Scottish Autism Support Service Care at Home 29b Balunie Avenue Douglas Dundee DD4 8QW Telephone:

Scottish Autism Support Service Care at Home 29b Balunie Avenue Douglas Dundee DD4 8QW Telephone: 01382738334 Inspected by: Amanda Welch Type of inspection: Announced (Short Notice) Inspection completed on: 3 March 2014

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 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Scottish Autism Service provider number: SP2003000275 Care service number: CS2008189149 Contact details for the inspector who inspected this service: Amanda Welch Telephone Email enquiries@careinspectorate.com Scottish Autism, page 2 of 22

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 Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well This is a good service that is providing a range of opportunities for people who use the service to live as independently as possible in their own homes. We found that relatives of service users were actively involved in developing care and support plans and also in contributing to overall service development. What the service could do better The managers within the service should continue to support all staff to adjust to changes that have taken place within the service. In particular there should be an emphasis placed on team building and group development to ensure that the changes continue to lead to positive outcomes. What the service has done since the last inspection Since the last inspection, the service recognised that changes in how staff were used across the service needed to be reviewed and ultimately changed. This process of change is now coming to an end. Our inspection found that this has been a positive move and has placed the needs of service users at the heart of service delivery. There is still some work to be done to now consolidate the changes to ensure on-going development and commitment to improvement. Scottish Autism, page 3 of 22

Conclusion Overall this is a good service. All staff now need to work together with service users and their relatives to ensure continued development and improvement. Who did this inspection Amanda Welch Scottish Autism, page 4 of 22

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, the Care Commission carried out this function. Information in relation to all care services is available on our website at www.scswis.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011 If we are concerned about some aspect of a service, or think it needs to 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 based on best practice or the National Care Standards. 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 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, we may make requirements. These are legally enforceable at our discretion. Scottish Autism is a support service for up to four adults with autism and Asperger's Syndrome at one time. The service (part of the Fife and Tayside Area Services) operates from staff accommodation in a block of four flats occupied by the people using the service. It is located in a residential area of Dundee. The staff team consists of the services manager, two senior autism practitioners and a number of autism practitioners. The provider is Scottish Autism, an independent Scottish charity. Its head office is in Alloa. The Fife and Tayside Area Services provides a range of day, residential. housing support and care at home services for both children and adults. The service's mission statement is to support individuals to live full lives and encourage them to progress through accessing local facilities, developing and maintaining independent living skills, and to promote inclusion, They also aim to support individuals to take responsibility and participate in the design of their services. Scottish Autism, page 5 of 22

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 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. Scottish Autism, page 6 of 22

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 inspection of the service. Visits were made to the service on 25 and 26 February. Feedback was delivered to the managers of the service on 3 March. As requested by us, the service completed and submitted an annual return. The service also submitted a Self-Assessment of the care and support they deliver. The information from both submissions has been used to inform the inspection process and this report. During the inspection evidence was gathered from a number of sources including the following: * Policies and procedures including participation strategy * Minutes of meetings * Evaluation documents * A sample of service user care and support plans * Examination of training and other staff records * Discussion with the manager and staff * Discussion with two relatives * Observation of practice We issued four questionnaires to service users, two were returned prior to the inspection. Responses were all positive and are included within this 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. Details of what we found are in Section 3: The inspection Scottish Autism, page 7 of 22

Inspection Focus Areas (IFAs) Inspection report continued In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Scottish Autism, page 8 of 22

What the service has done to meet any recommendations we made at our last inspection A number of recommendations were made at the last inspection. These have been addressed by the service. Further details are contained within the body of the report. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted an electronic self assessment as requested by the Care Inspectorate. This identified some strengths of the service as well as some areas for improvement. The assessment contained a wide range of relevant information. Taking the views of people using the care service into account We did not speak with any service users during this inspection. We did however visit a service user in their flat. They were unable to communicate verbally however we observed them to be relaxed in their surroundings and in the company of the staff member present. Taking carers' views into account We spoke with two relatives during our inspection. Overall they were happy with the service provided for their family member. They had raised some concern about changes to staffing and hoped that the service was becoming more settled again. Scottish Autism, page 9 of 22

