Penumbra - Edinburgh Supported Living Service West

Penumbra - Edinburgh Supported LivingService WestHousing Support Service496B Gorgie RoadEdinburghEH11 3AF

Inspected by: David Todd

Type of inspection: Unannounced

Inspection completed on: 27 March 2012

ContentsPage No

Summary 31 About the service we inspected 52 How we inspected this service 73 The inspection 114 Other information 215 Summary of grades 226 Inspection and grading history 22

Service provided by:Penumbra

Service provider number:SP2003002595

Care service number:CS2007145501

Contact details for the inspector who inspected this service:David ToddTelephone 0131 653 4100Email [email protected]

Inspection report continued

Penumbra - Edinburgh Supported Living Service West, page 2 of 23

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 4 Good

Quality of Staffing 4 Good

Quality of Management and Leadership N/A

What the service does wellThe service provides flexible and responsive support to people who have mentalhealth problems and who live in their own homes.

The service encourages people to take control over their own lives in everyday mattersand to take part in activities that help in their recovery from illness.

What the service could do betterThe service could improve on how it records risks in ways that are meaningful to thepeople using the service.

The service could encourage group activities where people using the service can meetto discuss its quality and the ways it could improve.

What the service has done since the last inspectionThe service has introduced a new support planning system called the 'Hope Toolkit'.This makes it easier for people to identify and measure what they want to achievefrom support.

The service has grown larger and now provides support to people in their owntenancies over a wider geographical area.



ConclusionThe service has continued to develop over the last year. The service is flexible in howit meets the peoples' needs. When we asked people about the service they wereusing they said they were very pleased with it.

Who did this inspectionDavid Todd



1 About the service we inspectedSocial Care and Social Work Improvement Scotland (SCSWIS) is the new regulatorybody for care services in Scotland. It will award grades for services based on thefindings of inspections. The history of grades that services were previously awardedby the Care Commission are also available on the SCSWIS website.

Edinburgh Supported Living West is part of the national Penumbra organisation. Theservice is based in central Edinburgh. Staff work from an office in the Gorgie area ofthe city. The service provides support to adults in their own homes, focusing onmental health issues.

When we inspected this service in September 2011 it was called Edinburgh SupportedLiving West (registration number CS2004061905). In March 2012 Penumbra, theprovider, told us the service would be transferred to Penumbra Edinburgh SupportedLiving Service West. This was a service that had been going to close and cancel butthey now wished to keep open. They asked us to copy the inspection report ofEdinburgh Supported Living West so that this report now appears under the newservice name and registration number.

The service aims to offer flexible and responsive support to people who have social,behavioural and mental health difficulties while helping people sustain their housingtenancy. It also aims to increase the opportunities open to people to improve thequality of their lives.

The Service Users' Charter states 'Penumbra envisages a society where people withmental health problems expect recovery and are accepted, supported and have theresources to fulfil their potential'.

At the time of this inspection 29 people were using the service.

Before 1 April 2011 this service was registered with the Care Commission. On this datethe new scrutiny body, SCSWIS, took over the work of the Care Commission, includingthe registration of services. This means that from 1 April 2011this service continued itsregistration under the new body, SCSWIS.

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

Quality of Care and Support - Grade 4 - GoodQuality of Staffing - Grade 4 - GoodQuality of Management and Leadership - N/A



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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices.



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 an unannounced inspection. The inspection wascarried out by SCSWIS Inspector David Todd. This took place between 9.30am and5.00pm on 26 September 2011 and between 10.00am and 4.30pm on 27 September2011. Feedback was given to the Manager and Assistant Manager on 27 September2011.

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

We issued 15 SCSWIS questionnaires to people using the service, carers, families andrelatives. Eight completed questionnaires were returned to us by people using theservice before the inspection.

