Hamilton Towers Resource Centre Support Service

Hamilton Towers Resource Centre Support Service Hamilton Towers Floor 1, Office 2 54 Castle Street Hamilton ML3 6BU Telephone: 01698 459337 Type of inspection: Unannounced Inspection completed on: 22 January 2018 Service provided by: Scottish Autism Service provider number: SP2003000275 Care service number: CS2003047729

About the service The service has been registered with the Care Inspectorate since 1 April 2011. Hamilton Towers Resource Centre is owned and managed by Scottish Autism and provides a support service for up to ten adults with Autism Spectrum Disorder. The centre is based in an office complex in the centre of Hamilton. The overall aim of the service is to provide a facility which can accommodate as wide a range of needs for people on the autistic spectrum as possible. The mission statement for this service states that, "The society seeks to ensure the provision of the best possible education, care, support and opportunities for people of all ages with autism in Scotland and to support families to improve their understanding of autism". What people told us Parents' comments included: "Our son loves attending Hamilton Towers and bounds in" "The staff always communicate what kind of day my son has had" "Great care has been taken in learning about my son". People using the service commented: "Yes I like coming here and going to my drama group" "The staff clearly demonstrate respect, care and compassion" "I wish there was more staff consistency". Self assessment This was not required by the care inspectorate for this inspection year. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 3 - Adequate 4 - Good 3 - Adequate 3 - Adequate Quality of care and support Findings from the inspection We looked at three personal plans and found they held detailed information about people's support needs. It was clear to the reader how the person should be supported in relation to various aspects of their lives. They also included how autism presented in people's behaviours and offered staff guidelines on how to effectively respond to this. page 2 of 12

However we found that information was out of date in some cases and regular six monthly reviews had not taken place for all people. This meant that health and wellbeing needs in particular could be missed and out of date. As this was a previous requirement we will repeat this. (See requirement 1). We looked at activity schedules which were place on the wall in the sitting area. This made it easy for people to see the activities and to plan and arrange them using their chosen way of communication. We advised the manager that the service could explore further opportunities for people to reach their potential particularly while in the support base. We found that epilepsy care plans were detailed and in place. Individual epilepsy protocols were included in people's plans. This ensured the best recovery plan when and if people experience seizures. The service also currently hold 'As required' medication in a locked cabinet with relevant procedures. We noted that accidents and incidents were recorded and information was detailed. As a demonstration of good practice staff had the opportunity to be debriefed following an incident and to reflect on what could have been done differently if the situation was to arise again. However we found that risk assessments were not up to date which had potential to leave people with complex needs at risk. We received four relative questionnaires which reported that people using the service were mostly happy with the support delivered. They spoke highly of the staff and their professional approach. We suggested to the manager that as an area for improvement all survey results could be collated and a reported back to people and their relatives. As an area for improvement we would ask the provider to continue seeking advocates for people who use the service. The manager had already started the process at the time of inspection. Requirements Number of requirements: 1 1. The Provider must ensure that each service user has an accurate, up to date personal plan, which sets out how the service user's health, welfare and safety needs are to be met. The personal plan must reflect current individual health and care needs and be reviewed (i) when requested to do so by the service user or their representative or (ii) when there is a significant change in a service user's health, welfare or safety needs and (iii) at least once in every six month period whilst the service user is in receipt of the service. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 5 (2) (b) (i) (ii) (iii) Personal Plans; Scottish Regulators' Strategic Code of practice - made under section 5 of the Regulatory Reform (Scotland) Act 2014. Timescale: to be in place by 28.5.18 In making this requirement we have taken into account the National care standards, Support services - Standard 4 Support arrangements. page 3 of 12

Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of environment Findings from the inspection In relation to the surroundings, we found the support base to be bright and colourful, decorated with the works that people had created such a paintings and textiles. We noted that there was a sitting area with soft seating along with a table and chairs were people chose to congregate to. Additionally there were more rooms for people to access such as, a computer room, art room and chill out areas. This offered people options depending on how they were feeling on the day. We looked and Health and safety checks which were weekly, quarterly and annually. We saw that one of the people using the service was also involved in this process which was good practice in relation to participation and empowering people. We advised the service manager that the audits could be more meaningful if they had clear follow up actions with dates for completion. We checked the storage situation as a recommendation was made around this at the previous inspection. We found that this was met. We found that equipment within the base had 'Portable Appliance Testing' carried out to ensure the safety of people using them. The entry to the building was secure which contributed to both staff and people using the service feeling safe. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of staffing Findings from the inspection While speaking with staff we heard that they enjoyed their support role and enjoyed building good relationships with people. From observation of staff interactions with people we could see they knew people well and adapted their communication to suit individuals. page 4 of 12

