Montgomery Place Care Home Service Children and Young People 4 Montgomery Place Kilmarnock KA3 1JB Telephone:

Transcription

1 Montgomery Place Care Home Service Children and Young People 4 Montgomery Place Kilmarnock KA3 1JB Telephone: Inspected by: George Stewart Morag McGill Type of inspection: Unannounced Inspection completed on: 10 August 2012

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 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: East Ayrshire Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: George Stewart Telephone enquiries@careinspectorate.com Montgomery Place, page 2 of 24

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 N/A What the service does well The service has achieved some very good outcomes for individual young people. We found that other agencies felt that communication with the service was of a good standard. The service had maintained a good physical environment under difficult circumstances. What the service could do better The service must improve their care planning arrangements. The provider should review support arrangements for staff particularly at times when young people are presenting extreme behaviour. What the service has done since the last inspection The service has faced a difficult set of circumstances since the last inspection. Progress has been slow however outcomes continued to improve for some young people. This included access to employment, attendance at school and the introduction of life skills. Conclusion Montgomery Place has operated with a difficult mix of young people often over their agreed numbers. Despite this the outcomes for some young people were good. They have struggled to mange extreme behaviours at times and young people have Montgomery Place, page 3 of 24

4 expressed the opinion that they have not always felt safe. It is essential that the mix of young People and the support arrangements in place are improved. Who did this inspection George Stewart Morag McGill Montgomery Place, page 4 of 24

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Montgomery Place is a 4 bedded Intensive Support Unit located in a residential area of Kilmarnock. The service is relatively close to the resources and amenities of Kilmarnock town centre. The service has an aims and objectives document which states "Montgomery Place offers young people an intensive residential experience supplemented by educational support which will aim to link them back into mainstream education provision either in school, work or vocational education". Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - Grade Quality of Staffing - Grade Quality of Management and Leadership - N/A 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. Montgomery Place, page 5 of 24

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We completed this report following 3 unannounced visits to the service between 23 July and 10 August The inspection was carried out by inspectors Morag McGill and George Stewart. In accordance with Care Inspectorate's 'Inspection frequency and Guidance ' this service was inspected against the following quality themes: Care and Support Environment Staffing. As requested by us, the provider sent us an annual return. The provider also sent us a self assessment. We issued 4 questionnaires to be given to young people who used the service. 3 completed questionnaires were returned before the inspection. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents: The provider's self assessment and annual return Notification reports to the Care Inspectorate Action plan for the previous inspection Minutes of meetings with young people Minutes of staff meetings Welcome brochure Care plans and associated records Accident, restraint and incident records and audits Medication records Individual risk assessments Repairs and maintenance log Management of laundry guidance Staffing schedule and staffing rotas Staff training records Staff register/qualifications/sssc Montgomery Place, page 6 of 24

7 We spoke with: The External Manager The House Manager The Assistant Manager Care staff who were present during the inspection visit The cook/cleaner 3 young people who were using the service We also inspected the premises and observed staff working with young people during our visit. We used the 'Case Tracking' methodology detailed in the Care Inspectorate supplementary guidance for this type of service and focused on outcomes specific to 2 of the young people using the service at the time of the inspection. Views and comments are reflected in the report and were taken into account in the grading process. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to Montgomery Place, page 7 of 24

8 take. You can find out more about care services' responsibilities for fire safety at Montgomery Place, page 8 of 24

9 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 self assessment should be aimed towards robust pieces of evidence linked to outcomes for young people. This activity will be more easily linked to new care plans. Information gathered from staff and external agencies will also better inform the self assessment. Taking the views of people using the care service into account Young peoples views are well documented throughout the report. Taking carers' views into account We did not speak to any family members during this visit. Montgomery Place, page 9 of 24

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: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The grade awarded for this quality statement was 4 - good. We concluded this after we talked to young people, staff and managers. We also took account of personal plans, minutes of meetings and other supporting documentation. This included: * Face to face discussions with young people * Observation of engagement between staff and young people. * Questionnaires * Reviews * Complaints Young people had regular meetings. Young people told us they had regular access to managers including external managers. Where necessary this had included 1:1 meetings with senior managers to discuss issues of concern. Examples included the damage to property and violence to staff. Young people felt it was important that senior staff listened. We found that managers had fed back to young people and that change had occurred in line with young people's concerns. The provider had reintroduced the young person's forum and that this was now well established. This allowed representatives from each of East Ayrshire's children's houses to meet with senior managers and get quicker responses to issues of concern. Issues discussed and resolved included the use of mobile phones at night. Young Montgomery Place, page 10 of 24

