St. Mary's Kenmure Secure Accommodation Service St. Mary's Road Bishopbriggs Glasgow G64 2EH

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1 St. Mary's Kenmure Secure Accommodation Service St. Mary's Road Bishopbriggs Glasgow G64 2EH Inspected by: Charlie Buckle Joan Lafferty, Ann Borland Type of inspection: Unannounced Inspection completed on: 29 June 2012

2 Contents Page No Summary 3 1 About the service we inspected 6 2 How we inspected this service 8 3 The inspection 12 4 Other information 37 5 Summary of grades 38 6 Inspection and grading history 38 Service provided by: St. Marys Kenmure Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Charlie Buckle Telephone enquiries@careinspectorate.com St. Mary's Kenmure, page 2 of 39

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 4 Good Quality of Environment 3 Adequate Quality of Staffing 4 Good Quality of Management and Leadership 3 Adequate What the service does well The service provides secure care for young people and identifies areas where each young person requires support to work through problems that resulted in admission to the service. The service provides good training opportunities for staff with the workforce being registered with the Scottish Social Services Council. The service has a safe and structured approach to staff recruitment with new staff receiving appropriate induction. St. Mary's Kenmure, page 3 of 39

4 What the service could do better The service should continue to develop their participation strategy in terms of how they will involve young people, parents and stakeholders. Other improvements we identified were: - meetings with the School Council need to be supported with an action plan - continue to develop child friendly support plans that demonstrates the young person's involvement, and that support plans are consistent in terms of detail and accuracy - ensure that all staff have a purposeful personal development plan in place - review the current training analysis for the service, and ensure that staff receive training relating to suicide, self harming, and substance misuse - ensure that there is improvements to cleanliness, décor, furnishings, and daily safety checks - ensure that the provider gives formal notification to the Care Inspectorate regarding investigations relating to staff practice - make improvements to care plan auditing. What the service has done since the last inspection The service has made improvements to staff supervision, and the implementation of individual personal development plans for staff. The training team now being located at the service has been instrumental in the progress. The service continues to work well with young people, and we have noted that incidents were low as a result of positive working relationships with young people. Conclusion Overall St. Mary's secure unit was continuing to work through many developments to improve how they provided the service to young people. Within this inspection we have identified that the service has some work to do in terms of improving performance. St. Mary's Kenmure, page 4 of 39

5 Who did this inspection Charlie Buckle Joan Lafferty, Ann Borland St. Mary's Kenmure, page 5 of 39

6 1 About the service we inspected St. Mary's Kenmure Secure Unit is a secure accommodation service that provides 24 secure beds for young people, (male and female) aged from 11 to 18 years. Located in the North East of Glasgow in Bishopbriggs, St. Mary's Kenmure is governed by an independent Board of Managers and is affiliated to the Cora Foundation, a registered charity committed to Christian social care and education. At the time of this inspection, there were 22 young people in the secure unit. The service has a campus style facility, which is formed by grouping three house units, education centre, administration and catering centre around a large central courtyard containing an outdoor recreation area. Additionally, there are indoor recreational facilities such as a swimming pool and a gymnasium. Above the recreational unit is a group work area that has a Programmes Team dedicated to the delivery of structured programmes such as cognitive skills and offending behaviour. The central courtyard, which is landscaped, is the main circulation route within St. Mary's Kenmure. The accommodation for the young people is a single bedroom and includes toilet and shower en-suite with fixtures and fittings designed to limit self-harm. There is a living/dining and kitchen area, office and visitors/activities room in each unit. Perimeter security is provided by the buildings and is supplemented by CCTV monitored by a designated team of operations staff. The stated objective of St. Mary's Kenmure is to offer "...individual young people who are experiencing and presenting difficulties in the community, a stable, safe, secure, stimulating environment to promote growth and development leading to eventual return to the community." The service was re-registered under the name of St. Mary's Kenmure with the Care Inspectorate on 24 January As well as being inspected by the Care Inspectorate the Secure Unit is also subject to joint inspections by Her Majesty's Inspectorate of Education (HMIE) at four-year intervals, and is registered with the Registrar of Independent Schools. St. Mary's Kenmure, page 6 of 39

