Bellshill Home Support Service
Housing Support Service
303 Main Street
Bellshill
ML4 1AW
Telephone: 01698 346666
Type of inspection: Unannounced
Inspection completed on: 1 June 2017
Service provided by:
North Lanarkshire Council
Care service number:
CS2004071279
Service provider number:
SP2003000237
Inspection report
About the service
North Lanarkshire Council provides Bellshill Home Support Service - home support and housing support. The
service was previously registered with the Care Commission and transferred its registration to the Care
Inspectorate on April 2011.
North Lanarkshire Council recognise that there has been a steady increase of people with complex health and
care needs, who are choosing to remain in their own homes. Therefore, a few years ago they introduced a
redesign of their care at home support with the aim of providing flexible person-centred support, which is
adapted to the service user's needs thereby, enabling people to remain in their own homes and prevent
admission to hospital or to care homes. Home care is delivered by three teams: Intensive, Reablement and
Mainstream. The intensive team focus on providing flexible, intensive home support for a limited period of time
rather than as a long-term support package for instance, providing end of life care. The reablement team provide
a rehabilitation programme which focusses on maximizing people's independence, following an illness or stay in
hospital. Whilst the mainstream team delivers the vast majority of home support.
This service is supported by the Community Alarm Service which operates on a twenty-four hour basis from
Merrystone in Coatbridge alongside North Lanarkshire Council's Social Work Emergency Services Team and
Housing.
The service provider employs approximately two hundred staff who deliver the care service to approximately five
hundred service users in their own homes. The aim of the service is to 'provide a support service to older people
and younger adults in their own homes' as stated by the provider.
What people told us
We sent two hundred and fifty questionnaires to service users and their carer and families and ninety were
completed and returned. People expressed high levels of satisfaction with the service.
Some of the comments received were:'All staff meeting my needs and very competent'.
'The carers are brilliant'.
'The girls who look after me could not be better... there is a lot of laughter'.
'The service provided from the start has been absolutely first class'.
'Agree that workers provide my service but homecare office don't agree with when. 'Support...don't know which
support staff are working. Communication is not great with office'.
'My carers and myself feel under pressure to get to the next client as there is no time given to drive or walk from
my home. It is especially hard if it is a carer who does not know your routine'.
'The service has been satisfactory'.
'I'm disappointed to lose the regular staff'.
'I cannot function without care and am very grateful as I know others are'.
'Either getting no letter for weeks planned or letter arriving half through week - all different carers. Can't arrange
to go out if I don't know when carer is coming'.
'The carers that come to my home. I know all of their names and they treat me with respect and the care that I
receive is above and beyond the remit'.
'We do not get notified with any changes to my care plan, we just get strange workers not known to be turn up
at my door and say out of hours changed my care plan. We find this totally unacceptable".
'Do not like when they change the carers as we have confidence in them'.
Inspection report for Bellshill Home Support Service
page 2 of 14
Inspection report
'When carers fail to arrive and you are not informed who will replace them'.
'All the carers for my mother are very good'.
'More than happy with the care provided...appreciates the continuity of carers who know her and make her feel
happy and secure. Their degree of attention to her needs helps myself to cope with changing medical needs'.
'Staffing inconsistent. Visiting time and duration inconsistent. Always feels a bit rushed'.
'Carers have been great in attendance and help issues'.
'The only think about the last year is the times carers were in, to late for her needs'.
'My mother told me she is really happy with the service provided and all carers are really friendly and talkative to
her'.
'The care my mother-in-law receives is excellent. We couldn't ask for more. The girls are kind, considerate and
go above and beyond what is expected of them. The only concern I have is that every so often the team changes
and we have to get to know everyone again'.
'There is a lack of consistency in the care'.
'Not informed when carer or time changes'.
'When started receiving care the times and the different carers visiting was not acceptable to my relatives needs.
We now have a set programme of times and teams calling each day so we are much happier with the service'.
'They could do with more training to do with bowel problems and signs to look for'.
'I strongly disagree with the way my times are changed without notifying me first, also some of the carers come
in to me at a time that suits them, not me'.
'On occasions carer has been very late and on one occasion never turned up. We were not informed... the lack of
communication is not acceptable'.
Self assessment
The Care Inspectorate did not request a self-assessment for this inspection year.
