Waterstone Farm Care Home Service Children and Young People Waterstone Farm Ecclesmachan Broxburn EH52 6NE

Waterstone Farm Care Home Service Children and Young People Waterstone Farm Ecclesmachan Broxburn EH52 6NE Type of inspection: Unannounced Inspection completed on: 14 January 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 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: CareVisions Group Ltd Service provider number: SP2003002569 Care service number: CS2007156847 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 Waterstone Farm, page 2 of 26

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Environment 6 Excellent Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service were very good at asking young people for their views. They used this feedback in their planning. They provided care to meet the young people's individual needs. What the service could do better The service should continue to develop the good practice we saw. They need to make sure that the acting manager had opportunities to develop her role in the service and provide a programme of regular staff supervision. They needed to make sure that the staff team and manager had opportunities to work together and ensure their high standard of practice was maintained. What the service has done since the last inspection Since the last inspection the service manager had taken up a position as acting area manager and one of the staff team had taken up position as acting manager. New members of staff had joined the team. This had led to some disruption and it was too soon for us to see improvements at this inspection. Waterstone Farm, page 3 of 26

Conclusion Waterstone Farm continued to provide a high quality service for the young people living there. There had been some changes to the staff team and management arrangements and the service now needed to consolidate on the very good practice which was evident. Waterstone Farm, page 4 of 26

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations If we are concerned about some aspects of a service, or think it could do more to improve, 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. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. * A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Waterstone Farm is a rural farmhouse situated outside Broxburn, West Lothian. Waterstone Farm is operated by CareVisions Ltd and was registered as a long term Care Home service for children and young people. The service is registered to provide residential care to three children and young people. CareVision's Mission Statement describes the company as existing 'to enhance the quality of the current and future lives of young people who are exhibiting behaviour which reflects traumatic, violent or abusive pasts, and who require high quality therapeutic residential care'. CareVisions Ltd have adopted the Sanctuary model of care which uses the SELF (Safety, Emotions, Loss and Future) framework and has commitments which are the organisation's core values. These are: non-violence, emotional intelligence, social learning, social responsibility, democracy, open communication and growth and change. Waterstone Farm, page 5 of 26

Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 6 - Excellent Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very 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. Waterstone Farm, page 6 of 26

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This unannounced inspection was carried out by an inspector for the Care Inspectorate on 9 January 2015. We visited the service between 11:30hrs and 19:30hrs. We returned on 14 January 2015 and gave feedback to the acting manager and acting area manager. During the inspection we met with two members of staff, one young person and the manager. We looked at the premises and examined records including:- care plans and young people's files incident and accident records staff rotas risk assessments for young people minutes of meetings supervision records staff training records guidance and procedures for staff quality assurance records medication records. We observed the interactions between staff and the young person who was present during the inspection. We took all of the above evidence into consideration when writing this report. We also took into account the Public Services Reform (Scotland) Act 2010 and its associated statutory instruments, the National Care Standards for care homes for children and young people and the Scottish Social Services Council (SSSC) Codes of Practice for Social Service Workers and Employers. Waterstone Farm, page 7 of 26

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. 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 Waterstone Farm, page 8 of 26

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 from the service. In this they identified where they felt they showed strengths in the Quality Statements we looked at, and some areas for improvement. Taking the views of people using the care service into account We received three competed Care Standards Questionnaires from young people. We spoke individually with one young person during the inspection. Comments were mixed and some are included in the body of the report. In addition, some of the comments included:- "It's all right here but it can get a bit boring sometimes." "Staff are good - keyworkers work through your care plans with you." "You get to do stuff here you wouldn't get to do otherwise." "They give you some structure in your life." "Staff help smooth out squabbles in the house." "Staff do take me to the cinema when there's time and sometimes watch a film with me when they are not too busy." "There's limited time on the internet, I think we should have more." "I can make suggestions, I do get heard." "I think we should do more stuff like swimming and get a proper barbeque." Taking carers' views into account Not appropriate at this inspection. Waterstone Farm, page 9 of 26

