Crossroads Caring Scotland - Aberdeen Support Service 5 Waverley Place Aberdeen AB10 1XH Telephone: 01224 641984 Type of inspection: Announced (short notice) Inspection completed on: 10 April 2017 Service provided by: Crossroads Caring Scotland Service provider number: SP2007008963 Care service number: CS2008171156
About the service The service Crossroads Caring Scotland - Aberdeen, is part of a national organisation. Crossroads Caring Aberdeen has been registered since 2008. The service provides support to the carers of people who are ill, disabled, frail or otherwise require a substantial level of care and support in order to remain living at home or with their families in the community. Its mission is "To provide a high quality service in the community to enable carers to take time off when needed". They state their aims are "To relieve stress on the persons or families caring for the elderly or people with physical, mental or sensory impairment; and to care in appropriate circumstances for the elderly or people with physical, mental or sensory impairment who are living alone". The service covers a small geographical area in Aberdeen. Crossroads provides support to around 46 people. What people told us We issued 15 Care Standard Questionnaires (CSQs) and five were returned by service users or family members. These provided some positive responses and comments about the service. Comments included: - "Would like to express my thanks for an excellent service. Our carer is so good and so caring". - "Highly delighted with the standard of care given and the personnel providing this. They are always courteous, caring, kind and considerate. Further, they treat us and our home with respect." - "We cannot speak highly enough of the service, the staff and all they do for us". - "Due to health and safety regulations I feel that we do not get the help that I need to support my wife". Self assessment We did not ask the service to complete a self assessment prior to our inspection. 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 page 2 of 13
Findings from the inspection At this inspection, we found that the performance of the service in relation to this theme was adequate. The service produced a variety of questionnaires for service users, families/carers and staff on a regular basis. This information was kept in quality development folders and the manager ensured the information was collated and fed back to users of the service and provided them with what improvements would be made. This year's survey had just been sent to all stakeholders at the time of the inspection. During feedback to the senior management, we highlighted a number of areas for improvement within the support plans. These mainly consisted of documents being out of date, little evidence relating to who has been involved in the makeup of the support plans, and evidence of some service user reviews being overdue. We found that since the last inspection service users' personal plans were inconsistent and plans did not reflect service users' individual support needs. We sampled seven users' files and found that not all contained a personal plan that had clear information to guide staff on how to support each person. They did not contain a schedule of days and times for support or information about any health or mental health condition service users may have. We saw very little meaningful clear goals or outcomes identified for service users. The reviewing of personal plans is an ongoing process, however, the service must ensure that the service users have their support reviewed at least every six months. This is to ensure that the service users receive the appropriate care and support. We found that the majority of service users had not had their personal plans and associated risk assessments updated within the last year. The risk assessments had not been reviewed for a number of years and did not always ensure they facilitate a clear understanding of risks and hazards and how these should be managed. There was no evidence of support staff signing to indicate they had read and understood the content. In order to continue to provide a quality service, all service users' reviews should be more specific and person-centred, reflecting how the service is supporting people to achieve their hopes and dreams. The service should also consider all of the appropriate recommendations set out in the 'Keys to Life' for the service users that they support with learning disabilities. We discussed this at feedback, as the new management structure in place was unclear at the time of inspection. There was a recommendation made at the previous inspection that will be re-worded and reinstated to reflect what we found during this inspection. (See requirement 1.) Requirements Number of requirements: 1 1. Service users can be confident that the care service will have plans in place that will support them to develop and reach their hopes and to live more independently. The provider must ensure that there are clear actions in the support plans detailing how they intend to maintain and develop the independence of service users. In order to achieve this, the provider must: a) Ensure each service user has a personal plan that details how their health, welfare and safety needs are to be met. b) The personal planning recordings should develop an outcome focus which should inform the progress - or otherwise - of each service user's individual care and support arrangements. page 3 of 13
