The Aveyron Centre Support Service

The Aveyron Centre Support Service 4 Leys Park Burnbank Hamilton ML3 9EQ Inspected by: (Care Commission Officer) Type of inspection: Jim Brannigan Announced Inspection completed on: 6 February 2008 1/15

Service Number Service name CS2007143644 The Aveyron Centre Service address 4 Leys Park Burnbank Hamilton ML3 9EQ Provider Number dummy Provider Name SP2003000181 SENSE Scotland Inspected By dummy Inspection Type Jim Brannigan Care Commission Officer Announced dummy Inspection Completed Period since last inspection 6 February 2008 15 Months. dummy Local Office Address Care Commission Princess Gate Castle Street Hamilton ML3 6BU 01698 208150 dummy 2/15

Introduction The Aveyron Centre was registered with the Care Commission on 1st April 2002 and is situated in the Burnbank area of Hamilton. The Centre provides day care services for up to 18 adults with profound learning disabilities. The Service is located within a purpose built premises. The service has been part of SENSE ( Scotland ) since 15 October 2007. The Day Centre is operational Monday to Sunday between 8.00 am to 8.00 pm. The Service caters for 24 students, with a maximum of 18 attending any one session. The Service Users are brought to the Centre by transport. The Students have multiple and complex needs, which require very special levels of care and support. The Service attempts to be needs led and pro-active in offering day-care, creating an environment which will facilitate the personal growth and development of everyone involved in the project, regardless of level or ability. Basis of Report The report was written following an announced inspection by one Care Commission Officer on 6 February 2008 from 10.00 am to 1.10 p.m and on 7 February 2008 from 10.00 am to 1.10 p.m Before the Inspection The Annual Return The manager stated that the service submitted a completed Annual Return as requested by the Care Commission. Regulation Support Assessment This service was inspected after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers: complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a high RSA score and so a high intensity inspection was required as a result. The inspection was then based upon the relevant inspection focus areas and associated National Care Standards for the particular service type for the inspection year, any other standards or regulations indicated by the RSA and follow up on any recommendations and requirements from previous inspections, complaints or other regulatory activity. During inspection, evidence was gathered from a range of sources including: A review of a range of policies, procedures, records and other documentation, including the following: 3/15

Certificate of Registration Public Liability Insurance. Staffing Schedule Training Records Training Plan In service days 2008 Protecting Adults Using Services Policy July 2007 Protection children and young people Policy Statement Quality Assurance Monitoring Policy Learning and Development Policy Statement Using your Continuing Professional Development Portfolio Challenging Behaviour:Position and approach July 2006 Physical Intervention Guidance July 2006 Staff vetting Policy Statement Survey 2007 ( Blank ) Survey Analysis ( Blank ) Gentle Teaching a guide for carers. Discussion took place with a range of care staff including: The manager One senior instructor Two instructors Inspection Focus Areas and associated National Care Standards for 2007/08 The Care Commission Officer spent time observing how staff worked with the service users, the environment and use of equipment. The Care Commission Officer took all of the above into account and reported on whether the service was meeting the Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002, Scottish Statutory Instrument 114 and elements of the following National Care Standards for support services; Standard 2: Management and staffing arrangements Standard 7: Using the support service Standard 12: Expressing your views and the following inspection focus areas: Child protection Adult protection Restraint Scottish Social Services Council (SSSC ): Staff training/training plans Quality assurance systems Fire Safety Issues The Fire (Scotland) Act 2005 introduced new regulatory arrangements in respect of fire safety, on 1 October 2006. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire 4/15

safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements in last Inspection Report 1.The service must keep accurate records of all medication administered. This is order to comply with SSI 2002/114 Regulation 19(3)(j). A provider shall keep a record of - medicines for the use of service users which are kept on the premises from which the care service is provided; Timescale for implementation: 6 weeks from the publication of this report. The Officer sampled the medication records and these were found to be correct. This requirement is met. Comments on Self-Evaluation The Manager stated that the service submitted a self-evaluation form as requested by the Care Commission and provided the Officer with a copy. View of Service Users Service users were unable to articulate their views on the service. However, service users spoken with were relaxed and confident and were observed to be relaxed, comfortable and demonstrated their confidence in staff. View of Carers There were no carers available during the inspection. 5/15

