Glasgow Supported Living Services Housing Support Service 2045-2047 Maryhill Road Glasgow G20 0AA

Inspected by: Tony Valbonesi Type of inspection: Unannounced Inspection completed on: 1 November 2012 Inspection report continued

Contents

Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 23 5 Summary of grades 25 6 Inspection and grading history 25

Service provided by: Loretto Care, wholly owned subsidiary of Loretto Housing

Service provider number: SP2006008236

Care service number: CS2008173361

Contact details for the inspector who inspected this service: Tony Valbonesi Telephone 0141 843 6840 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 5 Very Good Quality of Staffing 4 Good Quality of Management and Leadership 5 Very Good

What the service does well The service was offered in a flexible and person centred way.

Service users' support plans were generally well written and gave a good picture of the needs and wishes of the service user and what staff needed to do to help support the person.

What the service could do better The outcomes from participation methods should be clearly evidenced in the inspection self assessment and the Service Improvement Plan.

Managers needed to ensure all staff received appropriate ongoing training and supervision now that the restructuring of the service was complete.

What the service has done since the last inspection Since the last inspection, a reorganisation of Loretto Care services had taken place and this had resulted in this service being extended to cover locations in the Maryhill and Whiteinch areas of Glasgow. The reorganisation had included changes in the management and staffing structure and had meant some redundancies. At the same time, the local authority had taken forward an agenda of personalisation within the learning disability care services it commissioned and this involved service users at Glasgow Support Living Services. Despite this unsettling period of change we could see that a very good level of care and support to service users had been maintained.

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There was now a programme in place for carrying out service users' care reviews on a more regular basis than in the past.

The Maryhill location of the service had installed a new security entry system for service users' added protection.

Conclusion We continued to find that staff and managers at this service worked hard and meaningfully so that the service met the needs of those people receiving its support.

Who did this inspection Tony Valbonesi

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1 About the service we inspected

The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.scswis.com.

This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011.

Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement.

- A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards.

- A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate.

Glasgow Supported Living Services is a combined housing support and care at home service, managed by Loretto Care, a wholly owned subsidiary of Loretto Housing. Previously, the service had a different name and was based in the Maryhill area of the city. However, following a restructuring exercise, resulting in changes taking place for registered managers and the services they manage, it is now located in both Maryhill and Whiteinch.

The service offers a range of support to adults with learning disabilities, mental health or alcohol dependency needs. Some people who use the service live in the same location, others in flats with 42 hour staff support.

The aim of the service is..

"To provide the support that enables people to reach their full potential and achieve the goals they set."

Glasgow Supported Living Services, page 5 of 26 Inspection report continued Based on the findings of this inspection this service has been awarded the following grades:

Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 5 - Very Good

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 wrote this report following an unannounced inspection by Tony Valbonesi, Inspector. It took place over two days, 30 October and 1 November 2012.

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

We sent out twenty questionnaires to people who used the service prior to the inspection and received 18 back.

During the inspection we spoke with eight service users.

We also gathered evidence from various records and other documents, including: * Service information brochure * Annual Report * Registration Certificate * Support plans * Incident records * Complaint records * Medication records * Staff training records * Quality Audit Tools * Newsletter * Service User Meeting Minutes * Evidence folders * Noticeboards * Questionnaires sent out by the service to family carers, staff, external agencies and service users

* Discussions with various people including: - the service manager - two depute managers - two support staff - people who use the service.

Glasgow Supported Living Services, page 7 of 26 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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What the service has done to meet any requirements we made at our last inspection

The requirement The service must manage service users' medication in line with, The Royal Pharmaceutical Society of Great Britain's, "The Handling of Medicines in Social Care". In order to achieve this, the provider must: - maintain a complete and accurate record of all prescribed medicines administered.

What the service did to meet the requirement Since the last inspection, medication procedures had been revised, staff had received associated training and monitoring of medication management within the service had improved. In general, we could see that the action taken had met the requirement, but a few lapses by staff were still being highlighted by managers and indicated that this remained an area for improvement. We provided the manager with new good practice guidelines on medication management for staff to consider and adopt.

