Wishaw and Home Support Service Housing Support Service Kings House Kings Street ML2 8BS Telephone: 01698 348243

Inspected by: Lorraine McIntyre Alison Iles Type of inspection: Unannounced Inspection completed on: 4 December 2013 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 10 4 Other information 25 5 Summary of grades 26 6 Inspection and grading history 26

Service provided by: North Council

Service provider number: SP2003000237

Care service number: CS2004071348

Contact details for the inspector who inspected this service: Lorraine McIntyre Telephone 01698 897800 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 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate

What the service does well

Wishaw and Shotts Home Support Service provides care at home and housing support to a large number of people with a wide range of needs in the Wishaw and Shotts locality of . The care and support provided to the people who use the service is delivered in the individual's home and enables them to remain living in the community for as long as possible.

What the service could do better North Lanarkshire Council and Locality Management continue to monitor and have a Home Support Re-design plan for this support service through the development and recruitment of additional staff. As stated at the previous inspection, there continues to be minimal opportunities for the home support managers to leave the office in order to assess staff practice, competency and standard of completed documentation.

This planned re-design of the service will see the introduction of new staff which will allow existing staff to improve the standard of current quality assurance systems in place.

What the service has done since the last inspection

The service was in the process of piloting a new medication management system with the support of two pharmacists contracted to the NHS. The staff members

Wishaw and Shotts Home Support Service, page 3 of 28 Inspection report continued involved in this pilot have received additional training to provide them with a better understanding of the service users' medical condition and medication required.

Conclusion

The service continues to provide support to a wide range of service users some with complex needs. The service manager has acknowledged the need to improve the quality assurance systems in order to improve the standard of service provided. We will monitor how the redesign of the service and employment of additional staff has impacted on the service at the next inspection.

Who did this inspection Lorraine McIntyre Alison Iles

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1 About the service we inspected

Wishaw & Shotts Support Services - Care at Home and Housing Support is provided by North Lanarkshire Council. The service was registered by the previous regulator in 2004 - 2005 and Social Care & Social Work Improvement in April 2011.

The service provider employs over two hundred and sixty home support workers who deliver the care service to over six hundred service users in their own home. The service's support is offered to a range of individuals; for example, children, families, people with physical/mental disability and older people. It also provides a drop in support service for people with addictions.

The aim of the care service is to "provide high quality care that is tailored to the needs of the individual service user and promote dignity, empowerment and choice".

Based on the findings of this inspection this service has been awarded the following grades:

Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate 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 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 We compiled this report following an unannounced inspection. The inspection was carried out by Inspectors Lorraine McIntyre and Alison Iles.

The unannounced inspection took place on 30 and 31 October 2013 between the hours of 09:30 and 16:00. We concluded the inspection on 27 November 2013 between the hours of 09:30 and 15:45. Feedback was provided to the service manager on 4 December 2013.

In this inspection we gathered evidence from various sources including the following:

* Personal support plans * Service user, carer and staff questionnaires * Minutes of meetings * Staff training and recruitment files * Medication administration and recording * Accidents/incidents and complaints records * Managers' audits * Supervision and employee development * Results from returned Care Standard Questionnaires

During the inspection we also spoke to the following people:

* Service manager * Senior home support manager * Two home support managers * Five service users and their relatives in their own homes

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

Wishaw and Shotts Home Support Service, page 6 of 28 Inspection report continued 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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What the service has done to meet any requirements we made at our last inspection

The requirement The service must develop a method of recording accidents and incidents of people using the service. This will enable the service to identify areas of concern and introduce ways of managing and reducing risk to service users. The manager must review this information on a regular basis and record this information along with a suitable action plan.

This is in order to comply with;The Social Care and Social Work Improvement Scotland (requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 4 (a) Welfare of users.

Timescale; Immediately on receipt of this report.

What the service did to meet the requirement The service was continuing to record incidents but some of these incidents should have been recorded as an accident with evidence recorded of actions taken and outcomes.

The requirement is: Not Met

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. We 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 of the headings that we grade them under.

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The provider identified what they thought they did well, some areas for development and any changes they planned.

