Pathway Resource Centre Care Home Service Children and Young People Meadow Mill Tranent EH33 1DT Telephone:

Pathway Resource Centre Care Home Service Children and Young People Meadow Mill Tranent EH33 1DT Telephone: 01875 610794 Inspected by: Iain Lamb Type of inspection: Unannounced Inspection completed on: 11 January 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 11 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: East Lothian Council Service provider number: SP2003002600 Care service number: CS2003011077 Contact details for the inspector who inspected this service: Iain Lamb Telephone 0131 653 4100 Email enquiries@scswis.com Pathway Resource Centre, 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 Quality of Staffing N/A N/A Quality of Management and Leadership 4 Good What the service does well Staff provide young people with a range of opportunities to be involved in their care and in choosing how they spend their time. Young people have a comfortable environment and enjoy positive relationships with an established staff team. What the service could do better The service should make sure that personal plans are up to date and clearly describe how care will be provided for individual young people. Risk assessments should clearly reflect concerns about the safety and well being of individuals. What the service has done since the last inspection Since the last inspection the service has improved its arrangements for managing and administering medications. Record keeping for incidents has been changed and improved. Pathway Resource Centre, page 3 of 25

Conclusion Inspection report continued Pathway provides a range of positive experiences for the young people who live there. Staff and managers provide good levels of care and support and work hard to help young people achieve their ambitions and aspirations. The systems which underpin the delivery of care would benefit from review and improvement. Who did this inspection Iain Lamb Pathway Resource Centre, page 4 of 25

1 About the service we inspected Social Care and Social Work Improvement Scotland (SCSWIS) regulates care services in Scotland. It awards grades for services based on the findings of inspections. These grades, including any that the service was previously awarded by the Care Commission, are available on www.scswis.com. Before 1st April 2011 this service was registered with the Care Commission. On this date the new scrutiny body SCSWIS (also known as Care Inspectorate) took over the work of the Care Commission, including the registration of care services. This means that from 1st April 2011 this service continued its registration under the new body, Care Inspectorate. Pathway Resource Centre is a spacious building situated in large grounds in a rural setting close to the outskirts of Tranent. It provides care and support for a maximum of seven young people from East Lothian whose needs have been assessed to be best met in a residential setting. The home is part of the range of services provided for children and young people by East Lothian Council. The service's statement of Philosophy and Principles includes the following: "At Pathway, we hope to create and maintain community of trusted and trustworthy, caring adults to care for a group of young people who benefit from, and are helped to contribute to, a safe, caring environment that creates a sense of acceptance and belonging and promotes growth, learning and development." At the time of the inspection visits, 6 young people were resident at Pathway. There had been significant changes to the makeup of the resident group since the previous inspection. 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 - N/A Quality of Staffing - N/A 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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Pathway Resource Centre, page 5 of 25

2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection The unannounced inspection was carried out by Iain Lamb, Care Inspectorate Inspector on 20 and 21 December 2011. The service's external manager was consulted on 11 January 2012. During the inspection visit, evidence was gathered from a number of sources including observation of interaction between staff and young people. The Inspector looked at a range of documents including the following: Personal Plans Risk Assessments Incident records The service's manager, an assistant manager and two members of staff were interviewed. Other staff were spoken with informally during the inspection visit. Young people were consulted individually and informally throughout the inspection visits. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Pathway Resource Centre, page 6 of 25

Fire safety issues Inspection report continued 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 Pathway Resource Centre, page 7 of 25

