Cairn Mhor Childcare Partnership Limited Care Home Service 8 Pentland House Saltire Centre Glenrothes KY6 2AH Telephone: 01592 631031 Type of inspection: Unannounced Inspection completed on: 13 July 2016 Service provided by: Cairn Mhor Childcare Partnership Limited Service provider number: SP2010011349 Care service number: CS2010279527
About the service Cairn Mhor Childcare Partnership provides residential care for young people. The provider is Cairn Mhor Childcare Partnership Limited, a private limited company governed by a Board of Directors. It also has an advisory board which advises on practice. The service provides medium and long-term care and accommodation for up to 11 young people aged 6 to 18 years, most of whom have a history of being Looked After and Accommodated. The service is provided from three very well provisioned houses in the villages of Falkland ("Winstone") and Freuchie ("Burnside Cottage") and the town of Leven ("Leven House"). All young people have their own bedroom. Most bedrooms are en suite. The service uses a number of specialist consultants including a trauma therapist and play therapist. The service's stated aims are: "To offer young people the best possible standard of care. To offer a level of commitment to young people which is second to none. To ensure that every young person is at the centre of their planning process. To work in partnership with young people, carers and other professionals to help young people to develop their full potential". What people told us We spoke with two young people during inspection and received nine completed satisfaction questionnaires. Views of the service were very positive with relationships with staff being highlighted as a particular strength. In response to the statement "Overall, I am happy with the quality of care I get here", one young person "disagreed", one young person replied "Don't Know", one young person "Agreed" and six young people "Strongly Agreed". The young people we spoke with indicated a high level of satisfaction with the quality of care. The young person who disagreed with the statement cited delays in getting a new bed and felt that staff needed more training regarding safe use of the internet. In response to the statement "Staff treat me fairly and with respect", one respondent did not indicate a view, three "agreed" and five "Strongly Agreed". Young people we spoke with indicated agreement with this statement. Comments included: "The staff are genuine and truly want to help/care for the young people". "Staff are lovely". page 2 of 10
"I can talk to each individual (staff) either if there is an issue or where we can laugh and have fun". "I get on well with the staff". "I feel safe here and get on well with all the staff". Three respondents and one of the young people we spoke with indicated that they did not always feel safe from bullying. This appeared to be related to group dynamics within Leven House. We discussed this with managers at feedback and they were aware of these dynamics. The House Manager was taking the issue forward and the Anti-Bullying Group was also addressing the matter. We spoke with four parents/carers by telephone. Views of the service were very positive, with staff and stability for young people being cited as particular positives. Comments included: "I am happy with the service". "(young person) gets on well with the staff". "(young person) is definitely benefiting - most stable he has ever been". "(young person) is looked after well and gets on very well with the staff - he seems happy". "Excellent communication". "It's not a major thing but sometimes communication could be better". "Communication problems were ironed out". "It is the best place for him - I would be unhappy if he were moved". "(key worker) was a Godsend". "I am more than happy with the service". "Staff are nice - no problems". "(young person) is settled". "They should have more age appropriate books for young people - I am very happy with the service". We spoke with the Who Cares? Scotland (a young person's advocacy organisation) representative who was a frequent visitor to the service. page 3 of 10
She told us that communication was very good and that Managers were responsive to issues that she raised on behalf of young people. She stated that the service was keen to get young people involved in Who Cares? and that the service was "child friendly". Overall she rated the service as "good". We contacted placing social workers by e-mail. Three social workers responded. Overall, they held the service in high regard. Comments included: "the quality of care is excellent; knowledgeable and skilled staff provide consistent and nurturing care" "I would rate the staff team and management team highly; there is great communication and appropriate information sharing is used" "Cairn Mhor provide safe, consistent and personalised care. They tailor their support to the young person's needs and are heavily involved in the through care planning as well" "The quality of care provided is very high. The staff are a very nurturing group of staff and create a warm and welcoming environment to everyone within the building, both young people and visitors". "I feel the management could be more pro-active within the means of ensuring that tasks are fulfilled and timescales have been met". "Family are always asked to and supported to participate in planning meetings and feedback". "The communication from this service has been to a very high level". "Staff/management could be more pro-active in creating and identifying opportunities for the young people within the house and be able to use different skills in motivating young people whom may be deemed more difficult to engage". "It provides a safe, nurturing and stable living environment". "The service meets the needs of (young person) - they have responded to his needs very well - he has a good relationship with staff". "Staff go aver and above their duty - they hired a consultant and invited the school to attend training". "Overall I am very happy with the service". Self assessment The service provided us with a thoroughly completed self-assessment that identified areas of good practice and some areas for improvement. From this inspection we graded this service as: Quality of care and support 5 - Very Good page 4 of 10
