Green Pastures Care Home Service Children and Young People Green Pastures Sandilands Lanark ML11 9TY

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1 Green Pastures Care Home Service Children and Young People Green Pastures Sandilands Lanark ML11 9TY Inspected by: Janis Toy Type of inspection: Unannounced Inspection completed on: 6 June 2014

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 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Inspire Scotland Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Janis Toy Telephone enquiries@careinspectorate.com Green Pastures, page 2 of 26

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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service has continued to develop existing systems and processes in support of positive outcomes for young people. Young people's plans were comprehensive and were written in conjunction with young people living at the service. What the service could do better The service should further develop methods of consulting with young people, their families and other agencies. External monitoring practices should be implemented more consistently in order to provide more detailed overview of service provision. What the service has done since the last inspection The service was able to demonstrate that young people's care plans continued to be fully implemented, with very good evidence of participation from young people in their care and support. Conclusion Green Pastures offers young people a supportive environment in which they can feel safe and nurtured, by a staff team who were experienced and motivated. Green Pastures, page 3 of 26

4 Who did this inspection Janis Toy Green Pastures, page 4 of 26

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to April 2011, this function was carried out by the Care Commission. Information relating to all care services is available on our website at If we are concerned about some aspects 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 Reform (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. The service is a registered care home for children and young people. It is registered to provide for a maximum of four children and young people, who are encouraged to be responsible citizens: to take part and gain strength and confidence by being actively involved in the world around them. The accommodation is comprised over two floors, with a large lounge and separate recreational room. There is a large dining kitchen and three bedrooms with private bathroom facilities. In addition, there is a self-contained flat within the house which is currently used to prepare young people for a more independent lifestyle. Outside, the large garden is landscaped and affords young people further space, within a calming countryside location. 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 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Green Pastures, page 5 of 26

6 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. Green Pastures, page 6 of 26

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 During this inspection process, we gathered evidence from a range of sources including relevant sections of policies, procedures and other documents. These included; Certificates of Registration and Insurances The provider's self assessment and annual return Care plans Risk assessments Weekly planners Staff rotas Staff supervision files Young people's participation questionnaires Quality assurance audits/tools Training records Evidence of complaints Newsletters Individual Crisis Management Plans (ICMPs) Incident records Notifications to the Care Inspectorate Young people's reports 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 Green Pastures, page 7 of 26

8 Inspection Focus Areas (IFAs) Inspection report continued 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 Green Pastures, page 8 of 26

9 What the service has done to meet any recommendations we made at our last inspection We made a recommendation at the last inspection and asked the service to demonstrate that young people were involved in decisions to improve the environment. The service had recently involved young people in redesigning areas around the house. Painting and decorating, as well as new furnishings and fittings had been identified for some communal areas, intending to further enhance the quality and homeliness of the house. 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. Every year all care services are required to submit a self assessment form, telling us how they think their service is performing. We check to make sure this is accurate. We received a comprehensive self assessment and used this to inform the inspection process. Taking the views of people using the care service into account Some comments from young people are contained within the body of this report. These additional comments were gathered during the inspection visit. "I find staff are more supportive here than where I was before". "It's a good place. I get help with independence and get a budget for clothes and things I need". "XX is proper supportive". "I'm working. I prefer that to being in a class. I don't feel comfortable in a class situation". "Communication at times has been shocking". Green Pastures, page 9 of 26

10 "Big X has helped me with issues with my family. I like talking to him". Taking carers' views into account We did not speak with any parents or carers during this inspection process but we did see comments contained within service questionnaires, received in recent months. One comment included, "Staff are so friendly and approachable. I feel at ease knowing my son XX is well looked after and cared for in Green Pastures and that he is getting all the help and support that is needed. Keep up the good work!". We also noted that questionnaires had asked parents/carers to comment on how included they felt, in their child's care and support? All responses provided positive comments. Green Pastures, page 10 of 26

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: 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 At this inspection, we found that the performance of the service was good for this statement. We looked at weekly updates to care plans, newsletters, complaints, questionnaires and spoke with young people to assess this statement. We found that the service had continued to consult regularly with young people, through weekly updates to care plans. Weekly targets, reviewed with young people, helped to demonstrate the commitment to involving young people in all aspects of their care and support. Clear references to the well-being indicators of SHANARRI, allowed young people to reflect on their progress, across all key areas of their lives. Agreed outcomes were evidenced and regular discussions with key workers, meant that young people could express their views in private, while addressing any issues of concern to them. By engaging with young people individually, the service showed respect and consideration of privacy and dignity for young people in their care. Pathway plans were in place for those young people moving on from the service and these demonstrated that young people were aware of the plans for their future and were being supported to engage in discussions about their life beyond the service. By involving young people in decisions, the service and colleagues from Social Work were able to clearly identify the supports necessary to promote successful transitions. Young people contributed to the publication of newsletters, compiling articles about their experiences of living at Green Pastures. The most recent newsletter contained detailed articles from all young people, who discussed their achievements and what plans they had for the coming months. By encouraging young people to feel confident Green Pastures, page 11 of 26

