Autism Initiatives UK Housing Support Service 53 Clayton Road Bridge of Earn Perth PH2 9HE Telephone:

Transcription

1 Autism Initiatives UK Housing Support Service 53 Clayton Road Bridge of Earn Perth PH2 9HE Telephone: Inspected by: Amanda Welch Type of inspection: Unannounced Inspection completed on: 7 August 2013

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 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Autism Initiatives (UK) Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Amanda Welch Telephone enquiries@careinspectorate.com Autism Initiatives UK, page 2 of 21

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 Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well This is a service that is providing care and support of a very high standard. Staff remain committed to improving the lives of people with complex needs by providing new opportunities and promoting a consistent approach. Staff were able to show their skill, knowledge and commitment in day to day practice and also in managing crisis and emergency situations. What the service could do better The service continued to review and reflect on their day to day delivery of care and support. This has led to ongoing positive developments in how people with complex needs are supported by the service. Staff can at times work within very challenging situations which can leave them feeling vulnerable and unsafe. The managers of the service should continue to work closely with staff to manage challenging situations and ensure that staff feel safe in their working environment. What the service has done since the last inspection People who use the service had been supported to start up a Tenants' Forum. This has proved very popular and is now completely run by people using the service. This had enhanced opportunities and experiences for service users. Autism Initiatives UK, page 3 of 21

4 Staff and managers continue to review and develop their work practice. A service user with complex and challenging needs was able to cope with a hospital admission as a result of effective planning, communication and team work from a group of staff within the service. Conclusion This is a very good service that is focussed on initiative and continued development. There was a wide range of evidence that confirmed the high standard of work and the quality of staff within the service. Who did this inspection Amanda Welch Autism Initiatives UK, page 4 of 21

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 Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Autism Initiatives UK provides a combined Housing Support and Care at Home service to service users who have a supported tenancy, known as the Earn Project. This is a flexible service; the number of hours provided is based on identified needs of individual service users and is designed to provide a specialist support service for people on the autism spectrum. The aim of the organisation is to provide a supportive environment with the aim of developing people's independent daily living skills, self esteem and confidence and ability to be a part of the life of the local community. 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 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. Autism Initiatives UK, page 5 of 21

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. Autism Initiatives UK, page 6 of 21

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an inspection of the service. Visits were made to the service on 22 and 23 July Feedback was delivered to the manager of the service on 7 August. As requested by us, the service completed and submitted an annual return. The service also submitted a self assessment of the care and support they deliver. The information from both submissions has been used to inform the inspection process and this report. During the inspection evidence was gathered from a number of sources including the following: * Policies and procedures including participation strategy * Minutes of meetings * Evaluation documents * A sample of service user care and support plans * Examination of training and other staff records * Discussion with the manager and staff * Observation of practice and interaction between staff and service users. 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 Autism Initiatives UK, page 7 of 21

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 Autism Initiatives UK, page 8 of 21

9 What the service has done to meet any recommendations we made at our last inspection There were no recommendations made at the last inspection. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted an electronic self assessment as requested by the Care Inspectorate. This identified some strengths of the service as well as some areas for improvement. The assessment contained a wide range of relevant information. Taking the views of people using the care service into account We did not speak directly with any service users during this inspection. We observed some practice and heard conversations between staff and service users. These confirmed positive relationships and experiences for service users. We received six completed questionnaires from service users or their relatives. Five confirmed that overall they were happy with the service they received. Comments included: "I get good support." "I am very pleased with quality of and nature of the care provided." Taking carers' views into account We did not speak with any carers during this inspection. Autism Initiatives UK, page 9 of 21

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 The service continued to demonstrate its commitment to participation and we found a range of evidence and examples of excellent practice in this area. This was both on a provider led and also local service level. Discussions with staff, managers and examination of written records confirmed that there was a strong culture of participation at the heart of this service. Staff told us how they supported service users to have control of their lives and were knowledgeable about individual communication plans that supported each service user to make choices and decisions. Examples included pictures, short directed sentences and visual signifiers. The introduction of a yellow card for a service user to tell staff they wanted them to leave their flat had proved particularly effective in reducing incidents related to this. Records of day to day interaction and decision making were recorded for each service user and we saw how service they were able to make choices about what they wanted to do. This was linked to staff being aware of expectations on a day to day basis. This meant that service users had the opportunity enjoy activities with reduced feelings of anxiety or distress There was a range of local and national structures for service users to be involved. In particular, staff had supported service users to set up a 'Tenants Forum'. This had proved popular and is now completely run by service users. These included setting agendas, agreeing dates and venue, chairing the meeting, consulting with all service users, writing minutes and also linking with service wide groups for feedback and new ideas. Autism Initiatives UK, page 10 of 21