c) Ensure that the information held in the personal plan in relation to risk assessments, emergency and hospital information packs are current and accurate. d) Fully assess the needs of the supported person involving that person, and where appropriate any relative or appropriate professionals. e) Written agreements and personal plans are developed in consultation with each service user. f) The provider must review personal plans at least every six months or earlier should there be a change in the service users' care needs. Personal plans must be reviewed in line with all regulatory expectation, National Care Standards, best practice guidance and the provider's own procedures in addition that there is minutes available of these that accurately reflect the discussions held and the decisions made. g) Ensure service users' personal plans are reviewed in consultation with the service user or their representatives. h) Develop appropriate actions within the personal plan to meet these needs. i) Ensure the actions are completed within agreed timescales and reviewed with all those appropriately involved. j) Develop an effective audit system to monitor the information kept in the personal plan and use this to improve how plans are developed. This is in order to comply with: (SSI 2011/210) Regulation 4(1)(a) - Requirements to make proper provision for the health and welfare of service users. (SSI 2011/210) Regulation 5(2)(a)(b) - Requirements to make proper provision for the review of personal plans for service users. The following National Care Standards have been taken into account in making this requirement: - Care at Home - Standard 3.1 & 3.5: Your Personal Plan - Care at Home - Standard 4.1: Management and Staffing Arrangements - Housing Support Service - Standard 8: Expressing Your Views - Housing Support Service - Standard 4: Housing Support Planning - Housing Support Service - Standard 6: Choice and Communication Timescale for implementation: 14 August 2017. Recommendations Number of recommendations: 0 Grade: 3 - adequate page 4 of 13
Quality of staffing Findings from the inspection At this inspection, we found that the performance of the service in relation to this theme was adequate. We saw that staff worked well as a team, respected each other and people using the service praised the help and support. All new staff completed an induction before working with service users and the service had a clear staff development programme for new staff. New staff also shadowed staff to learn core values and their job role until they felt confident to work on their own. The service provided a consistent staff team who continued to support service users with whom they had developed good relationships. The same staff work with service users in order to offer consistency and continuity. The manager should consider service users' views about the staff provide support; this could meaningfully contribute to the performance appraisal and on going professional development. The provider should develop a recruitment process, which involves service users in a more meaningful way. This might include being involved in recruitment interviews for new staff and giving feedback on staff performance and values through the review process or quality assurance audits. (See recommendation 1.) We looked at five staff files; there was little evidence on how the management provided the staff member with support with induction, supervision and appraisal. A programme of support and development should take place. To ensure that the staff have the knowledge and expertise to meet the needs of the service users. Staff we spoke with said that supervision takes place individually and in a group. Staff told us that they felt supported, and able to raise worries, concerns or training/development needs with their line manager. We found during our inspection a lack of recording for such meetings with staff. A recommendation was made at the last inspection, this will be reworded and restated to reflect what we found during the inspection. (See requirement 1.) Overall, we spoke with staff who talked respectfully about service users' needs and how they were committed to supporting each other on a day-to-day basis. We saw the staff were very motivated and told us that they enjoyed working at this service. Staff said that the support that they got from their manager and all training they received enabled them to support people to a high standard. Requirements Number of requirements: 1 1. Each person using the service will experience quality care and support from staff that are suitably qualified and competent persons and available in such numbers that are needed to ensure their health welfare and safety. In order to achieve this the provider must: a) Implement appropriate recruitment checks for all employees. Which include checking a full employment history and satisfactory references from previous employers where possible. b)the provider must put in place and maintain regular staff supervision and appraisals arrangements. This is in order to comply with: page 5 of 13
