East End Project Support Service 2 Barlanark Drive Barlanark Glasgow G33 4QB
Inspected by: Sarah Gill (Care Commission Officer)
Type of inspection:
Inspection completed on: 30 August 2005
1/13 Service Number Service name
CS2004073430 East End Project
Service address
2 Barlanark Drive Barlanark Glasgow G33 4QB
dummy Provider Number Provider Name
SP2003000264 Quarriers
dummy Inspected By Inspection Type
Sarah Gill Care Commission Officer dummy Inspection Completed Period since last inspection
30 August 2005 N/A
dummy Local Office Address
Central West, Paisley.
dummy
2/13 Introduction The East End Projects comprises of three projects: Calvay, Robroyston and Braidfauld place.
The Calvay project offers support to 9 adults with learning disabilities from the Greater Easterhouse area of Glasgow. Support is provided on a flexible basis with each individual averaging around 15-25 hours of support per week. Each person has their own flat and tenancy agreement with the housing provider.
The Robroyston project supports 2 adults with learning disabilities, a 3rd place is currently vacant. The accommodation is within a 3 bedroom detached bungalow set in a quiet cul de sac in the North East of Glasgow. Support is provided on a 24 hour basis including staff sleepovers. Each person has their own tenancy agreement with the housing provider.
Braidfauld Place project supports one person with a learning disability. The accommodation is within a small house which has been adapted to meet the needs of the individual. The service is provided on a 24 hour basis, including staff sleepovers.
All of the projects aim to offer a range of supports in order to promote an ordinary living experience for the people they support. This is achieved using person centred planning.
Basis of Report This report is written on the basis of one Care Commission Officer visiting the projects over a period of two days. During this time 6 service users and 6 staff were consulted. A meeting was held with one relative and questionnaires were returned by two relatives.
The relevant records, policies and procedures were examined.
The Care Service was measured against the Regulation of Care (Requirements as to Care Services)(Scotland) Regulations 2002. Scottish Statutory Instrument 2002 No.114.
In addition six of the National Care Standards were focused on as follows:
Standard 1 Informing and Deciding (Care at Home) Standard 2 The Written Agreement (Care at Home) Standard 4 Management and Staffing (Care at Home) Standard 8 Keeping Well - medication (Care at Home) Standard 11 Expressing Your Views (Care at Home) Standard 7 Exercising Your Rights (Housing Support)
Action taken on requirements in last Inspection Report This is the first report by the Care Commission.
Comments on Self-Evaluation The self evaluation was completed by the Manager, this helped to identify many areas of strength and some areas for development against the five National Care Standards listed above.
3/13 View of Service Users All of the service users consulted expressed positive views about the Calvay Project. These included comments that "the staff are great", "they help you with things but you've still got your freedom", "the chance to build my confidence", "the neighbours treat us with respect and we can be a part of the community", "can't think how you could make it better they've just got it right"
View of Carers All three of the relatives of service users who could not express their own views provided feedback. They all stated they were very happy with the service their relatives received and had been given information if they wished to raise a complaint or concern. They all stated that they had been involved in reviews. There were also positive comments made regarding staff, "her carers are wonderful".
4/13 Regulations / Principles
Regulation 3: SSI 114 Regulation 3 Statement of Aims and Objectives
Strengths
A statement of aims was provided with the pre-inspection return. A mission statement was also evident in the draft information pack. There is a service description which details what the service is and how it is to be provided.
Areas for Development
As previously stated under Standard 1 the aims and objectives statement could be made clearer to define the function and purpose of the service and the aims and objectives as to how this is to be provided.
Regulation 4: SSI 114 Regulation 4 (1) Welfare of Users
Strengths
Each service user has their own G.P. and access to community health facilities. In addition each service user has a Care Manager and contact with the local Community Learning Disabilities Team.
Within each project service users are allocated two case coordinators. This assists with building relationships and providing continuity of care. Any health or welfare concern can be addressed either by the staff within the project or referred on to the appropriate agency.
Staff have all attended training in strategies for crisis intervention and prevention (SCIP). This assists staff in managing challenging behaviour. There is a Quarriers standard for "promoting positive behaviours". The SCIP training includes physical intervention. Service users who may exhibit challenging or difficult behaviours will have a behaviour support plan.
There is an infection control policy and there are suitable procedures in place for the uplift of clinical waste.
Areas for Development
The term restraint has not been defined for staff and there was a lack of recognition of when restraint may be in use. This could relate in particular to the use of chemical restraint if medication is given for the purposes of stopping or reducing a behaviour. Staff were not aware of the Mental Welfare Commission Guidance "Rights, Risks and Limits to Freedom guidance on the use of restraint." This is an area where the guidance to staff could be made clearer by defining restraint and including the guidance recommendations within the training for staff.
5/13 Regulation 5: SSI 114 Regulation 5 (1) Personal Plans
Strengths
All personal plans examined were very comprehensive and reflect a person centred approach in each support plan.
