Motherwell Integrated Day Service Support Service Without Care at Home Airbles Road Centre 49-59 Airbles Road ML1 2TP Telephone: 01698 210027

Inspected by: Arlene Woods Type of inspection: Unannounced Inspection completed on: 16 February 2012 Inspection report continued

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 20 5 Summary of grades 21 6 Inspection and grading history 21

Service provided by: North Council

Service provider number: SP2003000237

Care service number: CS2009236869

Contact details for the inspector who inspected this service: Arlene Woods Telephone 01294 323920 Email [email protected]

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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 Environment 3 Adequate Quality of Staffing 4 Good Quality of Management and Leadership 3 Adequate

What the service does well The service supports older people to participate in activities within a day-care setting. It assesses service users' healthcare and social needs and level of independence helps them access other services for example housing support and care at home or opticians..

The support plans were person centred and being reviewed monthly.

What the service could do better The service should develop ways to encourage its service users to comment on the quality of the service. It should effectively record this participation, develop action plans and take action on issues raised. It should then inform service users and their families of what action it has taken in response to their comments.

What the service has done since the last inspection This is the first inspection of the service since it was registered.

Conclusion This service is appreciated by those who use it. It is building up its service user group and is still developing its connections with other services. It involves people in

Motherwell Integrated Day Service, page 3 of 22 Inspection report continued activities they enjoy in a pleasant environment. They do this in a respectful and dignified way.

Who did this inspection Arlene Woods

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1 About the service we inspected

Motherwell Integrated Day Service is a Council service which is working in partnership with NHS Lanarkshire. It is based in an National Health Service (NHS) owned building on Airbles Road Motherwell. The building is shared with other NHS services and the accommodation used was once a hospital ward. This is a temporary base; a purpose built building has been commissioned and should be opened in 2013.

The project provides a building based support service. It operates from 8am until 8pm from Monday to Saturday, for up to 25 older adults with a range of support needs. There were 12 people using the service on the day of the inspection. The service used local taxies and there was access to public transport and to local amenities nearby.

The service aims to "provide a holistic approach and provide service users with a "one stop shop" for all health needs", "to provide rehabilitation and assessment services while promoting personal independence and educational opportunities".

The service was formerly registered with the Scottish Commission for the Regulation of Care (the 'Care Commission'). The Care Commission merged on 1 April 2011 with the Social Work Inspection Agency and the section of HMIE responsible for inspecting services to protect children, to form the new scrutiny body SCSWIS'

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 Environment - Grade 3 - Adequate Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate

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.

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2 How we inspected this service

The level of inspection we carried out In this service we carried out a medium 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 In this service we carried out a medium intensity inspection. We wrote this report after an unannounced inspection by Arlene Woods inspector, which took place between 10 am and 4.30pm on 16/02/12.

As requested by us, the care service sent us an annual return. The serviced also sent us a self assessment form.

We issued 20 Questionnaires to friends, relatives or carers of people who used the service. 9 Questionnaires were returned before the inspection. All of the questionnaires returned agreed or strongly agreed that people were treated with dignity and that individual support needs were met.

In this inspection we gathered evidence from various sources, including: * Evidence from the service's most recent self assessment * Personal plans of people who use the service * Training records * Health and safety records * Accident and incident records * Complaints records * Questionnaires that had been requested, filled in and returned to the care service from people who use the service, their relatives or advocates, and staff members * Discussions with various people, including: * the manager * care staff * the people who use the service * relatives and carers of the people who use the service * observing how staff work * examining equipment and the environment (for example, is the service clean, is it set out well, is it easy to access by people who use wheelchairs?)

Motherwell Integrated Day Service, page 6 of 22 Inspection report continued 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

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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. Social Care and Social Work Improvement received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each headings that wed grade them under.

