Grampian Autistic Society - Outreach Service Housing Support Service Grampian Autistic Society 33/35 Carnie Drive Aberdeen AB25 3AN Telephone: 01224 277900 Inspected by: James West Type of inspection: Unannounced Inspection completed on: 31 October 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 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Grampian Autistic Society Service provider number: SP2003000368 Care service number: CS2004073329 Contact details for the inspector who inspected this service: James West Telephone 01224 793870 Email enquiries@careinspectorate.com Grampian Autistic Society - Outreach Service, page 2 of 23
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 Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well This service works well with people and families to provide the support they want. There is a well-trained staff team who know people well and they work very flexibly. What the service could do better Most areas of support planning work well, but some of the plans could be reviewed more regularly and risk assessments could be more detailed. The general manager is about to bring in a new quality system and this will help identify areas to work on. People could be more involved in recruiting and assessing staff. What the service has done since the last inspection There had been some staff changes before the last inspection, so several people were new. This has now settled down, and people and carers are indicating the service has improved. Conclusion This service is flexible and it is appreciated by the people they support and their families. Bringing together the different quality checks used into one system will help the service to plan for improvement. Grampian Autistic Society - Outreach Service, page 3 of 23
Who did this inspection James West Grampian Autistic Society - Outreach Service, page 4 of 23
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 01 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.scswis.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 01 April 2011. Requirements and recommendations If we are concerned about some aspect of a service, or think it could 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, 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 Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Grampian Autistic Society is a local voluntary organisation providing support to people on the autistic spectrum. They state their core values as:- * To conduct our relationships with integrity and respect * To promote individual development, empowerment and quality of life * To promote high quality professional and needs led services * To promote equal opportunity and anti-discriminatory practice * To represent value for money This service aims to provide a specialist one to one service for people with autistic spectrum and communication disorders. It works very closely with the Grampian Autistic Society Support Service, sharing the same staff and management structure. The service is delivered on an individual basis, mainly in people's own homes. Based on the findings of this inspection this service has been awarded the following grades: Grampian Autistic Society - Outreach Service, page 5 of 23
Quality of Care and Support - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - Good Inspection report continued 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. Grampian Autistic Society - Outreach Service, page 6 of 23
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. This was carried out by one Inspector, James West. The inspection took place on Tuesday 29 October 2013 between 9 am and 4.30 pm. It continued on Thursday 31 October from 12 midday to 4 pm. We gave feedback to the manager and the general manager on Thursday 31 October at the conclusion of the inspection. As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. We sent ten care standards questionnaires to the manager to distribute to service users. Three people sent us completed questionnaires. We also asked the manager to give out ten questionnaires to staff and all of these were returned. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: * two service users * one relative * the manager * the general manager * four outreach support workers We looked at various documents, policies and procedures, including: * six care plans * policy on complaints * policy on protecting vulnerable adults * minutes of team meetings * service user and relative questionnaires * staff training records Grampian Autistic Society - Outreach Service, page 7 of 23
* staff supervision records * evidence of meetings with outside health professionals * risk assessments Inspection report continued We also shadowed a support worker and the person she was supporting, whilst having a meal and we joined a social group the service organised in a local church. 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 Grampian Autistic Society - Outreach Service, page 8 of 23
What the service has done to meet any requirements we made at our last inspection The requirement A requirement was made following a complaint against the service: The Provider must ensure that any complaint received is fully investigated and appropriate records are maintained. This is in order to comply with: SSI 2011/210 Regulation 18 (4) - a requirement for the Provider within 20 working days after the date on which the complaint is made, or such shorter period as may be reasonable in the circumstances, inform the complainant of the action (if any) that is to be taken. Timescale for implementation: immediately upon receipt of this letter. What the service did to meet the requirement We discussed this with the manager during the inspection. The complaints procedure in place was detailed and provided the necessary timescale, but the manager recognised that she failed to clarify how the complaint would be dealt with in this instance. She understood the importance of the timescale and said it would be met in future. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection There were three recommendations made at the previous inspection. 1. The service should continue to develop the aims of their service user, parent and carer participation strategy. National Care Standard 12 - Expressing your views. The service had a well developed participation strategy and an involvement policy, which meant this recommendation has been met. 2. Risk assessments should provide comprehensive information to ensure that service Grampian Autistic Society - Outreach Service, page 9 of 23
