Brothers of Charity Services (Scotland) Together Borders - Area Three Housing Support Service Triest House Galabank Business Park Wilderhaugh Galashiels TD1 1PR

Inspected by: Mandy Falconer Type of inspection: Unannounced Inspection completed on: 23 January 2012

Inspection report continued

Contents 1 2 3 4 5 6

Summary About the service we inspected How we inspected this service The inspection Other information Summary of grades Inspection and grading history

Page No 3 5 6 9 22 23 23

Service provided by: The Brothers of Charity Services (Scotland)

Service provider number: SP2008010095

Care service number: CS2008192059

Contact details for the inspector who inspected this service: Mandy Falconer Telephone 01896 664400 Email [email protected]

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 2 of 24

Inspection report continued

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 4

Good

Quality of Staffing 5

Very Good

Quality of Management and Leadership 5

Very Good

What the service does well The service provided good evidence that individuals receiving support had detailed personal plans which identified how they liked to be supported. These were written from the service users perspective. Staff working in the service were well supported through regular team meetings and training. Staff reported that the communication had improved and that they felt they knew what was going on in the service.

What the service could do better The service should continue to ensure all the staff receive the new medication training and that regular audits of the medications administered takes place in line with the services policy. A requirement is made about this under QS1.3. The service should continue to explore ways in which service users, staff and carers can continue to contribute to the ongoing improvements to the quality of the service provided.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 3 of 24

Inspection report continued What the service has done since the last inspection Since the previous inspection the size of the service had increased so, the manager and support managers were working closely with staff and service users to ensure that support plans were up to date and reflected the needs of each individual. Supervision and appraisals were ongoing and the manager was getting to know the new staff members.

Conclusion Brothers of Charity Area Three provided service users with very good care within their own homes. This enables them to live their lives as independently as possible. Staff supporting service users were well trained and were motivated to ensure service users had a good quality of life and had opportunities to try new activities and learn new skills. The service had a good rapport with other health professionals and welcomed their input to improve the quality of service for the service users.

Who did this inspection Mandy Falconer

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 4 of 24

Inspection report continued

1 About the service we inspected Before 1 April 2011, Brothers Of Charity Services(Scotland)-Together Borders-Area Three was registered by the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (known as the Care Inspectorate), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, the Care Inspectorate. Brothers of Charity Services (Scotland) - Together Borders - Area Three is a combined housing support and care at home service for people with a learning disability, living in the Scottish Borders. The service is currently provided to 28 service users in areas across the Borders, including Gattonside and St. Boswells. The staff team consists of the manager, four support managers and support staff. The service is part of a range of support services, care home services and care at home/housing support services provided by the Brothers of Charity, to adults with learning disabilities in the central Borders. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 5 - Very 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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 5 of 24

Inspection report continued

2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection.

What we did during the inspection We wrote this report following an unannounced inspection which took place between the 6th and 23rd January 2012. As requested by us, the service sent us an annual return. The service also sent us a self assessment form. We issued 20 SCSWIS questionnaires to service users and 17 were returned. We sent 20 SCSWIS questionnaires and 15 were returned. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents, including: • • • • • • • • • • • • • • • • • •

Self assessment Involvement policy Minutes of team meetings Minutes of support managers meetings Service user's review minutes "Checking it out" information( group of service users involved in developing the services policies and procedures) Audits Personal plans and person centred plans of service users Accident and incident records Training records Personnel and supervision records Complaints records Risk assessments Certificate of registration Staff duty rotas Discussion with various people, including: Manager, support managers, support staff and service users Observation of interaction between staff and service users whilst visiting six service users in their own homes. Observation of medication training

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 6 of 24

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

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 7 of 24

Inspection report continued 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. The self assessment was completed as requested prior to the inspection visit. The self assessment provided clear information about how the service was meeting the quality themes and identified some areas for development. The manager was able to evidence the documentation that supported the assessment and the inspector agreed with the grades the service awarded themselves.

Taking the views of people using the care service into account The inspector met with six service users during the inspection and received 17 of the 20 questionnaires sent. Service users were very happy with the support they received and were able to show the inspector their personal support plans which they all knew about and what was written within them. Service users liked the staff that supported them and felt that they could discuss any worries or concerns with them. Service users talked about the things they liked to do and how the staff supported them. Questionnaires returned form service users indicated they were very happy with the service they were receiving and there were no areas where they felt the service need to improve upon.

