Care service inspection report Full inspection

HRM Homecare Services Ltd - South West Branch (1) Housing Support Service Centrum Business Park Hagmill Road Coatbridge

Inspection report for HRM Homecare Services Ltd - South West Branch (1) Inspection completed on 13 January 2016

Inspection report Service provided by: HRM Homecare Services Ltd Service provider number: SP2004006645 Care service number: CS2009232697 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service.

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Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY

[email protected] 0345 600 9527 www.careinspectorate.com @careinspect

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Inspection report

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 4

Good

Quality of management and leadership 4

Good

What the service does well HRM continues to involve people using the service and their families in the planning, delivery and review of their care. People's support plans continued to contain some good information on care and support needs. The people we spoke with were generally satisfied with the care and support they received from support workers. What the service could do better The service should provide evidence of more meaningful engagement with people using the service. The service may see the benefit of engagement and it could result in the service receiving higher levels of feedback. The service should look at ways to involve the people using the service more in the interview process. The manager should meet more regularly with the staff teams. This could improve staff practices and competencies and could create a culture of team performance, to consider best practice guidance. What the service has done since the last inspection The service has worked to meet requirements and recommendations made at the last inspection. The details of these actions are contained in this report. Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 3 of 41

Inspection report Conclusion People we spoke with were generally very satisfied with the care and support they received. The manager is committed to developing systems and processes to progress the service. We have reported on these processes in this report.

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1 About the service we inspected HRM Homecare Services Ltd - South West Branch is one of two home care services in Scotland run by HRM Homecare Services Ltd. At the time of this inspection the service provided support to people in North and South Lanarkshire and Falkirk. While the majority of people who used the service were older, younger adults, children and families could also use this service. Help was available with personal care, social care, meals, medication, palliative care, shopping and laundry. The company's literature said that HRM's aim was to 'ensure that it remains focused on supporting service users and their families to live independent lives.' Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades:

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Inspection report Quality of care and support - Grade 4 - Good Quality of staffing - Grade 4 - Good Quality of management and leadership - Grade 4 - 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 0345 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 high 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. The inspection took place Wednesday 6 and Thursday 7 January 2016 between 9am and 4pm. We accompanied support staff as they worked with people who used the service Friday 8 January 2016, from 8am until 2pm. We returned to the service Monday 11 January 2016, between 9am and 4pm. We gave feedback to the director and manager Wednesday 13 January 2016. As part of the inspection we took account of the completed annual return and self-assessment forms that we asked the provider to complete and send to us. During this inspection process we gathered evidence from various sources, including the following: We spoke with: -

people who use the service the director the manager the HR officer the monitoring officer support co-ordinators support workers contract monitoring teams from South Lanarkshire council.

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Inspection report We looked at: - the participation strategy (the plan for how the provider will involve the people who use the service) - participation information - personal support plans - a range of policies and procedures. 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.firescotland.gov.uk

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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 Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. Taking the views of people using the care service into account We have included the views of people using the service in the report. Taking carers' views into account We have included the views of carers in the report.

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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: 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 A range of evidence was sampled and the performance of the service, for this statement, was found to be good. Examples of evidence and outcomes for service users which supported this included the service's welcome pack, participation strategy, complaint policy and procedure, review documentation and the minute of meetings. We also spoke with people using the service and their relatives, managers and support staff. We made a recommendation at the last inspection that the service should reintroduce annual satisfaction surveys for service users and relatives; collate results and communicate these to service users along with an action plan. We found that satisfaction surveys had occurred and noted that the responses had been generally favourable. This part of the recommendation has been met. The results from the surveys, however, had not been collated or shared with respondents. This part of the recommendation will be repeated. See recommendation 1.

