Station Road Care Home Service Children and Young People 39 Station Road Carluke ML8 5AD Telephone:

Transcription

1 Station Road Care Home Service Children and Young People 39 Station Road Carluke ML8 5AD Telephone: Inspected by: Howard Armstrong Duncan Craig Type of inspection: Unannounced Inspection completed on: 23 May 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 15 4 Other information 33 5 Summary of grades 34 6 Inspection and grading history 34 Service provided by: South Lanarkshire Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Howard Armstrong Telephone enquiries@careinspectorate.com Station Road, page 2 of 36

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 3 Adequate What the service does well Staff were motivated and enthusiastic. They worked well together as a team and with other local agencies. They understood the young people and their families well and had developed good strategies to support them. Overall, young people were happy with the care that they received. What the service could do better We made requirements about the lack of a robust quality assurance system, and about the need to make notifications to the Care Inspectorate. We made recommendations that included issues like participation, the administration of medicines, and staff supervision. Also, we made recommendations about staff shortages, staff deployment and 'safe holding' issues. What the service has done since the last inspection The provider had met most of the requirements and recommendations that we made at the last inspection. Station Road, page 3 of 36

4 Conclusion Staff continued to deliver a warm and supportive service to young people in often difficult circumstances. The house was more settled now, but imminent staffing changes would need sensitive management. Young people would benefit from a stable team that was supported to re-form and improve on the current good standards of practice. Who did this inspection Howard Armstrong Duncan Craig Station Road, page 4 of 36

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services 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 Care Inspectorate. Station Road is owned and managed by South Lanarkshire Council. The service is provided from a purpose built house in Carluke. It blends well with the local community and is not far from the town centre. It is registered as a care home for children and young people to accommodate a maximum of eight children. There were four young people living in the house at the time of this inspection visit. There are seven bedrooms, one of which could accommodate two people. Young people have access to a comfortable lounge, a computer and study room, a dining kitchen and very good outdoor space. In addition to the acting depute manager, there were two staff present throughout the inspection visit. The service aims to 'provide care for children in South Lanarkshire Council who require a safe environment' on a long term basis. Station Road, page 5 of 36

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 3 - Adequate 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. Station Road, page 6 of 36

7 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 wrote this report following an unannounced inspection visit on 23 May 2013 between 10.00am and 6.15pm. We gave feedback to the acting depute manager at the end of the visit. Inspectors Howie Armstrong and Duncan Craig carried out the inspection. We took account of the completed annual return and self assessment forms that we asked the provider to complete and return to us. We sent six care standards questionnaires (CSQs) to the service for distribution to young people so that they could give us their views about the service. Three completed forms were returned to us. We sent 10 staff questionnaires to the service and we received nine completed questionnaires. We sent questionnaires to social workers and young people who had left the service in the last six months. We received a response from one social worker that their young person was not able to provide feedback. We sent questionnaires to the social workers of all the young people currently accommodated and one completed questionnaire was returned to us. During this inspection process, we gathered evidence from various sources, including the following: * Interviews with the acting depute and three members of staff * Informal discussion with other staff and observation of a shift handover meeting * Telephone discussion with the 'Who Cares?' advocacy worker * Individual interviews with two young people * Observation of the environment and equipment * Observation of practice and staff interaction. We looked at a range of records, for example: * Young people's care plan files * Individual crisis management plans (ICMPs) * Incident records * Service's own questionnaires completed by two young people * Young people's meeting minutes * Staff meeting minutes * One 'peer manager' audit * Monthly performance management reports Station Road, page 7 of 36

8 * A selection of staff supervision and training files * Staff training records * Staff rotas * Policies and procedures * Medication policy and records * Communications book Inspection report continued 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 take. You can find out more about care services' responsibilities for fire safety at Station Road, page 8 of 36