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: 5 - Very 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 We found that the service continued to provide the excellent standard of care and support which we saw at the last inspection. We concluded this after discussions with one of the young people, speaking with staff and the acting manager, observation of interactions throughout the inspection, looking at records and minutes of meetings held, and from looking at photos and the service's 'Yammer' page.'yammer' is an online social network which organisations can use to share information within the organisation. Some of the evidence we considered included:- * CareVisions Ltd had a Participation Strategy. In this they outlined their committment to ensuring that "Children and young people, parents and carers would have opportunities to influence and directly contribute to the development of the services." In this strategy they took account of Article 12 of the United Nations Convention on the Rights of the Child, and incorporated the seven commitments of the Sanctuary model which underpinned all their work with children and young people. The strategy outlined the ways this was going to be achieved, and how they would recognise if it was effective. * We could see that the service used a range of ways to consult with children and young people. Two of the young people confirmed on Care Standards Questionnaires (CSQs) which they completed and returned to us that they agreed with the statement: "Managers and staff ask for my ideas and use them to make things better." Waterstone Farm, page 10 of 26

* Young people were given a booklet about the service when they arrived. If possible, young people visited the service to find out what it was like before they decided to move in. This meant that they had a good idea about what they should expect from their placement, and so were in a better position to assess if the service met their expectations. * We could see from records that young people, carers and other professionals were asked for feedback evaluations. Young people had been directly involved in recruiting new staff, and their views were sought in evaluating progress for new staff during their probationary period. * We saw that staff had built up good relationships with young people's families, where appropriate. There was evidence of how the service's support was appreciated by families. * During the inspection we saw that young people were confident in passing on their views and suggestions directly to staff and the manager. We saw examples of how suggestions were considered and action taken as a result. There were photographs of young people taking part in activities together with staff, such as CareVisions's Festival of Sport (linked to the recent Commonwealth Games). Waterstone Farm had been awarded a cup in recognition of their success in taking part in the challenge. It was evident that young people had built up positive relationships with staff, through which they were more likely to pass on feedback. * Young people confirmed that they knew how they could make a formal complaint, if they needed to. We saw that complaints were followed up appropriately and outcomes discussed with young people. Areas for improvement The service should continue to look at ways to develop the excellent practice we saw at this inspection. They must show that this can be sustained in order to maintain this grade. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 11 of 26

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that the service had very good systems in place to make sure that young people's health and wellbeing needs were met. We concluded this after we had discussions with a young person, looked at CSQs, carried out an audit of medication, had discussions with staff and the manager and looked at records. Some of the evidence we considered included:- * Each young person had a care plan where their health needs were identified, along with an indication of how these would be met. All of the young people staying at Waterstone Farm were in the process of developing skills towards independent living, and we could see that their care plans reflected this aim. * Staff demonstrated a commitment to supporting the young people in achieving their potential, and we saw that they gave guidance and encouragement to the young people. Through this young people were supported in attending school, college and work experience placements. * Staff had built up positive relationships with the young people and we saw that they used this to help young people feel nurtured and safe, while also having lively banter. * Young people were appropriately registered with local doctors, dentists, opticians and with the minor ailments clinic at the local pharmacy. Staff supported them to attend appointments and linked with other agencies such as the Looked After and Accommodated Children's (LAAC) nurse to provide consistent health care. Staff knew about resources in the local area which young people could access for independent support and advice. They linked with Throughcare services to help young people plan for moving on from Waterstone Farm when they felt this was what they wanted to do. * We saw that staff worked individually with young people on achieving aspects of their care plan. Young people were encouraged to budget, shop for and cook their meals. This included discussions about healthy choices. It was evident that staff made sure young people were aware of their rights and encouraged them to make positive choices about their lifestyles. * Young people were supported and encouraged to take part in sports and energetic activities. We saw examples of young people's successes in the CareVisions Festival of Sport, as well as individually in their chosen sport. Waterstone Farm, page 12 of 26