Taking the views of people using the care service into account "The staff are great" "this room is just like a big living room, its nice" "the food is good and the girls are lovely" "The buildings ok for what we need"

Taking carers' views into account We spoke to one carer

"my husband is very happy here" "he seems to like the food as he's not complained and he would if he was not happy".

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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 service was developing a written participation strategy to inform service users and their carers of the different ways they could give their opinions on the quality of the service received. This would include six monthly reviews, meetings, questionnaires, the complaints procedure and a suggestion box. It will also include the way service users and carers will be informed of actions the service had taken in response to issues raised. We felt that this would clearly inform service users how they could influence the development and performance of their service in the future.

The service held regular reviews of support plans with service users and their carers. Service user questionnaires were available to be used at reviews. These included grading the service out of 5 but also asked open questions like "are you satisfied with the assistance given to you?" The reviews gave people a regular forum to raise issues and comment on aspects of their support.

Service users meetings were being held monthly, the agenda was set by the staff and records were well structured identifying who attended, issues raised, action to be taken and timescale for that action being completed. There was evidence that service users were raising issues including not being happy with the menu choice "as every Tuesday it was the same" and they attended every Tuesday. Service users had also asked for new cruet sets and mugs. There was evidence of these being supplied and of this being discussed at the next meeting. The dates for the next meeting was discussed and agreed.

We felt that these meetings gave service users the opportunity to raise issues and be supported by their fellow service users which may encourage comments. A separate carers meeting had been held on 26 October 2011 these were of a similar content to the service users and showed a commitment to information sharing by the service.

Motherwell Integrated Day Service, page 9 of 22 Inspection report continued The service had developed annual questionnaires for service users, carers and GPs. The GPs questionnaires had been distributed in October and the manager was analysing these at the time of the inspection. We felt that this was a good opportunity to obtain comments on clinical practice and staff interaction with outside services.

There was a Complaints procedure which was displayed. It followed the most up to date guidelines and referred people to the Care Inspectorate. The service had recorded two informal complaints and there was evidence that appropriate action had been taken to address the issues. The manager had received training on investigating complaints. We felt this was good practice.

There was a comments and suggestion box in the main lounge. It was not used well but gave people the opportunity to make comments anonymously.

The manager discussed the intention to improve the key worker system as the number of service users increased. The small group of service users were able to be appropriately supported by all of the staff as there were so few of them and the staff knew them so well. We were happy with the support in place and that it was recognised that the more the service grew the more need there would be maintain the key worker system. Areas for improvement Residents were not having their support plan reviewed a minimum of 6 monthly. We feel that this denies the service users the opportunities to comment on the effectiveness of their care and whether they wish to continue to use the service. This is a new legal directive for this service (April 2011) and did not effect the grade at this inspection. (Requirement 1)

The service should complete the development of its written participation strategy.

Although there was evidence of good recording of service users meetings, some inconsistencies were noted depending on who took the minutes. Some of the records did not identify who had raised the issues and who had agreed with them, statements of for example "all service users' were happy with the transport" did not reflect individual participation.

The service should review the way it maintains its complaints records. This should demonstrate how the service has complied with its complaints policy.

Service user questionnaires were last used in November 2010. The service should plan this in the service diary to ensure they are used routinely every year or more frequently. Questionnaires available at reviews were not being used or audited

Motherwell Integrated Day Service, page 10 of 22 Inspection report continued regularly.

The service should develop a method to feedback the actions taken as a result of the questionnaires, meetings and complaints to service users and carers.

Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0

Requirements 1. The service must ensure that all care reviews are held a minimum of once in 6 months. This is in order to comply with SSI2011/5 - personal plans.

Timescale 8 weeks from receipt of this report

Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths The service had a brochure which was given to all service users before or on starting with the service.

On admission all service users were visited by a senior integrated support worker and assessed for. The service users and their carers were involved in the development of their individual support plans which recorded their care and support needs. This included service users' abilities and their preferences in activities to be involved in as well as risk assessments to keep them safe. The support plans were written in a very positive way identifying how to assist service users to take part in activities taking in to account their individual support needs.

