Care service inspection report Full inspection West Lothian Occupational Services Support Service Almond House 12 Quarrywood Court Livingston Inspection completed on 14 April 2016
Service provided by: Autism Initiatives (UK) Service provider number: SP2004006462 Care service number: CS2010272011 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 27
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 Quality of staffing Quality of management and leadership 5 Very Good N/A Very Good What the service does well The service provides support to people who have autism, in either one to one sessions or in groups. Many people are younger and some are moving from educational services. The service encourages people to develop everyday living skills and take part in activities to meet their own goals and needs. Families said they were fully involved in planning and reviewing their relatives' support and that staff communicated well with them. Staff are encouraged to develop their skills and knowledge. The staff we met were very enthusiastic about the work they did. What the service could do better The service works with a wide range of ages and individual needs. It should continue to think about how it works with people to meet these differences. Although a lot of support is provided away from it, the service should think page 3 of 27
about how well Almond House meets people's' needs. Some of the facilities such as accessible toilets and kitchen equipment could be improved. There seems to be a lack of storage. The service should ensure that the daily register of people in the building is well-completed. What the service has done since the last inspection The service has grown bigger and is having to think about how it develops the building spaces at Almond House. There are plans for a sensory room, for example. However it does need to think about how the greater numbers of users are accommodated when they try to use the facilities, and that these are suitable for people with different needs. The service continues to develop the online shop. There has been a further change in the way the service is managed. There are now three teams that reflect the different needs people using the service have. This helps provide more specific services and activities. Conclusion The people using this service received support which helped them develop and improve their skills, confidence and independence. Staff enjoy the work they are doing. Families were happy with the service given and how they were involved in the day-to-day support and in reviews of support plans. page 4 of 27
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Before 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.scswis.com West Lothian Occupational Services provides a support service to adults with autism and aspergers in the West Lothian area. Some people using the service are young adults who are making the transition from school and children's services to adults services. The service was registered on 11 January 2012. The service aims to provide support in an autism specific way. The young people are provided with individual packages of support. The service is based at Almond House in Livingston. Support is provided on a 1:1 basis or in groups, helping develop skills and confidence and getting involved in a range of activities and access to local community facilities. 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 service for people to enable them to have ownership of their own lives and futures'. At the time of this inspection about sixty-five people were using the service. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements page 5 of 27
A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. 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 - N/A Quality of management and leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. 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 0345 600 9527 or visiting one of our offices. page 6 of 27
2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection From the 1 April 2016 the way in which we carry out an inspection has changed. We choose which quality themes and statements are inspected for better performing services, to be more proportionate and targeted in our work. In highly performing services, inspections will consider Quality Theme 1: Quality of Care and support, Quality Theme 1, Statement 3 "We ensure that service user's health and well-being needs are met". This statement will be considered during all inspections. We will look at one other statement in this theme. We will also look at one other quality theme and two statements. This service is eligible for this type of inspection and based on our knowledge, experience and intelligence of the service, we have chosen Theme 1 and Theme 4. We wrote this report following an unannounced inspection. The inspection was carried out by one Care Inspectorate Inspector. This took place on 12 April 2016 between 9.30am and 5pm and on 14 April 2016 between 10am and 6.15pm. We told the Manager what we found at the inspection on 14 April 2016. We told the Manager what we found at the inspection on 14 April 2016. As requested by us the care service sent us an annual return. The service also completed a self assessment form. In this inspection we gathered evidence from various sources including the relevant sections of policies, procedures and other documents including: - Sampled support and care plans - Reviews of support and care plans page 7 of 27
- Risk assessments - Support agreements - Communication books and diaries - Team meeting minutes - Recruitment records - Training records - Support and supervision records - Appraisal records - Staff training records - Incident and accidents - Complaint records - Quality assurance information - Adult Support and Protection policy - Complaints policy. Minutes of meetings for People using the services. Discussions with the Service Manager. Discussions with six staff. We spoke with six people using the service. 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 page 8 of 27
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.firescotland.gov.uk page 9 of 27
