Action for Children - Gilmerton Road Outreach Services Support Service Without Care at Home 408 Gilmerton Road Edinburgh EH17 7JH

Action for Children - Gilmerton Road Outreach Services Support Service Without Care at Home 408 Gilmerton Road Edinburgh EH17 7JH Inspected by: Iain Lamb Type of inspection: Unannounced Inspection completed on: 12 December 2013

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 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Action for Children Service provider number: SP2003002604 Care service number: CS2007144549 Contact details for the inspector who inspected this service: Iain Lamb Telephone 0131 653 4100 Email enquiries@careinspectorate.com Action for Children - Gilmerton Road Outreach Services, 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 4 Good Quality of Management and Leadership 4 Good What the service does well The service provides a range of positive experiences for young people which, in turn, supports their families by providing respite. What the service could do better Record keeping and the organisation of information is not as good as it should be. Staff should be more accurate in maintaining records and plans. Staff recruitment should be more efficient. What the service has done since the last inspection Since the last inspection, some limited progress has been made in the introduction of new information systems. Staff have continued to develop a good range of skills which allow them to care for young people with complex needs. Conclusion The quality of care provided is very good. However the systems which support the staff to provide care are in need of review and development. Action for Children - Gilmerton Road Outreach Services, page 3 of 25

Who did this inspection Iain Lamb Action for Children - Gilmerton Road Outreach Services, 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. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. You can find the most up-to-date grades for this service by visiting our website, by calling us on 0845 600 9527 or visiting one of our offices. 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 Gilmerton Road Outreach service is provided by Action For Children and supports families from Edinburgh and the Lothians. It is linked to a residential respite service and is based in the shared office premises in Gilmerton Road in Edinburgh. Many families use both the respite and outreach services. At the time of the inspection the service was involved in providing a range of levels of support for young people and their families. Action for Children - Gilmerton Road Outreach Services, 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 5 - Very 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 0845 600 9527 or visiting one of our offices. Action for Children - Gilmerton Road Outreach Services, 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 inspection which was unannounced. The inspection was carried out by Iain Lamb, an inspector from the Care Inspectorate. The service was visited on 27 and 29 November, 2013. Feedback was provided to the managers on 12 December. In this inspection, we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents, including: - the service's most recent self assessment - service users' support plans and risk assessments - records of daily events - accident and incident records - minutes of meetings - staff records - monitoring reports - audits and evaluations of training and practice. The service's manager and depute manager were consulted. Two members of staff were formally consulted and others were spoken with informally during the visit. Families were consulted by phone. 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 - Gilmerton Road Outreach Services, page 7 of 25

Inspection Focus Areas (IFAs) Inspection report continued 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 - Gilmerton Road Outreach Services, page 8 of 25

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The self assessment was fully completed and described the service's strengths while identifying areas for improvement. Taking the views of people using the care service into account In this inspection we spoke directly to the parents of the young people who used the service. Taking carers' views into account The families we spoke to and who returned the questionnaires to us were generally happy with the service provided to them. They described the staff as professional and skilled and felt that they had been able to develop good working relationships. While communication was generally described as very good, it was mentioned that outreach sessions had occasionally been cancelled at short notice due to staffing issues such as sickness. Action for Children - Gilmerton Road Outreach Services, page 9 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 a very good range of systems in place to ensure that families who used the service were involved in assessing and improving the care it provided. Parents we spoke to told us that their views were sought about all aspects of the care they received. They said that they felt included in planning and evaluating the support provided to their children and their family. We were told that communication between the service and families was very good and that parents were kept appraised of any potential changes to the service and to agreed care arrangements. The service involved families in reviewing agreed packages of care and their views and comments were taken into account when updating care plans and risk assessments. We saw in records that discussions had taken place to adjust arrangements at the request of parents and that these were taken into account when organising specific care routines. Parents' forums were held regularly and issues and suggestions from these were taken forward by managers and through staff meetings. Parents were also invited to contribute to project reviews and the service provider regularly sought their views through the use of questionnaires. The service had participated in research projects which had included gathering and evaluating the involvement of parents and young people. The results of these had been published. The involvement of parents and young people in staff recruitment processes had been embedded in practice for some time. Action for Children - Gilmerton Road Outreach Services, page 10 of 25

Areas for improvement The service should continue to look at ways of involving parents and young people in evaluating the care which is provided. The use of interactive media should be considered as a means of maintaining effective communication with parents and also between parents whose children are supported by the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Action for Children - Gilmerton Road Outreach Services, page 11 of 25

