The Red House Care Home Service Children and Young People 29 Auchengreoch Avenue Johnstone PA5 0RJ Telephone:

Transcription

1 The Red House Care Home Service Children and Young People 29 Auchengreoch Avenue Johnstone PA5 0RJ Telephone: Inspected by: Janis Toy Type of inspection: Unannounced Inspection completed on: 7 November 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Young Foundations Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Janis Toy Telephone enquiries@careinspectorate.com The Red House, page 2 of 25

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 Red House has undergone a significant transformation, both in terms of models of care and improvements to the physical environment. A highly committed staff team offered young people a safe and comfortable environment in which they could feel valued and respected by those supporting them. What the service could do better The service should continue to develop existing practices, systems and processes and improve outcomes recordings, to better capture young people's achievements. What the service has done since the last inspection A comprehensive programme of works to refurbish the environment, had been carried out prior to this inspection process. The house was decorated and furnished to a very high standard and we were confident that young people would feel comfortable while living at the service. We noted that considerable work had been done to improve upon systems and processes and this had supported positive experiences for young people and staff and had created a preparedness, for when the service reached capacity, in terms of the number of young people placed at the Red House. The Red House, page 3 of 25

4 Conclusion Inspection report continued For those young people living at the service during the time of this inspection process, we found that a positively motivated and skilled staff team, provided a good overall standard of care and support to meet their needs. Who did this inspection Janis Toy The Red House, page 4 of 25

5 1 About the service we inspected "The Care Inspectorate regulates care services in Scotland. 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 If we are concerned about some aspects of a service, or think it could do more to improve, we may make a recommendation or a requirement. A recommendation is a statement that sets out the 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 that sets out what is required of the care service to comply with Public Service Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of regulation, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The service operates from a large detached villa situated in its own grounds in the residential area of Johnstone, Renfrewshire, and is registered to provide accommodation for a maximum of five children and young people aged 12 to 19 years who may have a learning difficulty or mental health problems. The organisation's Statement of Purpose includes a strong vision and mission statement. That is, " to support, develop and empower children with complex learning disabilities, behavioural and/or communication difficulties to enjoy their childhood, reach their potential and achieve a positive sense of self-worth". 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 - Grade This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. The Red House, page 5 of 25

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. The Red House, page 6 of 25

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high 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 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 A range of formal assessments. Care Plans Statement of Purpose Welcome Booklets Service Questionnaires Young People's Meeting Minutes Golden Rules of Participation Board Links with Advocacy Referral and Admission Processes Behaviour Management Plans (BMPs) Outcomes and Achievements Physical Environment Health and Safety Checks Quality Audits Improvement Planning/Self Assessment processes Staff Training Records Supervision Files Stakeholder Feedback 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 The Red House, page 7 of 25

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 The Red House, page 8 of 25

9 What the service has done to meet any recommendations we made at our last inspection The service had taken steps to improve methods of consultation and participation, with people using 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. 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 completed self assessment and used this to inform this inspection process. We agreed with the grades reflected by the service, in their self assessment. Taking the views of people using the care service into account We spoke with 1 young person living at the service who told us, " I'm really happy being here" " Staff are nice and I'm happy that I'm getting to stay for a while". " I feel safe" " I think I have a job in February at a garden centre. I went to see them to ask if they had any jobs. So I think I'll be doing that" Taking carers' views into account We did not speak with any parents or carers as part of this inspection process. The Red House, page 9 of 25

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 At this inspection, we found that the performance of the service was good for this statement. We looked at the revised Statement of Purpose, communication systems, service questionnaires, welcome booklets, young people's meetings and links with advocacy to assess this statement. Since the last inspection, the Red House had undergone a full review of provision for young people coming into the service. This allowed for a revision of the Statement of Purpose, to fully consider the nature of provision for young people and their families. A comprehensive vision and mission statement, set out a mandate, to support young people to enjoy their childhood, reach their potential and achieve a positive sense of self-worth. One of the ways in which the service achieved this, was to incorporate a total communication system into every day practices. By providing communication supports, suited to each individual's needs, the service helped young people to express their views and offer suggestions about how they would like to be supported. Examples included, personalised welcome booklets, adapted to the communication needs of every young person, pictures and symbols to assist young people to become familiar with their environment and planners to support their understanding of routines and enjoyment of activities. These and other methods used, helped young people to become less anxious about communicating their needs and allowed staff supporting them, to develop greater insight into how they could better communicate with each young person. The service used questionnaires to gather the views of young people and to understand how the service could improve the care and support of young people and their families. Comments from young people included, " I like it here. Staff are nice", The Red House, page 10 of 25

