Scottish Autism Support Service Care at Home 29b Balunie Avenue Douglas Dundee DD4 8QY Telephone:

Scottish Autism Support Service Care at Home 29b Balunie Avenue Douglas Dundee DD4 8QY Telephone: 01382738334 Type of inspection: Unannounced Inspection completed on: 15 January 2015

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Scottish Autism Service provider number: SP2003000275 Care service number: CS2008189149 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at enquiries@careinspectorate.com Scottish Autism, 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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The staff provide a high standard of support to a small group of people with complex needs. Staff work effectively as a team to provide a consistent approach and build positive relationships with the people who use the service. What the service could do better The management team should continue to support all staff to work effectively as a team to build on the high standards of service delivery established within the service. In particular, the manager and senior autism practitioners should plan development days throughout the year to support all teams within this service to contribute to improvement and development. What the service has done since the last inspection The service has recently appointed a new service manager. This has proved to be a positive experience as the manager had previously been a senior autism practitioner within the service. This appointment promoted continuity during the transition. Since the last inspection the managers and staff have worked hard to establish positive team relationships and create a culture of trust and confidence. Commitment in this area has ensured the service has continued to develop. Scottish Autism, page 3 of 23

The service had introduced service user forums over the last year. Staff work with service users to ensure that they are able to contribute in a way that is enabling them to participate at a range of levels. Conclusion This was a very positive inspection. We were pleased to see continued improvement across all aspects of service delivery. Scottish Autism, page 4 of 23

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, the Care Commission carried out this function. 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 1 April 2011 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, we may make requirements. These are legally enforceable at our discretion. Scottish Autism is a support service for up to four adults with autism and Asperger's Syndrome at one time. The service (part of the Fife and Tayside Area Services) operates from staff accommodation in a block of four flats occupied by the people using the service. It is located in a residential area of Dundee. The staff team consists of the service manager, two senior autism practitioners and a number of autism practitioners and support workers. The provider is Scottish Autism, an independent Scottish charity. Its head office is in Alloa. The Fife and Tayside Area Services provides a range of day, residential. housing support and care at home services for both children and adults. The service's mission statement is to support individuals to live full lives and encourage them to progress through accessing local facilities, developing and maintaining independent living skills, and to promote inclusion, They also aim to support individuals to take responsibility and participate in the design of their services. Scottish Autism, page 5 of 23

Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. 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. Scottish Autism, page 6 of 23

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an inspection of the service. A visit was made to the service on 14th January. Feedback was delivered to the manager of the service on 15th January. As requested by us, the service completed and submitted an annual return. The service also submitted a self assessment of the care and support they deliver. The information from both submissions has been used to inform the inspection process and this report. During the inspection evidence was gathered from a number of sources including the following: * Policies and procedures including participation strategy * Feedback from questionnaires * Minutes of meetings * A sample of service user support plans * Examination of training and other staff records * Examination of audits and service data * Discussion with the service manager and staff * Discussion with a relative of a service user 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 Scottish Autism, page 7 of 23

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 Scottish Autism, page 8 of 23

What the service has done to meet any recommendations we made at our last inspection There were no recommendations made at the last inspection. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted an electronic self assessment as requested by the Care Inspectorate. This identified some strengths of the service as well as some areas for improvement. The assessment contained a wide range of relevant information. Taking the views of people using the care service into account We did not speak with any service users as part of this inspection. We received one Care standards questionnaire that had been completed on a service user's behalf by a relative. They indicated that overall they were very happy with the service provided. Taking carers' views into account We spoke with one relative of a service user as part of the inspection. They were happy with the quality of care and support provided by the service. In particular they confirmed that they were very much involved in any discussion about their relative's support and had also recently participated in the recruitment process. Comments included,"she is very happy, very settled, she has a good team." Scottish Autism, page 9 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: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service continued to demonstrate its commitment to participation and we found a range of evidence across all Quality Themes and examples of very good practice in this area. Discussions with a relative, staff, manager and examination of written records confirmed participation and empowerment were a key strength of this service. We found that high standards of practice in this area were soundly established and embedded in practice. We were pleased to see that a Service User Forum had now been set up to enable service users in the Dundee services to meet as a group to discuss and plan social events, share information and learn about key events and issues. So far, there had been limited attendance from Balunie Avenue service users due to their particular needs. However, information was shared with them from the forums and they were able to contribute prior to meetings through discussion with a member of staff. All service users attended the social events that were organised by the group, enjoying the opportunity to socialise and enjoy what was happening. Service users were encouraged to become involved in a range of activities that supported service delivery such as regular keyworker meetings, service audit and review. This approach enabled service users to feel in control and experience a strong sense of responsibility for their own lives. The provider organisation was proactive in promoting participation in a range of areas and we saw how service users had contributed positively to reviews of their care and support. Scottish Autism, page 10 of 23