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service provider had a range of policies and procedures which set out the aims of the service and how these would be achieved. This was regularly reviewed and adjusted to ensure that the service was able to fulfill its obligations to the families and young young people it supported. All the young people who received an outreach support service had been assessed by the service to ascertain what their needs were and how they could best be met. Almost all the young people and their families involved with the service were also using the associated residential respite provision and had an overall plan which covered all aspects of their care and support. Staff we consulted were aware of the individual needs of the young people and their personal preferences. They were also clear on their responsibilities to keep young people safe during outreach activities, while providing them with new and positive experiences. The service provider was reviewing recording systems. The use of modern technology to support electronic record keeping was being gradually introduced. Areas for improvement Inspection report continued Not all the personal plans for the young people who used the service showed clear evidence of having been consistently reviewed at least every six months. While staff we spoke with were regularly updating some aspects of personal plans, this was not a coherent system and was not properly recorded. (See recommendation 1 ) Care planning files were disorganised and not easy to navigate. Many of the notes of care provided were handwritten, making them difficult to read and understand. Notes of outreach sessions were mixed up with records of respite stays and some were written on the wrong documents. (See recommendation 2 ) Most of the young people who received support also used the residential respite service and the bulk of the content of the care planning file was devoted to their care while using the respite service with one section mentioning outreach activities and their aims and outcomes. It would enhance the quality of the outreach service if there was a separate clear plan for outreach activities for individual young people which described its aims and evaluated their effectiveness. (See recommendation 3 ) Care planning documents were not consistently properly dated. (See recommendation 4) Action for Children - Gilmerton Road Outreach Services, page 12 of 25

While the provider was introducing the use of new devices to support record keeping, this had been planned for some time with little evidence of clear progress being made. Staff were still using a mixture of media to plan and record the care provided to young people and their families. This also meant that sharing information with other agencies was sometimes a time-consuming and cumbersome process for staff and managers. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 4 Recommendations Inspection report continued 1. Personal plans should be properly reviewed in line with the service provider's policies and current legislation. Documents should show that this has been done and what adjustments to planned care have been made. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. 2. The day to day use of large document files should be reviewed. The introduction of new recording systems which enable staff to record, store and share information quickly and effectively should be given priority by the service provider. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. 3. The system of planning residential care and outreach care within one document should be reviewed to ensure that there is clear information and guidance available for staff to follow. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. 4. All documents relating to care planning and delivery should be properly and accurately dated. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. Action for Children - Gilmerton Road Outreach Services, page 13 of 25

Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The strengths noted in Quality Statement 1.1 also apply to this Quality Statement. We saw evidence that young people and their families had expressed clear choices about where activities would take place and special places which young people liked to visit. These were included in activity planning. Areas for improvement The service should continue to explore a range of environments to allow young people access to new experiences and to develop new skills. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Action for Children - Gilmerton Road Outreach Services, page 14 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 which were made available to staff to help them assess the suitability of different environments for activities for young people. As the outreach service was intended to support some young people to learn new skills, there were situations where staff helped young people to tackle activities which had previously been too difficult or challenging for them. It was also planned that some young people were supported to access areas of their communities which they had previously been unable to use or which had been too difficult for them to visit with their family. Such situations were used to provide new experiences for young people and allow them to learn how to cope within the community with their family and friends. In such situations, risk assessments were carried out and used creatively by staff to allow young people to learn about their abilities and how they could be used. Not all of these type of outreach activities would be completely without an element of risk for the young people and would therefore be staffed by experienced members of the staff team who had positive relationships with the young people involved in the activity. Some outreach activities took place within the centre which also provided residential respite for many of the young people. These premises were adapted to meet the needs of the young people who used them and were equipped with mobility aids and other safety facilities. Areas for improvement While the different environments used for activities were risk assessed, these assessments were not always clear and up to date. (See recommendation 1) Some parts of the centre which was used for some outreach activities were in need of redecoration and upgrading. The service provider had some plans in place for this and for the improvement of the centre. These plans should be enacted as soon as is feasible. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Risk assessments should be clear and concise with up to date information. Documents should carry a precise date. Action for Children - Gilmerton Road Outreach Services, page 15 of 25

National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. Action for Children - Gilmerton Road Outreach Services, page 16 of 25