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 The service continued to demonstrate its commitment to participation and we found a range of evidence across all Quality Themes and examples of very good practice in this area. Discussions with relatives of service users, staff, managers and examination of written records confirmed that there was a strong culture of participation at the heart of this service. Staff had developed a range of systems to support positive communication for all service users using guidance from a multi-disciplinary team of health professionals. We saw practical examples of communication supports for a service user that used photographs to enable them to indicate to staff what they were wanting. This was a simple but effective way of promoting empowerment and a sense of control for service users who do not use speech to communicate. The approach to supporting communication and involvement was used consistently across the service by staff and we saw how this had promoted a sense of trust for service users and had enhanced confidence and self-esteem. As a result, staffing levels for one service user had been successfully reduced with the exception of support in new activities. This was very good practice and showed how commitment to participation could build confidence and slowly develop areas of increasing independence for service users. Scottish Autism, page 10 of 22

We spoke with the relatives of two service users. They very much confirmed their active involvement in all aspects of service delivery. They identified that they felt confident to voice their opinions. They also told us that whilst viewpoints and requests were not always taken foreword by the service, discussion was always open and opinions were on the whole taken into account. Examination of documentation and discussion with staff members confirmed that all staff had worked hard to enable all service users to participate in their local community, using facilities and enjoying opportunities to experience new things. This included going out for coffee, attending church, going to the cinema and attending classes at a local college. These new experiences had supported increased flexibility in thought for service users which had enhanced their confidence in making decisions and directing their support. For example, a service user had identified that they wanted to go on holiday again after enjoying the experience for the first time last year. Overall, the service was using an approach that enhanced the lives of all the people who use the service. There was a clear commitment to 'Active' Participation with service users very much in control and directing the care and support they wanted. Areas for improvement One relative told us that they sometimes felt that the service didn't always listen to them when decisions or changes were needed in their family member's support plan. This had led to some concern about staff mix for the service user. The relative did however confirm that communication with the new senior Autism Practitioner was good and that on going discussion remained a priority. we will follow this up at the next inspection. In their self assessment, the service identified that they remained committed to promoting participation for all service users. This included continued development of systems that enabled service users to have their views communicated at reviews even if they were unable to attend. We look forward to seeing how this progresses over the next year. The service also identified that they intended to consult staff, service users on their relatives on how to develop a service user's forum group which could provide service users with information on how to keep safe for example. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 11 of 22

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued This is an area in which the service met a very good standard. There was a clear commitment from staff to supporting service users to enjoy their life, experience good health and feel good about themselves. During the inspection, we examined two care plans in detail. They contained clear information and guidance on how to support the individual service user to ensure their wishes and needs were respected and met. Risks were identified with service users and their families. We found that the staff promoted safe risk taking rather than limiting opportunities. This approach promoted a strong sense of control and self-determination for people using the service and ensured they were able to make the most of the opportunities and experiences available to them. For example, support was provided to enable service users to take part in a range of activities in their local communities such as attending organised groups, going shopping, trips to the cinema or theatre or taking regular short breaks. Flexibility in approach, person focussed planning and observation ensured that people using the service enjoyed a wide range of regular and new activities over the last year. The health needs of service users was addressed and supported clearly within support plans. Service users were supported to access all community health professionals arranging appointments as required. This meant that service users were more likely to experience on going good general health. Evidence of a multi-disciplinary approach was consistently evident in all files examined. This ensured consistency in service delivery for service users and supported positive communication with good outcomes. In particular, a multi disciplinary approach to review and adjust prescribed medication for a service user had prevented hospital admission. This in turn avoided distress and anxiety for the service user. When we spoke with staff we found them to be committed to the work they did and knowledgeable about how to support the people they worked with. Staff told us how training had enhanced their work practice. In particular a member of staff told us they would soon be attending training on sexuality and sexual health for people with a learning disability. The staff member hoped this would enable her to offer appropriate support to service users in this area. Scottish Autism, page 12 of 22

During the inspection, we gained a strong sense of staffs' commitment to supporting service users to reach their full potential and take part in meaningful activities to the best of their abilities. This approach promoted positive self-esteem and ultimately, promotes both good physical and mental wellbeing. Areas for improvement Staff within the service often worked with service users who could present behaviour that challenged in a range of ways. The manager of the service was currently addressing issues in relation to training to ensure all staff were confident in managing such situations. As we had highlighted, the service had implemented a number of changes in staff teams and the way staffing was planned. The manager of the service should now work with everyone to ensure that the changes that have taken place settle to ensure continuity in care for service users Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 13 of 22

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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 14 of 22