Taking the views of people using the care service into account We issued 200 Care Standard Questionnaires of which 38 were returned by staff, 55 from service users and 36 from relatives and carers. The results were as follows;

* 83 people agreed or strongly agreed with all questions asked and were happy with the standard of service provided. * 4 people disagreed and said they were unhappy with the standard of care provided. * 17 people said they did not have a support plan. * 46 people said they did not know how to complain to the service or Care Inspectorate. * 32 people disagreed that the service regularly asked their opinions on how it could improve. * 23 people disagreed that the service regularly checks to ensure it is meeting their needs. * 24 people thought staff did not have enough time to provide care and support. * 8 people did not know staffs' names and 5 people thought that staff were not adequately skilled to meet their needs. Some of the comments we received from service users and carers were as follows; "there is a very good team of friendly and helpful carers and I am delighted with the service that I get" " my mother has always been treated with great care and concern, the current team of carers are excellent, the girls have a wealth of experience between them and it is reflected in their whole approach, we all benefit from their care, kindness and consideration. The only negative comment that I would make is the time that the staff are allocated to each person is inadequate" " I am very grateful for the help I am getting, thanks a lot" " although I get a letter every week detailing all the week days it never tells me who I have at the weekend, only on occasions it tells me but overall I am happy with the service" " there is no care plan in place for my mother, the carers are always rushed and don't seem to have enough time. The carers are changed quite often and because there is no care plan in place they do not have a clue what to do."

Taking carers' views into account Please see results and comments in previous statement " Taking the views of people using the care service into account."

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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: 3 - Adequate

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 We thought that the service was performing at an adequate level in areas covered by this statement.

The service continues to be provided from an office in of Wishaw with good transport links for people visiting the office.

Communication and consultation between the provider and the service users involved meetings, questionnaires, surveys, service user forums and tenants forum meetings. Recent forum meetings had representation from tenants, Carewatch North Lanarkshire and senior staff from the office. These forums, which included workshops, were used to promote and encourage service user participation in the service, particularly the recruitment of new staff. Other topics discussed included the future plans for the re-design of the service and how this would improve the standard of support delivered to service users and staff.

Service users were also encouraged to contribute and comment on the self- assessment. This is completed annually by the service for the Care Inspectorate and the information recorded is used in the inspection process.

The service continued to support people through the Re-ablement programme. This provided intense support in order to maximise people's dependency skills and promote independent living. There continued to be regular Re-ablement meetings with input from home support managers, district nurses and occupational therapists. Feedback from service users and relatives for this service continued to be positive.

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There was an informative newsletter produced at local level informing people of any changes to the service, useful telephone numbers and advice on how to survive winter.

There were support plans available in the homes we visited which contained a welcome leaflet and letter. This provided people with information on how to contact the home support manager if they were concerned or wanted to raise any concerns. Areas for improvement At feedback with the manager we discussed the difficulty we experienced in obtaining current, up to date information. The majority of evidence we sampled was relevant to the previous inspection.

We could see that there had been meetings and surveys taking place; however, there was no information recorded to demonstrate how the results had positively influenced outcomes for people using the service (see recommendation 1). The welcome leaflet needs to be improved to provide people with current up to date information. There were no details included on how to contact the Care Inspectorate should someone have a complaint. It also stated that "the service you receive will be reviewed at least once a year". This information is inaccurate as the service must provide reviews at least once in every six month period as stated in current legislation. (see requirement 1).

Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1

Requirements 1. 1. The Provider must review and update the current information leaflet taking account of current legislation. The information available must inform people that they will receive a review of their care at least once in every six months whist they are in receipt of the service.

This is in order to comply with; The Social Care and Social Work Improvement Scotland (requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 5(2)(b)(iii) Personal plans.

Timescale; within one month upon receipt of this report.

Recommendations 1. The service should ensure that minutes of meetings provide information to demonstrate any actions to be taken, the person responsible, timescale for

Wishaw and Shotts Home Support Service, page 11 of 28 Inspection report continued completion and conclusion to demonstrate positive outcomes for people using the service.

This is in order to comply with; National Care Standards, Care Homes for Older People, Standard 11: Expressing Your Views.

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We thought that the service was performing at an adequate level in areas covered by this statement.