(SSI 2011/210) Regulation 15(a) - a regulation about staffing. In writing this requirement, the following reference was taking into consideration, National Care Standard: Support Services - Standard 2.3, 2.4, and 2.5: Management and Staffing In addition best practice guidance Safer recruitment through better recruitment, Guidance in relation to staff working in social care and social work settings Timescale for achieving this requirement: 14 June 2017. Recommendations Number of recommendations: 1 1. The service should develop and record more systematic ways of including people they support in recruitment and in getting feedback about permanent and relief staff. National Care Standards Care At Home - Standard 4: Management and Staffing Grade: 3 - adequate Quality of management and leadership Findings from the inspection We thought that the service was performing to an unsatisfactory standard in the areas covered by Quality of Management and Leadership. The registered manager continued not to be as hands on with the service as they had been in 2015. There was a number of areas that required the organisation to take significant steps to review and address how the service was managed and delivered. We gave detailed guidance at feedback. The senior manager spoke about the management at this service. This service was currently under review and was in the process of amalgamating offices. It was clear that this had a detrimental effect on how the service has been run since 2015. The service should develop a clear plan of direction and know exactly what they needed to implement in order for the service to provide support to a high standard. (See requirement 1.) We saw evidence that the provider had appropriate quality assurance system that set baseline standards from which the performance of the service was measured. There was an audit system to check actual performance, identify gaps, develop, and share with service users and other stakeholders, action plans that were developed as a result. There was a programme in place so that the service got externally audited every two years. The audit took place in August 2016 and had identified a number of areas for improvement. However, they were not clear on which service required to be improved. It was unclear what action had taken place following the audit. The organisation must implement measures to ensure service users are free from abuse. We could see minimal evidence concerning reporting adult support and protection and any investigations following these reporting. It page 6 of 13
was also not clear who the adult protection was concerning. The organisation failed to report incidents to the Care Inspectorate. (See requirement 1.) There was a lack of dates and signatures on most documentation and it was unclear if staff were working with the most up to date information. (See recommendation 1.) There were a number of requirements and recommendations made at the last inspection and we saw little evidence that efforts had been taken to complete these and improvements for outcomes for service users, there are still outstanding recommendations and requirements that will be reworded and restated to reflect what we found during our inspection. Following the inspection, we sent a letter to senior management of this organisation detailing our concern. Requirements Number of requirements: 1 1. The provider must develop a system by which the manager of the service has comprehensive oversight of all aspects of the care provided. In order to achieve this, the provider must: a) Ensure that there is a manager in place who has the skills, knowledge and experience to manage the service. b) The organisation should ensure there is sufficient management cover at all times and that staff know whom to contact in the event of an emergency. c) Develop a system where the manager has their own quality assurance systems and procedures, which allow for the recording, measurement and review of all aspects of the day-to-day running of the service within the service. d) Ensure appropriate action when adult support and protection events occur. Allowing for a clear auditable trail. e)ensure incident and accidents are fully recorded and followed up by a manager. f) Appropriately follow the care inspectorate's notification guidance by notifying the care inspectorate when events occur. This is to comply with: (SSI 2011/210) Regulation 3 - Requirements to make proper provision for the promotion of quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. (SSI 2011/210) Regulation 4(1)(a) - Requirements to make proper provision for the health and welfare of service users. (SSI 2011/210) Regulation 4(1)(b) - Requirements to make proper provision for the protection of privacy and the protection of dignity for service users. page 7 of 13
The following National Care Standards have been taken into account in making this requirement: - Housing Support Service - Standard 3.1, 2, 3, and 4: Management and Staffing Arrangements Timescale for achieving this requirement: 14 June 2017. Recommendations Number of recommendations: 1 1. Staff should be encouraged to sign and date records and to ensure that participation is documented in ways, which are acceptable to the service users. National Care Standards Housing Support Service - Standard 4: Housing Support Planning National Care Standards Care at Home - Standard 3: Your Personal Plan Grade: 2 - weak What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 Service users can be confident that the care service will have plans in place that will support them to develop and reach their hopes and to live more independently. The provider must ensure that there are clear actions in the support plans detailing how they intend to maintain and develop the independence of service users. In order to achieve this, the provider must: a) Ensure each service user has a personal plan that details how their health, welfare and safety needs are to be met. b) Ensure that the information held in the personal plan in relation to risk assessments, emergency and hospital information packs are current and accurate. c) Fully assess the needs of the supported person involving that person, and where appropriate any relative or appropriate professionals. d) Written agreements and personal plans are developed in consultation with each service user. e) The provider must ensure that service users' personal plans are reviewed in line with all regulatory expectation, National Care Standards, best practice guidance and the provider's own procedures. page 8 of 13
