Murraythwaite Care Home Service Children and Young People Murraythwaite Mains Dalton Lockerbie DG11 1AU

Transcription

1 Murraythwaite Care Home Service Children and Young People Murraythwaite Mains Dalton Lockerbie DG11 1AU Inspected by: Chris Barratt Type of inspection: Unannounced Inspection completed on: 23 January 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Radical Services Ltd Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Chris Barratt Telephone enquiries@careinspectorate.com Murraythwaite, page 2 of 22

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 Quality of Environment N/A N/A Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service has continued to develop and improve its approach to young people's participation and this has become increasingly integral to the way that young people using the service are consulted about all kinds of decisions, big and small. An excellent standard of participation was now being achieved. What the service could do better The service needs to make an earlier start with staff induction, preferably before new staff are asked to engage in direct work with young people. What the service has done since the last inspection The service provider has implemented the improvements we asked for in its approach to staff recruitment. Conclusion The service provided at Murraythwaite is well managed and has continued to improve and the progress with young people's participation is especially welcome. There is now a settled group of staff who have worked in the service for several months and this has helped to achieve an improved team approach to the care and support of young people using the service. The service recently admitted a third service user for Murraythwaite, page 3 of 22

4 the first time and the size of the team has expanded to allow for this. We have made a recommendation about the induction of new staff. Who did this inspection Chris Barratt Murraythwaite, page 4 of 22

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 at This service was previously registered with the Care Commission and transferred to the Care Inspectorate on 1st April, Murraythwaite is registered as a care home service for up to three young people aged between 8 and 18 years. Assurances have been received from Radical Services Ltd that the mix of young people will be carefully considered prior to the admission of any new service user to ensure an appropriate match. Previously, most of the young people referred to Murraythwaite had been admitted at short notice at a time of personal crisis and placements have mainly been of only a few weeks duration. Now, one of the young people we met had been there during our last inspection and another had arrived as a planned admission from another of Radical's houses. Murraythwaite is a detached property in a remote rural location a few miles from Dumfries. The premises provide spacious accommodation and young people each have their own bedroom and en suite toilet. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - N/A Quality of Environment - N/A Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good 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. Murraythwaite, page 5 of 22

6 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 We carried out an unannounced visit on 17th December 2012 but there was nobody in so we made a short-notice announced inspection on 23rd January, Our main focus was to look at progress in relation to the Recommendations and Requirement made following our previous inspection. This inspection was therefore confined to just two of our Quality Themes. We met with two of the young people currently using the service, with staff and managers. We examined minutes of staff and young people's meetings and also at 'daily working files' for young people placed at Murraythwaite. We also looked at quality assurance records including management audits and records of requests made by young people. 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 Murraythwaite, page 6 of 22

7 take. You can find out more about care services' responsibilities for fire safety at Murraythwaite, page 7 of 22

8 What the service has done to meet any requirements we made at our last inspection The requirement Where any information of concern is received as a result of references and other checks, a rigorous written risk assessment should be undertaken of the candidates suitability to undertake the duties of the proposed employment. This must take account of the vulnerability and potential challenges of the service user group, the Codes of Practice for social services workers and employers and the recruitment policies and procedures of the service provider. If a decision is made to employ the candidate, the risk assessment should include details of the arrangements to be made to supervise and support the new employee, particularly during their probationary period. This is in order to comply with: SSI 2011/210 Regulation 9 - a requirement to ensure the fitness of employees. Time scale for implementation: From within 1 week of the date of our report of the safer recruitment inspection. What the service did to meet the requirement Fully implemented. The requirement is: Met What the service has done to meet any recommendations we made at our last inspection Appropriate actions had been taken in response to our recommendations. Progress is reported on under appropriate headings within the main body of this report. 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 Murraythwaite, page 8 of 22

9 Comments on Self Assessment Inspection report continued 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. Not applicable; second inspection and no further self assessment required. Taking the views of people using the care service into account Young people told us that they like the service provided at Murraythwaite and get on well with the manager and staff there. They were very well aware of who the Area Manager is and confirmed they could speak to him if they wanted to. One young person told us about an incident they were unhappy about when attending Radical's school in Carlisle. However, they confirmed that staff at Murraythwaite had supported them in dealing with this and that the situation was ongoing. We confirmed this with the manager. Both young people that we spoke with were preparing for independent living and confirmed to us that they felt they were being well supported as they make their future plans. It was clear that they felt very well listened to by the manager and staff at Murraythwaite. Taking carers' views into account We didn't meet any parents or other carers but did see feedback questionnaires that parents had completed for Radical Services. The example we saw included very positive feedback about the quality of staff and their awareness of plans for the young person. Murraythwaite, page 9 of 22

10 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 - NOT ASSESSED Murraythwaite, page 10 of 22