From this inspection we graded this service as:
Quality of care and support
Quality of staffing
Quality of management and leadership
4 - Good
4 - Good
4 - Good
Quality of care and support
Findings from the inspection
At this inspection we found that the service was performing at a good level for this theme.
The service offers personal care support and housing support to service users in the Bellshill Locality, enabling
people to remain as independent within their own homes. Service users receive support with a range of personal
care tasks, shopping and some domestic duties. The service provides home support in the form of a reablement
team, intensive team and mainstream support with support times varying depending on the individual's needs.
The reablement team provide a rehabilitation programme which focusses on maximizing people's independence
following an illness or stay in hospital, whilst the intensive team offer short interventions which include palliative
care. It was clear that these intervention are improving outcomes for service users such as independence and
increased levels of confidence.
Inspection report for Bellshill Home Support Service
page 3 of 14
Inspection report
The service has very good links with other social care and health resources and they will refer on as appropriate
and work in partnership with these other agencies, to improve the health and wellbeing outcomes for the
individuals involved.
During the inspection we shadowed a number of support workers in the community. They demonstrated a strong
value base aimed at upholding dignity and respect in service user homes. Service users were encouraged to
maintain safety levels during mobilising, wearing clean glasses, footwear and wearing the alert alarm pendant.
Staff showed good knowledge of service user's needs and preferences however, this was not always consistent
with information contained in the care plans. Whilst we saw an improvement in the care plans we did observe
some discrepancies therefore care plans continue to require improvement (see previous requirements 1, 2, 3 and
5 for further information). Care reviews are not being carried out in line with legislative requirements therefore,
the management need to develop a strategy to ensure that meaningful and holistic reviews are carried out at
least every six months (see outstanding requirement 1 for further information).
At the last inspection we emphasised the urgency for the provider to review and implement the medication
policy and procedure to ensure that staff are clear about assessment, the role in supporting people at the
appropriate levels of need and to improve record keeping. The provider has kept the Care Inspector abreast of the
progress made. However, in the absence of a policy and procedure there continues to be medication errors and a
lack of clarity to enable carers, to safely support with medication needs in-line with good practice (see
requirement 6 and recommendation 1 and 2 for further information).
The service has developed a number of methods to liaise with service users and their families and involve them
in assessing the quality of the overall service. The feedback from the annual survey highlight good levels of
satisfaction and this is consistent with the information received from the Care Inspectorate questionnaires and
discussions during the inspection. Service users and carers/family, offered positive feedback for the home
support workers role in improving their quality of life. However, scheduling letters continue to provide wrong
information (see 2016 report for further information). This causes anxiety for service users and impacts on their
experience of safety within their own home. This practice is not upholding the individual's dignity in their own
homes . This continues to need improvement (see outstanding requirement 7).
The service is supported by the Community Alarm Service which operates on a twenty-four hour basis from
Merrystone in Coatbridge alongside North Lanarkshire Council's Social Work Emergency Services Team and
Housing.
Requirements
Number of requirements: 0
Recommendations
Number of recommendations: 0
Grade: 4 - good
Quality of staffing
Inspection report for Bellshill Home Support Service
page 4 of 14
Inspection report
Findings from the inspection
At this inspection we found that the service was performing at a good level for this theme.
During the inspection we shadowed a number of support workers in the community and at their team meetings.
They demonstrated a strong value base, aim to maintain or improve the health and wellbeing of service users in
their own homes. From the feedback in questionnaires and interviews we were able to conclude that staff are
motivated to deliver a quality service that seeks to uphold individuals human rights. Staff indicated that they felt
supported by management however, they expressed a desire to have increased opportunities to communicate
with colleagues. Also, staff are not being offered supervision in-line with the providers policy and procedures or
good practice guidelines.
At the last inspection we highlighted the need for the provider to facilitate for staff to access essential training to
enable them to competently carry out their duties. During this inspection we found that this continues to need
improvement, particularly in relation to public protection training, dementia training and training on other health
issues. The service needs to ensure that staff are trained in-line with the national dementia strategy: Promoting
Excellence in Dementia Care. Last year we observed that the learning and development department had provided
information, to help the service access alternative training forums such as health agencies or on-line
programmes. However, we saw little to no evidence that these options have enable staff to access training.
