Shared Lives Moray Adult Placement Service

Shared Lives MorayAdult Placement ServiceMoray Council HQ Annexe2-10 High StreetElginIV30 1BY

Inspected by: Lindsey McWhirter

Type of inspection: Announced (Short Notice)

Inspection completed on: 25 April 2013

ContentsPage No

Summary 31 About the service we inspected 52 How we inspected this service 73 The inspection 114 Other information 225 Summary of grades 236 Inspection and grading history 23

Service provided by:The Moray Council

Service provider number:SP2003001892

Care service number:CS2010271882

Contact details for the inspector who inspected this service:Lindsey McWhirterTelephone 01463 227630Email [email protected]

Inspection report continued

Shared Lives Moray, page 2 of 24

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

Grades for this care service may change after this inspection following otherregulatory activity. For example, if we have to take enforcement action to make theservice improve, or if we investigate and agree with a complaint someone makesabout the service.

We gave the service these grades

Quality of Care and Support 5 Very Good

Quality of Staffing 5 Very Good

Quality of Management and Leadership 5 Very Good

What the service does wellThe service provides very good training and support for the Shared Lives carers.

The service works closely with Shared Lives carers, other agencies, service users andtheir families to ensure good person centred support is provided where it is needed.

The manager and Shared Lives officer are committed to further developing theservice they provide across the Moray community.

What the service could do betterThe service plans to continue to review the quality of the service and further developan annual evaluation tool to use with other agencies, service users and their families.

What the service has done since the last inspectionThe service has further developed the way they provide support for Shared Livescarers, for example monthly focus group meetings started up in October last year.

A quarterly newsletter for Shared Lives carers, service users and their relatives hasbeen introduced and two editions have been published so far.

The service has continued to recruit Shared Lives carers to enable more people to usethe service and to cover a wider area throughout Moray where the service is available.



ConclusionShared Lives Moray coordinates and supports Shared Lives carers to provide veryperson centred support to adults in the Moray area. The service has continued todevelop and expand to increase the availability of the service to people living inMoray. The manager and Shared Lives officer are committed to providing the righttraining and support to the Shared Lives carers. They demonstrate a commitment tomonitor the service, take account of people's views and continue to improve theprovision to ensure a quality service is provided.

Who did this inspectionLindsey McWhirter



1 About the service we inspectedThe Care Inspectorate regulates care services in Scotland. Information about all careservices is available on our website at www.careinspectorate.com

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

Requirements and recommendationsIf we are concerned about some aspect of a service, or think it could do more toimprove, we may make a recommendation or requirement.

- A recommendation is a statement that sets out actions the care service providershould take to improve or develop the quality of the service, but where failure to doso will not directly result in enforcement. Recommendations are based on theNational Care Standards, relevant codes of practice and recognised good practice.

- A requirement is a statement which sets out what is required of a care service tocomply with the Public Services Reform (Scotland) Act 2010 and Regulations or Ordersmade under the Act or a condition of registration. Where there are breaches ofRegulations, Orders or Conditions, a requirement must be made. Requirements arelegally enforceable at the discretion of the Care Inspectorate.Shared Lives Moray is registered to provide an Adult Placement service with no morethan two adults placed at any one time within the household of any Adult PlacementCarer. The office base of the service is located in Elgin. Shared Lives Moray AdultPlacement service provides a respite care and day support in Adult Placement carershomes, which can include overnight care and one to one day care services.

The service is provided by the local authority, Moray Council, which also operatesother registered care services in Moray including Housing Support, Care at Homeand Support Services - Daycare. The provider employs a Manager who hasresponsibility for the management of the service and is supported by a Shared LivesOfficer for the day to day running of the service.

The aims of Shared Lives Moray include:

• To provide day care and support to individuals who may require care andsupport due to frailness or disability or who may be at risk of social isolation.

• To deliver the care and support in a non-discriminatory way taking intoaccount the needs, requirements and any cultural wishes that individuals mayhave.

• To provide a service where individuals feel safe and physically comfortable.



• To ensure that Service Users experience a sense of control over their lives andwhat happens when they are using a Shared Lives Service.

