InspectionReport 316152

Br
Brot
others
hers of Charit
CharityyS
Ser
ervices
vices (S
(Scot
cotland)
land) -
Toget
ogether
her Bor
Borders
ders - Ar
Area
ea Thr
Three
ee
Housing Support Service
Triest House
Bridge Street
Galashiels
TD1 1SW
Telephone: 01896 661 200
Type of inspection:
Announced (short notice)
Completed on:
10 July 2023
Service provided by: Service provider number:

Brothers of Charity Services (Scotland) SP2008010095
Service no:
CS2008192059
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About the service

Brothers of Charity Services (Scotland) has recently reviewed their structure to clearly identify two
geographical areas of support as follows:
Supported Living Community of Care:

For individuals to experience maximum independence, health and wellbeing, and inclusion in their own
homes and local community.
Campus of Care:
Care Home, respite, and complex care services:
For individuals who have a learning disability and significant health needs. The service also provides short
breaks.
Brothers of Charity Services (Scotland) - Together Borders - Area Three covers support to adults with
learning disability and complex care within their Campus of Care service at Gattonside in the Scottish
Borders.
The organisation's headquarters is in the central Borders town of Galashiels.
'We provide care and support for adults, to enable them to flourish, live more independent lives and fulfil
their potential.'
About the inspection

This was a short notice announced inspection which took place on 22 June 2023 between 09:00 and 16:30;
26 June 2023 between 09:30 and 16:00; 27 June between 09:00 and 13:30 and 4 July between 09:00 and
13:00.
The inspection was carried out by two inspectors from the Care Inspectorate. Our visits were then followed
by time examining evidence remotely and having discussions via phone with relatives, staff and other
agencies involved with the service.
To prepare for the inspection we reviewed information about the service. This included previous inspection
findings, registration information, information submitted by the service and intelligence gathered since the
last inspection.
In making our evaluations of the service we:

• spoke with or met 31 people using the service and 10 of their family
• spoke with or had correspondence from 63 staff and management
• observed practice and daily life
• reviewed documents
• spoke with visiting professionals.
Inspection report for Brothers of Charity Services (Scotland) - Together Borders - Area Three
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Key messages
• Recruitment challenges throughout the health and social care sector alongside retention
challenges, meant there was a high number of new staff being inducted quickly to ensure people's
needs were being met.
• Most families praised how well their relative was supported and were very happy with staff who
knew people well. Some families were concerned at the number of new staff who did not know
their loved one and their support needs.
• People we met were being well supported however, staff shortages had an impact in what people
could achieve in their day.
• Some people were missing out on important exercise which should be part of their daily routine.
• Most staff were kind, respectful, caring and knew people well.
• Out of date information within care and support plans meant new or agency staff did not have the
most up to date information to guide them.
• There has been a lack of management oversight leading to risks or potential risks for people.
From this inspection we evaluated this service as:

