Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Housing Support Service
Care at Home Services Social Work Office Mull and Iona Hospital Carignure Isle of Mull Argyll and Bute PA65 6BG
Telephone: 01631 567800 Tiree: 01879 220765 Central No. 01546 605517
Type of inspection: Announced (short notice)
Completed on: 20 September 2018
Service provided by: Service provider number: Argyll and Bute Council SP2003003373
Service no: CS2004079385 Inspection report
About the service
The Mull, Iona, Colonsay, Tiree and Coll combined Home Care and Housing Support Service is run by Argyll and Bute Council and provided to people in their own homes on these five islands.
To organise and deliver the care at home and housing support service the provider employs the following, Home Care Manager and Home Care Organisers as well as over seventy home support workers and an administrator, who work in full and part-time capacity with a menu of hours and shift patterns.
At the time of the inspection the service was providing support to 54 service users.
There was also a team of home carers who work in Bowman Court a 'progressive care centre', where people are tenants of a Housing Association. The tenants have access to prepared and served lunch and dinner in the complex dining room. Bowman Court is adjacent to the hospital at Craignure, Isle of Mull. The home support workers have a shift pattern providing 24 hour cover, seven days per week rota for Bowman Court.
The service operates 24 hours per day 365 days per year. The people who use the service are supported by an out of hours service 'CareFirst'.
What people told us
Before and during our visit we received 13 completed care standards from service users and relatives and 7 from staff. There were 54 supported by the service at the time of our inspection. During our visit we spoke with 8 service users and 5 relatives. We spoke with staff throughout our inspection and as part of our general observations.
Overall service users and relatives gave very positive feedback about the standard of care delivered by the service. When areas for improvement were identified we explored these further and communicated them anonymously to the manager and with a view to supporting improvement if needed. Comments included:
- 'The service is excellent and staff are wonderful'.
- 'Very good service. Very reassuring and going the extra mile'.
- 'Very reliable. If they are held up they always let me know'.
- 'Their kindness, understanding and efficiency are great'.
- 'I'm extremely happy. They look after everything for me'.
- 'Overall wonderful, but name badges would be good'
- 'I enjoy chatting with the carers. We have become friends'.
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
Self assessment
The service had not been asked to complete a self assessment in advance of the inspection. We looked at their own improvement plan and quality assurance paperwork. These demonstrated their priorities for development and how they were monitoring the quality of the provision within the service.
From this inspection we graded this service as:
Quality of care and support 5 - Very Good Quality of staffing 4 - Good Quality of management and leadership 4 - Good
Quality of care and support
Findings from the inspection We were encouraged by evidence of positive experiences gathered from observations, sampling of records, feedback from service users and relatives and discussions with managers and staff. As a result we were confident that people experienced good outcomes while accessing care and support by the service. Service users and relatives we spoke to commented very positively on their experience of the service. People told us that they found staff to be caring, compassionate and reliable.
The service was pro-active in ensuring that people's needs could be met. We found that a very good example of this were the regular 'virtual ward' meetings. These meetings enabled senior staff to regularly meet with a variety of other health professionals, social workers and ambulance staff. Staff used these meetings to exchange important information and co-ordinate responsive support. This very good practice supported good outcomes for people and enabled them to be supported well in their own homes and communities.
We saw that the service had put great effort into ensuring that service users had up to date and complete personal plans. People confirmed to us that they were aware of their personal plans. The plans we sampled contained good and relevant detail. Staff completed detailed records of the support they provided during their visits. This meant that people's personal plans were right for them, because they set out how their needs will be met and respected their wishes and choices.
We found that the service operated a very clear policy on supporting people with their medication. Staff were aware of policies and guidelines. This meant that support was provided correctly and safely.
The service a clear and up to date schedule for ensuring that people could review their personal plans with managers every six months. Senior staff worked hard on improving this area and at the time of our inspection most service users had received their review on time. The service users we spoke to confirmed that they had met with managers to review their personal plan. This meant that people were given the opportunity to discuss their needs and outcomes and to provide important feedback. We encouraged managers to continue with driving improvements to ensure that people can be meaningfully involved in planning and evaluating their support.