12 about publishing their views, this helped them to feel valued and respected for their contribution and helped them to recognise the progress they were making. Young people and staff met weekly to discuss activities, travel plans and their choices of meals for the week ahead. These opportunities provided structure in the lives of young people who benefitted from the sense of purpose, that being involved in decisions, brought to their support. Complaints were managed appropriately by the service and where young people felt aggrieved about an issue, then evidence showed that this had been explored by the service and resolved, where possible. Young people were aware of the complaints procedure and felt able to make use of this to express their dissatisfaction on occasion. We asked young people about their views of their living environment. They confirmed that they were encouraged to choose items to personalise the house, and in particular, their bedrooms. We also noted that young people were being consulted about decoration of the main lounge, at the time of this inspection. This practice increased young people's sense of belonging and ensured that they felt empowered in decisions, taken to improve their home environment. The service worked hard to promote the inclusion of young people, and questionnaires distributed by the service to young people over recent months, conveyed positive feedback from about their support. Comments from young people included, "It's a good place to live. I get the help I need to be more independent. Most of the staff understand how to support me", and "I get on well with XX, she has really tried to help". Areas for improvement Inspection report continued Although most comments made by young people, were positive about living at the service, some young people were unhappy about specific arrangements. They told us that communication about their future had not been as good as it could have been and that where replacement items for the house were identified, these had been slow to arrive. We discussed these views with the manager, who told us that young people moving on were often highly anxious about plans for their future and while the service had tried to fully engage young people in each stage of their transition plan, this had at times, been met with some resistance by young people. It had therefore, been difficult to maintain open lines of communication at all times. We agreed that the service should continue to encourage full participation of young people, in helping them to achieve a smooth transition. We asked the service to explore how independent advocacy for young people could be promoted to a greater level than was currently in place. This may provide young people with another 'avenue' through which they can express their views. Green Pastures, page 12 of 26

13 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued At this inspection,we found that the performance of the service was very good for this statement. We looked at care plans, work experience opportunities, leisure and fitness activities and general health supports, to asses this statement. Care plans for young people provided detailed and relevant information relating to individual need. The service promoted the use of the Getting it Right for Every Child (GIRFEC) framework, throughout all paperwork, relating to young people. Very good application of SHANARRI indicators, allowed young people to understand how outcomes related to their overall well-being and it was clear that young people were gaining in confidence, through achievements such as passing their driving test and being involved in work experience in the local community. Successful outcomes were evidenced through a range of opportunities for young people. Examples of young people engaged in work experience, showed that their abilities to sustain placements, resulted from positive feelings of self-worth and achievement. High attendance at employability courses and participation in residential training courses, further demonstrated young people's commitment to learning new skills in support of actively achieving success. Recognition of achievements for young people, through a formal presentation, where family members were invited to join in celebrations, meant that young people could share their success in the company of those who meant most to them. Involvement in local community projects and volunteering, aimed at supporting national charities, meant that young people could help others, while benefitting from a structured approach to daily living. Weekly planners, compiled with young people, encouraged involvement in a range of leisure activities. These included use of a local gym, where young people could learn about the benefits of exercise and healthy eating. Other areas of interest included, skateboarding, golf and baking. By helping young people to lead active lives, the service was able to promote healthier outcomes and support young people to enjoy taking part, in activities which were of interest to them. The service promoted the health of young people by actively supporting them to attend appointments. Motivators provided encouragement and young people were supported to recognise the benefits of positive links with health professionals and we noted that young people took personal responsibility for their own health and well- Green Pastures, page 13 of 26

14 being, through their participation in health and fitness regimes and by seeking the expertise of medical professionals. Local mental health teams had contributed to the support of young people and LAAC Nursing staff offered advice and acted as a point of referral to other colleagues in health services. The service had worked hard to sustain positive links with health colleagues and this allowed young people to receive help, when they needed it most. Staff were trained in medication practices and a robust administration procedure ensured the safety and well-being of young people, who required treatment. Further support and training was provided by local consultants, where a focus on trauma informed care and self harming behaviours, offered staff valuable insight into the needs of young people. To support risk behaviours, the service compiled detailed risk assessments and Individual Crisis Management Plans (ICMPs), in consultation with young people, to help reduce these behaviours. We noted that a range of deescalation practices were implemented by staff and these assisted young people to reduce levels of anxiety and aggression. Contact with family members allowed the service to work in partnership with parents/carers and support young people to spend time in the family home. The service had supported young people to travel independently, to allow for positive experiences and outcomes for young people. Areas for improvement The service should continue to offer young people opportunities which support their learning and development. This will further enhance the skills and abilities of young people in preparing for a successful future. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Green Pastures, page 14 of 26