In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent
How well do we support people's wellbeing? 2 - Weak
How good is our leadership? 2 - Weak
How good is our staff team? 2 - Weak
How well is our care and support planned? 2 - Weak
Further details on the particular areas inspected are provided at the end of this report.
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We made an evaluation of weak for this key question. Whilst we identified some strengths, significant
weaknesses compromised these. Because these weaknesses concerned the welfare and safety of people, we
made two areas for improvement (AFI).
People being supported were relaxed in the company of staff they knew well, who were kind and caring.
Relatives were very complimentary of staff who knew their loved ones and their needs.
One relative told us: ''X is definitely treated with dignity, respect and compassion by all the staff who work
closely with X'. Whilst another relative told us: ''staff are wonderful but as soon as there is a change, it's
disruptive'.
The service had worked hard to retain skilled and experienced staff and had development plans in place to
build on this. However, we were concerned recent inconsistencies in staffing meant some people's
confidence suffered, causing them distress due to last minute changes or unknown people supporting them.
Where there was some stability, people were getting out and enjoying various daily experiences or particular
events and were being supported well. However, too many people were being affected by instability of
staffing leading to a poor quality of daily life. We have repeated a previous are for improvement for staffing
levels (AFI 1).
Although staff may know people well, we were concerned of some poor practices being embedded and this
led to poor outcomes for people. We spoke with the provider about a culture making it hard for people to
report poor practice, or staff failing to recognise the impact this had on people's wellbeing and dignity
leading to supported people being at risk of unsafe care and support. See key question 3 'How good is our
staff team'.
People were supported well to attend any health appointments and any changes to their health needs were
recorded within individual communication diaries, however, not all Individual Support Plans (ISP) were kept
up to date. This meant that important information could be missed by new staff. We have made a
requirement to improve ISP's in key question 5 'How well is our care and support planned'. One person had
specific guidance for support to use equipment for exercise and to maintain their mobility. This was not
being followed as frequently as instructed so their wellbeing was at risk of being compromised.
Staff sought guidance from health professionals where they had concerns about someone's wellbeing,
however, a relative told us there had been a delay seeking a referral for an injury to their loved one. Some
staff did not have a clear understanding of the clinical risks to people's health and wellbeing, which had led
to adult protection concerns being raised. We have made a requirement to improve management oversight
of incidents and accidents in key question 2 'How good is our leadership'.
Medication administration was being recorded and audited by staff teams however, there was no
management oversight of this to ensure medication administration was being followed well.
See key question 2 'How good is our Leadership'.
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Information guidance in relation to as required (PRN) medication was mixed. Some people had good
guidance for signs to be aware of if someone required PRN medication yet other people had limited
information. This meant there were risks that new or agency staff would miss opportunities to support
people well. We have repeated a previous area for improvement for medication (AFI 2)
The provider had recently recruited new managers and senior staff into post and they were working hard to
manage the issues we raised to ensure people's health and wellbeing was made safe. We will carry out a
follow up inspection to ensure these are being implemented and sustained.
Areas for improvement
1.
To support people's health and wellbeing needs being met, the provider should ensure staffing levels are
sufficient to meet people's assessed level of support.
This should include, but is not limited to:
• there is a clear record of the number of staff required to meet people's needs and this is updated as
needs change
• consistency of staff support for people is prioritised
• people are supported to become familiar with any new staff within their team prior to any lone
working.
This is to ensure that care and support is consistent with Health and Social Care
Standards (HSCS) which state that: 'I can build a trusting relationship with the person supporting and caring
for me in a way we both feel comfortable with' (HSCS 3.8) and
'My needs are met by the right number of people' (HSCS 3.15).
2.
For people to be confident their medication regime is being managed safely, the provider should ensure:
• staff have information to support them to monitor supported people's medication and the specific
condition the medication is prescribed for
• staff understand their role in, and accountability for monitoring medication
• when regular medication is not given or taken, staff record the reason why, along with any further
action taken, including the outcomes for the person and ensure all paperwork is signed and dated
• any 'as required' medication (PRN) has sufficient information to guide staff prior to administration
• when 'as required' (PRN) medication is given, an outcome is recorded
• management have oversight of medication and review of audits.
This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which
state that: 'I experience high quality care and support based on relevant evidence, guidance and best
practice' (HSCS 4.11) and 'I experience high quality care and support because people have the necessary
information and resources' (HSCS 4.27).
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weaknesses compromised these. As these weaknesses concerned the welfare and safety of people, we made
two requirements and two areas for improvement.
The organisation had recently restructured following their own self evaluation, resulting in the need to
improve to ensure their services were fit for the future. Senior management acknowledged they had not
communicated this well and it had resulted in a loss of confidence among the staff team about the direction
of the service. The provider had made improvements to rectify communication with supported people, staff
and relatives. This will ensure clarity and reassurance to enable people to feel confident, contribute to and
be part of implementing continual improvements. We made a new area for improvement (AFI 1).
The organisation had not been following safe recruitment practices routinely. The provider
recognised this and had implemented processes to ensure all required paperwork was in place as per Care
Inspectorate Safer Recruitment Guidance.
Quality assurance systems were not being followed. This meant there was no management oversight of the
services being provided leading not just to risks of people's health and wellbeing but also risks to the
organisation overall. We made a new requirement in relation to quality assurance (requirement 1)
Some recent notifiable events had not been submitted to the Care Inspectorate and we were not confident
that incidents, accidents or complaints reported where being monitored.
We made a new requirement in relation to notifications (Requirement 2) and a new area for improvement in
relation to complaints (AFI 2)
A new management team was now in post and it was reassuring to hear some staff say they had visited
services to start to build relationships.
Requirements
1.
By 30 November 2023 the provider must ensure effective management oversight of the service is in place
with strong leadership and enhanced quality assurance measures to drive sustained improvement.
In order to achieve this, the service provider must, at a minimum, ensure:
• quality assurance systems effectively enable areas for improvement to be promptly and accurately
identified
• the outcomes, as a result of any audit, are clearly recorded
• where areas for improvement are identified, an action plan is developed detailing timescales and
the person responsible
• systems to monitor whether documentation provides accurate accounts of service provision, quality
assurance and is fit-for-purpose are developed and implemented
• all current quality assurance arrangements are reviewed and developed to ensure these are
systematic, effective and integral to service provision
• ensure staff who undertake quality assurance roles are trained and supported.
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This is in order to comply with Regulation 4 (1) (a) of The Social Care and Social Work Improvement Scotland
(Requirements for Care Services) Regulations 2011 (SSI 2011/210).
state that: 'I benefit from a culture of continuous improvement, with the organisation having robust and
transparent quality assurance processes' (HSCS 4.19).
2. By 30 November 2023 the provider must ensure that all relevant accidents and incidents are notified to
the Care Inspectorate in line with "Records that all registered services (except childminding) must keep and
guidance on notification reporting".
In order to achieve this, the service provider must, at a minimum, ensure:
• notifications are reported in a timely manner