Areas for Development
As previously stated under Standard 2 Written Agreement, if service users are unable to consent to their personal plan their representative should be fully consulted.
Regulation 7: SSI 114 Regulation 7 Fitness of Managers
Strengths
There has been a recent change of Manager. The verification of fitness of Manager has not yet been received. It is expected that this will be supplied without delay.
Areas for Development as above.
Regulation 9: SSI 114 Regulation 9 Fitness of Employees
Strengths
Quarriers have robust recruitment policies and procedures which include Disclosure Scotland checks, references and an interview process.
Areas for Development
Some staff files examined could not verify the appropriate procedures had been carried out. As previously stated under Standard 4 Management and Staffing, this information is held at headquarters and discussion will take place regarding a visit there to sample files.
Regulation 13: SSI 114 Regulation 13 Staffing
Strengths
There is a high level of training amongst the staff group with most staff trained to Higher National Certificate (HNC) in Care or Scottish Vocational Qualification in Care (SVQ)
Quarriers have an aim of achieving a high staff percentage with SVQ 3.
6/13 There are no set staffing numbers for each of the projects and the provider can adjust the staffing numbers according to the needs of the service users.
Areas for Development
There is an ongoing need for staff development and training.
Regulation 19: SSI 114 Regulation 19 (1) Records
Strengths
All of the relevant records were found to be satisfactory.
Areas for Development none
Regulation 25: SSI 114 Regulation 25 Complaints
Strengths
Quarriers have a comprehensive systems in place to allow a service users or representative to make a complaint.
Areas for Development
To ensure that representative's of service users receive a copy of the relevant complaints information.
National Care Standards
National Care Standard Number 1: Care at Home - Informing and Deciding
Strengths
An introductory pack is under development. A draft copy was available on the day of the inspection and this provided a good level of information. Due to the amount of text within the pack it is likely that this will be best suited for representatives of service users. It is the aim of the service to develop a format that is suitable for people with learning disabilities and this will include the use of pictures.
There is a mission statement that will be included within the pack. A set of aims for the projects was provided with the pre-inspection return.
The pack will include information about Quarriers, as the provider of the service and it is intended to also include an introduction from the Manager, this will also be included in the new service brochure.
7/13 The draft pack includes information about managing risk and reporting accidents and incidents.
There is excellent information available on how to make a complaint. A format has been produced using pictures.
The self evaluation of the service against this standard also recognises that service users can visit the project and attend one of the Tenants meetings if they wish. A yearly operational audit is carried out and copies can be made available. Staff will always be happy to meet and discuss the service with new service users. There is also a service descriptor available.
Areas for Development
At present there is no introductory pack available for service users and their representatives. The completion of the pack in keeping with this standard will be a recommendation of this report.
The aims and objectives statement could be expanded upon and made more specific to each of the projects.
Information about relief staff and how shifts would be covered if staff are off sick or absent could be included in the pack.
Limits of the service could be made clearer. This could be done within the written function and purpose of the service.
A policy or procedure could be developed to cover the arrangements for accepting an emergency admission to the service.
A closure strategy should be developed in the event of a change of ownership or closure of the service.
National Care Standard Number 2: Care at Home - The Written Description
Strengths
All service users have a support plan which clearly defines the level of support required by that individual for different areas of lifestyle. The service users at Calvay project were able to be fully involved in the development and review of their individual agreements.
There is a weekly planner in use and this details the hours of support per week. The daily hand-over sheet gives the support need and the time allocated.
Quarriers have a standard statement entitled "supporting people who are beginning to use or move on from a Quarriers service".
8/13 Areas for Development
Service users at Robroyston and Braidfauld projects were unable to consent to their agreements. A method of ensuring representative involvement will be a recommendation of this report.
National Care Standard Number 4: Care at Home - Management and Staffing
Strengths
The Quarriers Quality Manual contains the relevant policies and procedures covering: staff induction, supervision, development and competency review. New staff undergo a 6 month probation period which is followed by an initial review of performance. There is then an annual development and competency review. Staff spoken with verified that this process was taking place.
The management aim to carry out 4 supervision sessions with individual staff members per year.
All staff have a development and learning handbook. The training events available to staff are accessed using either a paper copy or through the intranet site managed by Quarriers
Some training is considered to be mandatory and must be completed by all new staff and updated yearly.
Within the Quarriers Care Manual there is a standard for medication which includes all aspects of administration, collection and storage. In addition there is a medication folder which contains information for staff based on the Royal Pharmaceutical Society guidance. Each service user has a medication folder which details the individualised support and records for prescriptions requested, medication received, administered and returned. Staff who are involved in assisting service users with their medication needs all receive in- house training on this subject. Some staff have attended external training in addition.
There is a Risk Assessment standard detailed in the Quarriers Care Manual. This was last updated in May 2005. There is a seven step format for individual risk assessment and a five step format for general risk assessment. There is a "keeping yourself safe" pictorial guide which is used to assess risk using a person centred format. This is then signed by the person who was assessed and the assessor.
There is a health and safety representative for each of the projects with quarterly meetings held at Quarriers headquarters.