The service was piloting a new medication management and administration process system. Staff were working in conjunction with two pharmacists contracted to the NHS who were supporting staff and delivering training on this new system. This new process involved staff dispensing each individual tablet and recording this on the Medication Administration Recording (MAR) charts. This required staff to have a more in-depth knowledge of the service users medical conditions, reasons for the medication and how to recognise and manage side effects. The service had just developed and were in the process of implementing a new medication administration policy. New guidance 'Medicines Management at Home' had also been produced to assist staff on current protocols. We will monitor the implementation and impact this new system has had on staff's knowledge and competency at the next inspection.

The service had recently introduced a programme of training to assist staff''s understanding of people's health psychology. This had involved input from a trainee health psychologist who promoted a more person centred, non-judgemental and supportive form of communication for staff to implement.

We sampled support plans from the office and in individuals homes. They contained welcome leaflets and service user agreements. Each had a pen picture which provided a summarised version of people's support needs. The support plans informed staff of support required and dates and times of scheduled visits from care staff.

Staff's schedules were sent out by post informing people of the names of care workers and times they would be receiving support. The times and level of support required was determined by the information obtained from the shared Community Care Assessment which was completed by the social work department in conjunction with other agencies.

Service users who were unable to mobilise and allow access to their property were provided with a key-safe to ensure that staff could gain access, particularly in an

Wishaw and Shotts Home Support Service, page 12 of 28 Inspection report continued emergency situation. Some people had the added benefit of an 'Alert' alarm which was connected to the Community Alarm System who deployed staff to deal with the situation. The service users we spoke to told us that this provided them with added security and confidence that staff were available to help them 24 hours a day.

We visited service users and relatives in their own homes who told us the following;

"The girls are very nice, they are kind and respectful"

"Have the same two girls coming in and know them well, get on well with all the staff and have no complaints "

"My carers alternate each week, they are always on time and I never feel rushed. If I had a concern I would speak to my carers first before calling the office but don't have any issues at present." Areas for improvement The service is in the process of going through a re-design process. This will see the recruitment of additional home support co-ordinators to assist the home support managers in improving the quality of documentation and management of care provided. We have acknowledged that the service is in the process of changing and will monitor the impact this has had on the quality of care provided at the next inspection.

The support plans we looked at provided no information on the person's medical history, medication required, side effects or how staff were expected to recognise and manage this. For example, staff had no information on how to recognise and manage someone who had depression. The only information available to them was "has a diagnosis of depression ". There was no information included in the support plan to demonstrate who had the legal power to make a decision on the person's behalf; for example, Power of Attorney or Guardianship. This lack of information had the potential to have decisions made on the person's behalf by someone who did not have the legal status to do so.

Other comments included "been losing dramatic amount of weight is forgetting to eat". There was no risk assessment in place or details of how these concerns were managed by staff. We were satisfied to see that this had been addressed by the person's next of kin and had been investigated appropriately. There were no risk assessments in place for moving and handling and information recorded was inconsistent and confusing. For example, we were informed that one service user received overnight care; however, this was not recorded in the support plan. Some support plans stated "provide support" but had no further details explaining the amount or type of support required. There was no information recorded as to who had the legal powers to make a decision on the person's behalf; for example, power of attorney or guardianship. (see requirement 1).

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The service had worked hard to ensure that six monthly reviews were taking place in line with current legislation. However, there remained a large amount outstanding. (see requirement 2).

We looked at the Medication Administration Records and found that staff were not completing these correctly despite recent training and support from the community pharmacists. We found signatures missing with no explanation therefore it was unclear if the medication had been administered. This had the potential to cause confusion which may result in the person receiving their medication by another staff member who has assumed it has not been administered. We saw medications were not stored securely which provided risk to service uses that were forgetful or confused. Some staff were responsible for providing support to take medication. We saw from the schedules and allocated times that there were less than four hours between visits. The impact of this was that people were being given medication outwith the prescribed times. For example, we could see that staff had visited a service user at 12:30 hrs and, as the person was out, had dispensed and left the medication out. At 15:30 hrs another staff member attended and repeated this procedure. This had the potential to put the service user's health and wellbeing at risk from taking a double dose of medication which could have had serious consequences. (see requirement 3).

Schedules were posted to all service users weekly. We have acknowledged that the postal service used had recently changed which had resulted in some schedules not being delivered on time or not at all. This resulted in some people not being informed of the staff member or times of visits. The manager assured us that issues with the postal service had been identified prior to inspection and actions were being taken to have this resolved in the near future. We will continue to monitor this and will review further at the next inspection. Some comments received from service users were as follows;

"Got last week's schedule but nothing for this week, don't get one every week"

"Staff change regularly, never get told when there is a change, sometimes phone out of hours to see who is coming".