users are well supported. National Care Standard 10 - Feeling safe and secure. Risk assessments had been developed and were in place for all the care plans we examined during the inspection, however control measures in place lacked detail on how people would be supported in difficult situations or if they became distressed or upset. This recommendation has been re-stated. 3. The service should continue to progress their plans to develop comprehensive quality assurance systems. National Care Standard 2 - Management and staffing arrangements. While some progress had been made the service still did not have a comprehensive quality assurance system. As a result this recommendation has been re-stated. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. Every year all care services 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 provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. Taking the views of people using the care service into account The people we spoke with during the inspection appreciated the service and the support they received. All three of the people who returned questionnaires strongly agreed with the Grampian Autistic Society - Outreach Service, page 10 of 23
statement: 'Overall I am happy with the quality of care and support this service gives me.' One person who responded was concerned about the cost of the service. This was in relation to a charge imposed by Aberdeen City Council and was not something the service could change. Taking carers' views into account We spoke with one carer as part of this inspection, who said the service was very good and their family member was well supported. They indicated that the service had improved recently. Grampian Autistic Society - Outreach Service, page 11 of 23
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 During the inspection the manager provided evidence to show that service users and carers were involved in improving the quality of support to a very good standard. The support plans had been drawn up along with people being supported and their families. They were signed to show that people had been involved in developing them and that they agreed with them. Some people made detailed plans in advance for each of their support sessions. Three monthly summaries of the support provided were completed and these were also discussed and shared with service users, who signed the summary to show they agreed with it. Reviews gave an opportunity to formally consult people and record their views on the support received. Questionnaires had been used to gather information from people on the service they received and a separate questionnaire had been used to what level of involvement people wanted in specific areas, such as recruitment. The general manager was in the process of collating the responses to these. There was a 'you said, we did' board in the office which described some of the ways the service had responded to request for changes to the service. People had communication books that were used by staff to share information with them and their families or carers. Grampian Autistic Society - Outreach Service, page 12 of 23
At the previous inspection a recommendation was made to develop the participation strategy. This was in place as was an involvement policy. This recommendation has been met. Areas for improvement Whilst the service had used questionnaires to gather people's views on the service provided, this had not been repeated since the last inspection. The manager advised that new questionnaires were about to be circulated. There were two formal agreements in place for service users; one was a rights and responsibilities document and another was a formal legal agreement. The information needed in an agreement was available in these documents, but during feedback we discussed making this information more accessible to people, possibly by combining the two documents into one agreement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued The manager demonstrated, in the course of the inspection that service users health and wellbeing needs were met to a good standard. Support plans were detailed and contained a great deal of information on how people should be supported. They showed that services were flexible to meets people's needs. They contained information on the person's background and life history and also included risk assessments describing some of the risks that people faced and the control measures in place to reduce these risks. There was evidence of staff working with other professionals including; GP's, psychiatrists, social workers, community nurses and addiction services. This meant that people had access to specialist support when they needed it. The interactions we saw between staff and service users were appropriate and supportive. People were treated with respect and were given the opportunity to make choices for themselves. Healthy lifestyles, including diet and exercise, were promoted while recognising that people should make their own choices. People undertook a range of activities, including swimming, walking and going to the gym. One of the people who used the service told us of the work that staff had done with him on looking at healthy options, Grampian Autistic Society - Outreach Service, page 13 of 23
and the changes he had made to his diet as a result. All staff undertook food hygiene and first aid training. Areas for improvement The service provided to most people had been reviewed regularly, but some of them had not met the required standard of being reviewed every six months. We discussed this with the manager. She was aware of the need to review services and was maintaining a spreadsheet showing when reviews were due. We discussed the possibility of using a tracking sheet in the care plan file, to be signed when reviews took place. See Requirement 1. During the last inspection a recommendation was made on improving the information in risk assessments. The risk assessments had been developed, but still did not provide sufficient information on the measures staff would need to take to keep themselves, members of the public and the people they supported safe. This recommendation has been re-stated. See Recommendation 1. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 1 Requirements 1. The provider must ensure that all personal plans have been reviewed in consultation with the service user or representative. They must be reviewed: (i) when requested to do so by the service user or any representative; (ii) when there is a significant change in a service user's health, welfare or safety needs; and (iii) at least once in every six month period whilst the service user is in receipt of the service. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, No 210: 5(2)(b) Personal Plans Timescale: Within two months on receipt of this report. Inspection report continued Grampian Autistic Society - Outreach Service, page 14 of 23
Recommendations Inspection report continued 1. Risk assessments should provide comprehensive information to ensure that service users are well supported. Reference: National Care Standards for Support Services, Standard 10 - Feeling safe and secure. Grampian Autistic Society - Outreach Service, page 15 of 23
