Action for Children - Silverton Short Breaks Care Home Service Children and Young People Larch Grove Silvertonhill Hamilton ML3 7NF Telephone: 01698

Action for Children - Silverton Short Breaks Care Home Service Children and Young People Larch Grove Silvertonhill Hamilton ML3 7NF Telephone: 01698 424102 Inspected by: Iain Lamb Type of inspection: Unannounced Inspection completed on: 11 June 2013

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 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Action for Children Service provider number: SP2003002604 Care service number: CS2005110586 Contact details for the inspector who inspected this service: Iain Lamb Telephone 0131 653 4100 Email enquiries@careinspectorate.com Action for Children - Silverton Short Breaks, page 2 of 25

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 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 The service provides a comfortable environment which is welcoming and safe. The staff team is committed to providing good quality care which meets the needs of the families who use Silverton. What the service could do better Some documents in the care planning system need to be more regularly updated. Evidence of outcomes from reviews need to be more clearly stated in personal plans. The audit process for care planning needs to be more consistently carried out. What the service has done since the last inspection Since the last inspection, the centre has been gradually redecorated and developed in line with the suggestions and ideas from the young people who use it. The staff team has continued to work towards improving the service and meeting the needs of the young people as fully as possible. Action for Children - Silverton Short Breaks, page 3 of 25

Conclusion The Silverton short breaks service provides a very good quality of care for the young people who use it and their families. Staff are clear about their responsibilities and work hard to ensure that young people enjoy their time at the centre. They also communicate well with parents who feel reassured that their children are well cared for. Who did this inspection Iain Lamb Action for Children - Silverton Short Breaks, page 4 of 25

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. 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 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 five 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 25

Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good 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 25

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 completed this report following an unannounced inspection. The inspection was carried out by Iain Lamb, an Inspector from the Care Inspectorate, on the 31st May and the 5th June 2013. Feedback was provided to the manager on 11th June. In this inspection, we gathered evidence from various sources, including: the relevant sections of policies, procedures, records and other documents. These included: evidence from the service's most recent self assessment young peoples' personal planning records minutes of staff meetings minutes of the conversation group questionnaires returned to us from families who used the service questionnaires issued by the service and returned to the service. The manager was consulted and three members of staff were interviewed. Other members of staff were spoken with informally during the visit. Two shift changeover meetings were observed. Interaction between staff and young people was observed. All areas of the premises were inspected. 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 25

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 25

What the service has done to meet any recommendations we made at our last inspection There were two recommendations made in the last inspection report. We saw that they had received appropriate attention from the manager and the staff team. 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. Taking the views of people using the care service into account We spoke to two young people who were using the service. They said they enjoyed coming to Silverton and liked the activities. They said there was always lots to do. They also said that they liked the staff. They couldn't think of anything about their respite visits which they didn't like. Action for Children - Silverton Short Breaks, page 9 of 25

Taking carers' views into account We received two completed questionnaires from parents. These were very positive and indicated a high level of satisfaction with the service. The respondents indicated that they felt the young people were safe and well looked after. They confirmed that they were consulted by the service about personal plans and were aware of the ways in which care was provided. We saw the questionnaires sent out by the service and completed by parents. These were positive and described a range of situations which parents felt had been well managed by the service to provide very positive experiences for the young people who stayed for respite and their families. Action for Children - Silverton Short Breaks, page 10 of 25

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 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 The service had developed a very good range of methods of involving young people and their families in assessing and improving the quality of care provided at Silverton short breaks. We saw that young people were involved in discussing their care and choosing different activities. Staff used a variety of different communication methods to ensure that young people were able to express their views about the activities and routines available to them. Routinely, young people were encouraged to make choices and these were listened to and acted upon by staff. A conversation group had been developed to directly consult young people on specific subjects. A number of subjects had been discussed through the conversation group including health and nutrition issues and activities. Improvements to the environment were discussed and this had led to improvements and changes to the decor and design of the bedrooms. Prior to each respite stay, parents/carers were contacted by staff to check that all the information held by the service was still accurate and up to date. Any changes to circumstances, routines or care patterns were noted and this information was passed on to the staff who were providing the care for the young people during their stay. This process encouraged families to comment about the care provided and suggest different activities and routines. Action for Children - Silverton Short Breaks, page 11 of 25

