Teen Challenge UK - North East Scotland Housing Support Service Sunnybrae Woodhead Fyvie Turriff AB53 8LS Telephone:

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1 Teen Challenge UK - North East Scotland Housing Support Service Sunnybrae Woodhead Fyvie Turriff AB53 8LS Telephone: Inspected by: Mark Causer Type of inspection: Unannounced Inspection completed on: 15 January 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 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Teen Challenge UK Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Mark Causer Telephone enquiries@careinspectorate.com Teen Challenge UK - North East Scotland, 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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service offers people an opportunity to address their addiction problems, in a drug-free environment which is fully structured, and involves opportunities to participate in a programme which involved participation in group work and practical activities. What the service could do better There was a need for the service to ensure that their medication policy was fully operational in both sites of the service. There was also a need for all staff to have access to regular formal supervision in keeping with the organisation's policy. What the service has done since the last inspection The service has continued to develop the environment and develop opportunities to gain a range of work-based skills which will be beneficial when service users move on from the service. Conclusion Teen Challenge offers a structured environment that helps service users to address their addiction problems. All service users who were interviewed at both centres indicated informed consent of the structured service and stated that they thought that the service was very good. Teen Challenge UK - North East Scotland, page 3 of 22

4 Who did this inspection Mark Causer Teen Challenge UK - North East Scotland, page 4 of 22

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 01 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at: Teen Challenge UK is registered to provide this housing support service to people with drug and alcohol related problems in temporary shared accommodation as specified in the notice granting registration. The service is called Teen Challenge UK - North East Scotland. Its stated goal is 'to help people become mentally sound, physically well, emotionally balanced, socially adjusted and spiritually alive'. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 01 April Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - 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 Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. 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 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. Teen Challenge UK - North East Scotland, page 5 of 22

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. Teen Challenge UK - North East Scotland, page 6 of 22

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 We wrote this report after an unannounced inspection, carried out by Mark Causer, Inspector. We visited over two days, 14 and 15 January We gave feedback to the registered manager at the end of the inspection. As requested by us, the provider sent us an annual return and self assessment form. In this inspection we gathered evidence from various sources, including relevant sections of policies, procedures, records and other documents, including: We looked at the following: * service user care plans * support plan reviews/risk assessments * service users meeting minutes on both premises * complaints record * employee handbook * sample of staff files * supervision timetabling * staff training checklist * team meetings * healthy eating policy * procedure for the safe handling of medicines * service users consultation policy * residents handbook * residents charter * Bennaiah handbook We spoke with the following people: * the registered manager * 4 support workers * 3 service users from Benaiah * 8 service users from Sunnybrae Teen Challenge UK - North East Scotland, page 7 of 22

8 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 report continued 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 Teen Challenge UK - North East Scotland, page 8 of 22

9 What the service has done to meet any recommendations we made at our last inspection All previous recommendations had been met by the service. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted a self assessment form as requested by the Care Inspectorate. This contained information on what the registered manager and staff thought that they did well and how they thought some things should be improved. Taking the views of people using the care service into account We did not issue any Care Standards Questionnaires (CSQs) prior to our visit. However we interviewed 11 out of 12 service users; the exception was a service user who was out on a planned activity. All service users indicated their satisfaction with the service. Some of their comments have already been contained in this report. The following are some additional comments: "We have lots of activities, like building sheds which I'm happy to contribute to." "We have an opportunity to be listened to." "You can leave at any point and get help to move on." "Staff help you 24/7." "Staff treat you with respect. Didn't want to go through secular rehabilitation." "I have no complaints, I'm very happy as staff will doing everything to help." "It's about freedom of choice, but the standards are set very high, so that you can live by them when you leave." Teen Challenge UK - North East Scotland, page 9 of 22

10 "The structure routine is explained to you at the interview. You are made ware that you are free to leave at any stage." Taking carers' views into account It was not possible to interview relatives during this visit. Teen Challenge UK - North East Scotland, page 10 of 22