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 completed self assessment document from the service provider. The service provider had completed this and with some relevant information for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. We discussed with the Manager how more information could be provided to evaluate the strengths of the service and demonstrate how the views of people using the service, families and staff were used. Taking the views of people using the care service into account We sent out twenty-eight Care Inspectorate Care Standard Questionnaires and three were returned before the inspection by people using the service. All agreed or strongly agreed that they were 'happy with the overall quality of the service'. The people we met in the service said they were happy with it and enjoyed coming to it. Generally they got on well with staff and the manager. They thought they had different things to do that met their needs, both at Almond House and in the community. Other views can be found under the relevant quality statements. page 10 of 27
Taking carers' views into account We sent out twenty-eight Care Inspectorate Care Standard Questionnaires and three were returned before the inspection by people using the service. All agreed that they were 'happy with the overall quality of the service'. We spoke with others by phone. Comments included: -'Have found the service very willing to understand and meet my brother's needs. Feel confident that he is in safe hands'. Other views can be found under the relevant quality statements. page 11 of 27
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 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service Strengths The service was performing well in this quality statement. Whenever possible people and families are given information about the service and what it can offer. Introductory meetings will also take place. The service has good links with social workers and other agencies. Taken together these help people make a choice about whether this is the right service for them. People were supported to put together activity plan and this was used to map out what they were doing during their contact with the service. Some activities took place in the community. These included people paying bills, looking after their home or shopping. Other activities took place at Almond House. These included cooking and baking practice. Staff talked about work practices that supported people to develop their skills, abilities and independence. Staff discussed how they had supported people to make changes in their lives. Emphasis was put upon the use of meaningful activities to promote people's' well-being. People using the service went swimming and trampolining. There was a women's and a men's group. The Manager told us they were keen to offer qualifications to people using the service. They had teamed up with a college to make this happen. This meant that the service could offer activities to help people develop their abilities and page 12 of 27
independence and gain a qualification. This could include for example computer skills, health issues and accessing community facilities. The service employed some staff with specific skills that could be used to offer choices to people using the service. This included arts and crafts work. Singing, whether in 1:1 instruction or as part of a choir was a more recent addition to the opportunities on offer that people could choose to take part in. The 'Almond House Newsletter' is produced every other month. This provides people with information about the range of activities available, feedback about events that have taken place and service user and staff news. The manager told us that the newsletter was put together by a service user. We saw that there were a number of contributions from other service users too. We met six people using the service. They all said they enjoyed using the service. Some comments included: -'I think the service is amazing - it is very good'. -'It is a two way process - the staff get to know you and you get to know the staff - that's why it is successful'. -'Good for experiences and building my confidence'. -'I think everybody is supportive and friendly'. -'Staff treat me with respect and I feel that I belong'. We spoke with families. They told us about some of the difficulties in moving between child and adult services and how that could be hard. They said however that staff in this service did listen to them and their concerns and had worked on ways to improve the support, making it far more effective. Intowork is now based in Almond House. This is a supported employment charity who help people find employment and support them on placement. This has created other opportunities for people using this service to work towards paid employment. Areas for improvement The service could continue to develop the service user group and consider ways to increase the number of people who take part. It could also consider how effective the representation of people and their issues is in the 'I'm Heard' page 13 of 27
group and ways to develop this. Support work was reviewed every four weeks in a meeting between service user and key worker. While people were asked what they thought, it may help to provide a more evaluative report that considers how far people's' needs are being met in relation to outcomes set. This could then feed more clearly into the six monthly reviews. At the last inspection we said that the service should ensure that all support plans are signed by the person using the service, their representative or a reason recorded why this has not happened. This time we also saw that other documents were not always signed or dated. We saw that some risk assessments did not have the person's name, nor signed or dated correctly. It is important that all documents are signed to show that the service user agrees with them (see recommendation 1). Although some very good notes were kept, staff seemed less clear how to reflect on the daily work carried out and how this helped people achieve their goals and outcomes. In particular how to record how this impacted on each person and helped improve their lives. We saw that this was part of discussions taking place within the services in West Lothian and look forward to seeing how this will change in future. Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The service should ensure that all paperwork is signed by the person using the service or their representative. All records should be completed accurately and dated. National Care Standards, Care at home, Standard 4 - Management and staffing. page 14 of 27
Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths Each person using the service had a support plan, called a 'working file'. This contained clear guidance for staff about to provide their support. Plans were of a very good standard. These contained information about the health and wellbeing needs each person had and the health professionals and staff members responsible for their care. Key workers were responsible for ensuring support plans were up to date and that people using the service and their relatives were involved in regular reviews. We looked at five working files and consultation folders. We saw that these contained well written guidelines for staff about how to help people using the service meet their activity, health and well-being needs, where appropriate. Each person had specific goals they were working on to help develop new skills. These were related to activities such as baking or developing computer skills. Staff were expected to record daily notes in relation to the goals. This meant that when reviews took place the notes provided a record of what had been achieved. The working file was put together with family, relatives and other health professionals' help where the person being supported was not able to provide information. We found that people using the service had good contact with health professionals such as speech and language therapists or the community learning disability nurse. Relevant information was gathered together to develop a holistic support plan. Although it was not a main focus for the work this service carried out, staff we spoke with said they were familiar with the health needs or specific health conditions of people using the service. File notes showed the range of health professionals people using the service had recent contact with and who was responsible for supporting people with different issues.. page 15 of 27
Families we spoke with said that staff knew their relatives' needs and helped people to make positive changes. They thought that the service provided good support and that their relative really benefitted from this. Other comments included: -'Caring, supportive and fully aware of his needs'. -'High levels of communication with families - good information sharing'. -'The service is really good - works with us on improvements' -'Very adaptable with the personal plan, to accommodate changing needs'. One person using the service said they were 'very happy with the support that I get'. Areas for improvement The service could consider whether the risk assessment format used could, where appropriate, be more person-centred, include service users' views and demonstrate that the assessment is shared with the individual. The assessment could show how everyone is involved in minimising risk. We saw that the service was considering how to adapt the Almond House building to meet the different needs that people had. This was partly because more people were using the service as it expanded and demand increased. However some people had physical needs that needed improved facilities, for example, in the kitchen and for personal care. The service was considering a range of improvements, including a sensory room and adaptions to the other rooms, to offer quieter spaces. This is important because more people coming to the service. As work has begun on this we shall see how facilities have improved, at the next inspection. The service is reminded it can also contact the Care Inspectorate for further advice. page 16 of 27
Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The service should consider the use of a person centred risk assessment that would enable people to take part in the assessment and discuss the risks and their part in minimising these. National Care Standards, Care at Home, Standard 4 Management and staffing and Standard 11 - Expressing your views. page 17 of 27
Quality Theme 3: Quality of Staffing Quality theme not assessed page 18 of 27
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 We asked staff how they helped determine the direction of the service. They said that they were kept informed about changes in the monthly team meeting. This gave them opportunities to discuss the shape of the service as it changed to accommodate more people. This had resulted for example, in there being three teams of staff instead of two, each working in more specific ways with people's' needs. They said that training was good and that this helped equip them with the knowledge and skills to work effectively. They said that the team worked well together and that they learned from each other as well as from people using the service. Some training helped staff understand the specific needs of the people they worked with. For example, ASIST training, to help staff work with people with suicidal thoughts was provided as required. Training was now managed in a planned way. This meant that overall most mandatory training was up to date. This included Positive Behaviour Support, epilepsy and first aid. There were file planning meetings about every two weeks. This gave staff opportunities to talk about and plan their work. Support and supervision meetings were taking place regularly, every six to eight weeks. These meetings give staff space to talk about their work, reflect on how they do it and consider any training or development needs they have. We saw that each session was structured to cover these points. page 19 of 27
A meeting had taken place last December with staff to consider how well the service was working, what its strengths were and areas where improvements could be made. Staff had been split into group to consider how resources, staffing and ways to work effectively with service users. This resulted in a number of actions including: - More key working evenings with manager support. - Staff to take responsibility and leadership in their own support. - Improve facilities in Almond House, for example, a sensory room. - Plan better to help prevent rooms becoming too crowded. For example, at the December meeting staff had agreed that 'they should strive to ensure that opportunities were in place including: - Supporting friendships and reducing isolation - Social groups - Evening activities - Respite and holiday opportunities - Skills building. Areas for improvement The service should continue to involve staff in determining its future direction, aims and objectives. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 20 of 27
Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service Strengths The service had developed a positive attitude to development and learning. This helped staff feel they were part of a good team with good management support. Staff told us that they were supported and encouraged to take responsibility in work. This included taking a key working role with some service users, or more specific work. This included leading and supporting groups, or arranging specific events to meet peoples' needs and requests. This included a women's group, the service users' consultation group and the evening social group. Staff told us that having this level of responsibility was important to them in their development and work satisfaction. Other systems which helped support the quality of the care included: - Staff support and supervision meetings - Informal support - Monthly team meetings - Incident and accident records - Complaints. As we have said in other parts of this report, staff are expected to reflect upon the work they are doing with people using the service and to consider how this may be improved. Staff were encouraged to take responsibility for their work. Staff said that the approach to working with people was important. Support was provided in a pro-active way. This meant staff needed to be aware of peoples' behaviours and anticipate possible difficulties in advance. As one person put it, they tried to encourage service users to be 'happy and relaxed - start from a positive point of view, helping staff and people using the service avoid more serious incidents much of the time. Staff were mentored, supported and trained in these ways of working. page 21 of 27
Some staff were trained in Positive Behaviour Support so that they could train and support other staff. This helped them develop particular skills and confidence which they could pass on to others. They were also able to help lead the team they were in and mentor staff. Further, staff were encouraged to take leadership roles in specific projects and develop ways of working with people. This was true for individual work and group work. Staff's own skills were used, in music, art and IT - both to support service users but also to improve how they could use their own abilities. This seemed to mean that staff would be helped to develop their own skills and in turn use these to benefit people using the service. Staff who took on promoted posts were offered training in supervision and other internal management training. Team leaders were able to undertake the SVQ4 qualification to develop their management skills. There were regular team meetings. Staff told us they were able to contribute to these meetings and that their views and opinions were usually listened to. In particular we were told that any issues, concerns and worries were discussed and agreement reached. This meant that there could be better consistency in the ways staff approached their work with individual users. Autism Initiatives had an internal quality assurance system and a senior staff member had been asked to carry out the quality checks with the Manager or senior staff. This was to improve consistency of approach and to achieve improvements to each service. The service was inspected against a range of benchmark statements, strengths were identified and recommendations made where improvements were required. We were told the report was shared with staff, managers and organisation's directors. We saw that an action plan had been produced to tell us what the service was going to do to meet the recommendations. Areas for improvement The service continues to develop the internal audit process to make sure that any recommendations made and improvement actions are followed through. We would suggest that the service could be clearer about how it involved page 22 of 27
people using the service and their families in developing this process. It could also show how people using the service, families and staff contribute to the self- assessment that it completed prior to this inspection. The service should also consider how to record and make use of feedback from other stakeholders and professionals. At the last inspection we said that the service had a visitors' book at the entrance to the service but only a few people signed this as they came and went. It is important the service knows who is in the building at any time. On the day we first visited this had not been completed. We have made the recommendation again (see recommendation 1). When we asked staff in senior posts about supervision training they said they were able to undertake a PDA module. However they gave the impression that this could be better. The service could review how staff are trained in giving support and supervison. It could also refer supervisors to the training - how good refer to IRISS paper 'Achieving Effective Supervision' July 2015. Staff could also be referred to the 'Step into Leadership' information provided by SSSC. In its self-assessment the service said it would support staff members who have leadership qualities, give them additional roles and coach and support them using mentors. We looked at incidents and accidents that had happened in the service in the last few months. We saw that some of these had meant people had to go to hospital We thought these should have been notified to the Care Inspectorate and discussed this with the Manager. Please see recommendation 2. Information about the kinds incidents and accidents that need to be notified can be found on out website. page 23 of 27
Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations - 2 1. The service should ensure that all health and safety procedures are adequate and will keep everyone safe in an emergency. National care Standards, Care at Home, Standard 4 - Management and staffing. 2. The service should ensure that the Care Inspectorate is notified when accidents take place resulting in a person being taken to hospital. National care Standards, Care at Home, Standard 4 - Management and staffing. page 24 of 27
4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The service should ensure that all health and safety procedures are adequate and will keep everyone safe in an emergency. National care Standards, Care at Home, Standard 4 - Management and staffing. This recommendation was made on 22 April 2015 On the day of the inspection the record had not been completed. Please see statement 4.3. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. page 25 of 27
8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 22 Apr 2015 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 5 - Very Good Not Assessed 5 - Very Good 4 - Good 17 Apr 2014 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 5 - Very Good Not Assessed 5 - Very Good 4 - Good 21 Feb 2013 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 4 - Good Not Assessed 5 - Very Good 4 - Good page 26 of 27
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 27 of 27