Lothian Occupational Services Support Service Without Care at Home Autism Initiatives Head Office (Scotland) 11 Granton Square Edinburgh EH5 1HX

Lothian Occupational Services Support Service Without Care at Home Autism Initiatives Head Office (Scotland) 11 Granton Square Edinburgh EH5 1HX Telephone: 0131 551 7260 Inspected by: Mary Moncur Type of inspection: Announced (Short Notice) Inspection completed on: 20 November 2013

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Autism Initiatives (UK) Service provider number: SP2004006462 Care service number: CS2008175789 Contact details for the inspector who inspected this service: Mary Moncur Telephone 0131 653 4100 Email enquiries@careinspectorate.com Lothian Occupational Services, page 2 of 25

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 The service provides personalised support to the young people using the service, with each person having an individual activity programme. Families felt fully involved in planning and reviewing their family member's support package and told us the service communicated well with them. Staff were knowledgeable and skilled in delivering support. The service is focused on making sure the support provided is autism specific and recognises each person's individual needs. What the service could do better The service plans to continue to develop expertise in autism specific practice. Continued development of the internal audit processes and the Autism Partnership Validation process will support this improvement. The service is continuing to improve the use of the training needs analysis to make sure staff's learning is up to date. We also discussed the need for better consistency in the structure for staff supervision. The service plans to hold local events over the next year, involving people using the service, their families and staff to consider what is working well and what things the service could develop and improve on. What the service has done since the last inspection The service had continued to develop best practice in supporting people with autism. They had used the internal quality audit process to identify areas for improvement and workshop style training had supported staff's development. The service had responded to issues raised in staff questionnaires, improving frequency of 1:1 supervision for staff and team meetings and introducing support team meetings to Lothian Occupational Services, page 3 of 25

discuss individual's support arrangements. They had also developed the service in a range of ways based on ideas and feedback from people using the service and their families. Autism Initiatives had begun the Autism Partnership Validation process, working with other members of the Autism Alliance to continue to improve services for people with autism. Conclusion We found the young people using the service were receiving an individualised support package and improving their skills, confidence and independence as a result. Families were very happy with the support their family members received and the ways the service involved them and communicated with them. Staff continue to be motivated and creative about the way they work with individuals to make sure they experience the best service possible. The service's strong focus on providing best autism specific practice and the experienced and knowledgeable management team supports the service's continuous improvement. Who did this inspection Mary Moncur Lothian Occupational Services, page 4 of 25

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 www.careinspectorate.com. Lothian Occupational Services provides a support service to adults with autism in Edinburgh and the Lothians. Most people using the service are young adults in the process of transition from school and children's service to adults services. The service aims to provide support in an autism specific way. The young people are provided with individual packages of support in and from three resource centres in Livingston in West Lothian and Craigmillar and Inverleith in Edinburgh and/or in and from their own home. Support is provided on a 1:1 or group basis to develop skills and confidence, to get involved in a range of activites and to access a variety of community facilities. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Autism Initiatives vision statement says, "Our expectation is that people with autism can learn and develop and we support this process every single day. We will create unique services for people to enable them to have ownership of their own lives and futures." Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, 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 based on best practice or the National Care Standards. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Inspectorate. We have not made any requirements or recommendations for improvement in this report. We have agreed areas for continued improvement with the service. 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 Lothian Occupational Services, page 5 of 25

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 www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Lothian Occupational Services, page 6 of 25

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 after a short notice announced inspection of the service. We gave the service a few days notice to make sure staff were available when we visited. The inspection was carried out by Mary Moncur, Care Inspectorate inspector. The inspection took place between 31 October and 14 November 2013. We gave feedback to the manager and team leaders on 20 November 2013. As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to submit to us. We sent 15 care standard questionnaires to the manager to distribute to people using the service and their families. Seven people returned completed questionnaires. We also asked the manager to give out 15 questionnaires to staff and we received nine completed questionnaires. During this inspection we gathered evidence from various sources, including the following: We spoke with * six people using the service * three family members * the manager * the training and quality coordinator, team leaders and staff present We looked at * a sample of records for people using the service * information leaflets about the service and the service information pack * information from surveys * "I'm Heard" group information * Family and Friends forum meeting notes * complaints and compliments records * incident and accident records * staff training plan * sample of staff records Lothian Occupational Services, page 7 of 25