The provider and management need to the develop the strategy and procedures to ensure that they are able to
demonstrate that staff are competent to carry out their duties, which will result in improved outcomes for service
users and their carers/relatives.
We would encourage the management to improve and develop administrative roles and processes to increase
the capacity of the home support managers to carry out their own responsibilities and competing demands. This
is essential in order to generate the time necessary for home support managers, to address the repeated
requirements from previous inspections.
Requirements
Number of requirements: 0
Recommendations
Number of recommendations: 0
Grade: 4 - good
Quality of management and leadership
Findings from the inspection
At this inspection we found that the service was performing at a good level for this theme. The manager and
management team are seeking to address the areas of improvement in order to improve outcomes as
experienced by the service users.
Inspection report for Bellshill Home Support Service
page 5 of 14
Inspection report
The management continue to attend and inform a variety of social care and health forums as a means of
keeping abreast of changes in legislation, care practice, national policy and organisational changes. We
encouraged the management to develop links with a number of other bodies such as the police and the Scottish
Social Service Council to ensure that advise is sought where necessary.
We examined the complaints and accidents and incident records and found improvement could be made to
ensure that service users are protected and lessons learned where possible. Notifications to the care inspectorate
are not being submitted in line with the Notifications Guidelines.
The management should continue to demand an improvement in the quality of care plans to ensure that they
are accurate, person centred and contain all relevant and signed documents such as agreements, consent to
share, risk assessments and reviews. In terms of reviews, we recommended that staff are provided with clearer
guidelines of how to record salient information with an evaluation. We suggested to the management that they
develop a strategy and procedure for ensuring that reviews are undertaken in line with legislation and providing
procedural guidance to staff.
The service should continue to work towards ensuring that areas for improvement identified through the
auditing process are actioned to demonstrate a positive outcome for service users. Where action is needed or a
training need is identified there should be a clear action plan showing the person responsible, agreed timescale,
review of competency and sanctions of failure to rectify to ensure that areas for improvement are progressed.
Whilst some improvements have been made since our last inspection, the service would benefit from fulfilling
our recommendations made at previous inspections to a higher standard and be fully embedded within the
service to raise the quality of service provided.
Requirements
Number of requirements: 0
Recommendations
Number of recommendations: 0
Grade: 4 - good
Inspection report for Bellshill Home Support Service
page 6 of 14
Inspection report
What the service has done to meet any requirements we made at
or since the last inspection
Previous requirements
Requirement 1
The provider must ensure that at least once in every six month period, personal plans are reviewed, in order to
ensure that the service is able to meet individual care and support needs. The support plans must be updated to
reflect any changes and inform current planning of care and support.
This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care
Services) Regulations 2011 (SSI 2011/210) Regulation 5 (2)(b)(iii) Personal Plans.
Timescale for implementation: to commence upon receipt of this report and be completed within six months and
remain on going every six months thereafter.
This requirement was made on 5 November 2014.
Action taken on previous requirement
The service has developed systems to improve the monitoring off review dates, which enables the manager and
team leader to identify review deadlines and prioritize workloads. The provider needs to review the capacity of
the home support manager caseload and responsibilities to increase the opportunities for them to undertake
reviews regularly. Home support managers need further guidance on conducted and documenting reviews.
Not met
Requirement 2
The service provider must ensure that service users' personal plans set out how the health, welfare and safety
needs of individuals are to be met in order to do this the service must ensure that the personal plans:
- Accurately reflect the current needs of the individual and how the service plans to meet these needs.
- Include details of care and support that is up to date and regularly evaluated demonstrating consultation
with the service user/relative.
- Reflect an accurate meaningful account of the support provided by staff and activities undertaken involving
the service user.
- Demonstrate the use of appropriate risk assessment documentation which provides the outcomes of these
and are used to inform support planning .
- Evidence that consideration has been given to Adults With Incapacity (Scotland) Act 2000.
This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care
Services) Regulations 2011(SSI 2011/210) Regulation 5(1) Personal plans.
Timescale within six months upon receipt of this report and on going thereafter.
This requirement was made on 5 November 2014.
Inspection report for Bellshill Home Support Service
page 7 of 14
Inspection report
Action taken on previous requirement
We found a range in the quality of personal plans that we looked at in service user's homes. We saw some real
improvements in a number of plans however, improvements are still needed in ensuring plans are compiled
within 28 days of the service starting and that the careplan is delivered to the service users.