Requirements Number of requirements: 0
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
Recommendations Number of recommendations: 0
Grade: 5 - very good
Quality of staffing
Findings from the inspection We found that feedback from service users and families regarding staff competence and conduct was very good. People appreciated that staff demonstrated compassion, skill and helpfulness. A service user told us 'all are very friendly and so really good to talk to'. A relative said 'their kindness, understanding and efficiency are great'. People we spoke to were very happy with the reliability of their support. A service user told us 'they are very reliable and if they are ever held up, they let me know right away'. People therefore felt that staff provided comfortable and safe support for them.
Staff we spoke to appreciated that, after a recent period of change, they now had a stable and experienced team of managers. This meant that they felt settled and well supported.
We saw that the service progressed well with implementing a good system of staff supervision, including individual and group supervision meetings. Staff told us that they found their supervision beneficial and elevantr to supporting them with their current practice. Managers had also started to use observations of practice alongside the supervision process. This meant that the service had good processes in place to support staff and to evaluate their skills and training needs.
The service maintained a clear and up to date training plan for staff. This contained all necessary training and was also aiming to include a variety of topics relevant to supporting staff with their current practice. A very good example was a staff member who had attended training with the RNIB to become a lead practitioner who could help other staff learn about supporting people with vision problems. The service's proactive approach to training meant that staff felt they were given opportunities to learn things that helped them to do their job well.
Some staff members had recently attended an enhanced level course for supporting people with dementia who experience stress and distress. However, we found that staff members overall still needed more and better access to training for supporting people living with dementia. We discussed this with managers and identified this as an area for improvement (see recommendation 1). We also encouraged managers to increase the use of reflective practice alongside this training.
Requirements Number of requirements: 0
Recommendations Number of recommendations: 1
1. The service should further increase efforts to ensure that staff are supported to complete Promoting Excellence in dementia care learning at a level corresponding to their role. This should include learning at
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
enhanced level for senior staff and enabling one or more staff members to join the SSSC Dementia Ambassador network.
This is to ensure that care and support is consistent with the Health and Social Care Standards which state that I experience high quality care and support based on relevant evidence, guidance and best practice (HSCS 4.11).
Grade: 4 - good
Quality of management and leadership
Findings from the inspection Service users, families and staff told us that they found managers to be effective, supportive and approachable. People appreciated that managers worked hard to stabilise the service after a recent period of management changes and absences of senior staff. We found that managers had very effectively addressed a number of requirements following the previous inspection. This meant that people experienced stability and consistency in their care and support.
The leadership team had successfully implemented or restored effective systems for quality assurance. This enabled managers to gain a good overview of performance in key areas and to drive improvements. We encouraged managers to continue with developing effective, relevant and responsive systems for their quality assurance.
We found that the management team was proactive in looking for opportunities to improve the service. People confirmed to us that managers were open to feedback and suggestions. We discussed that the service could further improve the involvement and participation of service users and families in the service. Managers had a number of ideas, including offering more involvement in staff recruitment. We encouraged managers to explore ideas with service users and relatives.
Managers organised regular staff meetings. This helped staff members to feel part of a team and to stay informed about developments in the service. The meetings also contained elements of learning that were relevant to current practice. This meant that people's care and support benefitted from staff having the necessary information and resources.
Requirements Number of requirements: 0
Recommendations Number of recommendations: 0
Grade: 4 - good
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
What the service has done to meet any requirements we made at or since the last inspection
Previous requirements
Requirement 1
The provider must ensure that they apply to the Care Inspectorate to advise of the proposed responsible employee within care at home to be the registered manager and have the capacity to facilitate the inspection process. The provider must ensure that the responsible person ensures all reportable events are notified to the regulator in a timely manner as per the Care Inspectorate and the provider's service guidance for reportable incidents and events.
This is in order to comply with:
The Social Care and Social work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) regulation 3 - Principles and regulation 4(1)(a) - Welfare of users
Timescale: To start immediately and be completed by 25 June 2018.
This requirement was made on 24 May 2018.
Action taken on previous requirement The service had a registered manager and the necessary leadership team in place to run the service effectively and to facilitate the inspection process well. The service notified the care inspectorate of applicable events.
