Daldorch House School School Care Accommodation Service

Daldorch House School School Care Accommodation Service Sorn Road Catrine Mauchline KA5 6NA Telephone: 01290 551666 Type of inspection: Unannounced Inspection completed on: 24 January 2018 Service provided by: The National Autistic Society Service provider number: SP2004006215 Care service number: CS2003000781

About the service This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Daldorch House School is registered to provide a school care accommodation service and is also registered with HM Registrar of Independent Schools as a residential special school. The service is registered to provide care for a maximum of 28 children and young people who have a primary diagnosis of Autistic Spectrum Disorder and/or associated conditions. The usual age range of the young people who may be accommodated is eight to 21 years. However, due to delays in finding suitable places for two older service users to move on, we have agreed special arrangements to allow three people over the age of 22 years to remain in the service until no later than 12 January, 4 March and 20 March 2018 respectively. One of those three service users had now left the service. Accommodation is provided in seven houses within the school grounds as follows: Arran 2 - Up to four young people; Bute 1 and 2 - Up to eight young people; Cumnock 1 and 2 - Up to eight young people and Darvel 1 and 2 - Up to eight young people. At the time of our inspection, 21 young people were accommodated at the school. The service is located in Catrine in East Ayrshire and operates a 24-hour service all year round. Accommodation is provided in seven residential houses within an enclosed perimeter. Twenty-one young people were being supported by the service at the time of our inspection and all had been assessed as having an autistic spectrum disorder. Many of the young people experience significant communication and language difficulties and all required individualised support to develop their personal and social skills. What people told us Young people we met were non-verbal and unable to communicate their views of the service. Our observation of interaction between young people and staff confirmed positive relationships in which young people participated in a range of recreational activities and were supported in the activities of daily living. A parent told us that their child "continues to enjoy life to the full at Daldorch" and that "staff continue to support (them) excellently". They added that, "we have no concerns reference (their) care and education and are eternally grateful." Another parent told us that the service made their "heart swell" and praised the 'dedicated and caring staff' for embracing their child's uniqueness and for 'just getting' them, for the love and care shown to them and their family, and for the support to their child as they prepared for transition. Self assessment No self-assessment was required prior to this inspection. We saw an updated copy of the service's own Improvement Plan which confirmed the provider's commitment to self-assessment and improvement. 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 page 2 of 13

Quality of care and support Findings from the inspection We found that the quality of care and support was good overall and took account of young people's identified needs. A social worker told us "the care and support appear to be of a high standard and meet (the young person's) needs. (They have) progressed well since living at Daldorch....There has been a marked reduction in the aggressive behaviour which was a main feature of the challenges they presented." A young person who would soon be leaving Daldorch told their parents, "I am really going to miss this place when I move on." The service had made progress with each of the areas that we identified for improvement at the last inspection. House teams now took greater responsibility for identifying any remedial action required following incidents of concern and these were included on the agendas for team meetings. A social worker felt the level of information shared with them about incidents was insufficient to form a clear view of what had happened. More attention needed to be given to ensuring that the most up to date version of paperwork is in the young person's 'My Progress' working folder. See recommendation 1. Managers had tried unsuccessfully to identify an independent advocacy provider for young people. Although individual local authority advocacy arrangements were known for some young people, this was not the case for everyone. Managers had identified some young people who would have benefitted from the support of an independent advocate, particularly when preparing to move on. We have repeated our recommendation. See recommendation 2. We sampled from individual risk assessment documents and found that these were more up-to-date than previously found. Risk assessments we saw were written in a way which included some recognition of the benefits of risk-taking in terms of new experiences and positive outcomes for young people. The provider's approach to risk assessment requires assessors to include standardised generic information which sometimes detracted from specific individual risk information and strategies for managing these safely. A social worker felt that the number of different risk assessment documents was confusing. A more concise format with greater focus on the identified risks and risk management strategies for the individual would be less cumbersome and a more effective tool for staff. See recommendation 3. The frequency and variety of activities and outings away from the Daldorch campus had improved, although this still presented a number of challenges, given the complex needs of young people and the level of planning necessary to ensure such activities. A parent told us that their child "enjoys various activities both on campus and within the local community." Managers recognise this nevertheless as an area which requires continuing attention to ensure that all young people have regular opportunities to participate in familiar activities and new experiences. New 'My Progress' working files had helped staff to improve their focus on outcomes for young people and some staff were now using evaluative statements to describe outcomes for young people. This was at an early stage and needs to be developed further; for example, describing a young person's responses to a drive in the car rather than just stating they had been for a drive. See recommendation 4. Requirements Number of requirements: 0 page 3 of 13