9 What the service has done to meet any requirements we made at our last inspection The requirement Requirement 1: The provider must ensure the safety of children and young people by updating ICMPs (Individual Crisis Management Plans) regularly. Also, they should be updated in response to serious incidents and circumstances. For example, the ICMPs of all residents should be updated when young people move in to the house, or leave. Care should be taken to update ICMPs in relation to individual or group dynamics. A copy of the latest ICMP for each resident should be sent to the Care Inspectorate. This is in order to meet Scottish Statutory Instrument (SSI) 2011 No. 210 Social Care, Regulation 4(1)(a), Welfare of Users- a requirement that a provider must make proper provision for the health, welfare and safety of service users. Timescale for completion: by 28 February What the service did to meet the requirement We confirmed that ICMPs were now of much better quality and were being updated as we had required. Senior staff were monitoring ICMPs more robustly. This meant that staff had more comprehensive and accurate information about young people's behaviours, and could use this to better meet their needs. The requirement is: Met The requirement Requirement 2: The provider must ensure that any evidence that relates to serious mental health issues is properly recorded, discussed and acted upon. Such information must be shared with other professionals as appropriate. This is in order to meet SSI 2011/ 210, Regulation 4(1)(a), Welfare of Users- a requirement that a provider must make proper provision for the health, welfare and safety of service users. Timescale for completion: by15 February What the service did to meet the requirement The provider had put in place a better process for recording, discussing and progressing these issues. We noted that some young people were getting specialist professional support. The requirement is: Met Station Road, page 9 of 36

10 The requirement Requirement 3: The provider must make sure that any repairs or improvements made to the building do not leave temporary or permanent hazards that could lead to injury to young people or staff. The provider must confirm to the Care Inspectorate that it has a system in place to meet this requirement. This is in order to meet SSI 2011/ 210, Regulation 4(1)(a), Welfare of Users- a requirement that a provider must make proper provision for the health, welfare and safety of service users, and SSI 2011/ 210, Regulation 10(2)(b), Fitness of Premises- a requirement that a provider must make sure that premises are kept in a good state of repair externally and internally. Timescale for completion: by 28 February What the service did to meet the requirement The manager had met with the Council property manager to make sure that the premises were safe following the completion of any repairs or improvements. The requirement is: Met Inspection report continued The requirement Requirement 4: To help the service make sure there were enough staff to meet the physical, social, psychological and recreational needs of each young person, the provider must measure the level of support needed by each individual. This must be carried out at least every four weeks and used to determine the level of staffing needed. Alongside this the service must respond to any increase or change in the young people's support needs and adjust staffing levels accordingly, making records to show this. Also, the service must record where staff have been deployed during each shift. This is in order to meet SSI 2011/ 210, Regulation 15(a), Staffing- a requirement that a provider must ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users, and SSI 2011/ 28 (Registration), Regulation 4(1)(a): Records, notifications and returns- a requirement to keep certain records. Timescale for completion: by 28 February 2013.In making this requirement we have taken into account the National Care Standards, Care Homes for Children and Young People, Standard Management and staffing. What the service did to meet the requirement The manager and senior staff identified 'hot spots' in staffing arrangements. However, they were not recording any of this. We have viewed the requirement as met and have made two recommendations in quality statement 4.4. to help the service organise this better. The requirement is: Met Station Road, page 10 of 36