Met - within timescales
Requirement 2
The provider must ensure a consistent and sustainable support to the registered manager and employees at Mull, Iona, Tiree, Coll and Colonsay care at home service to ensure that the aims and objectives of the care service are met and that staff are in sufficient numbers and have the necessary competency levels to acilitatef the inspection process, arrange delivery of the care service and ensure positive outcomes for all persons and their advocates.
This is in order to comply with:
The Social Care and Social work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) regulation 3 - Principles and regulation 4(1)(a) - Welfare of users and regulation 15(b)(i) - Staffing.
Timescale: To start immediately and be completed by 30 July 2018.
This requirement was made on 24 May 2018.
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
Action taken on previous requirement The service was supported by a permanently employed locality manager who supported the service manager through regular meetings. The management team based at Bowman Court facilitated the inspection well. All managers and the locality manager were present during the inspection.
Met - within timescales
Requirement 3
The provider must review the staff training and competency levels to implement best practice to protect the people who use the service. The provider must provide the Care Inspectorate with a copy of the training calendar developed and to be delivered, to meet the requirements of all employees identified through supervision and the assessed needs of residents to provide positive outcomes for people who use the service.
* Promoting Excellence - Dementia
This is in order to comply with:
SSI 2011/210 Regulation 15 - Staffing - ensure that persons employed in the provision of the care service receive -
* training appropriate to the work they are to perform; and
(ii) suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work
Timescale for improvement: To be completed by 30 July 2018.
This requirement was made on 24 May 2018.
Action taken on previous requirement The service had an up to date training plan for all staff. Training provided was relevant to the delivery of care and to meeting the objectives of the service.
Met - within timescales
Requirement 4
The provider and management must review that the provider's policies and procedures are accessible and understood by all parties regardless of roles and responsibilities. The audit system is implemented to ensure positive outcomes for people who use the service and to protect the health and wellbeing of all stakeholders. For example ensure that each individual has a copy of their own care plan and records of care plan reviews a minimum of six monthly, minutes of meeting, action plan, outcomes and way forward.
This is to comply with:
SSI 2011/210 Regulation 4(1) (a) - Welfare of Users - a provider must make provision for the health, welfare and safety of service users
To start immediately and be completed by 25 June 2018.
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
This requirement was made on 24 May 2018.
Action taken on previous requirement Staff had access to policies on the local authority website 'hub'. The service had worked effectively on re- establishing quality assurance systems. Well working systems were in place to provide managers with a detailed overview of progress and outstanding work. This included an overview system for six-monthly care reviews.
Met - within timescales
What the service has done to meet any recommendations we made at or since the last inspection
Previous recommendations
There are no outstanding recommendations.
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 22 Mar 2018 Unannounced Care and support 3 - Adequate Environment Not assessed Staffing Not assessed Management and leadership 1 - Unsatisfactory
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
Date Type Gradings 4 Apr 2017 Announced (short Care and support 4 - Good notice) Environment Not assessed Staffing Not assessed Management and leadership 5 - Very good
5 Feb 2016 Announced (short Care and support 4 - Good notice) Environment Not assessed Staffing 4 - Good Management and leadership 4 - Good
26 Mar 2015 Unannounced Care and support 3 - Adequate Environment Not assessed Staffing 4 - Good Management and leadership 3 - Adequate
27 Feb 2014 Announced (short Care and support 3 - Adequate notice) Environment Not assessed Staffing 4 - Good Management and leadership 3 - Adequate
11 Mar 2013 Announced (short Care and support 4 - Good notice) Environment Not assessed Staffing 4 - Good Management and leadership 4 - Good
13 Dec 2011 Unannounced Care and support 3 - Adequate Environment Not assessed Staffing Not assessed Management and leadership 3 - Adequate
3 Jun 2009 Announced Care and support 4 - Good Environment Not assessed Staffing 4 - Good Management and leadership 4 - Good
30 May 2008 Announced Care and support 3 - Adequate Environment Not assessed Staffing 3 - Adequate Management and leadership 3 - Adequate
Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service Inspection report
To find out more
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Inspection report for Mull & Iona, Coll & Tiree and Colonsay Home Care Service/Housing Support Service