In this inspection we gathered evidence from various sources including the relevantsections of policies, procedures and other documents including:

A sample of support plansReviews of the plansSupport agreementsTeam meeting minutesTraining recordsQuality assurance information

Service questionnairesAccident and Incident records

Discussions with the Manager and Assistant ManagerWe spoke to a number of staff during the inspection and met with the staff team attheir weekly meeting.We observed staff as they carried out their work.

We spoke to three people who were using the service during the inspection.



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 recommendations we madeat our last inspection1. The service should continue to develop the personal planning and review system toprovide clearer evidence of outcomes and objectives. National Care Standards,Housing Support Services, Standard 4 - Housing support planning

The service had introduced the 'Hope toolkit'. This means the person using theservice is supported to develop an outcome focused support plan which states whatthey want to achieve. The toolkit includes regular review. This recommendation hasbeen met.

2. The service should review the information pack to ensure that financialarrangements and costs relating to support including activities are clearly set out.National Care Standards, Housing Support Services, Standard 1 - Informing anddeciding.

The service had not completed this. See Statement 1.2.

3. The provider should consider if the existing newsletters that are being producedmay be made available to people who use the service. The information provided inthis way may help people using the service to become more aware of the strategicdevelopment and organisational aims. National Care Standards, Housing SupportServices, Standard 3 - Management and staffing arrangements.

We were told that newsletters were available at local offices and that people usingthe service who requested an individual copy would get one. People who contributedarticles would also get a copy. Some progress has been made. However the focus ofthe area for improvement made at the last inspection was about ensuring all peopleusing the service had easy access to information, including the service producing itsown news sheet. The recommendation is repeated (see statement 3.4).

4. New staff should be appropriately supported to know how the strategicdevelopment of the organisation relates to their tasks. National Care Standards,Housing Support Services, Standard 3 - Management and staffing arrangements.

Staff had attended the Directors' Road Show, and some staff attended the StrategicPlanning conference. All staff had access to the strategic plan. New staff attendedinduction. This recommendation has been met.



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 provider.We were satisfied with the way the service provider had completed this and with therelevant information they had given us for each of the headings that we grade themunder.

The service provider identified what they thought they did well, some areas fordevelopment and any changes they planned.

Taking the views of people using the care service into accountWe sent out 15 SCSWIS Care Standard Questionnaires to people using the service,carers and relatives. Eight were returned by people using the service.

Five people strongly agreed or agreed with the statement that 'overall I am happywith the quality of care and support this service gives me'.

We also spoke to three people in their own homes.

Comments made included:

'staff are very helpful and supportive and friendly''an excellent service''...amazing'.

Other views are referred to in the relevant quality statements.

Taking carers' views into accountNo SCSWIS Care standard Questionnaires were returned by carers, relatives or familybefore the inspection. No carers were available during the inspection.



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: 4 - Good

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

Service strengthsPeople using the service had support plans and guidance for staff on how theywanted their care provided. People said they were able to discuss how their care andsupport was given. Examples were given where the timing of the service or a staffmember was changed to meet individual requests. People therefore had regularopportunities to improve the quality of their support.

The evidence showed people using the service and, where appropriate, their familieswere involved in discussions about the care they wanted and changes to it.

When reviews of the service took place, people were helped to think about whatinvolvement they wanted in their own care and in influencing the direction of theorganisation.

The service had sent out a letter asking people to choose from a number ofparticipatory activities they might attend. A meeting was planned for people who saidthey would like to meet as a group. First meetings would be run by Managers whohoped to withdraw once the group was established.

People using the service met with the Manager to review their support plans. Theywere able to comment on and influence the quality of their care, support and staff.This information was used to make changes to the service provided.

The organisation had a commitment to ensure peoples' views were heard andlistened to. It had a Participation Policy which stated the different ways people usingthe service could be involved in the development of the organisation. For examplethey were encouraged to attend the 'directors' roadshow'. This meant they were ableto get information about the future direction of services and speak to SeniorManagers.



The service gave people information about advocacy services and encouraged peopleto use them.