The service users were happy that the support workers knew them well and supported them the way they wished to be supported.

The service users interviewed were able to show the inspector the choices they made within their daily lives. The staff supported them in making these choices and were able to describe the individual strategies used to gain the service users opinions on activities they wished to participate in.

The service had menus on the dining room tables which listed the choices available on the day. There were picture cards available to help people choose their meal.

We felt that the service used a range of strategies that allowed service users to make

Motherwell Integrated Day Service, page 11 of 22 Inspection report continued choices in the way they were supported while at the centre.

Areas for improvement The support plans were being developed at the time of the inspection. It was noted that not all support plans had been signed as agreed by the service user or their carer. The manager had developed a strategy to address this.

The support plans should include who should be involved in support plan reviews and when the reviews should take place.

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0

Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service strengths The people who used this service had varying communication difficulties. These included hearing difficulties, being unable to speak due to having suffered a stroke and confusion in those people diagnosed with dementia.

Support plans held instructions on how to communicate effectively with the service user. These included speaking clearly, loudly or face to face, giving time to respond and using different tools and technologies.

Written information was available to help those with hearing difficulties. This was available in larger print which could help those with sight problems. There were picture cards available to show service users the choices available to them and the service had recently purchased talking mats, where a picture is pointed to indicate what the person wishes to say. We felt that these tools could be used by a variety of service users to gain their opinions and reduce their frustration in not being understood clearly.

There was a small group of service user's, at the time of the inspection, and the staff group knew them all very well. Staff were observed interacting well with service users in obtaining their opinions and assisting them to participate in activities.

Service users told us they were able to talk to the staff who understood their needs and wants throughout the day.

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There was a portable loop system in place to improve the use of hearing aids within the unit Areas for improvement

The service should continue with their good practice in using different approaches and tools to communicate effectively with their service users.

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0

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Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths The opportunity for service users and their carers to comment on the quality of the environment are as of those listed under Quality statement 1:1.

The questionnaires contained the question "how happy are you with the environment"

The service users we talked to were very positive about the environment and did not have any issues with it. Areas for improvement These are listed under Quality statement 1:1

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Requirements 1. The service must improve service users safety by ensuring that the controlled entry system is used effectively to control and monitor entry to the unit. This is in order to comply with SSI2011/4 - welfare of service users. Timescale 8 weeks from receipt of this report

Recommendations 1. All items being should be stored in a way the adheres to the most up to date guidance. This is to comply with National Care Standards, Support Services 10 feeling safe and secure.

Statement 4 The accommodation we provide ensures that the privacy of service users is respected. Service strengths The accommodation was on the ground floor with good wheelchair access.

There was one large main lounge and two small activity lounges which were

Motherwell Integrated Day Service, page 14 of 22 Inspection report continued comfortable warm and airy. The service users told us that they liked the way the lounges were set out and thought they were "a home from home".

The toilet facilities were suitable to meet the needs of the service users. Where a toilet was situated off a communal space a permanent screen had been put up to make it less visible from the room. There were emergency pull cords and hand rails available. We felt that this part of the accommodation allowed the service users to have independence and to maintain their privacy and dignity.

The service used public transport and a taxi firm to transport service users . The service users confirmed that they liked to travel by taxi as they only had a short journey before they arrived at the service. Only two people shared any taxi. We felt that this was a respectful way to treat the service users rather than a dedicated bus picking up everyone at the one time. Areas for improvement Due to the sharing of the building, service users were unable to walk around the unit unaccompanied and there was no outdoor space. This is a temporary building and is not ideal. The provider should continue to progress the development of the new building which will house the service.

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

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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 opportunities for commenting on the staff group were as reported under Quality statement 1:1

At service users meetings there was evidence that they were asked if there were any issues with staff. Service users were identified stating there were no problems. The service users we talked to were very happy with the staff who supported them.