11 The requirement Requirement 5: The service should put in place a structured system of quality assurance, so that outcomes for young people and the quality of interventions can be measured. This is in order to meet SSI 2011, No. 210 Social Care, Regulation 4(1)(a), Welfare of Users - a requirement that a provider must make proper provision for the health, welfare and safety of service users. Timescale for implementation: 31 March In making this requirement we have taken account of the National Care Standards, Care Homes for Children and Young People, Standard Management and staffing. What the service did to meet the requirement We could not find evidence of a robust quality assurance system either internal or external. The requirement is repeated with a new timescale in quality statement 4.4. The requirement is: Not Met Inspection report continued What the service has done to meet any recommendations we made at our last inspection We made 10 recommendations at the last Inspection: Recommendation 1: Staff should find more ways of evidencing the involvement of young people in improving the service. The team should investigate ways of getting feedback from young people, and recording it, even when circumstances may be difficult. National Care Standards, Care Homes for Children and Young People, Standard Concerns, comments and complaints. Progress: Staff had continued to find it difficult to encourage young people to meet together given the current house dynamics. Also, they had not developed other ways of gathering feedback from young people. We have carried over the recommendation into this report as recommendation 1 in quality statement 1.1. Recommendation 2: The service should make sure that young people's daily logs (as well as other available information) were used to complete the SHANARRI (Safe, Healthy, Achieving Nurtured, Active, Respected, Responsible and Included) well-being indicators that fed into care plans. It should follow its own guidance in the 'Read before you care' document. Individual crisis management plans should be kept up to date. National Care Standards, Care Homes for Children and Young People, Standard 4 - Support arrangements. Station Road, page 11 of 36

12 Progress: The provider was working actively on this issue. The Council's Getting it Right For Every Child (GIRFEC) Co-ordinator had provided a training session to the team in the Spring. Recommendation 3: Any fridge used to store medicines should be locked. Access to the fridge should be available to any young person who is managing their own medication. National Care Standards, Care Homes for Children and Young People, Standard Keeping well - medication. Progress: The recommendation had been met. Recommendation 4: Local authority policies and paperwork about the administration and recording of medicines should be revised where necessary. Staff practice should be consistent with policy, and paperwork like MAR sheets should support this. The service should add specimen staff initials to its staff signature sheet. The service should put in place a 'homely remedies' policy that links in with the local minor ailments service. Staff should be trained in line with the Scottish Vocational Qualification (SVQ) HSC375 module 'administering medicines to Individuals'. National Care Standards, Care Homes for Children and Young People, Standard Keeping well - medication. Progress: We remained concerned about some of the recordings that we audited. The acting depute told us that the medication paperwork was due to be reviewed in the near future. The provider was arranging to make sure that training for staff met the necessary standards. So that we can follow up, we have carried the recommendation over into this report as recommendation 1 in quality statement 1.3. Recommendation 5: It would be good practice to ask young people to counter-sign accident and incident forms if they are prepared to do so. Where they do not wish to counter-sign, this fact should be recorded. National Care Standards, Care Homes for Children and Young People, Standard Feeling safe and secure. Progress: The recommendation had been met. Station Road, page 12 of 36

13 Recommendation 6: The service should find a way to reduce the risk of infection caused by the current use of a single cloth towel in the downstairs toilet. The service should train some of its staff in Infection Control issues and procedures. Good infection control practice should be shared within the staff team. National Care Standards, Care Homes for Children and Young People, Standard Management and staffing. Progress: The recommendation had been met. Recommendation 7: The service should involve young people in personalising the upstairs corridor area, with a view to making it look less institutionalised. National Care Standards, Care Homes for Children and Young People, Standard 5.1 -Your environment. Progress: The recommendation had been met. Staff had involved young people in personalising the upstairs corridor area and it was now much more welcoming and homely. Recommendation 8: Staff should be supervised according to the provider's policy, and sufficiently often to meet the needs of the young people who are resident. Where a supervision session cannot be held at the specified frequency, this fact should be recorded. It is good practice for supervision notes to be agreed formally and signed off. The manager should review supervision practice so that action points and professional development can be tracked properly. National Care Standards, Care Homes for Children and Young People, Standard 7.2 Management and staffing. Progress: This recommendation had not been met. We checked supervision records and discussed this with staff. We confirmed that formal supervision was not being carried out as the provider intended. However, staff told us that informal support was regular and helpful. See amended recommendation 1 in quality statement 3.3. Recommendation 9: The service should apply to the Care Inspectorate to vary its conditions of registration to reflect accurately the capacity of the home, and the age range that it wished to accommodate. National Care Standards, Care Homes for Children and Young People, Standard 7.9 Management and staffing. Progress: The provider had been in contact with us to arrange for this to happen. The recommendation had been met. Station Road, page 13 of 36

