Action for Children - Silverton Short Breaks Care Home Service Children and Young People Larch Grove Silvertonhill Hamilton ML3 7NF Telephone: 01698 424102 Inspected by: Duncan Craig Type of inspection: Unannounced Inspection completed on: 2 July 2014
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Action for Children Service provider number: SP2003002604 Care service number: CS2005110586 Contact details for the inspector who inspected this service: Duncan Craig Telephone Email enquiries@careinspectorate.com Action for Children - Silverton Short Breaks, 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 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well We found that Silverton Short Breaks provided a very good service to young people and their families. Young people and their families were encouraged and facilitated in participating in individual support plans and the life of the service generally. Respite breaks were well planned and person centred. We saw that young people had very good relationships with staff. We saw that young people enjoyed their stay and were able to take part in a range of activities, both inside and outside the service. The service provided a welcoming atmosphere for young people and their families. We found a skilled, cohesive and well motivated staff and management team. What the service could do better The service should continue to improve upon the existing very good levels of practice. The kitchen needed an upgrade to match the rest of the premises. Action for Children - Silverton Short Breaks, page 3 of 27
What the service has done since the last inspection The service had continued to improve upon the existing very good levels of practice. The outreach provision had increased and the manager was working on a separate registration for this aspect of the service. The manager was sharing his time with another service. The depute had taken planned leave and her role was being fulfilled on an 'acting up' basis. These changes did not appear to be having a detrimental effect on Silverton Short Breaks. We saw that personal care plans and behaviour support plans were up to date and subject to audit. The service had been redecorated throughout. Conclusion We found that Silverton Short Breaks provided a very good service to young people and their families. Respite breaks were well planned and person centred. Young people had very good relationships with staff. We saw that young people enjoyed their stay and were able to take part in a range of activities, both inside and outside the service. We found a skilled, cohesive and well motivated staff and management team. They worked hard to provide a consistently very good quality of service. The manager provided very good leadership that encouraged and facilitated staff to be confident about their role. Who did this inspection Duncan Craig Action for Children - Silverton Short Breaks, page 4 of 27
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. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations. If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The service is registered to provide respite care for a maximum of six children and young people between the ages of four and 18 years. Children and young people may have learning disabilities and sensory impairments. The service is provided by Action for Children Scotland who have several similar services registered with the Care Inspectorate. There are approximately 80 young people using the service over the year. There were three young people staying in the service at the time of this inspection. The project aims "to offer socially valuable experiences that help extend children's life experiences and development, while enabling parents to take a break from caring." Action for Children - Silverton Short Breaks, page 5 of 27
Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - Grade Quality of Staffing - Grade Quality of Management and Leadership - Grade 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. Action for Children - Silverton Short Breaks, 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 This unannounced inspection was carried out by an inspector from the Care Inspectorate on 1 and 2 July 2014. Prior to inspection we examined the service's Self Assessment and Annual Return. We received one completed Care Standard Questionnaires from a parent/ carer. We received one e-mail response from a placing social worker. We received one e-mail response from an ex-user of the service. With the help of staff, we spoke with three young people who used the service. At inspection we spoke with staff members, the acting depute and the manager. We examined a range of records and documentation including care plans, behaviour support plans and risk assessments. We looked around the premises. Staff practice and interaction between young people and staff members were observed throughout the inspection. 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 Action for Children - Silverton Short Breaks, page 7 of 27
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 Action for Children - Silverton Short Breaks, page 8 of 27
What the service has done to meet any recommendations we made at our last inspection Three recommendations were made following the inspection 1. Information in overviews in care planning folders should be kept up to date. National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and Staffing. Outcome: This recommendation has been met. 2. All personal plans should contain evidence that they have been updated and amended following their review. National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and Staffing. Outcome: This recommendation has been met. 3. Audits of case files should be carried out consistently. Where adjustments or updates are required, they should have a date by which the work is to be completed and an acknowledgement when improvements are carried out. National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and staffing. Outcome: This recommendation has been met. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a self assessment document which had been fully completed. It outlined the service's strengths and identified areas for improvement. Action for Children - Silverton Short Breaks, page 9 of 27