We found that staff went through an induction process including shadowing staff so that people using the service could get acquainted with them. However staff also felt that further improvements could be made to ensure staff are confident and competent before working on their own. This could be achieved by frequent formal and informal supervision during their early experiences of the service however some staff had received supervision whilst others had not. This was a recommendation previously and will be repeated (see recommendation 1). We looked at paperwork such as application forms, references and PVG's and found these to be in place. This contributed to the safe recruitment of staff. Some staff told us they felt demotivated with low moral due to staff shortages and frequent turnover, they felt that this also impacted on people who used the service and they responded with expressions of distress at not being able to attend their routine activities. This also added to staff frustration. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service should continue to regularly provide staff with support meetings, supervision and appraisals regularly and put in place plans that ensure continuity through changes of management. National care standards, Support Services - Standard 2 Management and staffing arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection At the time of the inspection the manager had been on maternity leave and was due to return on a part time basis within a few weeks. During that time an interim manager was in position. Staff told us this had been an unsettling period for the team as they had also experienced a high turnover of staff. The service manager reassured us that they had a successful recruitment drive in for the manager's job share post which would hopefully stabilise the team moving forward. We advised the service manager to find creative ways of involving people who use the service in the recruitment programme. We discussed some good practice initiatives that have been proven beneficial to people. (See recommendation 1) As a result of staff turnover, staff did not have much opportunity to access training and development as recommended in the previous inspection so this recommendation has been repeated. (See recommendation 2) page 5 of 12

We looked through the service development plan and found this to be still in progress with timelines for completion throughout 2018. The plan will be shared with the current manager on her return to work as well as with the new part time manager to ensure it's completion. This will help the service to action improvement. We read minutes of two staff meetings which discussed relevant topics. We advised the manager that the minutes presented as being focussed on the manager's agenda topics with limited recordings of staff views. We advised the service that staff should be encouraged to contribute to the meeting agenda and have the opportunity to put forward their views and have them documented. Meeting minutes should have actions stated and who will be responsible for completing this and by when. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The service should look at creative ways in how to involve people who use the service in the induction of new staff, their probation and the on going supervision of staff. This should be evidenced at the next inspection. National care standards, Care at Home - Standard 4 Management and Staffing National Care standards, Support Services - Standard 2 Management and Staffing 2. The service should develop a training matrix that is clearly influenced by, and links into staff supervision and training needs. This must include information of training needs identified, requested, planned, attended and due. National care standards, Care at Home - Standard 4 Management and Staffing National Care standards, Support Services - Standard 2 Management and Staffing Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The Provider must ensure that each service user has an accurate, up to date personal plan, which sets out how the service user's health, welfare and safety needs are to be met. The personal plan must reflect current individual health and care needs and be reviewed (i) when requested to do so by the service user or their representative or (ii) when there is a significant change in a service user's health, welfare or safety needs and (iii) at least once in every six month period whilst the service user is in receipt of the service. page 6 of 12

This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 5 (2) (b) (i) (ii) (iii) Personal Plans; Scottish Regulators' Strategic Code of practice - made under section 5 of the Regulatory Reform (Scotland) Act 2014. Timescale: Within eight weeks from receipt of this report. In making this requirement we have taken into account the National care standards, Support services - Standard 4 Support arrangements. This requirement was made on 2 December 2016. Action taken on previous requirement Due to staff turnover and shortages this requirement was not met at the time of inspection Not met Requirement 2 The provider must keep an oversight and monitoring of each individual's support hours. This should include; - When they did not receive their allocated support - The reason they did not receive their allocated support - The outcome of not receiving their allocated support - Any action taken following this, for example contacting the Local Authority or family/guardian. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users; Scottish Regulators' Strategic Code of practice - made under section 5 of the Regulatory Reform (Scotland) Act 2014. Timescale; one week from receipt of this report. In making this requirement we have taken into account the National care standards, Support services - Standard 2 Management and staffing arrangements. This requirement was made on 2 December 2016. Action taken on previous requirement We looked at the missed visit log book and saw evidence of these being recorded and the hours being calculated. Met - within timescales Requirement 3 The Provider must make proper provision for the health, welfare and safety of all service users. To achieve this, the provider must take action to; 1) Ensure there is a robust system in place which enables effective monitoring and evaluation of all accidents and incidents. page 7 of 12