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 The strengths noted in Quality Statement 1.1 also apply to this Quality Statement. We saw and heard good evidence of routinely clear and accurate communication between families and staff. We also saw evidence that staff were experienced and skilled in using a variety of communication systems with young people. In most cases, staff had developed good relationships with young people which enabled them to interpret non-verbal communication and respond well to needs and emotions expressed in this way. Areas for improvement The service should seek to use staff as consistently as possible with specific young people and their families to allow the development of good working relationships. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Action for Children - Gilmerton Road Outreach Services, 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 that all staff were registered either fully or conditionally with the Scottish Social Services Council (SSSC). We saw that the provider had training opportunities available and most staff we spoke to said that they were able to access training relevant to the needs of the young people they cared for. During the inspection we spoke individually with some staff and informally with others. From these consultations and from records, we concluded that most staff were experienced and knowledgeable about the needs of the families and young people they supported. In discussion, staff demonstrated a good level of understanding of the benefits of the care they provided and were able to describe how their work contributed to the wellbeing of the young people. The staff we spoke to were also able to express a committment to the continuing development of new skills for young people through the provision of new experiences which could not easily be provided by their families. Staff meetings were held which allowed opportunities to share information and discuss any practice issues which arose. Staff were also able to electronically access practice information as well as policies and procedures. Areas for improvement Inspection report continued There had been some staff turnover since the last inspection and those we spoke to felt that recruitment had taken a long time, leaving gaps in the staffing provision which had sometimes been difficult to fill. Parents we spoke to mentioned that outreach activities had sometimes been cancelled due to staffing issues. While they had been promptly informed about these, it had led to disappointments on occasion. We also heard from staff that there had been some staff absences which had further affected consistent staffing and put pressure on the team to prioritise aspects of their role. This had led to a lack of available time for administrative tasks and nonessential areas of training and development. (See recommendation 1) While staff were aware of their role and responsibilities, not all staff had maintained records and recording systems to the standard expected. We saw evidence that keyworkers had from time to time contacted staff to remind them to complete notes and records of work they had carried out. (See recommendation 2) Action for Children - Gilmerton Road Outreach Services, page 18 of 25

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The service provider should review the staffing complement of the service and ensure that recruitment processes are carried out promptly and efficiently. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. 2. Staff should be reminded through team meetings and formal supervision that they must accurately record the care they provide in line with the provider's policies and with current legislation. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. Also applicable are the SSSC codes of practice for Social Service workers - 6.2. 'As a social service worker, you must be accountable for the quality of your work and take responsibility for maintaining and improving your knowledge and skills. This includes maintaining clear and accurate records as required by procedures established for your work.' Action for Children - Gilmerton Road Outreach Services, page 19 of 25

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 The strengths noted in Quality Statement 1.1 also apply to this Quality Statement. The methods used by the service to seek the views of families and young people who use the service include opportunities for comments to be made about the effectiveness of managers and the overall management of the service. During the inspection it was clear that senior staff and managers were regularly in contact with families and worked directly with young people supported by the service. This provided opportunities for dialogue about ways in which the service was operating and how it could be improved. Areas for improvement Managers should continue to hve regular, routine contact with service users. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Action for Children - Gilmerton Road Outreach Services, page 20 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 The service provider had a range of corporate systems which were used to monitor and assess the performance of the service. These included statistical returns and regular reporting to external managers regarding a range of subjects including staff attendance and the level of use of the service by different commissioning authorities. There were also systems in place to audit incidents, accidents and other events. Regular meetings were held with stakeholders to discuss the effectiveness of the service in meeting the needs of service users and we were aware of different areas of practice which had been adjusted as a response to the needs of individual service users and young people with specific needs. These meetings were also used to share concerns and look at ways of adjusting the service to take into account the changing needs of commissioning authorities. Formal supervision was provided to staff on a regular basis. Sessions were minuted and both supervisees and supervisors retained copies of the minutes. These sessions were used to monitor the practice of individual members of staff and ensure that they were working effectively within their assigned role. They were also used to discuss and agree training needs and aspirations for individual members of staff which then informed the training plan for the staff team as a whole. Staff we spoke with said that they felt supported by the service's managers and that informal support was always available and freely given. Managers were said to be easily accessible and familiar with the roles and responsibilities of individual members of the staff team. Areas for improvement There was little evidence of file audits being used regularly to ensure that record keeping and care planning were as effective as possible. (See recommendation 1) We were aware that staff absences and recruitment delays had led to managers being involved in sometimes covering shifts more often than would be normal. This meant that the managerial role for those involved in supervisory positions had not always been as much of a priority as would normally be the case. (See recommendation 2) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Inspection report continued Action for Children - Gilmerton Road Outreach Services, page 21 of 25

Recommendations Inspection report continued 1. File audits should be regularly carried out to ensure that records and care planning documents are complete, up to date and of a good standard. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. 2. Management roles and staffing levels should be reviewed to ensure that there is sufficient capacity to carry out routine management tasks to support the effective running of the service. National Care Standards, Support Services. Standard 2 - Management and staffing arrangements. Action for Children - Gilmerton Road Outreach Services, page 22 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 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 - Gilmerton Road Outreach Services, page 23 of 25

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 5 - Very Good 3 - Adequate Quality of Environment - 5 - Very Good Statement 1 Statement 2 5 - Very Good 5 - Very Good Quality of Staffing - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 5 - Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 3 Dec 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 28 Jan 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Action for Children - Gilmerton Road Outreach Services, 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 - Gilmerton Road Outreach Services, page 25 of 25