14 Recommendation 10: The service should put in place a closure strategy to cover the permanent closure of the unit. National Care Standards, Care Homes for Children and Young People, Standard Management and staffing. In making this recommendation we have taken into account the Convention of Scottish Local Authorities (COSLA) good practice guidance on the closure of a care home. Progress: The provider sent us a closure strategy shortly after the inspection visit. We consider this recommendation to have been met. 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 Care Inspectorate received a fully completed self assessment document from the service provider. We were not fully satisfied with the way the service provider had completed this and with the information they had given us for each heading that we grade them under. The document was largely factual, and should be extended to give some qualitative views about the service provided. The provider should avoid repetition, for example, in the participation standards. Comments should address specific quality statements only. Taking the views of people using the care service into account The feedback we received from young people was generally very positive. We received further feedback from our own questionnaires, direct contact with young people and from feedback from a referring social worker. Taking carers' views into account We did not have the opportunity to meet or talk with parents or carers during this inspection. Station Road, page 14 of 36

15 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found good evidence that the service involved young people and carers in a number of ways. We talked with the acting depute about this, two young people and the 'Who Cares?' advocacy worker. The 'Who Cares?' organisation was contracted by the Council to provide independent advocacy advice to young people staying at Station Road. Also, we looked at the service's own questionnaires that young people had completed, and our own CSQs. We found good evidence that staff listened to young people's issues, discussed them, and fed back information. Some aspects of this statement were very good, for example how the service involved young people day to day in improving the quality of their care and support. Overall we have awarded a grade of 4 -'Good'. The group dynamics in the home were now reasonably settled. However, there had been a lengthy period since the last inspection when the behaviour of some young people had been very challenging. Staff told us that one young person had had a '360 degree turnaround' and this had contributed to a considerably more settled and relaxed atmosphere. Staff told us that they did a lot of very good work involving young people in improving their experience of living at Station Road. Young people were able to exercise choice in several areas, like the activities they wanted to be involved in, and their diet. Staff gave us some very good examples of changes that they had made as a result of informal meetings with young people. Station Road, page 15 of 36

16 The Who Cares? worker had changed recently and had only carried out one introduction visit to the home. Staff were supportive and left the young people on their own with the advocate. This meant that it was more likely that young people would feel able to raise any issues or concerns that they had. The feedback from young people, staff, questionnaires and the advocacy worker was that young people generally were fairly settled and content in the home at the moment. The two young people who completed the service's own questionnaires and three who returned our CSQs confirmed that generally they were happy with their care. There was unhappiness about some areas from individual young people. For example, one felt that they 'could not talk to staff about anything' and that staff 'don't talk about the future and leaving school'. However, we found that the 'pathway planning' for leaving care was very good in the care plans and recordings we examined. Also, we confirmed that staff had regular 'one to one' sessions with young people. Our face to face conversations with two young people confirmed this. All three young people who completed our CSQs agreed strongly that managers and staff asked for their ideas and used them to make things better. Areas for improvement Young people refused to attend meetings at the moment, largely due to the dynamics of the relationships between them. Therefore, staff should explore other ways of engaging with young people. For example, they could think about having 'subject specific' meetings rather than general ones. Young people will often come along to discuss a subject that they are interested in, for example summer holiday activities or discussing new resources for the home. There could be a 'thoughts and suggestions' book, as mentioned in the peer audit that we saw. Also, 'young people's views' should be a 'standing item' at all staff meetings. This would provide a further opportunity to collate and record views that had been given to a range of staff at different times. Staff did not keep records of a lot of the informal participation work that they did with young people. They should record some of these informal discussions with young people. They could then consider highlighting their responsiveness to suggestions by using a noticeboard to display 'you said - we did' issues. All of this should help to establish a stronger and more visible culture of participation and involvement in the home. We have carried forward into this report the recommendation we made at the last inspection about participation. See recommendation 1. Station Road, page 16 of 36