f) Ensure service users' personal plans are reviewed in consultation with the service user or their representatives. g) Develop appropriate actions within the personal plan to meet these needs. h) Ensure the actions are completed within agreed timescales and reviewed with all those appropriately involved. i) Develop an effective audit system to monitor the information kept in the personal plan and use this to improve how plans are developed. This is in order to comply with: (SSI 2011/210) Regulation 4(1)(a) - Requirements to make proper provision for the health and welfare of service users. (SSI 2011/210) Regulation 5(2)(a)(b) - Requirements to make proper provision for the review of personal plans for service users. The following National Care Standards have been taken into account in making this requirement: - Care at Home - Standard 3.1 & 3.5: Your Personal Plan - Care at Home - Standard 4.1: Management and Staffing Arrangements - Housing Support Service - Standard 8: Expressing Your Views - Housing Support Service - Standard 4: Housing Support Planning - Housing Support Service - Standard 6: Choice and Communication Timescale for implementation: Within 12 weeks. This requirement was made on 12 August 2016. Action taken on previous requirement We found little evidence that the service had taken any action to address this requirement, therefore it has been reworded and restated to reflect what we found during this inspection. Not met Requirement 2 Each person using the service will experience quality care and support from staff that are suitably qualified and competent persons and available in such numbers that are needed to ensure their health welfare and safety. In order to achieve this the provider must: - Implement appropriate recruitment checks for all employees. Which include checking a full employment history and satisfactory references from previous employers where possible. This is in order to comply with: page 9 of 13
(SSI 2011/210) Regulation 15(a) - a regulation about staffing. In writing this requirement, the following reference was taking into consideration National Care Standard: - Support Service - Standard 2.3, 2.4, 2.5: Management and Staffing In addition best practice guidance Safer recruitment through better recruitment, Guidance in relation to staff working in social care and social work settings Timescale for achieving this requirement: 6 weeks. This requirement was made on 12 August 2016. Action taken on previous requirement We found little evidence that the service had taken any action to address this requirement, therefore, it has been reworded and restated to reflect what we found during this inspection. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The personal planning recordings should develop an outcome focus which should inform the progress - or otherwise - of each service user's individual care and support arrangements. National Care Standards Care at Home - Standard 3: Your Personal Plan This recommendation was made on 30 May 2014. Action taken on previous recommendation We saw little evidence that any action had been taken to address this recommendation during this inspection. Therefore it will be incorporated in to a requirement within Care and Support. Recommendation 2 Staff should be encouraged to sign and date records and to ensure that participation is documented in ways, which are acceptable to the service users. National Care Standards Housing Support Service - Standard 4: Housing Support Planning National Care Standards Care at Home - Standard 3: Your Personal Plan page 10 of 13
This recommendation was made on 12 August 2016. Action taken on previous recommendation We saw little evidence that any action had been taken to address this recommendation during this inspection. Therefore it will be restated into Quality of Management and Leadership. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 15 Jun 2016 Unannounced Care and support 4 - Good Environment Staffing Management and leadership 3 - Adequate 8 Jul 2015 Unannounced Care and support 4 - Good Environment Staffing 4 - Good Management and leadership 4 - Good 30 May 2014 Announced (short notice) Care and support 1 - Unsatisfactory Environment Staffing 2 - Weak Management and leadership 2 - Weak 17 Dec 2012 Unannounced Care and support 5 - Very good Environment Staffing 4 - Good Management and leadership 3 - Adequate page 11 of 13
Date Type Gradings 1 Sep 2010 Announced Care and support 5 - Very good Environment Staffing 5 - Very good Management and leadership 7 Dec 2009 Announced Care and support 5 - Very good Environment Staffing 5 - Very good Management and leadership 5 - Very good page 12 of 13
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 13 of 13