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 Quality Statement. The service encouraged and supported service users to participate in their care and support very effectively. We looked at records, spoke with service users and staff. The service had a range of comprehensive policies, procedures, forms and information provided to service users which actively encouraged their participation. Participation was built into housing support agreements and personal support plans. The interviews with service users showed that there was high levels of involvement and reflection in their personal advice session with their personal advisor. Service users confirmed that they were actively involved in the day-to-day planning of their support plans. All service users were involved in agreeing and signing off their support plans. These were reviewed frequently with their personal advisor in "progress meetings". There was regular opportunities for service users to comment directly on the development of the service, and also to comment directly on the staff at formal personal development stages of the programmed work. There were five phases to the 44 week programme and at the end of every stage, there was a full review with service users. Service users indicated that there were daily meetings and a formal weekly residents meeting that they could raise any issues that they wished clarified or some form of action. There were examples where service users had brought issues from the skills workshops and have had the practice in the workshop changed. Teen Challenge UK - North East Scotland, page 11 of 22

12 Most service users indicated that they were aware of the formal complaints procedure. They confirmed that information pertaining to complaints was given to them at initial meetings with staff, and was signed off in the new residents check list. All stated that they were knew how to make a complaint and all had no issues of complaint with the service. Service users told us that: * "We have opportunities to put suggestion forward at residents meetings." * "Complaints information is in the welcome pack which is in my bedside drawer." * "Every week we have a residents meeting but there is an open door policy where you can go the manager anytime." * "I have never needed to make any suggestions as I have no issues with the service." Areas for improvement Although the service issues all service users with a premises handbook, it would be beneficial for the service to be more explicit in regards to what literature and music that service users can access during their stay in the service. We found that the service users at Benaiah were not fully informed of regular service users meetings. The service should consider having these at regular intervals within their structured programme and fully advertise these at the daily service users meeting. (See Recommendation 1) It may be beneficial for the service to offer service users the opportunity to sign off their new resident check list, to ensure that all service users are totally aware of all aspects where they are giving informed consent, that they were given full information on the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service to ensure that all service users are informed of the regular service users meetings. National Care Standards Housing Support Service, Standard 3: Management and staffing. Statement 3 We ensure that service users' health and wellbeing needs are met. Inspection report continued Teen Challenge UK - North East Scotland, page 12 of 22

13 Service strengths The service was delivering programmed support package that resulted in good outcomes for service users using the service. We looked at records, spoke with service users and staff. All service users had a comprehensive assessment carried out by the personal advisor. This was then used to establish the development of individual life plans where aspects of general wellbeing, financial stability, social networking, career options and home requirements were considered on a weekly basis service users care package. Service users and their families indicated that they were fully involved in the assessment and the development of care that was to be provided. There was good information in personal plans about interventions aimed at developing or maintaining service users' health and wellbeing and there was good evidence that the service supported service users to access specialist services such as doctors, dentists and any other allied health professionals. The service had a proactive approach in developing a healthy approach to diet, exercise and also awareness of spirituality. Service users indicated that this allowed them to benefit for growing self-confidence and many indicated that they felt more physically fit and well as result of the support. In both premises, there was access to the countryside and provision of the in-house gym and regular organised recreational trips to the swimming and sports centre. Service users told use that: * "Staff help you accessing the doctor and dentist." * "I've had been to ten pin bowling and even a swim in the sea." * "We also regularly go to the sports centre to play badminton." * "Health is always discussed at your individual sessions and there is a set structure put in place to help you become healthy." Areas for improvement We found that the service was not operating its medication system in keeping with their policy. The service should regularly audit its medication system to ensure that they are operating in keeping with their medication policy. (See Recommendation 1) All service users had risk assessments. It would be beneficial for service users to sign these documents to ensure that the risks are fully explored with service users. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Inspection report continued Teen Challenge UK - North East Scotland, page 13 of 22

14 Recommendations Inspection report continued 1. The service must audit its medication system to ensure that this is in keeping with the policy. National Care Standards Housing Support Service, Standard 3: Management and Staffing. Teen Challenge UK - North East Scotland, page 14 of 22

15 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 The findings in this section are similar to those identified in Quality Theme 1, Statement 1. Areas for improvement The service should continue to consult with service users in accessing and improving the quality of staff. 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 We found staff in the service to be motivated and caring about the people in their care. The examination of the relevant records and our discussions with staff and the management team showed that the service had achieved the grade of good. All staff interviewed were aware of the need to be registered with the Scottish Social Services Council (SSSC). A number of staff were already registered with the SSSC. Staff spoken with confirmed that they had access to an internal induction programme and training package which had been developed by Teen Challenge. All staff had completed first aid and food hygiene training. All staff confirmed that they had been provided with opportunities to access training in the last year. We found established systems for supervision on an informal basis. The service had an annual appraisal system and the manager was in the process of updating these for this year. All staff indicated that they had good support from the manager. They also Teen Challenge UK - North East Scotland, page 15 of 22