The introduction of the 'My Review' format had enabled service users to actively contribute to a review of their care and support and make changes as they required. Staff made use of a range of personalised communication systems that maximised participation. These included pictures and symbols and boardmaker charts. This meant that service users were able to express themselves and have a voice. This approach supported an overall culture of empowerment within the service. We found that the manager and staff worked closely with relatives and service users to enable them to feed into the recruitment and review of staff at the service. For example, relatives had attended interviews for new staff and provided feedback to the manager on the people interviewed. Service users were also given opportunities to meet interviewees in less formal situations where interaction could be observed as part of the process. We found that staff encouraged service users to become involved in activities and events in their local community. This promoted a strong sense of belonging. Written records confirmed that service users attended a range of activities out with the service and used local facilities on a frequent basis. Feeling confident within the local community is vital in accessing new opportunities, developing social skills and overcoming isolation at home. We were pleased to see that service users made use of a local walking group and used local shops and facilities. Overall we could see that service users enjoyed a range of opportunities to influence, not only their own care, but also wider service delivery. Areas for improvement The staff should continue to ensure that participation and empowerment to make choices remains a high priority within the service. They should continue to reflect on the approaches they use to maximise inclusion and communication. In particular, the service highlighted that continued development of the Service User Forum would continue. This should focus on developing ways to enable more service users to attend. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 11 of 23

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths During the inspection we examined a range of evidence to confirm that staff delivered a very good standard of care and support in this service. Systems and practice in place across the service that supported good outcomes for health and wellbeing included person focussed planning, meaningful risk taking assessment, a strong multi-disciplinary approach and good communication within staff teams. We found that staff worked in a way that promoted positive physical and emotional well-being. This approach was reflected in the personal care and support plans we examined in the service. Emphasis was placed on healthy lifestyles and service users were encouraged to eat healthily and take part in a range of activities. This approach supported a number of personal outcomes and goals for service users. These included reduced anxiety and distress, increased confidence, more contact with family and increased levels of enjoyment through social interaction and activity. A member of staff had linked with the Royal National Institute for the Blind (RNIB) and was trained to take on the role of 'vision champion' within the service. Information had been shared within the team and a service user was supported to have a test for the first time in many years. The result of this was a prescription for new glasses. The staff were working with the service user to wear their new glasses to aid their vision. We examined two care and support plans in detail and found clear guidance on how to offer support and care that was designed to meet individual need. Records confirmed that staff followed guidance consistently which in turn promoted the best possible outcomes for people. Positive outcomes included reduced levels of anxiety, improving relationships, reduced incidents of escalating aggression, improved physical health and access to a wide range of opportunities and activities. Success and a sense of achievement was supported by a consistent approach from staff. This was confirmed in discussion with staff who all spoke confidently about specific guidance and strategies in place to support service users. Records of discussions held with service users and their relatives showed how staff worked innovatively to overcome difficulties and promote positive outcomes. Staff used a process of task analysis to help them consider how they may support a service user to reach a particular outcome. This was particularly useful in supporting people to develop key skills for living and learn about responsibility. Scottish Autism, page 12 of 23

As a result, one service user had reduced staff support to a lower level. This meant that the service user felt empowered to continue to develop new skills and in particular increase the interaction they had with family members. Staff spoke confidently throughout the inspection about their practice and we found communication records supported this. Records confirmed that mandatory training was up to date. This meant that all staff were confident in their day-to-day practice and had built positive working relationships with service users built on trust and confidence in their skills. Overall staff across the service spoke confidently about their work and we were aware of their values and commitment to person centred practice. This in turn led to a strong sense of physical and emotional wellbeing for service users. Areas for improvement The service identified in their self assessment that they would continue to ensure that staff had the appropriate skills and knowledge to address particular areas of need for people who used the service. This included training in supporting sexual health needs and increasing knowledge of harm protection issues. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 13 of 23