Regulations / Principles National Care Standards National Care Standard Number 2: Support Services - Management and Staffing Arrangements Strengths This report does not include comments on elements 5, 6, 7, 11, 12, and 13 of standard 2 as these did not apply to the support service at this visit. This inspection focussed on the following 'Inspection Focus Areas'; Child protection Adult protection Restraint Scottish Social Services Council: Staff training/training plans. Following discussion with the manager, and a review of the documentation relating to the management of child protection, this service was found to have an appropriate policy on child protection. Staff spoken with were aware of their responsibilities in relation to child protection. This service was found to have a policy on adult protection. Staff spoken with were aware of their responsibilities in relation to adult protection. Some staff had attended protection of vulnerable adults training. The Officer was made aware of one adult protection issues since the last inspection. The manager had been advised that the Care Commission would contact the provider following a review of the documentation as to whether the actions taken had been appropriate. The service had two relevant policies in relation to restraint, 'Challenging behaviour:position and approach', July 2006 and 'Physical intervention guidance' July 2006, both of which contained valuable guidance on the use of restraint. Staff and management have a clear understanding of the appropriate use of restraint and staff had received appropriate restraint training ( Gentle Teaching ). Each service user had a comprehensive risk assessment in place in relation to restraint and this was reviewed annually as part of the support plan review. The service has appropriate systems in place to record incidents of restraint. Following discussions and a review of the documentation relating to staff training an appropriate training needs assessment, a training programme, including first aid food hygiene and non statutory training, e.g. epilepsy awareness and rebound therapy were in place. The service had an in service day every month for in house training. Staff spoken with said they received sufficient training to allow them to register with SSSC and to do their job. The service currently had 21 staff of whom 12 were qualified to SVQ level II or above. Three staff were currently completing SVQ level II and plans were in place for six staff to commence SVQ II. The manager was currently working towards the registered managers award at SVQ level IV. Training was evaluated and monitored through regular 1:1 supervision and the completion of training evaluation questionnaires. Each member of staff had a 'Continuous Professional Development Portfolio' which details a 6/15

Training Needs Analysis and the manager advised that these will be completed at the next round of staff appraisal. The manager stated that the service had a corporate Training and Development Policy. However, he was unable to locate it on the day of the inspection. Areas for Development The Adult Protection Policy did not contain a statement that the provider will follow the local area protection guidelines, appropriate phone numbers i.e. police and social work, and there was no information on the arrangements for service users to access independent advice and support. ( see Requirement 1 ) The majority of staff had not received training on adult abuse issues. ( see Requirement 2 ) The Officer acknowledges the appropriateness of the guidance contained in the services restraint policies.however, the policies were not up to date with best practice. e.g. policies refer to CALM as being the preferred training method for the use of physical restraint. The section on 'disguising of medication' does not accurately reflect best practice on the use of Covert Medication form the Royal Pharmaceutical Society of Great Britain and Covert Medication, Mental Welfare Commission. (see Requirement 3) It was unclear if Gentle Teaching was an appropriate system to equip staff specifically on the use of physical restraint. SENSE Scotland policies state that staff will receive CALM training on the safe techniques of physical restraint. The manager advised that it is the services policy not to use direct physical holding techniques. The service should review if Gentle Teaching equips staff in the safe techniques of physical restraint. The service should also review if this has implications for the services restraint assessment and recording systems. ( see Requirement 4 ) SENSE Scotland policies and procedures were all held on computer with a number being available on hard copy. Staff did not have full and open access to all of the organisations policies and procedures. ( see Recommendation 9 ) The service did not have a copy of the 'Area Inter-Agency Adult Protection Procedure'. ( see Recommendation 10 ) The service did not have a copy of 'Rights risks and limits to Freedom', the principals and good practice guidance, Mental Welfare Commission 2006. ( see Recommendation 11 ) 7/15

National Care Standard Number 7: Support Services - Using the Support Service Strengths Service users were unable to verbalise their views on using the support service. Staff spoken with where able to describe an effective key worker system where they would advocate on service users behalf, liaise with parents, make home visits, attend multi disciplinary reviews with service users, complete support plans, arrange input from other professionals such as Speech and Language Therapists. Staff also completed daily report sheets, attend care groups and staff meetings where they would bring care issues to the attention of management. Staff stated that they met regularly with their key group to discuss issues. Staff stated that they were confident that issues raised by service users would be addressed. The Officer observed that service users were relaxed and comfortable with staff. The service had an effective key worker system. Areas for Development There were no recommendations made at this inspection.. National Care Standard Number 12: Support Services - Expressing Your Views Strengths This inspection focussed on the following 'Inspection Focus Area'; Quality assurance. The service was part of SENSE Scotland Quality Assurance System and this was in place. However, this had not yet been implemented in The Aveyron Centre. The service was found to have effective systems to obtain service user feedback. Service users support plans contained comprehensive and person centred information on all aspects of daily care and personal preferences. Staff completed daily record sheets,care group meetings were held every six weeks and issues were recorded. Weekly team meetings were held and these were minuted. Staff confirmed as key workers they were responsible for raising any care issues on behalf of service users at these meetings. 8/15