15 Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths At this inspection we found that the performance of the service was good for this statement. Please see statement 1.1 Areas for improvement At the time of this inspection, we commented to the manager that we felt that the physical environment, in some areas of the house, would benefit from some repair and redecoration. We were pleased to observe that on a further visit, the service had taken steps to improve and renew aspects of flooring and to purchase new furnishings for the lounge. Young people were involved in these decisions. The service should continue to identify and improve the environment, as required. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths At this inspection, we found that the performance of the service was very good for this statement. We looked at environment checks, risk assessments, incident records, repairs and maintenance files and spoke with managers and staff to assess this statement. Green Pastures require visitors to sign in and produce identification, to confirm the purpose of their visit. This practice supports the safety and security of young people within their home. Green Pastures, page 15 of 26

16 A detailed system of environmental checks ensured the continued comfort and safety of young people, staff and visitors to the house. The house was maintained to a good standard, with evidence that most repairs were carried out quickly, in order to avoid any inconvenience to young people. Where external contractors were required to attend to more specific repairs, or safety tests such as water temperature and legionella, electrical or fire safety, the service was attentive to such issues and ensured an appropriate response to annual checks. A repairs book provided evidence of works carried out and timescales suggested prompt solutions were sought. Risk assessments, which encouraged young people to recognise and manage their own behaviours, provided further safeguards, prior to participating in activities. Examples of safe independent travel and involvement in local work experience, meant that young people were empowered to lead active lives which enhanced their personal experiences and skills. Where incidents involving young people had taken place, the service kept detailed records to ensure accurate recordings of behaviours, including absconding and police involvement. Records held appropriate and adequate information, relating to young people, and where absconding may occur, a pre-populated document helped to inform other agencies of the potential whereabouts of young people when they were missing from the service. The service also liaised with families, to help minimise any risk to young people whose whereabouts could not be confirmed. Where notifications were required to be made to the Care Inspectorate, the service ensured that they submitted the necessary information to comply with this requirement. Records showed that young people were supported to understand the impact of their behaviours and by discussing any consequences of specific behaviours, young people were supported to take more responsibility for their actions. Staffing levels were appropriate to the needs of young people living at the service. Staff were trained in de-escalation techniques and de-briefs were carried out with staff and young people following each incident. The service had made improvements to recordings in respect of de-briefs with young people, where they were asked to comment on how safely they felt they had been supported. Food hygiene training supported safe practices in relation to the preparation of food and infection control was further supported through daily cleaning routines. A recent Environmental Health visit, produced no key issues requiring improvement. Areas for improvement The service should continue to develop its protocols for de-briefing, following incidents involving young people and make use of the data collated to support the ongoing development of staff practice. Green Pastures, page 16 of 26

17 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Green Pastures, page 17 of 26

18 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths At this inspection, we found that the performance of the service was good for this statement. Please see statement 1.1 Areas for improvement The service should continue to explore creative ways in which young people can influence the quality of staffing within the service and how this practice can provide further evidence for this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection, we found that the performance of the service was very good for this statement. We looked at training records, supervision files, staff qualifications and spoke with staff, young people and managers to assess this statement. Improvements to the induction programme for staff included updated policies and procedures around food safety and infection control practices. The service made use of current guidance to ensure effective food hygiene practices and improved safety in relation to hand washing. This meant that staff were informed of best practice guidance and could implement this effectively. Green Pastures, page 18 of 26

