Lothian Occupational Services Support Service Care at Home Autism Initiatives Head Office (Scotland) 11 Granton Square Edinburgh EH5 1HX Telephone:

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1 Lothian Occupational Services Support Service Care at Home Autism Initiatives Head Office (Scotland) 11 Granton Square Edinburgh EH5 1HX Telephone: Inspected by: Duncan Craig Type of inspection: Unannounced Inspection completed on: 21 November 2012

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 18 5 Summary of grades 19 6 Inspection and grading history 19 Service provided by: Autism Initiatives (UK) Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Duncan Craig Telephone enquiries@careinspectorate.com Lothian Occupational Services, page 2 of 20

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 4 Good What the service does well We found that the service provided a high quality of individualised care and support. We saw that service users were well supported in accessing community resources and were supported in developing their life skills, self esteem and independence. We found the service to be flexible in responding to each service user's needs and to provide people with varied activities, and new opportunities, in helping them to reach their full potential. We found the service to be well managed and staffed. What the service could do better We discussed with the manager ways of improving and delivering formal staff supervision. We also discussed, how a "participation statement" could enhance existing consultation arrangements with service users, their families and stakeholders. We found very good "Health Plans" included in some service user's Support Plans. We discussed the benefit of including these in all Support Plans. What the service has done since the last inspection We found that the service had continued to make positive progress in supporting people in the community and at home. We saw that service users had access to a range of information about different advocacy providers. This information was included in "Welcome Packs" for new service users and their family. Lothian Occupational Services, page 3 of 20

4 We found very good audit and monitoring arrangements had been put in place to ensure that Support Plans were up to date and that these, and "Quarterly Reports", were shared with service users and their families. The service, as with all Autism Initiative resources, was working to a new person centred "framework for supporting excellence in Autism Practice". This allowed all activity to be contextualised within a 5 point bench mark: sensory perception, understanding, communication, expectation and motivation. This concept was "bedding in" at inspection and was being enthusiastically welcomed. The West Lothian part of the service had relocated to a more spacious office base in Livingston. Discussion was taking place at inspection regarding the best use of this additional resource. The base was already being used as a meeting place for the service's "Activity Group" and "Girls Group" as well as specific group and individual meetings. Conclusion We found the service to be well managed and staffed. We concluded that Lothian Occupational Services provided a high quality of care and support to service users at home and in the community. Who did this inspection Duncan Craig Lothian Occupational Services, page 4 of 20

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. Lothian Occupational Services is provided by Autism Initiatives and operates to its national policies and procedures. The service is registered to provide support to people living in their own homes (Support Service - Care at Home) and to provide support to people in the community (Support Service - Day Service for Adults). The service is available to adults,16 years and above, with Autistic Spectrum Disorder. The service has a base in Edinburgh and in Livingston. Staff support is available to service users over a 7 day, 24 hour period with an "on call" system operating between 9 pm and 9 am. The service states within its Aims and Objectives state: * Provide a holistic support to adults with ASC (Autism Spectrum Condition) * We aim to provide young adults with transition into accessing adult services from schools and children's services in an Autism specific way * Our service is designed to provide an Autism specific support to meet the individual needs of people with ASC throughout the Lothians * AI (Autism Initiatives) acknowledges that each person with ASC will have different support needs and abilities and we aim to provide a tailor made support plan to meet the specific needs of each individual service user * Community based resources are augmented by the two building base resources which provide a safe environment where service users can develop and practice skills they have learned Lothian Occupational Services, page 5 of 20

6 * To support service users to access the community and develop life skills, allowing service users to increase their self esteem and independence in order to achieve their full potential * We endeavour to support young adults with autism to reach their full potential in whatever activity they choose and support each service user to fulfil any goal they want to meet * We strive to support people with ASC to develop active, meaningful and enjoyable daily lifestyles through our person centred, flexible and varied occupational services * We aim to support service users with ASC to develop employment skills by providing and creating real opportunities for them * We will support the provision of further learning by creating opportunities within opportunities in environments that best suit the needs of people with ASC * We aim to develop a supportive and trusting relationship with each individual service user and aim to be responsive to the changing requirements of each service user to ensure that each service user's needs are met. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 4 - Good Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Lothian Occupational Services, page 6 of 20

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This unannounced inspection was carried out by Duncan Craig of the Care Inspectorate on 14 November An announced follow up visit took place on 21 November Prior to inspection, we received five completed parent/carer Care Standards Questionnaires, one service user questionnaire and six staff questionnaires. The service submitted an annual return and a service self assessment prior to inspection. We met with a service users activity group and discussed the service with them. We spoke with staff and managers. A range of policies, procedures and documentation was examined. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to Lothian Occupational Services, page 7 of 20

8 take. You can find out more about care services' responsibilities for fire safety at Lothian Occupational Services, page 8 of 20

