Aberlour Sycamore Service Care Home Service Children and Young People 101-103 Veronica Crescent Kirkcaldy KY1 2LJ Telephone: 01592 592123 Inspected by: Linda Paterson Type of inspection: Unannounced Inspection completed on: 27 February 2014
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Aberlour Child Care Trust. Service provider number: SP2010011118 Care service number: CS2010272700 Contact details for the inspector who inspected this service: Linda Paterson Telephone 01382 207200 Email enquiries@careinspectorate.com Aberlour Sycamore Service, 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 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well The Aberlour Sycamore service at Veronica Crescent provides young people with a caring, nurturing environment in which they are well supported by an experienced staff team to attend and achieve at school. They are encouraged to lead a healthy lifestyle, and are supported to take part in a range of physical activities and to develop independent interests in the community. Young people's views are valued, and they have contributed well to the development of the organisation's model of care based on social pedagogy, and to national events. Staff work effectively with parents, families and relevant agencies to make sure that young people are safe and supported to reach their potential. What the service could do better The service should continue to implement its action plan and make sure that improvements become embedded into its practice. What the service has done since the last inspection The service had made very good progress towards addressing the areas identified for improvement at the previous inspection. Some of the important improvements were: Aberlour Sycamore Service, page 3 of 25
* reviewing and updating care plans and risk assessments * improving medication storage and recording; * putting in place regular team meetings and staff supervision; * improving quality assurance systems Conclusion The Aberlour Sycamore service at Veronica Crescent provides children with a safe, secure and nurturing environment in which they are supported to develop strengths and skills and reach their potential. The organisation has embarked on a structured plan to improve those aspects of the service which have been identified as being in need of development, and is committed to the ongoing development of the service in line with statutory requirements and best practice guidance. Who did this inspection Linda Paterson Aberlour Sycamore Service, page 4 of 25
1 About the service we inspected 103 Veronica Crescent was originally deemed registered with the Care Commission in April 2002. A change to Aberlour's legal identity required the provider to re-register in 2010. Before 01 April 2011, this service was registered with the Care Commission. On this date the new body, Social Care and Social Work Improvement Scotland, (SCSWIS), known as the Care Inspectorate, took over the work of the Care Commission, including the registration of care services. This meant that from 01 April 2011 this service continued its registration under the new body, the Care Inspectorate. Requirements and recommendations If we are concerned about some aspect 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 Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. 103 Veronica Crescent is part of Sycamore Services which comes under the auspices of Aberlour Childcare Trust, a registered Scottish Charity, working in the fields of: Parenting and young children's development Children and families affected by drug and alcohol misuse Children and families affected by disability Young people at risk. 103 Veronica Crescent is one of four residential resources within the Sycamore Project in Kirkcaldy. There is a further residential unit in Dunfermline. At the time of the inspection, the service was registered to provide residential care for six young people ranging in age from 8-16 years. The house, formerly two semi-detached houses, is situated in a residential estate and allows for good access to local amenities, local schools, shops and leisure facilities. Aberlour Sycamore Service, page 5 of 25
Young people living in 103 Veronica Crescent attend local schools, and have established friends within the local community. There is good sized public space. Young people have their own single rooms, and public space consists of a large sitting room, and a separate, semi-open plan dining area. The house has an extension at the back of the building, which includes the senior management team office, a games/quiet room and a flat. The flat, known as the Family Resource Centre, is used to accommodate occasional overnight stays for service users' families as part of the family work undertaken by the service. The conditions of registration have recently been varied to take account of the fact that young people are remaining in the service as they get older and now are: To provide a 24 hour care service to a maximum of 6 young people aged between 8 years and 16 years To provide a support service for service users, their families and former service users, in the Family Resource Centre (flat adjacent to the care home) To comply with the current staffing schedule attached, dated 20 September 2010, which must be displayed with this certificate. At the time of this inspection, the house was fully occupied. 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 0845 600 9527 or visiting one of our offices. Aberlour Sycamore Service, 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 wrote this report following an unannounced inspection of the service which took place on 27 February 2014. The inspector was Linda Paterson. The main purpose of this inspection was to follow-up on the recommendations and requirements made at the last inspection, and to make sure that progress had been made in relation to areas identified for improvement at the last inspection. During the inspection, we gathered information from a range of sources which included: * discussion with two of the young people who were around during the inspection * discussion with the manager, deputy manager and three members of care staff * observation of interaction between young people and staff * brief inspection of the premises. We also looked at a range of relevant documents including: * sample of three care plans * medication records and storage * accident and incident records * staff supervision records * performance management plans * team meeting minutes * managers' checks * external manager's audit report. 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. Aberlour Sycamore Service, page 7 of 25
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 Aberlour Sycamore Service, page 8 of 25