The provider must assess the dependency levels of people using the service. This must take into account individual's medical history and people's physical and cognitive impairment. The support times provided should be reflective of the individuals needs and demonstrate that it provides a suitable standard of quality and support. The times allocated for people's personal care and support must not be inclusive of staffs' travelling time. (see requirement 4).

Further comments we received from staff and service users were as follows;

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"The clients deserve more than a 15 minute slot which includes travel time"

"Service users with Alzheimer's needs to be recognised, simple tasks can take a long time depending how advanced their condition is and rushing these people only has a negative effect" "I barely take my jacket off to do what I have to do for the service user then its straight out the door and off to the next one. I never get any travelling time and the person that is losing out is the service user. As I have to be at the next person on the half hour this means that a half hour visit can be as little as 20 minutes. I am always rushing and don't have enough time to give 100% to the job."

Grade awarded for this statement: 3 - Adequate Number of requirements: 4 Number of recommendations: 0

Requirements 1. The service provider must ensure that service users' personal plans set out how the health, welfare and safety needs of the individual are to be met. In order to do this the service must ensure that the personal plans;

* accurately reflect all the current needs of individuals * reflect a person centred approach and are developed in line with National Care Standards * include details about individuals preferences over all aspects of care and support * include information about care and support interventions and are developed to fully reflect the care being provided * include information about care and support that is up to date and regularly evaluated * have a full range of risk assessment tools in place and that the outcome of the assessments are used to their full potential to inform care planning *contain information or make reference to where the information is recorded regarding the medication prescribed for individuals and possible side effects * include information regarding the use of special equipment to support the individual * there is up to date information regarding the legal status or individual residents supported by certificates detailing who has the legal authority to make decisions on the individuals behalf * include reference to information relating to power of attorney, guardianship or adults with incapacity certificates supported by an appropriate treatment plan for

Wishaw and Shotts Home Support Service, page 15 of 28 Inspection report continued the residents who lack capacity to make formal decisions about their own care and support. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulations 5(1) Timescale; to commence upon receipt of this report and be completed by 31/10/ 14. 2. The provider must ensure that at least once in every six month period personal plans are reviewed. The format used to record the six monthly care review meetings must fully reflect the discussions that take place and inform current planning of care and support.

This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210), Regulations 5(2)(b)(iii) Personal plans.

Timescale for implementation; to commence upon receipt of this report and be completed by 31/10/14. 3. The service provider must ensure that all service users have been assessed and have clear records in the personal plan of the specific intervention required by staff in the administration of medication. This must be reviewed and evaluated regularly to ensure that there is an up to date evaluation on individuals level of compliance, motivation, physical ability and understanding to demonstrate the level of support required is suitable. Staff must receive further training on the recording and administration of medication. The service provider must demonstrate how staffs competency and standard of documentation has been assessed and reviewed regularly to ensure safe practice.

This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 4(1)(a) Welfare of users.

Timescale; to commence upon receipt of this report and be completed by 30/06/ 14. 4. The service provider must ensure that service users needs and dependencies are suitably assessed to ensure that staff are allocated support times which take into account the service users physical and psychological needs. People who are frail or present with behaviour that is challenging must be assessed and provided with suitable time to ensure their needs are not compromised due to insufficient time allocation. The direct care time allocated to a service user must not be compromised by staff's travelling time. The service provider must demonstrate how service users have been assessed, the times allocated for each individuals direct care which should not be inclusive of travel time.

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This is in order to comply with The Social Care and Social Work Improvement Scotland(Requirements for Care Services) Regulations 2011(SSI 2011/210) Regulation 4(1)(a) Welfare of users.

Timescale; to commence upon receipt of this report and be completed by 30/06/ 14.

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Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate

Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths We thought the service was performing at an adequate level in areas covered by this statement. The areas of strengths highlighted in Quality Statement 1.1 are also relevant to this Quality Statement. Areas for improvement The areas for improvement highlighted in Quality Statement 1.1 are also relevant to this Quality Statement.

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

Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We thought the service was performing at an adequate level in areas covered by this statement.