9 What the service has done to meet any recommendations we made at our last inspection Two recommendations were made at the inspection of November 2010: 1. We recommend that information about advocacy services is developed in formats suited to the individual needs of service users. National Care Standards, Care at Home. Standard Expressing Your Views. Outcome: We saw that information regarding various advocacy arrangements were included within service user "Welcome Packs" and in case files. A pictorial internal complaint form was also available. This recommendation has been met. 2. We recommend that the service reviews the systems it has in place for recording when personal support plans and quarterly reports have been shared with service users and relatives. National Care Standards, Care at Home. Standard 3.2. Your Personal Plan. Outcome: We saw that support plans and quarterly reports were signed off by parents/carers.this recommendation has been met. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service provided us with a detailed self assessment in which they identified good practice and areas for development. Lothian Occupational Services, page 9 of 20

10 Taking the views of people using the care service into account We received one completed Care Satisfaction Questionnaire. In response to the statement "Overall, I am happy with the quality of care and support this service gives me", the respondent "Agreed". The respondent agreed with all the other statements. Comments were about the new "E-Bay" project within the service and the need to sell more items. At inspection, service users told us that they liked being involved with the service and particularly praised the group activities. We saw that service users enjoyed very positive relationships with staff. A lot of appropriate humour was shared between workers and service users. Taking carers' views into account Five Care Satisfaction Questionnaires were completed and returned to us. In response to the statement "Overall, I am happy with the quality of care and support this service4vice gives me", four "Strongly Agreed" and one "Agreed". Comments included: "We are very happy with the support we receive - wish we knew about this service years ago" "I feel that the service understands the needs of my son and since attending he has experienced and enjoyed many activities which he had not tried before - my son is respected as an individual" "The team members are extraordinary caring and compassionate individuals whose dedication makes a remarkable difference to their service users and families - the difference they have made to our lives is unbelievable" "We continue to be very happy with the service provided for our son. He is happy and well placed with a superb network of carers". Lothian Occupational Services, page 10 of 20

11 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found that the service routinely involved service users and their relatives in assessing, planning and reviewing individual support plans and there outcomes. An effective Key Worker system was in place and we saw that discussion with families took place on a regular basis. Support Plans and Risk Assessments were "signed off" by service users or their family representative. A system of 3 monthly summary reporting allowed for further discussion. We found that Support Plans were of a very good quality and detailed very specific areas of work. The 5 points from the Autism Initiatives framework for supporting excellence in Autism Practice were used. (see "How the service has progressed since the last inspection"). Like wise, Risk Management Plans were of a very good quality and, again, broken down in to specific areas of work. We saw that Support Plans and Risk Assessments were up to date and subject to regular audit. We found that there was a very healthy focus on abilities and aspirations. We saw returns from the service's own questionnaire exercise and 2 service users discussed their involvement in this with the Inspector. Pictorial questionnaires were used where appropriate. The service also periodically issued questionnaires to families/carers. We saw that positive comments had been made about the quality of care and support offered. We saw that issues raised by, or concerning service user welfare, were discussed and recorded in minutes of staff meetings. The service had a complaints policy set out in pictorial format. No internal complaints had been logged since the last inspection. Lothian Occupational Services, page 11 of 20

12 We saw that staff had developed very good skills in communicating with service users who were non-verbal. Areas for improvement The service could benefit from circulating a "Participation Statement" making it clear to service users, their families/carers and stakeholders that comments, suggestions and concerns about the service are welcomed. A service user was planning to produce a "Newsletter". He already provided regular reports on group activities. Autism Initiatives produced a national magazine about service events and developments. We discussed with the manager how this activity could be enhanced by a service specific "Managers Bulletin" updating all stakeholders about events and developments within the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. To enhance service user, family and stakeholder involvement, the service should: 1) prepare and circulate a "Participation Statement" 2) Issue a regular manager's update bulletin. NCS 1 Care at Home - Informing and Deciding NCS 11 Care at Home - Expressing Your Views. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found very good assessment, planning and review arrangements were in place. This included very thorough risk assessment and management plans. The service ethos focused upon abilities, achievement and aspirations. This was reflected in discussions we had with service users and staff members. Staff were trained appropriately regarding Autism. An introduction to autism was included in induction training and a follow up event was available to staff entitled "Thinking Differently About Autism". More general health and wellbeing issues were addressed through ongoing training including HNC and SVQ 3. The Senior Support Worker described to us the preparation taking place regarding a new service user joining the service. This took account of specific health needs as well as general planning focused on overall development. Lothian Occupational Services, page 12 of 20