The requirement is: Met

What the service has done to meet any recommendations we made at our last inspection We made one recommendation following the last inspection that the service introduce systems for periodic spot checking and monitoring of individual staff, This recommendation was now 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

Glasgow Supported Living Services, page 9 of 26 Inspection report continued 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. There was scope to better demonstrate how service users had influenced the completion of inspection self assessment, which appeared to be more focused on systems and inputs rather than outcomes and specific examples of how participation methods had led to improvements.

Taking the views of people using the care service into account We met 8 people who used the service during the inspection and out of 20 satisfaction questionnaires we sent out, we received 18 back from people. We could see from questionnaire responses and from speaking to people that the majority were happy or very happy with the care and support they received from Glasgow Supported Living Services. Comments included, "I go to the health centre, Stobhill and podiatry" "Fine service" "I come in when I want" "Sometimes go to house meetings" "Going to Sydney Devine concert" "They listen to my views and can make a complaint" "Service is alright" "Been very lucky, no problems, they do homecare, take me shopping and to hospital appointments and the doctor" "See my keyworker a lot" "I know how to make a complaint" "If I want to I can speak to the manager" "Take me out if I ask them" "Staff are usually respectful" "Happy with service over last 30 years" "Staff are good, do not keep you waiting" "Good service" "Go out myself".

A few service users raised some issues, but the manager was aware of these and was able to show how these had been or were being dealt with.

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Taking carers' views into account We did not speak with carers on this occasion, however two of the questionnaires we received back were completed on behalf of the service user by a family carer. These were both positive with one commenting,

"Very impressed by the care my cousin receives by Loretto Care" He seems to be very happy and content with his flat and the carers around him who I think do a marvellous job."

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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: 5 - Very 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 We found the service was performing very well in the areas covered by this statement. We came to this view after we:

- spoke with the manager and staff - looked at questionnaire responses - reviewed support plan files, meeting minutes and other records - talked to people who use the service.

The majority of service users that we spoke with confirmed their confidence in it for meeting their care and support needs. For instance, one person said, "I have been here as one of the longest, a good service". Another person who had recently moved in told us that he had no issues with the service and we could see that he was relaxed around staff and managers. We received some negative comments from a few individuals, but the manager was able to give us information to indicate that these issues had been or where being dealt with.

Service users were provided with a detailed support plan, which gave a good picture of the person. The support plan was devised with the involvement of the individual. It covered specific areas of the person's support, for instance, personal care, budgeting and medication management, leading staff to work in a person centred and consistent way. Those people who had moved to self directed support through the Local Authority's 'Personalisation' initiative also had an outcome based support plan in place. This meant that staff were guided to provide support to people in line with agreed and identified needs and wishes.

Glasgow Supported Living Services, page 12 of 26 Inspection report continued Daily notes showed detailed recording of service users' choices and support needs with a strong emphasis on the person's continued well being.

The service had moved to adopting a six monthly service and care review system in line with statutory requirements. This encouraged service users and their representatives to focus the service on achieving positive outcomes for people.

Satisfaction questionnaires were given out to people who used the service, family carers and external agencies on an annual basis as a way of gathering their views about the service's strengths and areas for improvement. This gave people the opportunity to be involved and grade the service received or delivered under the key themes of care and support, staffing and management and leadership. We noted that most people expressed positive experiences. This feedback was collated and analysed so that it could be used to evaluate how well the service was doing and where any action needed to be taken to make things better.

Service User Participation Forums were in place in both service locations, which meant that the people living there could discuss and be involved with service developments, such as social activities and holiday planning.

There were a number of good examples of written information being provided in an easy read format with pictorial and photographic prompts to assist with communication. For instance, we sampled a very user friendly support plan for a service. We were pleased to note that the manager was keen to continue work in this area to improve communication and understanding with service users. Areas for improvement Consultation methods used within the service continued to rely a lot on managers and staff leading them, for instance in chairing service user meetings and asking the questions. Finding someone from outwith the service to help from time to time with gathering people's views would improve participation. When it comes to helping people complete questionnaires, we suggest that it would be better to consider impartial representatives to help with this rather than support staff.

It was good the annual questionnaires encouraged people to grade and give their views about the service under the quality themes. However, there was scope to better demonstrate how this had influenced the completion of inspection self assessment, which appeared to be more focused on systems and inputs rather than outcomes and specific examples of how participation methods had led to improvements.

