Orems Care Services Ltd - Eilean Gorm Care Home Service Eilean Gorm Kinlochard Stirling FK8 3TL Telephone: 01786 860 512 Type of inspection: Unannounced Inspection completed on: 29 March 2018 Service provided by: Orems Care Services Ltd Service provider number: SP2004005509 Care service number: CS2003055637
About the service Orems Care Service - Eilean Gorm is registered with the Care Inspectorate as a care home service. The service can provide a care service to a maximum of five adults with learning disabilities and associated disorders for planned respite/short breaks and/or for a period of transition in the care home. The service is provided by Orems Care Services Limited, a private provider of care services. The provider has two other registered services; a day support service in Torrance, and a housing support service. The service aims to provide a flexible respite service for adults who have been assessed as having autistic spectrum disorders and/or challenging behaviours with access to ordinary community based activities individually tailored to the person's identified needs. At the time of the inspection about eight people used the service over the course of a year. The staffing ratio is a minimum of one to one during the day. Overnight at full occupancy there will be a minimum of four support workers, with a minimum of two awake and two sleepover staff. People's support plans will identify if additional staff are required and if so the number and skills, and will specify whether at night staff are to be awake or sleepover. At less than full occupancy there will be a minimum of one staff member for each person. The number of staff who need to be awake and asleep will be determined by a written assessment for each shift based on the needs of the people, individually and collectively, staying in the service at that time. The provider has one staff team that supports all people using the service and one management team for all three services. At the time of the inspection there were about 40 staff working for the service including the management team. What people told us We met two people using the service, and spoke to two relatives, and received two questionnaires from relatives. The two people who we met had communication needs and it was not appropriate to conduct interviews. We observed interactions between them and their staff. We saw that the two people were settled, and responsive to the support of their staff. We were impressed with how calm, supportive and responsive staff were with the individuals they were supporting. In the two questionnaires from relatives of people who use the service everyone agreed that: - My support plan tells people about me and what I like. - Staff know how to support me. - The service helps me to be as independent as possible. - I feel safe in the service. - Staff treat me well. - I am confident staff have the right training and skills to support me. - Staff members have enough time to support and care for me. - I am asked for my views on how things can be improved. - I feel my views are listened to by the service. - When I tell the service I am unhappy with anything, they do something about it. - Overall I am happy with the quality of care and support this service gives me. page 2 of 8
The two relatives' comments included: 'I think the service is ideal for my son. I felt confident from the beginning when I first met the senior staff. His person plan is very detailed to cater for all his needs. He is with staff who understand how he ticks. The have helped my son lose weight by supporting him to have fewer snacks, and him being more physically active. He goes swimming and walking most days. His surroundings are very calming, spacious, and clean. He has his personal belongings in his room for when he needs them. I have a good relationship with the staff. I feel included in any developments and plans for him, with phone calls and emails from the staff.' 'My son has had the support of Orems for a couple of years at the day service and at the respite service. The service has been very good for him. It is the best place for him. I was worried how the service would support him with his challenging behaviour, but I now feel relaxed about how they support him. I can speak to any of the senior staff, who are all very supportive. When I go with him to health appointments, the staff support him, which is really helpful for us both. He was used to his respite stays in the other places, but he has taken to the new respite place right away. I think it is an absolutely stunning place where he can chill out.' Self assessment The service had not been asked to complete a self assessment in advance of the inspection. We looked at its quality assurance paperwork. This demonstrated how they were monitoring of the quality of the provision within the service. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good 5 - Very Good 5 - Very Good What the service does well The service has continued high quality outcomes for people since the last inspection. The provider had identified the need for new premises for its respite service, where the service had opened a new care home premises in Kinlochard to replace the two premises previously used in Torrance and Gargunnock. This was a significant development by the provider to further improve the service. People had a high quality living environment, and could use the respite premises as a base for activities without having to use the day service building. People had privacy with their own bedrooms, each with an en suite toilet and shower or bath. The house was clean, tidy and freshly decorated. The accommodation had both a domestic scale feel, and enough space and facilities for people to not feel intruded upon by others. People had access with support to the kitchen to prepare their meals. There were pictures made by people using the service, and photographs of people from their activities displayed through the house, which gave a very personal touch to people staying there. People's relatives told us how impressed they were by the house, its grounds and the resources in the surrounding rural area, and thought that these were all well used by the service for the benefit of the people staying there. page 3 of 8