11 and " Staff treat me fairly. I met with someone who was an advocate but he was old". These and other comments showed that young people had developed positive relationships with staff and had access to others who could listen to their views and advocate for them where necessary. We also noted that the service consulted with young people, prior to coming to live at the Red House. Questionnaires asked young people, in considerable detail, about their preferences, such as, would they like blackout blinds in their bedroom and whether they preferred specific types of soap powder, to support improved health and well-being. This genuine approach to understanding the needs and wishes of young people, showed that detailed aspects of planning, were important when securing appropriate placements. A comprehensive, child friendly complaints procedure, once again adapted to suit the communication needs of individuals, meant that young people could raise a concern, in a way that this could be understood. A tracker system helped to ensure that any complaints were followed through in a timely manner. Evidence of participation by young people included the creation of a Golden Rules of Participation board, which showed several examples of young people involved in activities. By supporting young people to reflect on their experiences, the service successfully built upon relationships between young people and those supporting them. Weekly meetings with young people meant that opportunities were available to discuss and agree what supports could be put in place to promote engagement, in meaningful activity. We found evidence of young people being supported to budget and take more personal responsibility. Agreement was reached about various projects around the house, in particular the installation of a pond in the garden, where one young person prepared the ground and created a feature for themselves and others to enjoy. Further ways to encourage young people to influence the quality of their support, was noted within 'Wee Me' profiles of staff. By engaging young people in considering the main qualities of staff, they were able to express their views and help the service to consider more carefully, allocations of key workers and more specific supports, where required. Young people developed greater insight into the skills and strengths of staff and this helped to improve relationships, leading to better outcomes. Areas for improvement Inspection report continued Although we noted that the service had worked hard to develop links with local advocacy services, for young people who were placed out of area, and had also developed links with Who Cares? Scotland, we asked that they ensure that purposeful links are maintained. This will ensure that young people have access to independent support, should they require this in future. The Red House, page 11 of 25

12 Grade awarded for this statement: 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 good for this statement. We looked at referral and admission processes, access to health professionals, a range of assessment processes, behavioural management strategies and activities and achievements to assess this statement. Referral and admission procedures included full multi-disciplinary assessment, of the needs of young people and their families.pre-admission risk assessment concluded whether the service could adequately meet the needs of young people and provide a positive experience during the placement. Extensive pre-placement visits and information gathering, supported the effective implementation of these procedures. Evidence of comprehensive assessment, had resulted in the successful placement for one young person, who was achieving well within the service. The service had access to a range of clinical supports. Psychiatry, psychology and nursing expertise were among the health professional supports for young people and this helped to inform the clinical and broader assessment of young people's needs. We also noted that young people could attend GP, dental and other primary health services as required. One particular young person had successfully stopped smoking, through the support of aids offered by the Pharmacist and encouragement from the staff team. This meant that they enjoyed better health and could feel positive about their achievement. A full range of assessments helped to inform care plans for young people. Individualised assessments helped to determine young people's ability to recognise a healthy diet, maintain a safe environment and undertake personal care tasks. All of this allowed the service to 'tailor' plans to meet individual need. One outcome of assessment, included the creation of Health Action Plans, which focused on care needs such as medications and how these impacted on the young person, sleep patterns, in order to monitor any impact on aspects such as, energy levels and concentration and mental health, to identify how young people could be better supported to experience positive self-worth. Care plans were based on SHANARRI well-being indicators and by measuring outcomes across key aspects of young people's lives, the service could assess the progress of young people within the context of self-esteem and social functioning and this allowed the service to react and respond to the evolving needs of young people in their care. The Red House, page 12 of 25

13 Upon arriving at the service, risk assessments informed the behaviour management plans for young people. By developing insight into the coping abilities of young people, throughout the initial months of the placement, BMPs could be formulated through a combination of information gathered prior to commencement of the placement and early observations relating to risk and need. BMPs were reviewed throughout the placement and these offered staff helpful guidance in support of young people's safety and well-being. This was enhanced through a recognised training programme which taught staff, to help young people to express themselves in more meaningful and constructive ways. Positive outcomes for young people were evidenced through care plans and other young people's records. Examples included, the installation of a garden pond and other projects, by one young person, resulting in an enhanced the outdoor space. Attendance at work experience interviews, positive links with careers services, improved fitness and well-being through gym membership, more positive relationships with family members and a reduction in absconding and high risk behaviours all showed the commitment by young people to improve the quality of their experiences. We also noted that for others, achievements included increased attendance at school for some young people and improved diet, through involvement in preparing and cooking meals. Young people developed increased confidence and self belief, through their commitment to improve their choices and experiences. These examples demonstrated the effective strategies employed by the service, in supporting vulnerable young people, to achieve their goals. Areas for improvement Although we found that care plans and other records, relating to young people, were detailed and were based on strong assessment findings, we asked the service to continue to develop recordings which capture more clearly, the outcomes for young people. This will help young people to reflect on their achievements and allow them to feel more respected and valued for their efforts. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Red House, page 13 of 25