We sampled staff personal files which contained a range of relevant up to date information. Each file contained previous employment history, training attended, copies of identification documents and results of a health questionnaire. There were two satisfactory references and information recorded on Protection of Vulnerable Groups (PVG) checks.

All new employees received a comprehensive induction covering the relevant sections of policies/procedures and health and safety.

Wishaw and Shotts Home Support Service, page 18 of 28 Inspection report continued Areas for improvement The induction checklist for new employees contained a range of topics and training discussed at the induction process. This had been signed by the employees' line manager however the dates recorded suggested the full induction had been completed in one day.

Grade awarded for this statement: 3 - Adequate 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 We thought the service was performing at an adequate level in areas covered by this statement.

Staff had attended 'Road' shows organised by the provider to ensure people were kept informed of the future changes and re-design of the service. Staff also received newsletters and internal memos informing them of any changes within the service which effected their roles and responsibilities.

Training was organised at corporate level through the Learning Organisational and Development Team. Some of the training available included dementia, palliative care and adult/child protection. More specialist training was organised at local level through district nurses and other independent providers depending on the training required for staff who were supporting people's individual needs. New staff benefitted from a five-day induction period. This covered their roles and responsibilities, policies and procedures and a range of training which included food and nutrition, stroke awareness, dressing skills and skin and pressure area care. They then worked alongside a permanent employee and shadowed them for a few days until they got to know the service users needs and routines.

All staff had mobile phones which allowed them to contact the office or other staff members for advice or assistance. They were able to access an out of hours service for further advice and support outwith office hours. As part of the re-design process the provider was planning to issue all staff with new smart phones. This would provide staff direct access to their work schedules and avoid any confusion or delays in receiving these. Regular Re-ablement meetings were taking place with home support managers organising 'patch' meetings for mainstream staff.

Staff were invited to an Easi-MO day which provided all staff with access to a general health and lifestyle check-up. They were given advice on how to access

Wishaw and Shotts Home Support Service, page 19 of 28 Inspection report continued complimentary therapy sessions, information on tax credits and benefits and were offered the seasonal flu vaccine. Areas for improvement From the evidence we were presented with and comments from staff we concluded that there was insufficient staff consultation and support being provided in the form of meetings, supervision and assessment of competencies. However we have acknowledged that the service is currently in the process of a redesign programme which demonstrates they have recognised the need to address these issues.

The provider was currently in the process of recruiting more home support co- ordinators as part of this re-design process. The introduction of additional staff will provide support to the home support managers with office based duties. This will allow the HSM to organise and provide more frequent staff meetings, supervision and assess working practice and competency. The manager informed us that the provider was in the process of developing and improving the Personal Development Reviews (PDR) for all staff. This will require further training for home support managers on how to deliver and record this effectively.

We received 38 completed Care Standard Questionnaires from staff. The results were as follows;

* 26 disagreed that they had regular supervision * 29 said they had no opportunity to meet with other staff * 16 said they felt unsafe at work * 18 said they were not asked for their opinions on how to improve the service.

Some comments received from staff were as follows;

"Overall the service is very good, sometimes it the time factor which has an impact on the staff. It could be better planned out as we are left to explain to service users why we are late, they can sometimes be very angry if no one appears at the times stated on the schedule"

"I only get supervision with my manager once a year and we don't have regular meetings with other staff."

We concluded that new staff received a comprehensive induction covering a range of health care topics. However staff who had been employed for a number of years did not benefit from this training or were able to attend in order to update their knowledge and practice. The provider should review and extend this training to ensure that all staff employed within the service have the opportunity to attend training and receive these updates(see recommendation 1).

Wishaw and Shotts Home Support Service, page 20 of 28 Inspection report continued Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1

Recommendations 1. The service provider should implement a system to ensure that all staff have the opportunity to attend training and updates on current best practice and legislation. The information and training provided to new employees at induction should be extended to ensure that staff who have worked in the service for a number of years have access to the same updated information.

This is in order to comply with; National Care Standards, Housing Support Services, Standard 3: Management and Staffing Arrangements.

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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 We thought the service was performing at an adequate level in areas covered by this statement.

The areas of strengths highlighted in Quality Statement 1.1 are also relevant to this Quality Statement. Areas for improvement The areas for improvement highlighted in Quality Statement 1.1 are also relevant to this Quality Statement.