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Inspection report At the previous inspection we made a recommendation, in respect of reviews, that: (i) where social work and HRM reviews take place at different times and significant changes to packages are planned there should be better communication between care managers and home care providers and service users; and (ii) service users or their representatives should routinely be given a copy of their service review report by HRM. We noted evidence of better communication between care managers and the service and that this was recorded effectively. We also found that people received a copy of the service review, where requested. This recommendation has been met. We made a recommendation at the last inspection, in respect of the complaints procedure, that the service should continue to reinforce awareness of these procedures by having this as a standing item at service reviews. We noted that updated information around the complaints procedure had been given to people using the service, to raise awareness of the procedure. The people we spoke with confirmed they had relevant information on the complaints process. We sampled records and found that the procedure was discussed at the review setting. This recommendation has been met. We saw evidence that people using the service and their families were encouraged to give their views at the initial assessment and were fully involved in the development of their personal support plans. The personal plans were accessible by plain language or large print. The benefits to people using the service were that it gave them the opportunity to be more involved in planning their care and support. The service's participation strategy promoted the participation in the service delivery, by service users. We saw the service continued to encourage people using the service and their families to get involved in developing the services. The service used various ways to gain the views of people using the service such as questionnaires, satisfaction surveys, reviews and one-to-one meetings Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 11 of 41

Inspection report with staff in their own homes. We examined completed satisfaction survey forms and noted that service users had rated the service as being excellent, very good or good. People were either very satisfied or satisfied with the service and the standard of care and support they received. Comments from people using the service included: -

"Never need to complain; excellent service." "Happy with carers, but not with timing and turnover of staff" "No complaints." "Always polite and helpful." "Happy with service at present." "Fantastic service; couldn't do without them." "Staff are very helpful - lovely girls."

At reviews and meetings, people were encouraged to give their views of the service they received. We found that reviews had occurred regularly and at least once in every six month period. Complaints and other information for people using the service were provided in a user-friendly format, using plain language to make the information more accessible. The service had received some complaints since the last inspection. We found that these had been investigated per the procedure, to the proper completion of the process. Areas for improvement Although we saw evidence that the opinions of people using the service were sought via questionnaires, we did not see how the findings were used or shared. The service should ensure that results from findings are shared, in the form of an action plan, to make the questionnaire process seem worthwhile, open and transparent. See recommendation 1.

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Inspection report Reviews and questionnaires were the only methods of participation evident during our inspection. The service should provide evidence of more meaningful engagement with people using the service. The service may see the benefit of engagement and it could result in the service receiving higher levels of feedback. We also discussed how feedback could be shared with service users with communication difficulties or cognitive impairments. The manager confirmed she will develop the service's approach to this area for improvement. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The manager should summarise the findings of service user surveys and questionnaires to provide evidence of how feedback was evaluated or acted upon to enable service users to contribute to the daily running of the service. National Care Standards - Care at Home - Standard 4 - Management and staffing

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Statement 3 “We ensure that service users' health and wellbeing needs are met.” Service Strengths At this inspection we found that the performance of the service was good for this statement. The service met the health and welfare needs of people using the service effectively. We looked at personal plans, reviewed records of staff training and observed staff in practice to assess this statement. We made a recommendation at the last inspection that the service should consider having some more detailed information about medical conditions and different types of dementia in personal care plans for support workers to refer to. We saw evidence that information relating to specific conditions was now documented in care plans. This recommendation has been met. At the previous inspection we recommended that coordinators should always be prompt to address health and wellbeing concerns raised by support workers and take appropriate action such as contact main carers and/or amend the care plan where necessary. We examined health and wellbeing forms and noted that any concerns raised had been addressed, with the appropriate action taken. This recommendation has been met. We made a recommendation at the last inspection that the service should clarify with staff in what circumstances support workers should complete a written health and wellbeing report when they have already advised coordinators of their concerns over the phone. We noted that this subject was now part of the induction training for new staff and that staff, in general, had received instruction that reminded them of their duty to report concerns that may arise. This recommendation has been met. At the previous inspection we made a requirement, under quality theme 1, statement 5, that the service provider must ensure at all times that:

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Inspection report (a) service users are provided with care and support which meets their individual needs, as detailed in their personal plans (b) scheduled visit times and actual visit times correspond with those agreed with service users. We reviewed this requirement under quality theme 1, statement 3 at this inspection. We noted that the service's monitoring officer had visited people using the service to ensure that current levels of need were reflected in personal plans. We observed that a new care plan summary sheet was being held at the office base and in people's homes. We saw that the levels of need were monitored by means of care diary audits, which were checked by the monitoring officer or care coordinator. We found that staff 'spot checks' had been completed. This requirement has been met. We recommended at the previous inspection, under quality theme 1, statement 5, that in terms of personal care plans, the service should: (i) provide the Care Inspectorate with a copy of the proposed format for an easy-to-read care plan summary for when a visit is done by someone other than the regular carer; and (ii) ensure that care plans clearly state when support workers need to write more than just "all care given as per care plans" such as for the service users who had memory or communication difficulties and might not recall, e.g., what they had last eaten. We reviewed this recommendation under quality theme 1, statement 3 at this inspection. We examined the new care plan summary format and found that it provided relevant information that could be followed by all care workers. We saw that the summary was in situ at some of the people's homes we visited. We found that new care diaries were being introduced to people's homes and that these contained clear guidance as to what information should be recorded by staff. The diaries we sampled showed that the guidance was being followed and that staff were being more descriptive about the tasks they had completed. This recommendation has been met.

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Inspection report At the previous inspection we recommended, under quality theme 1, statement 5, that the service should keep the Care Inspectorate informed of progress with the introduction of an electronic call monitoring system in Lanarkshire and Falkirk. We reviewed this recommendation under quality theme 1, statement 3 at this inspection. We found that the service had not progressed with this recommendation and it is, therefore, repeated under this quality statement. See recommendation 1. We recommended at the previous inspection, under quality theme 1, statement 1.5, that with regard to communication, the service should: (i) ensure that everyone who wants a weekly schedule gets sent one; and (ii) whenever possible notify service users of delays or changes to their regular carer. We reviewed this recommendation under quality statement 1.3 at this inspection. We found that weekly schedules were despatched to people who wished to have one. People who used the service told us that they could receive a copy of their schedule. People also told us that they were made aware of possible delays or changes to their regular support worker. This recommendation has been met. We sampled personal plans that provided clear and comprehensive guidance about personal care needs and preferences. The support assessments in place captured meaningful information about people using the service and we found, and observed that staff used this effectively. Plans clearly identified service users' needs and wishes. We saw evidence that support staff had received training in moving and handling, administration of medication, food hygiene, adult support and protection and infection control. Service user specific training had been completed in the use of specialised equipment, such as hoists, wheelchairs and specialised beds. By following care plans for service users and observing practice in their homes, we saw staff appropriately implemented the planned care. Staff made good use of published practice guidance, such as in relation to infection control. We saw that staff promoted the choice of people using the service, by taking a choice of Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 16 of 41

Inspection report breakfasts to them so they could choose their preferred meal. We observed that the support staff encouraged the service users' health and wellbeing through diet and gentle exercise, if appropriate. We saw that the support staff observed the service users during their visits and any health related issues were recorded and concerns passed on to the appropriate health professionals. Staff we spoke with during this inspection showed a good knowledge of the needs of the people using the service. People using the service stated they were very confident that the support staff met their health and wellbeing needs. Areas for improvement The management team should continue to encourage the staff team to record and report, when completing daily records or care planning activities, in a manner that focuses on individual personal outcomes for the people using the service. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The service should keep the Care Inspectorate informed of progress with the introduction of an electronic call monitoring system in Lanarkshire and Falkirk. National Care Standards - Care at Home - Standard 4 - Management and staffing

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Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good

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 Our examination of records, discussion with service users, relatives, staff and management supported that the service performs at a good level in this quality statement. We made a recommendation at the last inspection, in terms of recruitment, that: (i) support worker interviews should be conducted in line with best practice guidance in relation to staff working in social care and social work setting which is to "have a minimum of two interviewers"; (ii) comments from coordinators and trainers following induction and shadowing should be recorded and kept on file with interview notes to evidence that these were taken into account when making a decision about appointment; and (iii) recruitment checklists should record planned and actual induction and shadowing dates. We found that interviews had been conducted in keeping with best practice. The personnel files we sampled showed that two people had been involved in the interview process for new staff. This part of the recommendation has been met. We noted that the service had developed its induction systems and made use of their 'developing competency through effective probation' resource booklets to enable the induction process. We commended the service for the development of this resource. However, the booklets we examined had not been completed Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 18 of 41