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 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: 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 good for this statement. We looked at the safety and security of the physical environment, staff training, quality audits, incident recordings and links with local Police to assess this statement. The Red House is accessed via a secure front door entry system, where a signing in book ensures that all visitor's identification is checked, and the purpose of their visit can be determined by staff, and where appropriate, young people living at the service. This means that young people remain safe and protected within their environment. We found that the interior of the house was decorated and furnished to a very high standard, offering young people a comfortable and safe environment. Significant consideration had been given to colour schemes which helped to promote a low The Red House, page 14 of 25

15 arousal approach to meeting the needs of young people who may experience sensory issues. Further to this, communication supports were evident throughout, in order to support young people to understand the purpose of each area. This included the classroom facility, where young people could make use of space dedicated to their learning needs and to further promote the safety of young people, some windows were fitted with polycarbonate, while some doors had toughened glass. Door closers were in place, to allow for free movement of doors, but with the facility to close in the event of a fire. These measures helped to protect young people from harm. Externally, the house offered ample space, with extensive gardens, a trampoline, a pond and various flower beds. In respect of the safety of young people, all areas were risk assessed for use. This meant that young people could experience the outdoors, in a way most meaningful to them. Various policies and practices, including a no smoking policy, which had resulted in one young person engaging in a smoking cessation programme, allowed young people to experience better health and examples of good practice included staff who were trained in Food Hygiene, Infection Control and Fire Safety. In relation to behaviour management, the service had fully trained the staff team in Managing of Actual or Potential Aggression (MAPA), a programme aimed at reducing restraint risk and enhancing the safety of young people and staff. Based on new models of care and support for young people, the manager had requested that all staff re-visit this course, to empower those supporting young people, to feel as confident as possible, should they require to intervene, to protect young people in their care. A range of health and safety procedures were in place, with regular checks of the physical environment. Fire doors were installed, where required and tests of fire equipment were routine. Other checks included, careful examination of vehicles and COSHH risk assessments, to prevent harm to young people and staff, while in the community and from hazardous substances. Improvements to the system for recording and reporting incidents, meant that a more analytical approach was taken to identify patterns and trends relating to young people's presentation and this allowed for greater insight into how young people were feeling and ways of supporting positive outcomes. Due to the nature of some young people's difficulties, the service had developed close links with local Police Officers, in order to promote the safety of young people, when in the local community. Where young people coming into the service, were likely to experience difficulty through high risk behaviours, the service provided local Police with a 'profile' of young people, in advance of the placement, in order to be prepared for any event which could arise. By managing situations jointly, Police and the service were pro-active in supporting young people's safety. The Red House, page 15 of 25

16 Areas for improvement The service should continue to ensure the safety and security of young people through robust auditing of the physical environment. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Red House, page 16 of 25

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 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: 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 good for this statement. We looked at staff qualifications, staff retention, training, team meetings and supervision records to assess this statement. All staff were registered with the Scottish Social Services Council (SSSC) and had achieved qualifications in respect of their role. The majority of staff were fully qualified, indicating a high level of skill and knowledge, in support of young people. Staff retention was extremely high, with 100%, in post throughout this year. We spoke with some members of the team, who told us," The service is now more needs led. It's been a huge learning curve for all of us, but the manager works with us and discusses how we can all improve the service", and " We feel better coming to work. It's a more nurturing approach and it has raised morale". Staff conveyed high levels of motivation and were keen to see the service, operating at full capacity. The Red House, page 17 of 25