Quality of environment Quality of staffing Quality of management and leadership not assessed 5 - Very Good not assessed What the service does well We found that the service provided very good care and support to young people. We saw that staff had very good relationships with the young people. Young people were relaxed with staff and able to exercise choice. We saw that visitor's identification was checked by staff. The service had a participation policy statement. This made it clear that views were welcomed, both as regards individual care and the running of the service generally. Thorough initial assessment, and ongoing review, ensured that care plans were relevant and up-to-date. Files were well-ordered and maintained. Care plans incorporated the SHANARRI (safe, healthy, achieving, nurtured, active, responsible, respected and included) wellbeing indicators from Getting it Right For Every Child (GIRFEC).This meant that young people were able to progress in clearly defined areas. Young people had opportunities to discuss and develop their personal plans, including compiling a star chart on progress made/areas to be worked upon. Daily and weekly reporting were based upon the SHANARRI wellbeing indicators. Young people were encouraged to contribute to their own log recordings (Reflective Notes). Positively, these notes were written as a letter to the young person. This encouraged young people to read them and comment on them. Staff celebrated significant events and achievements in young people's lives to promote a sense of worth and self-esteem. These included birthdays, anniversaries and educational awards. The service linked some young people to befrienders to enhance their access to support and activities. Young people's health was promoted very well. All young people were registered with the local GP, dentist and, where applicable, optician. We saw that the storage and administration of medicine were satisfactory. Risk Assessments were detailed and showed evidence of regular update. We saw very detailed Positive Behaviour Support Plans focused upon positive reinforcement These helped promote positive responses to stressful, frustrating or angry situations for young people. Incidents were very few and managed well. The service employed an intervention policy based upon "NAPPI" (Non Abusive Physical and Psychological Intervention). This focused upon de-escalation of potential and actual incidents. All staff had, or were due to have, training in NAPPI. page 5 of 10
We saw evidence of effective liaison with schools. All the young people, bar one, had a mainstream school placement and were well supported to attend. The other young person was attending college and gaining work experience at the service's office base. Older young people had access to Pathways materials and were supported through the assessment and planning processes. A very good key worker system was in place that ensured effective overview of care planning and delivery. Young people had access to a range of indoor and outdoor activities. These included arts and crafts, console games, cooking, scouts, youth clubs, walks and swimming. Each young person had a holiday during the summer. At inspection one young person was due to return from Spain and one young person was due to leave for Lego Land. Another young person was looking forward to visiting Portugal. Each House had its own transport to facilitate activities. The Who Cares? Scotland worker had a high-profile within the Houses. She worked with young people to promote their participation and provided independent advocacy support, as well as independent advice to the service. She had played a part in supporting the anti-bullying group attended by young people. This group explored reasons for bullying and ways to combat it. Staff promoted a culture of safety, tolerance and positive coexisting. Bullying was not a major issue, however, managers and staff were working on improving group dynamics within Leven House. The service met with all the young people from the three Houses once every three months. This provided young people with a formal forum to raise issues. The service had formed a group for parents and carers. Their commitment to, and support for, this was clear and provided opportunities for parents and carers to share their experiences with others and to contribute to service development. Examples included their involvement in the development of the new service handbook, which had individualised sections for individual young people, and of the anti-bullying policy. Recently, parents and carers attached to other independent providers had joined the group. Parents told us, with one exception, that communication was effective and that they felt included in care planning. The service was held in high regard by parents. We saw that catering arrangements were very good with young people being offered a healthy and varied diet. Some young people enjoyed cooking and we saw that the chef was happy to offer advice and guidance. Some staff had received training on Life Story work. There were plans to train the remainder of the team. Staff were enthusiastic about adding this skills set and tool to their working with young people. We found that staffing arrangements were a major strength of the service. Management and staff presented as skilled, knowledgeable and committed to their work with young people. We formed a view of a cohesive team that was supported and in turn was supportive. Morale was described as "very good". The manager and staff described very thorough recruitment and induction arrangements. All appointments were subject to a six month probationary period in order to assess their suitability in practice. The manager and staff were registered (or in the process of registering in the case of new relief staff) on the appropriate part of the Scottish Social Services Council (SSSC) register. This meant they had to abide by the code page 6 of 10