• all relevant staff responsible for providing such notifications have their knowledge evaluated to
ensure compliance
• all staff's understanding of Adult Support and Protection concerns are evaluated to ensure
knowledge and compliance.
This is in order to comply with Regulation 4 (1) (a) of The Social Care and Social Work Improvement Scotland
state that: 'I benefit from a culture of continuous improvement, with the organisation having robust and
transparent quality assurance processes' (HSCS 4.19).
1.
To enable improved communications, the provider and management teams should hold regular team
meetings to:
• share and embed best practice within staff culture

• provide information to staff on internal procedures
• facilitate staff discussions and involvement
• ensure external communications are clear and consistent.
state that: 'I have confidence in people because they are trained, competent and skilled, are able to reflect
on their practice and follow their professional and organisational codes' (HSCS 3.14).
2.
To ensure people have confidence that concerns or complaints are taken seriously the provider should
ensure that complaints systems effectively address issues raised which could impact on the health and
welfare of people.
This should include but not be limited to:
• ensure any concerns raised internally or externally are recorded and responded to in an appropriate
and timely manner
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• ensure there is a robust action plan in place for all staff to follow when concerns are raised
• ensure staff are aware of how best to support someone if they wish to raise a concern
• ensure staff are aware of how to monitor any agreed actions following the outcome of a concern
• audit complaints and expressions of dissatisfaction to identify any trends and allow for continuous
improvements.
This is to ensure that care and support is consistent with Health and Social Care Standard (HSCS) which
state that: 'I benefit from a culture of continuous improvement, with the organisation having comprehensive
and transparent quality assurance processes' (HSCS 4.19) and 'I know how, and can be helped, to make a
complaint or raise a concern about my care and support' (HSCS 4.20).