• To ensure that Service Users feel valued as individuals.• To ensure that Service Users experience stimulation throughout the day,

appropriate to their needs.• To ensure that Service Users are consulted with and participate as well as they

can in the Shared Lives Service.

The National Care Standards for Adult Placement Services uses the following terms:Adult Placement Carer - The adult placement carer is the person you go to stay within the placement. The adult placement carer is recruited and approved by the adultplacement service to provide support and care in his or her own home.Adult in Placement - The adult in placement is the person receiving support and carefrom the adult placement carer in their own home.Adult Placement Worker - The worker is employed by the adult placement service tosupervise and support your placement with the adult placement carer.

In terms of Adult Placement Services the Adult Placement Carer is recognised as theprimary service user.

For the purpose of this report the Adult Placement Carer is referred to as the SharedLives Carer and the person using the placement is referred to as the Service User.

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

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

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

Grades for this care service may change following other regulatory activity. You canfind the most up-to-date grades for this service by visiting our websitewww.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of ouroffices.



2 How we inspected this service

The level of inspection we carried outIn this service we carried out a low intensity inspection. We carry out theseinspections when we are satisfied that services are working hard to provideconsistently high standards of care.

What we did during the inspectionWe wrote this report following a short notice announced inspection. This was carriedout by Inspector Lindsey McWhirter. The inspection took place on 24 April 2013 duringwhich we visited the office base and met with the Shared Lives Carers at the resourcecentre before their training event in the evening. We gave feedback to the managerand the Shared Lives officer the following day.As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us.

We sent five care standards questionnaires to the manager to distribute to serviceusers. Four service users sent us completed questionnaires.

We also asked the manager to give out three questionnaires to Shared Lives carersand staff and we received three completed questionnaires.

During the inspection process, we gathered evidence form various sources, includingthe following:

We spoke with:* The manager and Shared Lives Officer* Shared Lives Carers* One relative and service user

We looked at:* The information about the service* Newsletters* Questionnaires* Care documentation* Review records* Evidence of meetings and communications with outside health professionals* Training records* Shared Lives Carers Handbook



Grading the service against quality themes and statementsWe 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'. Undereach quality theme are 'quality statements' which describe what a service should bedoing well for that theme. We grade how the service performs against the qualitythemes 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 ourinspections. These are extra checks we make on top of all the normal ones we makeduring inspection. We do this to gather information about the quality of these aspectsof care on a national basis. Where we have examined an inspection focus area we willclearly identify it under the relevant quality statement.

Fire safety issuesWe do not regulate fire safety. Local fire and rescue services are responsible forchecking services. However, where significant fire safety issues become apparent, wewill alert the relevant fire and rescue services so they may consider what action totake. You can find out more about care services' responsibilities for fire safety atwww.firelawscotland.org



What the service has done to meet any requirements we made atour last inspection

The requirementNo requirements were made during or since the last inspection visit.

What the service did to meet the requirement

The requirement is:

The annual returnEvery year all care services must complete an 'annual return' form to make sure theinformation we hold is up to date. We also use annual returns to decide how we willinspect the service.Annual Return Received: Yes - Electronic

Comments on Self AssessmentEvery year all care services must complete a 'self assessment' form telling us howtheir service is performing. We check to make sure this assessment is accurate.We received a fully completed self assessment document from the service completedon behalf of the provider. We were satisfied with the way the service completed thisand with the relevant information included for each heading that we grade servicesunder.

The service identified what it thought they did well, some areas for development andany changes it had planned. They told us how information from the people who usedthe service, Shared Lives carers and relevant others had contributed to the selfassessment process.

Taking the views of people using the care service into accountIn terms of Adult Placement services, the adult in placement (service user) is theperson receiving support and care from the adult placement carer (Shared Lives carer)in their own home. The adult in placement is recognised as the secondary serviceuser. We have used this section to report the views of the secondary service users, theadults in placement.