of conduct, obtain a relevant qualification and undertake a minimum amount of relevant learning and development. Recently appointed senior staff were completing SVQ 4. Staff we spoke with were familiar with the SSSC Codes of Practice and the National Care Standards (NCS). The advisory board, we were told, used individual NCS as a theme for their visits. Staff had access to an e-mail and an intranet system which gave access to policies and procedures. These included Whistle Blowing and Child Protection. Staff had access to a range of training and development opportunities including First Aid, Autism, Sexuality and NAPPI (a method of de-escalation and safe holding). Staff presented as knowledgeable regarding child protection and safe care generally. Some staff had received training in Child Sexual Exploitation (CSE) and some had trained as CSE trainers. All staff were to receive this training in the near future. A draft CSE policy was in place and due to go to the staff team for consultation. A supervision model was in place that ensured that staff were developed and supported. Staff described very good ongoing support from the manager and colleagues. We discussed with the managers how supervision might be improved. An annual appraisal system was in place that allowed further development and overview of practice. A weekly staff meeting was held in each House that allowed for discussion and planning. Every four weeks a whole service business meeting was held. Likewise we saw that daily changeover meetings ensured that information was passed on and shift planning took place. A very good key worker and co-key worker system was in place. We saw that staff had very good relationships with the young people. We saw that incidents of challenging behaviour were managed well, including debriefing by managers. Parents told us that the manager and staff team were approachable. Staff we spoke with felt that their views were valued, that they were well supported by managers and had opportunities to make suggestions and raise issues about the service. House managers visited each House morning and afternoon. The Chief Executive Officer visited the Houses regularly and was known to young people and staff. This provided a further level of overview of practice. Staff turnover had been quite low and was key in providing young people with continuity of care. One of the House managers produced a weekly "update" for staff to ensure everyone was up-to-date with developments within the service. The other House manager intended to do likewise. We saw that the service's Values and Objectives had been the subject of a broad consultation and review. Values and Objectives were a standing agenda item at staff and management meetings. page 7 of 10
The service had introduced "Strength Finder" analysis for all staff. This was aimed at ensuring "all staff are working to their strengths to ensure that we are all giving of our best to the care of young people". What the service could do better Seniors worked with the same staff member on every shift. Rota arrangements should provide Seniors with the opportunity to work alongside all members of the team. The service should continue to work upon the group dynamics within Leven House. Each House should introduce a Visitors Book. We felt that this would enhance safety. The frequency of supervision should be reviewed to enable targets to be achieved. As per current practice, informal support should complement formal supervision. Requirements Number of requirements: 0 Recommendations Number of recommendations: 4 1. The service should continue to work upon the group dynamics within Leven House. National Care Standards Care Homes for Children and Young People - Standard 6: Feeling Safe and Secure 2. Each House should introduce a Visitors Book. National Care Standards Care Homes for Children and Young People - Standard 6: Feeling Safe and Secure 3. The frequency of supervision should be reviewed to enable targets to be achieved. As per current practice, informal support should complement formal supervision. National Care Standards Care Homes for Children and Young People - Standard 7: Management and 4. The recently introduced Senior role is to be welcomed. Rota arrangements should provide Seniors with the opportunity to work alongside all members of the team. National Care Standards Care Homes for Children and Young People - Standard 7: Management and page 8 of 10
Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Inspection and grading history Date Type Gradings 22 Jul 2015 Unannounced Care and support Management and leadership 4 - Good 11 Jul 2014 Unannounced Care and support 4 - Good Management and leadership 4 - Good 27 May 2013 Unannounced Care and support 4 - Good Management and leadership 4 - Good 30 Nov 2012 Unannounced Care and support 2 - Weak 4 - Good Management and leadership 4 - Good 7 Mar 2012 Unannounced Care and support Not assessed Management and leadership Not assessed 22 Dec 2011 Unannounced Care and support Management and leadership page 9 of 10
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 10 of 10