Areas for improvementThe letter sent out to people using the service contained a number of options forways they could be involved in the development of the service. All the options need tobe considered (see recommendation 1).

Grade awarded for this statement: 4 - Good

Number of requirements: 0

Number of recommendations: 1

Recommendations

1. The service should analyse the results of the recent survey. It should develop andimplement an action plan to help people participate, comment on and improve theservice. National Care Standards, Housing Support Services, Standard 8 -Expressing your views.

Statement 2We enable service users to make individual choices and ensure that every service usercan be supported to achieve their potential.

Service strengthsThe service was performing at a very good level in relation to this quality statement.

People using the service were able to discuss their support needs and wereencouraged to develop personal support plans. The service used the 'Hope Toolkit'.This had been developed by Penumbra to help people say what they wanted toachieve through their support. The plan asked people to be specific about how theysaw the service supporting them.

A written agreement was provided. This detailed the service provided and conditionsas well as information about how to end the service.

Staff we spoke with thought the service was person-centred. Staff were able todiscuss how they worked with people using the service in ways that encouragedpeople to maintain their independence and retain or develop skills in daily living. Staffencouraged people to manage household tasks. We observed very good relationshipsbetween staff and service users during the inspection.

Staff supported people using the service to attend a range of activities to improvetheir well-being. These included contacts with family and friends, shopping, day tripsand supporting people to attend specific events. People we spoke to said they chose



to use the support in ways they wanted. They thought that if they did not wantsupport they could ask the worker to leave.

Staff helped people arrange holidays. We spoke to people using the service whothought this was an important part of the service. Staff helped them plan for the tripand book it through the internet.

Staff listened to the views of people using the service. They tried to present serviceusers' views to other health professionals so they got the service they wanted. Wesaw how the staff debated the rights of the individual to have a service provided howthey wanted it, considered the views of other professionals and family and supportedthe person as best they could. We thought this was good practice.

Areas for improvementDuring feedback we discussed how the ways risk assessments were recorded did notreflect the risks people using the service were taking. We discussed different ways theservice could record risks. These would demonstrate the work being done to involvethe person in understanding the risks and devising ways of managing these (seerecommendation 1)

We were told that, while the 'Hope Toolkit' helped people set targets for themselves,the picture representation of the changes each person had made was difficult tounderstand. The service could consider other ways to present this information.

The service had carried out reviews of the support plans annually. The service needsto carry out formal reviews every six months. The Manager agreed to put this intoplace. The 'Hope toolkit' is reviewed within this time frame. The service couldconsider how to use these reviews in the formal process (see requirement 1).

At the last inspection we recommended people using the service had clearinformation about what they paid towards the costs of activities. This has nothappened. The recommendation is repeated (see recommendation 2).

A key worker system is used to ensure records are kept up to date. Support to eachperson however can be provided by any member of the staff team. While this systemappears to have worked the service could consider whether, in the light of thechanges that have taken place, it needs to plan work differently to meet the needs ofthe service and the people using it.






Requirements

1. The provider must complete formal reviews of personal plans with people using theservice at least every six months.

This is to comply with SSI 2011/210 5(2)(b)(iii) - a provider must review thepersonal plan at least once in every six month period.

Timescale: within three months of receiving this report.

Recommendations

1. The service should ensure that risks which apply to the person using the serviceare recorded in ways that help people understand the risks in their lives andpromotes ways to help people manage these. People should be involved indetermining the risks. National Care Standards, Housing Support Services, Standard3 - Management and staffing arrangements and Standard 4 - Housing supportplanning.

2. The service should review the information pack to ensure that financialarrangements and costs relating to support including activities are clearly set out.National Care standards, Housing Support Services, Standard 1 - Informing anddeciding.

Statement 4We use a range of communication methods to ensure we meet the needs of serviceusers.