18 Staff training had been a key aspect of the service throughout the year, with opportunities for leadership, where some staff hoped to become trainers in antibullying practices. A two-day course aimed at equipping staff to deliver "It's never acceptable" toolkit to colleagues and other events including Child Protection, delivered through the host Local Authority and Children in Mind, Health and Safety training, created opportunities to support their continued professional development. Additional events included promoting safe practices and specialist training relating to Autism and Speech and Language Therapy. This and other in-house training, allowed the team to feel more confident about their practice and support young people more effectively. Team meetings took place regularly and were consultative in nature. The manager, who has extensive experience, viewed meetings as a means of sharing good practice and further developing the knowledge and skills of the staff team. Minutes of meetings showed that a clear and structured agenda, resulted in identified actions and timescales for work to be completed. This meant that the service continued to make progress in respect of improvements. Formal supervision of staff was undertaken by the manager. This conscious decision was part of the process of ongoing assessment of skills, qualities and experience within the team and allowed for supportive allocations of staff, in meeting the needs of young people and their families. This approach also helped to standardise practice and support staff through the process of change within the service. Areas for improvement An area for improvement, identified by the service, related to training in Intensive Interaction, which is an approach used to teach young people improved communication skills. By equipping staff with this additional knowledge, young people coming into the service will be supported to experience a positive outcomes in line with their care plan. We advised that leadership opportunities for staff should continue to be promoted. We suggested several ways of achieving this. Supervision training for senior staff would help to develop the abilities of staff with supervisory responsibilities. Further to this, the development of 'Champion' type roles within the staff team, would encourage increased levels of participation and assist staff in meeting the requirements of their SSSC registration. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 The Red House, page 18 of 25

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 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: 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 quality audits, improvement planning, management meetings and stakeholder feedback to assess this statement. Monthly auditing informs improvement planning within the service. We found that systems to monitor staff performance and training, had led to events being organised to improve the skills and knowledge of the staff team. Further to this, regular supervision and team meetings, supported the ongoing development of practices for all members of the team. This included the manager, who was supported in her role, by external managers. These measures ensured regular review of systems and practices, therefore promoting positive experiences for both staff and young people. The Red House, page 19 of 25

20 Further auditing of young people's records, medications, incident analysis, updates to Social Workers and other professionals and all aspects of the physical environment, meant that young people were assured of support, which met current need and were safe within their home. Self assessment played a key role in determining priorities for the service. Further to the extensive refurbishment programme of the house, additional works had been identified and further phases of improvements to the environment were planned. The service also identified that links with advocacy services were required and we noted that there had been proactive steps taken to secure this support for young people. Other improvements identified by staff during development time, included the creation of an achievement tree, which would allow young people to display their achievements and reflect on these as they grow and develop within the service. Monthly management meetings allowed for review of service provision and a standard agenda which included looking at outcomes for young people, risk assessments and other aspects of young people's plans, meant that senior managers could consider how further improvements could be made to the quality of decisions and opportunities for young people. The service had approached external professionals to obtain their views of the service for young people and their families. We noted the following comment: " In all the years I have known XX I have never known him to be so engaging and enthusiastic about his future". When asked how well the service communicates with them, stakeholders stated that they found communication from the service to be very good. In addition, positive comments were received about how the service supports young people to keep them safe. These responses helped the service to assess their contribution to the progress of young people in their care. Areas for improvement The service should continue to develop and refine existing systems and processes, as the service grows and the number of young people increase. This will ensure that there is an ongoing preparation and improvement, as other young people and their families are supported by the service. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Inspection report continued The Red House, page 20 of 25

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 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). The Red House, page 21 of 25

22 5 Summary of grades Quality of Care and Support - Statement 1 Statement 3 Quality of Environment - Statement 1 Statement 2 Quality of Staffing - Statement 1 Statement 3 Quality of Management and Leadership - Statement 1 Statement 4 6 Inspection and grading history Date Type Gradings 12 Dec 2013 Unannounced Care and support Environment Staffing 3 - Adequate Management and Leadership 3 - Adequate 10 Oct 2013 Unannounced Care and support 2 - Weak Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 2 - Weak 29 Jul 2013 Unannounced Care and support 1 - Unsatisfactory Environment 1 - Unsatisfactory Staffing 1 - Unsatisfactory Management and Leadership 1 - Unsatisfactory The Red House, page 22 of 25

23 8 Nov 2012 Unannounced Care and support Environment 3 - Adequate Staffing Management and Leadership 19 Aug 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Management and Leadership Not Assessed 18 Nov 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 5 Jul 2010 Announced Care and support Environment Staffing Not Assessed Management and Leadership 4 Feb 2010 Unannounced Care and support Environment 3 - Adequate Staffing Management and Leadership 3 - Adequate 28 Oct 2009 Announced Care and support Environment 3 - Adequate Staffing Management and Leadership 3 - Adequate 26 Mar 2009 Unannounced Care and support Environment Staffing 3 - Adequate Management and Leadership 3 - Adequate 8 Dec 2008 Announced Care and support Environment Staffing 3 - Adequate Management and Leadership 3 - Adequate The Red House, page 23 of 25

24 All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. The Red House, page 24 of 25

25 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: The Red House, page 25 of 25