Daily diaries were completed by staff and these were given to parents/carers on a daily basis for there information and to add any comments on any issues they had. Staff communicated verbally with parents/carers on a daily basis The service had a carers group which meets once a month. The manager had issued the 'Annual Parent Survey' to give parents/carers the opportunity to comment on and influence the delivery of the service. This would be analysed when all returns had been received. Staff confirmed that they have regular opportunities to provide direct feedback to management through regular care meetings, 1:1 supervision, staff meetings and on in service days. Staff spoken with stated they had confidence in management and any issues raised would be addressed. The service used a range of systems to assist service users with significant communication difficulties e.g. Non verbal communication, talk, signs, photographs, pictorial activity diaries,facial expressions and gestures. This service was found to have effective systems to facilitate service users expressing their views. Service users were unable to play an active part during the inspection process. This service was found to have a informal system to monitoring staff practice. This included the manager regularly walking the floor to observe practice, going out with groups, regular recorded 1:1 sessions with staff, and completion of personal development reviews for staff. Areas for Development The service does not have a formal system to directly observe and monitor staff practice e.g. record of contacts, unannounced visits. ( see Recommendation 12 ) National Care Standard Number 99: Other Issues Related to National Care Standards and Regulations Strengths 1. The service should develop information in a format that service users can understand. ( NCS Support Services Standard 1-1:Informing and deciding). The Manager advised that SENSE Scotland Communication Dept. was currently working on a DVD to provide this information. This recommendation was not met. 9/15

2. The service should explore innovative ways in which to involve service users in the management of the service. (NCS Support Services Standard 8-10,11:Making choices ). Service users are involved through staff consulting with parents, completion of daily report sheets by staff, through the key worker system. Information is taken to Care Group and Staff Meetings where issues are discussed. Service users are also involved at formal reviews with multi - disciplinary teams. This recommendation is partially met. 3. The manager should ensure the service complies with the principals of the Adults with Incapacity Act. The manager should establish if any service users have a ' a continuing power of attorney' and /or ' welfare power of attorney' appointed, or a Department of Work and Pensions 'Appointeeship'. The manager should obtain written confirmation that parents/carers agree/disagree with the current arrangements for managing the social fund. (NCS Support Services Standard 2-13:Management and staffing arrangements ). The Manager advised that a letter had been sent to parents to obtain their views on how the social fund was managed and this process was almost complete. The Officer had not yet seen a copy of the letter or the final response from service users parents/carers. This recommendation is partially met. 4. The manager should develop a system to check staffs physical and mental fitness for work and this information should be held in staffs personnel files. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). The following applies to recommendations 4,5, 6, and 7. The Manager advised that staff personnel files are now held by SENSE Scotland and was unable to confirm if any of these recommendations had been actioned. The Manager agreed to ask SENSE Scotland Personnel Dept. to write to or email the Officer with any action that has been taken to address these recommendations This recommendation was not met. 5. The manager should ensure that two references including one from a previous employer should be on file for all new employees. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). This recommendation was not met. 6. The manager should develop a procedure on what action will be taken if checks are unsatisfactory and develop a policy on how often Disclosure Scotland checks will be rechecked. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). This recommendation was not met. 10/15

7. The manager should ensure that copies of staffs qualification certificates are kept in staffs personnel file. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). This recommendation was not met. 8. The manager should put in place written guidelines/develop policy and procedures for food, fluid and nutrition to ensure that service users' food, fluid and nutritional care are supported by clear management guidelines. ( NCS Support Services Standard 15:Eating well and Standard 2-4:Management and staffing ). The Manager stated the service had developed a policy on food, fluid and nutrition. However, the Manager was unable to locate the policy on the day of the inspection. This recommendation was not met. 9. The manager should ensure that the provision of fresh fruit and vegetables meets the needs of service users who have difficulty in eating whole fruit and vegetables. (NCS Support Services Standard 15-2:Eating well ). The Manager advised that he had sought advice from Speech and Language Therapist and a Dietician and service users now had access to soft, pureed and liquidised fruit and vegetables. The Manager also advised that plans were being developed to promote Healthy Eating for service users. This recommendation was met. 10. The manager should arrange for catering staff to receive formal training and or qualifications in catering. (NCS Support Services Standard 15-2:Eating well ). The Manager advised that plans were in place to provide Food Hygiene Training for all staff in April 2008. The Manager advised that Environmental Health had stated that there was no requirement for catering staff to receive formal training. The Manager advised that catering staff had several years catering experience and had no desire to undertake formal training. The Officer agreed to remove this recommendation. Areas for Development Ten recommendations have been made since the last inspection. Two of these have been met. 11/15