two areas for improvement.
Training records evidenced most staff were not up to date with mandatory training which is essential to
ensure the health and safety of people being supported.
There was no evidence of staff competency being checked which meant management had no oversight of
staff practices, consequently, people could not be reassured staff have the right knowledge, skills and
competence to support better outcomes.
A new training department was in place and had made good inroads to catch up with refresher training for
staff.
The organisation has a number of new staff recruited and needs to ensure induction training is robust and
effective. We have repeated a previous area for improvement in relation to training (AFI 1).
Staff supervision and team meetings were beginning to restart now there was a more stable management
team in place. These protected times are important for staff to have opportunities to reflect on their
practice, share knowledge and learn from each other. We made a new area for improvement (AFI 2)
We advised the provider to check all staff are registered as appropriate with the Scottish Social Service
Council.
1.
For people to have confidence they are being supported by skilled and knowledgeable staff, the provider
should ensure staff access training appropriate to their role, and apply their training in practice.
This should include, but is not limited to:
• training or refresher training in Adult Support and Protection

• medication administration
• support for new staff throughout probationary and induction period to ensure competence
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• senior staff and management training is reviewed to ensure all topics enable development into their
role
• competency observations of staff skills and practices.
2.
To ensure people experience high quality care, the provider must ensure arrangements for staff to reflect on
their practice through team meetings, observations of staff practice and regular supervision with their
manager are planned and sustainable.

a requirement for improvement.
It is essential staff have all the relevant information about each person to be able to deliver care and
support effectively. Individual Support Plans (ISPs) held a wealth of information about the person, however,
these had become bulky over the years and difficult to follow. ISPs were of varied quality across the service.
The onus was on support staff to update ISPs and where staff knew people well, their ISP or risk
assessments held some good guidance. However, for most people, their ISP had not been reviewed since our
last inspection and information was out of date. This meant there were risks to people's health and safety
when new or agency staff were supporting people. (Requirement 1)
The system used to update ISPs in people's homes and within the main office was dated and meant new
management did not necessarily have access to up to date information on people's needs and support
requirements
Some sections in the ISP which should detail legal representation were blank. Knowledge as to
whether each person had third party legal representation in place was not clear. This information is
important as there will be specific powers and/or welfare decisions which will impact on care and support
planning. We have given the manager further guidance from the mental welfare commission.
Requirements
1.
By 30 November 2023 the provider must ensure people will have confidence their Individual Support Plans
(ISP) are up to date and reflect their individual needs, intended outcomes and associated risks.
To achieve this the provider must ensure:
• ISP's are accurate, sufficiently detailed and reflect the care and support planned or provided
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• ISP's are updated in a timely manner when a person’s care and support needs change
• ISP's are regularly reviewed with people, and/or their family/friends/carers as appropriate, to
evaluate how accurately the plans reflect the needs of the person and how well the service is
meeting these needs
• following an assessment of risk, procedures developed to reduce risk and ensure safety are detailed
• where a person has third party legal representation this is clearly detailed
• all staff involved in planning and documenting care and support are provided with appropriate
training, time, and support for this
• demonstration that managers are involved in monitoring and the audit of ISPs.
This is in order to comply with Regulation 5 of The Social Care and Social Work Improvement Scotland
state that: 'My personal plan is right for me because it sets out how my needs will be met, as well as my
wishes and choices' (HSCS 1.15) and 'My needs, as agreed in my personal plan, are fully met, and my wishes
and choices are respected' (HSCS 1.23).
What the service has done to meet any areas for improvement we
made at or since the last inspection
Previous area for improvement 1
To ensure people experience a medication system that is safe, up to date, complete and accurate the service
should develop systems that:
- Staff have adequate information to support them to monitor supported people's medication and the
specific condition the medication is prescribed for.
- Staff understand their role in, and accountability for monitoring medication.
- Staff administer medicines in a way that recognises and respects people's dignity and privacy taking into
consideration the daily routine of the resident and the possible need for medication to be available
for administration out with set times. (PRN medication)
- Staff are supported with procedures detailing the home's medicines management systems, covert
medication and the principles of consent and confidentiality.
- Staff understand their responsibility to keep accurate and current records of medicines.
- There is a system in place for regular reviews of MAR charts to remove items no longer prescribed, used or
needed
- When regular medication is not given or taken that staff record the reason why along with any further
action that was taken including the outcomes of the action that is signed and dated.
This is to ensure care and support is consistent with the Health and Social Care Standards which state;
'Any treatment or intervention that I experience is safe and effective.' (HSCS 1.24)
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This area for improvement was made on 13 March 2020.
Action taken since then