What the service has done to meet any requirements we made at our last inspection The requirement The service must ensure that it takes immediate action to review and update the care plans for young people, taking into account all areas of need and risk. Plans must be regularly reviewed to take account of the changing needs of young people, and should be discussed and shared with young people, staff, social workers and families where appropriate in order to ensure clarity and consistency of approach. This is in order to comply with: the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI/2011/210-5(1)), which requires service providers to make a personal plan which sets out how the health, wellbeing and safety needs of young people will be met, and also(ssi/2011/210-5 (2)(b)(ii)), which requires services to review the plan when there is a significant change in a service user's health, welfare or safety needs. Timescale for implementation, by 31 January 2014. What the service did to meet the requirement The service had carried out an extensive review of care plans, and we were satisfied that relevant and current information about young people was recorded. Risk assessments had been updated and reflected the current influences affecting young people. Young people had been involved in reviewing and updating their plans. The requirement is: Met - Within Timescales The requirement The service must ensure that it has appropriate arrangements in place for the safe storage and appropriate recording of medication. This is in order to comply with: the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI/2011/210-4(1)(a) - which requires the service to make proper provision for the health, welfare and safety of service users. Aberlour Sycamore Service, page 9 of 25
Timescale for implementation: By 15 January 2014. What the service did to meet the requirement The medicine cabinet had been replaced and provided secure storage. Staff had been given additional guidance and training about managing medication. We found that medication records were accurate. The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection The service had taken appropriate action in response to recommendations made at the last inspection as noted: * Young people had been involved in reviewing and updating their care plans and risk assessments * Staff had had regular opportunities to meet as a team to discuss their practice * A regular pattern of 1:1 supervision had been established for all staff * Administrative support had been put in place. The service was also in the process of addressing the two remaining recommendations as follows: * They had begun to review the aims and objectives of the service. They were involving staff, young people, parents and other stakeholders in this process, which was expected to be completed by the end of March 2014. * The organisation was reviewing its external monitoring systems. 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 Aberlour Sycamore Service, page 10 of 25
Comments on Self Assessment Inspection report continued 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. As this was the second inspection of the service this year, we did not ask the provider for a self assessment form. However, we took into account the information provided in the action plan as a basis for this inspection. Taking the views of people using the care service into account We spoke to two of the three young people who were in the house while we were doing the inspection. One young person was quite quiet and didn't have a lot to say. However, they indicated that they were generally happy with how things were going at Veronica Crescent. They also said that they were treated fairly and were given plenty of encouragement to join in activities within the community. The second young person we spoke to was very upbeat and positive about how things were going for him at Veronica Crescent. They felt they were being given lots of opportunities to enjoy activities and interests, and they felt he was becoming more responsible and independent as a result. They enjoyed the food, and that they were able to help to prepare meals and bake on a regular basis. They said that they felt safe and, generally got on well with staff and other young people. Taking carers' views into account We did not have the opportunity to speak to parents or carers during this inspection. Aberlour Sycamore Service, page 11 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 From our discussions with the manager, deputy manager, staff and young people and from our observations during the inspection, we found that the service had maintained the good standard of practice we found at the last inspection: * Young people were involved in discussions about their own care plans. They were encouraged to attend their reviews, and some did so with the support of staff. Some young people used "Have your say" forms to help them to contribute their views. Since the last inspection, all young people had been involved in reviewing and updating their care plans. * The service also had a very positive approach to involving parents and other family members to stay in touch and build relationships with their children. There was a comfortable family resource flat attached to the premises where families could come and stay overnight and have one-to-one time with young people in a more relaxed homely environment. * On a day-to-day basis, young people were involved in decisions about what they wore, what they had to eat, and how they spent their spare time. They also had the opportunity to choose furnishings and equipment to personalise their bedrooms, and were consulted about the decor for the communal areas of the house. This helped to develop a sense of ownership and belonging within the house. During this inspection, we spoke to one young person who talked enthusiastically about how he helped out with cooking and baking, which he really enjoyed. * The organisation was very committed to supporting young people to contribute to the development of the wider service, for example, one young person had been involved in the development of the social pedagogy model of practice which was Aberlour Sycamore Service, page 12 of 25
