Aspire 'Gatehouse' School Care Accommodation Service Gatehouse of Caprington Caprington Estate Kilmarnock KA2 9AA Type of inspection: Unannounced Inspection completed on: 27 March 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 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Aspire Scotland Ltd Service provider number: SP2010011131 Care service number: CS2011299805 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 Aspire 'Gatehouse', 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 4 Good Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The service promotes positive experiences for young people. A wide range of opportunities, which enhanced learning and development, meant that young people achieved positive outcomes within the service, education and community. What the service could do better We identified the following as areas for improvement: The service should formally consult with parent/carers. The service should source and implement appropriate medication training for members of the staff team. The service should implement appropriate Child Protection training for all members of the staff team. What the service has done since the last inspection The service had improved their processes and practices in relation to supporting young people during incidents and safe holds. Outcomes for young people continued to be positive and we found that young people were positive about their placement. Aspire 'Gatehouse', page 3 of 27
Conclusion Inspection report continued The service offers young people a stable and supportive environment, in which they can flourish, with the support of a committed staff team. Aspire 'Gatehouse', page 4 of 27
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about the care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Inspectorate 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 aspects of a service, or think it could do more to improve, we may make a recommendation or a requirement. - A recommendation is a statement that sets out the actions the care service provider should take to improve or develop the quality of the service, but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement that sets out what is required of the care service to comply with Public Service Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of regulation, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. 'Gatehouse' is provided and managed by the independent company Aspire Scotland. The service can accommodate five children and young people, both males and females (aged 8 years to 17 years). The detached house is spacious and set in pleasant gardens within a rural setting near Kilmarnock. Bedrooms were decorated and furnished in a style selected by the young people and there were suitable communal areas. On the day of the inspection, there were five young people living at Gatehouse. The aims of Aspire Scotland include; involving children and young people fully in the life of the house and their living situation via a robust commitment to inclusion and participation. Aspire 'Gatehouse', 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 4 - Good Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - Grade 4 - 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. Aspire 'Gatehouse', page 6 of 27
2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection During this inspection, we gathered evidence from a range of sources, including relevant sections of policies, procedures and other documents. These included: - Certificates of Registration and Insurances - Records of Incidents and Safe holds - Behavioural analysis records - Quality Assurance Records - Records relating to Young People's Achievements - Personal Learning Plans - Staff Training Records. We spoke with three young people. We met with five staff members. We spoke with one parent. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Aspire 'Gatehouse', page 7 of 27
Fire safety issues Inspection report continued 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 Aspire 'Gatehouse', page 8 of 27
What the service has done to meet any recommendations we made at our last inspection We made one recommendation at the last inspection. 1. The service should source and implement training in Child Protection for all members of the staff team. National Care Standards, School Care Accommodation Services, Standard 7: Management and staffing. We saw that the provider had sourced and planned for this training, for all staff, and that this would be implemented throughout April 2015. This recommendation is: Met. Please see Quality Theme 1, Statement 3 for details. 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 form and used this to inform the inspection process. Taking the views of people using the care service into account We spoke with three young people during the inspection visit. Some of their comments are contained within the body of this report. Taking carers' views into account We spoke with parents, whose comments are contained within the body of this report. Aspire 'Gatehouse', page 9 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: 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 At the previous inspection on 18 December 2014 we conducted a focussed inspection relating to incidents and safe holds and considered how the needs of young people were met during times of crisis. At this inspection, we followed up on areas for improvement and the recommendation made at the last inspection to determine progress made by the service. At this inspection, we considered that the performance of the service remained good for this statement. At the last inspection, we asked the service to further develop and implement methods of gathering the views of young people and their parents/carers. We made this a recommendation. Since the last inspection, the organisation had initiated a full review of its aims and objectives. Comprehensive questionnaires had been created, based on the principles of a recognised model that encourages cooperation, collaboration and innovation. By adopting these principles the service was committed to engaging young people and their parents/carers, in reviewing the Statement of Purpose of the service and evaluating current systems, which promote the involvement of people using the service. We were encouraged by this progress and we will consider further progress at the next inspection. We noted that existing methods of gathering the views of young people and their parents/carers remained a priority for those working at the service. Examples of young people contributing to decisions affecting their lives were contained within care plans, My World discussions with key workers, recruitment of new members of staff and the continued involvement of independent advocates, which ensured young people's views remained at the centre of every day practices. When asked, young people were able to confirm that they had a care plan and were able to influence Aspire 'Gatehouse', page 10 of 27