Inspection report as instructed, or in a standard manner. We felt that this let down the process of induction, which was easily managed and evidenced by the resource. We have repeated this part of the recommendation. See recommendation 1. We saw that checklists for shadowing and observations of practice were provided by the developing competency resource. We found from our sample, however, that there were inconsistencies in the completion of the resource. We have repeated this part of the recommendation. See recommendation 1. We selected some files from staff that began working with the service since the previous inspection. We focused on the recruitment and selection process and associated records. We found that all of the files sampled contained a completed application form, PVG from Disclosure Scotland and interview notes. We found that the service provider had used care scenarios as part of the interview process, to gain insight on how potential candidates would respond to potential situations they may face. All of the staff files sampled contained references. We saw that there was a structured induction programme and noted that a copy of a letter inviting staff to attend a four day induction programme was found in the files sampled. We read the content of the organisation's induction policy, which reflects that there is effective monitoring of the induction process particularly in the first three months of employment. Areas for improvement The service should encourage more active involvement in the supervision and appraisal process of staff by service users. The service could introduce a Service User Feedback Form to evidence active involvement. The service should look at ways to involve the people using the service more in the interview process.

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Inspection report Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The service should ensure that: (i) comments from co-ordinators and trainers following induction and shadowing should be recorded and kept on file with interview notes to evidence that these were taken into account when making a decision about appointment; and (ii) recruitment checklists should record planned and actual induction and shadowing dates. National Care Standards - Care at Home - Standard 4 - Management and staffing

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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 that the performance of the service was good for this statement. We interviewed the registered manager, co-ordinators and support staff. We looked at staff files, training records and observed the practice of support staff. We made a requirement at the last inspection that the service must: (i) ensure that all grades of staff including support workers and coordinators have had moving and handling training and refreshers within the required timescales; (ii) ensure that all support workers and office based staff undertake more indepth dementia training based around the promoting excellence framework; (iii) take steps to increase the percentage of staff with the social care qualification needed to register with the Scottish Social Services Council; (iv) assess the competence of staff and ensure that all support workers have regular spot check visits and visits to observe their practice; and (iv) provide the Care Inspectorate with details of the new 'bespoke' training programme that is being developed to meet the training needs of all staff following the restructure. We found that all staff had received moving and handling training and refreshers within the required timescales identified in the organisation's policy. We noted that training for staff working with people with dementia had been developed and was being delivered around the Promoting Excellence framework. We found that a tracker to monitor the registration process of staff with the Scottish Social Services Council had been developed and implemented. We saw that this was being used to track the progress of staff as they worked towards the required qualifications for their registration. We examined personnel files and saw that regular competency checks and regular spot check visits had occurred. We discussed the training programme at the service and Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 21 of 41

Inspection report saw that it had been developed to meet the training needs of staff. This requirement has been met. At the previous inspection we made a recommendation that past supervision records should be retained for information in personnel files regardless of whether a new system has been introduced. We examined personnel files and saw evidence that past supervision records had been retained. This recommendation has been met. We made a recommendation at the previous inspection that the service should reintroduce annual employee surveys for both support workers and office-based staff. We noted that a survey of the staff team had occurred since the previous inspection. This recommendation has been met. We saw evidence that the service continued to show commitment to ensuring staff receive training appropriate to the needs of the people they support. We examined the content of the service's training programme and saw topics included: -

moving & handling medication workbook adult support & protection food hygiene infection control.

Staff supervision took place regularly and staff told us they found supervision beneficial and positive. They discussed practice issues, training needs and personal development. Staff showed a good understanding of the National Care Standards and their role as support workers. They were also aware of the Scottish Social Services Council Codes of Practice and the expectations for registration.

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Inspection report We examined the minutes of staff meetings and identified a number of areas of improvement. We found that the minutes reflected being used for information sharing rather than true staff participation. We were unclear of specific actions that would be taken, timescales for achievement and which staff had been identified to take areas forward. Areas for improvement The results from the staff survey had not been collated or shared with respondents. This will be the subject of a recommendation. See recommendation 1. We saw that matters were discussed at team meetings, but the minutes were quite basic. It may benefit the service if better minute recording identified action to be taken, by whom and timescales. This could enable a checking process to ensure actions are completed and could feed into quality assurance systems. We noted that the workers attending team meetings were predominantly from the area near the service's office base, where meetings were held. The service could look to use a community resource where services are delivered, to enable staff there to attend meetings more readily. This may give the staff a voice and they may participate in shaping the service. We noted that only two team meetings had occurred since the last inspection. The manager should meet more regularly with the staff teams. This could improve staff practices and competencies and could create a culture of team performance, to consider best practice guidance. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The manager should summarise the findings of staff surveys and questionnaires to provide evidence of how feedback was evaluated or acted Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 23 of 41