Taking carers' views into account Many of the service users had very little contact with their carers or families but those that did visit the service regularly were kept up to date with any changes in the needs of the service users. Staff supported service users to visit family members who were too old or unable to come to the service to see them.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 8 of 24

Inspection report continued

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: 4 - 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 Brothers of Charity Area Three continue to provide staff, service users and carers with very good opportunities to be involved in assessing and improving the quality of care and support within the service. This was evidenced through minutes of team meetings, attending one staff meeting and observing medication training taking place in the office, review of support plans, discussion with staff and service users whilst visiting some of the properties. Since the last inspection the size of the service had increased. More service users were being supported and more staff had been employed. Due to the increase, the manager was working with all the support managers to ensure all the written documentation was up to date and reflected individuals current needs. The area had four support managers who all had responsibility for a large staff team working across a number of properties. The support managers held monthly meetings with each staff team and were responsible for their supervision and appraisal. Team meetings provided an opportunity for all staff to discuss care issues with their service users, house issues, training, planning for social and leisure activities and reviewing the support plans of the individuals. Staff members spent time with individual service users through keyworker meetings and this provided opportunities to update support plans and make plans for the future. The service had introduced individual planning meetings for some tenancies to work with the staff group to ensure that when they were planning support for the service users that it was person centred and took account of their hopes and wishes for the future.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 9 of 24

Inspection report continued The service had also introduced active support training for staff groups and the main focus of this training was to help staff to look at what success means to service users when working towards achieving their goals and wishes. It took account how small changes to support can make a difference to the service user. Service users were able to take part in the regular forums and "checking it out" groups. This enabled them to have a say in how staff were recruited, the qualities the organisation should look for when employing staff to work with them. Information about what the service had to offer to staff and service users was available through the regular newsletters and the organisations website. The service is in the process of updating the information brochure about what the organisation can offer to people. The "Moving on" tool, used by the organisation, helps service users to identify what they would like to achieve and this tool was broken down into smaller steps to help service users achieve their goals. Over the last year this has been used by several service users and had resulted in one service user retiring from day services and planning their own daily timetable of activities and social outings. For another the tool allowed them to plan a holiday with their family, something that they had been unable to do before with their family. The service had good systems in place to ensure that all service users personal plans were formally reviewed on a six monthly basis, or sooner if needed. Areas for improvement The service identified the need to provide clear and concise support plans for all service users that accurately reflect each individuals needs. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 10 of 24

Inspection report continued Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths Brothers of Charity Area Three provided evidence that service users health and wellbeing needs were being met within the service. The inspector found evidence of this from meeting service users and staff in their homes, reviewing support plans for six service users, training records and minutes of team meetings. Each service user had their own person centred support plan, as well as individual care plans and risk assessments, to ensure staff supporting service users had enough information about individuals needs and how they liked their support to be provided. Support plans covered the following areas: • Personal health history • Medical history and medications- including pictorial guidelines for service users • Nutrition • Personal hygiene • Mobility • Communication • Finances • Day activities including social and leisure As well as the support plan each service user had a resource file, communication diary and medication file. Each service user was registered with a local health centre and they were able to access doctors, dentists, chiropody, physiotherapy, opticians, dietician and other health professionals as needed. The service had built up a good working relationship with the learning disability team (LDT) who had an input into health related issues with some service users. The LDT were involved in reviews of service users care and helped train staff on specific health care topics including PEG feeding, epilepsy and behaviour that may challenge others. Staff working in the service received training appropriate to the needs of the service users to enable them to work confidently and provide good support to individuals.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 11 of 24

Inspection report continued Each service user was registered with a doctor of their own choice or practice close to their home. Service users had a health record detailing key health care professionals which may include a doctor, dentist, physiotherapist, podiatrist etc. Staff supported service users to make and attend appointments and outcomes were communicated in the health record and service user's diary. Where an action plan was required from a health appointment this was included in the health needs section of the support plan. Service users were all encouraged to eat healthily and their weights were monitored monthly or weekly if required. For some service users they had regular input from the dietitians and LDT to support them with good nutrition. Staff were encouraged to promote healthy eating and planned menus on a weekly basis with service users in their own homes. As part of the inspection the inspector looked at the medication policies, audited the medication of six service users and spoke with staff involved in the administration of medication. The inspector also observed one support manager undertaking the new medication training that had been introduced. The service had a few different systems in place across the service which were all covered by the organisations policy on administration of medications. Some service users were using the biodose system, which is similar to the monitored dosage system, and others were using the boxes received from the pharmacy. The inspector audited the medications, audit systems and the recording charts in two properties with six service users involved. The inspector found the audits to be robust and staff were able to account for all the medications in the homes. Recording charts were completed correctly and copies of all the original prescriptions were there to check what had been ordered and provided by the pharmacy. Areas for improvement Over the recent months the Care Inspectorate had received a number of notifications from the service regarding medication errors. The errors included missed signatures on recording charts, two errors made by the pharmacy providing the medication, some missing medication and medication given at the wrong times, or, administered at times outside of the recording chart. As a result of these errors the service had revised the medication policy and had updated the training for all staff involved in the administration of medication. The training included a power point presentation on the administration of medication, its benefits and side effects and the importance of correctly administering medication. Following this, staff have to complete three competency tests around the administration of medication, then a multiple choice test takes place if they get through the three competency tests. At the time of the inspection, however, only the support managers and two support workers had completed the training. A plan was in place for all other staff to complete the training by the end of March.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 12 of 24