Taking the views of people using the care service into account The three young people we spoke with told us that they enjoyed their time at Silverton. They liked the activities best and said that they got on well with the staff. We saw that they enjoyed very close and trusting relationships with staff. Taking carers' views into account One parent/carer responded to our questionnaire. They said: "My son loves going to Silverton Short Breaks. He has so much fun and likes the staff. They are friendly and helpful. They also make sure he has loads of activities to keep him active and safe." Action for Children - Silverton Short Breaks, page 10 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: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We saw very good evidence that young people and parents/carers who use the service were involved in assessing and improving the quality of care provided and the service generally. The service worked to the Action For Children document 'What Participation Means To Us'. We saw that staff used a range of methods of communication to enable young people to express their wishes and make choices. Staff encouraged young people to communicate about all aspects of their care and used this information to design activity programs and daily routines. We saw that staff were skilled at interpreting the responses of young people to different activities and events. Regular 'conversation' meetings were held with young people. We saw from minutes that young people had been consulted regarding decor and music on the service's ipod. The service managed placements to ensure, where possible, that all young people's respite groups were compatible. We saw evidence that communication between staff and parents/carers was very good. This enabled routines and care processes within the service to 'dovetail' with expectations and routines at home. A telephone discussion ('Pre-call') between the key worker and parent/carer took place prior to each period of respite. Action for Children - Silverton Short Breaks, page 11 of 27
The service employed parent/carer questionnaires periodically to further gather the views of service users' families. A suggestion and complaint system was in place. An annual review of placement took place. This provided an opportunity to formally involve young people and their parents/carers in assessing how well their needs were being met and suggest ways of adapting or changing care systems and routines if required. Care plans were very detailed and included updated lists of likes and dislikes. Parents' Forum meetings were regularly held to provide opportunities for discussions about the way the service worked and how it could best meet the needs of the families who used it. A recent event focused on self directed support had been very well attended. These meetings were complemented by occasional 'side by side' events that provided a further opportunity for dialogue. These events focused on outings involving young people, their families and staff. From returned parent evaluation forms we saw that a recent trip to the Heads Of Ayr had been well received. The service also used 'Family Fun Days, activities and food within the service, to further promote the involvement of families. A quarterly newsletter was used to inform young people, families and stakeholders about changes to the service and keep them informed of staff changes and other developments. The newsletter also encouraged parents to contribute ideas and opinions and comment on any aspect of the service. Areas for improvement We discussed with the manager the benefits of a brief participation statement, making it clear that views were welcomed, for inclusion in the newsletter and other documentation targeted at young people, their families and stakeholders. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 12 of 27
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We saw that each young person who used the respite service had a care plan which outlined their needs and how they would be met. This included information and guidance about any medical needs and how the service would ensure the health and wellbeing of the individual young person. We saw that complex issues were comprehensively documented and there was good, clear guidance for staff to support their care of the individual young people. Staff demonstrated a very good understanding of the needs of individuals and how they could best be met. This information was updated prior to each period of respite through the 'pre-call' system. A very good key worker system was in place that ensured effective overview of care planning and delivery. Staff received regular epilepsy, first aid and moving and handling training. The service enjoyed very good relationships with school nurses. Training regarding a particular feeding process was being arranged with a nurse at inspection. We saw that medication was well managed within the service. A range of risk assessments was employed to keep young people safe. These ranged from individual behaviour management plans through to trips to specific venues. An overview was maintained by a summary of risk assessments in each young person's file entitled 'Keeping Me Safe At Silverton'. All incidents were recorded. These were subject to scrutiny by managers. This allowed for an analysis of incidents with a view to identifying and eradicating triggers of negative behaviours. A range of activities was available to young people and physical exercise and outdoor play were encouraged. Outings to parks and other outdoor attractions were a central part of the activity program wherever possible. At inspection, two young women were escorted to the Falkirk Wheel and a barge trip. We saw that an enclosed and well equipped garden provided a safe play. Meals and snacks used fresh ingredients where possible and the staff were aware of the nutritional needs of individual young people. This included any food allergies or ingredients which were potentially harmful if combined with specific medical conditions. Action for Children - Silverton Short Breaks, page 13 of 27