decisions and express their views to staff supporting them. We spoke with some parents/carers about their experiences of the service. Some of their comments included, "I feel things are going well for XX. They're lovely people", and "Generally staff are doing their best. I feel very comfortable talking to them and they keep us informed about what's happening". These comments helped to show that parents/ carers felt that those working at the service respected their rights as parents, to be involved in their child's life. When reviewing incident records, we noted that in the majority of instances, young people were supported to reflect on their behaviours and the events leading up to incidents, including those involving safe holds. During most occasions the service conducted discussions with young people to help them to consider adopting other more appropriate ways, to express their needs and this practice supported improved outcomes for young people. At this inspection, our assessment of participation was carried out whilst examining other quality statements. Young people were asked whether their views were considered and acted upon and they confirmed this to be the case. Areas for improvement The provider should now implement formal consultation methods with young people and their parents/carers. This will ensure that the views of people using the service, influence the quality of care and support for young people and inform future developments within the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Aspire 'Gatehouse', page 11 of 27
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection, we found that the performance of the service was very good for this statement. We followed up on our focussed inspection regarding incidents and safe holds and considered outcomes for young people, in support of their health and well-being, to assess this statement. At the last inspection, we identified an area for improvement relating to the need for consistent practices, when involved in supporting young people during times of crisis. We advised that discussions should take place with young people following each incident or safe hold. During this inspection, we found that the service had improved this practice, with all records sampled, showing follow-up discussions with young people. This meant that young people were more engaged in participating and reflecting on the reasons for their behaviour. This practice was confirmed by young people during our inspection visit. They said, "Staff talk to us after an incident. They ask you what the reason was for a safe hold and help you to think about what happened". When we spoke with staff, they told us that the service had worked hard to improve this practice and that all staff were aware of the need for the processes to be followed. We saw that staff continued to support young people's dignity during incidents and safe holds and were clear about why a range of interventions were necessary, to keep young people safe. By creating this understanding, for all members of the staff team, the service promoted more nurturing approaches to support young people's wellbeing. During this inspection, we also considered progress made by young people, in relation to their care and education. We saw that some young people were involved in work experience opportunities, which supported their achievement and helped them to mature and become more confident individuals. We noted that through positive experiences, some young people were involved in fewer incidents and were making responsible choices and decisions for themselves. Other young people had improved family contact and this supported their sense of identity and offered optimism about their future. By attending local clubs, some young people were building selfconfidence through socialising with peers outwith the service and this helped them to establish themselves within their communities. We also met with one young person, who displayed their musical talent and we noted that the service supported attendance at music lessons, which helped this young person to grow and develop skills through their chosen activity. Aspire 'Gatehouse', page 12 of 27
Strong key worker allocations allowed for improved interaction with health professionals for some young people. Through well-developed relationships, based on mutual trust and respect, young people and staff had both worked hard to create the circumstances which promoted young people's engagement with other agencies. Young people told us, "I have the best key worker ever. She's open-minded and comes in on her days off just to support me" and "My key worker always asks, what can we do to change things? This shows that she wants to help". These positive comments from young people, confirmed our view, that staff working at Gatehouse were committed to promoting the improved health and well-being of young people in their care. Areas for improvement We found that not all staff working in the service were trained in appropriate medication procedures. We were aware that the organisation were sourcing appropriate training and we will review progress at the next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Aspire 'Gatehouse', page 13 of 27
Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths At this inspection, we found that the performance of the service was good for this statement. Please see Quality Theme 1, Statement 1. Areas for improvement Please see Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Aspire 'Gatehouse', page 14 of 27
Statement 2 We make sure that the environment is safe and service users are protected. Service strengths At this inspection, we found that the performance of the service was very good for this statement. We reviewed areas for improvement identified at the last inspection. These arose from our focused inspection relating to incidents and safe holds and we considered how young people were supported, within the environment, to assess this statement. At the time of this inspection, we found that there had been a further decrease in the number of critical incidents and safe holds relating to young people living at the service. We confirmed that all staff were trained in Therapeutic Crisis Intervention (TCI) practices and noted that young people commented positively about how physical interventions were carried out by staff. Young people told us, "Staff always discuss things after an incident. They don't hold grudges and help you to move on afterwards" and "This is the best placement I've been in. Staff are respectful and care about you. When I've been involved in an incident, staff will go outside with me and support me". These positive comments from young people showed that those working in the service were committed to improving outcomes for young people, whilst promoting their safety within the environment. We found that when we inspected the service previously, a number of safe holds involved young people being re-directed to their bedrooms during a crisis. We advised that the service should review this practice to encourage all involved, to reflect on the suitability of young people's private space being used during times of crisis. We considered that these areas should remain a positive environment for young people and therefore should, where possible, not be used in the process of safe holding. We were encouraged to find that the service had responded positively to this area for improvement and this helped to demonstrate to young people, that this was a safe space. Similarly, at the previous inspection we found that a number of safe holds were implemented for brief periods of time. We discussed this with the service and asked that they conduct a review of all safe holds, in order to determine the necessity for physical interventions lasting less than five minutes. We advised that other methods of de-escalation could be considered at such times. The service had continued to respond positively to these observations and an analysis of safe holds, carried out by managers, showed clearly that this practice had been reviewed and amended, where possible. Aspire 'Gatehouse', page 15 of 27