There were fifteen people receiving support and care from Shared Lives carers at thetime of the inspection.We received four completed care standards questionnaires from people using theservice and spoke with one relative and service users by phone.All the views we received were very positive about the service. All four people whocompleted the questionnaires agreed (3) or strongly agreed (1) that overall, they werehappy with the quality of care and/or support this service gives them.

We have included further comments and views from people using the servicethroughout the report.

Taking carers' views into accountIn terms of Adult Placement services, the Adult Placement carer (Shared Lives carer)is recognised as the primary service user. We have used this section to report theviews of Shared Lives carers.

There were three Shared Lives carers providing the service in their own homes at thetime of the inspection, one of whom also provided a respite provision as part of theadult placement provision.

We received two completed care standards questionnaires from Shared Lives carersand spoke with the Shared Lives carers focus group when they met for a trainingsession.All the views we received were very positive about the support and training theyreceived and the communication with the Shared Lives Officer.

We have included further comments and views from people using the servicethroughout the report.



3 The inspectionWe looked at how the service performs against the following quality themes andstatements. Here are the details of what we found.

Quality Theme 1: Quality of Care and SupportGrade awarded for this theme: 5 - Very Good

Statement 1 We ensure that service users and carers participate in assessing andimproving the quality of the care and support provided by the service.

Service strengthsWe found the service was performing to a very high standard in the area covered bythis statement. We concluded this after we spoke with the manager, shared livesofficer and shared lives carers. We also examined care and support documentation,review records, questionnaire responses, the services feedback data and informationabout the service.

The service involved Shared Lives carers, service users and their families in a numberof ways. It was clear that the service actively sought the views and opinions of serviceusers and Shared Lives carers and that their views were listened to. The manager andShared Lives officer demonstrated a commitment to involving service users, carersand the Shared Lives carers in the further development and improvement of theservice.

There were comprehensive handbooks given to both parties which set providedrelevant information about the service provision, for example, responsibilities, reviewprocess, how to make a complaint and relevant contact details they might need.

Service users were provided with information sheets about the Shared Lives carer andinitial visits were arranged before a placement became a regular arrangement. Thisprovided both parties to be introduced and to give their views about whether theplacement would go ahead. The service worked closely with the community careofficer. A care plan was in place for each service user and around six weeks aftercommencing a placement the care officer held a review to discuss how the placementwas going with the service user. The Shared Lives officer attended where possible andthere was very good communication systems and follow up contact in place whereshe was not able to attend.



Each Shared Lives carer had a contract which was reviewed on an annual basis withthem. An annual review with each Shared Lives carer had been introduced which bothparties had found useful. It was planned that all Shared Lives carers would have anannual review once they had been there a full year and there was regularopportunities throughout the first year for support and supervision. The reviewprocess gave an opportunity for the Shared Lives carer to give their views. They werealso provided with support from the Shared Lives officer who contacted them directlythrough a visit, by telephone and by email. The Shared Lives officer could also becontacted out with these times to discuss any concerns or issues which the SharedLives carer found useful. In addition to this there was a monthly focus group whichhad been set up in October. This provided the opportunity for Shared Lives carers toregularly meet with each other and the Shared Lives officer. Shared Lives carers foundthis beneficial to share ideas, network and to put forward ideas or suggestions todiscuss. The focus groups had been put in place since the previous inspection andhad been something the Shared Lives carers at that time had suggested they wouldfind beneficial. During the inspection visit the focus group was being held in theevening and on this occasion was being used to have a moving and handling trainingsession. A newly recruited Shared Lives carer was attending the training and had theopportunity to meet other Shared Lives carers. During the focus group monthlymeetings the Shared Lives officer attended for the first section only. This provided theShared Lives carers time to talk with each other and the opportunity to meetindividually in private with the Shared lives officer in another room if they had anymatters they wished to discuss with her.

A newsletter had been started which provided information for both service users andShared Lives carers. Two editions, December 2012 and March 2013, had already beenpublished and circulated. The Shared Lives officer had sought feedback following thefirst edition to see what people thought and to get ideas of what they would like tobe included. Positive feedback had been received and it was proposed to continuewith the newsletter on a regular basis.