2) Ensure that all incidents that may constitute Adult Support and Protection are referred immediately to the appropriate authority. 3) Ensure that all staff attend training and can demonstrate their understanding of Adult Support and Protection. This must include knowledge of, but not exclusively, the definition of an adult at risk and harm, and their duty to report. 4) Ensure that where appropriate, incidents are notified to The Care Inspectorate where required. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users; Scottish Regulators' Strategic Code of practice - made under section 5 of the Regulatory Reform (Scotland) Act 2014. Timescale for completion: 1 week from receipt of this report. In making this requirement we have taken into account the National care standards, Support Services - Standard 2 Management and staffing arrangements. We have signposted the manager to; "Records that all registered care services (except childminding) must keep and guidance on notification reporting". http://www.careinspectorate.com/images/documents/2611/ This requirement was made on 2 December 2016. Action taken on previous requirement We looked at the service notifications and found these to be relevant and appropriate. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should develop robust epilepsy support plans and risk assessments which should take into account procedures to be followed both within and outwith the centre. Timescales must be clear within protocols of when to summon emergency help. All seizure activity should be monitored and evaluated to influence support plans, risk assessments and reviews. National care standards, Support Services - Standard 4 Support arrangements. This recommendation was made on 2 December 2016. page 8 of 12

Action taken on previous recommendation We sampled files and found that epilepsy protocols were in place and details of how staff should respond to this. This recommendation has been achieved. Recommendation 2 The service should develop a training matrix that is clearly influenced by, and links into staff supervision and training needs. This must include information of training needs identified, requested, planned, attended and due for renewal. National care standards, Support Services - Standard 2 Management and staffing arrangements. This recommendation was made on 2 December 2016. Action taken on previous recommendation This recommendation was not met as supervisions had not taken place therefore training was not influenced by this process. Recommendation 3 The service should continue to regularly provide staff with support meetings, supervision and appraisal regularly and put in place plans that ensure continuity through changes of management. National care standards, Support Services - Standard 2 Management and staffing arrangements. This recommendation was made on 2 December 2016. Action taken on previous recommendation This recommendation was not achieved as staff supervisions had not taken place for many staff. There was only two team meetings since the last inspection. Recommendation 4 The service should examine its storage needs and ensure that they have enough. National care standards, Support Services - Standard 5 Your environment. This recommendation was made on 2 December 2016. Action taken on previous recommendation This recommendation was achieved. Recommendation 5 The service should explore the involvement of service users in the recruitment of staff as described in report. National care standards, Support Services - Standard 2 Management and staffing arrangements. This recommendation was made on 2 December 2016. Action taken on previous recommendation This recommendation was achieved with some people being involved in recruitment. page 9 of 12

Recommendation 6 The service should explore the inclusion of independent advocacy in the service user experience. National care standards, Support Services - Standard 3 Your legal rights. Complaints This recommendation was made on 2 December 2016. Action taken on previous recommendation Advocacy links had been made and plans in place to invite them to meet with family. This recommendation has been achieved. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. page 10 of 12

Inspection and grading history Date Type Gradings 2 Dec 2016 Unannounced Care and support 4 - Good Environment Not assessed Staffing Not assessed Management and leadership 3 - Adequate 29 May 2013 Unannounced Care and support 5 - Very good Environment 5 - Very good Staffing 5 - Very good Management and leadership 5 - Very good 18 Jan 2010 Announced Care and support 5 - Very good Environment Not assessed Staffing 4 - Good Management and leadership Not assessed 2 Jun 2010 Announced Care and support 5 - Very good Environment 5 - Very good Staffing 5 - Very good Management and leadership 4 - Good 13 Jan 2009 Unannounced Care and support 5 - Very good Environment 4 - Good Staffing 4 - Good Management and leadership 4 - Good page 11 of 12

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 12 of 12