We spoke with staff during this inspection visit, some who were established in their role and others who were relatively new to the team. All commented positively about working in the service. Staff stated that their key responsibilities included supporting one another to develop positive relationships with young people in their care. They identified the importance of the environment in providing young people with alternative strategies to manage their behaviours and identified that the extensive grounds surrounding the house, where young people could take time away from others, provided a benefit to some young people during difficult times. When we spoke to young people, they told us, "I like the house and all the staff. They're really nice and I feel safe here" and one young person, who showed us their bedroom, commented, "I like my room. I painted some of it. I've been here a long time, so I get on with staff". Areas for improvement The service should continue to improve practices which support young people to feel safe within the environment. By using inside and outside space creatively, young people will have opportunities to remove themselves from difficult situations and learn to manage their behaviours more appropriately. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Aspire 'Gatehouse', page 16 of 27
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths At this inspection, we found that the performance of the service was good for this statement. Please see Quality Theme 1, Statement 1. Areas for improvement Please see Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Aspire 'Gatehouse', page 17 of 27
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection, we found that the performance of the service was very good for this statement. We reviewed progress made by the service in relation to areas for improvement identified at the last inspection, which focused on incidents and safe holds and consideration of how staff practice supported the needs of young people during these times. We followed up on areas for improvement identified at the last inspection and found that staff were consistently supportive of young people and ensured a sensitive and caring approach to helping them during difficult situations. All safe holds were conducted with adequate levels of support from staff and this helped to ensure the safety of all during these times. We found that all staff were trained in Therapeutic Crisis Intervention techniques (TCI) and reflective practice, routinely supported learning for those involved and this helped staff to feel confident about interventions used to support young people. The manager is a trainer in these techniques and this further provided helpful and qualified support for those working in the service. During the inspection process, we were encouraged to find that key workers provided a degree of consistency for young people in supporting their needs. We found that where young people's needs could be further supported through increased awareness of the work of other organisations, the service had explored how such organisations could influence the work of staff. We noted that training, specific to individual needs of some young people, had been delivered by external organisations and this had supported staff awareness of potential challenges facing some young people. Additionally, we noted that de-briefing for staff, following any safe hold of a young person, took place more frequently than before. The service had reviewed its procedures to ensure that de-briefs were conducted on each occasion and were in the process of creating an improved format for recordings. We found that de briefs with staff, reflected on reasons for escalating behaviours and identified where other agencies may offer additional supports. This practice showed that the service were keenly aware of patterns and trends in respect of young people's behavioural presentation and took appropriate action to promote more positive outcomes for young people. Aspire 'Gatehouse', page 18 of 27
We found continued improvement to learning and development opportunities for staff. We found that some staff had received additional training to support their involvement in the use of the learning platform, an online system which helped to promote greater access to training and development for members of the staff team. By becoming tutors, senior staff were able to improve their own knowledge and skills, while supporting others to learn and develop in their roles. Equally, staff had become more familiar with the organisation's Gateway, a web-based system for reporting on outcomes for young people. Through increased confidence, staff contributed to the child's plan, by updating Social Workers and others involved. This promoted increased accountability for quality recordings and supported staff in their continued professional development. Other training events included delivery by external organisations, which focused on equality and diversity and improved accessibility for some young people to local groups and First Aid, Fire Safety, Chronologies and SafeTalk, which supported staff alertness to the risk of suicide. Further to these opportunities, new staff continued to bring a fresh perspective to the work of the team and who told us, "I love my job. I was desperate to get into this work and am very keen to learn" and "I feel I've slotted into the team. It's great that the director asks how I am getting on. This really motivates you". These and other positive comments from members of the team, helped to demonstrate that the needs of young people were being met through the hard work and dedication of those working at the service. As part of the formal review of aims and objectives of the organisation, the staff team had participated in a number of development days, during which they had the opportunity to contribute to the comprehensive review of organisational improvements. Staff spoke positively about this experience and were optimistic about the future. We will continue to review outcomes for young people and improved opportunities for staff, as a result of changes within the organisation. Areas for improvement We reviewed training records during the inspection process and identified an area for improvement in relation to Child Protection training for some members of the staff team. Although this training forms part of the TCI programme and, therefore, all relevant staff had participated in some form of Child Protection training, we considered that additional opportunities should be made available. We made a recommendation at the last inspection that the service source and implement appropriate training to meet the needs of the whole staff team. We have repeated this recommendation and will review progress at the next inspection (see recommendation 1 under this quality statement). Aspire 'Gatehouse', page 19 of 27