11 Minutes of recent meetings written by service users, confirmed meetings where meaningful discussion and consultation was taking place with a group of service users who were confident and clear about what they wanted. Service users with a range of abilities and needs were supported to attend meetings. Particular outcomes from meetings included arrangements for future social events, feedback from the national 'I'm Heard' group and information sharing on the new 'One Stop Shop' in Perth. The service had also continued to work hard at involving parents, relatives and carers in service delivery and development. In particular, the introduction of keyworker meetings with service users and/or their relatives were proving successful and in some cases had helped to promote more positive interaction between the service and some relatives. Strong evidence also showed how parents were involved and consulted regularly on staffing issues such as recruitment. Overall, the service was using an approach which enhanced the lives of all the people who use the service. There was a clear commitment to 'active' participation, with service users very much in control and directing the care and support they want. Areas for improvement During the inspection, some staff highlighted an issue regarding communication with relatives of a service user. Staff felt that preference was being given to particular service users regarding deployment of drivers for service users cars to access activities further away. We raised this with the manager of the service who agreed that this situation had been arising as a result of ongoing communication difficulties with particular family members. The manager assured us that they are currently looking at ways of how they could address this issue to ensure a more equal service for all on a day to day basis. We will follow this up at the next inspection. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Autism Initiatives UK, page 11 of 21

12 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths This is an area in which the service met a very high standard. Inspection report continued During the inspection, we examined two care plans in detail. All the plans contained clear information and guidance on how to support the individual service user to ensure their wishes and needs were respected and met. Clear evaluations from staff confirmed that service users were developing a range of skills both practical and social and emotional. This ensured that service users were able to experience new situations, make the most of their local communities and also for some, work towards increased independent living situations. Achievements were clearly recorded through files and we examined photographic evidence that confirmed service users' confidence and pleasure at different activities and events in their lives. The service continued to use an effective way to assess risks with service users. The written content of risk assessments placed an emphasis on enhancing opportunities and promoting as much independence as possible as opposed to limiting opportunities. Safe and calculated risk taking is good practice and helps to promote a sense of continuity and achievement in people's lives. The service was currently looking at minimising restrictive practices for service users. This had required reflective discussion amongst staff and flexible thinking to make changes. Excellent examples included kitchens remaining unlocked at all times and water supplies not being turned off at night. Staff had been able to identify alternative approaches to managing safety for service users in their own flats with great success. This meant that service users had access to all areas of their own accommodation and started to learn about keeping safe and well rather than having risks completely removed and access prohibited. There was strong evidence of a multi-disciplinary approach which ensured a consistent approach and addressed changes or concerns in a coordinated manner. Particular pieces of work included extensive support from a range of health and psychiatric professionals to develop strategies to manage the challenging behaviour of service users. Records of discussion confirmed regular review and reflection on incidents with strategies adapted to minimise risks of injury and pro-actively manage situations that could cause distress and anxiety for service users. Autism Initiatives UK, page 12 of 21

13 We examined detailed, recorded evidence and discussed with staff a recent situation where they had supported a service user to go into the local hospital for observation and tests, following concern about their health. The service had already developed a Hospital Passport system for all service users. This linked to further work to ensure that the service user knew clearly what was going to happen, where they would be staying and most importantly that they would be returning home. This piece of work was clearly linked to recent research on the experiences of adults with learning difficulties who required medical treatment. Staff involved in this had shown commitment and knowledge to minimise disruption and anxiety for the service user. As a result, serious health implications were ruled out and surgery avoided. All staff within the service had opportunities to attend a range of appropriate training to enable them to provide care and support of a very high standard. This meant that service users and their families felt confident in staff ability. During the inspection, we gained a strong sense of the service's commitment to supporting service users to reach their full potential and take part in meaningful activities to the best of their abilities. This approach promoted positive self-esteem and ultimately promoted both good physical and mental wellbeing. Areas for improvement The service identified that they intended to continue to discuss and develop ideas to reduce restrictions for service users. This would continue to enhance their lives by taking small steps to increased skill development for more independent living in the future. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Autism Initiatives UK, page 13 of 21