11 people confirmed they were happy at how this issue had been resolved in their favour. Areas for improvement One young person told us the response from senior managers "ridiculously long process" to get any action. Young people told us they had lost confidence in young people's meetings because nothing ever changes and they would "become a boxing match". It is important that young people feel that their views are valued. The organisation should consider how they can change the perception currently held by young people. The service had found difficulty in retaining their commitment to participation during times when the house was unsettled. It is important they review their participation strategy and set short and medium term goals.(see recommendation 1 for this quality statement). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service and the provider should review their participation strategy and set and monitor achievable goals. Young people should be involved in this review. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths The grade awarded for this quality statement was 4 good. Inspection report continued There were some very good outcomes for individual young people. These included full time employment, holidays abroad which young people told us was an excellent experience. Young people were taking part in a planned and structured summer programme. This was consistent with the aims identified in care plans and interests expressed by the young people. Activities included "drama school", football and trips to places of interest. Montgomery Place, page 11 of 24

12 Young people told us that staff tried hard to help them achieve their potential. This included support in transition and work with other agencies to achieve goals. This included the intensive support team and sports development team. Areas for improvement Young people told us that at times they could not live their lives normally. They felt that at times staff were too busy dealing with behaviours to "drop them off" or "spend any time". Young people told us that when there was more than the agreed registered maximum of 4 young people staff had struggled to meet their needs. We found clear evidence that the mix of young people had impacted on the quality of service on offer at Montgomery Place. The provider must assess the impact of admissions on an ongoing basis particularly when the unit is operating above it's agreed numbers. (See recommendation 1 for this quality statement). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should better assess the impact of new admissions on the quality of life of young people already accommodated within the service. Where this impact cannot be managed steps should be taken to support the service and the young people. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The grade achieved for this quality statement was 4 good. Inspection report continued Young people continued to have access to initial Health Assessments from the LAAC Nurse. Further specialised support was available on an individual basis. This had included innovative work with health staff to support young people who were refusing to engage through the normal appointments system. We found the service had worked well with other agencies such as Child and Adolescent Mental Health Services (Calms) to ensure young people had access to the additional support they required. We found that young people living at Montgomery Place had an allocated leisure and development worker. They supported young people to try a range of healthy leisure Montgomery Place, page 12 of 24

13 pursuits. Where a young person found an activity that they liked they were supported to join and attend regularly. The support offered to continue attendance was consistent with the needs of individual young people. This approach continued to provide very positive outcomes for young people. They had been supported to access a range of activities including the Gym, Dance and Zumba. The following recommendation was made at the previous inspection, The service must work to ensure that all care plans are being progressed and continue their work to include all relevant professionals in this process. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. The service had worked with other agencies and departments to achieve the goals set out in young People's care plans. This included access to employment and planning for transition. This recommendation was met. Areas for improvement The organisation had been reviewing the content of care plans for a long period of time. This had not progressed at an acceptable pace and implementation of the new plans should become a priority. We would expect that the new plans are inclusive are within the "Getting it right for Every Child" (GIRFEC) framework and make clear reference to the SHANARRI well being outcomes. (see recommendation 1 for this quality statement. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The proposed new care plan documents should be implemented at the earliest opportunity. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. Montgomery Place, page 13 of 24

14 Quality Theme 2: Quality of Environment Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The grade achieved for this quality statement was 4 good. We concluded this after we considered feedback from young people, staff and other stakeholders. Please see statement 1.1. for information on how the service consulted with young people and their families. Young people confirmed that they had been involved in the selection of furnishings that had recently purchased. In addition where decoration had taken place they had selected the wallpaper. Areas for improvement See quality statement 1.1 Grade awarded for this statement: 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 The grade awarded for this quality statement was 4 good. The service had worked to maintain the improvements made to environmental safety at the previous inspection. We found a range of generic risk assessments that had been reviewed and signed off by senior staff. These included security of the house. Each risk had a series of actions that should be taken to minimise the danger to young people. We found staff familiar with child protection policy and procedures and Therapeutic Crisis Intervention (Behaviour de-escalation techniques). This helped ensure young people were looked after safely. Montgomery Place, page 14 of 24

15 We found appropriate arrangements for the management of infection control and food hygiene. Areas for improvement Young people told us that they did not always feel safe. The service had gone through an unsettled period in which young people at times had felt intimidated and fearful. We found that although the provider had listened to concerns support for staff and therefore for young people had not been well received. There is a need to ensure that staff and young people feel listened to and supported in times of crisis. (see recommendation 1 for this quality statement). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should review the arrangements for supporting staff and young people in times of difficulty. These arrangements should be recorded and reviewed. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths The grade achieved for this quality statement was 4 good. Each young person had their own room with en-suite shower facility. Despite recent challenges thees had been maintained to a good standard. Night staff had continued to be innovative in supporting young people at vulnerable times. Young people had welcomed this approach that had included a range of theme nights. We found young people supported to undertake age appropriate tasks designed to support them for future transitions towards independence. This included cooking, washing and budgeting. We found very good individualised arrangements to motivate some young people towards achieving the goals set out in their care plans. This was particularly true of young people who were working. This had included good partnership working with employers and variation to arrangements within the house. Montgomery Place, page 15 of 24

