CAIR Scotland Care Home Service Care Home Service Children and Young People CAIR Scotland Intensive Support Service 27 Glenclova Terrace Forfar DD8

CAIR Scotland Care Home Service Care Home Service Children and Young People CAIR Scotland Intensive Support Service 27 Glenclova Terrace Forfar DD8 1NR Inspected by: Linda Paterson Type of inspection: Announced (Short Notice) Inspection completed on: 2 October 2013

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: CAIR scotland Service provider number: SP2009010388 Care service number: CS2009217078 Contact details for the inspector who inspected this service: Linda Paterson Telephone 01382 207200 Email enquiries@careinspectorate.com CAIR Scotland Care Home Service, 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 4 Good Quality of Environment 4 Good Quality of Staffing 4 Good Quality of Management and Leadership 4 Good What the service does well CAIR Scotland's care home service provides young people with 1:1 respite care in a safe and nurturing environment. The experienced staff team know the young people well, and take their individual needs and preferences into account when planning and providing the service. They encourage them to eat well and to be physically active, which helps to promote their physical health and wellbeing. Where appropriate, staff work effectively with families and carers to make sure that there is consistency and continuity of care. What the service could do better In the care plans, the service should clarify the purpose of the residential placement and evaluate how well it is achieving its aims. The service should also improve the environment by providing more secure storage for medication, and by providing lockable storage for young people's personal belongings. It should develop a more structured approach to staff training and development, and make sure that records of staff training and supervision are well-maintained. CAIR Scotland Care Home Service, page 3 of 22

What the service has done since the last inspection This was the first inspection of the service. Inspection report continued Conclusion CAIR Scotland's care home service provides young people with respite and/or crisis care, usually as part of a planned programme of intensive support, to help them to remain within their own community and reduce their risk-taking behaviour. Young people appreciate the sense of security and support which is offered by this service. The service should continue to review and develop the service, taking into account the areas highlighted for improvement in this report. Who did this inspection Linda Paterson CAIR Scotland Care Home Service, page 4 of 22

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was registered with the Care Inspectorate on 15 October 2012. This was the first inspection of the service since it was registered. 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. CAIR Scotland provides community based intensive support services for young people. The statement of aims and objectives for this service include: - "To improve the quality of life for children, young people and families." - "To provide local authorities with a credible community based alternative to all forms of accommodation, especially secure care." - "To safeguard local communities affected by offending, substance misuse and/or anti-social behaviour." The care home element of the service is registered to provide care and accommodation to young people between the ages of 12-17 for short periods of respite, up to a maximum of 72 hours, to avoid other forms of compulsory care, for example a secure placement. The care home provides care for one young person at a time, and operates on a flexible basis, taking into account the assessed needs of young people, and the requirements of the placing authority. CAIR Scotland Care Home Service, page 5 of 22

At the time of this inspection, no young people were living in the care home, though one young person who had recently used the service met with us to give us their views. 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 Inspection report continued 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. CAIR Scotland Care Home Service, 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 a short notice announced inspection to the residential premises in Forfar which took place on 27 September 2013. We made a second planned visit to the service's headquarters in Dundee to complete the inspection. We shared our findings with the current and previous managers of the service. Before the inspection, the service completed a self assessment document as requested by the Care Inspectorate. During the inspection, we gathered evidence from a range of sources including: discussion with one young person who had previously used the service. discussion with the recently appointed service manager, and with the previous manager of the service. we inspected the residential premises in Forfar. We looked at a range of documentation including: a sample of care plans; medication records and storage; risk assessments; young people's welcome pack; staff handbook; induction training programme; staff training records; staff supervision records; quality assurance calendar; We also looked at a range of policies and procedures including: CAIR Scotland Care Home Service, page 7 of 22

child protection; health and safety; complaints; staff support and supervision; behaviour management. 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. 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 CAIR Scotland Care Home Service, page 8 of 22