We saw that contract agreements and consent to share were largely signed and dated. We saw some evidence of
risk assessments and would encourage the service to ensure that this level of documentation continues and
becomes embedded in practice. However, some personal plans did not reflect current needs or did not include
essential information about the personal care needs.
The careplan has a dedicated section for clarifying medication needs and level of need however, this does not
provide sufficient information. As a matter of priority, the service needs to improve how it safely supports people
in the community with their medication (including tablets, liquids, topical creams and patches).
Improvements are needed in assessment, documentation of needs and the recording of support given.
Were advised that the medication policy is likely to be available by August 2017.
We would also encourage the manager to continue in her endeavors to improve the quality of personal plans and
demand a greater level of scrutiny to ensure that the information contained in personal plans is accurate,
reflects current needs and reflects consideration to other legislation (including Adults With Incapacity Act (2000)
and Data Protection Act (1998), the National Care Standards and good practice guidelines.
Not met
Requirement 3
The provider must ensure that when a service user has a specific health need, for example, diabetes or dementia
and associated challenging behaviour, that this is recorded in the personal plan and that a support plan to guide
staff in relation to best practice is in place.
This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services)
Regulations 2011 (SSI2011/210), Regulation 4 (1) (a)
This requirement was made on 5 November 2014.
Action taken on previous requirement
It was our observations during the inspection that specific information relating to particular health conditions
was not recorded in care plans. For instance, where the person had epilepsy this was not clear in the care plan
and the support need and preferences was not documented. This needs further improvement therefore this
requirement will be repeated.
Not met
Requirement 4
The provider must review the way in which staff training is managed within this service, as part of this they
must:
- Carry out a training needs analysis which enables them to identify what training staff need.
- Develop an action plan with timescales indicating when training will take place.
- Through supervision, evidence that the outcome of training is being considered as part of assessment of
Inspection report for Bellshill Home Support Service
page 8 of 14
Inspection report
staff competence and that ongoing learning is being addressed.
This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services)
Regulations 2011 (SSI2011/210), regulation 15 (a).
Timescale: Within six months of receipt of this report.
This requirement was made on 10 November 2015.
Action taken on previous requirement
The service has a training matrix however the training detailed is largely historical. We were able to see that staff
had requested training via supervision however, this had never been sourced. The training in adult protection is
dated as 2009 therefore we encouraged the service to deliver refresher training and consider how to deliver child
protection training. There is little evidence of training related to specific health and care needs such as dementia
care, palliative care and substance misuse.
We would encourage the provider to support the locality in delivering the required training to ensure that staff
have the necessary knowledge and skills to undertake their duties.
Not met
Requirement 5
We made the following requirement as a result of a complaint investigation.
The provider must ensure that a review of a service user's personal plan is carried out when there has been a
significant change in their health, welfare or safety needs and at least once in every six month period while they
are in receipt of the service; and notify the Care Inspectorate of arrangements made to ensure compliance with
this requirement.
This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - Welfare of users, 5(2)(b)(c)(d) - Personal plans.
This requirement was made on 10 November 2015.
Action taken on previous requirement
During the inspection we visited service users and found that where there had been a significant change in their
health, welfare or safety needs of the service user that some reviews had been held and the care plans had not
been updated. See requirement 1.
Not met
Requirement 6
The Provider must ensure that medications are managed in a manner to protect the health and welfare of
service users. In order to achieve this, the Provider must:
a) Ensure that staff are made aware of up to date guidance on medication management.
b) Ensure that staff implement best practice in relation to medication management.
c) Ensure that personal plans record the assessment of need and level of support to be provided.
Inspection report for Bellshill Home Support Service
page 9 of 14
Inspection report
This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care
Services)Regulation 2011 (SSI 2011/210) 4(1) (a) - Health and Wellbeing.
National Care Standards, Care Homes for Older People - Standard 15 Keeping well - medication.
The handling of medicines in social care.
https://www.rpharms.com/social-care.../the-handling-of-medicines-in-soc
Prompting, assisting and administration of medication in a care setting: guidance for professionals.
http://hub.careinspectorate.com/
Timescale for meeting this requirement: immediately
This requirement was made on 27 September 2016.