17 Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should find more ways of evidencing the involvement of young people in improving the service. The team should investigate ways of getting feedback from young people, and recording it, even when circumstances may be difficult. National Care Standards: 18 Concerns, Comments and Complaints: Care Homes for Children and Young People. Station Road, page 17 of 36

18 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that staff were very good at meeting young people's health and wellbeing needs. We looked at issues like care planning, risk assessments, 'holding safely', nutrition and medication. We talked with the acting depute, staff and two young people. We examined relevant records, including staff rotas, care plans, Individual Crisis Management Plans (ICMPs), administration of medicines, and minutes of staff meetings. Also, we observed a staff shift handover meeting. Staff had a very good understanding of young people and their families. Where appropriate, they arranged regular 'contact' visits between young people and their parents or carers. This meant that young people were able to maintain and develop relationships that were important to them. The quality of these relationships would be important in relation to transition to independent living or a return to the family home. We found that personal plans (care plans) were well kept and reviewed regularly. The referring social worker who completed a questionnaire for us confirmed this. We were pleased to note that staff were receiving support and input in relation to the Scottish Government 'Getting It Right For Every Child' system (GIRFEC) and the related indicators. We could see that staff were now using this in the information that fed into care plans, as well as in the care plans themselves. Staff worked on health and lifestyle issues with young people. For example, they had bought bikes and regularly went out on them with individual young people. This helped young people stay fit and also provided very good opportunities for informal support to young people. Staff were realistic about what could be achieved at times with teenagers. For example, they had clear expectations that young people would do their own washing and tidy their rooms. However, staff would sometimes do this for them. This was important in preventing relatively minor issues being blown out of proportion, given the major challenges some young people were working to resolve. There was very good evidence of inter-agency working and staff had developed very good strategies for supporting individual young people. We observed a health related incident that was managed very professionally by staff. We found that they displayed very good insights into this when they discussed the issue with us. Station Road, page 18 of 36

19 Some young people cooked for themselves at times, and the development of cooking skills formed part of the work of pathway planning for independent living. Staff used appropriate healthy eating guidance and tried to involve young people in menu planning. The key worker system worked well and meant that young people had a specific person who knew them very well and could negotiate on their behalf. For example, we noted that young people's education was supported well. A combination of different educational resources was being used to meet young people's specific needs. Also, staff could arrange home education when appropriate via the local specialist education resource. Young people were encouraged to be involved in the community through local organised groups, voluntary work and involvement in Further Education (FE) activities. All three young people whom completed CSQs for us agreed strongly that if they were not feeling well, staff would look after them and help them to get better. Two agreed strongly, and one agreed, that they had a say in what went into their care plan, and that it was reviewed regularly. They all agreed strongly that staff tried to get them to choose healthy food. Also, they all agreed strongly that staff helped them to stay in touch with people who were important to them. Areas for improvement When we examined the administration of medicine records we found some errors. This included five tablets missing, several miscounts of medicine remaining, and several dosages not recorded. We know from the service self assessment that the manager is following up on the related issues that we raised at the last inspection. However, as they are not yet resolved fully we have carried over the recommendation we made at the last inspection. See recommendation 1. Staff told us that young people did not have a huge input into menus and shopping for food. It was difficult to involve them in looking at healthy eating issues. Nonetheless it is important that staff continue to raise this important issue with young people. This could be done informally, for example, through regular 'Come Dine with Me' sessions or similar. Station Road, page 19 of 36