What the service has done to meet any recommendations we made at our last inspection Not applicable - this was the first inspection of this service. 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: No 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. This was completed to a satisfactory standard prior to the inspection. For future inspections, the service should tell us how people who use the service have been involved in the self assessment process. Taking the views of people using the care service into account We spoke to one young person who kindly came in during the inspection to give us his views. He was very positive about the environment, which he described as "safe, homely and comfortable". He also told us that he had really good support from staff, who, he said, had helped him a lot. It was clear from the interaction we observed between the young person and staff, that relationships were relaxed and respectful. Taking carers' views into account We did not have the opportunity to speak to parents or carers during this inspection. CAIR Scotland Care Home Service, 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: 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 We found that the service had good arrangements in place for involving young people and, where appropriate, their parents or carers in assessing and improving the quality of the service. The ways in which they could be involved were restricted by the very short-term nature of the placements: nevertheless, the service used a range of methods to seek their views and use these to make improvements in the service. From our discussions with one young person, staff, and from looking at written records, we noted the following strengths: * Young people were provided with a clear, user-friendly welcome pack which gave them the information they needed to make the most of their stay. This, along with a friendly welcome from staff, helped young people to feel welcome and settle in to the flat. * In discussion, young people confirmed that staff asked for their views and preferences and gave them some choice about how they spent their time in the service. Records showed that staff helped young people to spend their time doing activities they enjoyed, within the context of the placement. * We found evidence in the sample of care plans that the service had worked in partnership with parents and carers to provide a consistent and structured approach to supporting young people. CAIR Scotland Care Home Service, page 10 of 22

* The service had sought the views of young people about the service using questionnaires. There was evidence that they had taken some of these views on board, for example by buying more games and DVD's, and a more comfortable sofa. Areas for improvement The service should continue to review and develop the service in the light of feedback from young people. 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 The service had effective arrangements in place to ensure that the health and wellbeing needs of young people were met. We noted the following strengths: Inspection report continued * Information about young people's health needs (including allergies, and any issues with drugs or alcohol) were recorded, along with details of their GP and relevant healthcare contacts. * An appropriate policy, procedure and recording system was in place with regard to the administration of medication. * Care plans showed that staff within the service encouraged and supported young people to be as active as possible when on a respite break. Young people had been involved in a range of outdoor activities which contributed to their physical health and mental wellbeing. * Young people were encouraged to eat healthily, choosing from a range of healthier options, and participating in food preparation and cooking. This helped to raise young people's awareness of the importance of eating well, and also helped them to be more involved in the day-to-day life of the service. * Care plans also showed that young people were encouraged to follow good personal hygiene routines while in respite care. There was a smoking policy in place through which young people were discouraged from smoking. * The service provided staff with a range of training to help them to meet the health and wellbeing needs of young people, including child protection, behaviour CAIR Scotland Care Home Service, page 11 of 22

management, emergency first aid, and ASIST (applied suicide intervention skills training), as well as specific training around the consequences of misusing drugs and alcohol. Taking into account the strengths noted above, and the areas identified for improvement, we have given a grade of 4 - Good - for this Quality Statement. Areas for improvement The service should provide secure storage for medication. See Recommendation 1. The respite care service is usually offered as part of a wider intensive support package provided by the organisation. The service should continue to develop the care plans to make it clear what the purpose of the respite care placement is, and that it is evaluated to determine the extent to which the objectives have been achieved. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service should provide secure storage for medication in line with current good practice guidance. It should also make provision for the storage of controlled drugs if required. National Care Standards for Care Homes for Children and Young People - Standard 12 - Keeping well - medication. CAIR Scotland Care Home Service, page 12 of 22

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 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 2 We make sure that the environment is safe and service users are protected. Service strengths The service provided a safe and secure environment for young people. From our discussions and observations during the inspection, we noted the following strengths: * The premises were clean, comfortable and smoke free and in a very good state of decoration and repair. * There was a secure entry system which helped to make sure that only authorised visitors had access to the premises. * The service had carried out a detailed risk assessment which reflected the use of the premises by young people. There had been no accidents or incidents on the premises. CAIR Scotland Care Home Service, page 13 of 22