7 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 3 - Adequate Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate 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. St. Mary's Kenmure, page 7 of 39

8 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We compiled the report following an unannounced inspection. The inspection was carried out by Charlie Buckle, Ann Borland and Joan Lafferty (Inspection Team) over a four day period between the 6 and 11 June Feedback was given to the management team on Friday the 22 June In this inspection we gathered evidence from various sources, including the relevant sections of policies and procedures, records and other documents including: * Incident records and physical intervention analysis * Single separation records * Individual Crisis Management Records * Complaints * Record of sanctions * Medication records * Staff supervision records * Training plan * Staff ongoing development plans * Record of searches * Staff rota * Senior management team meetings * Unit Staff team meetings * Young persons meetings * Support plans (case tracking) * Observing how staff work with young people * Observation of the environment through visiting the units * Discussion with several people including: - 11 young people - Head of Service, Depute Head of Service - 4 Unit Managers, 3 Assistant Unit Managers - School nurse - 16 residential workers (Including day and night staff) - The chef - Training officer - Control room staff. St. Mary's Kenmure, page 8 of 39

9 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 take. You can find out more about care services' responsibilities for fire safety at St. Mary's Kenmure, page 9 of 39

10 What the service has done to meet any recommendations we made at our last inspection Outstanding recommendations have been reported on within the relevant statements in 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: No 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. We received a fully completed self assessment document from the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. The service provider told us how the people who used the care service had taken part in the self assessment process. St. Mary's Kenmure, page 10 of 39

11 Taking the views of people using the care service into account We spoke with 11 young people during the inspection as a group within three of the units. They told us the following: "The staff are ok with you" "The food is ok sometimes, depends who cooks it" "I think being here has helped me to get myself sorted" "We have house meetings, and most of the time they try and do what you suggest" "Room is comfortable enough, but some of the furniture is a bit scabby" "If I feel a bit down I can talk to the staff" "Usually have things to do, like football or the gym" "Not much to do for lassies in here, seems to be all about the boys getting what they want" "The school nurse is ok, if you feel no well then you can talk to him". All young people told us that they felt safe within the placement, and had the chance to speak with staff about any concerns or worries they had. Taking carers' views into account There were no parents available during this inspection. St. Mary's Kenmure, page 11 of 39

12 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: 4 - 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 The service continues to have a good performance in relation to this statement. We gathered evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Checking reports and other documents - Case tracking care plans - Information from placing authorities. Young people had the opportunity to complete a self assessment about how they felt being at St. Mary's and how the placement has helped them and where they feel they need further support. Young People attended reviews where they had opportunity to give their views and opinions about their care and support provided at St. Mary's. Young People had meetings within each of the house units. These meetings gave young people the opportunities to talk about what was happening within their unit, make plans about activities, and also raise any issues or ideas they may have. We found that these meetings had a good level of detail with young people being able to discuss activities, furniture and fittings for the units, planned cook nights and other relevant interests that young people had. The service has a School Counsel where young people could be appointed as representatives for other young people. Views and opinions of young people were discussed at both staff and management team meetings. Recently a young person had the opportunity to attend the management team meetings to discuss ideas. St. Mary's Kenmure, page 12 of 39