The manager was aware that delays with personalisation had led to some service users having a care review a month or so outwith the six month statutory timescale. However, his assurances accompanied by a review planner showed us that efforts were being made to ensure this issue would not be repeated.

Glasgow Supported Living Services, page 13 of 26 Inspection report continued We noticed that some paperwork in support plan files we sampled had not been signed off by the service user or their representative and the manager agreed to look at this.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found the service was performing very well in the areas covered by this statement. We came to this view after we:

- spoke with the manager and staff - looked at questionnaire responses - reviewed support plan files, meeting minutes and other records - talked to people who use the service.

People we spoke with were generally happy with the attention given to their health and social care needs. One person commented, "Been very lucky, no problems, they do homecare, take me shopping and to hospital appointments and the doctor". Another said, "I pull the alarm cord for emergencies, staff give me my medication each day."

We could see that the service had very good links with health care professionals such as the community Adult Learning Disability Team and Social Work Services. We could see that there was close working and regular meetings with the link nurse who provided ongoing support and guidance to staff and managers, for instance, in relation to healthy eating. Daily reports showed that high importance was given to the health and well being of service users and encouraging hospital and medical appointments.

Support plans provided a range of information regarding the person's health and the support that staff needed to give to help the person keep well. Records sampled were up to date and relevant to the person's support package. Daily notes showed us that staff regularly evaluated support plans to ensure that people's choices, preferences and support needs were being catered for as much as possible.

Rick assessments were in place to support people when they might be at risk in a particular area such as medication management.

Many of the service users had lived in the service for a long time and so had developed good relationships with staff who knew them well. Their spiritual and leisure pursuits were encouraged and maintained. Physical and social activities featured heavily within the lives of service users. This was confirmed by many we spoke with.

A previous requirement to improve medication systems had been met and staff practice in this area was the subject of ongoing monitoring by staff.

Glasgow Supported Living Services, page 15 of 26 Inspection report continued Areas for improvement Medication care plans and associated paperwork were good as they covered relevant information, such the name of medicines, what they were for, instructions on administration and side effects. Medication was also reviewed on a regular basis, but medicine review dates should also be identified and recorded in the care plan to remind staff.

Staff and managers expressed their concerns about the impact the local authority's personalisation programme was having on individual service users' care packages as it usually resulted in a reduction in the support they could provide to the person. The manager was aware of the need for ongoing review of people's care packages in this respect to ensure individuals were not unduly disadvantaged.

Grade awarded for this statement: 5 - Very Good 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 We found the service was performing very well in the areas covered by this statement. We came to this view after we:

- spoke with the manager and staff - looked at questionnaire responses - reviewed support plan files, meeting minutes and other records - talked to people who use the service.

The strengths for service user and carer involvement, detailed under Quality theme 1, statement 1, are the same for this statement. Areas for improvement The areas for improvement for service user and carer involvement, detailed under Quality Theme 1, statement 1, are the same for this statement.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service was performing well in the areas covered by this statement.

We came to this view after we:

- spoke with the manager and staff - looked at questionnaire responses - reviewed support plan files, meeting minutes and other records - talked to people who use the service.

Staff were supported by regular team meetings where they could discuss service delivery, service users needs, training, policy development and other matters.

As well as formal staff supervision, staff were supported in their work by periodic spot checks by managers to observe and give feedback on practice as they worked with service users. A record was kept to discuss with the member of staff and we could see that this encouraged staff to maintain standards of practice and receive support and guidance where necessary.

Individual staff supervision and annual appraisal were in place to assess and assist team members' learning and development.

Staff had the opportunity to undertake in-house training and pursue a Scottish vocational qualification, which we understand more than 70% had achieved.

Staff were encouraged to reflect on their practice when they did something well or not so well by writing up an account of what they did for discussion with their supervisor. This meant that staff were encouraged to think about the consequences of their actions and how they could develop their practice.

Staff told us that managers were supportive and approachable. Areas for improvement The organisation had undergone a period of re-organisation and change, which had disrupted training programmes for staff. In general, there was a need to address the backlog in training needs such as around child protection and provide client focused training in areas such as dementia or general mental health. The manager was aware of this and was able to show us steps he was taking to address gaps in staff knowledge or where there was a need for refresher training.