Inspection report upon to enable staff to contribute to the daily running of the service. National Care Standards - Care at Home - Standard 4 - Management and staffing

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

Statement 2 “We involve our workforce in determining the direction and future objectives of the service.” Service Strengths We found that the performance of the service was good in the areas covered by this statement. We came to this view after we: - spoke with people who use the service - spoke with the staff team - looked at documentation. The staff we spoke with during the inspection commented that they received good support from their peers and from the management team. Staff confirmed that they were able to discuss issues with the management team, that they felt listened to and that any concerns they had were addressed. There were a range of ways that the management team gathered views from staff regarding their personal training and development, and the development of the service. This included staff meetings and a programme of supervision. The manager operates an 'open door' policy, which ensures that staff have the opportunity to directly meet with her to express their views or concerns. Areas for improvement We spoke with the management team and discussed where a staff meeting minute relates to a specific issue that is identified within the national care standards, then the specific standard should be referenced within the staff meeting minute. This could also be utilised to identify opportunities for further learning or development.

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Inspection report The service should utilise supervision sessions to explore the ways to support staff to develop their roles. This could include becoming a care champion, or forming a focus group for consulting with residents, relatives or colleagues to develop the service. The management team should consider further ways to involve staff to contribute to the development of the service. This could include, for instance, involvement with content of the self-assessment document sent to the Care Inspectorate. The management team confirmed they will develop the service's approach to this area for improvement. Grade 4 - 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 that the performance of the service was good for this statement. We interviewed the director and the registered manager. We looked at staff files, policies and procedures and observed the practice of support staff. At the previous inspection we made a requirement, under quality theme 4, statement 3, that the service provider must within specified timescales report all notifiable events to the Care Inspectorate including allegations of abuse in relation to a person using service, allegations of misconduct by provider or persons employed in the care service, absence of manager, increase in WTE care staff of 10% and change of registration details such as change of manager. We reviewed this requirement under quality theme 4, statement 4 at this inspection. We noted that all notifiable events had been reported to the Care Inspectorate since the last inspection. This requirement has been met. We made a recommendation at the previous inspection, under quality theme 4, statement 3, that the service provider should review managers' practice when completing action plans for the Care Inspectorate and ensure that they clearly records any remedial steps planned. We reviewed this recommendation under quality theme 4, statement 4 at this inspection. We found that action plans for the Care Inspectorate had been reviewed and contained remedial steps or proposed developments within the service. This recommendation has been met. At the previous inspection we made a recommendation that the service should advise the Care Inspectorate of the appointment of new/ replacement quality and monitoring staff for Lanarkshire and Falkirk.

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Inspection report We reviewed this recommendation under quality theme 4, statement 4 at this inspection. These appointments have not yet occurred and this recommendation is, therefore, repeated. See recommendation 1. We made a recommendation at the previous inspection that once electronic call monitoring is up and running in Lanarkshire, collate and analyse the information this gives you about service delivery problems and take necessary action to reduce the incidence of these. This has not yet occurred and this recommendation is, therefore, repeated. See recommendation 2. At the previous inspection we made a recommendation that the service should: (i) ensure that all Care Diaries are audited on a regular basis. (ii) ensure that written personal care plans, service user histories, health and wellbeing records, review reports and complaints paperwork are sampled and audited as part of the new quality assurance approach. This is in order to ascertain that paperwork is kept up to date, that timescales are being met and that the quality of content is acceptable. To facilitate this create a central record of service reviews and record in the complaints log whether the 20 day timescale had been met or not. (iii) ensure that records of observational visits, spot check visits, supervision meetings and appraisals get sampled and audited as part of the new quality assurance approach. This is in order to ascertain whether these are taking place within the timescales specified in the new Developing Competency Framework and assess how effective this framework is. We did not find evidence of quality assurance audits having occurred and discussed with the manager how other exigencies had impacted on the process. This recommendation is, therefore, repeated. See recommendation 3. We made a recommendation at the previous inspection that the service should make sure that the content of monitoring reports for the funding local authorities is an accurate reflection of events and service delivery. We noted that accurate information had been supplied to funding local authorities. This recommendation has been met.