13 Young People were able to give their views through 'Have your say' questionnaires. The service had a participation strategy in place. By this we mean the service had a system that describes how they will involve young people and others to make ongoing improvements to the service. The Participation group were currently working on driving the participation strategy in terms of getting the views of young people to see what needed to change at St. Mary's. Young people were encouraged to give their views about food at each mealtime. These comments were recorded on the Duty Officers meals feedback sheets which we checked. The service encourages the use of advocacy for young people. By this we mean young people being able to discuss the service with their children's rights officer, who in turn can represent their views to management and staff. Young people had access to telephone numbers for them to talk with 'Childline' and 'Who Cares Scotland'. Areas for improvement Much of the work regarding participation we have acknowledged was still in progress which we will look at within the next inspection in terms of outcomes for young people. Minutes of the School Council should have an action plan that will explain who will take responsibility for decisions being made at these meetings and what action is required. We had made this a recommendation at the last inspection, which will be repeated. (See recommendation 1 within this statement) Minutes of staff meetings should reflect decisions from young people's meetings, that explain what action has been taken following discussion. We noted in a meeting that staff had decided that a young person required to be shadowed, however there was no specific action plan in place that would explain how the situation would be monitored and reviewed. We had previously made this a recommendation, which will be repeated. (See recommendation 2 within this statement) Although young people had support plans in place, we felt that the service should now develop these further with a more child friendly approach. By this we mean care plans could be written from the viewpoint of the young person. We were made aware that a new support plan was being devised, however in the interim it is important that the current plans reflect the involvement of young people. We previously made this a recommendation at the last inspection, which will be repeated. (See recommendation 3 within this statement) St. Mary's Kenmure, page 13 of 39

14 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. The provider should ensure that an action plan is implemented following decisions made at the School Council meetings National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing 2. The provider should ensure that minutes of staff meetings reflect decisions that require to be made from young people's meetings. National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing. 3. The service should continue to develop support plans to reflect a child friendly approach which also evidenced that they have been clearly involved. National Care Standards, Standards for School Care Accommodation Services, Standard 10, Contributing to your care St. Mary's Kenmure, page 14 of 39

15 Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths The service continues to have a good performance in relation to this statement. We gathered our evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Checking reports and other documents - Case tracking care plans - Speaking to Children's Rights representative - Information from placing social workers. Each young person had an individual support plan in place which identified what support the young person required, and what strategies and resources were in place to ensure needs were being met. The service had appropriate risk assessments in place for each young person which identified strategies to manage risk and support the young person. Young people continued to achieve at St. Mary's with good input regarding their education. Many young people have gained qualifications and awards. Achievements continued to be celebrated at award ceremonies which were fully attended by the young people, staff, management, parents, Board members, and social workers. We noticed that there were a variety of activities that young people could get involved in. These were planned and discussed with young people. The service had introduced life guard training for young people. Young people were supported by care staff in terms of completing homework. The service continues to do good work with young people in relation to specific programmes. These were designed to work with the young person through addressing offences that resulted in secure care. For example looking at issues regarding substance misuse, anger management, and other work that focuses on cause and effect. St. Mary's Kenmure, page 15 of 39

16 Many young people told us that programmes work had helped them to look at things differently, consider consequences and reflect on the effect to others. Young people had good opportunities for physical activities and supported by physical training instructors and staff. The use of the swimming pool, the gym and the courtyard was used regularly by young people. The service also provided activities for girls within the secure unit for example beauty nights, yoga, aerobics, swimming, and 'sing star '. Areas for improvement We acknowledge that the service is developing their care plans and assessment documentation further. We will look at progress at our next inspection. We made a recommendation at the last inspection to ensure that support plans were signed and dated. Progress had been made therefore we will not repeat this recommendation. We carried out an in depth analysis of some young people's support plans. Our findings demonstrated that specific areas of improvement were required, for example: - some support plans were very descriptive, where others lacked sufficient detail, in terms of what action requires to be taken by whom and when to meet the identified need - some information did not have sufficient detail of what the issues were, or what the needs of young people were - some support plans were not outcome focused - timescales did not reflect an exact time for completion to meet an identified need. An example being, recorded as' for the duration of the placement'. Detail has to be more accurate. - information linking work within the community and the service, not recorded in the care plan. For example where there has been Vulnerable Young Person's meeting held and decisions made, then information should be included in the young person's support plan. We also noted that where a full and comprehensive assessment of risk needs was undertaken by a mental health service, then this should have also been included with the young person's support plan. St. Mary's Kenmure, page 16 of 39