The service had reviewed and amended the questionnaires they used to gain theviews of service users. Three questionnaires had been sent out to service users andone had been returned. The person who responded was happy with the service andindicated they did not know the complaints procedure; the service had responded andtaken action to ensure the person was aware of the complaint procedure. The servicehad not received any formal complaints from Shared Lives carers or service users.

We received four completed Care Standards Questionnaires from service users. Threeout of four people agreed that the service asks for their opinions about how it canimprove and that the service tells them how they have taken their views into account.One respondent had indicated that this was not applicable.



Areas for improvementThe service should continue to develop the very good practice and communicationmethods they have already put in place to involve people using the service and theShared Lives carers.

The service should continue to look at different ways to involve service users, carersand Shared Lives carers in giving their feedback about the service and anysuggestions about ways in which the service could be improved.

Grade awarded for this statement: 5 - Very Good

Number of requirements: 0

Number of recommendations: 0

Statement 3 We ensure that service users' health and wellbeing needs are met.

Service strengthsWe found the service was performing to a very high standard in the area covered bythis statement. We concluded this after we spoke with the manager, Shared Livesofficer and shared Lives carers. We also examined care and support documentation,review records, questionnaire responses, the services feedback data and informationabout the service.

The service had clear processes in place for receiving referrals, assessments, matchingShared Lives carers and service users and reviews. The service worked closely with thecommunity care officer and other members of the Moray Council community careteam. Records and documentation used to inform the support included sharedassessments, an individual care plan, risk assessment, information 'About Me' andany relevant health information the Shared Lives carer might need to be aware of.The service provided a range of support for example, to meet the need of individualswho were at risk of moving in to care, to support families under stress who wereinvolved in the service users care and to reduce social isolation of service users livingalone. The support was provided in different ways ranging from day support a fewhours per week to respite and short breaks in the Shared Lives carers home.

The Shared Lives officer met with the Shared Lives carer and service user and amatching process was used. The service and Shared Lives carers had developedindividual service leaflets about each shared Lives carer to give service users andfamilies some information about themselves and initial visits were arranged as part ofthe process. The matching process was used to ensure the optimum placement couldbe arranged and to agree the level of support and how it would be provided forexample, one to one support, small group support, respite or short breaks. Care wasplanned in an individual, person centred way and took account of the service userspreferences, likes, dislikes, interests and requirements. Each service user had a paperfile and electronic records containing relevant information about their



placement arrangements, identified needs and how these would be met and reviewedand records of meetings, referrals and reviews.

We looked at a sample of review notes. Reviews were held after 6 weeks andthen annually or more frequently if a need was identified. Where possible the reviewsinvolved the service user and their family, Shared Lives care officer, Shared Livescarer and the community care officer. The review included the views of the family/service user, Shared Lives carer and actions taken by the service as a result ofsuggestions made by them.

Responses we received through the care standards questionnaires we receivedincluded service users agreed:

• They had a personal plan or support plan which contained information abouttheir support needs and their preferences have been detailed in the personalplan.

• The service checked with them regularly that they are meeting their needsand they update their personal plan if their needs change.

• The adult placement service treats them with respect.• Overall, they are happy with the quality of the care and/or the support this

service gives them.

One relative we spoke to told us she was very happy with the service and she is keptwell informed. She told us her relative would tell her if they were unhappy aboutanything with Shared Lives however they were happy and tells her about what theyhave been doing when they were with the Shared Lives carer.

We looked at the comments and feedback the service had received from otherdepartments or agencies involved in people care and relatives. These were verypositive about this service and how the support was being provided and included howit gave 'peace of mind', how the service was progressing locally and the flexibility andchoice it provided.

The service had recently reviewed the medication policy and Shared Lives carers wereaware of their roles and responsibilities. Shared Lives carers were provided withmedication awareness training and specialised training was provided on an individualbasis where this was needed to support a specific service users needs.

We were satisfied the service used a person centred approach, each placementwas arranged on an individual basis and took account of the service users health andwell being needs to ensure these were met.