Grade awarded for this statement: 3 - Adequate 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 We thought the service was performing at an adequate level in areas covered by this statement.

North Lanarkshire Council had implemented a Continuous Improvement Plan for 2013/14. This informed people of plans to develop and improve the service by encouraging more participation and involvement of service users in order to influence future change. Previous roadshow meetings had been one source used to encourage consultation with service users and staff. The feedback and outcomes from these meetings had been used to plan the future direction of the service. These planned changes will involve creating more flexible home support teams in each locality to provide greater support to people with more complex needs. This will be done by

Wishaw and Shotts Home Support Service, page 22 of 28 Inspection report continued working in partnership with district nurses, community mental health integrated day services and out of hours support.

The North Lanarkshire Council Older Adults Locality Planning Group met regularly throughout the year. This involved groups of various stakeholders meeting to discuss and reflect on their joint progress and future priorities. Some representations and contributions included people from the council, health and housing departments.

The council was currently redesigning the home support service. This involved recruiting more home support co-ordinators, senior home support workers and one home support manager for overnight support at the out of hours centre. By redesigning the service the council aimed to improve the quality of management and care delivered. It aimed to improve the support and management of frontline staff more effectively in order to provide a better customer service. We will monitor the implementation and outcome of this re-design plan at the next inspection and how this has influenced the quality of care and support provided.

The service kept a record of any complaints received and had analysed these for each locality highlighting any common themes. Records of missed calls, hospital admissions and out of hours calls were kept and checked by the manager daily. Areas for improvement We discussed with the manager the difficulty we had in obtaining evidence relevant to this inspection and suggested alternative methods of storing and presenting new evidence in a more consistent, organised way.

Complaints were logged and analysed for each locality which provided an overview of common issues reported, for example 32% of people were unhappy with staff's attitude. However, there was no further information recorded of how this was then managed and the outcome achieved. (see recommendation 1)

We looked at the recording of accident and incidents and found good information regarding incident recording. However, we found that the records of accidents were not being recorded appropriately; for example, we saw an incident record with details of a service user falling from a chair onto the floor knocking over medication which could not be used. This information was recorded as an incident. The fall should be recorded as an accident with the missed medication recorded as an incident with details of actions taken and outcomes recorded. We saw numerous incidents of distressed behaviour recorded but there was no evidence of how the service analysed and managed these appropriately. (see requirement 1)

Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1

Wishaw and Shotts Home Support Service, page 23 of 28 Inspection report continued Requirements 1. The service provider must develop a method of recording accidents and incidents of people using the service. This will allow the service to identify areas of concern and introduce ways of managing and reducing risk to service users. The manager must review this information on a regular basis and provide evidence of actions taken and outcomes for the people involved.

This is in order to comply with; The Social Care and Social Work Improvement Scotland (requirements for Care Services) Regulations 2011(SSI 2011/210)Regulation 4(a) Welfare of users.

Timescale: within two weeks upon receipt of this report.

Recommendations 1. The service provider should ensure that where service users, carers or staff have raised issues through the consultation or complaints process that these are suitably addressed within a reasonable timescale. This information should be available demonstrating any actions raised, actions taken and outcomes.

This is in order to comply with National Care Standards, Housing Support Services, Standard 6: choice and communication.

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4 Other information

Complaints The Care Inspectorate received a complaint about the service on 21/10/13. The complaint was made in relation to the quality assurance systems which were in place and how effective these were when specific equestsr had been made to the service manager. This complaint had been fully investigated which resulted in one recommendation being made. We received this information after the inspection had been completed therefore we will review this at the next 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).

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5 Summary of grades

Quality of Care and Support - 3 - Adequate

Statement 1 3 - Adequate

Statement 3 3 - Adequate

Quality of Staffing - 3 - Adequate

Statement 1 3 - Adequate

Statement 2 3 - Adequate

Statement 3 3 - Adequate

Quality of Management and Leadership - 3 - Adequate

Statement 1 3 - Adequate

Statement 4 3 - Adequate

6 Inspection and grading history

Date Type Gradings

23 Nov 2012 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good

3 Oct 2011 Unannounced Care and support 4 - Good Staffing Not Assessed Management and Leadership 4 - Good

5 Nov 2010 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate

19 Feb 2010 Announced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate

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30 Jan 2009 Announced Care and support 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate

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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