What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that medication is administered safely and correctly and that staff (i) administer medicine as currently instructed by the prescriber. Records should be kept of any instance where this is not the case and describe the reason. (ii) ensure medicines are always available to be administered as instructed by the prescriber. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a) make provision for the health, welfare and safety of service users. In making this requirement, National Care standards, Care Homes for Children and Young People Standard 7 - Management and staffing is also taken into account. Timescale: To commence on the date of receipt of this report and for completion by the 22nd August 2011. What the service did to meet the requirement The service had reviewed its systems for recording and administering medications. The manager met with the Looked After and Accommodated Children's Nurse (LAAC Nurse) to discuss issues relating to medical treatment and medication. Procedures for recording and administering different types of medications were updated. Assessment of the abilities of individual young people to look after their own medication was undertaken and where desirable, support was provided for young people to learn how to store and self-administer any medication they took regularly. The local GP practice had been consulted regarding prescriptions and their management. A member of staff had been allocated to attend the LAAC health group to access information and ensure accurate communication. Within individual shift teams, a member of staff was assigned the task of ensuring medication issues were properly dealt with. The requirement is: Met The requirement The provider must keep a record of all episodes of physical restraint in a format which allows analysis of incidents to be carried out to identify patterns of behaviour, the roles of individual staff and the staffing needs of the service. Pathway Resource Centre, page 8 of 25

This is in order to comply with SSI 2002/114 Regulation 19 - Records(3) A provider shall keep a record of- (a)any occasion on which restraint or control has been applied to a user, with details of the form of restraint or control, the reason why it was necessary and the name of the person authorising it; It is also in order to comply with SSI 2011/210 Regulation 4 (1)(a) make provision for the health, welfare and safety of service users. In making this requirement, National Care standards, Care Homes for Children and Young People Standard 7 - Management and staffing is also taken into account. The content of Holding Safely published by the Scottish Institute for Residential Child Care is taken into account in making this requirement. Timescale: To commence on the 1st of September 2011. What the service did to meet the requirement The manager and external manager had discussed this issue with relevant members of the service provider's staff to seek a long term solution to this issue. In the interim, incidents of physical restraint were being recorded on the provider's health and safety recording system and on holding safely documents. This has met the requirement but has provided a time-consuming method of record keeping which is not ideal. The service's manager and external manager intend to pursue a more appropriate system which will better meet the needs of the service and the provider. The requirement is: Met 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 self assessment had been submitted prior to the last inspection as requested by the Care Inspectorate. Pathway Resource Centre, page 9 of 25

Taking the views of people using the care service into account The young people spoken with during the inspection visits were generally happy with their care at Pathway. They said that they got on well with most of the staff and were able to confide in individual, trusted adults. They liked the activities that were available and said that they were able to negotiate around different activities and things they liked to do. One resident felt that the allowance for Christmas presents was not as generous as it should be. Taking carers' views into account Families were not directly consulted during this inspection. Pathway Resource Centre, page 10 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 The grade achieved for this statement at the last inspection was 5 - Very Good. Elements of the evidence noted in the service's self assessment were re-examined to assess the service's performance since the last inspection. The service had maintained a very good level of involvement of young people in determining their care needs and how these would be met. The grade remains as 5 - Very Good. Young people consulted during the inspection visit were confident that they would be consulted about their care and how it was provided. They said that staff discussed their personal plan with them and that they were able contribute to it. They also said that staff and managers would support them to express their views in meetings and reviews of their care. The service had used questionnaires to consult young people, their families, staff and other practitioners involved in the care of the residents as a means of informing their self assessment. Plans were in place to make this a regular feature of the development of the service. Areas for improvement The contribution of Who Cares? Scotland which had previously been a positive feature of service user participation in the service had not changed since the last inspection in July 2011. In the report of that inspection, it was suggested that this be reviewed. The service's external manager confirmed that this process was underway and it was anticipated that a good level of input would be restored in the near future. This will be monitored at future inspections. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Pathway Resource Centre, page 11 of 25

Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths The grade achieved for this statement at the last inspection was 4 - Good. Elements of the evidence noted in the service's self assessment were re-examined to assess the service's performance since the last inspection. As a result, the service has been graded as 3 - Adequate. The last inspection report contained the following recommendation: Managers should consider the needs of all the residents at Pathway and ensure that staff resources are equally shared to enable all personal plan objectives to be met. At the last inspection, older residents had felt that younger ones were taking up a lot of staff time and they were losing out on activities as a result. Since then, there have been a number of changes to the group of young people and while there were significant age differences between the oldest and youngest, this was not as much of an issue for those consulted. Young people and staff consulted during the inspection visits described a wide range of opportunities for residents to make choices about different aspects of their life. All resident young people had personal plans which provided information about their care needs and how these would be met. Detailed daily records were kept which described the routines and activities of individual young people and noted any significant events or changes to their situation. Staff and managers consulted during the inspection visits demonstrated a thorough knowledge of the resident young peoples' needs, ambitions and aspirations. Areas for improvement Inspection report continued The personal planning documents seen at the last inspection had resulted in the following recommendation: Team Teach positive handling checklists should be consistently used to guide and inform staff practice in dealing with episodes of challenging behaviour. This had not been actioned and the recommendation is repeated in this report. Personal plans were not all up to date and some contained old information which was not consistent with the content of daily recordings for individual young people. For example, staff spoke positively about the progress made by one young person and described a more mature attitude which had been recognised and commented upon. The personal plan showed no updates for more than six months and had not been adjusted to take account of the changes which staff described. Pathway Resource Centre, page 12 of 25

Other personal plans had not been updated on a regular basis and some did not have dates to indicate that they had been reviewed. (See requirement 1) Not all young people had accurate risk assessments to guide staff in their day to day work and highlight areas of concern for individuals. While most staff seemed conversant with the needs of the young people there was insufficient written evidence that risk assessment was being consistently carried out. (See requirement 2) Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 1 Requirements 1. Personal plans should be reviewed six monthly to ensure that they are accurate and provide accurate guidance to allow staff to meet identified needs. This is in order to comply with: SSI 2011/210 - The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011- Regulation 5 (2) (iii) Personal plans. A provider of a care service must review the personal plan at least once in every six month period whilst the service user is in receipt of the service. 2. Risk assessments should be put in place and regularly reviewed and updated to reflect the lifestyle choices and areas of concern for the wellbeing of each young person. This is in order to comply with: SSI 2011/210 - The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011- Regulation 4.-(1)(a) Welfare of users. A provider must make proper provision for the health, welfare and safety of service users; Recommendations Inspection report continued 1. Team Teach positive handling checklists should be consistently used to guide and inform staff practice in dealing with episodes of challenging behaviour. National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and staffing. Pathway Resource Centre, page 13 of 25

Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths The grade achieved for this statement at the last inspection was 2 - Weak. Elements of the evidence noted in the service's self assessment were re-examined to assess the service's performance since the last inspection. The service had made significant improvements in this statement and as a result the grade has been raised to 4 - Good. Young people continued to have good access to medical facilities and a range of health agencies and practitioners. Staff were clear about ways in which young people could be guided to make healthy lifestyle choices and within the staff team there was a good range of knowledge about local opportunities to access advice and information. The last inspection report had contained a requirement regarding the management and administration of medications. This requirement had been met. Action had been taken to ensure that young people had proper support to take prescribed medicines in line with policies and best practice guidance. Staff were suitably informed of their role in this process and, in consultation, were able to describe their responsibilities and how they should be met. The last inspection report had also contained a requirement regarding the recording of incidents of physical restraint. This requirement had been met. A system which complied with current legislation was in place. Areas for improvement Although records were now kept of physical restraints, the system in place could be improved upon as it had increased the work of staff in completing multiple documents. Efforts were underway by the service's manager and external manager to rectify this situation and the success of this work will be monitored in future inspections Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Pathway Resource Centre, page 14 of 25

Quality Theme 2: Quality of Environment - NOT ASSESSED Pathway Resource Centre, page 15 of 25

Quality Theme 3: Quality of Staffing - NOT ASSESSED Pathway Resource Centre, page 16 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 As noted in Theme 1, Statement 1 young people felt that they were consulted about aspects of their care and this included ways in which the service was managed. They spoke positively about the service's managers and said that they were confident they could speak to the service manager and the external manager if they had concerns. Questionnaires had been used to source comments about the management of the service from service users, their families and other stakeholders. Managers worked across different shifts including weekends, evenings and sleep-ins. This allowed them to be accessible to young people and their families and ensured that they were conversant with issues arising from day to day life within the service. Areas for improvement Managers should ensure that they continue to provide opportunities for young people to discuss issues, concerns and achievements with them. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Pathway Resource Centre, page 17 of 25

Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths Managers worked closely with staff across a variety of shifts and were closely involved in the day to day care of resident young people. Staff spoken with during the inspection visits said that they appreciated the management input into daily routines and discussions. They confirmed that they had very good opportunities for informal advice and and support. The service's external manager was a regular visitor to the service and was known to staff, who said that they felt comfortable discussing care and development issues with her. The service provider had held a number of training events which had supported the development of skills for individuals within the staff team. Whole team events had taken place and external consultants had been engaged to support the process of team building and the development of the care ethos of Pathway. Staff and managers spoke positively about these events and appreciated the consistency and shared approach which such events had promoted. Staff had been consulted by questionnaire and through team meetings about the service's performance as part of the completion of the service's self assessment document. Areas for improvement Inspection report continued The service provider had been involved in discussions and development planning with another provider to explore the possibility of sharing resources. Staff at Pathway were aware of this process and there was some uncertainty for them regarding future developments. Intended plans should be shared with staff as soon as they become clear. Due to the number of training and development events, staff team meetings dealing with routine care issues and the progression of care planning for individual young people had not taken place as regularly as they should. This had inhibited the sharing of information about newly admitted young people at a time when there had been substantial changes to the resident group. (See recommendation 1) While the frequency of formal staff supervision had improved since the last inspection, there was still a need to develop a system to prompt managers to ensure that supervision sessions were being held in line with the service provider's policy. Pathway Resource Centre, page 18 of 25

Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Regular, minuted staff meetings should be held as a priority to ensure that information about resident young people is shared across the staff team and any concerns, incidents and achievements are properly discussed and noted. National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and staffing. Pathway Resource Centre, page 19 of 25

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 The service provider had a wide range of policies and procedures which guided staff practice and advised on a number of subjects such as health and safety, infection control as well as care issues. Staff and managers had access to support from other departments with the provider's organisation to support the provision of care for the resident young people. Systems for audits and controls of financial matters and materials such as food, cleaning materials and fixtures and fittings were in place. Managers were clear about their responsibilities for ensuring that the service operated efficiently and in ways which maximised the resources available. Young people were supported to make decisions based on common sense and how to achieve the best value from their personal finances. Areas for improvement The manager was aware of the need to develop a system to oversee the quality of personal plans and risk assessments for resident young people and ensure that they were regularly updated and reviewed. This should be put in place as a matter of priority. (See recommendation 1) Assistant managers were being allocated specific responsibilities which would avoid duplication and clarify areas for development within the service. This should be completed as soon as possible to enable staff and young people to identify which manager is responsible for particular aspects of daily life at Pathway. (See recommendation 2) Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. A system should be put in place to allow managers to provide support and guidance to staff as a means of ensuring that personal plans and other care planning documents are up to date, regularly reviewed and accurate. National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and staffing. 2. Assistant managers should be allocated areas of responsibility and these should be communicated to staff and young people. Pathway Resource Centre, page 20 of 25

National Care Standards, Care Homes for Children and Young People. Standard 7 - Management and staffing. Pathway Resource Centre, 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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Pathway Resource Centre, page 22 of 25

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 2 Statement 3 5 - Very Good 3 - Adequate 4 - Good Quality of Environment - Not Assessed Quality of Staffing - Not Assessed Quality of Management and Leadership - 4 - Good Statement 1 Statement 2 Statement 4 5 - Very Good 4 - Good 3 - Adequate 6 Inspection and grading history Date Type Gradings 6 Jul 2011 Unannounced Care and support 2 - Weak Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 10 Sep 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 31 May 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 3 Feb 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Pathway Resource Centre, page 23 of 25

Staffing Management and Leadership 4 - Good Not Assessed 6 Oct 2009 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 30 Mar 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 23 May 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Pathway Resource Centre, 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 SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.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@scswis.com Web: www.scswis.com Pathway Resource Centre, page 25 of 25