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 14 of 23

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths During the inspection we saw in written documentation and in discussion with the staff and managers that the staff team were an enthusiastic group of people who were motivated in their day-to-day practice and were also keen to learn and develop on a continuing basis. Staff told us they felt valued. Comments included, "I like my job" "You're encouraged to think about learning and development" "Good team communication" "You certainly get variety" "Great environment to work in" "Managers are approachable." During the inspection we spoke with a range of levels of staff. They were all enthusiastic about the work they did and how they played a part in supporting people to develop new skills, be as independent as possible and maintain as much control over their lives as possible. Staff spoke with a strong sense of pride in their work. We found that staff were very clear about their responsibilities within their different roles. The service, as a whole, placed an emphasis on a continuous cycle of improvement and development and we found this reflected in discussion with staff. We also examined minutes of staff meetings that confirmed staff were able to reflect on key concepts of service delivery such as values and dignity. This was good practice and enabled all staff to keep up to date with best practice methods. Staff members confirmed that team meetings were generally positive experiences which contributed to a feeling of job satisfaction and motivation. Access to training and continual learning was also supported by a process of supervision and appraisal. Staff commented that they felt supported by their line management. This approach from management supported staff to feel confident in their day-to-day practice which, in turn led to positive experiences for people who used the service. We were pleased to see that the manager and staff had worked hard over the last year to develop positive team dynamics and promote good communication. Scottish Autism, page 15 of 23

All staff confirmed that the teams within the service all worked well together and there was positive outlook to development and improvement. This had also led to a more consistent approach for service users and we could in written records and from discussion with staff that positive relationships had led to increased trust from service users. Overall, we concluded that the staff worked effectively as a team and as individuals. All staff we spoke with were aware of their responsibilities and felt that they contributed positively to the lives of service users. Areas for improvement The manager and senior autism practitioners should now ensure that all staff teams are able to attend planned development days throughout the year. These should focus on team building, continuous learning and development and service improvement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 16 of 23

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 17 of 23

Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths During the inspection, we saw that the service had a strong commitment to quality assurance. As a result, service users continued to experience a consistently high standard of care and support. The service continued to use a wide range of strategies both internal and external to ensure standards were maintained and improved as required. We examined very good records of a range of checks and audits including medication, finance, support planning and review. This ensured that errors were identified and addressed quickly to promote well-being and consistency for service users. Discussion with the manager confirmed that they had a clear overview of service delivery and areas where improvement and development were required. We were pleased to see that the manager and staff were now in the process of establishing a cycle of improvement and development across the service. The provider organisation had established good links with Quality Scotland, an organisation that promotes excellence and improvement in organisations across Scotland. Scottish Autism had introduced Public Service Improvement Framework (PSIF) as a means of assuring quality across their service through self and external assessment. We look forward to seeing how this progresses over the next few years. Overall, the systems used by the service ensured that a high standard of service delivery was maintained and continually developed. The involvement of service users and staff ensured that a range of opinions were heard and confirmed with everyone the importance the service placed on them. Areas for improvement The service identified in their self assessment that they intended to support more regular peer auditing across the service. In particular this would see senior autism practitioners conducting audits in other parts of the service to monitor practice and share ideas for development. The service also identified that they intend to consider how information about service users is shared with others when it is not covered by legislation so as to support the right to privacy for service users. Scottish Autism, page 18 of 23

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 19 of 23

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Scottish Autism, page 20 of 23

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 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 3 Mar 2014 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 4 - Good 4 - Good 3 Jan 2013 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 6 Jan 2012 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 29 Nov 2010 Unannounced Care and support 4 - Good Staffing Not Assessed Management and Leadership 4 - Good 25 Mar 2010 Announced Care and support 3 - Adequate Staffing 4 - Good Scottish Autism, page 21 of 23

Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Scottish Autism, 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 0345 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 0345 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0345 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Scottish Autism, page 23 of 23