* staff meeting notes * staff survey information * quality audit records * Autism Partnership Validation process information * the service's development plan. Inspection report continued We took part in the activity group at the resource centre in Livingston. 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 www.firelawscotland.org Lothian Occupational Services, page 8 of 25

What the service has done to meet any requirements we made at our last inspection The requirement This requirement was made as a result of a complaint we investigated about the service. The provider must ensure the organisational complaints procedure is responsive and appropriate to the needs of the service users and any complaint made under the procedure should be fully investigated in line with the procedural stages. What the service did to meet the requirement The service had followed the complaints procedure in dealing with any concerns or complaints received about the service. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection 1. To enhance service user, family and stakeholder involvement, the service should prepare and circulate a participation statement issue a regular manager's update bulletin. The service has taken action to meet this recommendation. See Quality Theme 1 Statement 1. 2. Specific "Health Plans" should be included within all support plans. The service has included specific "health plans" where the person has specific health needs. 3. Consideration should be given to recording practice discussions and introducing group supervision (for common issues) to help meet supervision targets. The service had improved regularity of 1:1 supervision and team meetings where practice could be discussed. Lothian Occupational Services, page 9 of 25

4. The planned parent/carer group should be established as intended. Parents/carers had opportunities to meet with other parents/carers. 5. The service should maintain proper records which include systems being in place to ensure phone calls are answered and responded to timeously. This recommendation was made as a result of a complaint we investigated about the service. The service had put systems in place to make sure phone calls were responded to timeously. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the provider. We were satisfied with the way they had completed this with relevant information included for each heading we grade services under. They identified what they thought the service did well, some areas for improvement and any changes they had planned. The provider told us how the people using the service were involved in improving the quality of the service. Taking the views of people using the care service into account We received one completed questionnaire from a young person using the service. They strongly agreed they were happy with the quality of support overall. The people we met during our inspection were very happy with their support. They talked about the range of things they were supported to do and spoke highly of the staff providing their support. Lothian Occupational Services, page 10 of 25

Taking carers' views into account Inspection report continued Six parents returned completed questionnaires to us. They all agreed, four of the six strongly agreeing, they were happy with the support overall. Comments included; "We appreciate the amazing support we get from Autism Initiatives. Not only does my daughter benefit greatly from Autism Initiatives our whole family do." "The service Autism Initiatives provides to us as a family is second to none. The care, patience, knowledge and experience they have is simply astonishing. Without their help and advice I have no idea what life would be like. From management to support workers they support us more than we could ever imagine." "As a parent of a young adult with autism I can relate to how challenging it can be on a day to day basis, as no two days are the same. As far as information regarding support needs we are kept informed on a daily basis through a diary or for more complex issues by telephone or a face to face meeting." "This is a brilliant service, the support they give my son is fantastic. He is happy to go with support staff every day...he refers to the support staff as his "friends". They are well trained and approachable and are always keen to offer help or information. My sons needs are well met at Autism Initiatives and he enjoys all outings and interactions with his "friends". We spoke to three parents by phone and they confirmed these very positive views about the service. We saw the feedback from surveys the service had carried out. This also showed a high level of satisfaction with the service. Lothian Occupational Services, page 11 of 25