There is a complaints log book and a quarterly return of complaints received is sent to the Quarriers headquarters. There is a complaints leaflet which fully explains how to make a complaint or express a concern.
There is an incident/ accident logging system in place, these are passed on to Quarriers headquarters.
9/13 The staff can access all the relevant policies and procedures. Each project has copies of the Quarriers policy manuals. New policy guidance is highlighted to staff using a memo system. This can then be discussed at staff meetings. There is a staff sign sheet which evidences when staff have read a policy or procedure.
There is a recruitment file which provides guidance on all aspects of staff recruitment. Some staff files contained the relevant criminal record check and references.
The "New Horizons Group" involves service users in the recruitment process.There is staff training available for staff involved in recruitment.
Each service has a development plan and the organisation has a strategic plan. A copy of the operational audit was provided with the pre-inspection return. This is carried out regularly and assists the provider in monitoring the quality of the service.
Staff dress appropriately and carry identification cards.
Areas for Development
Risk assessments carried out with service users who cannot consent and agree the outcome should be fully discussed and agreed with the service user's representative.
Some staff who were recruited some time ago did not have evidence of the relevant criminal record check or references. This information is stored at headquarters. A tracking system should be put in place to ensure that Managers can verify staff fitness. Discussion will take place with Quarriers and it may be necessary to visit the headquarters to sample staff files held there.
National Care Standard Number 7: Housing Support Services - Exercising Your Rights
Strengths
The draft introductory pack contains a service user's charter which sets out the rights of service users.
The support plans examined were detailed and were updated every 6 months. This gives service users the opportunity to explore any issues which may be affecting them.
There is a whistleblowing policy and a protecting vulnerable adults policy which dates form May 2005.
There is training available to staff about detecting and preventing any form of abuse.
The files with personal information are stored in a locked filing cabinet.
The support plans given to service users are stored in their own flat or in the case of Robroyston project there is a locked cabinet in each of the bedrooms.
10/13 All staff have been issued with the Scottish Social Services Council (SSSC) codes of conduct and prior to this Quarriers had also issued their own codes of conduct.
Service users spoken with at the Calvay Project were confident that staff acted appropriately and always dealt with their requests quickly as far as possible.
There are 2 coordinators who act as the usual contact for service users and service users spoken with were clear about who they were allocated.
Areas for Development
As previously stated in Standard 1 the introductory pack should be completed and issued to all service users and their families/ representatives.
Agreements reached about the level of information collected about an individual should be agreed with the service user's representative if they are unable to consent to this.
National Care Standard Number 8: Care at Home -Keeping Well -Keeping Well - Medication (where help with taking medication is provided as part of the service)
Strengths
The medication files viewed were very detailed and demonstrated adherence to best practice.
There is a medication administration sign sheet used to evidence each medication administered.
The medication name and details of what it was for and any side effects was available in each file. This is very good practice.
The arrangements for helping an individual with medication were all detailed according to individual preferences through the support plan.
Areas for Development
If a service user lacks capacity for decision making over a change of medication this should be fully discussed and agreed with the G.P, and the service user's representative.
Some service user's may benefit from having access to homely remedies. Staff guidance and a protocol for administering homely remedies such as cough linctus could be considered. Such a protocol should include agreement with the service user's representative where appropriate.
11/13 National Care Standard Number 11: Care at Home - Expressing Your Views
Strengths
Service users spoken with were confident that they would be able to discuss any concerns with staff or management of the service.
The complaints leaflet was seen to be available at the projects visited. There has also been a recent introduction of a postcard system in which comments or concerns can be raised to Quarriers.
The leaflet supplied by Quarriers contains the name and address of the Care Commission and makes it clear that service users or representatives can also contact the Care Commission.
The complaints procedure set out by Quarriers includes timescales for resolution and that a response will always be given.
The staff have received information about the new Mental Health Act.
There was advocacy information displayed at the Calvay project.
Areas for Development
Ensuring that family members and representatives of service user's who cannot express their views independently have access to complaints leaflets is an area that still needs to be developed.
Staff development in recognising the need for independent advocacy and having links with local advocacy services should be explored. There is no clear guidance from Quarriers on advocacy and the role of representatives.
12/13 Enforcement N/A
Other Information N/A
Requirements There are no requirements.
Recommendations Standard 1 Informing and Deciding (Care at Home) It is recommended that all of the information listed within this standard is made available to service users and their representatives.
Standard 2 The Written Agreement. Service users who lack capacity and cannot consent to their written agreement should have this signed by a representative.
Standard 4 Management and Staffing It is recommended that service users who are unable to consent to the decisions made during a risk assessment have the assessment and outcome fully discussed and agreed with their representative. It is recommended that a tracking system be implemented to verify the relevant checks have been carried out during staff recruitment.
Regulation 4 Welfare of Users It is recommended that the term restraint is defined for staff and that training reflects the guidance issued by the Mental Welfare Commission.
Sarah Gill Care Commission Officer
13/13