Areas for improvement These are listed under Quality statement 1:1

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 There was an annual staff development plan in place which covered mandatory and service user specific training for example epilepsy and dementia. This was devised from development opportunities offered by NLC and those identified at supervision by both the staff member and the manager.

A high level of staff had been awarded their Scottish Vocational Qualification (SVQ) 3 qualifications in care. Staff confirmed that they had received sufficient training to support their service users. We saw records of staff training which supported this.

The service had a system in place to monitor the attendance of staff at mandatory training to help keep them up to date.

The service used an online training system to update staff on various topics related to their work. This included infection control and food hygiene.

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There was staff supervision policy in place which stated that this would take place six weekly. The service was complying with this. Staff interviewed, felt that this was a positive activity and were confident in aisingr service management and training issues at these meetings. We noted that the content of staff supervision was appropriate to the post held.

Staff were familiar with the National Care Standards and the SSSC (Scottish Social Services Council) codes of practice. Areas for improvement The service should continue with the current good practice being demonstrated. We felt that further bedding in time was needed to allow the service to develop strategies to ensure support and training continue to take place routinely.

The service should continue to identify training needs within its staff and deliver appropriate training. We feel that this would help the staff support the service users using the most up to date knowledge. This could improve their participation in activities within the service.

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0

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Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths As with quality statement 1:1, systems were in place for people to comment on all aspects of the service. As this is a new service it was developing the way it obtained the opinions of its service users. The manager discussed their intention to address the management of the service in future meetings. Areas for improvement These are listed under Quality statement 1:1

Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0

Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths The service had an ethos of encouraging staff to take on more responsibility including opportunities to act up into more senior post on a temporary basis. The staff rota included the manager and was used to clearly identify who was managing the service when the manager was absent. We felt that this supported the member of staff, who was acting up, to accept the authority to carry out the role with the support of their colleagues.

Staff development plan were devised from training needs identified by the staff member and their manager at supervision.

Supervision notes recorded issues and performance related to the post held. They also held records of discussions about opportunities for the staff member to take on further responsibilities. There was evidence of promotional opportunities being discussed and how the service would help staff to develop skills to improve their prospects of promotion. We felt that this could help to keep the staff motivated and keen to attend further training and development. We felt improved knowledge and motivation would improve outcomes for those using the service.

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Staff were involved in auditing care plans. We felt this could introduce them to the value of audit and help them improve their care planning skills. This could help ensure consistency in the quality of support given to service users. Areas for improvement The service should continue with the current good practice being demonstrated. We felt that further bedding in time was needed to allow the service to develop strategies to ensure support and training continue to take place routinely.

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 regularly monitored the changes to service users' conditions. The manager had a system in place to ensure these reviews took place on time and took action when they did not. From these reviews the manager identified those service users whose conditions needed monitored more closely.

The service monitored all aspects of its performance for example staff absence, complaints, food quality, the taxi suitability for individuals and cleanliness within the unit.

Accidents and incidents were clearly recorded and monitored by the service for any patterns that could indicate a need for action.

We felt that these methods of monitoring the service could identify areas for development. These could then be addressed before they had a negative effect on the experiences and outcomes for those who use the service. Areas for improvement The service should develop pro formas for all ongoing monitoring. We felt that this would help ensure all issues would continue to be effectively monitored and reported on in the absence of the manager.

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0

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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 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).

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5 Summary of grades

Quality of Care and Support - 4 - Good

Statement 1 4 - Good

Statement 2 4 - Good

Statement 4 4 - Good

Quality of Environment - 3 - Adequate

Statement 1 3 - Adequate

Statement 4 3 - Adequate

Quality of Staffing - 4 - Good

Statement 1 4 - Good

Statement 3 4 - Good

Quality of Management and Leadership - 3 - Adequate

Statement 1 3 - Adequate

Statement 3 4 - Good

Statement 4 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.

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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: [email protected] Web: www.careinspectorate.com

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