Gillburn Road Residential Respite Unit Care Home Service Children and Young People Gillburn Road Dundee DD3 0AB Telephone:

Transcription

1 Gillburn Road Residential Respite Unit Care Home Service Children and Young People Gillburn Road Dundee DD3 0AB Telephone: Inspected by: Linda Paterson Clare Cartwright Type of inspection: Unannounced Inspection completed on: 19 March 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Dundee City Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Linda Paterson Telephone enquiries@careinspectorate.com Gillburn Road Residential Respite Unit, page 2 of 23

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The manager and staff at Gillburn Road are very good at getting to know and understand the complex individual needs of the young people who use the service. They provide them with a safe and homely environment where they can relax and have fun. The service is very good at working in partnership with parents to help them and their children to benefit from the time they spend at Gillburn Road. What the service could do better The service should make sure that risk assessments are consistently updated, and that the service clearly records the actions it takes to minimise risks in the environment. It should also take forward the plan to develop a structured approach to quality assurance. What the service has done since the last inspection Since the last inspection, the service has reviewed and developed the structure of care plans in line with GIRFEC principles. Gillburn Road Residential Respite Unit, page 3 of 23

4 The new approach also helps the children and the service to be more focused on progress and to record positive outcomes for children and young people who use the service. Conclusion This is a very good quality service which provides flexible care and support to children with complex needs and their families. The manager and staff team are confident, competent and enthusiastic, and provide a warm welcome for young people who come for short breaks. Who did this inspection Linda Paterson Clare Cartwright Lay assessor: Not applicable. Gillburn Road Residential Respite Unit, page 4 of 23

5 1 About the service we inspected Gillburn Road Children's Respite Unit provides short breaks for children with a wide range of disabilities, including physical and learning disabilities, and who have associated health care, behavioural and communication needs. The breaks are individually planned in conjunction with families to try to best meet their needs. The unit was purpose-built and opened in October It is a single-storey detached building with a fenced garden and patio area which is used frequently in better weather. The living area is spacious and open-plan, in good condition and comfortably furnished. At the time of this inspection, the premises were clean, bright and welcoming. The lay-out of this accommodation facilitates wheelchair access while maintaining a homely feel. There are four bedrooms available for use by the children. All of these have a wash-basin and built-in storage. A lockable drawer is available for secure storage. There is a bathroom and a shower room, both equipped to facilitate assisted bathing. There is a range of equipment to support mobility, and a wide variety of toys, music and videos was available. A well-equipped gym room provides opportunities for improving fitness and co-ordination. There is a modern kitchen and laundry, a staff sleep-in room, and various offices. The aim of the unit is to provide the children with "a range of life-enhancing experiences" while allowing families to "have a break from the responsibilities of dayto-day caring." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Gillburn Road Residential Respite Unit, page 5 of 23

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection of this service on 22 January The inspectors were Linda Paterson and Claire Cartwright. We gave feedback to the Senior Social Care Officer on 19 March, having delayed feedback to allow for pre-inspection questionnaires to be issues and returned. During the inspection, we gathered information from a variety of sources including: Discussion with the manager, senior social care officer and tow members of staff; Informal discussion with young people, and observation of interaction between young people and staff. We looked at the following documents: a sample of care plans; accident, incident and complaint records; risk assessments; team meeting minutes. We looked at the system for storing, administering and recording medication; We inspected the premises. 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 Gillburn Road Residential Respite Unit, page 6 of 23

7 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 Gillburn Road Residential Respite Unit, page 7 of 23

8 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. We received a fully completed self assessment form from the service in good time for the inspection. We were satisfied with the information that the service had provided for the quality statements we looked at during this inspection. Taking the views of people using the care service into account We spoke informally to the three young people who came to Gillburn Road for their short break while we were visiting. We also observed their interaction with staff. All were cheerful and visibly relaxed in the company of the staff. We also received the following comment from one young person who had completed the pre-inspection questionnaire "How satisfied are you with this care service?". They said that: "I am happy at Gillburn Road Respite. I really enjoy coming to stay" Taking carers' views into account Although we didn't meet with any relatives during our visits, we did receive two completed pre-inspection questionnaires for parents. of these, one "agreed" and one "strongly agreed" that they were happy overall with the quality of care their child received at Gillburn Road. One parent made the following comments: Gillburn Road Residential Respite Unit, page 8 of 23