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Inspection report We found that observational monitoring of staff performance occurred and saw evidence in staff files. This practice met good guidance and the needs of the service users. This led to good outcomes for people using the service. Service users were very satisfied or satisfied with the care and support they received. We noted that the service had processes and systems in place to undertake audits of care plans, medication and staff training. As mentioned above, we did not find evidence that these had occurred since the last inspection. The manager was very keen to promote the involvement of service users and other stakeholders in assessing the quality of the service. We discussed the methods that could be used to enable this development. Areas for improvement The management team should ensure that audits of the service's systems and processes are completed. The findings from these audits should be used to inform future practice within the service. See recommendation 3, repeated from the previous inspection, below. The service should develop its involvement of people using the service and other stakeholders in its quality assurance processes. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 3 1. The service should advise the Care Inspectorate of the appointment of new/ replacement quality and monitoring staff for Lanarkshire and Falkirk. National Care Standards - Care at Home - Standard 4 - Management and staffing 2. Once electronic call monitoring is up and running in Lanarkshire, collate and analyse the information this gives you about service delivery problems and take necessary action to reduce the incidence of these. National Care Standards Care at Home - Standard 4 - Management and staffing

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Inspection report 3. The service should: (i) ensure that all Care Diaries are audited on a regular basis (ii) ensure that written personal care plans, service user histories, health and wellbeing records, review reports and complaints paperwork are sampled and audited as part of the new quality assurance approach. This is in order to ascertain that paperwork is kept up to date, that timescales are being met and that the quality of content is acceptable. To facilitate this create a central record of service reviews and record in the complaints log whether the 20 day timescale had been met or not (iii) ensure that records of observational visits, spot check visits, supervision meetings and appraisals get sampled and audited as part of the new quality assurance approach. This is in order to ascertain whether these are taking place within the timescales specified in the new Developing Competency Framework and assess how effective this framework is. National Care Standards - Care at Home - Standard 4 - Management and staffing

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Inspection report

4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The service provider must ensure at all times that: (a) service users are provided with care and support which meets their individual needs, as detailed in their personal plans (b) scheduled visit times and actual visit times correspond with those agreed with service users. This is in order to comply with Regulation 5 of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) This requirement was made on 06 November 2015 We reviewed this requirement under quality theme 1, statement 3 at this inspection. We noted that the service's monitoring officer had visited people using the service to ensure that current levels of need were reflected in personal plans. We observed that a new care plan summary sheet was being held at the office base and in people's homes. We saw that the levels of need were monitored by means of care diary audits, which were checked by the monitoring officer or care coordinator. We found that staff 'spot checks' had been completed.

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Inspection report

Met - Within Timescales 2. Staff Training, Competence and Qualifications (i) Ensure that all grades of staff including support workers and coordinators have had Moving and Handling trainingand refresherswithin required time scales (ii) Ensure that allsupportworkers and office based staffundertake more in depth dementia training based around the Promoting Excellence framework (iii) Take steps to increase the percentage of staff withthe social care qualification needed to register with the Scottish Social Services Council (iv) To assess the competence ofstaff ensure that the all support workers have regular spot check visits and visits to observe their practice (v) Provide the Care Inspectorate with details ofthenew 'bespoke' training programme that is being developed to meet the training needs of all stafffollowing the restructure This is in order to comply with Regulation 15 of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210). A provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users. (a)ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users; and . (b)ensure that persons employed in the provision of the care service receive (i)training appropriate to the work they are to perform; and (ii)suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work. This requirement was made on 06 November 2015 We found that all staff had received moving and handling training and refreshers within the required timescales identified in the organisation's policy. We noted that training for staff working with people with dementia had been developed and was being delivered around the Promoting Excellence framework. We found that a tracker to monitor the registration process of staff with the Scottish Social Services Council Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 32 of 41