Questionnaires had been used to gather the views of parents in a more formal way. These asked for comments and opinions about the way the service supported young people and families. The questionnaires also sought ideas and suggestions about any changes and improvements which should be implemented to further meet assessed needs. We saw the recently returned questionnaires from this year's survey which indicated a very high level of satisfaction with the care provided for individual young people. Parents and carers were encouraged to visit the centre to discuss any issues arising from respite stays. Some parents dropped off or collected their children and these times were used by staff to discuss any issues arising from care routines or activities. Parents' forums were regularly held to provide opportunities for the views of parents to be gathered and discussed. This meant that ideas and improvements could be developed and agreed in relation to the identified needs of young people and their families. We saw minutes of the parents' forums which had discussed a range of topics and issues. These were then taken to staff meetings for any implementation of changes to be discussed. Family fun events had been held which allowed young people and their parents to be involved in a range of joint activities at the centre. These occasions encouraged all who used the service to feel involved in developing different ways of using the respite facility and the expertise of the staff. A newsletter was distributed on a quarterly basis which contained news, pictures and information about the service and how it worked. The contributions of information and views from young people and their parents for the newsletter were welcomed and encouraged. Areas for improvement The service should continue to seek creative ways of involving young people and their parents in contributing to the development and improvement of the service. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 12 of 25

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths All young people who used the service had a personal plan which outlined their care needs and described how these would be met. This included information on all aspects of their care including health and nutrition. Care planning folders contained a comprehensive range of information which was updated from conversations in 'pre calls' which were telephone discussions with parents prior to respite stays. Each care planning folder contained an overview which was designed to provide information to staff about the day to day care needs of young people, including their personal preferences and any specific issues which would affect their respite stay. These were particularly useful where young people had significant gaps between visits or where staff on duty were not familiar with the needs of the individual young people. We saw that there was a very good range of activities for the young people who used the service. Staff encouraged them to try new experiences and we saw from records and photos that young people had been introduced to different outdoor activities and sports. For example, using funds from different sources, some young people had learned to ski and gone on a short skiing trip. Local facilities and attractions such as parks and country centres were used to encourage outdoor exercise and access to fresh air. The centre had a large enclosed garden which had been partially developed to provide play opportunities. Plans were being drawn up in conjunction with the young people to further develop the garden and increase the range of play equipment. Staff were trained in food hygiene and, where feasible, involved the young people in food preparation. We saw that staff were aware of the nutritional needs of the young people and took account of their personal preferences when planning and preparing meals and snacks. Areas for improvement While the overviews in the care planning folders were well designed and contained a good range of information, not all of them were up to date. In some overviews, the information was old and had not been kept as accurate as it needed to be to inform and guide staff practice. (See recommendation 1). Not all personal plans contained evidence of having been updated following their review. (See recommendation 2) Action for Children - Silverton Short Breaks, page 13 of 25

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 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. 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. Action for Children - Silverton Short Breaks, page 14 of 25

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 identified in Quality Statement 1.1 also apply to this Quality Statement. Young people had been consulted about the uses of different communal areas and the decor in all areas of the centre. Bedrooms had been redecorated in line with young peoples' suggestions, based on different themes. The garden area was being redeveloped and improved with the views of the young people being taken into account. Areas for improvement The service should continue to use the conversation group to inform improvements to the care environment. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 15 of 25

Statement 2 We make sure that the environment is safe and service users are protected. Service strengths The provider had a range of policies and procedures to guide and inform staff practice in ensuring the environment was safe and appropriate for the care of the resident young people. Staff we consulted confirmed that they were aware of these and had access to them through the provider's online information system. Individual members of staff confirmed that they had undertaken Child Protection training and were able to describe appropriate action to be taken in the event that they had concerns about the safety and wellbeing of any of the young people. We saw that staff had undertaken training and regular updates on the provider's behaviour management system (PROACT-SCIP) which was designed to de-escalate and manage challenging behaviour and consequently keep young people safe. Other training such as food hygiene and first aid were routinely attended by staff as well as other training linked to ensuring that there was a good understanding within the staff team of the safety requirements of young people with different medical and physical needs. The premises were regularly checked by staff to ensure that known risks were properly managed. This included checking the outdoor play area to ensure it was clear of any unexpected items or risks. Contractors were used to maintain and service heating, water and equipment systems on a regular basis. We saw that tracking hoists were in use in parts of the building to ensure that young people could be helped to safely make the best use of their respite stays. Risk assessments had been completed for activities in and around the centre as well as for outings and visits to other places. During the visit we saw that staff were very aware of the needs and limitations of the young people in terms of recognising their own safety. This meant that staff were vigilant and worked well to support access to a variety of experiences while minimising risks. Areas for improvement Staff and managers should continue to carry out regular checks and assessments to ensure that young people can safely try different sports, activities and pastimes which provide positive new experiences. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 16 of 25