16 indicated that informal methods were strong and that there was an open door policy, where they had daily contact with the manager. All staff also had access to regular team meetings; these were open forums where their opinions were encouraged. Staff indicated that these staff meetings were often used directly for training and they regularly explored aspects such as policies. Staff interviewed indicated high levels of morale at this time. Service users told us about staff: * "You get unconditional care from staff." * "Quite confident that staff are skilled." * "Staff are very supportive and help you sort issues out." * "Staff see a problem but allow you to sort it out." Areas for improvement The service should consider developing the minutes of their staff team meetings to include more information, especially with regard to discussing the needs of service users. The service should develop an annual training plan which outlines individual staff development needs and indicates how these will be met by the service. (See Recommendation 1) It was evident that although there was good informal supervision of staff, all staff had not received formal supervision for some time. This should be rectified as soon as possible. (See Recommendation 2) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service to develop an annual training plan which identifies individual training needs and indicates how these will be met. National Care Standards Housing Support Service, Standard 3: Management and staffing arrangements. 2. All staff to have supervision in keeping with the provider's policy. Inspection report continued National Care Standards Housing Support Service, Standard 3: Management and staffing arrangements. Teen Challenge UK - North East Scotland, page 16 of 22

17 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 The findings in this section are similar to those identified in Quality Theme 1, Statement 1. Areas for improvement The service should continue to consult with service users, where appropriate, regarding the quality of management. 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 The service evidenced a good approach to quality assurance. The manager provided a range of evidence to show that it involved service users and staff in evaluating all aspects of the service's operation. We found the manager was effective in the use of the self assessment process; as it provided opportunities for the service to reflect on their overall quality of the provision. The manager carries out regular audits of the service and there is an annual audit carried out by the external manager. This produces an action plan which is updated with the service's progress. The service had regular opportunities for service users to be involved in feedback of the service. This included residents meetings, and service users' feedback after completion of residential phases. These were used to inform the future improvement to the service. Teen Challenge UK - North East Scotland, page 17 of 22

18 Staff were involved supervision and team meetings and used these as a platform to identify improvements to the service. Staff and service users confirmed that the service users review procedure allowed them opportunities for their practice to be improved and monitored. The provider had recently purchased a quality assurance management system which has recently been started by the manager and the co-ordinator. There was evidence that staff had carried out regular file audits and we found that service users' files were of a high standard. We also examined a timetable of quality assurance events which were planned for the following year. There had also been good compliance with previous inspections and the service had developed action plans which they were working towards completion. Areas for improvement We found that there was a need for the medication system to be audited in keeping with the service's internal policy. There may be a need to review internal audit systems to ensure that aspects, such as medication and supervision, are regularly monitored and reviewed. It would be beneficial for the service to create a report on all aspects of development that have been identified by service users, staff and external professionals. This report should outline what and how the service has acted on these suggestions. (See Recommendation 1) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service to create a report on all aspects of development that have been identified by service users, staff and external professionals. This report should outline what and how the service has acted on these suggestions. National Care Standards Housing Support Service, Standard 3: Management and staffing. Teen Challenge UK - North East Scotland, 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 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). Teen Challenge UK - North East Scotland, page 19 of 22

20 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Good 4 - Good Quality of Staffing Good Statement 1 Statement Good 4 - Good Quality of Management and Leadership Good Statement 1 Statement Good 4 - Good 6 Inspection and grading history Date Type Gradings 20 Feb 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 5 - Very Good 5 - Very Good 21 Feb 2012 Re-grade Care and support Not Assessed Staffing Not Assessed Management and Leadership 1 - Unsatisfactory 13 Oct 2011 Unannounced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 1 Dec 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 19 May 2008 Announced Care and support 4 - Good Staffing 4 - Good Teen Challenge UK - North East Scotland, page 20 of 22

21 Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Teen Challenge UK - North East Scotland, 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: Teen Challenge UK - North East Scotland, page 22 of 22