Glasgow Supported Living Services, page 18 of 26 Inspection report continued We noted from speaking with staff and reviewing staff files that not all staff were receiving regular supervision. (See Recommendation 1 under Quality Theme 3, statement 3)

Staff were not wearing their ID badge and this was also raised as a concern by a service user. (See Recommendation 2 under Quality Theme 3, statement 3)

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2

Recommendations 1. Management should ensure that all staff receive regular supervision in line with good practice and the provider's supervision and appraisal policy. National Care Standards Care at Home, Standard 4: Management and Staffing

2. Staff should wear their ID badges at all times. National Care Standards Care at Home, Standard 4.9: Management and Staffing

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Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good

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 found the service was performing very well in the areas covered by this statement. We came to this view after we:

- spoke with the manager and staff - looked at questionnaire responses - reviewed support plan files, meeting minutes and other records - talked to people who use the service.

The strengths for service user and carer involvement, detailed under Quality theme 1, statement 1, are the same for this statement. Areas for improvement The areas for improvement for service user and carer involvement, detailed under Quality Theme 1, statement 1, are the same for this statement.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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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 found the service was performing very well in the areas covered by this statement.

We came to this view after we:

- spoke with the manager and staff - looked at questionnaire responses - reviewed support plan files, meeting minutes and other records - talked to people who use the service.

Managers monitored different aspects of staff practice and service delivery, such as the management of service users' medicine and the quality of record keeping.

Spot checks of staff performance was another key way in which they measured and assessed the quality of the service. This met a previous recommendation.

Participation methods such as questionnaires helped to gather people's views about service quality. This included seeking feedback from external agencies. The response from the latter had been low, but we noted the following positive comments made about the service: "Good interactions from the support team and the health link for all the tenants" and "Person centred good value base..."

Monthly reports were used to provide a management overview of significant issues relating to service users and staff.

We could see that complaints received were appropriately investigated and addressed.

Service users were actively encouraged to take part in the inspection process.

Since the last inspection the service had changed manager. We found the new manager to be knowledgeable about the needs of the service, staff and service users. He was able to provide us with evidence folders relating to the service, which were well organised and demonstrated the high importance given to maintaining high standards of quality assurance. Areas for improvement It was recognised that the provider's Quality Assessment Tool had become unwieldy and difficult to implement. The manager advised that there was work in progress to develop a new quality assurance tool along the lines of the inspection self assessment. We will review progress with this in due course.

Glasgow Supported Living Services, page 21 of 26 Inspection report continued We sampled incident reports at the Whiteinch base and found that these were not being signed off by the manager until some months later. The manager agreed to look at a better way of evidencing that he has had overview of incident reports sooner than what the records suggested.

The Service Development Plan (SDP) was good but as an area for improvement there was scope to clearly evidence stakeholder involvement, for instance, findings from participation methods with stakeholders should be reflected in this continuous improvement plan. The annual report and SDP could be provided in a more user friendly format that service users could understand and access.

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

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4 Other information

Complaints Since the last inspection we have investigated one complaint. This was partially upheld and led to three recommendations:

1. A review should be conducted as soon as practicable so that the personal preferences of the person who uses the service can be fully explored and agreement reached about how these will be met.

Progress: We found from sampling this person's support plan that this recommendation was met.

2. The letter to acknowledge complaints should include a timescale so that people know when to expect a reply. The complaints procedure should be amended to meet statutory requirements.

Progress: Appropriate amendments had been made to paperwork to meet this recommendation.

3. The person who uses the service should be encouraged and supported to reconsider the use an independent advocacy service.

Progress: We understood that independent advocacy had been offered, but had been declined by the person in question.

Enforcements We have taken no enforcement action against this care service since the last inspection.

Additional Information None.

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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 - 5 - Very Good

Statement 1 5 - Very Good

Statement 3 5 - Very Good

Quality of Staffing - 4 - Good

Statement 1 5 - Very Good

Statement 3 4 - Good

Quality of Management and Leadership - 5 - Very Good

Statement 1 5 - Very Good

Statement 4 5 - Very Good

6 Inspection and grading history

Date Type Gradings

20 Sep 2010 Announced Care and support 4 - Good Staffing Not Assessed Management and Leadership 5 - Very Good

24 Sep 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good

1 Dec 2008 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good

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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