11 Quality Theme 2: Quality of Environment - NOT ASSESSED Murraythwaite, page 11 of 22

12 Quality Theme 3: Quality of Staffing 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 staffing in the service. Service strengths We reported following our last inspection that the service provider's Participation and Involvement Officer had left the company and had not been replaced. We commented that it would be important to ensure that participation continues to be "championed" both at a local level and across the company to ensure that the considerable success of the various participation initiatives is maintained and built upon. Based on our findings during this inspection the service has achieved this by building on the very good standard we reported last time in relation to this Quality Statement. An excellent standard of participation by young people had now been achieved. The service's manager is now the lead manager for young people's participation in the services operated by Radical and its sister company in Scotland. There is also a staff member at Murraythwaite who is designated as "participation officer". Both are enthusiastic about the benefits of participation and are keen to explore ways of developing this even more. Young people had been consulted about questions they wanted to ask at staff interviews and the kind of answers they hoped to receive to these. Other commitments prevented young people from attending interviews but newer staff confirmed these questions had been asked. Young people had also had opportunity to tell the manager what they felt about new recruits when they worked their 'shadow shifts' as part of their induction to the service. The service provider continued to implement its Valuing Individual Performance (VIP) staff appraisal scheme. This includes the manager seeking young people's views about staff's strengths and weaknesses and providing feedback to staff through individual staff supervision every three months. The service provider now has a Scottish Youth Board and young people from all the houses were invited as well as the service provider and senior managers. A notice on the house notice-board invited agenda items for the next meeting in early February. Murraythwaite, page 12 of 22

13 Minutes of young people's meetings confirmed that young people use these to raise matters that are important to them. Team meeting minutes demonstrate that young people's issues are taken seriously by staff. A "request book" had also been introduced for staff to record anything requested by young people between meetings and any action taken regarding such requests. In addition to this there was a weekly 'budget meeting' when young people and staff discussed together how to allocate the weekly budget for the house. This exercise enables young people's understanding of financial priorities and has particular benefits for young people preparing for independent living. Quality assurance questionnaires used by the service include questions about the quality of staff and young people's experience of staff. The manager confirmed that, if these highlight any areas of potential concern, she follows these up with the young person concerned. Areas for improvement None identified in this inspection Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths Inspection report continued Based on our findings during this inspection a good standard has now been achieved in regard to this Quality Statement. Following our last inspection we required that where any information of concern is received as a result of references and other checks, a rigorous written risk assessment should be undertaken of the candidates suitability to undertake the duties of the proposed employment. We said that this must take account of the vulnerability and potential challenges of the service user group, the Codes of Practice for social services workers and employers and the recruitment policies and procedures of the service provider. We also said that, if a decision is made to employ the candidate, the risk assessment should include details of the arrangements to be made to supervise and support the new employee, particularly during their probationary period. This requirement and the recommendation that follows, result from an inspection we made of staff recruitment records held at Radical Service's head office in England. The Area Manager has confirmed to us that the necessary changes have now been made to the service provider's recruitment policy to address this requirement and Murraythwaite, page 13 of 22

14 provided us with a copy. It is now proposed by the service provider that, at the initial application stage, all candidates will be asked any questions around any gaps of employment and any disclosures made around any type of conviction will be fully explored at interview stage They also propose to "fully assess" any risks and take these "into account" prior to any offer of employment being made. New recruits that we met during this inspection described to us the process by which they had been appointed and confirmed this had included reference checks and that they had been required to join the Protecting Vulnerable Groups (PVG) Scheme. The service provider's approach to recruitment now included a much more robust overview of recruitment processes by the service provider's head office staff. We therefore accept the necessary changes have been made to the recruitment policy and the service provider's continuing commitment to implementing these. We also recommended that the service provider's recruitment policy should be reviewed and amended to include: Arrangements for the storage of PVG Scheme records in line with Disclosure Scotland guidance; Arrangements to check professional registers and to ensure that candidates seek the necessary category of registration and maintain this; Arrangements for following-up reference requests where no reference is immediately forthcoming; the need to request written references in addition to any testimonials provided by the candidate; the need to receive a written reference from the previous employer and a character reference from somebody independent of any of the Pebbles group of companies; the role of the service provider's HR team in maintaining a robust approach to safe recruitment of staff consistent with company policies and best practice. The service provider's Action Plan confirmed that these matters had all now been addressed, copies of the new documentation and guidance have been provided to us and the house manager described to us how this was currently being implemented. Areas for improvement We met three newer staff members (two from another house who were assisting the team at Murraythwaite on the day of our visit). New staff confirmed they had been taken through the company's induction folder by their house manager; this helped to familiarise them with the service's policies and procedures and a range of best practice publications. Staff told us this had been helpful but some said that they had, so far, received "very little training"; however, those who had received the range of training offered as part of Radical's induction programme confirmed this had been interesting, relevant and helpful. We discussed this with the manager and Area Manager and, following the inspection, we received Radical Service's "New Starter's" policy and procedure. We found that, Murraythwaite, page 14 of 22