* Risk assessments had been carried out and recorded for each young person. The best way to help the young person stay calm, or prevent them becoming distressed or agitated was recorded in their Safety Plan. These were displayed so that all staff and young people could be aware of the actions they could take to help calm situations. * There was a system for recording incidents and accidents. There had not been any since the previous inspection, however, staff were aware of the records they should make, and who should be informed. Areas for improvement Inspection report continued We looked at medication storage and administration. We highlighted an issue regarding one young person's medication, which the manager took appropriately to the LAAC nurse for advice. We discussed this during feedback and were satisfied that the service were actively looking for a resolution for the issue. However, they should ensure that their audits effectively identify any such issues so that they can be more proactive. Not all the young people who returned CSQs to us indicated that they were happy with the care they received. One indicated that they did not feel safe or protected from bullying. While we acknowledge that these questionnaires can provide only a snapshot of how a young person may be feeling on the day they complete the form, the service should consider ways to assure themselves that all the young people continue to be happy with the service and feel safe there. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 13 of 26

Quality Theme 2: Quality of Environment Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths Evidence found in Quality Theme 1 Statement 1 also applied to this statement. We found the service used the same systems for consultation about the environment. Areas for improvement Areas for improvment identified in Quality Theme 1 Statement 1 also applied to this statement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 14 of 26

Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Inspection report continued We found that the service had excellent systems in place to make sure that young people were cared for safely and protected. We concluded this after discussions with a young person, staff and the manager, observing practice and from looking at records. Some of the evidence we considered included:- * We saw that checks were made to make sure that the premises, appliances and equipment were safe, well maintained and in good working order. These complied with relevant legislation. There was a system for routine maintenance, fire safety and health and safety checks to be carried out. * The premises were securely locked. Visitors were asked to sign in and out of the premises, which meant that staff knew who was in the building and could track who had visited, if necessary. * It was evident that young people were relaxed and confident in their interactions with staff. They were given appropriate praise and encouragement, and limits were set gently. Young people were encouraged to talk through any worries, issues or fears with staff and we saw that there were regular sessions with keyworkers. * Staff received training on Child Protection and Adult Support and Protection and knew the steps they should take if they had concerns about a young person's wellbeing. * Staff knew the procedures they should follow if a young person was missing. We saw that risk of absconding was identified in individual risk assessments, where this was relevant for the young person. These risk assessments identified any areas which could result in the young person being vulnerable to harm. They detailed actions staff and young people should take in order to help minimise these risks. * The service had a policy on internet safety. We saw that young people all signed to confirm they agreed to the service's guidelines to not access inappropriate sites. * The service drew up agreements with young people about who, and under what circumstances, could enter their bedrooms; for example, whether staff could go into their room to wake them to help them get to appointments or college. * Staff had been trained in elementary food hygiene and guidance was provided on the safe storage of food and preparation of meals. They confirmed that they tried to help young people learn about food hygiene through working together in meal preparation. Waterstone Farm, page 15 of 26

* Staff knew about the steps they should take to help prevent the spread of infection. The premises were kept clean and hygienic, and individual hand towels were provided to limit the risk of infections being passed round. Areas for improvement In order to maintain this grade, the service should continue to sustain and develop the excellent practice we saw at this inspection. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 16 of 26

Quality Theme 3: Quality of Staffing 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 staffing in the service. Service strengths Evidence found in Quality Theme 1 Statement 1 also applied to this statement. We found the service used the same systems for consulting about the staffing. Areas for improvement Areas for improvement identified in Quality Theme 1 Statement 1 also applied to this statement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 17 of 26

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued We found that the service showed very good practice in relation to this Quality Statement. We concluded this after discussions with young people, staff and the manager, observing practice and looking at records. Some of the evidence we considered included :- * CareVisions Ltd continued to use safe recruitment practices to make sure that the staff appointed had the right skills, qualifications and experience for the work they were to do. * An induction and probationary period was in place for new staff so that they could learn about the service and what was expected of them, as well as practical information about the work they were to do, before they started to work with the young people. * Staff we spoke with were very positive and enthusiastic about their work. They confirmed that they felt supported by the manager and area manager, and felt there was an open culture where they could ask questions and reflect on their practice. Staff took on particular areas of responsibility within the team. They confirmed that this helped them with their professional development. * All staff were required to register with the SSSC. In order to do so, all staff were expected to achieve their SVQ 3 (Scottish Vocational Qualification) and HNC (Higher National Certificate) by the end of their third year of employment. CareVisions provided opportunities for staff to gain these qualifications. * Staff confirmed that they accessed a range of online training to extend their skills and knowledge. They said that doing this helped them keep up to date with best practice, and helped them in the work they did with young people. * We saw that staff team meetings were held regularly. These were used to look at ways the service could be improved, as well as for reflection on practice and discussions about strategies to help young people. * The service used emails to communicate information about any changes, or updates to policies and procedures. Staff confirmed they felt they were part of the organisation through this. Waterstone Farm, page 18 of 26