13 We saw examples of very good communication between staff, service user and family regarding the addressing of health issues. This encouraged consistency and provided security to the individual. We were also told about a visit by a hospital Doctor to the activity group to help allay fears about hospital appointments. We saw a very good example of a service user and a staff member addressing a joint healthy living issue together. We also saw very good work helping one service user be aware of personal space and over familiarity. The service had designated First Aiders. We saw that due regard was given to healthy eating and service that users were able to prepare meals in the previous service location. Plans were in place to install a cooker in the new building to allow this activity to continue. We found staff to be knowledgeable regarding the protection of vulnerable adults (POVA) and safe care generally. Training regarding POVA was provided at induction and at "refresher" training. Areas for improvement We saw very good examples of "Health Plans" within Support Plans. these covered specific health conditions and issues. We discussed with the manager the benefits of including this section in all Support Plans. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Specific "Health Plans" should be included within all Support Plans. NCS 6 Care at Home - Eating Well NCS 7 Care at Home - Keeping Well - Healthcare NCS 8 Care at Home - Keeping Well - Medication. Lothian Occupational Services, page 13 of 20

14 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the staff and managers we met to be knowledgeable, skilled and motivated. We saw evidence of very thorough induction training, including a detailed "checklist" type programme ("Progress Log Of Standards"), where key issues required to be evidenced and signed off by the candidate and the manager. Induction training was also available to staff on a "refresher" basis. Training was focused on staff attaining qualifications that would allow for registration with the Scottish Social Services Council (SSSC). We saw that staff had attained HNC and/or SVQ 3, or that plans were in place to achieve appropriate qualification. The service had a policy of allocating a specific training budget to each staff member. Fees for formal training (HNC, SVQ,etc) were "topped up" by the service. All six returned Staff Questionnaires responded "Yes" to the statement "Are there opportunities to gain qualifications" and, in response to the statement "Do you have training needs that are not being met by the service, five stated "No". Five stated that they had access to training "in the last 12 months", with the remaining respondent highlighting that their training was "due to begin in 2 weeks". We saw evidence of very good national training events called "Visioning Days". These focused on the whole service remaining focused upon their person centered values and ethos. The previously mentioned Autism Initiatives framework for supporting excellence in Autism Practice had been explored at a recent event. We saw that staff meetings took place regularly and focused upon service user wellbeing and development. The service was very good at consulting and supporting the staff team. Staff told us that there was an open culture where they could express their views to management about any issues affecting the quality of their work. We saw staff seek advice at inspection. The service operated an annual appraisal for all staff and a supervision model was in place. Staff told us that they felt supported. Areas for improvement The manager told us that the service had difficulty adhering to delivering 6 to 8 weekly individual staff supervision, as prescribed by the national provider. This was Lothian Occupational Services, page 14 of 20

15 due to a range of work pressures. We discussed with the manager how recording practice discussions and introducing group supervision (for common issues) might allow the formal supervision agenda to reduce and the target to be achieved. (See also Quality Statement 4.4. and Section 4 - Other Information - Complaints.) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Consideration should be given to recording practice discussions and introducing group supervision (for common issues) to help meet supervision targets. NCS 4 Care at Home - Management and Staffing. Lothian Occupational Services, page 15 of 20

16 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths We found that the service had good internal audit arrangements. We saw that reports from the service managers 6 monthly audit of practice and documentation. This was very thorough and identified areas for improvement and specific tasks to achieve this. As recorded in Quality Statement 1.1, good arrangements were in place to gather service user and their families views. We saw that a recent staff consultation had taken place using questionnaires. Written feedback was given by the service manager. Staff Personal Development files were externally monitored by the provider. We saw evidence of service user consultation by conducting "I Am Heard" groups. Nationally, parent/carer groups took place to inform service direction. The senior support worker talked enthusiastically regarding establishing a local parent/carer group. Areas for improvement The planned parent/carer group should be established as intended. All staff should receive regular "one-to-one" supervision as per the service's own policy. (See Requirement recorded within Section 4 - Other Information - Complaints of this report and the Recommendation within Quality Statement 3.3.) The grade for this Quality Statement was adjusted accordingly. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The planned parent/carer group should be established as intended. NCS 4 Care at Home - Management and Staffing. Lothian Occupational Services, page 16 of 20

17 Lothian Occupational Services, page 17 of 20

18 4 Other information Complaints A complaint was received on 1 October 2012 alleging that Staff were not receiving regular supervision. Following investigation, the Care Inspectorate made the following requirement: 1. The provider must ensure that persons employed in the provision of the care service receive regular supervision and support appropriate to the work they are to perform. In order to achieve this there must be: i) A system in place to assess and reassess staff competency This is in order to comply with Scottish Statutory Instrument 2002/114 Regulation 15 (b) (i) a requirement regarding Staffing. This also takes account of the National Care Standards - Care at home services, Standard 4 - Management and staffing. (See also Quality Statements 3.3. and 4.4. of this report.) Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Lothian Occupational Services, page 18 of 20

19 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement Very Good Quality of Management and Leadership Good Statement Good 6 Inspection and grading history Date Type Gradings 24 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 20 Jan 2010 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Lothian Occupational Services, page 19 of 20

20 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Lothian Occupational Services, page 20 of 20

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