The provider is a registered limited company with two directors. One of the directors is also the named manager. Hera Homecare operates from a small office base in the town of Ayr. Services are available on a private basis, via direct payment and by contractual arrangement with South Ayrshire Council. At the time of this inspection, the service covered the areas of Ayr and Prestwick and Troon. The stated aim of the service is: "To ensure that all service users receive the highest standards of service and care possible". At the time of the inspection, four people were using this service. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good 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. Homecare by Hera Limited, 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 In this service we carried out a low intensity inspection. We wrote this report after the unannounced inspection that took place between: 20 January 2014 - and 04 March 2014. Feedback was given to the Manager on 04 March 2014: Inspector, Mala Thomson, carried out the inspection. During the inspection, we gathered evidence from a number of sources including: Care files (2) Care reviews (2) Staff communication records Complaints records Information about advocacy Staff training records Staff supervision policy & records Staff meeting records Communication records Accident /incident records Certificate of Registration Insurance details Participation Strategy Quality assurance The self assessment We spoke with the following people: Service users (2) Relative (2) Care Staff (2) Service Manager (1) As requested by us, the service sent us a self assessment form. Homecare by Hera Limited, page 6 of 23

We sent out 30 questionnaires for service users and 20 for staff. None were returned to us. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Homecare by Hera Limited, 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. The service submitted a self-assessment form as requested by the Care Inspectorate which clearly identified their own areas for development. Information from this was taken into account during this inspection. Taking the views of people using the care service into account Feedback to the Care Inspectorate was highly positive. Service users stated: "I like the staff. They are very pleasant." "All the staff are really good." "They are never late. They do my washing and help me with personal care." Taking carers' views into account We refer to relatives, friends and advocates as carers. They do not include care staff. The views of carers were very positive of the service and the staff. Relatives stated: "Very efficient." "Perfect care." "Yes- the staff keep me informed and there have been reviews." "Very caring people, very reliable, nothings a bother." Homecare by Hera Limited, page 8 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: 4 - 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 The grade awarded for this quality statement is 4 -Good. We reached this decision after we had spoken with manager, staff members, service users and carers (relatives) during the inspection visit. We also reviewed a number of relevant documents and records and observed practice. Carers confirmed that they are consulted about issues affecting them and the service user. The service deploys a variety of methods to gain people's views. This included: * Face to face interviews with service user, carers and partner agencies * Complaints procedure * Direct meetings and reviews * Newsletters * E.mail People were appropriately supported with communication needs. The manager invited relatives to speak with her or with the staff to discuss any concerns they had and a complaints procedure was in place. People we spoke with were keen to state they had no concerns and that the manager and senior staff were available if they needed to raise any issues. Interaction between staff and carers was positive. Carers and service users told the Inspector that they are treated with respect and dignity and that staff listen to them. They clearly valued the help and support they received and stated that the care staff are "excellent." Homecare by Hera Limited, page 9 of 23

The manager had distributed satisfaction questionnaires to clients. The manager audited those returned. The audit was used to gain feedback and those we sampled were highly positive. The manager and staff had tried to address issues raised by service users. The manager has introduced a newsletter. This keeps people informed of developments in the service. For example, questionnaire returns had indicated that "cooking, communication and time" were aspects of the service which could improve. As a result, the service tried to communicate to service users if staff were slightly delayed by factors out with their control. They also tried to ensure that staff were matched to service users in terms of service user's needs, preferences, location and staff skills. In addition, the Manager is intending introducing training "basic cookery to instruct simple meal preparation within time limits." We found that service was performing very well in this area. Good communication between the service, the service user and the carers had developed over time. Areas for improvement The service should continue to develop meaningful involvement of service users and carers in improving the quality of the service. The Participation Strategy should continue to be reviewed and implemented as the service develops and expands. The service should demonstrate sustained improvements. Grade awarded for this statement: 4 - Good 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 We found the Services performance to be very good in the areas we sampled for this statement. The grade awarded for this quality statement is 4 - Good. Much of the grading for this statement is influenced by people who use the service who told us that they are very happy with the service and staff pay very good attention to health and wellbeing needs. We found that the service played a significant role with the service user in ensuring they managed their health in a safe manner. Care staff demonstrated a good awareness of the health issues and the need for promoting healthy eating and healthy lifestyles. Person centred care planning promoted the health and wellbeing service users. Homecare by Hera Limited, page 10 of 23