Areas for improvement While we were aware that the manager had been in a temporary position and this had recently been extended, it was evident that staff supervision had not been provided as regularly as it should. The manager confirmed that a programme of supervision and appraisal was in place and this would be resolved in the near future. We will continue to monitor progress on this at our next inspection. We discussed the changes which had happened within the staff team and management arrangements, and advised that the Provider needed to ensure that staff and the manager had opportunities to work together to ensure consistent practice and a team ethos. It was evident that staff and the manager had provided cover in other services, and the manager had commitments outwith the service to further her development. We discussed the need to ensure that these factors did not have a negative impact to the staff group. Young people commented that staff were "too busy" and had "not enough time in our service." One young person commented "Staff don't spend enough time with me as they're always busy." Another commented "The staff are always in the office doing paperwork and the manager is hardly ever in, to ask for our opinions." We will continue to monitor progress on this at our next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 19 of 26

Quality Theme 4: Quality of Management and Leadership 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 management and leadership of the service. Service strengths Evidence found in Quality Theme 1 Statement 1 also applied to this statement. We found the service used the same systems for consulting about the management. Areas for improvement Areas for improvement identified in Quality Theme 1 Statement 1 also applied to this statement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Waterstone Farm, page 20 of 26

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 Some of the evidence which we discussed in Quality Theme 1 Statement 1 also applied to this statement. In that statement we identified a range of ways that the young people, and their parents and carers could pass on their views. Other people who were involved with the service were known as stakeholders. These could include social workers, health professionals and workers from other services offering support to the young people. We saw that the service had continued to develop systems for quality assurance, some of which included the views of stakeholders. Some of the evidence we considered included:- * The manager and area manager confirmed that there was a system of monthly checks which were carried out and discussed with the area manager. * The service's systems for participation provided feedback which linked to their systems of quality assurance and improvement plan. * Staff were involved in giving feedback to the manager through staff meetings as well as in day to day contact. * The area manager visited the service regularly, which meant that she had an overview. The young people knew her and confirmed they would speak with her if they had concerns about the service. * There was a system of on call managers to provide support and guidance at times when the manager was not present. Managers from other CareVisions services took turns to provide this. Areas for improvement Inspection report continued We discussed the organisation's plans for quality assurance to be checked through peer reviews. This involved managers from other services visiting and carrying out an audit of the service, following an agreed improvement framework document. These were due to start soon after the inspection and would result in each service being reviewed annually. It was anticipated that this would contribute to the service's improvement plan. We will monitor progress on this at our next inspection. We discussed the need for the management arrangements to be maintained for the service to show that the very good practice we saw at this inspection can be sustained and further developed. Waterstone Farm, page 21 of 26

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Waterstone Farm, page 22 of 26

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). Waterstone Farm, page 23 of 26

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 6 - Excellent 5 - Very Good Quality of Environment - 6 - Excellent Statement 1 Statement 2 6 - Excellent 6 - Excellent Quality of Staffing - 5 - Very Good Statement 1 Statement 3 6 - Excellent 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 6 - Excellent 5 - Very Good 6 Inspection and grading history Date Type Gradings 10 Mar 2014 Unannounced Care and support 6 - Excellent Environment 6 - Excellent Staffing 6 - Excellent Management and Leadership 6 - Excellent 4 Mar 2013 Unannounced Care and support 6 - Excellent Environment 6 - Excellent Staffing 6 - Excellent Management and Leadership 5 - Very Good 8 Mar 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed Waterstone Farm, page 24 of 26

8 Feb 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 17 Aug 2010 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 24 Mar 2010 Unannounced Care and support 4 - Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 4 - Good 29 Jan 2010 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 19 Mar 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and Leadership 4 - Good 3 Dec 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Waterstone Farm, page 25 of 26

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 Waterstone Farm, page 26 of 26