Recommendations Number of recommendations: 4 1. House teams should ensure that, once paperwork is updated, it is dated and the most up to date version placed in the young person's 'My progress' working folder. National Care Standards for school care accommodation services - Standard 7.4: Management and staffing. 2. The National Autistic Society should take steps to ensure that young people using the service have access to other agencies and services who can support them to make their needs and preferences known. National Care Standards for school care accommodation services - Standard 18: Advocacy. 3. The National Autistic Society should review its approach to individual risk assessments in order to achieve a more concise format with greater focus on the identified risks and risk management strategies for individual young people. National Care Standards for school care accommodation services - Standard 8.4: You as an individual. 4. The service should continue to develop recording systems which maintain an evaluative approach and focus on outcomes for the young people they support. National Care Standards for school care accommodation services - Standard 7.4/9: Management and staffing. Grade: 4 - good Quality of environment Findings from the inspection We found that the quality of the environment was adequate overall but a number of shortcomings became evident through this inspection process. In the period prior to this inspection, some of the notifications received from the school highlighted the limitations of the residential accommodation. For example, there had been occasions when the confined and 'busy' environment had been a contributory factor to incidents. This had included occasions when the restrictive physical interventions (RPI) in which staff were trained had proved insufficient to maintain young people's safety. This had resulted in recourse to approaches which, although deemed the least restrictive possible, would normally be considered unsuitable. Paragraph 3.1.4 of Rights, risks and limits to freedom, a guidance document published by the Mental Welfare Commission for Scotland (2013), states that,"a well-designed facility can reduce...the kinds of behaviour that lead to interventions that restrict their freedom of movement". Staff worked hard, within the constraints of the school care accommodation, to support young people and regulate their interaction with other young people according to individual tolerance levels. This included utilising the facilities of the school building to supplement their own house, e.g. for recreation and for mealtimes. page 4 of 13

National Care Standards for school care accommodation services state that there should be "rooms you can use in private (for instance if you have visitors) and you have enough space for individual and group activities. This includes play space or quiet areas..." The Scottish Government's new health and Social Care Standards speak of the need for premises to be "designed or adapted for high quality care and support." A social worker told us that "the quality of the accommodation is poor." They described how some of their young person's posters were "damaged due to damp conditions". They also told us that, if the young person wanted any private time, "staff have to sit outside their door". They added that the young person had sometimes been disturbed by the challenging behaviour of another young person. They also said that, when managers had agreed to make changes, e.g. a change of room or modifications to a room, these had taken too long to happen. We discussed the constraints of the premises with managers and, following the inspection, they provided assurances that the provider had now made a commitment to addressing this. See recommendation 1. The RPI referred to above included a form of 'seclusion' which, although carefully monitored from outside the room, fell short of guidance on "The Use of Seclusion" provided by the Mental Welfare Commission for Scotland (2007) which states that "observation into the room should be clear and effective". We note that this was used in order to protect a young person during an incident involving another young person but this highlights the constraints of the accommodation. We confirmed that steps had been taken to minimise the risk of further incidents of this type but modifications to door furniture, advised by the provider's challenging behaviour lead, had not yet been implemented. NAS should proceed with changes which help to protect the privacy and security of young people in their own rooms whilst allowing young people to leave their room when they wish. See recommendation 2. The service makes conspicuous use of surface-mounted plastic trunking to conceal electrical wiring but this is a risk to some young people due to specific challenging behaviour. The provider should review this arrangement and identify safer means of concealing electrical and other wiring. See recommendation 3. Due to some young people's tolerance levels, their preferences concerning bath or shower were important to them. Some young people, however, did not have access to their preferred choice of bath or shower close to their own room and staff told us that some young people, therefore, used the facilities in the separate school building. Any plans for the redevelopment or improvement of the accommodation provided should take account of the need to offer a choice of bath or shower facilities close to young people's own room. Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The National Autistic Society should review its accommodation needs with a view to providing an environment more conducive with the identified needs of the young people supported by the school care accommodation service at Daldorch House. National Care Standards for school care accommodation services - Standard 4: Privacy and dignity and Standard 5: Comfort, safety and security. See also the new Health and Social Care Standards: My support, my life - Standard 5 (I experience a high quality environment). page 5 of 13