Support plans indicated and the service users confirmed that they were supported to access primary and other health services. The level of support was flexible depending on the health needs of individuals at any given time. Support staff confirmed that they liaised with community health professionals and social work services. Health information was available for care staff. They had undertaken training in matters relevant to the promotion of health and well-being of service users. For example: Risk assessments Moving and assisting Dementia The management of support was tailored for individual needs and the service user also accessed other community based resources. We found that practical assistance for people was well-managed to meet the needs of the service users we spoke with. For example, assistance with personal care such as showering and getting ready took account of people's needs and abilities. The service strived to take needs and preferences into account and service users told us they were always treated with respect and dignity. People we spoke with told us they knew who would be attending them and at what times throughout each week. This ensured that clients knew who would be providing their support. This limited the number of people going to a person's house, ensures continuity of care and allows for service users to get to know staff. The service allocated key worker responsibilities to care staff. They took account of service users preferences. The staff we spoke with were very knowledgeable about their "key clients" and their support needs. Service users told us that they were contacted to advise them, when there was going to be an unexpected delay. They told us that this was not a frequent issue and that staff were always prompt and reliable. The manager retained a copy of each service user's care plan to ensure that they were always fully aware of the expected input to each service user when care was agreed. This contained useful information about the service user and their support package. This ensured that staff were clear about care delivery. Staff were knowledgeable about the support for service users. We found that there was good communication between support workers, relatives and other professionals to ensure continuity of care. Each service user had a current care plan and care diary to enhance communication and detail care delivery. We found these to be well detailed and entries were respectful. (See areas for development for this Quality Statement) Inspection report continued Homecare by Hera Limited, page 11 of 23

We saw that the service users had information of the complaints procedure. People we spoke with were clear of their right to make a complaint but keen to stress that they were very happy with the service. The service had conducted risk assessments on working within the clients home's as well as technical assessments on moving and handling where these were needed. Care management was delivered in a person-centred way. The service user and carer agreed their support plan and how it would be implemented. We found that staff were clear about their roles and responsibilities in ensuring that support was delivered to ensure positive outcomes for service users. The service users we spoke with told us that they are able to relate well with the staff who attend them and expressed fondness for their support workers. We found that staff were respectful and offered choice and assistance at service users pace. Service users said of the care and support: "Never late" "They help me get ready and do my meals" "Hygienic practice - very flexible" Areas for improvement Whilst medication procedures were good, we advised the manager that the medication procedure should be updated to ensure clarity for staff about the differences between prompting, assisting and administering medication. In addition, we found an example where staff had missed a signature for administration, compromising accountability. (See recommendation 1 of this Quality Statement) Each service user had a current care plan and care diary to enhance communication and detail care delivery. Relatives and service users told us that staff attended to them timeously as agreed. Staff sign in to record time of arrival. However, staff do not sign entries to record departure. Staff should ensure that care records detail in and out times of attendance for each service user. (See recommendation 2 of this Quality Statement) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Inspection report continued Homecare by Hera Limited, page 12 of 23

Recommendations Inspection report continued 1. Medication procedures and policy should be updated to ensure clarity for staff and service users about the differences between prompting, assisting and administering medication. In addition, staff should ensure that all medication administration records are appropriately signed to ensure accountability. National Care Standards -- Care at Home - Standard 3 Your Personal Plan. 2. Care records held in service users homes should ensure that staff record both arrival and departure of staff. National Care Standards -- Care at Home - Standard 3 Your Management and Staffing. Homecare by Hera Limited, page 13 of 23

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The grade awarded for this quality statement is 4 -Good. We found that good communication between the service, service users and the relatives had developed over time. There was systematic application of formal methods of involvement such as personal plan development and regular reviews. The service user was encouraged and supported by staff to comment and express their view about the service. We found that the service had developed around the needs and wishes of the person using the service through full involvement of relatives and the service user in close collaboration with the service. The service manager conducted spot checks on staff. At these times, she was also able to interact with service users to ensure that there were no outstanding issues or views, which needed to be addressed. Service Users told us that: "Staff are excellent" "They are always respectful". "I have become fond of her." (support worker) Areas for improvement The service should continue to gain service user views on the quality of staffing. Also see areas for development in statement 1.1 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 Homecare by Hera Limited, page 14 of 23

We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The grade awarded for this quality statement is 4 -Good. The evidence we looked at included: Staff Training Records and Training Plan Staff Supervision Records Speaking with relatives and service users Speaking with staff Speaking with the Manager We spoke to staff who told us they have a supportive working environment where there is effective communication with one another and their Manager. Staff were positive about team work. We think staff are caring, well motivated and professional. We looked at staff training records. There is a good annual programme of mandatory, formal and occupational training relevant to the work staff do. The manager has reviewed the training calendar and staff confirmed they have access to training. Staff interviewed stated that they could also request training to enhance their learning and development so they could support people with specific needs. Examples of training undertaken by staff are: * Food Hygiene * Moving and Handling * Dementia * Nutrition * Safe management of medication. Inspection report continued In addition, the service had plans and dates for staff to attend training for end of life and adult support protection. This gave staff knowledge and confidence in working with service users. All staff have completed SVQ training and are professional registered workers with the Scottish Social Services Council. We found staff were knowledgeable about key legislation, National Care Standards and Scottish Social Services Council codes of practice. We reviewed the planned programme of individual supervision. The manager has a supervision policy and procedure in place. Staff said they could approach their Manager at any time for guidance and support. We think there were good staff communication systems in place. This is largely Homecare by Hera Limited, page 15 of 23