Managers and staff we spoke with had a very good knowledge and understanding of child protection and safe care generally. Areas for improvement The service should maintain this high standard. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 14 of 27
Quality Theme 2: Quality of Environment Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The strengths noted in Quality Statement 1.1 are also applicable to this Quality Statement. Young people had chosen, through their involvement in the conversation group, the bedroom designs on a themed basis, for example, music, space and football themes. The service had recently been redecorated to a high standard. This excluded the kitchen. Areas for improvement The kitchen did not reflect the high standard of decoration elsewhere in the building. Fittings were old and prone to disrepair. A cupboard door was hanging off at inspection. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The kitchen should be refurbished to better reflect decor and furnishings elsewhere in the service. NCS 5 Care Homes for Children and Young People - Your Environment. Action for Children - Silverton Short Breaks, page 15 of 27
Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found that access to the service was monitored and there was a signing-in system for visitors. We found that the provider had a comprehensive range of policies and procedures in place to guide and inform staff in their practice. This meant that all staff understood their role and responsibilities in keeping young people safe. Staff members we spoke with appeared knowledgeable about their child protection responsibilities and safe care in general. Members of the staff team were also aware of any action they should take in the event of an emergency occurring or when a young person was affected by a medical condition. A range of risk assessments was employed to keep young people safe. These ranged from individual behaviour management plans through to trips to specific venues. An overview was maintained by a summary of risk assessments in each young person's file entitled 'Keeping Me Safe At Silverton.' Staff had received training in a method ('pro act scip') for holding safely young people who exhibited challenging behaviour or who were sometimes unable to fully control their actions. This meant that staff could safely intervene in difficult or stressful circumstances to ensure everyone's wellbeing. The garden area where young people could play was enclosed and young people were accompanied by staff when they used the outdoor play areas. Play equipment was subject to regular safety checks and risk assessment. Systems were in place to regularly maintain equipment used to support young people. Checks of portable electrical appliances were also routinely carried out. Health and safety risk assessments of the premises were carried out and a system was in place to record and report maintenance issues. We were told that the service had been visited by the relevant local authority's Environmental Health department. Additionally, as part of the provider's peer audit arrangements, the service health and safety arrangements had been audited. Areas for improvement The service should continue to maintain a safe environment for young people. Action for Children - Silverton Short Breaks, page 16 of 27
Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 17 of 27
Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The strengths noted in Quality Statement 1.1 are also applicable to this Quality Statement. Young people were routinely involved in selecting substantive staff for the service. We saw examples of questions candidates were asked. Areas for improvement Young people should be involved in the recruitment of sessional staff. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Young people should be involved in the recruitment of sessional staff. NCS 7 Care Homes for Children and Young People - Management and Staffing. Action for Children - Silverton Short Breaks, page 18 of 27
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We formed a view of a skilled and motivated management and staff team who were committed to the young people in their care. The manager provided very good leadership that was consultative and encouraged ideas to be progressed. We saw that very good staff induction arrangements were in place, including a check list of key information that included the provider's Code of Conduct. All staff were registered, fully or conditionally, with the Scottish Social Services Council (SSSC). Staff had access to SVQ 3 training to attain full registration. Staff had access to a range of training and development opportunities including first aid, 'pro act scip', risk assessment, epilepsy and 'sign along' (a non verbal communication method). Rota and deployment arrangements were very good and ensured the optimum wellbeing of the young people. Flexibility enabled the service to respond to emergency requests for respite. Some staff had delegated areas of responsibility; for example, a member of staff held overview of the rota and other staff members had delivered 'master classes' (training sessions run by specific staff members who had a broad range of skills in a particular area of practice). A formal supervision policy and procedure was in place. Staff told us that they felt very supported by managers and colleagues. Staff communicated well with each other and told us that there was a strong commitment to a team approach to the provision of care for the young people. Changeover meetings were key to this effective communication as was the weekly staff meeting.this meant that positive ways of working with individual young people were shared. This resulted in a consistent approach to the care of individual young people. There was an effective use of e-mail communication that allowed information to be exchanged across different shifts. Action for Children - Silverton Short Breaks, page 19 of 27