Service strengthsThe service provided a 'welcome pack' to people applying to it. This pack included:* a statement of aims and objectives and the kinds of service on offer* copies of support plans and 'Hope Toolkit'.* the service users' charter* an 'easy read guide' to the mental health act* a copy of the service contract* a service leaflet.* the complaints policy and leafletThis helped people decide if the service could provide what they needed.

The service provided information for people to ensure they understood they had theright to change service provider if they wished. When this happened we were toldhow the service supported people to do this.

We spoke to people using the service. They told us how they would make a complaintand who they would speak to if they had the need to. They said they would contactthe Manager if they thought that was necessary.



We saw evidence that people using the service were asked to complete 'AdvanceStatements'. This statement is used when a person with a mental health problembecomes ill and not able to say what kind of medical treatment they would want.Staff arranged for an advocate to help complete the statement when needed.Advocates are workers separate from the support service. They make sure peoples'wishes are made clear.

Each person had a support plan. Communication needs were recorded. Staff told ushow they changed the ways they worked with people to meet that persons needs.This might include communicating in writing or in pictures. They would use aninterpreter when this was needed. Staff said they got to know people well. The peoplewe spoke to agreed with this. The SCSWIS questionnaires that were returned allstated people 'strongly agreed' or 'agreed' that 'staff have the skills to support me'.

Staff spoke to each other daily and also used a communication book to pass oninformation and to ensure appointments people had were recorded.

The Manager sent out a letter to inform people using the service when inspectionreports were available and where they could see a copy.

Areas for improvementThe service should consider how staff could be trained to meet the specificcommunication needs some people using the service have.

Grade awarded for this statement: 5 - Very Good





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

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

Service strengthsThe strengths in statement 1.1also apply here

People using the service we spoke to said they were able to discuss issues with thestaff that worked with them or felt they could contact the Manager.

When the Manager carried out reviews they did so without staff present. This meantpeople using the service were able to comment about staff in confidence. We sawevidence where people had raised concerns about staff and how the Managers haddealt with these issues.

People using the service were also asked their views about staff performance duringthe staff's six month probationary period. This allowed the Manager to address anyconcerns people using the service had.

People we spoke to said they knew how to complain and that they would do so ifnecessary.

Areas for improvementThe service should continue to develop opportunities for people using the service tobe involved in assessing and improving the quality of staffing.

We discussed how people using the service and their relatives could be involved ininterviews for new staff or developing the staff training programme (seerecommendation 1).




Recommendations

1. The service should develop opportunities for people using the service to be fullyinvolved in the recruitment of staff and developing the staff training programme.



National Care Standards, Housing Support Services, Standard 8 - Expressing YourViews.

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

Service strengthsThe service supported staff in a range of ways in their work.

These included:* Training* Regular support and supervision* Weekly team meetings

Training was identified in supervision sessions, or annually in the performancedevelopment review. Staff said they were able to ask for specific training related tothe work they did. This included training in mental health recovery, working withpeople who had suicidal thinking and the protection of vulnerable groups.

Training and development were recorded in personal development folders and trainingrecords. Staff spoke positively about support and supervision, saying that it helpedthem to reflect upon and develop their work. They said they were able to contact theManager at any time with specific concerns.

The service encouraged staff to undertake Scottish Vocational Qualifications (SVQs) atlevel 3, once they had completed their first year working for Penumbra. This meantstaff would have the necessary qualifications when they were required to registerwith the Scottish Social Services Council (SSSC).

Staff knew about the National Care Standards and SSSC Codes of Practice. Staff wereable to discuss the values they used to ensure the service met the needs of peopleusing it.

Staff said the organisation had kept them informed about possible changes to theorganisation. They said this had been important because of the anxieties caused byuncertainty about the future of the services. The organisation also issued a newsletterregularly to keep staff informed. A questionnaire for staff was issued annually.

Applicants for work go through a rigorous recruitment process. This involved aninterview, taking up references, one of whom is the most recent employer and aProtection of Vulnerable Groups (PVG) check. Staff did not start work in the serviceuntil checks were completed.