20 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Local authority policies and paperwork about the administration and recording of medicines should be revised where necessary. Staff practice should be consistent with policy, and paperwork like Medicine Administration Record sheets (MAR sheets) should support this. The service should add specimen staff initials to its staff signature sheet. The service should put in place a 'homely remedies' policy that links in with the local minor ailments service. Staff should be trained in line with the Scottish Vocational Qualification (SVQ) HSC375 module 'administering medicines to Individuals'. National Care Standards, Care Homes for Children and Young People, Standard 12 - Keeping well - medication Station Road, page 20 of 36

21 Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths See quality theme 1, quality statement 1.1 for information about participation and involvement that also applies to this statement. We have given the same grade here as quality statement 1.1. Areas for improvement The areas for improvement in quality statement 1.1 also apply to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Station Road, page 21 of 36

22 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Inspection report continued We found that Station Road provided a very safe environment, and that staff worked hard to protect young people. We looked at young people's safety, security and arrangements for advocacy support. We considered the environment and furnishings, talked to young people and staff, and examined relevant records like incident and restraint recordings. We examined young people's risk assessments. These were called Individual Crisis Management Plans (ICMPs). The service had met the requirement and recommendations that we made at the last inspection. We have awarded a grade of 5 - 'very good'. This was a considerable improvement on what we found at the last inspection. The home was in a very good state of repair and there was a controlled entry system to keep young people safe. Overall, the surroundings for young people were good. The was a 'handy person' available to do minor repairs and decoration. The two young people we talked with were clearly comfortable living in Station Road. All three young people who completed CSQs for us agreed strongly that it was a nice place to stay. We were pleased to see the significant improvements that the service had made to the upstairs corridor area. It was now much, much brighter due to the installation of new lighting. The corridor area was much more homely, as young people had been involved in choosing paintings and artworks to display on the walls. The service self assessment told us that further improvement work was planned by an artist who would work with young people to create a wall mural. All of this would help to build young people's 'ownership' and respect for Station Road. Staff went about their business in a calm, controlled and professional way that helped to maintain a warm and safe atmosphere. The majority had been trained in key areas designed to help keep young people safe. These included Therapeutic Crisis Intervention (TCI), child protection and First Aid. All staff have had 'Respect me' anti-bullying training and we confirmed that staff were skilled and effective in tackling bullying issues. Two young people who completed CSQs for us agreed strongly that they felt protected from bullying. One young person disagreed with this statement. When we talked with this young person they confirmed that staff intervened to protect them when necessary. Two young people agreed strongly, and one agreed, that they felt protected from abuse. The referring social worker who completed a questionnaire for us stated that they did not have any safety concerns about the unit. They confirmed that maintenance work was carried out quickly to deal with damage caused by some young people. Station Road, page 22 of 36

23 Areas for improvement One young person told us that they would like to be able to decorate their own room. We talked with the acting depute about this and understand why this cannot happen quickly in some circumstances. For example, if a young person has requested a change to an empty room that has only recently been decorated. However, we know that this provider limits the choices that young people can make in relation to personalising their rooms. This has been raised as an issue in relation to some of the other services run by this provider. The Care Inspectorate will take this up with the provider in due course as a corporate issue. We noticed that there was litter around the front door area of the house. As this was easily seen from the pavement, it could give a poor impression of an otherwise very smart and presentable building. See recommendation 1. One member of staff highlighted that the unit was not as homely as it had been in the past. This was due to the need to remove some furnishings and pot plants to prevent damage or injury, given the challenging behaviour of some young people over the past months. However, the home seemed to be becoming more settled now. The service should improve the environment with additional homely furnishings and plants when it was prudent to do so. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The provider should keep the front door area litter free to create a positive first impression, and to reflect that young people residence are valued. National Care Standards, Care Homes for Children and Young People, Standard Your environment. Station Road, page 23 of 36

24 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths See quality theme 1, quality statement 1.1 for information about participation and involvement that also applies to this statement. We have given the same grade here as quality statement 1.1. Areas for improvement The areas for improvement in quality statement 1.1 also apply to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Station Road, page 24 of 36