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 identified in Quality Statement 1.1 also apply to this Quality Statement. Young people and parents have been involved in recruitment processes and it was planned that this would continue in a planned round of staff recruitment. Parents and young people were involved in the contributing to service development planning, including staff planning through the use of forums and the conversation group. Areas for improvement The service should continue to involve children and their families wherever possible in evaluating and developing the roles of staff members. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 17 of 25

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The manager confirmed, in discussion, that all staff were appropriately registered with the Scottish Social Service Council (SSSC) and were either fully qualified or working towards any necessary qualifications. We spoke with some staff individually and observed the interaction of staff with young people. We also attended two shift changeover meetings. Members of the staff team demonstrated a very good understanding of the needs of the individual young people and how they could best be met. We saw good shift planning to meet different aims for young people and to provide a varied program of activities and care. We heard staff discuss different ways of ensuring that young people enjoyed their time at Silverton and saw them put plans into action while encouraging young people to make choices and express their views. We found that the staff team consistently shared and expressed ideas for improving the service and increasing the opportunities for young people. The ethos of service improvement appeared to be embedded in day to day practice and formed a core component of staff team meetings. We saw staff rotas that indicated that there were always enough staff available on shift to meet the assessed needs of the resident young people. In consultation, individual staff confirmed that there was a good sense of teamwork which meant that staff supported each other and had adopted a flexible approach to help deal with staff absences at times of sickness or severe weather. We saw that staff were skilled in different methods of communication and were comfortable using them to help young people to make the most of their time at Silverton. Areas for improvement Within the staff team there were mixed views about the increase in numbers of part time staff. Given the different respite patterns for young people and the number of staff in the team, care should be taken to ensure that young people receive consistent care from staff who have opportunities to build relationships with them. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 18 of 25

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 identified in Quality Statement 1.1 also apply to this Quality Statement. Managers and senior staff were involved in day to day discussions with young people and parents. They understood the needs of the young people and were involved in discussions about their care. This meant they were aware of the different preferences and aspirations of the families who used the service. Areas for improvement Managers should continue to have close regular contact with the young people and their families in order to fully appreciate the best methods for improving and developing the service. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 Action for Children - Silverton Short Breaks, page 19 of 25

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 We saw very good evidence that there was a range of methods used to monitor and assess the quality of care provided at Silverton. The personal plans for young people were subject to regular reviews and these involved parents and in some situations, social workers. Care plans were regularly discussed with young people to check that their preferences and favourite things were still properly recorded. 'Pre calls' to parents provided opportunities for checking that the service was meeting the family's expectations in terms of the quality of care and the methods used to deliver the care. The manager had regular contact with the local authority which commissioned the service. These meetings looked at the service with a variety of care and financial purposes and sought to ensure that the care being provided met the needs of the families who used it as well as the expectations of the funding authority. Local authority departments also monitored the service. For example the environmental health department carried out routine checks to ensure that food production areas and systems were operating properly. Questionnaires were used to formally seek the views of parents and these indicated a very high level of satisfaction with the care provided at Silverton. Staff meetings were regularly held. These allowed discussion of all aspects of the service and staff told us that they were encouraged to raise any issues which they felt were relevant in terms of service improvement and development. Individual staff were regularly provided with formal supervision which was recorded and delivered in line with the provider's policy. Staff questionnaires had been used to assess the quality of summer programs as a means of improving activity planning and organisation. The provider had a system in place for visits by independent managers to review and inspect different aspects of the service. Areas for improvement An audit tool for care planning files had been introduced but was not yet fully operational. There was not consistent evidence that managers were carrying out checks and audits of personal plans and the overall care planning system, including records of young peoples' respite stays. (See recommendation 1) Action for Children - Silverton Short Breaks, page 20 of 25

Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. 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. Action for Children - Silverton Short Breaks, page 21 of 25

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 We did not receive an action plan from the provider detailing how they would meet the recommendations arising from the last inspection. 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 22 of 25

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 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 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 24 Nov 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed Action for Children - Silverton Short Breaks, page 23 of 25

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 24 of 25

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Action for Children - Silverton Short Breaks, page 25 of 25