A high number of staff were out of date with medication administration training. There was no management
oversight of any medication audits completed by staff.
This has been continued under a new areas for improvement (see key questions 1 and 3 of this report ) and
under a new requirement (see key question 2).
To ensure people experience care that is right for them, robust systems should be developed to ensure the
most current and up to date needs of that individual is documented and is regularly assessed and
monitored.
To do this the service should:

- Ensure that documentation and records are accurate, sufficiently detailed and reflect the care planned or
provided
- Demonstrate that staff follow policy and best practice about record-keeping and documentation.
- Ensure that staff know policy and best practice.
- Demonstrate that managers are involved in monitoring and the audit of records.
'My personal plan (sometimes referred to as a care plan) is r

Care and support plans were not up to date and there was no management oversight of these.
This has been continued under new requirements. See key questions 2 and 5 of this report.
To ensure people experience safe care and support where the management team have good monitoring and
quality assurance systems in place to identify concerns.
The service provider should develop methods to make certain.
- The system effectively enables areas for improvement to be promptly and accurately identified.
- That the outcomes because of any audit are clearly recorded.
- Where areas for improvement are identified that an action plan is developed detailing timescales and the
person responsible.
- Systems to monitor whether documentation provides accurate accounts of service provision, quality
assurance and is fit-for-purpose are developed and implemented.
- All current quality assurance arrangements are reviewed and developed to ensure that these are
systematic, effective, and integral to service provision.
'I benefit from a culture of continuous improvement, with the organisation having robust and transparent
quality assurance processes.' (HSCS 4.1)
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Quality assurance records were not being managed.
This has been continued under a new requirement. See key question 2 of this report.
The provider should ensure that there is a robust and flexible training programme in place for all staff.
In order to achieve this the manager should:
Ensure that all staff are kept abreast of the best way to safely support people
they are supporting.
The manager should continue to work with the learning and development team
to ensure the training schedule is flexible to accommodate changes in the
service needs.
The different departments of the service to work together and ensure that staff
can be made available to attend training and be supported to carry out their role
within the service in the best way for people experiencing care.
This is to ensure care and support is consistent with Health and Social Care
Standard 3.14: I have confidence in people because they are trained, competent and skilled, are able to
reflect on their practice and follow their professional and organisational codes.
This area for improvement was made on 8 September 2022.

A new training department was in place, however, a high number of staff were still to receive refresher or
new training.
This has been continued under a new area for improvement. See key question 3 of this report.
The provider must ensure that the level of staffing is adequate to provide the
assessed level of support to people at all times.
In order to achieve this the manager and provider should:
Ensure that all service users are assessed and that they have a clear and robust programme in place for the
number of staff required to meet people's needs and that this is reflective of any changes.
Ensure people are adequately supported and supervised to minimise risk.
The provider should continue with their recruitment drive to fill any remaining vacant posts.
This is to ensure care and support is consistent with Health and Social Care
Standard 3.15: My needs are met by the right number of people.
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Recruitment was continuing. People had not had their support reviewed.
The provider should ensure that when concerns are raised these are reacted to
appropriately.
In order to achieve this they should:
Ensure that any concerns are recorded and responded to in an appropriate

manner.
The service should ensure that there is a robust action plan in place for all staff
to follow when concerns are raised and ensure they are aware of how best to
support someone if they wish to raise a concern.
Ensure that any changes that have been made are monitored to ensure they
remain effective and any remedial actions taken if required.
Staff should be made aware of how to action any concerns they have with in the
service and how to monitor any agreed actions.
This is to ensure care and support is consistent with Health and Social Care Standard 4.20: I know how, and
can be helped, to make a complaint or raise a concern about my care and support.