25 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued Overall, we found that the performance of the service was very good for this statement. Young people were supported by well trained and motivated staff. They were enthusiastic and committed and had succeeded in coming through a period of very challenging behaviour from young people. We reviewed supervision, training and support. We looked at supervision records, training and minutes of staff meetings. We checked staff registrations with the Scottish Social Services Council (SSSC). We observed a shift changeover meeting, and interviewed the acting depute, two young people and three members of staff. We talked on the phone with the Who Cares? advocacy worker. We have awarded a grade of 5 - 'very good' for this statement. This was an improvement on what we found at the last inspection. The team had successfully come through a long period of very challenging behaviour with young people. We found staff to be motivated and enthusiastic, even though they were about to embark on a further period of staffing change. Staff that we talked with told us that they felt well supported by their manager, supervisors and their colleagues. In our discussions with staff we found that they were exceptionally knowledgeable about the young people they were working with. We saw good examples of cooperative working. At the shift handover meeting we noted good delegation of tasks and issues, as well as good deployment of staff to meet young people's needs. Staff were able to plan ahead to support young people through regular team meetings. We concluded that staff were very good at responding to, and supporting young people's daily care needs. We found that staff had regular access to relevant training. Some of this was through a 'rolling programme' that the provider organised. Most staff were trained in child protection and several in adult protection issues. Several staff had attended other courses like first aid and sexual health. Staff told us that they were happy working as a team and that they really supported each other. They thought that it was a good team and that some of the recent changes had led to a healthier 'group dynamic'. Station Road, page 25 of 36

26 There was lots of informal supervision, and staff found this to be a helpful process. Support from managers was very good and staff felt comfortable about approaching them about issues. Generally, staff had confidence in their manager and supervisors and felt that their opinions were valued. One member of staff described manager and supervisors as "compassionate" in they way that they had handled some staffing situations. All of this meant that staff were more likely to be able to work with young people in a positive and supportive way. The responses in the staff questionnaires that were returned to us were generally very good. Some individual written comments included: "I feel supported and guided in my day to day work..." "My manager is very approachable..." "...I feel supported in my role and my opinions are always validated and considered by management. I am given a fair deal of autonomy on shift and feel valued as a member of staff." The referring social worker who completed a questionnaire for us confirmed that all staff in the home were aware of their young person's individual needs and responded appropriately to them. All three young people who completed CSQs for us agreed strongly that staff understood the things that were important to them. In discussion, one young person told us that 'Staff treat me well and understand me. I like to sit down with the night staff and have a cup of tea and a chat.' Areas for improvement We made a recommendation at the last inspection about formal staff supervision and found that the situation had not improved. Although staff confirmed that they had regular informal supervision sessions, neither the timing or content of these sessions was recorded. The dates and 'bullet points' of such sessions should be recorded. This was particularly important in the current circumstances where formal supervision sessions were not being held regularly. See recommendation 1. Staff were responding well to the immediate needs of young people and had an indepth knowledge of them. However, the quality of care was not as good as it could have been. This was due to the pressures caused by ongoing staff shortages and overtime working. This had resulted in some key systems deteriorating, for example formal supervision and management oversight. Also, some important training like TCI had been postponed. We have made a recommendation about this in quality statement 4.4. Station Road, page 26 of 36

27 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should make sure that staff are supervised according to the provider's policy, and sufficiently often to meet the needs of the young people who are resident. Where a supervision session cannot be held at the specified frequency, this fact should be recorded. It is good practice for supervision notes to be agreed formally and signed off. The manager should review supervision practice so that action points and professional development can be tracked properly. Supervisors should record the dates of informal supervision sessions and the key points that were discussed. National Care Standards, Care Homes for Children and Young People, Standard Management and staffing. Station Road, page 27 of 36