17 We have made two recommendations for the service to make improvements in these areas. (See recommendation 1& 2 within this statement) We identified that on occasions, background information was not always readily available prior to the young person's admission to the secure unit. Delays were having an impact on the service gaining relevant information to put a plan of care together which highlights the young person's immediate needs. We have made a recommendation for the service to look at ways this could be improved. (See recommendation 3 within this statement) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations 1. The provider should ensure that there is a consistent approach to the level of detail recorded in young people's support plans. These should be clear and concise with specific timescales identified along with what action will be taken by the responsible person. National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing. 2. The provider should ensure that where work is being undertaken with young people in the community and the service, then this should be reflected within the support plan. In addition this should also apply to any assessment work being undertaken by other agencies. National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing. 3. The provider should look at ways that they can gain relevant information about young people's needs from placing authorities prior to admission, or within a shorter timescale. National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing. St. Mary's Kenmure, page 17 of 39

18 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service continued to have a good performance in relation to this statement. We gathered evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Checking reports and other documents - Case tracking care plans - Speaking to Children's Rights representative - Information from placing social workers. The service had a good approach to ensure that young people's health needs were being met at the point of admission and throughout their placement. Young people that we spoke to during the inspection, told us that they were able to discuss issues about their health with staff. A nurse was employed on a full-time basis by the service. The nurse carried out a health assessment within a week of young persons admission using the British Adoption and Fostering (BAAF) assessment checklist. This was a comprehensive health check and a plan of action was identified to meet individual health needs. The completed BAAF assessment was held in a medical file by the nurse and a summary of the findings were provided to the unit in which the young person was placed. In the main health assessments, identified needs associated with emotional wellbeing, dental health, and visual checks and immunisation needs. However the nurse had in recent times, requested speech and language therapy input, testing for diabetes, monitoring of asthma conditions and visual aids for those with specific disabilities. A General Practitioner from a local surgery visited the service weekly to see young people. However short notice appointments could be made outwith this weekly arrangement. St. Mary's Kenmure, page 18 of 39

19 The service nurse established links with the placing Local Authority (LAAC ) nurses, to gather health information and background. Arrangements were made to have missed immunisations carried out. The nurse met monthly with the Senior LAAC nurse for the host Local Authority (LA) to keep abreast of the health needs of the children placed from that LA, which typically made up the majority of the young people placed in the service. A dentist visited the service monthly, and young people had the necessary dental care carried out. There was evidence that the service had been successful in encouraging young people who had a history of refusal to attend to dental health needs. Some young people at the service had also been referred to have orthodontic work undertaken. The service promoted good sexual health. Contraception advice was available. The nurse offered screening for sexually transmitted disease. Young people were seen by the Sandyford sexual health services, following referral by the nurse, for more complex testing access to female medical practitioners or pre- test counselling. There was evidence that eye care was attended to, where an optician tested young people during the admission phase, to carry out eye checks and replace lost or broken glasses. Annual eye tests were carried out thereafter for young people who remained at the service longer term. The school nurse and staff members reported a high level support from mental health services. A typical response from referral was up to two weeks, however, emergency same day responses were also available. Support included consultations for staff to provide ongoing advice on the management of mental health issues presented by individual young people. Assessment and ongoing support was also provided directly to young people from CAMHS (Child and Adolescent Mental Health Services) and Forensic CAMHS. Psychological and Psychiatric assessments had been carried out when requested. Healthy eating was promoted with fresh fruit available daily. The nurse monitored the weight of those young people assessed of being outwith the normal Body Mass Index range. Young people with a limited dietary preference were encouraged to experiment with a wider range of foods. The chefs in the kitchen were informed of any specific dietary needs and meals were provided accordingly. The medication is provided by a local pharmacy and checked by the nurse prior to being issued to the units. Staff members use pre-printed medication administration record sheets to record when medication has been issued. The nurse kept a spread sheet of the medication prescribed to all young people. Necessary monitoring regarding the impact of medication was carried out with an example being regular blood testing to ensure no detriment to liver functioning and assessments of mood. St. Mary's Kenmure, page 19 of 39