Inspection report had been developed and implemented. We saw that this was being used to track the progress of staff as they worked towards the required qualifications for their registration. We examined personnel files and saw that regular competency checks and regular spot check visits had occurred. We discussed the training programme at the service and saw that it had been developed to meet the training needs of staff. Met - Within Timescales 3. Notifications HRM must within specified timescales report all notifiable events to the Care Inspectorate including allegations of abuse in relation to a person using service, allegations of misconduct by provider or persons employed in the care service, absence of manager, increase in WTE care staff of 10% and change of registration details such as change of manager. This is to comply with Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 (SSI 2002/114), Regulations 21-23. This requirement was made on 06 November 2015 We reviewed this requirement under quality theme 4, statement 4 at this inspection. We noted that all notifiable events had been reported to the Care Inspectorate since the last inspection. Met - Within Timescales

5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The service should reintroduce annual satisfaction surveys for service users and relatives; collate results and communicate these to service users along with an action plan. This recommendation was made on 06 November 2015 Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 33 of 41

Inspection report We found that satisfaction surveys had occurred and noted that the responses had been generally favourable. This part of the recommendation has been met. The results from the surveys, however, had not been collated or shared with respondents. This part of the recommendation will be repeated. 2. Reviews (i) where social work and HRM reviews take place at different times and significant changes to packages are planned there should be better communication between care managers and home care providers and service users; and (ii) service users or their representatives should routinely be given a copy of their service review report by HRM. This recommendation was made on 06 November 2015 We noted evidence of better communication between care managers and the service and that this was recorded effectively. We also found that people received a copy of the service review, where requested. This recommendation has been met. 3. The service should continue to reinforce awareness of these procedures by having this as a standing item at service reviews. This recommendation was made on 06 November 2015 We noted that updated information around the complaints procedure had been given to people using the service, to raise awareness of the procedure. The people we spoke with confirmed they had relevant information on the complaints process. We sampled records and found that the procedure was discussed at the review setting. This recommendation has been met. 4. The service should consider having some more detailed information about medical conditions and different types of dementia in personal care plans for support workers to refer to. This recommendation was made on 06 November 2015 We saw evidence that information relating to specific conditions was now documented in care plans. Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 34 of 41

Inspection report This recommendation has been met. 5. Co-ordinators should always be prompt to address health and wellbeing concerns raised by support workers and take appropriate action such as contact main carers and/or amend the care plan where necessary. This recommendation was made on 06 November 2015 We examined health and wellbeing forms and noted that any concerns raised had been addressed, with the appropriate action taken. This recommendation has been met. 6. The service should clarify with staff in what circumstances support workers should complete a written health and wellbeing report when they have already advised coordinators of their concerns over the phone. This recommendation was made on 06 November 2015 We noted that this subject was now part of the induction training for new staff and that staff, in general, had received instruction that reminded them of their duty to report concerns that may arise. This recommendation has been met. 7. The service should: (i) provide the Care Inspectorate with a copy of the proposed format for an easy-to-read care plan summary for when a visit is done by someone other than the regular carer; and (ii) ensure that care plans clearly state when support workers need to write more than just "all care given as per care plans" such as for the service users who had memory or communication difficulties and might not recall, e.g., what they had last eaten. This recommendation was made on 06 November 2015 We examined the new care plan summary format and found that it provided relevant information that could be followed by all care workers. We saw that the summary was in situ at some of the people's homes we visited. We found that new care diaries were being introduced to people's homes and that these contained clear guidance as to what information should be recorded by staff. The diaries we sampled Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 35 of 41

Inspection report showed that the guidance was being followed and that staff were being more descriptive about the tasks they had completed. This recommendation has been met. 8. The service should keep the Care Inspectorate informed of progress with the introduction of an electronic call monitoring system in Lanarkshire and Falkirk. This recommendation was made on 06 November 2015 We found that the service had not progressed with this recommendation and it is, therefore, repeated. 9. The service should: (i) ensure that everyone who wants a weekly schedule gets sent one; and (ii) whenever possible notify service users of delays or changes to their regular carer. This recommendation was made on 06 November 2015 We found that weekly schedules were despatched to people who wished to have one. People who used the service told us that they could receive a copy of their schedule. People also told us that they were made aware of possible delays or changes to their regular support worker. This recommendation has been met. 10. In terms of recruitment, that: (i) support worker interviews should be conducted in line with best practice guidance in relation to staff working in social care and social work setting which is to "have a minimum of two interviewers"; (ii) comments from coordinators and trainers following induction and shadowing should be recorded and kept on file with interview notes to evidence that these were taken into account when making a decision about appointment; and (iii) recruitment checklists should record planned and actual induction and shadowing dates. This recommendation was made on 06 November 2015 Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 36 of 41