* Young people told us that they felt safe and secure in the respite unit. One young person described how relaxed he had felt to be in the unit and away from some of the pressures he was experiencing in other areas of his life. * Staffing levels were variable according to the assessment of risk and what was needed to keep young people safe. Generally, two staff worked with one young person. * There was a good system in place for recording young people's details in the event of them going missing from the service. Areas for improvement The service should make sure that it has effective systems in place to prevent and control the spread of infection within the service, with particular reference to the provision of suitable handwashing/drying facilities in the shared bathroom. See Recommendation 1. The service should provide lockable storage for young people so that they can keep their belongings safe. See Recommendation 2. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The service should ensure that there are suitable handwashing and drying facilities in place to prevent and control the spread of infection National Care Standards for Care Homes for Children and Young People - Standard 5 - Your environment. 2. The service should provide lockable storage so that young people can keep their personal belongings safe. National Care Standards for Care Homes for Children and Young People - Standard 5 - Your environment. CAIR Scotland Care Home Service, page 14 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 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 The core staff team were qualified, experienced practitioners who were registered with the Scottish Social Services Council (SSSC). * They knew the young people who used the respite service well, as they had worked with them as part of their community-based intensive support plan. In discussion, young people told us that the fact that they knew the staff who were looking after them made the placement a more positive experience than it might otherwise have been. * Staff were carefully recruited in line with the organisation's procedures. The organisation provided potential candidates with a structured 8-week training programme which helped to make sure that they had a good grasp of the work they would be doing once appointed. This period of training helped candidates to decide whether they were suited to this type of work, and also gave the organisation an opportunity to get to know staff and assess their skills over a period of time. This CAIR Scotland Care Home Service, page 15 of 22

helped to ensure that only people who were suitable went on to a more formal interview process and if successful, appointment to a sessional post. * Staff had access to a good range of training which supported their work with young people. As well as their own core training programme, staff were able to access a range of relevant training provided by other providers, including Angus Council, with whom they worked in partnership. * Full time staff had 1:1 supervision on a regular basis to support them in their work. Sessional staff had supervision as a group every 8-10 weeks, with additional discussion on an informal basis as required. An annual appraisal system helped to identify training and development needs. * Young people commented positively on the support they received from staff. In discussion, one young person told us: "The staff are really good: they have given me really good support." From the service's own records of feedback included the following comments: - "I could tell them anything and they found a way to make things better." - "They are really good people and I have a lot of respect for them." Areas for improvement The service should develop a staff training strategy which defines the core training requirements of both permanent and sessional staff and sets out timescales within which the training will be delivered. See Recommendation 1. The service should improve the way that it records staff training, supervision and appraisal. See Recommendation 2. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The service should develop a staff training strategy which defines the core training requirements of both permanent and sessional staff, and sets out timescales within which the training will be delivered. The service should also ensure that it keeps records of training done by staff. CAIR Scotland Care Home Service, page 16 of 22

National Care Standards for Care Homes for Children and Young People - Standard 7 - Management and staffing. 2. The service should make sure that it keeps clear records of staff training, supervision and appraisal. National Care Standards for Care Homes for Children and Young People Standard 7 - Management and staffing. CAIR Scotland Care Home Service, page 17 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 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 The service had some effective systems in place for monitoring and developing the quality of the service. It was committed to seeking feedback from service users, parents and carers and other stakeholders to help inform the development of the service. From the evidence we gathered during the inspection, we noted the following strengths: * The organisation had developed a good range of clear corporate policies which supported safe practice within the service. * The service was subject to external monitoring by Angus Council. It produced quarterly performance reports which gave details of its work with young people which was then reviewed by the Council as the placing authority. The reports gave clear CAIR Scotland Care Home Service, page 18 of 22

information about the work it had done with young people, and included some information about the outcomes for young people who had used the service. * The service had asked young people, parents and carers and placing social workers for their views about the service. They had also recorded what they had done in response to some of the suggestions made by young people. The feedback was also included as part of the contract monitoring information provided to Angus Council. * The recently appointed service manager was at an early stage of carrying out file audits to help to develop the quality of planning and recording. * Throughout this inspection, the management team demonstrated a positive approach to the inspection process, and were committed to the continuous improvement of the service. Areas for improvement The service had been operating for less than a year at the time of this inspection, and as such was at an early stage of developing an approach to evaluating the service and planning for improvement. It should now develop a more structured and outcome focussed approach to quality assurance. See Recommendation 1. During the inspection, the service told us that they were planning an external evaluation of the service. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service should develop a systematic approach to quality assurance, which includes information about outcomes for young people who use the service. National Care Standards for Care Homes for Children and Young People - Standard 7 - Management and staffing. CAIR Scotland Care Home Service, 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). CAIR Scotland Care Home Service, page 20 of 22

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 All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. CAIR Scotland Care Home Service, 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 CAIR Scotland Care Home Service, page 22 of 22