20 Medication reviews were carried out by the nurse and GP. There were examples when prescribed medications had been reduced successfully. The service has recently updated the medication policy which has been made available to staff. The nurse caries out periodic medication audits and more recently an audit of medication was carried out by the pharmacist. The findings of this audit were mostly favourable with a few recommendations which had been addressed by the service. We made three recommendations at our last inspections to ensure that when young people leave the service, medication is disposed of, and where young people have a prescribed inhaler, this must be labelled.in addition we recommended that MAR sheets were being signed consistently. We carried out an audit within each of the house units, and found that medication management practices had now improved. Therefore, the recommendations have been successfully met. The service had a no smoking policy for young people who live there. Smoking cessation advice and nicotine replacements were available to those young people who require them. Young people confirmed this had been offered. Physical exercise appeared to be popular among the young people. This included using the gym facilities and in team sports, such as, football and basket ball. It was evident in the school council meeting that effort is made to provide resources to allow a range of physical sports so that this is opportunity for all. This included plans for body combat classes, boxing and zumba. All young people had an individual crisis management plan (ICMP) in place. These were the assessment documents that staff used to inform them of how to support a young person who was in crisis. Information within these plans had improved in terms of detailing what strategies of intervention would work for the individual young person. The service had an audit system in place which was checked by management in terms of ensuring that records were accurate and reflective of each young persons support needs. Staff members were trained in Therapeutic Crisis Intervention (TCI) which provided skills and knowledge in working with young people with challenging behaviours. Some staff had been trained in First Aid and other in Young Minds mental health training. St. Mary's Kenmure, page 20 of 39

21 Areas for improvement The service did not routinely us a specific risk management tool to record risk behaviours and the interventions to reduce or eliminate risk. Instead there was an over reliance on the ICMP to record risk. This was not a robust way to record risk managements with evidence was found of gaps in the recording of risk. We have made this a recommendation. (See recommendation 1 within this statement) Staff had not received dedicated training on suicide awareness and prevention. Staff members who spoke with the Inspector thought this would be beneficial given the level of vulnerability of the young people who lived at the service. We have made this a recommendation on the basis that appropriate training would enhance staff knowledge on this subject. (See recommendation 2 within this statement) Staff had not received training relating to substance misuse. Given that many young people being admitted to St. Mary's, had significant issues of misusing substances, then staff should have significant awareness in order to support young people. We have made this a recommendation. (See recommendation 3 within this statement) The quality of food was raised by several staff and young people. The method in which food was transported, use of a hot trolley, was thought to contribute to this as it looked unappetising and on occasions cold foods, i.e. salad could become warm as due to resting on top of the trolley. We have made a recommendation that issues about food are kept under review. (See recommendation 4 within this statement) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 4 Recommendations 1. The service should introduce the use a specific risk management tool which clearly states risks identified, the action to be taken to reduce and/or eliminate the risk and a date for review. National care Standards for School Care Accommodation Services. Standard 7.8 Management and Staffing 2. Staff members should receive dedicated training on suicide awareness and prevention. National care Standards for School Care Accommodation Services.7.8 Management and Staffing St. Mary's Kenmure, page 21 of 39

22 3. The provider should ensure that staff have appropriate training in relation to substance misuse, in order to support young people. National care Standards for School Care Accommodation Services.7.8 Management and Staffing 4. The service should continue to keep the quality of food and menu choices under review. National care Standards for School Care Accommodation Services Standard 11.2 Eating Well St. Mary's Kenmure, page 22 of 39

23 Quality Theme 2: Quality of Environment Grade awarded for this theme: 3 - Adequate Statement 2 We make sure that the environment is safe and service users are protected. Service strengths The service had an adequate performance in relation to this statement. We gathered our evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Speaking to Children's Rights representative - Information from placing social workers - Observation of the environment. The service had policies and procedures that guided them with matters about Health and Safety, and making sure that regular checks were being carried out. These safety checks were undertaken by the Depute Service Manager who had appropriate qualifications relating to Health and Safety. Health and Safety meetings were held to ensure safe practices regarding the environment were undertaken. The service had good fire safety arrangements in place which was carried out in line with the organisational procedures. The service had safe procedures in place when employing new staff. All staff had received appropriate Child Protection training. Movement across the service was effectively monitored by CCTV and managed by the control room staff. Staff had radios and personal alarm systems that allowed them to respond to emergency situations. Procedures were in place for searching to ensure a safe environment for young people, staff and others. The service used a drugs detector machine and had procedures in place to prevent illegal substance being taken in the premises. St. Mary's Kenmure, page 23 of 39