Inspection report We found that interviews had been conducted in keeping with best practice. The personnel files we sampled showed that two people had been involved in the interview process for new staff. This part of the recommendation has been met. Recommendation 11 Past supervision records should be retained for information in personnel files regardless of whether a new system has been introduced. Action Taken on recommendation 11 We examined personnel files and saw evidence that past supervision records had been retained. This recommendation has been met. Recommendation 12 The service should reintroduce annual employee surveys for both support workers and office-based staff. Action Taken on recommendation 12 We noted that a survey of the staff team had occurred since the previous inspection. This recommendation has been met. Recommendation 13 The service provider should review managers' practice when completing action plans for the Care Inspectorate and ensure that they clearly records any remedial steps planned. Action Taken on recommendation 13 We found that action plans for the Care Inspectorate had been reviewed and contained remedial steps or proposed developments within the service. This recommendation has been met. Recommendation 14 The service should advise the Care Inspectorate of the appointment of new/ replacement quality and monitoring staff for Lanarkshire and Falkirk.

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Inspection report Action Taken on recommendation 14 These appointments have not yet occurred and this recommendation is, therefore, repeated. Recommendation 15 Once electronic call monitoring is up and running in Lanarkshire, collate and analyse the information this gives you about service delivery problems and take necessary action to reduce the incidence of these. Action Taken on recommendation 15 This has not yet occurred and this recommendation is, therefore, repeated. Recommendation 16 The service should: (i) ensure that all Care Diaries are audited on a regular basis. (ii) ensure that written personal care plans, service user histories, health and wellbeing records, review reports and complaints paperwork are sampled and audited as part of the new quality assurance approach. This is in order to ascertain that paperwork is kept up to date, that timescales are being met and that the quality of content is acceptable. To facilitate this create a central record of service reviews and record in the complaints log whether the 20 day timescale had been met or not. (iii) ensure that records of observational visits, spot check visits, supervision meetings and appraisals get sampled and audited as part of the new quality assurance approach. This is in order to ascertain whether these are taking place within the timescales specified in the new Developing Competency Framework and assess how effective this framework is. Action Taken on recommendation 16 We did not find evidence of quality assurance audits having occurred and discussed with the manager how other exigencies had impacted on the process. This recommendation is, therefore, repeated. Recommendation 17 The service should make sure that the content of monitoring reports for the funding local authorities is an accurate reflection of events and service delivery.

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Inspection report Action Taken on recommendation 17 We noted that accurate information had been supplied to funding local authorities. This recommendation has been met.

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

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

8 Additional Information There is no additional information.

9 Inspection and grading history Date

Type

Gradings

6 Nov 2014

Unannounced

Care and support Environment Staffing Management and Leadership

3 - Adequate Not Assessed 3 - Adequate 3 - Adequate

26 Sep 2013

Announced (Short Notice)

Care and support Environment Staffing Management and Leadership

4 - Good Not Assessed 5 - Very Good 5 - Very Good

Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 39 of 41

Inspection report 7 Dec 2012

Announced (Short Notice)

Care and support Environment Staffing Management and Leadership

4 - Good Not Assessed 5 - Very Good 4 - Good

10 Aug 2011

Announced (Short Notice)

Care and support Environment Staffing Management and Leadership

5 - Very Good Not Assessed 4 - Good 4 - Good

21 Jan 2011

Announced

Care and support Environment Staffing Management and Leadership

3 - Adequate Not Assessed 3 - Adequate 3 - Adequate

Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 40 of 41

Inspection report

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Inspection report for HRM Homecare Services Ltd - South West Branch (1) page 41 of 41