because it is a very small staff group who support each other well. Through discussion, we found that staff practice demonstrated a professional approach. Areas for improvement Although staff were clear about their responsibilities in relation to protecting people, not all staff had undertaken training in adult support protection. The Manager should include this as part of the services mandatory training plan and also ensure refresher training. (See Recommendation 1 of this Quality Statement) The service has a supervision policy. However, this has not been implemented and staff should receive regular individual supervision to enhance professional learning and development. (See Recommendation 2 of this Quality Statement) Staff have received some training in working with people with dementia. It is also part of the services induction programme for all new staff. The manager should access the "Dementia skilled - Improved Practice" learning resource. As discussed during inspection, all care staff should complete the skilled level, and all nurses and managerial staff should undertake the enhanced level. The provider should use the Promoting Excellence framework, Scottish Government 2011 to review staff training and development to ensure that all staff have the necessary knowledge and skills to meet the needs of people with dementia. (See Recommendation 3 of this Quality Statement). The service should continue to develop procedures to ensure staff are competent and supported in their role. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 4 Recommendations Inspection report continued 1. The manager should ensure that all staff receive training and are familiar responsibilities in relation to adult support protection. National Care Standards - Care at Home, Standard 5: Management and Staffing 2. The manager should ensure that staff receive regular individual supervision to enhance professional learning and development. Homecare by Hera Limited, page 16 of 23

National Care Standards - Care at Home, Standard 5: Management and Staffing 3. The manager should use the Promoting Excellence framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia. This should include training at skilled and enhanced level for all staff working directly with residents. National Care Standards - Care at Home, Standard 5: Management and Staffing Promoting Excellence framework, Scottish Government 2011 Homecare by Hera Limited, page 17 of 23

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 The grade awarded for this quality statement is 4 - Good. We concluded this after we read service users records and spoke with staff, service users and relatives about their involvement in influencing their care and the management of the service. Those service users we spoke with told us that they felt involved in their care and support. They believed that they could raise any issues with the staff or the manager, who carried out spot checks. We were told that the manager was accessible and that they felt they could raise any issues with her. We saw minutes of review meetings with service users. The review process gave clients the chance to speak about their care, what changes they would like to see and any additional changes or concerns that they may have about anything to do with the service. People we spoke with were very happy with the service. The senior carer said she regularly visited service users and any issues relating to the management of the service could also be raised at these visits. The manager has sent out regular newsletters to keep people informed about the developments of the service. Satisfaction questionnaires offered service users the opportunity to comment on the quality of the service. The manager was aware of the need to continually review the quality assurance system, to ensure that all themes and statements were covered over time. Areas for improvement The service should continue to gain service user views on the quality of management and leadership. See Areas for Improvement in statement 1.1. Homecare by Hera Limited, page 18 of 23

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 grade awarded for this quality statement is 4 -Good Inspection report continued The Manager demonstrated good leadership in determining the direction and future objectives of the service. Service users and staff commented positively about the manager being supportive and approachable. Communication and teamwork was continuing to be promoted as the service develops. Effective systems were in place. Support Staff were clear about their responsibilities and service users said that the staff were a very good and that they always treated them with respect and dignity. We found that the management and staff involved service users in a range of ways to ensure they could make their views known about a range of issues in relation to their care. The manager was aware of her responsibilities to notify the Scottish Social Services Council (SSSC), the Local Authority and the Care Inspectorate about issues which they would respectively be interested in, such as staff conduct, adult or child Protection concerns and issues regarding the regulation over the service. The service had a range of policies and procedures to guide staff practice. There was an induction and training plan in place to support those staff appointed to work within the service. The service had risk assessment and personal plan recording systems to ensure that staff followed agreed care and support and knew what to do, record and report. Recording of daily notes were very good and well detailed. This ensures effective communication and continuity for service users. Monitoring by the manager on the quality of work in the service was through practice and spot checks. The service had a range of questionnaires which went to clients and carers, staff and stakeholders. Responses were evaluated by the manager to improve the service. We noted that responses from service users stated that they considered the service to be "excellent". Homecare by Hera Limited, page 19 of 23

Areas for improvement The service has identified in their self assessment that they intend to use "How good is our team" as a means to evaluate their performance. We consider that the manager needs to be more proactive in being available for the management of the service. Whilst accepting that the service is relatively new and still developing, we were concerned about her lack of availability during this inspection. Examples of improvement are improved signage to the registered address and more effective communication methods such as telephone contact details to ensure her availability. (See Recommendation 1 of this Quality Statement). The manager should continue to develop on the service and its systems of management, demonstrating how the service is assessed and influenced by service users and stakeholders. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The manager should review her contact details and ensure that there is a process for availability for the day-to-day management of the service. National Care Standards - Care at Home, Standard 5: Management and Staffing. Homecare by Hera Limited, 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 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). Homecare by Hera Limited, page 21 of 23

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Homecare by Hera Limited, 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 Homecare by Hera Limited, page 23 of 23