28 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 See quality theme 1, quality statement 1.1 for information about participation and involvement that also applies to this statement. We have given the same grade here as quality statement 1.1. Areas for improvement The areas for improvement in quality statement 1.1 also apply to this statement. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Station Road, page 28 of 36

29 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 the service had an adequate range of quality assurance processes in place. We looked at various policies and records that were kept, including incident reports and ICMPs. We looked at a recent 'peer audit' that had been carried out by the manager of another service. We talked with the acting depute and staff. Following the inspection visit we discussed quality assurance issues with the external manager of the service. The provider had implemented a 'peer audit' system to assess the quality of care in its homes. This involved the manager of another of the provider's children's homes visiting every six months to complete a report on various aspects of the service's work. This seemed to be the main method used to monitor and assess the quality of care. The acting depute told us that supervising staff checked various files as part of their supervision process. The external manager visited the unit regularly and supervised the manager. Informal support for staff was very good. We confirmed that annual appraisals took place as part of a Performance Development Review (PDR) system for staff. The 'keyworker' system worked well and made sure that young people's issues were taken forward quickly. The referring social worker who completed a questionnaire for us confirmed that the manager attended most of the planning meetings and reviews for their young person. Also, the manager was available by telephone when needed, and in person when the social worker visited. The social worker was happy with the management of the service and confirmed that the young person's needs were being met. One young person who completed a CSQ for us agreed strongly, and two agreed, that overall they were happy with the care that they received at Station Road. Areas for improvement Inspection report continued Although the service had a few quality assurance processes in place, we could not find evidence of a robust quality assurance system, either internal or external. For example, there was no evidence of staff, stakeholder and parent or carer feedback. We thought that the peer audits were mainly factually based and did not comment much on outcomes for young people. They should be developed to have more of a quality focus. When we checked files and records, we could not find any evidence of the checks that supervising staff carried out. We have carried over with an amended timescale the requirement that we made at the last inspection. See requirement 1. Station Road, page 29 of 36

30 This service has not made any notifications to the Care Inspectorate for a number of years, for example, in relation to incidents or accidents. Our review of records and discussions with staff indicated that incidents had taken place that should have been reported. So that notifications can be made within the required timescales, the provider should consider making sure that more than one member of staff has access to our eforms electronic notification system. See requirement 2. The manager and senior staff identified 'hot spots' in staffing arrangements. This meant that they knew when additional staffing was needed and could try to make appropriate arrangements. However, they were not recording any of this. They needed to do this and also evidence staffing issues better, for example at shift changeover and management meetings. Also, the team remained understaffed at present, and overtime was used in the main to plug gaps caused by sickness, maternity leave and other absences. This was not good practice. We established from more than one source that staffing was sometimes at minimal levels. This affected the quality of care. Also, it made it difficult to organise management meetings in the current circumstances, because manager and senior staff were working 'on the floor'. The provider needed to look at a more strategic resolution to this ongoing problem, which has been evident in the past two inspections. See recommendations 1 and 2. The service needed to consider adding other quality monitoring systems to support the peer audits. For example, there was no analysis of incidents available to staff to help them identify any patterns, hotspots and possible solutions. This is an essential part of any quality assurance system, and is something that could be put in place quickly. Likewise, the service could monitor and audit ICMPs, the administration of medicines, care plans and case notes. See recommendation 3. Some young people's ICMPs made it clear that they should not be 'held safely' (restrained), for example, on medical grounds. This information was shared with the young people concerned. We did not think it a good idea that young people should be given the impression or promise that they would never be restrained, no matter the circumstances. We discussed hypothetical situations with the acting depute and one member of staff. In both cases, they confirmed that they thought restraint would be the proper course, even when the ICMP said otherwise. Best practice guidance suggests that situations might arise where young people could be injured, physically or psychologically if safe holding did not take place. See recommendation 4. Station Road, page 30 of 36