Care Inspectorate Report

Community Care Choice

Housing Support Service

571 Cathcart Road
Govanhill
Glasgow
G42 8SG
Telephone: 0141 423 3200

Inspected by: Moira Agolini
Type of Inspection: Unannounced
Inspection Completed on: 24 April 2012

Service Provided by: Community Care Choice Ltd
Service Provider number: SP2005007220
Care Service number: CS2005088402

Contact Details for the Inspector:
Moira Angolini
Telephone: 0141 843 6840
Email: enquiries@scswis.com

 

Contents

Summary
About The Service We Inspect
How We Inspect The Service
The Inspection
Other Information
Summary of Grades
Inspection and Grading History

 

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.

You can find the most up-to-date grades for this service by visiting our website www.scswis.com or by calling 0845 600 9527.

We gave the service these grades:

Quality of Care and Support – (Very Good)
Quality of Staffing – (Very Good)
Quality of Management & Leadership – (Good)

What the service does well

The service continues to provide a high standard of care that improves people’s quality of life. The staff team showed a commitment to exploring support that is flexible, person-centred and focused on good outcomes.

What the service could do better

There is a need to improve audit procedures. Paperwork in general would benefit from review. The manager should update policies and procedures where necessary and develop a system that ensures all staff have read and understood the documents.

Formal reviews should be held within the agreed timescales. Staff supervision should also take place at an agreed frequency.

What the service has done since the last inspection

The service has developed new support plans that are outcome-focused with clear goal-setting timescales. Staff continue to be supported to progress the SVQ programme. The service plans to re-locate on 4th May to premises that will offer improved accommodation for staff and those who use the service.

Conclusion

The service offers a high standard of care with a consistent staff group who are skilled in meeting the needs of people who are seeking person-centred support. However, the service paperwork is not consistent with this standard of care and requires review.

Who did this inspection

Moira Agolini

 

About the service we inspected

Community Care Choice had been registered with the Care Commission since June 2005 and is ‘Deemed Registered’ by the Social Care and Social Work Improvement Scotland. The service provides an integrated Housing Support/Care at Home service to people within their own homes.

The service operates from offices in the Shawlands area of Glasgow.

The service aims to provide personal and domestic assistance to enable people to remain in their own homes for as long as they wish and to provide such support as the service user requires. Support may include 24 hour sleepover, escorting, personal care, shopping and befriending.

The service is an authorised care provider with Glasgow City Council, East Renfrewshire Council and South Lanarkshire Council.

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

Quality of Care and Support – 5 (Very Good)
Quality of Staffing – 5 (Very Good)
Quality of Management & Leadership – 4 (Good)

This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection.

 

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

This unannounced inspection was carried out by one inspector that took place between office hours on the 18th April 2012. A further visit on 24th April completed the inspection process.

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

We issued 25 questionnaires to people who use the service. Twelve were returned completed and the comments from the questionnaires are offered through out this report.

In this inspection we gathered evidence from various sources, including:

  • Evidence from the services most recent self-assessment
  • Relevant sections of policies and procedures including recruitment policy, medication policy and adult protection policy
  • Service User Information Pack
  • Financial Transaction Paperwork
  • Induction Pack
  • Team Meeting Minutes
  • Accident and Incident Records were examined
  • 5 support plans of service users
  • Information from the service newsletter
  • Results of service user survey
  • Job description for Support Workers
  • Recruitment procedures
  • We examined three staff files
  • Staff training records
  • We checked the registration and employment liability insurance certificates.

We also met with four people who use the service. We met with two carers and spoke with a District Nurse and two Social Workers.

 

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 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 authorities so they may consider what action to take. You can find out more about care services’ responsibility for fire safety at www.firelawscotland.org.

 

What the service has done to meet any recommendations we made at our last inspection

All support plans should show more evidence of involvement by those who use the service in assessment and care planning; this should include individual goal-setting where relevant.
NCS4.

The service has now developed an outcome-focused support plan which is person-centred. This plan includes opportunities to set goals. In discussions with the management team about the new support plans we have suggested that in order to fully implement the aims of the plans, reviews must take place as per service agreement.
Met.

The paperwork for recording accidents and incidents should be reviewed to make sure there is a better standard of recording, both of the incident and the outcome.
NCS Standard 3.

The service has improved the recording of accidents and incidents. We have spoken with the management team to ensure that staff are aware that, where appropriate, risk assessments must be updated to reflect any practice development from either an accident or an incident.
Met.

The service should develop a participation strategy that details the aims and objectives of the service and the ways that service user involvement will inform service development.
NCS Standard 3.

The service has not met this recommendation. This is a repeat recommendation.

 

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 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 have spoken with the manager about the self assessment and have asked that future submissions focus on evidence.