Areas for improvementThe manager and shared Lives officer should ensure that care plans are reviewed withservice users and Shared Lives carers at least once every six month period.

The service highlighted in the self assessment document they were reviewing thprocedures regarding help with personal care, to bring them in to line with the HomeCare Service (the Moray Council) and to amend the current induction process forShared Lives carers to reflect this update.

The service should continue to maintain and build on their current very good practicein relation to this quality statement and ensuring service users health and wellbeingneeds are continuing to be met.






Quality Theme 3: Quality of StaffingGrade awarded for this theme: 5 - Very Good

Statement 1 We ensure that service users and carers participate in assessing andimproving the quality of staffing in the service.

Service strengthsSee Quality Theme 1, Quality Statement 1.

Areas for improvementSee Quality Theme 1, Quality Statement 1.




Statement 3We have a professional, trained and motivated workforce which operates to NationalCare Standards, legislation and best practice.

Service strengthsWe found the service was performing to a very high standard in the area covered bythis statement. We concluded this after we spoke with the manager, Shared Livesofficer and Shared Lives carers. We also examined induction and trainingrecords and information and questionnaire responses.

There were a range of polices and procedures in place which provided guidance forstaff to ensure staff, Shared Lives carers and service uses were safe and protectedwhile either working for or using the service.

The Shared Lives officer had taken up post last year and had attended acomprehensive range of training opportunities relevant to her role and the furtherdevelopment of the service. She had established good links with other services in theMoray area and also networked with the National Shared Lives plus developmentofficer for Scotland and other Adult Placement service providers she had met throughtheir annual conference. The Shared Lives officer received regular supervision fromthe service manager and was supported to undertake training and developmentopportunities. The communication between the manager and the Shared Lives officer



was very good and they kept each other well informed about the day to day runningof the service and service developments.

The Shared Lives officer had worked hard to promote and develop the service with themanager's support and had recently completed an overview of the training receivedby the Shared Lives carers. There was a core training programme which wasmandatory and additional developmental training which was specific to eachindividual. Shared Lives carers had to successfully go through the robust Shared LivesCarers Approval process and be passed by a panel before they could become SharedLives carers for this service. Although the Shared Lives carers were self-employed,they were contracted by the provider and relevant personnel files were maintained.

The Shared Lives carers received a comprehensive induction programme which waswell delivered and the information they received was useful and relevant. They alsoreceived the Shared Lives Carers Handbook which was a clear comprehensive guideabout what they needed to know and where to find further information and guidance.They received on going support and supervision from the Shared Lives officer and aformal annual review. Each Shared Lives carer was provided with a copy of theNational Care Standards for Adult Placement services, Scottish Social Services Council(SSSC) codes of practice, and relevant policies and procedures for example, AdultSupport and Protection, Health and Safety, Food Handling policy and Complaintsprocedure. Additional training and refresher training was provided to support theShared Lives carers. For example, on the evening of the inspection Shared Lives carerswere attending moving and handling training which had been adapted by the trainerto meet the specific needs of the Shared Lives carers and the type of support theyprovided. We received two questionnaires from Shared Lives carers, both confirmedthey had an induction, the service had provided them with opportunities to accesstraining in the last 12 months and they were confident that they had the skills tosupport people using the service. One Shared Lives carer told us she had been givenextensive support and all the training opportunities she required. She found the focusgroup very supportive, sharing ideas and experiences and also being kept up-to-datewith things on a wider scale by the Shared Lives officer. The other Shared Lives carerswe spoke to confirmed they had received induction and found the focus groupsbeneficial.

Areas for improvementThe service highlighted in the self assessment document they proposed to build ingrater links into other existing policies as appropriate.

The service should continue to build on their very good practice relating to thisstatement and regularly review the training needs of the Shared Lives officer andShared Lives carers.








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

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the management and leadership of the service.

Service strengthsSee Quality Theme 1, Quality Statement 1.

Areas for improvementSee Quality Theme 1, Quality Statement 1.