There was no management oversight of concerns raised.
The manager should ensure that all servicer user's care and support plans are
reviewed and any identified changes are implemented immediately to make sure
people's needs are being met.
In order to achieve this the provider should:
Ensure there is a robust review programme in place that is meaningful to the people experiencing care.
Ensure this review programme is audited regularly to monitor its effectiveness and any changes required
made to ensure that regular meaningful reviews of people's needs continues to happen.
This is to ensure care and support is consistent with Health and Social Care Standard 1.12: I am fully involved
in assessing my emotional, psychological, social and physical needs at an early stage, regularly and when my
needs change.
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Care and support plans were not up to date and there was no management oversight of these.
This has been continued under new requirements. See key questions 2 and 5 of this report.
Complaints
Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the
service which have been upheld.
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Detailed evaluations
1.1 People experience compassion, dignity and respect 3 - Adequate
1.2 People get the most out of life 2 - Weak
1.3 People's health and wellbeing benefits from their care and support 2 - Weak
2.2 Quality assurance and improvement is led well 2 - Weak
3.2 Staff have the right knowledge, competence and development to care
2 - Weak
for and support people
5.1 Assessment and personal planning reflects people's outcomes and

2 - Weak
wishes
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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
enquiries@careinspectorate.com
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.
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Telephone: 01896 661 200

Service provided by: Service provider number:

About the service

Supported Living Community of Care:

The organisation's headquarters is in the central Borders town of Galashiels.

About the inspection

In making our evaluations of the service we:

From this inspection we evaluated this service as:

How well do we support people's wellbeing? 2 - Weak

How good is our leadership? 2 - Weak

How good is our staff team? 2 - Weak

How well is our care and support planned? 2 - Weak

How well do we support people's wellbeing? 2 - Weak

Areas for improvement

This should include, but is not limited to:

How good is our leadership? 2 - Weak

In order to achieve this, the service provider must, at a minimum, ensure:

In order to achieve this, the service provider must, at a minimum, ensure:

• notifications are reported in a timely manner

Areas for improvement

• share and embed best practice within staff culture

This should include but not be limited to:

How good is our staff team? 2 - Weak

Areas for improvement

This should include, but is not limited to:

• training or refresher training in Adult Support and Protection

How well is our care and support planned? 2 - Weak

To achieve this the provider must ensure:

Areas for improvement

Previous area for improvement 1

This area for improvement was made on 13 March 2020.

Action taken since then

Previous area for improvement 2

To do this the service should:

This area for improvement was made on 13 March 2020.

Action taken since then

Previous area for improvement 3

This area for improvement was made on 13 March 2020.

Action taken since then

Previous area for improvement 4

This area for improvement was made on 8 September 2022.

Action taken since then

Previous area for improvement 5

In order to achieve this the manager and provider should:

This area for improvement was made on 8 September 2022.

Action taken since then

Previous area for improvement 6

In order to achieve this they should:

Ensure that any concerns are recorded and responded to in an appropriate

This area for improvement was made on 8 September 2022.

Action taken since then

Previous area for improvement 7

In order to achieve this the provider should:

This area for improvement was made on 8 September 2022.

Action taken since then

1.1 People experience compassion, dignity and respect 3 - Adequate

1.2 People get the most out of life 2 - Weak

How good is our leadership? 2 - Weak

2.2 Quality assurance and improvement is led well 2 - Weak

How good is our staff team? 2 - Weak

How well is our care and support planned? 2 - Weak

5.1 Assessment and personal planning reflects people's outcomes and