9 "X always enjoys going to respite. he likes to join in with games and activities. he is always happy to go to respite, and looks forward to coming home at the end of his break. He also likes going to the shops and outings with the members of staff. X has always been made very welcome at Gillburn Road, and he gets on well with everyone." Gillburn Road Residential Respite Unit, page 9 of 23

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found that the service had achieved a very high standard of practice in relation to this quality statement and s has major strengths which had had a positive impact on the quality of the service, and on the children and families who use it. During the inspection, we sampled the available evidence and found the following strengths: * Young people and their parents and carers were closely involved in planning for their short break at Gillburn Road. The manager and staff worked closely with families to get to know their needs and views, and to plan to make sure that they get the best out of their short break. The manager and or a member of staff visited the family in their own home, and young people built up contact with Gillburn Road through tea visits, and if necessary, a series of single overnight stays, until all concerned were confident that the young person had been well-prepared for their break. * Young people are valued as individuals and their stay at Gillburn Road takes into account the details which are important to them, so that as far as possible they can relax and enjoy their break. Details such as who they share their stay with, which room they prefer to be in, what equipment they like to have, whether they prefer their door to be open or closed, are all considered when planning their stay. Staff know the young people well, and were very well-prepared for their arrival, helping them to feel immediately welcome and at home when they arrived. Gillburn Road Residential Respite Unit, page 10 of 23

11 * The service has introduced the use of "short break summaries" as a way of helping parents and carers to keep in touch with what their children have been doing during their short break. The summaries were developed in response to requests from parents for more information, and are tailored to each families preferences about the kind of things they want to hear about. The young people were involved in giving their views about their break, and the summaries reflected their experiences. Some young people were supported to write their own views into the short break summaries. * Young people were encouraged to contribute to the quality of the environment in a variety of ways, for example by placing a hand print on the "Oor Hands" wall in the entrance hallway, or by collaborating in an ever-changing art activity with staff (at this inspection, a wild west theme complete with horse and cowboy added to the fun!). Involving young people in artwork in this way helped to create not only a sense of fun, but also contributed to a sense of familiarity, ownership and belonging, especially important when young people only come to stay for short periods of time. * Young people and their parents have been involved in updating a DVD which gives a view of Gillburn Road from their perspective, helping to give prospective service users a view of the service before they come along, This had proved a useful tool to help some young people to become familiar with the building and settle more easily. The recent update will give an overview of the service from parents' perspectives, enabling them to help enhance the quality of the service. * The service was in the process of carrying out a survey of parents' views, as it has done in previous years. Although not yet complete, the service described how it has responded to suggestions for improving the service by including staff photographs in a newsletter to help parents to identify which staff have been involved in looking after their child during the short breaks, which also contributes to more meaningful communication in some situations. Overall, we found that the service had achieved an excellent standard of practice in relation to its approach to enabling service users and their families to participate in assessing and improving the quality of the service. The service has demonstrated an ongoing commitment to the development of effective participation, using a variety of creative approaches to involve young people and their parents. By actively listening to their views, and by using the feedback gained, the service has been able to develop and improve the young person's individual experience, and the overall quality of the service. Areas for improvement Inspection report continued The service should continue to build on the very high standard of practice we found at this inspection. Gillburn Road Residential Respite Unit, page 11 of 23

12 Grade awarded for this statement: 6 - Excellent 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 We found that the service had very effective arrangements in place to meet the health and wellbeing needs of young people. From the self assessment form, and from evidence gathered during the inspection, we noted the following strengths: * Many of the young people who come to Gillburn Road have complex health and care needs which are clearly recorded in their care plans. Staff worked closely with families and the health professionals involved with the young person to make sure that they have appropriate information and detailed plans in place to meet their health care needs. Staff were well-trained to make sure that they are competent and confident in carrying out any emergency procedures which might be necessary, for example staff had been trained to administer buccal midazolam to support young people who have seizures. * We found that there were very good, clear systems in place for the storage and administration of medication. In this service, this is a complex matter, as children come and go frequently, and many of them take medication regularly. During the inspection, staff demonstrated a confident and competent approach to dealing with medication, and in fact the team are currently involved in training staff and supporting other residential services to develop similarly high standards. The service supported young people to self-medicate wherever possible, providing them with suitable storage and privacy. Clearly this helps to promote independence and self-help skills. * The service maintains a positive focus on meeting the wellbeing needs of young people as well as ensuring that physical health needs are met. The new care plan structure introduced by the service includes space for emotional needs to be identified and recorded. Gillburn Road Residential Respite Unit, page 12 of 23