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 The manager provided evidence during the inspection to show that service users and carers were involved in assessing and improving the quality of staff to a good standard. Grampian Autistic Society is a small voluntary organisation which was set-up to meet a local need. Several of the board members were parents of people who used the service, so there was a direct involvement in the service. People and carers had been asked to contribute interview questions, and every time new staff were recruited some questions provided by people who used the service or carers were used. Areas for improvement While people were involved in providing questions for interview we discussed with the manager other ways they could develop how people are involved in the recruitment process and in staff appraisals. See Recommendation 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The manager to consider ways of involving people who use services and their carers in recruitment and appraisal of staff. Reference: National Care Standards for Support Services, Standard 12 - Expressing your views. Grampian Autistic Society - Outreach Service, page 16 of 23
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The manager provided evidence to show that there was a trained and motivated workforce to a very good standard. The staff we spoke with were very enthusiastic about their work and recognised the key part they played in providing services for people who often had limited contacts with other people outside their immediate family. Both the manager and general manager spoke about the responsibility placed on staff in working on a one-to-one basis in community settings with limited opportunities to discuss their work and share difficulties with others. They both emphasised the need to be available to staff and to have an open-door approach. Staff we spoke with agreed that they were well supported and said they could phone or come into the office to talk to a senior member of staff when they wanted to. In addition to the informal support, staff supervisions were planned on a six weekly basis. These were written into staff rotas and the records we inspected showed that they were happening regularly, with detailed records kept, including action points for members of staff. This meant staff had regular opportunities to meet with their manager to discuss their role, personal development and workload. Team meetings were also regular and well attended. They were also part of staff rotas which meant attendance at them was very good. They covered a range of topics, including service developments, the participation group, staff training and updated policies. This was a valuable opportunity to provide support for staff and to develop consistent services. Staff training was comprehensive, with new staff having an induction programme and an opportunity to shadow existing members of staff, before being expected to work on their own. Training provided included epilepsy awareness, first aid, child protection, adult support and protection and food hygiene. Most of the training was up-to-date and there was a schedule of training in place, showing regular opportunities for staff to undertake training. Areas for improvement Inspection report continued The service is currently changing how it provides training, with members of staff taking responsibility for specific areas and using external training companies, where there was previously a training co-ordinator. It will be important to ensure that training is maintained during this period of transition. Grampian Autistic Society - Outreach Service, page 17 of 23
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Grampian Autistic Society - Outreach Service, page 18 of 23
Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths The manager demonstrated during inspection that service users and carers participated in improving the quality of management to a good standard. People and families had an opportunity to comment on the management of the service in the questionnaires. Parents and carers had an active involvement in the management of the service as part of the management committee. Please also see Quality Theme 1, Quality Statement 1 for further evidence for this statement. Areas for improvement Please see Quality Theme 1, Quality Statement 1 for further evidence for this statement. Grade awarded for this statement: 4 - 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 The manager provided evidence during the inspection that they had quality assurance systems and processes involving stakeholders to a good standard. There were a series of quality checks in place that were used to provide information on the service and to identify improvements. Grampian Autistic Society - Outreach Service, page 19 of 23
The manager audited the care files and advised the staff who maintained these of the areas they needed to work on. She also kept a record of reviews and identified when these were due. The information from the questionnaires circulated to families and people who used the service was collated and used to improve the service. The general manager had a development plan which had been agreed by the trustees and he was working towards making the improvements identified within it. Areas for improvement While many of the individual components of a quality assurance system were in place, such as audits and the use of questionnaires, these were not combined to provide an overall quality audit or to identify areas of improvement for the organisation. The General Manager said they were about to undertake an audit using an external auditor with the intention of implementing iso 9001. This was the subject of a previous recommendation and this has been re-stated. See Recommendation 1. Questionnaires returned to us from members of staff were very positive in most areas, but several people selected, 'don't know' or 'disagree' to the comment; 'The service asks for my opinion on how it can improve.' We discussed this with the manager and general manager and suggested that in addition to the other questionnaires in use a questionnaire could be circulated to members of staff. This would provide a way of gathering their views and showing that they were being listened to. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should continue to progress their plans to develop comprehensive quality assurance systems. Recommendations: National Care Standards for Support Services, Standard 2 - Management and staffing arrangements. Grampian Autistic Society - Outreach Service, page 20 of 23
4 Other information Complaints One complaint was upheld, about how the service managed a complaint they received. This is described under Requirements Outstanding. 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). Grampian Autistic Society - Outreach Service, page 21 of 23
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 30 Jan 2013 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 29 Feb 2012 Unannounced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 4 - Good 20 Aug 2010 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership Not Assessed 18 Feb 2009 Announced Care and support 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Grampian Autistic Society - Outreach Service, page 22 of 23
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 Grampian Autistic Society - Outreach Service, page 23 of 23