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 At this inspection we found the service was performing to a very good standard in relation to this statement. We spoke to some of the people using the service and their families. We looked at individual's records, including support plans and reviews, the service's information pack, information from surveys the service had carried out, records of the family and friends forum and the "I'm Heard" group. We spoke to the manager, team leaders, support staff and quality co-ordinator. We saw the information pack provided to everyone interested in or starting to use the service. This included detailed information on Autism Initiatives, the service they offer, their approach to working with individuals with autism, the most recent newsletter, copies of relevant policies, including working in partnership, complaints and compliments and moving in, moving on, as well as a policy index of other organisational policies available. This information met the recommendation we had made at the last inspection that the service should circulate a participation statement. All of the information had a strong emphasis on personalised services and working with the person and their family to develop a service to meet their individual needs. This gave people the information on how this would be achieved. There was strong evidence from talking to people using the service, their families and staff and from looking at individual's records that the emphasis on personalised support was reflected in practice. Each person had an individualised activity plan which reflected the skills they needed and wanted to develop and the things they wanted to do. At our last inspection we recommended the service should issue a regular update Lothian Occupational Services, page 12 of 25

bulletin. We heard the service was establishing a "writer's group" and they planned to develop a local newsletter. This could include information on how the service was using feedback from people using the service and their families to continue to improve the service. The service used a range of ways to involve people using the service and their families in assessing and improving the service. They continued to use questionnaires to gather views. These had most recently been circulated in June 2013. We saw that the feedback and suggestions made had been followed up. Autism Initiatives facilitated an "I'm Heard" group for people using their services. They also held a family and friends annual forum. This had most recently taken place in October 2013. The director of Autism Initiatives had led the forum, updating friends and families on progress over the last year and plans for the next. People attending had opportunities to ask questions and had asked about things like staff recruitment and retention. We saw evidence that the service responded to the views of people using the service and their families. For example the development of the kitchen and computer facilities at the resource centre in Livingston, the use of staff's expertise in music and art at the Craigmillar resource centre and the use of a variety of community resources and development of the horticulture project from the Inverleith resource centre. We saw some very good examples of people "taking control" in aspects of their service. For example, one person was putting together and circulating a newsletter to the activity group in Livingston. Areas for improvement The service could look at developing use of the questionnaires to encourage more feedback to inform improvement planning. This would better evidence how this is being used to improve the service. The quality co-ordinator told us about their plans to develop the links between the "I'm Heard" group and local services. We discussed the service could consider holding local events involving families and people using the service to discuss what's working well and what could be better. The managers said they had done this successfully in the past and would look to hold events over the next year. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Lothian Occupational Services, page 13 of 25

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The service met people's health and well being needs very well. To assess this statement we spoke to people using the service and their families and looked at a sample of individuals' records. We spoke to the manager, team leaders and support staff. The service used "About Me" documents as part of the assessment and planning process. This was completed with the person and their family and focused on understanding the person and their support needs. We saw these were completed to a high standard and linked to the support and activity plans for the person. The service's expectation is that "people with autism can learn and develop". The support plans we saw reflected this expectation as they highlighted the skills the individual needed and wanted to develop and how they would be supported to achieve this. We saw that risk assessments linked to the "About Me" information and planned activities. This meant staff had the information needed to support individual's development and help keep them safe. We saw and heard about individual's support plans in action. We found evidence that the service was creative and innovative in the way they provided individual's support. The service formally reviewed support arrangements with families on a regular six monthly basis, recording progress and making changes as relevant. Families told us they were very happy with communication, that they were kept informed on a day to day basis and could discuss any issues or concerns with the service. Staff told us about differences they had seen in individuals they worked with, including increased skills, independence and confidence. The service had introduced support team meetings; where staff involved in an individual's support met together to specifically discuss that person's support. We heard very positive comments about how useful these meetings were. Autism Initiatives had a strong philosophy and used a strength based model based on a 5 point star framework. Staff were encouraged to use this model in practice through the assessment and support planning process, the training they received and the support and supervision of their practice. Services were supported to follow the Autism Initiatives approach through the quality assurance process, which included a range of standards to make sure the service was provided in an autism specific way. We saw how this was continuing to improve staff's practice and service delivery. We checked that where the service supported people to manage their own money or to take medication they had systems in place, including recording and checking procedures, to do this safely. We saw records of staff's competence in administering medication being observed six monthly. Lothian Occupational Services, page 14 of 25