2. The National Autistic Society should proceed with changes to doors which help to protect the privacy and security of young people in their own rooms whilst allowing young people to leave their room when they wish. National Care Standards for school care accommodation services - Standard 5: Comfort, safety and security. 3. The National Autistic Society should review its use of surface-mounted plastic trunking for wiring and identify safer means of concealing electrical and other wiring. National Care Standards for school care accommodation services - Standard 5: Comfort, safety and security. Grade: 3 - adequate Quality of staffing Findings from the inspection An overall, good standard had been maintained in regard to this quality theme. Staff that we spoke to presented as being well-informed about the young people they were working with and senior support staff especially demonstrated very good insight concerning autism-specific approaches to care and support. A young person who would soon be leaving the service told their parents "I love spending time with staff and I like spending time in their company when I go out and about. I like spending time with the night staff as well." levels had improved and there were fewer problems with staff deployment. The service had mostly managed to maintain staffing levels through periods of sickness. This was largely due to staff goodwill and flexibility. Any use of agency staff had been workers already familiar with the service and the young people supported there. Staff turnover had slowed but the provider had maintained a programme of regular recruitment and induction in order to ensure suitable staffing levels are maintained. The service has a small core of experienced longerserving staff with very good understanding and insight concerning autism and good autism practice. However, the ratio of such experienced and confident staff to newer staff had reduced. This had sometimes placed constraints on staff deployment, e.g. when supporting young people on outings to the community, when staff confidence is an important consideration. A new "assessment centre" approach to staff recruitment was thought by managers likely to result in fewer new staff leaving soon after appointment. They were hopeful that this would help them to build up staff skills and confidence and achieve a more settled and confident staff team. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good page 6 of 13

Quality of management and leadership Findings from the inspection An overall, good standard had been maintained in regard to this quality theme. Staff we spoke to confirmed they felt supported by their team managers and that they had also found senior managers interested and helpful. A staff member told us "I have seen a lot of changes since the new Head of Care has been in place, which has been a welcomed difference." Some senior support workers expressed dissatisfaction to us and we understand that the morale of this group of staff has been affected by issues concerning their terms of employment. The registered manager was aware of this and hoped the matter would soon be resolved. It is important that managers meet with this more experienced group of staff in order to identify and address other issues and concerns they have not related to pay and conditions. Concerns expressed to us include that some senior support staff feel they need more support with mentoring and supporting less experienced staff. (See also staffing quality theme). See recommendation 1. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. Managers should meet with senior support workers to identify, address and resolve the concerns they have in order to ensure a settled and committed staff team and promote staff retention. National Care Standards for school care accommodation services - Standard 7.9: Management and staffing. Grade: 4 - good 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 staffing levels are maintained at all times to ensure that young people receive the quality care and support as agreed in their plans. The provider must provide evidence to the Care Inspectorate of how this will be achieved. page 7 of 13

This is in order to comply with: Scottish Statutory instrument 2011 - No 210, Regulation 4(1)(a), Children's welfare - a regulation which ensures proper provision for the health, welfare and safety of children. Timescale: To be started on receipt of this report and completed within four weeks. This requirement was made on 27 January 2017. Action taken on previous requirement Systems to manage staffing and deployment were introduced and maintained and satisfactory staffing levels have been achieved most of the time. Met - outwith timescales Requirement 2 The provider must ensure that young people receive quality care and support that minimises incidents and deals with them effectively. In order to achieve this, the provider must: Ensure that incident reports are completed to a quality standard noting, where appropriate, the actions required to minimise future incidents Review the risk assessments of young people involved in incidents and demonstrate that the actions taken to manage and support young people during incidents are clearly noted Provide all staff with incident and risk assessment recording training to aid support practices of staff supporting young people during crisis. This is in order to comply with: Scottish Statutory Instrument 2011 - No 210, Regulation 4(1)(a) Children's welfare - a regulation which ensures proper provision for the health, welfare and safety of children. Regulation 15 (a) - a regulation which ensures staff receive training for the work they are to perform and that they are competent to provide such care. Timescale: To be started on receipt of this report and completed within 10 weeks. This requirement was made on 27 January 2017. Action taken on previous requirement Arrangements for following up incidents had been maintained and consolidated and there had been prompt and appropriate follow-up to the incidents and restrictive physical interventions that we sampled. Met - outwith timescales page 8 of 13