24 There was an anti bullying policy in place, with both staff and young people having a good awareness about bullying behaviour and the impact this can cause. We saw within minutes of young people's meetings that bullying is discussed at these meetings, and where issues arise staff are responsive. We checked that the service had an appropriate system in place to check young people at night and that they were safe. The system in place involves night staff using a fob to enter corridors and check young people every fifteen minutes through their viewing panel. Staff then record each time they have checked each young person. The fobbing system can provide electronic records from the control room. Staff had been trained in Therapeutic Crisis Intervention (TCI).This is the techniques that staff would use if they had to hold a young person safely. Staff received updated training on a yearly basis, to ensure that they were competent in their practice. The service had a maintenance person employed who had responsibility for ensuring repairs were being undertaken. Areas for improvement We observed that cleanliness within two of the units required some improvement. For example, fridge freezers had not been adequately cleaned, and that a kitchen cupboard door in one of the units had not been replaced for some time. The kitchens in general needed to be cleaner with an appropriate schedule in place to do this. We were informed that one of the units did not have a domestic worker, and that tasks were being undertaken by staff instead. There is potential risk to young people if kitchen areas and equipment are not cleaned to an acceptable standard, in terms of infection control issues. Staff have had food hygiene training, therefore should have had more of an awareness for these tasks to be undertaken. We found that daily security checks undertaken by unit staff was inconsistent. For example, there were several dates when these had not been recorded. In particular, this was in relation to the counting of cutlery. We noted that this was a previous concern raised at a staff team meeting. It is paramount that recording is undertaken on a daily basis, as these checks had been implemented by the service to ensure safety and security measures. We have made a requirement to ensure that cleaning of kitchen areas and equipment are cleaned to an acceptable level, and that daily security checks were consistent in order to ensure safety. (See requirement 1 within this statement) St. Mary's Kenmure, page 24 of 39

25 Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 0 Requirements 1. The provider must ensure that cleanliness and security within house units is given priority. The provider must ensure that: - kitchen areas and equipment are cleaned to an acceptable standard at all times in accordance with infection control practices - staff adhere to the organisational daily safety checks at all times. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, No 210: Regulation (4 ) (a) (b), welfare of users. Timescale: On receipt of final report St. Mary's Kenmure, page 25 of 39

26 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths The service had an adequate performance in relation to this statement. We gathered our evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Speaking to Children's Rights representative - Information from placing social workers - Observation of the environment. Young people were able to personalise their rooms, for example putting up posters, and have electrical goods such as TV, DVD, play station etc. Young people told us that the atmosphere was generally relaxed, safe and people getting on well with each other. Each unit had a small room that young people could play computer games. Young people had access to making telephone calls in private, and a room used for visitors was in place. The service had a gym and swimming pool, with the outside area used for exercise and games. Young people told us "staff respect your privacy and so do other young people". Areas for improvement Units in general required refurbishment as a result of wear and tear, for example communal rooms and bedrooms required to be painted. Bedrooms had graffiti ingrained on furnishings, with some bedroom windows likewise. We noticed that chairs and couches within the units were torn or damaged. These were concealed by throw over covers, to try and make them look slightly more comfortable to sit on. The overall presentation of the house units required improvements to current standards, in order to make the environment more comfortable for young people.. It was also noted that during a walk round previously by a member of the Board, that similar issues were identified. Current standards have also resulted in the current grade applied on this inspection. St. Mary's Kenmure, page 26 of 39

27 We have made 2 recommendations for improvements to be made. (See recommendation 1 & 2 within this statement) Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The provider should ensure that the house units are refurbished to an acceptable standard, and maintained on an ongoing basis. National care Standards for School Care Accommodation Services Standard 5, Comfort, Safety, and Security 2. The provider should ensure that furnishings are kept to an acceptable standard, and should either be appropriately repaired or replaced. National care Standards for School Care Accommodation Services Standard 5, Comfort, Safety, and Security St. Mary's Kenmure, page 27 of 39