Staff said they were motivated and worked well as a team. They talked about how



they supported each other in their work with people using the service. This meant thesupport provided was very consistent. We asked people we visited if they thought theservice was consistent. They agreed that it was.

Areas for improvementWe were told that some staff had difficulties attending core and other training in theprevious twelve months. In part this seemed to be because of a vacancy in thetraining post and staff illness. This meant some training had been postponed. Stafftold us that dates for core training not yet attended had now been set. However itwas also clear that some staff had not been able to attend training they hadrequested. This was raised as an issue at the last inspection. We have made arecommendation (see recommendation 1).




Recommendations

1. The service should ensure staff receive the training they need to carry out the workthey are expected, to meet the needs of the people using the service. National CareStandards, Housing Support Services, Standard 3 - management and staffingarrangements.

Statement 4We ensure that everyone working in the service has an ethos of respect towardsservice users and each other.

Service strengthsThe people we spoke to said they thought the staff attitude was very good and thattheir views were listened to. They said staff were very respectful of them and therelationships they had. One person said that 'the staff are amazing'.Another described them as 'excellent'. Everyone thought the staff and the Managerwere very approachable.

The service brochure stated 'service users can expect to be treated with dignity andrespect by all members of staff'.

Staff said respect was embedded in the philosophy of the service. This was importantto ensure the service was able to offer positive support and understanding to peoplewith different mental health and other needs.

Staff and people using the service were able to have discussions in private wheneverrequired. All information was treated in confidence, although the reasons whyconfidentiality may have to be broken were discussed, for example, when a person



was at risk of serious harm.

Penumbra had a staff code of conduct. This stated 'all staff ...will conduct themselvesin a manner that supports the values of the organisation, is respectful of the rights ofservice users, carers, colleagues and external partners'. Staff we spoke to said respectwas a key aspect of their work and that this supported the ethos of the service. TheDignity at Work policy was also explicit in supporting the need for respect andinstructed staff to 'make a stand against any forms of harassment'.

Staff we saw in their work were respectful of the people they were supporting, wereattentive to them and listened to their views and opinions.

In the SCSWIS Care Standard Questionnaires returned to us six people 'stronglyagreed' and two people 'agreed' that 'staff treat me with respect'.

Areas for improvementStaff agreed the service had come through difficult times because of the problemswith funding and the uncertainty this had caused. They thought the organisation hadmanaged this with care but that at times more information would have been helpful.The organisation should consider how this is managed for future changes.

At the last inspection we made a recommendation about how the newsletters in theorganisation were circulated. While some progress had been made (see Action takenon recommendations outstanding section) the purpose - to keep all people using theservice informed about the organisation and changes - had not been. Therecommendation is repeated (see recommendation 1).




Recommendations

1. The provider should consider if the existing newsletters that are being producedmay be made available to people who use the service. The information provided inthis way may help people using the service to become more aware of the strategicdevelopment and organisational aims. National Care Standards, Housing SupportServices, Standard 3 - Management and staffing arrangements.



Quality Theme 4: Quality of Management and Leadership - NOTASSESSED



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, includingany agreed extension, where requirements and recommendations have been made,will result in SCSWIS re-grading the Quality Statement within the Management andLeadership Theme as unsatisfactory (1). This will result in the Quality Theme forManagement and Leadership being re-graded as Unsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 4 - Good

Statement 1 4 - Good


Statement 4 5 - Very Good

Quality of Staffing - 4 - Good




Quality of Management and Leadership - Not Assessed

6 Inspection and grading history

Date Type Gradings

6 Nov 2009 Announced Care and support 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 5 - Very Good

22 Dec 2008 Announced Care and support 5 - Very GoodStaffing 5 - Very GoodManagement and Leadership 6 - Excellent

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



Documents

Penumbra - Edinburgh Supported Living Service West