19 Training and leadership opportunities for staff and managers included a new focus on the social paedagogy model of practice, with initial training for all staff. The service had enrolled the expertise of an external consultant to deliver aspects of trauma informed care to the staff team and contracted CELCIS to update staff on issues affecting young people who self harm. Internal training included learning about new child care legislation and the development and implementation of an assessment framework, had improved staff understanding of outcomes recording and reporting. This meant that the team had developed the ability to report more effectively on outcomes for young people. Leadership roles had been further developed to take account of daily systems such as, fire safety and medication. An in-house CALM trainer continued to ensure all staff were aware of best practice when supporting young people presenting challenging behaviour, with comprehensive analysis of incidents informing the agenda at staff meetings. These and other forms of training and development had promoted consistency within the team and staff told us that they felt that they worked better as a team, through the support of their skills and knowledge. Comments included, "I feel that there have been definite improvements in our team working and that generally we have a better understanding of our roles", and "We all have a 'can do' attitude and that comes from managers". Some staff were undertaking formal qualifications suited to their role, while others met the conditions of their registration with the Scottish Social Services Council (SSSC). The manager had completed a management and leadership award since the last inspection and was implementing this learning into daily practices at the service. Staff recruited into the service, over previous months, had been selected in terms of what added value they could bring to the existing team and those we spoke with, commented that this had been successful in sharing learning and experiences and had allowed them to develop further as a team. Development of staff had been further supported through a whole team development day, where old and new ways of working had been explored. Staff spoke positively about this opportunity to reflect on current practice and consider how improvements could be implemented, to raise standards, in support of young people. Staff supervision and appraisals were up to date, with files demonstrating effective progress towards agreed objectives, for staff and managers. Improvements to the recording format, now allowed for training and continuing professional development records, to be included in staff files. This practice ensured a continued focus on the need for staff to demonstrate their ongoing training and development within their roles, in line with SSSC registration requirements. Green Pastures, page 19 of 26

20 Areas for improvement The service should continue to engage the support of suitable external professionals, who can further enhance the work of the staff team. This will ensure that key issues experienced by young people can continue to be supported effectively. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Green Pastures, page 20 of 26

21 Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths At this inspection, we found that the performance of the service was good for this statement. Please see statement 1.1 Areas for improvement Please see statement 1.1 Grade awarded for this statement: 4 - Good 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 At this inspection, we found that the performance of the service was good for this statement. We looked at a range of quality systems including audits and assessment frameworks, stakeholder feedback, improvement plan and spoke with managers to assess this statement. The service had further developed systems and processes to ensure quality within all aspects of the service. A range of audits provided evidence of strengths and areas for improvement. Where systems, processes and practices, required to be addressed, there was written evidence of appropriate guidance and realistic timescales for staff to remedy any outstanding work. These audits showed that the manager was up to date with developments and had a thorough knowledge of the needs of young people and the staff team. Green Pastures, page 21 of 26

22 The provider had developed an assessment framework, which focused on the wellbeing indicators of SHANARRI and evidence contained within daily and weekly records for young people, showed an increased understanding of outcomes recording. This meant that young people's plans demonstrated progress towards agreed objectives and individual achievements. The manager ensured the quality of recordings through weekly audits of all care plan information. In consultation with stakeholders, the service had created an improvement plan. Based on the quality themes of the Care Inspectorate, the plan identified areas for improvement, those responsible and evidence of progress. An example of this was demonstrated within the theme of care and support, where young people had requested additional activity monies and this had been agreed, allowing more access to local resources, where the health and well-being of young people had been further supported. Other examples of progress were found within the heading of, safety of the environment, with the external manager undertaking regular 'walkarounds' of the house and garden to provide an external overview of standards. External stakeholder feedback, offered additional evidence of the quality of the provision, with comments from placing Social Workers, including, "It's difficult to balance and maintain safety and yet not compromise developing independence. Green Pastures try to achieve this and are good at opening discussions and involving myself as the Social Worker", and "The living environment at Green Pastures is lovely and welcoming and meets the needs of young people resident there". Areas for improvement Although the external manager regularly visits the service to provide support and to assess the quality of the environment, as well as monitor staff practice, we would encourage a more wide-ranging audit of the service to take account of all aspects of service delivery. We advise that a formal audit tool is used to capture the current standards of practice and provide the team with clear direction in terms of improvements. The service should develop more systematic ways in which it can elicit the views of external stakeholders in order to inform improvements. By more consistently evidencing consultation with stakeholders, the service will better demonstrate how the evolving views, of all involved in the support of young people, are taken into account when developing the improvement plan. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Inspection report continued Green Pastures, page 22 of 26

23 Recommendations Inspection report continued 1. The service should implement formal quality audits by external managers, taking account of all aspects of service delivery. National Care Standards, Care Homes for Children and Young People, Standard 7, Management and staffing. Green Pastures, page 23 of 26

24 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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Green Pastures, page 24 of 26

25 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 5 - Very Good Quality of Environment Good Statement 1 Statement Good 5 - Very Good Quality of Staffing Good Statement 1 Statement Good 5 - Very Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history Date Type Gradings 6 Sep 2013 Unannounced Care and support 4 - Good Environment 4 - Good 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. Green Pastures, page 25 of 26

26 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: Green Pastures, page 26 of 26

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