15 although the service provider is committed to providing a suitable range of training during staff's probationary period, the timing of this can vary. We note, for example, that there had sometimes been delays in providing training in Crisis and Aggression Limitation and Management (CALM). This could potentially result in only one person being on duty who has the necessary training. We accept the manager's assurances that she would risk-assess such situations but this does not allow for unexpected outbursts. We also acknowledge her assurances that, in the event of it being considered likely that staff may be involved in supporting young people with such challenging behaviour, she would aim to have sufficient trained and experienced staff on duty. We also note that there is an effective duty manager system which provides additional support to staff 'out of hours'. We concluded however that an earlier start needs to be made with CALM training and other induction training addressing the essential skills of the job. Until then staff should only work directly with young people if they are supernumerary to minimum staffing levels. This will help to ensure that staff working with young people are suitably skilled and avoid the need to move staff between houses in order to achieve the right skill-mix. See Recommendation. See also our comments under Quality Statement 3.3 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service provider should develop an approach to staff induction that ensures that staff are trained in CALM and other essential skills of the job earlier in their employment. Until then staff should only work directly with young people if they are supernumerary to minimum staffing levels. National Care Standards, care homes for children and young people. Standard 7.8: Management and staffing Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued The improvement that we reported following our last inspection had been maintained and a very good standard had now been achieved in respect of this Quality Statement. The manager had concentrated on team building and team communication and staff that we spoke to were very positive about the team at Murraythwaite. Although there had been a number of challenging situations involving young people, the number of Murraythwaite, page 15 of 22

16 serious incidents had reduced and staff comments include "it's a good wee team" and "it feels good now, we've achieved good boundaries and there's good continuity". Longer serving staff members told us that new staff had "settled in well." Very good staffing levels had been maintained including, when identified as necessary, waking night staff. The amount of staff turnover at Murraythwaite had reduced and there was now an established core of team members. Staff told us this had helped recently when the size of the team increased following the admission of a third young person. Team members had a broad range of previous experience and qualifications and the manager told us it was a "good cross-section of staff". Staff were at different stages of training but, those who still needed to satisfy the qualifications criteria of the Scottish Social Services Council confirmed that they were being supported by Radical Services to achieve this within the required time-scale. Due to the Depute having been off since December the manager was currently providing all staff supervision. Staff told us they felt very well supported by the manager, the Area Manager and by Duty Managers. Areas for improvement It was unfortunate that, on the day of our inspection, staff changes had resulted in a mixture of less experienced staff and staff from other services being on duty. This was due to a number of unplanned factors and we accept that the manager had assessed this arrangement to be suitable to meet the needs of young people and was available to provide additional support in the event of this being required. Young people appeared happy to engage with the staff who were there and they were well supported in keeping appointments and participating in agreed activities. However, care needs to be taken to ensure a suitable skill mix at all times (see also our comments under Quality Statement 3.2). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Murraythwaite, page 16 of 22

17 Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths We didn't look specifically at this Quality Statement but, based on our findings for Quality Statement 3.1, we accept that an excellent standard has been achieved for this aspect of participation. Areas for improvement None identified during this inspection. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 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 Based on our findings during this inspection a very good standard has now been achieved in regard to this Quality Statement. Following our last inspection we recommended that the service provider should carry out a thorough audit of staff files and ensure that any potentially unsafe appointments identified through this process are subject to a thorough risk assessment and suitable action. This recommendation followed an inspection of staff recruitment records held at Radical Service's head office in England. The Area Manager has since confirmed that he has completed an audit of staff files and that "regular checks will be ongoing". We have not re-visited Radical Service's Head Office but comments made to us by managers and newer staff reassure us that appropriate recruitment procedures are now being followed. Murraythwaite, page 17 of 22

18 The service has a range of effective arrangements which help the manager, Area Manager and service provider to evaluate the quality of the service being provided. This includes a variety of weekly and monthly audits carried out by the manager. The Area Manager visits the service at least every month and carries out an audit including examination of paperwork and meeting with young people and staff. Social workers and carers had been asked to complete feedback questionnaires and examples we saw confirmed their satisfaction with the service provided, indicating strong agreement with most of Radical's quality statements. Areas for improvement We note that the manager at Murraythwaite had been working closely with the Area Manager to develop a new "service care audit" tool linked to the national care standards and our Quality Assessment Framework. A draft copy of this was provided to us and has the potential to further improve arrangements for quality assurance including an ongoing "improvement plan" for the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Murraythwaite, page 18 of 22

19 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. 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). Murraythwaite, page 19 of 22

20 5 Summary of grades Quality of Care and Support - Not Assessed Quality of Environment - Not Assessed Quality of Staffing Very Good Statement 1 Statement 2 Statement Excellent 4 - Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Excellent 5 - Very Good 6 Inspection and grading history Date Type Gradings 9 Aug 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 2 - Weak Management and Leadership 4 - Good 22 Nov 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 27 Apr 2011 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 18 Nov 2010 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Murraythwaite, page 20 of 22

21 Management and Leadership 4 - Good 3 May 2010 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Murraythwaite, page 21 of 22

22 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: Murraythwaite, page 22 of 22