28 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good 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 The service had a very good performance in relation to this statement. We gathered evidence from a number of sources including: - Speaking to staff and management - Checking reports and other documents. A sample of staff recruitment files were examined, with application forms informing of previous employment history, and a medical questionnaire. References, in the main were obtained from suitable sources including the applicant's last employment or education placement. Staff were employed subject to an Enhanced Disclosure/PVG check. This made sure that staff were suitable to work with young people, and did not have criminal convictions that would prevent them being employed in a secure setting. The recruitment process involved an assessment type interview and written task. This thorough approach ensured that the service was recruiting staff in a safe manner, and that were suitable to work with young people. Once new staff started working within the home, they were subject to a period. of induction training, to help them learn more about the job and to do it professionally. They would also work beside experienced staff, so they could be supported and learn good practice skills. Staff had good opportunities to go on and do further training and gain professional qualifications, for example an SVQ in care. Staff told us that their induction training helped them and that they had a chance to do further training for the job they do. Areas for improvement The service should continue to operate to these standards in relation all staff being recruited into the service. St. Mary's Kenmure, page 28 of 39

29 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 St. Mary's Kenmure, page 29 of 39

30 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service continues to have a good performance in relation to this statement. We gathered evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Observing staff practice - Checking reports and other documents - Speaking to Children's Rights representative - Information from placing social workers. All staff were registered with the Scottish Social Services Council (SSSC). This is the organisation that staff need to be registered with in order to be employed in child care. Staff had good opportunities in developing their skills and knowledge through training and ongoing development. The outcome for young people is that they will be looked after and supported by qualified and skilled staff. Some staff had received training for adolescent mental wellbeing. This will help staff to provide young people with additional support who may have more complex needs. Some staff had undertaken GIRFEC (Getting it Right For Every Child) training. This helped them promote effective wellbeing for young people. Staff had a good understanding of the National Care Standards and the SSSC Codes of Practice. We made a recommendation at our last inspection to ensure that staff were receiving formal supervision more regularly. Through checking records and staff confirming this, we were satisfied that the recommendation has been met We made a recommendation at our last inspection to ensure that supervision records needed to have a more effective approach in identifying staff development. We noted within this inspection that improvements had been made, especially records for unit managers. We could see that there was more emphasis on performance and practice, and that there were links to the individual personal development plan. St. Mary's Kenmure, page 30 of 39

31 Managers had received recent supervision training, therefore we will not repeat the recommendation as supervisory staff had more of an awareness about the concept of relating supervision to performance. We made a recommendation at our last inspection, to ensure that all staff had an up to date Personal Development Plan in place. In addition we highlighted that work required to be done to ensure that these plans were clearly identifying performance and training needs, and sufficient ongoing self learning. Within this inspection we met with the training team, who had done work with staff to explain the purpose of Personal Development Plans, and how this can be used in relation to registration. Training staff had assisted the process, and we could see improvements being made in this area of work. Staff now completed pre development questionnaires to establish training needs, and following training, they would complete a post training questionnaire which would assist in explaining what they had learned. We are satisfied that work undertaken was assisting improvements, therefore we will not repeat the recommendation The service had a training plan in place, and the training needs analysis was at an early stage. Staff told us that they felt motivated in their work and supported by their colleagues and management. Areas for improvement Although we had identified progress in how formal supervision was being recorded, we identified that there was still some work in progress, in order for all work being completed to the same standard. We will look at how this has developed the next time we visit. We mentioned that progress had been underway in improving the quality of staff Personal Development Plans. However we acknowledged that there was still work in progress, in order for all work being completed to the same standard. We will look at how this has developed the next time we visit. We made a recommendation at the last inspection to ensure that the training needs analysis was developed further. The training team informed us that work still required to be fully completed. St. Mary's Kenmure, page 31 of 39