The submitted self assessment lacked any meaningful evidence about the outcomes the service is achieving for the people who use the service. There was also an absence of specific evidence about how the service involves people in the development of the service.

The self assessment did not adequately identify the user involvement processes that are in place and which we examined during inspection. Neither did it detail the areas for improvement in any meaningful way. There is now an expectation that this document will be improved by the next submission.

 

Taking the views of service users into account

We met with four people who use the service. Care standard questionnaires were also returned and the responses to all the key questions were positive with ‘strongly agreed’ and ‘agreed’ noted. Comments are included throughout the report.

The care standard questionnaires reflected the high standard of care that we observed in our visits to peoples homes. Some of the comments are given in the body of the report but the following are typical of the feedback we received:

  • “I cannot speak highly enough of Community Care Choice. The carers are punctual, helpful, well-trained and always willing to ‘go the extra mile'”.
  • “The management team are superb and could not be better. Considerate and understanding at all times. It is a pleasure to talk with them”.
  • “Couldn’t do without them (would be in a home)”.

 

Taking carers’ views into account

We met with two carers, both of whom spoke of the positive outcome on their lives and on the lives of those they care for. Comments included:

  • “The support we receive means my mother can stay in her own home, eat her own food and have her own friends visit”.
  • “The carers are wonderful, couldn’t manage without them”.

Comments from the returned questionnaires are similarly positive and include:

  • “As a relative…I must add that the service Community Care Choice give my aunt is professional and very caring. They give me tremendous peace of mind as I live 200 miles away from my aunt. Without their care I would have many worries”.
  • “Community Care Choice has provided an excellent service to my cousin. They have been particularly good when emergencies have arisen”.
  • “Mum’s carers supply emotional support as well as dealing with her physical needs”.

 

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

The service continues to improve in this area. We concluded this after we:

  • Spoke to the manager and four staff members
  • Reviewed Care Plans
  • Talked with people who use the service

There was very good evidence that the views of people who are supported by the service and their carers are sought in a number of ways. These include:

  • Support planning
  • Reviews
  • Questionnaires
  • Complaints
  • Newsletter which provides information about service provision/development and staffing

The sampled support plans we viewed reflected the aims and objectives of the service to provide person-centred assessment and planning. The revised support plans are outcome-focused and goal-setting is now clearly outlined. We found strong evidence to indicate that individuals using the service had been involved in developing their personal support.

People who receive a service are ‘matched’ with a carer that aims to promote good working relationships. This practice meets the key aims of the service; to give individuals choice and control over their care and support.

We heard from service users and their carers that communication with staff is particularly good. For example they felt able to raise concerns with members of staff or the management team. We were told that concerns were addressed.

We saw evidence that the service took action on issues that were raised by service users. As a result of feedback from some people regarding the location of the office, this service has plans to relocate.

Through discussion with service users there are now alternative ways to pay invoices, including telephone/internet banking.

The service information pack provided details of advocacy services and how to complain.

Areas for improvement

We acknowledge that the evidence we gathered and detailed within the report indicates a flexible, individualised approach to care and support. However, some of the paperwork and audit procedures, as identified in the previous inspection, does not always reflect this approach.

We suggested at last inspection that a review of paperwork would be beneficial. In discussions with the manager it was agreed that individual audit sheets for particular areas of the support plan would better monitor the agreed frequency of these procedures.

We saw that the 12 returned Care Standards questionnaires replied positively to the statement that “the service check with me regularly that they are meeting my needs”. however, we conclude that this is often an informal process and formal reviews are not taking place as per agreed service guidance. Risk assessments also need to be updated within the agreed frequency.

As detailed above the absence of robust monitoring procedures may have contributed to these issues. This will now form a recommendation.

Note the intention to provide some staff with ‘participation skills’ training. We would like the service to continue to develop and improve the system in place in relation to participation. A repeat recommendation has been made in relation to the development of a participation strategy. This should detail how staff will involve people in the areas of care and support, staffing and management/leadership.

The service should develop an action plan to address any issues/developmental opportunities that may arise from feedback in questionnaires. The service should continue to develop ways of gaining feedback from carers/relatives.

Grade Awarded for this Statement: 5 (Very Good)
Number of Requirements: 0
Number of Recommendations: 1

Recommendations

1. Support Plans should be reviewed as per agreed frequency. Details of who should be involved in reviewing support plans should be included in any correspondence with an individual.
National Care Standards – Care at Home: Standard 3
National Care Standards – Support Services: Standard 2

 

Statement 3

We ensure that service users’ health and wellbeing are met.

Service Strengths

We found that the service was performing very well in relation to the areas covered in this statement. We concluded this after we:

  • Listened to service users and their carers/friends
  • Listened to staff members
  • Looked at Care Plan information and other documents which guide staff members in their practice.