14 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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Autism Initiatives UK, page 14 of 21

15 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths During the inspection we saw in written documentation and in discussion with the staff and managers that the staff team were a valuable asset to this service. The staff were confident in talking about their day to day roles and responsibilities within their teams and confirmed that they worked from a strong value base. During the inspection we spoke with seven members of staff including the manager and two team leader. They were all enthusiastic about the work they do and how they played a part in supporting service users to develop new skills, be as independent as possible and maintain as much control over their lives as possible. Comments from staff included, "I enjoy my job." "It's a great staff team...we all get on really well." "We support each other." "It can be challenging." "It's a good place to work." "The work you do...improving people's lives." Inspection report continued We received twelve completed Care Inspectorate staff questionnaires. Eight of these confirmed that they felt the service delivered was of a high standard and that they received appropriate support to carry out their job. Four returned questionnaires raised concerns about how staff were supported in relation to challenging and physical incidents. See further discussion under Areas for Improvement. Training opportunities for staff remained very good over the last year. Records showed a range of training attended by staff. This included Autism, Risk Assessment, Epilepsy, Positive Intervention, Sensory Awareness and Support Planning. A clear training matrix ensured staff were able to access refresher training as required. This was good practice and enabled all staff to keep up to date with best practice methods. Access to training and continual learning was supported by a process of supervision and appraisal. Staff commented that they felt supported by their line management and found supervision to be a positive experience. Discussion in this format enabled staff to build positive working relationships, which encouraged and motivated both individuals and staff teams. Autism Initiatives UK, page 15 of 21

16 We examined minutes from team meetings and staff forums. These reflected the commitment of staff to providing a quality service that met the individual needs of service users. We examined a sample of meeting minutes across the service and found all teams were being given the opportunity to contribute to service delivery and kept informed of developments and issues. Staff members confirmed that team meetings were generally positive experiences which contributed to a feeling of job satisfaction and motivation. Overall, we concluded that the staff worked effectively as a team and as individuals. All staff we spoke with were aware of their responsibilities and felt that they contributed positively to the lives of service users. We agreed with this assessment. Areas for improvement During the inspection, some staff discussed instances of challenging behaviour from service users that had led to staff injury. A number of staff had also identified that they did not always feel safe in their working environment. We raised this with manager in the service who described their role in providing debriefing, staff support and ongoing discussion in this area. They acknowledged that some staff required additional support to feel safe and would ensure this was reviewed and implemented with all staff in the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Autism Initiatives UK, page 16 of 21

17 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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Autism Initiatives UK, page 17 of 21

18 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 During the inspection, we saw that the service had a strong commitment to quality assurance and in particular involving service users, relatives, carers and other stakeholders such as health professionals in the assessment and improvement process. The service continued to use a wide range of strategies both internal and external, to ensure standards were maintained and improved as required. We examined very good records of a range of checks and audits including medication, finance, support planning and review. A range of matrix systems was in place to ensure service delivery, training and supervision for staff were up to date. This meant that team leaders had a clear picture of service users and staff requirements at any time. The manager of the service commented that the introduction of two Team Leaders had led to improvements in day to day service delivery and monitoring. Overall, the systems used by the service ensured that a high standard of service delivery was maintained and continually developed. The involvement of service users, their relatives and staff ensured that a wide variety of opinions are heard and confirms with everyone the importance the service places on them. Areas for improvement Information from a staff member in their completed questionnaire highlighted that at times confidentiality within the staff flat was compromised, due to access by service users. During the inspection, we spent time in the staff flat and found a number of rooms that would provide privacy for discussion. We discussed this with the manager and a team leader who advised this had recently been discussed with staff. We would recommend that all staff within the service are reminded of where confidential discussion can take place within the staff flat. The service identified in their self assessment that they intended to support all staff to be more involved in the quality assurance processes. This will be both in local procedures and also the national Autism Initiatives Scotland's Quality Assurance. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Autism Initiatives UK, page 18 of 21

19 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Autism Initiatives UK, page 19 of 21

20 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Excellent 5 - Very 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 30 Jul 2012 Unannounced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 7 Jul 2011 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 8 Nov 2010 Announced Care and support 3 - Adequate Staffing 4 - Good Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Autism Initiatives UK, page 20 of 21

21 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: Autism Initiatives UK, page 21 of 21