13 The enthusiastic staff team are well-trained in a range of communication methods which enabled them to communicate with young people who have particular communication difficulties. They promoted the wellbeing of each individual by providing a warm, friendly welcome, inclusive relationships, praise and encouragement and opportunities to develop independence, skills, confidence and friendships. * The service aims to promote a healthy lifestyle for young people within the context of the short breaks, by encouraging healthy food choices wherever possible, and also by encouraging young people to be physically active. The layout of the building and the equipment available helped to encourage physical activity, for example, the outdoor area has plenty of space for football, basketball and go-karting, while inside, there is a range of gym equipment, and the ever-popular games console which provides lots of opportunities for games and sports activities. The sensory room is popular with some children who enjoy the relaxing mix of sound, light and texture. During the inspection, we saw that young people benefited greatly from the active participation of staff in their chosen activities. * The service was at an early stage of developing an approach to helping young people to understand the physical, emotional and sexual changes associated with puberty, using well-designed training materials and methods: this could be of real help to both young people and their parents. Areas for improvement The service should continue to build on the very good practice we noted at this inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Gillburn Road Residential Respite Unit, page 13 of 23

14 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths For information about the service's strengths in relation to this statement, please refer to QS 1.1. Areas for improvement For information about this statement, please refer to QS 1.1. Grade awarded for this statement: 6 - Excellent 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 Gillburn Road provides a safe and secure environment for children and young people who come along for short breaks. During the inspection, we noted the following strengths: *The premises were clean, bright and in a good state of decoration and repair; there is a secure entry system which ensures that only authorised people can access the building. * There was a range of service-specific risk assessments which address issues pertinent to Gillburn Road, eg safe use of minibus, the securing of wheelchairs, the security of the grounds etc. Routine health and safety checks are built in to the daily shift objectives for the staff team. Gillburn Road Residential Respite Unit, page 14 of 23

15 We saw that the incidence of accidents and incidents in this service was very low, indicating that risk assessments and staff adherence to safe practice were effective in helping to maintain a safe environment for young people. * The service had well-established health and safety routines in place, and paid particular attention to how the individual needs of each service user would be met in the event of an emergency, for example, how young people who use wheelchairs could be safely evacuated from the building. The service had also recently purchased new monitors to ensure that children who were prone to seizures could be effectively monitored while in their bedrooms. * In the sample of care plans we looked at, we found some comprehensive risk assessments for individual young people, detailing strategies which could be used to manage and de-escalate incidents of challenging behaviour. * Staff have access to up-to-date training and relevant policies and procedures about a range of safety and protection issues, including child protection, CALM and Moving and Handling. Areas for improvement Although as we have already described, there was a good range of general and individual risk assessments, there was not always a clear enough record of measures which had been taken to minimise the risks for particular young people. This information was often shared at handover meetings, which were not recorded. The service should put in place a system which clearly evidences that appropriate risk management procedures have been followed (see recommendation 1, QS 2.2). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should clearly record the measures it has put in place to manage risk - Standard 6 - Feeling safe and secure. Gillburn Road Residential Respite Unit, page 15 of 23

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths For information about the service's strengths in relation to this statement, please refer to QS 1.1. Areas for improvement For information about this statement, please refer to QS 1.1. Grade awarded for this statement: 6 - Excellent 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 that this was a professional, motivated and skilled staff team which operated to national care standards, current legislation and local and national policies and guidance. The quality of staffing in this service had a positive impact on the experience of young people and families who use this service. We noted the following strengths: * All staff at Gillburn Road were appropriately qualified and registered with the SSSC. They had access to a range of focused training which enabled them to meet the complex needs of young people. For some, training was specific to the needs of an individual young person, and was provided by parents or other professionals already involved. This helps to ensure that care and support are person-centred and meet individual needs. Gillburn Road Residential Respite Unit, page 16 of 23