Inspection report continued Given that staff had not yet received training and medication errors were still being reported to the Care Inspectorate the grade for this statement remains adequate. See requirement 1 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Requirements 1. All staff working in the service must complete the updated medication training. The provider must ensure that all staff carrying out this task are competent and have shown that they understand their role and the procedures in the administration of medications. The provider must ensure that they have a regular auditable system in place to check that medications are being administered correctly in line with the organisations Medication policy. This is to comply with Social Care and Social Work Improvement (Requirements for Care Services) Regulations 2011 SSI 2011/210 Regulation 4(1)(a) Welfare of users Timescale: By the end March 2012

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 13 of 24

Inspection report continued Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service strengths Service users across Area Three had detailed communication care plans within their support plan. Each of the plans detailed the level of communication service users had and the way that staff supported them to communicate their wishes. Where needed the service used communication passports, light writes, gestures, digital photo frames and pictures to aid communication. All the support plan documentation and service user policies had been written with both pictures and words so that it was easier for service users to understand. The service had regular input from the speech and language department to work with service users who had communication difficulties and staff also received training from them to. The service had devised it's policies and procedures as well as other documentation in other formats, including large type and braille. At present the service were not using any translation services but if requested they felt this would be possible. Staff working with service users were observed to communicate well with service users and had a good understanding of their capabilities. Staff were observed to treat service users with respect and dignity when they were speaking with them. Service users were supported by staff to maintain relationships with their families and carers and were assisted in making telephone calls, emails or letters to ensure that they kept up with regular communications. Staff supported service users to attend appointments where they needed additional support to express their views. Areas for improvement The service should continue to look at ways in which they communicate with service users and, where possible, encourage service users to take the lead in expressing their needs to others. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 14 of 24

Inspection report continued 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 Comments made under quality statement 1.1 also apply to this area. Service users had been involved in training to enable them to be involved in recruiting their own staff. The course was run over six sessions to develop their skills in staff recruitment. This included developing team profiles of skills and experience they wanted from staff members to enable them to be supported. The organisation had invited staff to be involved in a liaison group looking at staff recruitment. The organisation was looking into what attracts carers to this type of work and what incentives might make the job more appealing when advertising the posts locally. From this working group they had made a few leaflets about working with the organisation and these were being sent out to the job centres and local businesses. The service had a very good staff training programme in place for all staff groups across the organisation. Staff spoken with and who returned questionnaires made the following comments: " I feel I have had comprehensive training over the recent months" "Company made sure all relevant training was done ASAP and kept up to date" "All aspects of training covered by the training department" "The organisation provides a very high quality training service to all employees" "Excellent training opportunities both internally and externally" "Excellent training opportunities" Staff also commented that they receive regular team meetings and supervision from the support managers. Areas for improvement The service should continue to maintain their very good standards in this area. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 15 of 24

Inspection report continued 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 Brothers Of Charity Area Three provided very good evidence regarding the recruitment of staff into the organisation. The service held staffing files centrally at their main office in Galashiels. The service had a recruitment and selection policy in place which detailed the necessary documentation required prior to appointing personnel to the service. This included: • • • • • • • • • • •

Job specification and qualifications Advertising Shortlisting Application forms Interviewing References( two references including most recent employer) PVG or Disclosure Offer of employment Contract Health declaration Occupational health check

Once an offer of employment is accepted staff were provided with a four week induction covering the mandatory training, values of the service, staff handbook. Staff spoken with confirmed they had been well supported through the induction period. All new staff will undertake the new medication training prior to administering medication to service users. The management had introduced a new review system for all staff which means that new staff will have a formal meeting every three months to look at their work progress. This is in addition to the regular supervision all staff receive. From the questionnaires returned from staff it was clear staff had received induction training prior to working with service users. All staff spoken with confirmed they had a period of time where they shadowed senior staff prior to working by themselves.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 16 of 24