The outstanding recommendations are included in the recommendations section of this report. (see Recommendations 1 to 8 ) 12/15

Enforcement There has been no enforcement action against this service since the last inspection. Other Information "The Care Commission Officer informed the Manager of the Regulating for Improvement project - a development which will significantly change how the Care Commission will regulate services from April 2008. It will mean better information, more involvement with people who use care services and their carers, and the introduction of clear gradings which will help people make more informed choices about the care services they want to use. Senior staff were advised to familiarise themselves with the information and briefings that have been made available at www.carecommission.com /Care Services/Regulating for Improvement/Information for Service Providers." Requirements 1. The care service must review and develop its existing Adult Protection/Adult Abuse policy to meet the needs of its service users. This is in order to comply with: SSI 2002/114 Regulation 4(1)(a)-Welfare of users Timescale for implementation: six months from the publication of this report. 2. The care service must ensure access to appropriate training in adult abuse issues and use of associated policy and procedures to all staff with access to service users. This is in order to comply with: SSI 2002/114 Regulation 4(1)(a)-Welfare of users Timescale for implementation: One year from the publication of this report. 3. The provider must review and develop their policy on restraint. The management of restraint must be based on current best practice guidance as described in 'Rights risks and limits to Freedom', the principals and good practice guidance, Mental Welfare Commission 2006. This is in order to comply with: SSI 2002/114 Regulation 4(1)(a)(c)-Welfare of users Timescale for implementation: six months from the publication of this report. 4.The provider must review and where appropriate, staff must have receive appropriate training, assessment and record keeping associated with restraint and, receive training in safe techniques of physical restraint. This is in order to comply with: SSI 2002/114 Regulation 13-Staffing 13/15

Timescale for implementation: One year from the publication of this report. The management of restraint must be based on current best practice guidance as described in 'Rights risks and limits to Freedom', the principals and good practice guidance, Mental Welfare Commission 2006. In making these requirements the following National Care Standards were taken into account: Management and staffing, Standard 2 (1), 2 (9) and 2 (10), National Care Standards, Support Services. Recommendations 1. The service should develop information in a format that service users can understand. ( NCS Support Services Standard 1-1:Informing and deciding). 2. The service should explore innovative ways in which to involve service users in the management of the service. (NCS Support Services Standard 8-10,11:Making choices ). 3. The manager should ensure the service complies with the principals of the Adults with Incapacity Act. The manager should establish if any service users have a ' a continuing power of attorney' and /or ' welfare power of attorney' appointed, or a Department of Work and Pensions 'Appointeeship'. The manager should obtain written confirmation that parents/carers agree/disagree with the current arrangements for managing the social fund. (NCS Support Services Standard 2-13:Management and staffing arrangements ). 4. The manager should develop a system to check staffs physical and mental fitness for work and this information should be held in staffs personnel files. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). 5. The manager should ensure that two references including one from a previous employer should be on file for all new employees. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). 6. The manager should develop a procedure on what action will be taken if checks are unsatisfactory and develop a policy on how often Disclosure Scotland checks will be rechecked. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). 7. The manager should ensure that copies of staffs qualification certificates are kept in staffs personnel file. National Care Standards, SSSC Employer.(NCS Support Services Standard 2-5:Management and staffing arrangements ). 8. The manager should put in place written guidelines/develop policy and procedures for food, fluid and nutrition to ensure that service users' food, fluid and nutritional care are supported by clear management guidelines. ( NCS Support Services Standard 15:Eating well and Standard 2-4:Management and staffing ). 9. The provider should ensure that all staff have full and open access to all of the organisations policies and procedures. (NCS Support Services Standard 2-2:Management and staffing arrangements ). 14/15

10.The care service should obtain a copy of the 'Area Inter-Agency Adult Protection Procedure'. ( NCS Support Services Standard 2-1:Management and staffing arrangements ). 11.The care service should obtain a copy of 'Rights risks and limits to Freedom', the principals and good practice guidance, Mental Welfare Commission 2006. (NCS Support Services Standard 2-6:Management and staffing arrangements ). 12. A system ensuring regular direct observation of staff practice should be developed and implemented. ( NCS Support Services Standard 2:Management and staffing arrangements ) Jim Brannigan Care Commission Officer 15/15