Statement 4We use quality assurance systems and processes which involve service users, carers,staff and stakeholders to assess the quality of service we provide

Service strengthsWe found the service was performing to a very high standard in the area covered bythis statement. We concluded this after we spoke with the manager, Shared Livesofficer and Shared Lives carers. We also examined care and support documentation,review records, questionnaire responses, the services feedback data and informationabout the service.

The service had several quality assurance methods in place to assess the quality ofthe service they provided. These included the use of questionnaires to gain feedbackabout the service, reviews, supervision, training evaluations and focus groupmeetings. These methods included the involvement of people who used the serviceand their families, Shared Lives carers, community care staff and other health careprofessionals or external agencies where applicable.

Policies, procedures, training and information about the service was regularlyreviewed and amended to ensure the information provided was current, relevant andreflected best practice and current legislation where applicable.



There were effective systems in place for the recruitment and selection of staff andShared Lives carers, induction and supervision. Shared Lives carers had a serviceagreement contract with the Moray Council which set out what was expected fromboth parties and the arrangements for review of the contract. A system was in placeto review the contract and to identify any training and development needs the SharedLives carer might have. The service carried out a review of new placements with thoseinvolved after the initial six week period to ensure that the arrangements were goingwell.

The service identified the self assessment document and inspection process as part oftheir quality assurance systems. The self assessment document had been verycomprehensively completed and submitted to us within the timescales we hadrequested.

The questionnaires used to gain feedback about the service had been furtherdeveloped. The service had used the questionnaires for people using the service inNovember 2012. Three had been sent out and one had been returned. The serviceproposed to repeat the questionnaires this year now there were more people usingthe service.

The service held an electronic spreadsheet record of the comments and suggestionsthey received about the service and any action and changes made as a result ofthese. The comments they had received were very positive. One social worker hadcommented that it was a wonderful service for community care officers to be able tooffer now and that the flexibility of the service is great. It was evident the service wasproactive in the way they assessed the service they provided and how they involvedservice users, families, Shared Lives carers and other stakeholders. The Shared Livesofficer had visited various care teams including the Mental Health and LearningDisabilities team to share information and highlight the service within the Moray area.

The provider, the Moray Council, had quality assurance systems in place at a corporatelevel. Meetings were chaired by the Head of Community Care and incorporated themonitoring and evaluation of this service. The service had links with the PublicInvolvement Officer who they could seek advice from when carrying out developmentwork, for example the participation strategy.

Three out of four service users who returned care standards questionnaires told usthe service asks for their opinions about how it can improve and that the service tellsthem how they have taken account of their views. One service user had indicated thisquestion was not applicable to them.

Areas for improvementThe service highlighted in their self assessment document they proposed to developan annual service evaluation tool to use with all relevant stakeholders. This service



should progress with the development and implementation of the evaluation tool andcontinue to further develop the ways they assess the quality of the service theyprovide.






4 Other information

ComplaintsNo complaints have been upheld, or partially upheld, since the last inspection.

EnforcementsWe have taken no enforcement action against this care service since the lastinspection.

Additional Information

Action PlanFailure to submit an appropriate action plan within the required timescale, including any agreedextension, where requirements and recommendations have been made, will result in the CareInspectorate re-grading a Quality Statement within the Quality of Management and LeadershipTheme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result inthe Quality Theme being re-graded as unsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 5 - Very Good

Statement 1 5 - Very Good


Quality of Staffing - 5 - Very Good



Quality of Management and Leadership - 5 - Very Good



6 Inspection and grading history

Date Type Gradings

19 Jan 2012 Unannounced Care and support 4 - GoodStaffing 4 - GoodManagement and Leadership 4 - Good

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



To find out more about our inspections and inspection reportsRead our leaflet 'How we inspect'. You can download it from our website or ask us tosend you a copy by telephoning us on 0845 600 9527.

This inspection report is published by the Care Inspectorate. You can get more copiesof this report and others by downloading it from our website:www.careinspectorate.com or by telephoning 0845 600 9527.

Translations and alternative formatsThis inspection report is available in other languages and formats on request.

Telephone: 0845 600 9527Email: [email protected]: www.careinspectorate.com



Documents

Shared Lives Moray Adult Placement Service