Staff were made aware of their roles and responsibilities in relation to adult support and protection through induction and refresher training. We saw examples of staff working with individuals to help them to keep themselves safe. We saw examples of the service supporting individuals to access general health services and working with the specialist multidisciplinary team. At our last inspection we recommended the service should include specific "health plans" in all support plans. We heard these had been put in place where the person had particular health needs. We heard very positive feedback from people using the service and their families about the support they receive and the difference it has made in their lives. Areas for improvement We heard the service is continuing to develop consistency in delivering an autism specific service based on the Autism Initiatives approach. This is being developed through staff learning opportunities linked to the quality assurance system. We saw some inconsistencies in use of support records, such as having "health plans" for everyone and completion of financial assessments. The managers agreed this is part of the ongoing development. We discussed the importance of the support team meetings in making sure these continued improvements are achieved. We noted that the environment in the Edinburgh resource centres could be improved to make them more welcoming and comfortable for people who use them. We heard that refurbishment of the Craigmillar resource centre was planned and that Autism Initiatives were considering relocating the Inverleith resource centre to a more suitable location. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Lothian Occupational Services, page 15 of 25

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service performed very well in making sure people experienced support from staff who had the skills, knowledge and experience required. To assess this we took into account the views of people using the service and their relatives. We looked at a sample of staff records, the service's training information and some staff meeting records. We looked at questionnaires staff returned to us and spoke to some members of support staff. We also spoke to the quality and training co-ordinator. We saw that the strengths we found at the last inspection had continued including; * thorough induction procedures for new staff, including detailed records of competence demonstrated * regular 1:1 supervision meeting with staff where they could discuss practice and professional development * annual calendar of training for staff so that managers can make sure staff complete refresher training as necessary * annual performance appraisal for staff, leading to a professional development plan for the next year * opportunities for staff to achieve qualifications that will allow them to register with the Scottish Social Services council * regular team meetings where staff can keep up to date with service development and share ideas and suggestions. We heard that more workshop type learning had been developed as a result of the quality assurance process. This offered staff more opportunities to reflect on and develop practice specific to the individuals they were supporting. Autism Initiatives was using EVOC's training needs analysis to record staff's learning needs and learning completed. The training and quality co-ordinator told us they had been working hard to make sure the information was up to date. This was providing managers with better information on what training had been completed, what was due for refresher and what was out of date in order that they could better plan for Lothian Occupational Services, page 16 of 25

staff's training. We heard that Autism Initiatives were committed developing autism specific expertise by supporting staff to undertake accredited training in autism practice. We spoke to some staff who had received support with this. Autism Initiatives were also working towards accreditation of training they deliver. Staff told us colleagues were supportive and shared ideas and information. They felt supported by managers and said they could get advice as and when needed. We heard morale was positive and we were impressed by the high level of commitment and enthusiasm shown by staff. We saw staff work in a skilful way with individuals they were supporting. The service used a system of performance review meetings where there were any concerns about staff's practice. These strengths meant people using the service and their families could be reassured the service was working hard to support staff's professional development. Families spoke highly about staff and their knowledge and skills in supporting their family member. We heard this has improved over recent years, with relatives believing staff support and training had improved. Areas for improvement The service acknowledged they wanted to further develop the use of EVOC's training needs analysis system to forward plan staff's training and make sure everyone's knowledge was kept up to date. While the records we saw indicated staff were having regular 1:1 supervision meetings, there were inconsistencies in records kept. Not all supervision was being recorded on the Autism Initiatives supervision records. Supervisors said this was because they did not find the format helpful in structuring the meetings. The manager said they would raise this issue again in order that a format can be developed that staff and supervisors will find helpful in developing practice based on the 5 point star framework. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service strengths The service was excellent at making sure staff worked with an ethos of respect towards people using the service. We heard from people using the service and their Lothian Occupational Services, page 17 of 25