currently being integrated into the operation of the service and, had represented the young person's perspective at in-house and external training events * Young people were also actively encouraged to be involved in national events, such as, the recent Care Inspectorate initiatives "Reaching High" and "Meeting Sid" which helped them to influence the quality and direction of childcare services. Such events not only helped to make sure that young people had a voice in the development of policy and practice, but provided young people with opportunities to develop confidence and skills on an individual basis. Areas for improvement The service should continue to support young people to be meaningfully involved in discussions about their own care plans. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths From our discussions and observations during this inspection, we found that the service had addressed the issues identified for improvement at the last inspection, and was now performing at a good standard in relation to this quality statement. We noted the following strengths: Inspection report continued * Young people had very good access to primary health care services. Their health needs were assessed and recorded, and they were well-supported by staff to attend appointments with doctors, dentists and opticians and to follow-up with treatment where necessary. This had helped to ensure that young people's health improved as a result of the care they received at Veronica Crescent. For example, it was noted that the dentist had said that he was "impressed with the improvement in the way that X was brushing their teeth", and good evidence that staff had been encouraging this. * Since the last inspection, we found that the service had reviewed and updated care plans and risk assessments, and was developing a more structured approach to care planning. Young people's files were in good order and contained relevant and accessible information about their care needs and how these should be met. * Since the last inspection, the service had significantly improved its approach to managing medication. Medication was stored securely, with medicines appropriately labelled. Records of the administration of prescribed medication were accurate. Aberlour Sycamore Service, page 13 of 25
* Staff provided young people with good opportunities to lead a healthy lifestyle, for example, by providing a balanced healthy diet and by encouraging them to be physically active every day. Young people had bikes which they were encouraged to ride safely. Their individual interests were known and supported. They were encouraged to make use of community facilities such as the gym and local clubs, which helped them to get to know people and build up confidence in using local resources. * We found that staff had been creative in their approach to encouraging young people to find and maintain hobbies and interests. For example, one young person had been encouraged to develop his interest in fishing. This had then provided opportunities for building confidence, social contacts and helping him to develop the ability to travel independently and to manage time out of the house safely and responsibly. During the inspection, the young person talked enthusiastically about his hobby, and was able to describe himself, how he felt that he had become more mature and independent as a result of this activity. * The service provided young people with a very good level of support to attend school. For most young people, this enabled them to maximise their attendance in school, and increase the time spent in class with and without support. This was clearly of benefit to their current and future wellbeing. During the inspection, we saw that one young person was being supported to develop an individualised timetable of activities with the aim of developing skills and confidence to go to college. * Overall, this was a warm, nurturing environment in which staff established caring relationships with young people and worked individually and collectively to provide them with positive experiences which contributed to a healthy lifestyle and a sense of achievement and wellbeing. Areas for improvement Inspection report continued While the main concerns we had raised about care planning had been addressed, the development of the care plans was an ongoing issue, and the manager acknowledged that there was still work to be done to improve on the quality of recording. this was being addressed by providing staff with guidance and support to implement the new format. In particular, we thought that there was a need to improve the way that records were kept of decisions which had been made, and how they affected the care plans. The service should also review its use of "homely remedies". In particular, the service should make it clear that it is not appropriate to share topical medicines such as antiseptic creams or anti-viral preparations in order to avoid the risk of crosscontamination (see recommendation 1). Aberlour Sycamore Service, page 14 of 25
Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service should review its policy and procedure in relation to the use of "homely remedies", and in particular should make it clear that it is not appropriate to share topical medicines such as antiseptic creams or anti-viral preparations in order to avoid the risk of cross-contamination. National Care Standards for Care Homes for Children and Young People - Standard 12 - Keeping well - medication. Aberlour Sycamore Service, page 15 of 25
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 For information about the service's strengths in relation to this quality statement, please refer to Quality Statement 1.1. Areas for improvement Please refer to Quality Statement 1.1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Form our discussions and observations during this inspection, we found that the service had maintained the good standard of practice we found at the last inspection. We noted the following strengths: * The premises were clean, hygienic and smoke free throughout, and in a good state of repair. * A comprehensive risk assessment of the premises had been carried out and recorded. Regular premises checks were done, repairs and maintenance issues were dealt with efficiently. The service carried out a comprehensive Health and Safety inspection on an annual basis, which took account of all aspects of premises safety and security, including access, security and safety of the water supply. * There was clear system in place for recording accidents and incidents. Incident records were detailed and most included a record of young people's views. These records had been audited by the external manager of the service, which contributed an additional level of scrutiny and safeguarding to this important aspect of safe care. Aberlour Sycamore Service, page 16 of 25