Inspection report continued Areas for improvement The service should continue to maintain their very good standards in this area. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 17 of 24

Inspection report continued Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Brothers of Charity Area Three provided very good opportunities for staff working in the organisation to develop their training and knowledge through a wide range of training courses. This was evidenced through discussion with staff, training manager and staff training records. Questionnaires returned by staff stated they were very happy with the training provided with three staff saying the training was excellent. Each staff member had a personnel file which detailed their supervision and appraisal and all the training they had attended since they commenced their employment. Training included: • "Working Safely" - which covered all areas of infection control, infectious diseases, health and safety, good personal hygiene and control measures, clinical waste, hand washing and the legislation to support this. • Food hygiene • Moving and handling • Epilepsy and medications training for emergency situations • First aid • PITN-Physical intervention • Medication • Adult support and protection • Communication • Values • Principles and learning disabilities • SVQ Scottish Vocational Qualification in Health and Social Care levels 2,3,4 • Management training • Supervisory training Staff spoken with during the inspection were well motivated and reported that they really enjoyed their work. Everyone stated they were well supported by the support managers and the service manager. They felt that there was always an "open door" policy in operation. Staff commented that the communication had greatly improved across the service. They felt that they were able to voice their views and opinions, were listened to and their views were taken account of when reviewing the services.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 18 of 24

Inspection report continued This was particularly noted whilst attending a team meeting where staff freely contributed to the discussion about the service users and the property that they worked in. Areas for improvement The managers should continue to discuss training needs through supervision sessions and source the appropriate training for the staff requiring this. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 19 of 24

Inspection report continued 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 Comments made under quality statement 1.1 also apply to this one. The organisation had a commitment to providing regular support to the support managers and service managers through regular meetings and supervision. Support managers spoken with during the inspection felt that they had received very good training to support them in their roles and that the registered manager was very supportive. The organisation had comprehensive policies and procedures in place and were available to staff and service users. They regularly held open recruitment days for the public and were involved in a number of national forums for people with learning disabilities which involved service users. The organisation had newsletters for staff and relatives and the organisation's website provided information about the services they provided to people with a learning disability and how people could contribute to the ongoing improvement of these. The service had a complaints procedure and all staff were aware of how to make a complaint and they were able to support service users to make a complaint. Staff were able to support service users to make a complaint if they wanted to. Areas for improvement The service identified the need to make the strategic aims more accessible to staff and service users in a simpler format and this was currently being worked on. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 20 of 24

Inspection report continued Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths Brothers of Charity Area Three provided very good evidence that staff were involved in the future direction of the service. The inspector evidenced this through reading documentation and speaking with staff. All staff were given copies of the employee handbook which contained information on the strategic aims and objectives for the organisation. Staff, service users and cares were all involved in the plans to build the new complex at Gattonside and some were actively involved in the design for the homes. Staff were consulted on policies and initiatives being developed, for example, the current recruitment drive to attract new people into the organisation. Staff were kept up to date about new events and changes in the service at team meetings and training. Staff also had access to newsletters, internet and forums where they can participate. Staff were encouraged to further their knowledge through training and those showing an interest in management were given an opportunity to access management training. The training department had a good source of books, periodicals and good practice guidance to ensure staff are up to date with current practices. The managers regularly reviewed the staff teams to ensure service users were supported by staff that they liked and respected. Within Treetops changes had regularly been made to the staff team to ensure that staff were knowledgeable and skilled to meet the needs of the service users who had complex needs. When the inspector met with staff members from this team they commented that the changes had a positive impact on the service users. Areas for improvement The service should continue to keep staff involved in all aspects of the operation of the service and update them on any changes taking place. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 21 of 24

Inspection report continued

4 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 Not applicable.

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).

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 22 of 24

Inspection report continued

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1

5 - Very Good

Statement 3

3 - Adequate

Statement 4

5 - Very Good

Quality of Staffing - 5 - Very Good Statement 1

5 - Very Good

Statement 2

5 - Very Good

Statement 3

5 - Very Good

Quality of Management and Leadership - 5 - Very Good Statement 1

5 - Very Good

Statement 3

5 - Very Good

6 Inspection and grading history Date

Type

Gradings

8 Oct 2010

Announced

Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good

11 Mar 2010

Announced

Care and support 5 - Very Good Staffing 5 - Very 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.

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 23 of 24

Inspection report continued 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 SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.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.scswis.com

Brothers of Charity Services (Scotland) - Together Borders - Area Three, page 24 of 24