families, saw staff work with people using the service and each other and spoke to staff about the people they support, their relatives and their colleagues. The things we looked at to assess Quality Theme 1 Statement 1 and Quality Theme 3 Statement 3 were also relevant to this statement. The strengths relating to service user participation noted under Quality Theme 1 Statement 1 are relevant to this statement. The service's commitment to involving people demonstrates respect for people using the service and their family. The feedback gathered provides information on how well the service does in treating people with respect and suggestions for improvement. The strengths in relation to having a well trained, professional and motivated workforce noted under Quality Theme 3 Statement 3 are relevant to making sure everyone has an ethos of respect towards people using the service and their colleagues. Achieving Scottish Vocational Qualifications encourages reflective practice. 1:1 support and supervision and team discussions provide opportunities for ongoing reflection and improvement. Staff talked about people they work with and their families in a respectful way. We saw staff show respect when working with people. People who returned questionnaires agreed, five of the seven strongly agreeing, that staff treated them and/or their family member with respect. The strengths noted under Quality Theme 1 Statement 3 in relation to involvement of families in planning and reviewing support and in relation to communication with families shows the service's respect for them. We saw staff work together in a respectful way and heard about teams working well together. Managers spoke to and about staff in a respectful way. Areas for improvement The service was aware this was an area where continued vigilance was required to maintain excellent practice. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Lothian Occupational Services, page 18 of 25

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths The information we looked at for Quality Theme 3 Statements 3 and 4 is also relevant to this statement. We also spoke to managers and staff about opportunities staff had to put forward ideas to improve the service and how these were used. We found the service provided very good opportunities for staff to get involved in developing the service. The strengths we noted under Quality Theme 3 Statement 3 about supervision and team meetings are also relevant to this statement. These provided opportunities for staff to put forward ideas and suggestions. The strengths noted under Quality Theme 3 Statement 4 are relevant to this statement. Staff who feel valued are more likely to put forward ideas and suggestions for improvement. The service used questionnaires to gather staff's views. When last completed in May 2013, staff were positive about managers being approachable and supportive, team meetings being more regular and good team support. Some common issues had been identified including regularity of supervision meetings, training needing updated, time for key work tasks and support team meetings. We heard and saw the service had taken action to address these issues. Autism Initiatives had a clear vision and were clear about the autism specific approach expected. This meant staff had a clear framework to use in service development. Support staff were encouraged and supported to take responsibility for working with key individuals and their families to develop their support arrangements. Local managers were encouraged and supported to develop the service they had responsibility for. Most support staff and managers we spoke to said they felt they had opportunities to make suggestions for service development and felt their ideas were listened to. These strengths meant that people using the service could feel the service is open to hearing the views of staff who know them well. Lothian Occupational Services, page 19 of 25

Areas for improvement In self assessment the service said they planned to develop a local publication by staff for staff. We heard some comments from staff that, while they had a lot of autonomy in working with individuals to develop their support plans, they had limited opportunities to influence the direction of the service overall as these decisions were taken at a more senior level. As noted under Quality Theme 1 Statement 1 we discussed the service could consider holding local events involving families and people using the service to discuss what's working well and what could be better. Support staff's involvement in these events could also increase opportunities for them to put forward ideas on how the service could develop. While we heard about improvements in relation to the issues raised through staff questionnaires, it was not clear how the service had planned to make improvements or how they were monitoring progress. The service could consider how it follows through suggestions for improvement from staff questionnaires. Grade awarded for this statement: 5 - Very Good 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 Inspection report continued At this inspection we found the performance of the service was very good for this statement. The information we looked at to assess the quality of support and the quality of staffing was relevant to this statement. We looked at the service's quality assurance systems and quality audit records and spoke to the managers and the quality assurance co-ordinator. The strengths relating to service user participation noted under Quality Theme 1 Statement 1 are relevant to this statement. These provided opportunities for people using the service and their families to influence the quality of support they receive. The strengths noted under Quality Theme 3 in relation to the quality of staffing contribute to assuring the quality of the service people receive, providing reassurance that staff who are delivering their support are safe and competent to do so. The service's strengths in involving the workforce in determining the direction and future objectives of the service, noted under Quality Theme 4 Statement 2, are relevant to managing the quality of the service and meant that people using the Lothian Occupational Services, page 20 of 25