* There were well-developed protocols in place which were followed if young people went missing from the premises. We found evidence that staff had responded appropriately to incidents when young people were absent from the house. They made use of social media and personal contacts to help to maintain communication and keep track of the young people and facilitate their return home. * Since the last inspection, we noted that the service had updated the risk assessments for individual young people and had taken appropriate action to minimise risks which had been identified. * Staff benefitted from a range of well-planned training which helped them to keep young people safe. All staff had been trained and accredited in CALM (Crisis, Aggression, Limitation and Management) and used de-escalation techniques and physical intervention effectively when necessary. They also had relevant Child Protection training and, were familiar with the referral system and agencies for contact should these be necessary. * Staffing levels were maintained at a level which ensured a good level of supervision for young people. Where it was judged necessary, staffing levels were increased to make sure that the safety and security of young people was maintained at critical times. Areas for improvement The service should continue to build on the good practice we found at this inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Aberlour Sycamore Service, page 17 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 For information about the service's strengths in relation to this quality statement, please refer to Quality Theme 1 Statement 1. Areas for improvement Please refer to Quality Theme 1 Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths From our discussions and observations during the inspection, we found that the service had maintained the good standards we found at the last inspection. We noted the following strengths: * From our observations and discussions with staff and young people, it was clear that the staff knew the young people well and worked hard to provide them with a supportive and nurturing environment. They had established positive working relationships with schools, social workers and others involved in young people's care. They were creative in their approach to helping individual young people to make the most of opportunities to develop life skills. During the inspection, we observed some very good practice which helped a young person to manage their behaviour and get back into school. Aberlour Sycamore Service, page 18 of 25
* Staff were well-qualified and experienced and benefitted from a range of relevant training which supported their work with young people. Staff had been encouraged and supported to acquire the qualifications needed for registration with the Scottish Social Services Council (SSSC). They had been assisted by the secondment of a member of the team as an SQA assessor to support staff effectively through this process. * The service had invested heavily in developing staff knowledge and skills through providing some very good training and development opportunities, particularly in relation to the implementation of social pedagogy as a framework for working with young people. Some staff had had the opportunity to visit Denmark to study the model there, and others had benefitted from more locally based training opportunities. * During this inspection, we noted that the systems for supporting staff and developing a consistent approach to caring for young people had improved. Regular team meetings were being held and were well-attended. Staff had also been given regular opportunities to discuss their practice in supervision. We were also advised that a team development day was planned in the near future. Areas for improvement The service should continue to provide staff with appropriate guidance and learning opportunities to support their practice with emerging needs of the young people who are currently using the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Aberlour Sycamore Service, 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 For information about the service's strengths in relation to this quality statement, please refer to Quality Theme 1 Statement 1. Areas for improvement Please refer to Quality Theme 1 Statement 1. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 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 From our discussions with the manager and our observations during the inspection, we found that the service had improved its performance in relation to this quality statement. We noted the following strengths: * The service valued the views of young people, staff, and other stakeholders. It asked for their views on a regular basis and had used these to contribute to the annual reviews of the service. Close partnership working with other agencies, including social work and schools, helped to ensure that these agencies' views positively influenced the quality of the service given to individual young people. * The service had some good systems in place to monitor the quality of the service. The system of quarterly reviews, health and safety inspections, and inspections by the external manager provided a good basis for monitoring and developing the quality of Aberlour Sycamore Service, page 20 of 25
the service. Since the last inspection, a series of focused inspections had been carried out by the external manager of the service. Since the last inspection, the service: * Had reviewed and updated care plans and risk assessments * Staff had had regular opportunities to meet as a team to discuss and develop their practice * A regular pattern of 1:1 supervision had been established for all staff * Administrative support had been put in place * They had begun to review the aims and objectives of the service, involving staff, young people, parents and other stakeholders in this process * The organisation was reviewing its external monitoring systems. In summary, the service provider had responded promptly and positively to the requirements and recommendations made at the last inspection and, had implemented a clear plan for improving its approach to quality assurance. While the organisation needs to continue to make sure that the improvements made are firmly embedded into practice, we felt that the improvements made to date were sufficient to warrant an improved grade of 4 - Good at this time. Areas for improvement The service should continue to ensure that its quality assurance systems are implemented effectively. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Aberlour Sycamore Service, page 21 of 25
4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information 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). Aberlour Sycamore Service, page 22 of 25
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Environment - 4 - Good Statement 1 Statement 2 4 - Good 4 - Good Quality of Staffing - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 7 Nov 2013 Unannounced Care and support 2 - Weak Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 1 Feb 2013 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 6 - Excellent Management and Leadership 5 - Very Good 9 Feb 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good Aberlour Sycamore Service, page 23 of 25
15 Sep 2011 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Aberlour Sycamore Service, 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 Aberlour Sycamore Service, page 25 of 25