What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The National Autistic Society should take steps to ensure that young people using the service have access to other agencies and services who can support them to make their needs and preferences known. National Care Standards for school care accommodation services - Standard 18: Advocacy. This recommendation was made on 17 June 2016. Action taken on previous recommendation Independent advocates have been identified for some service users through existing local authority arrangements but the service doesn't have a contract with any independent advocacy provider. This was ongoing and our recommendation remains unmet. See The Quality of Care and Support, recommendation 2. Recommendation 2 In order to retain suitably qualified, experienced and knowledgeable staff, the service should continue to address means of improving staff retention. National Care Standards for school care accommodation services - Standard 7.3: Management and staffing. This recommendation was made on 17 June 2016. Action taken on previous recommendation There has been some improvement in staff retention which, combined with a more robust assessment centre approach to recruitment, has led to improved staffing. We found some evidence of discontent among senior support staff and have made a recommendation concerning this. See Management and Leadership, recommendation 1. Recommendation 3 The National Autistic Society should review its approach to risk assessments to ensure that this avoids aversion or delay to activities which may make a positive contribution to young people's experience and development. This recommendation was made on 15 August 2017. Action taken on previous recommendation More staff have been trained in the NAS approach to risk assessment and those we saw had been updated and reviewed. We didn't hear of any examples of activities being delayed or curtailed due to the lack of an appropriate risk assessment. Recommendation 4 The service should develop a more evaluative approach to daily records maintained by staff. This should provide increased focus on outcomes in relation to the identified aims for each young person. page 9 of 13

This recommendation was made on 15 August 2017. Action taken on previous recommendation New 'My progress' files have been introduced for plans and records. These include a weekly set of handover sheets which guides staff to use SHANARRI headings to record outcomes. Recommendation 5 Managers should ensure that improvements to young people's private living space do not encroach upon the amount of space available for group living activities in each house. This recommendation was made on 15 August 2017. Action taken on previous recommendation This recommendation is accepted by the provider who is now looking carefully at the future accommodation needs of the service. No new alterations had been made or proposed since our last visit although the provider acknowledges the need to make improvements in the longer term. We have made a new recommendation concerning this (see The, recommendation 1). We have also made specific recommendations about other aspects of the environment (see The, recommendations 2 and 3). 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 13

Inspection and grading history Date Type Gradings 2 Aug 2017 Unannounced Care and support Management and leadership 16 Mar 2017 Unannounced Care and support Management and leadership 20 Feb 2017 Re-grade Care and support 3 - Adequate Management and leadership 2 - Weak 17 Jun 2016 Announced Care and support Management and leadership 19 Nov 2015 Unannounced Care and support 3 - Adequate Management and leadership 3 - Adequate 20 Mar 2015 Unannounced Care and support Management and leadership 16 Sep 2014 Unannounced Care and support Management and leadership page 11 of 13

Date Type Gradings 23 Jan 2014 Unannounced Care and support 5 - Very good Management and leadership 10 Oct 2013 Unannounced Care and support 5 - Very good Management and leadership 3 Dec 2012 Unannounced Care and support Management and leadership 16 May 2011 Unannounced Care and support Management and leadership 8 Dec 2010 Unannounced Care and support Management and leadership 14 Oct 2010 Announced Care and support Management and leadership 5 Feb 2010 Unannounced Care and support 5 - Very good Management and leadership 30 Oct 2009 Announced Care and support 5 - Very good 5 - Very good Management and leadership page 12 of 13

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 13 of 13