service and their families can feel the service is open to hearing the views of staff who know them well. As noted under Quality Theme 1 Statement 3 the service had thorough systems in place to make sure individual's personal money was managed and medication administered safely. We spoke to the quality assurance co-ordinator. They showed us the programme for internal quality audit and explained the process of audit visits. The quality framework included 21 standards with benchmarks to evidence the standard was met. The audit visit was completed by the quality assurance co-ordinator along with a manager or team leader. Support staff were also now getting involved, raising their awareness of quality issues. The "auditors" completed a report of evidence found, including best autism specific practice, and recommendations for improvement. The manager completed an action plan and the "auditor" followed up with a visit to check improvement actions had been taken. We saw examples of records of the process having been completed. The co-ordinator told us they had been able to complete the standardised process over the past year, improving consistency. Autism Initiatives was taking part in Autism Partnership Validation, a framework developed by the Autism Alliance to support organisations providing services to people with autism. The process involved Autism Initiatives completing a self assessment in a range of areas relevant to the quality of services. This was followed by a validation visit by a partner member of the Autism Alliance. The process aimed to continuously improve the service, providing a better specialist service resulting in improved outcomes for people the service supports. The service had a development plan, identifying the areas for development, who was responsible, targets and review dates. This provided a framework for continued improvement. The service works well with us in our role as regulator. They provide us with the information we require and inform us of events we must be told about. The service was open with us at inspection, making sure we had access to all the information we required and encouraging people using the service, their families and staff at all levels to get involved. These quality assurances systems and processes mean people using the service and their relatives can feel the service is working hard to make sure their service continues to improve. Areas for improvement Inspection report continued The areas for improvement noted under Quality Theme 1 Statement 1 relating to service user participation, under Quality Theme 3 relating to quality of staffing and under Quality Theme 4 Statement 2 relating to involving the workforce in determining Lothian Occupational Services, page 21 of 25

the direction and future objectives of the service will all contribute to continuous quality improvement. The service plans to continue to develop the use of the internal audit process, making sure the approach is consistent and improvement actions are followed through. The quality assurance co-ordinator told us they were considering how people using the service could be more involved in the process. Autism Initiatives intends to complete and develop use of the Autism Partnership Validation process. We noted that the service's development plan was broadly similar year on year. We discussed that the service could look at making sure the development plan is reviewed and future plans show ongoing development and continuous improvement. The service could use feedback from people using the service, their families and staff along with information gathered through the quality assurance process to be more specific about areas for development. Monitoring and evaluation of the development plan would provide better evidence of continuous improvement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Lothian Occupational Services, page 22 of 25

4 Other information Complaints We have upheld one complaint since our last inspection. Information on upheld complaints can be found on our website www.careinspectorate.com. 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). Lothian Occupational Services, page 23 of 25

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Staffing - 5 - Very Good Statement 3 Statement 4 5 - Very Good 6 - Excellent Quality of Management and Leadership - 5 - Very Good Statement 2 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 21 Nov 2012 Unannounced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 4 - Good 24 Nov 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 20 Jan 2010 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Lothian Occupational Services, page 24 of 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 0845 600 9527. 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: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Lothian Occupational Services, page 25 of 25