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 During the inspection we saw in written documentation and in discussion with the staff and manager that the staff team were committed to the service and working to a good standard. The staff were confident in talking about their day to day roles and responsibilities and confirmed that they worked from a strong value base. During the inspection we spoke with five members of support staff. They were all enthusiastic about the work they did and how they played a part in supporting service users to develop new skills, be as independent as possible and maintain as much control over their lives as possible. Training opportunities for staff remained good over the last year. Records showed a range of training attended by staff. This included Manual Handling, Supporting Safe Administration of Medication, Epilepsy Awareness, CALM and Values. A small number of staff had recently attended vision training through RNIB and were now being encouraged to implement and share their learning through their work practice. We also examined minutes of staff meetings that confirmed staff were able to reflect on key concepts of service delivery such as values and dignity. This was good practice and enabled all staff to keep up to date with best practice methods. In the last inspection we recommended that all staff should have adult support and protection training and should review the need for food hygiene training. We examined records that confirmed this recommendation had been met. Access to training and continual learning was supported by a process of supervision and appraisal. Staff commented that they felt supported by their line manager. Discussion in this format enabled staff to build positive working relationships which encouraged and motivated both individuals and staff teams. The last Inspection report had recommended that the service continue to improve the frequency and consistency of supervision for all staff. We examined records to confirm that a system was now in place to ensure this was happening. Weekly meetings between the manager and Senior Autism Practitioners also ensured supervision for staff was happening regularly. Overall the staff we spoke with were aware of their responsibilities and felt that they contributed positively to the lives of service users. Scottish Autism, page 15 of 22

Areas for improvement As highlighted in the report, there had been significant change over the last year in terms of how staff were deployed across the service. This had led to an unsettled period for staff and service users. The manager and staff identified that there was still some progress to be made in terms of team building and development. They felt this was the next stage in the process and were planning how this could be taken forward. In particular we were pleased to see that senior autism practitioners were in the process of planning development sessions. It was planned that these would start the team building and learning process to promote a consistent approach and a high quality of service delivery from confident staff. We will follow this up at the next inspection. Within this process it is important for the manager and senior autism practitioners to encourage all staff to take responsibility for service development through guidance and support. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 16 of 22

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 Evidence in support of this statement can be found in Quality Theme 1 Quality Statement 1. Areas for improvement See Quality Theme 1 Quality Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Scottish Autism, page 17 of 22

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 Inspection report continued The service continued to use a wide range of strategies both internal and external to ensure standards were maintained and improved as required. We examined good records of a range of checks and audits including medication, finance, support planning and review. Regular discussion between the manager and senior autism practitioners ensured that improvements were made as required and concerns addressed. We found that the manager of the service had introduced a wide range of checks to be carried out by different staff grades. This approach encouraged all staff to take a level of responsibility and recognise their place within the cycle of continuous improvement. We will follow up progress with this at the next inspection. The provider organisation had established good links with Quality Scotland, an organisation that promotes excellence and improvement in organisations across Scotland. Scottish Autism had introduced Public Service Improvement Framework (PSIF) as a means of assuring quality across their service through self and external assessment. We look forward to seeing how this progresses over the next few years. In the last inspection we made a recommendation that the service should include staff in developing the self assessment. Discussion at supervision and team meetings on a range of service issues had enabled staff to voice their opinions and reflect on the service provided. This should now be developed further. Overall, the systems used by the service ensured that a good standard of service delivery was maintained and developed. The involvement of service users, their relatives and staff ensured that a wide variety of opinions were heard and confirmed with everyone the importance the service places on them. Areas for improvement Over the last year the manager had supported the development of a local Quality Assurance group for staff within the service. Attendance at this had been poor and the group was not continued. The manager advised that they were looking at how staff could be encouraged to recognise their role in service development, both in identifying areas for improvement and also in identifying examples of good practice. Scottish Autism, page 18 of 22

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Scottish Autism, page 19 of 22

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). Scottish Autism, page 20 of 22

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Staffing - 4 - Good Statement 1 Statement 3 5 - Very Good 4 - Good Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 5 - Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 3 Jan 2013 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 6 Jan 2012 Unannounced Care and support 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 29 Nov 2010 Unannounced Care and support 4 - Good Staffing Not Assessed Management and Leadership 4 - Good 25 Mar 2010 Announced Care and support 3 - Adequate Staffing 4 - Good Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Scottish Autism, page 21 of 22

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 Scottish Autism, page 22 of 22