16 Areas for improvement The following recommendation was made at the previous inspection. The provider should provide a clear protocol including timescales regarding the suitability of accommodation when unit's are operating above the agreed numbers. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. The service operated above their agreed registered number for a significant period. This meant that one of the two sitting rooms had to be used as a bedroom. Young people told us that at that time behaviours were challenging and that the additional space was needed to retreat from the aggressive behaviour. The house is not well designed to accommodate additional young people. Where those accommodated have to remain for an extended period this must be included in the risk assessment and protocols. This recommendation was not met. (see recommendation 1 for this quality statement). Where the service is repeatedly unable to operate within the conditions of registration consideration should be given to varying the conditions of registration. (see recommendation 2 for this quality statement). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The provider should provide a clear protocol including timescales regarding the suitability of accommodation when unit's are operating above the agreed numbers. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. 2. The provider should consider varying the conditions of registration to reflect the numbers of young people accommodated within the children's house. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. Montgomery Place, page 16 of 24

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The grade awarded for this quality statement was 4 good. Please see quality statement 1.1 for evidence of how the service consulted with young people and their families. In addition we, Examined documentation, Spoke to the manager and staff members, Spoke with young people who use the service. We also reviewed the following arrangements, Service user involvement in the selection of staff, Keyworker roles. We found that the service provider continued to include young people in the recruitment and selection of staff. This included involvement in group interviews and the development of questions for individual interviews. Areas for improvement See quality statement 1.1. Grade awarded for this statement: 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 The grade achieved for this quality statement was 4 good. Montgomery Place, page 17 of 24

18 The evidence we looked at included: Staff training records and training Plan, Staff supervision records, Speaking with staff, Speaking with the manager, Observing practice. All staff were professionally qualified and registered with The Scottish Social Services Council. We looked at the training programme in place. Staff had undertaken training in a wide range of areas designed to better equip them to deal with the challenges presented by a diverse group of young people. Staff generally presented as committed and enthusiastic about their work. They knew the young people well and were able to outline strategies used to support young people especially in times of crisis. We reviewed the planned programme of individual supervision and found that staff had access to regular and purposeful supervision. Staff we spoke to found this to be helpful. Supervision fed into East Ayrshire general employee review (EAGER) which measured staff performance against 6 core competencies. The records sampled were considered and constructive with a clear action plan for future development. We think there were good staff communication systems in place. We examined Care Inspectorate questionnaires that had been returned from people who use the service. Young people agreed that staff had the knowledge and skills to support them. This was confirmed by young people when we discussed staffing issues during the visits. Areas for improvement We found staff had been under significant pressure in recent months. We found that support arrangements had not been robust enough. This had left many staff demoralised. Young people told us that thy felt staff had been under pressure dealing with the challenging behaviour of some young people. This at times this had included high levels of violence. (see recommendation 1 for this quality statement). Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Montgomery Place, page 18 of 24

19 Recommendations 1. The provider should review their support arrangements for staff. This should include a review of training needs and de-escalation training. National Care Standards, Care Homes for Children and Young People Standard 7: Management and Staffing. Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service strengths The grade achieved for this quality statement was 4 good. During our inspection visits we found there was usually a positive attitude between staff and young people. Young people and staff showed respect for each other and were comfortable in each other's company. It was evident that young people were used to putting forward their views and having these taken into account. We saw that young people were tolerant of one another and were supported by staff acting as good role models. Evidence in other statements of this report also supports the grade for this statement. We found that staff and young people have a good range of opportunities to put forward their views and have access beyond immediate line managers to senior managers. Young people were very clear that recent changes within the house had made living arrangements far more pleasant Areas for improvement The absence of recent questionnaires meant it was difficult to gauge the overall morale amongst staff who had clearly been through a difficult period. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Montgomery Place, page 19 of 24

20 Quality Theme 4: Quality of Management and Leadership - NOT ASSESSED Montgomery Place, page 20 of 24

21 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Montgomery Place, page 21 of 24

22 5 Summary of grades Quality of Care and Support - Statement 1 Statement 2 Statement 3 Quality of Environment - Statement 1 Statement 2 Statement 3 Quality of Staffing - Statement 1 Statement 3 Statement 4 Quality of Management and Leadership - Not Assessed 6 Inspection and grading history Date Type Gradings 27 Feb 2012 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 3 Jun 2011 Unannounced Care and support Environment Staffing Not Assessed Management and Leadership Not Assessed 20 Dec 2010 Unannounced Care and support 3 - Adequate Environment Not Assessed Staffing 3 - Adequate Montgomery Place, page 22 of 24

23 Management and Leadership 3 - Adequate 13 Jul 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 6 - Excellent Management and Leadership Not Assessed 3 Mar 2010 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 23 Oct 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing Management and Leadership 27 Mar 2009 Unannounced Care and support 5 - Very Good Environment Staffing Management and Leadership 4 Sep 2008 Announced Care and support 5 - Very Good Environment Staffing 5 - Very Good Management and Leadership All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Montgomery Place, page 23 of 24

24 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: Montgomery Place, page 24 of 24