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should source and implement appropriate training in Child Protection for all members of the staff team. National Care Standards, School Care Accommodation Services, Standard 7: Management and staffing. Aspire 'Gatehouse', page 20 of 27
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths At this inspection, we found that the performance of the service was good for this statement. Please see Quality Theme 1, Statement 1. Areas for improvement Please see Quality Theme 1, Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Aspire 'Gatehouse', 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 At this inspection, we found that the performance of the service was very good for this statement. We followed up on areas for improvement identified at the last inspection. This included a focus on the monitoring of incidents and safe holds. We also reviewed progress following the formal evaluation of the organisation's Gateway system and looked at the role of the Quality Manager to assess this statement. Our review of incident records, including safe holds of young people, showed that managers were aware of the behavioural presentation of young people and were involved in quality assuring practices, including analysing and reporting on patterns and trends. Evidence of a comprehensive service review of incidents, including safe holds, showed a clear reduction in physical interventions with young people. We found that improved record keeping demonstrated that staff understood the importance of maintaining accurate up to date recordings and this helped to quality assure practise, as well as the experiences of young people, during times of difficulty. All paperwork was signed, dated and audited by managers. This represented a significant improvement since the last inspection. Other improvements to processes included ensuring that the Care Inspectorate was notified within 24 hours, of any significant incident. We reviewed records and concluded that the service was mainly compliant with this practice. As a further means of quality assuring practices, the service had improved the consistency with which discussions with young people and staff were conducted, following an incident. This allowed the service to consider alternative approaches and identify any training needs for staff. In order to maintain these standards, the service ensured that all staff were appropriately trained and informed about their role in supporting young people. As part of a review of the effectiveness of the residential services' web based outcomes model, the Gateway, external consultants collated questionnaires and evaluative comments from staff and external stakeholders. The evaluation of staff comments confirmed that all staff believed that the Gateway was helping to promote greater consistency and that the role of managers in monitoring contributions also provided a supportive mechanism for improved practice. Examples of comments from professionals included, "Aspire appear to regularly review their targets for the young person I am involved with and aim for them to be both achievable and realistic in order for the young person to achieve success in their learning and development", and "Helps keep professionals on the same page and any changes to support required Aspire 'Gatehouse', page 22 of 27
can be communicated quickly and consistently". It was clear from the evaluation, that those involved in supporting young people were consistently reviewing young people's progress and adapting approaches and strategies to support positive outcomes. The organisation had employed a Quality Manager, whose role included a focus on assessment and outcomes for young people. By collating information about young people at the point of admission to the service, this information supported the initial assessment processes which informed the identification of agreed outcomes between the service and the placing authority. This systematic approach to ensuring that supports provided were appropriate to the needs of individual young people, in joint agreement with other agencies, meant that young people's plans would maintain a clear focus on agreed outcomes and the measurement of progress could be closely monitored. Improvement planning had been a clear focus throughout the previous year, with extensive consultation within the organisation, examining and identifying existing perceptions and cultures of the Aspire 'brand'. By asking questions which determined the perceptions of those involved, a range of workshops helped to inform on the way ahead for the organisation. External Consultants engaged with those working in the service, to explore their opinions on all aspects of the organisation. Consultation meetings took place with all Aspire employees and feedback allowed the organisation to consider future priorities. We will review the impact of this consultation at the next inspection. Areas for improvement We found that the service had produced a revised improvement plan, informed by a range of stakeholders involved in the service. Although the plan identified improvements to medication procedures, we considered that monitoring of the administration of medication, should be reviewed again once all staff have received appropriate medication training. This will ensure that procedures are fully informed by best practice guidance. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Aspire 'Gatehouse', 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 N/A. 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). Aspire 'Gatehouse', page 24 of 27
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Environment - 4 - Good Statement 1 Statement 2 4 - Good 5 - Very Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 5 - Very Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 17 Oct 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 14 Feb 2013 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 8 Nov 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good Aspire 'Gatehouse', page 25 of 27
All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Aspire 'Gatehouse', 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 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 Aspire 'Gatehouse', page 27 of 27