People we spoke to told us how the quality of their lives had improved since receiving support from the service. One individual is supported with personal care which enables her to be in full-time employment. The consistency of carers was identified by this service user as particularly valuable. This ensures that issues around dignity and privacy are appropriately met.

Another individual is helped to maintain voluntary posts in a local football club and radio station. Others are assisted to identify preferred activities and all spoke of the flexibility of service support as a key area for commendation.

From the sampled Support Plans it is clear that staff members are familiar with the health needs of the people they support. We saw evidence that people are supported to attend a variety of appointments including GP, Hospital, Optician and Chiropodist.

There was evidence of good links with GPs and other primary care services. We spoke to a District Nurse who referred to good working relationships with staff. She also referred to the skills of carers who manage health issues well.

We spoke with a Social Worker who told us that staff are very good at communicating any concerns they may have about individuals.

The service has a full-time Nurse in place who oversees all aspects of the personal care of service users. A nutrition and hydration assistance plan includes details of allergies.

Areas for improvement

Reviews of Risk Assessments should be completed as per agreed service procedures. This should include all issues around infection control. This will form a recommendation.

Support Plans should include a Mental Health Assessment where appropriate.

Grade Awarded for this Statement: 5 (Very Good)
Number of Requirements: 0
Number of Recommendations: 1

Recommendations

1. Risk Assessments to be completed for all service users and reviewed as agreed with service users and management.
NCS Care at Home – Standard 2 NCS Support Services: Standard 2

 

Quality Theme 3: Quality of Staffing

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 staffing in the service.

Service Strengths

Further evidence to support strengths in this quality statement is detailed under Quality Theme 1, Statement 1.

Service users are asked through their reviews, questionnaires, complaints and suggestions to comment on the quality of staff. The matching process referred to in Statement 1.1 is an opportunity for people to assess staff. The initial introduction process is an opportunity for people to get to know each other before the working relationship is in place.

There is continual assessment of staffing through informal telephone calls and home visits. Both service users and carers have advised of good communication regarding staffing. Service users told us they were clear about service procedures if there is a problem with staff.

In the Care Standards Questionnaires 100% of those who replied stated that they “strongly agreed” or “agreed” that staff “treat me with respect”. The overall response reflects the positive feedback that we received from service users regarding staff attitudes and their ability to meet their care needs.

Areas for improvement

The service should, as detailed in the recommendation for Statement 1.1, develop a participation strategy to explore ways that people can discuss different aspects of staff recruitment, including skills and attributes of applicants and interview questions. This should also detail ways that people can, if they so wish, be directly involved in recruitment.

The management may wish to consider using feedback from service users to inform staff appraisals.

Grade Awarded for this Statement: 5 (Very Good)
Number of Requirements: 0
Number of Recommendations: 0

 

Statement 3

We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice.

Service Strengths

The service had the relevant policies in place to support this statement including whistle-blowing, confidentiality, adult support and protection and child protection.

There was evidence of an Induction programme in place and those staff that we interviewed advised that it offered good opportunities to develop relevant skills and enhance knowledge about the service aims and objectives.

Staff confirmed that they were provided with information on the National Care Standards, SSSC and company policy and procedures. All of those interviewed showed an understanding of those documents and subsequent guidance.

Staff that we spoke with felt that the service provided good training opportunities.

Staff are aware that the Scottish Social Services Council (SSSC) registration requirements and were working towards this through SVQ11 and other relevant training. The service manager and her deputy are in the process of completing SVQ4. There is an in-house SVQ assessor who oversees all relevant training.

There was evidence that team meetings take place and the minutes reflect discussions around areas of best practice and service development.

The staff interviewed showed a very good knowledge of the needs of the service users. Satisfaction with staff was also confirmed by comments viewed in questionnaires by Social Workers who stated:

  • “Carers are happy with the reliability of carers and responsiveness to issues that can arise”.
  • “Good communication with professionals re any issues, e.g; hospitalisation, illness or death”.

Staff also confirmed they are clear about the processes in place to report poor practice.

As reported elsewhere all those people we met spoke of the value of staff consistency and how working relationships benefit from a core group of staff who are familiar with service users’ care needs.

Areas for improvement

Although there is clear commitment to SVQ training, there is an absence of any staff development strategy or an annual training plan that would assist in identifying refresher training. This will form a recommendation.

From discussions with staff and from viewing staff files there is no framework for staff supervision. Management should ensure that there is structures, protected time for all staff. Supervision arrangements should be detailed in a staff development strategy.

References from an individual’s last employer should always be sought. In the event that a reference is refused it is the responsibility of the manager to record the reason given. Two references must be secured for every applicant. This will form a recommendation.