Staff we saw and spoke with demonstrated a very good understanding of the needs of the young people they cared for and were clear about the best ways to meet these needs. We saw that young people were treated with respect by staff and that their individual needs were known to those who were working with them. We saw that staff were skilled and worked hard to communicate with young people in a manner best suited to their needs. The service had recently held a Development Day to which all staff were invited. This further promoted team cohesion. Areas for improvement The service should maintain this high standard. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 20 of 27
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 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 strengths noted in Quality Statement 1.1 are also applicable to this Quality Statement. The acting depute and occasionally the manager worked alongside staff. Both had an 'open door' policy at other times that enabled young people and staff to see them, if they so desired. Areas for improvement The service should continue to explore ways of involving service users and their families in all areas of practice. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 21 of 27
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 provider had a range of management and audit processes in place to monitor the effective running of the service. This included centralised systems for financial and budget monitoring, human resources systems, a training department and an IT department. The service had good, clear links with the local authority that purchased the service. We saw from records of meetings that the effectiveness of the service was monitored and evaluated to ensure that it was meeting agreed aims and goals. The manager attended such a meeting during inspection. A line management structure was in place which provided both support and overview to the service's manager. The external manager visited the service to conduct supervision and attend meetings. We saw, and were told, that absences were managed well and within the provider's policy and procedure. The provider operated a system of peer audit, whereby managers from another service visited and evaluated aspects of the service's functioning. Staff regularly received formal supervision which looked at the quality of their performance, training needs and their achievements. Sessions were structured and recorded, which enabled managers to maintain an overview of the skills and abilities available within the staff team. Staff felt supported by this supervision. An annual appraisal took place. A staff meeting took place every Tuesday and we saw from minutes that an appropriate agenda was followed. Staff told us that this meeting was inclusive and that views and ideas were welcomed. We were told by staff that they felt well supported by managers who they could consult at any time and who, on occasion, worked alongside them. The service held occasional whole team Development Days. We saw that personal plans and behaviour support plans were reviewed and 'signed off' by seniors and managers. Action for Children - Silverton Short Breaks, page 22 of 27
Areas for improvement The external manager should make himself available to young people and staff by 'popping in' occasionally or visiting briefly prior to, or after, supervising the manager or meetings. Due regard should be given National Guidance for the External Management of Residential Child Care Establishments in Scotland, The Scottish Government, Edinburgh 2013. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 23 of 27
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). Action for Children - Silverton Short Breaks, page 24 of 27
5 Summary of grades Quality of Care and Support - Statement 1 Statement 3 Quality of Environment - Statement 1 Statement 2 Quality of Staffing - Statement 1 Statement 3 Quality of Management and Leadership - Statement 1 Statement 4 6 Inspection and grading history Date Type Gradings 11 Jun 2013 Unannounced Care and support 4 - Good Environment Staffing Management and Leadership 19 Jul 2012 Unannounced Care and support Environment Staffing Management and Leadership 13 Mar 2012 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership Action for Children - Silverton Short Breaks, page 25 of 27
24 Nov 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 20 Jul 2010 Announced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 11 Feb 2010 Unannounced Care and support Environment Staffing Management and Leadership 4 - Good 2 Oct 2009 Announced Care and support Environment Staffing Management and Leadership 27 Mar 2009 Unannounced Care and support Environment Staffing Management and Leadership 18 Jul 2008 Announced Care and support Environment Staffing Management and Leadership All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Action for Children - Silverton Short Breaks, page 26 of 27
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 Action for Children - Silverton Short Breaks, page 27 of 27