32 We will repeat the recommendation to ensure that the analysis includes the following areas: * staff skill mix * gaps that need to strengthen knowledge and practice * areas where specialised training for staff could be identified and benefit young people's needs * evidencing staff competence through knowledge and understanding of best practice * areas where leadership skills could be promoted. The analysis should be linked to the service development plan in terms of priorities for projected training needs of the workforce. We have made a recommendation that the provider develops this area of work further. (See recommendation 1 within this statement) We made a recommendation at the last inspection to ensure that documentation relating to young people being searched should give clearer explanation for the reason. Within this inspection we noted slight improvement, however there still needs to be consistency. This recommendation will be repeated. (See recommendation 2 within this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The provider should review the current training needs analysis to reflect relevant information. We have given some direction under quality theme 3, statement 3 in terms of what should be considered. National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing 2. The provider should ensure that records relating to searching procedures, clearly explains reasons why it had been necessary. National Care Standards, Standards for School Care Accommodation Services, Standard 7, Management and Staffing St. Mary's Kenmure, page 32 of 39

33 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths The service had a good performance in relation to this statement. We gathered evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Checking reports and other documents - Information from placing social workers. We saw within managers individual supervision records and Performance Development Plans that they were being supported and encouraged to develop their leadership skills and performance further. Unit managers and assistant unit managers had some input to development plans. Assistant Unit Managers were involved in mentoring new staff, taking on recommendations from inspection, and improving the service. Some staff were encouraged to take on additional tasks to promote their leadership skills. Areas for improvement The service should continue to look at ways that staff could continue to develop leadership skills, through ongoing involvement in working groups, or promoting the service through seminars and sharing best practice. Staff informed that they did not have input to the self assessment information sent to the Care Inspectorate. This is something that the provider should consider in order to seeking the views about service delivery and provision. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 St. Mary's Kenmure, page 33 of 39

34 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 The service had an adequate performance in relation to this statement. We gathered evidence from a number of sources including: - Speaking to young people - Speaking to staff and management - Checking reports and other documents - Speaking to Children's Rights representative - Information from placing social workers. Within St. Mary's, auditing systems were in place along with different types of meetings. By this we mean we could see that: * Health and Safety within the service was being monitored * There were regular meetings to discuss food provided * Meetings took place with both day staff and night staff to ensure standards were being met * The Senior Management Team met weekly to discuss standards of care with good information sharing. * Members of the Board visited the service regularly to look at standards, and meet with management * The Head of Service was supported by the Chairman of the Board. We found that there were monitoring systems being carried out by management. By this we mean that they would carry out checks to make sure that: * care plans were accurate * medication was being properly used * staff were being provided with good training and development St. Mary's Kenmure, page 34 of 39

35 * environmental checks were undertaken * Incident reports were quality assured and evaluated * checks were undertaken to ensure young people were safe at night * health and safety checks undertaken. Each house unit had the responsibility of devising a unit development plan, which was designed to drive performance, and prioritise improvement. Management had started to devise an overall service development, which would look at current performance, and the future direction of the service. We spoke with several staff during the inspection who told us that they felt respected and valued in there work. Staff told us that they received support and supervision from their line managers. Areas for improvement We evidenced that two of the house units had commenced the completion of unit development plans, whilst the other two were still developing work. We will look at how this has progressed at our next inspection. Although auditing systems were in place, we observed that monitoring of support plans had not highlighted issues raised in this inspection. We have made a recommendation to ensure that auditing systems are used more effectively. (See recommendation 1 within this statement) We met with the Chairman of the Board who confirmed support for the Head of Service. We have made a recommendation that these meetings are formalised in the shape of formal supervision, with appropriate records identifying support and performance. (See recommendation 2 within this statement) We were informed by the Head of Service that there had been two Investigations undertaken by management in relation to staff practice. However, the Care Inspectorate had not been formally notified in accordance with responsibilities of providers. This is clearly documented within the Public Services Reform Act 2010, with regards to notifications to the regulator. We have made a requirement to ensure that this action is undertaken without delay. (See requirement 1 within this statement) St. Mary's Kenmure, page 35 of 39

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