Grade Awarded for this Statement: 5 (Very Good)
Number of Requirements: 0
Number of Recommendations: 3

Recommendations

1. The management team should provide a staff development strategy. An annual staff training plan should also be included and should detail any specialised training and identify any refresher training needs. Supervision arrangements should be detailed in this document. N

National Care Standards: Support Services: Standard 2 Management & Staffing Arrangements

National Care Standards: Care at Home: Standard 4: Management & Staffing

2. The service must make sure that their recruitment procedures are followed and two references, one from the applicant’s last employer, where relevant, are secured. In the event that the last employer declines to offer a reference the service manager must record this in the applicant’s file if a decision is made to employ the individual.

National Care Standards: Support Services: Management & Staffing Arrangements

National Care Standards: Care at Home: Standard 4 Management & Staffing

3. The management team should complete Risk Assessments for all those staff who do not provide the required references or whose disclosure is not completed before employments with the service commences.

National Care Standards: Support Services: Management & Staffing Arrangements

National Care Standards: Care at Home: Standard 4 Management & Staffing

 

Quality Theme 4: Quality of Management and Leadership

Grade awarded for this theme – 4 (Good)

Statement 1

We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service.

Service Strengths

Evidence to support strengths should be read in conjunction with associated comments made under Quality Themes 1 and 3, Statement 1.1 and 3.1.

There was evidence that the manager had made sure that service users were involved in the grading process. The evidence gathered during inspection showed a commitment to promoting involvement of individuals and their carers/friends in certain areas of service provision.

It was also evident that the management and office based staff of the service made themselves available to service users. They had an open door policy and the service user satisfaction questionnaire asked specifically about the service management and how it could be improved.

We saw considerable evidence that the service promotes peoples’ rights to express their views and promote change.

Areas for improvement

The service has shown good evidence of seeking service user and carers’ views in all aspects of service delivery. However there is an absence of service planning that reflects those views in a strategic way that will inform long-term development plans.

The management team should consider expanding current quality assurance systems to inform a development plan that will outline service planning to include staffing and management.

Grade Awarded for this Statement: 4 (Good)
Number of Requirements: 0
Number of Recommendations: 0

 

Statement 4

We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide.

Service Strengths

As identified in Quality Statements 1.1, 3.1 and 4.1 the service is committed to securing the views of service users. The management team has also developed ways of gaining feedback from others including Social Workers and workers from external agencies.

In the questionnaires we sampled, the following are some of the comments from Social Workers who were asked to contribute:

  • “Community Care Choice is highly reputable and a high quality care provider”.
  • I am regularly informed if there is anything that needs to be brought to our attention or any concerns”.
  • Community Care choice have always responded promptly to passed messages to their manager who has contacted me in good time”.

Comments in Care Standard questionnaires were similarly positive and included:

  • The manager of Community Care Choice is one of the very best care managers both my husband and I have ever had. She and all her staff from office to carers treat us all with the utmost respect and dignity”.

There are informal systems in place to gather the views of carers/friends.

The service submitted an appropriate action plan following the last inspection.

There is a robust complaints procedure in place and those we spoke with are clear about the complaints procedure regarding any aspect of service delivery.

Areas for improvement

The management team should consider further developing the current methods in place to expand carer and stakeholder involvement.

Feedback from questionnaires from all who are involved in the service should inform all service planning, including the Quality Themes of Care and Support, Staffing and Management/Leadership. There is a need to improve service development planning.

Some work is required ensuring the Self Assessment process provides clear evidence of strengths and areas for improvement. This should be a reflection of the ongoing service developments and improvements that are informed by participation and engagement with all service users.

Grade Awarded for this Statement: 4 (Good)
Number of Requirements: 0
Number of Recommendations: 0

 

Other Information

Complaints

No complaints have been upheld or partially upheld since the last inspection.

Enforcements

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

Additional Information

n/a

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).

 

Summary of Grades

Quality of Care and Support – 5 (Very Good)
Statement 1 – 5 (Very Good)
Statement 3 – 5 (Very Good)

Quality of Staffing – 5 (Very Good)
Statement 1 – 5 (Very Good)
Statement 3 – 5 (Very Good)

Quality of Management and Leadership – 4 (Good)
Statement 1 – 4 (Good)
Statement 4 – 4 (Good)

 

Inspection and Grading History

Date: 10 January 2011
Type: Announced
Gradings:
Care and Support – 5 (Very Good)
Staffing – Not Assessed
Management/Leadership – Not Assessed

Date: 5 February 2009
Type: Announced
Gradings:
Care and Support – 5 (Very Good)
Staffing – 5 (Very Good)
Management/Leadership – 5 (Very Good)

All inspections and grades before 1 April 2011 are those reported by the former regulator of the care services, the Care Commission.

 
Published by Social Care and Social Work Improvement Scotland 2012


Community Care Choice     |     Citywall House, 1st Floor, 32 Eastwood Avenue, Shawlands, Glasgow, G41 3NS     |     Telephone: 0141 632 8198