People and their relatives were encouraged to decide how they would like to use their allocated number of respite nights in the year. Some people using the service indicated when they want a respite break, and this was arranged when possible. The respite service was also provided at short notice to assist their relatives. This level of responsiveness to the needs of people and their relatives can assist in averting more serious problems by providing a break when most needed. The service also provided transitional accommodation and support to people who can no longer live with their relatives. The service had a very person centred approach to providing people's service. People had a minimum of one to one staff support which helped them have a highly individualised service. People had consistency of support, with staff allocated to work with them throughout the day, and staff often supporting the same person regularly. People's plans included comprehensive information about them, what is important to the person, their likes and dislikes, their daily routines, means of communication, and personal care needs. The plans gave staff very structured guidance on how to meet people's individual support needs. A senior staff member had worked with people to assess their needs and then with staff for some weeks to model how to safely and consistently support the person and prepare the initial personal plan. People's relatives are involved in their daily lives and support arrangements by the service and felt supported by the service. People's support was reviewed with their relatives in annual reviews with their social work department and healthcare professionals. There were also informal discussions through the years between relatives and senior staff which they found helpful to be involved in the running of the service. The staff had positive working relationships with good, regular communication with people's relatives, by phone, email, text and in person. Relatives felt listened to by the management and staff and any difficulties were dealt with promptly. To support people with their behaviours that challenge the service used an accredited behavioural support approach. The behavioural support approach provided people with structured support from staff. The behavioural support approach helped staff to diffuse situations which would otherwise escalate using individually agreed strategies. While staff were taught to use specific safe holding and breakaway techniques safely, physical interventions was a last resort. Any serious behavioural incidents were recorded by staff and reviewed by senior staff to establish what led up to an incident, if the agreed strategies had been used, and how the incident had been resolved. People's communication was supported through assessment and awareness by staff of how they made their feelings, needs and wants known through; speech, known phrases and topics of conversation, facial expressions, body language and communication symbols. Some people had a daily planner, some with symbols, which gave them reassurance about the sequencing of activities through their day. The staff responded to people's behaviour as communication and responded to this by making immediate or planned changes to improve their support. The service assisted people to have their healthcare needs met. There was very good liaison between the service and healthcare professionals including; GPs, community nurses, psychiatrists, dentists, podiatrists and hospital staff. The staff supported people to accept medical treatment, such as accompanying them to appointments and hospital. The service's observations of people's behaviours and symptoms assisted healthcare staff to better assess people's health needs. The staff were well supported in their work. Staff had a comprehensive induction and in-house training programme for; autism awareness and behavioural support training, fire, food hygiene, infection control, protection of vulnerable adults and medication. They told us they had a lot of support from other staff, senior staff and management. Senior staff worked directly with people to model expected practice. page 4 of 8
In an annual supervision staff were asked to evaluate their own performance and were given feedback on how well they were doing and an individual staff development plan was agreed with them. Staff were supported to register as practitioners on the care at home, housing support service and care home parts of the Scottish Social Services Council register to reflect their high level of skills and responsibility in supporting people, and are supported to obtain an SVQ 3 in Care. Staff were encouraged to assess how guidance was meeting people's needs and to suggest how it could be improved. Senior staff were supported to obtain an SVQ 4 in Care to reflect their additional responsibilities. All senior staff had a role in direct support of people, and modelling best support practice for each individual. The service used a comprehensive improvement plan to continue the improve the service across a range of issues. The plan had areas for improvement with; desired outcomes, target dates, and who was responsible for each action. The service had sustained its high quality outcomes for people, and there were plans by management for further improvement and development in the service. What the service could do better In between annual joint reviews with people social work departments and other agencies the service was not reviewing people's support arrangements with them and their relatives. It is a regulation that people's personal plans are reviewed at least once in every six months. The service. As part of this the service could show how the wishes and views of the people using the service are known and acted on for making plans about their support. The service could share its improvement plan with people and relatives and involve them in setting goals for the development of the service. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 5 of 8
Inspection and grading history Date Type Gradings 17 Mar 2017 Unannounced Care and support 31 Mar 2016 Unannounced Care and support 4 Feb 2015 Unannounced Care and support 28 Mar 2014 Announced (short notice) Care and support 29 May 2013 Unannounced Care and support 29 May 2013 Unannounced Care and support 30 May 2012 Unannounced Care and support 6 - Excellent 28 Sep 2011 Unannounced Care and support page 6 of 8
Date Type Gradings 23 May 2011 Unannounced Care and support 28 Jan 2011 Unannounced Care and support 17 Aug 2010 Announced Care and support 22 Feb 2010 Announced Care and support 5 Aug 2009 Unannounced Care and support 2 - Weak 2 - Weak 27 Nov 2008 Announced Care and support 27 Feb 2009 Unannounced Care and support page 7 of 8
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 8 of 8