17 * We saw that staff worked effectively as a team to ensure that they provide a consistently high standard of care. Regular team meetings provided a forum for sharing information and developing strategies to support young people effectively. Daily handover meetings and responsive care planning help to maintain a focus on current and emerging care needs. * There was a well-established system in place for regular 1:1 supervision sessions which focused on practice issues and professional development plans. During the inspection, staff told us that this was an essential and meaningful process which supported their work and professional development. The organisation is at an early stage of implementing a Continuous Learning Framework (CLF) which will provide a more structured approach to evaluating and planning staff development needs. Comprehensive training has been provided to help staff to adapt to the CLF. * Staffing levels within the service were currently very good. This enabled staff to attend training as planned, and to take forward developments in the service, such as incorporating GIRFEC into the new care plan structure. * Some staff within this service have achieved Group training certificates which has enabled them to deliver training to colleagues within the service and more widely within the organisation. This has contributed to the development of staff knowledge and skills in key areas, for example about Trauma and Recovery, and the administration of medication. Areas for improvement The service should continue to evaluate and record the impact of training and staff development on the quality of care provided. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Gillburn Road Residential Respite Unit, page 17 of 23

18 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths For information about the service's strengths in relation to this statement, please refer to QS 1.1. Areas for improvement For information about this statement, please refer to QS 1.1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths We found that this service had some very effective processes in place for ensuring that the quality of the service was maintained. From the self assessment form, and from evidence gathered during the inspection, we noted the following strengths: * The manager and senior social care officer (SSCO) were actively involved in service delivery and modelled good practice. They provided clear guidance for staff about expected standards of practice. The SSCO told us that the service planned to use Video Enhanced Reflective practice (VERP) as a tool to explore practice and communication. Gillburn Road Residential Respite Unit, page 18 of 23

19 * The service has a well-established system of regular supervision. Supervision was used to support staff, to monitor and develop staff practice, and to identify training needs, which helped to contribute to the provision of a high quality service. The service was in the process of introducing a Continuous Learning Framework (CLF) to support staff to further develop their practice. * There was an effective system in place for assuring the quality of practice and recording through the close monitoring of written records. The increased use of computerised records had helped senior staff to read and amend records more efficiently. All care plans and behavioural risk assessments were quality assured in this way. File audits were carried out to ensure that information was appropriately stored. * There was an effective system in place for monitoring the quality of medication records. * As described in QS 1.1, the service actively sought feedback from young people and their parents or carers and used this to improve the service. Over recent years, the manager and staff at Gillburn Road have continued to evaluate and develop their approach to involving young people and their families in helping to shape the service, and has demonstrated that it responds positively to suggestions for improvement - short break summaries and the inclusion of staff photographs in a newsletter were examples of this. * The external manager was actively involved in monitoring the quality of the service. Dundee City Council's Scrutiny Committee also monitored the quality of services through annual inspection reports. Areas for improvement As described above, this service had some very effective systems in place for assuring the quality of the service. It should now develop a more structured and systematic approach to quality assurance and self-evaluation. It should make sure that it keeps records of file and records audits. The service could also consider producing an annual report to share information about the service with young people, parents and carers and other stakeholders. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Gillburn Road Residential Respite Unit, page 19 of 23

20 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 No additional information noted. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Gillburn Road Residential Respite Unit, page 20 of 23

21 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Excellent 5 - Very Good Quality of Environment Very Good Statement 1 Statement Excellent 4 - Good Quality of Staffing Very Good Statement 1 Statement Excellent 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Excellent 5 - Very Good 6 Inspection and grading history Date Type Gradings 3 Feb 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 22 Nov 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 3 Aug 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good Gillburn Road Residential Respite Unit, page 21 of 23

22 22 Jan 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 15 Jun 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 27 Jan 2009 Unannounced Care and support Not Assessed Environment 4 - Good Staffing Not Assessed Management and Leadership 4 - Good 8 Sep 2008 Announced 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. Gillburn Road Residential Respite Unit, page 22 of 23

23 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: Gillburn Road Residential Respite Unit, page 23 of 23