Action taken on previous requirement
The provider is in the final stages of agreeing and implementing the Medication Policy. It was our observation
that this needs to implemented without any further delay in order to ensure that service users are safely
supported in the community. All staff need training to ensure that they implement best practice in relation to
medication management.
Not met
Requirement 7
The Provider must ensure that the service provides accurate information of planned support to service users in
manner which respects the privacy and dignity of service users.
This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care
Services) Regulations 2011(SSI 2011/210) Regulation 4 Welfare of Users and Regulation 5 Personal Plans.
Timescale within six months upon receipt of this report and on going thereafter.
This requirement was made on 27 September 2016.
Action taken on previous requirement
Service users advised that they continue to receive letters that contain inaccurate information of planned
support. Some people indicated that they have received a telephone call or additional letter where changes are
made whilst others indicate that there is no further information. A number of service users and
relatives highlighted the anxiety that this can cause particularly for individuals with cognitive impairment or
mental health problems.
Not met
Inspection report for Bellshill Home Support Service
page 10 of 14
Inspection report
What the service has done to meet any recommendations we
made at or since the last inspection
Previous recommendations
Recommendation 1
The service should continue to address medication errors by offering staff clarity in relation to what is expected
of them when assisting service users with medication. This should be clearly recorded in each individuals care
plan. This should be in-line with current guidance in this area.
National Care Stardards Care at Home standard 8.2 Keeping Well - Medication.
This recommendation was made on 16 February 2017.
Action taken on previous recommendation
The service continues to monitor medication errors however they are unable to offer true clarity to staff in
relation to what is expected of them until the medication policy has been implemented and staff have received
appropriate training of best practice in medication management (see requirement 6).
NOT MET
Recommendation 2
The service must provide staff with a complete and up-to-date Medication Policy and Procedure to offer clear,
practical and up-to-date guidance in this area.
National Care Standards Care at Home standard 8.3 Keeping Well - Medication.
This recommendation was made on 16 February 2017.
Action taken on previous recommendation
The medication policy and procedure has yet to be implemented. See Requirement 6.
NOT MET
Complaints
There has been one complaint that was upheld by the Care Inspectorate. Please see Care Inspectorate website
(www.careinspectorate.com) for details of complaints about the service which have been upheld.
Inspection report for Bellshill Home Support Service
page 11 of 14
Inspection report
Enforcement
No enforcement action has been taken against this care service since the last inspection.
Inspection and grading history
Date
Type
Gradings
18 Aug 2016
Unannounced
Care and support
Environment
Staffing
Management and leadership
3 - Adequate
Not assessed
4 - Good
4 - Good
10 Sep 2015
Unannounced
Care and support
Environment
Staffing
Management and leadership
3 - Adequate
Not assessed
3 - Adequate
3 - Adequate
5 Nov 2014
Unannounced
Care and support
Environment
Staffing
Management and leadership
4 - Good
Not assessed
4 - Good
4 - Good
5 Jul 2013
Unannounced
Care and support
Environment
Staffing
Management and leadership
3 - Adequate
Not assessed
3 - Adequate
3 - Adequate
27 Jul 2012
Unannounced
Care and support
Environment
Staffing
Management and leadership
4 - Good
Not assessed
4 - Good
4 - Good
19 Nov 2010
Announced
Care and support
Environment
Staffing
Management and leadership
4 - Good
Not assessed
Not assessed
Not assessed
16 Dec 2009
Announced
Care and support
Environment
4 - Good
Not assessed
Inspection report for Bellshill Home Support Service
page 12 of 14
Inspection report
Date
3 Feb 2009
Type
Announced
Gradings
Staffing
Management and leadership
4 - Good
4 - Good
Care and support
Environment
Staffing
Management and leadership
3 - Adequate
Not assessed
3 - Adequate
3 - Adequate
Inspection report for Bellshill Home Support Service
page 13 of 14
Inspection report
To find out more
This inspection report is published by the Care Inspectorate. You can download this report and others from our
website.
Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award
grades and help services to improve. We also investigate complaints about care services and can 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.
You can also read more about our work online at www.careinspectorate.com
Contact us
Care Inspectorate
Compass House
11 Riverside Drive
Dundee
DD1 4NY
[email protected]
0345 600 9527
Find us on Facebook
Twitter: @careinspect
Other languages and formats
This report is available in other languages and formats on request.
Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas.
Inspection report for Bellshill Home Support Service
page 14 of 14