Clannalba Respite And Transitional Assessment Centre Care Home Service

Clannalba Respite And Transitional Assessment Centre Care Home Service Clannalba House Edinburgh Road Lamington Biggar ML12 6HP Inspected by: (Care Commission Officer) Type of inspection: Annwyn Noble Unannounced Inspection completed on: 25 March 2009 1/16

Service Number Service name CS2003001385 Clannalba Respite And Transitional Assessment Centre Service address Clannalba House Edinburgh Road Lamington Biggar ML12 6HP Provider Number dummy Provider Name SP2003000275 Scottish Society For Autism Inspected By dummy Inspection Type Annwyn Noble Care Commission Officer Unannounced dummy Inspection Completed Period since last inspection 25 March 2009 6 months dummy Local Office Address 3rd Floor Maxwell House Bridge Street Galashiels TD1 1SW dummy 2/16

Introduction Clannalba Respite And Transitional Assessment Centre is situated in a rural location near to the South Lanarkshire town of Biggar. This service was registered with the Care Commission on 1 April 2002 to provide a care home service to a maximum of 10 children and adults who are within the Autism Spectrum Disorder. The service aims is to provide a unique integrated service, offering flexible, individual support to children and adults. Based on the findings of this inspection the service has been awarded the following grades: Quality of Care and Support - 4 - Good Quality of Environment - 4 - Good This inspection report and grades represent the Care Commission s 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. Please refer to the care services register on the Care Commission s website (www.carecommission.com) for the most up-to-date grades for this service. Basis of Report This Inspection was carried out by Annwyn Noble, Care Commission officer on an unannounced basis between 12.00pm and 5.00pm approximately on Wednesday 25 March 2009. Before the Inspection The Annual Return The service submitted a completed Annual Return as requested by the Care Commission, which was used as part of the announced Inspection in September 2008. The Self-Assessment Form The service submitted a self-assessment form as requested by the Care Commission. Views of service users The views of residents and their relatives were not sought prior to the Inspection. However, the officer had the opportunity to speak with residents during the visit. Regulation Support Assessment The inspection plan for this service was decided after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (the officer) which considers complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The officer will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a low RSA score and so a low intensity inspection was required. The inspection was based on the relevant Inspection Focus Areas and associated National Care Standards, recommendations and requirements from previous inspections and complaints or other regulatory activity. 3/16

During the inspection process Staff at inspection -The Care Commission officer -The service manager -An acting resource manager -3 care staff (the services registered manager was on annual leave at time of this Inspection) Evidence During the inspection, evidence was gathered from a number of sources which consisted of: -Viewing team meeting minutes, the activities planner for one resident and the care plan of 2 residents. -Spending time with 2 residents. -Through speaking with the service manager, acting resource manager and 3 care staff members. -Through spending time observing the interactions between staff and residents and through observation of the communal environment. -Viewing documentation relevant to the follow up of recent complaint activity. (General Policies and Procedures were reported on during the annual announced Inspection) During this Inspection Quality Statements 1.1,1.2,2.1 and 2.2 were sampled only. Inspection Focus Areas and links to Quality Themes and Statements for 2008/09 Details of the inspection focus and associated Quality Themes to be used in inspecting each type of care service in 2008/09 and supporting inspection guidance, can be found at: http://www.carecommission.com Fire Safety Issues The Fire (Scotland) Act 2005 introduced new regulatory arrangements in respect of fire safety, on 1 October 2006. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw Action taken on requirements since last Inspection The following requirements were made following complaint activity, in October 2008. Requirement: 1. The provider must ensure that staff and management consistently consider and competently manage the care of service users in accordance with the care planning information held, considering past significant events known as well as current behaviours and do so in a robust manner which includes detailed written assessment of risk. - a requirement that providers shall make proper provision for the health and welfare of service users. SSI 114/2002 Regulation 4 (1)(a)Welfare of users, and - a requirement that a provider shall having regard to the needs of service users will ensure that at all times suitably competent persons are working in the care service, SSI 114/2002 4/16

Regulation 13 (a) Staffing. Timescale for implementation: Within one week of the date of this report Progress: The service manager stated that all residents risk assessments had been reviewed and updated as part of a review of care plans with all residents now having their own risk assessment for swimming pool usage. In addition, the service manager stated that staff ensured but all current and past behaviours and other significant events affecting residents were considered as part of the care planning and risk assessment process. In addition the swimming pool guidelines to staff were seen to have been updated. The care provider was reported to be in the process of piloting another risk assessment format which more detailed than the previous format. In addition the training officer planned to update staffs knowledge of risk assessment through training once the pilot was finished. This will be subject to follow up by the officer. -Sufficient progress had been made for this requirement to be Met. Requirement: 2. The service must ensure that care practice, assesses and considers the needs and best interests of service users timeously when a service user requires healthcare intervention- a requirement that provider shall make proper provision for the health and welfare of users and providers shall make such arrangements as are necessary for the provision to service users from any health care professional. SSI 114/2002, Regulation 4 (1) (a),(d) Welfare of users Timescale for implementation: Within one week of the date of this report. Progress: The service manager stated that all staff had discussed through the staff meeting cycle when outside healthcare intervention should be sought following accident or incident with resulting injury. It was recognised that some injuries may require first aid to be administered by the home's staff only and may not require the intervention of a GP or visit to hospital, as before this decision would be made by staff following assessment of the situation. It had been reiterated that the shift coordinator may decide to seek emergency healthcare for a resident before the on-call manager was able to respond to the situation. With regard to when relatives of the resident would be informed and involved in the management of an accident or incident, the service manager stated that: As part of the initial assessment for new residents she was now discussing with relatives when they would like to be informed of an accident or incident involving their relative who was using the service. Also relatives were being asked if they would want to be involved in the management of the situation or be informed after the event had been managed by the staff team. For current residents, staff were in the process of asking all existing relatives what involvement they would like to have in the event of their relative who is using the service being injured following an accident or incident. This information would then be clearly written into the care plan. As this had not been implemented in full, this will be subject to follow up as a recommendation. -Sufficient progress had been made for this requirement to be Met. Information about complaints that have been upheld or partially upheld can be found on the Care Commission website. 5/16

Comments on Self Assessment This was considered during the announced Inspection in September 2008. View of Service Users Due to the nature of residents disabilities it was difficult to ascertain their views. However both residents who spent time with the officer appeared to be comfortable in the company of their 1:1 staff member. One of the residents was able to say how they spent their time and was happy to show the officer their timetable of activities which was an important part of their routine. This the resident had complied with the assistance of their 1:1 staff member. View of Carers There were no relatives present at the time of the officer's Inspection. 6/16

Quality Theme 1: Quality of Care and Support Overall CCO Theme Grading: 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 This follow up inspection report should be read in conjunction with the unannounced inspection report for November 2008. At this visit, the service was seen to be maintaining the good systems that were in place for residents, their relatives and carers to be involved in assessing and improving the quality of the care and support. For example the minutes sampled showed that staff continued to meet on a monthly basis to discuss residents care and to review care planning information. As previously, the service had good systems in place to ensure that external stakeholders, such as social work were given opportunities to contribute to the care of the resident and to receive regular feedback from the service on the resident's progress. The key working system remained in place, and as part of this staff ensured that a detailed 6 monthly review document was issued to relatives and involved professionals on the adult or child's/young person's progress. Questionnaires were issued annually, but had not been re-issued since the last inspection. The service was seen to be maintaining consistent practice. Based on the findings of this Inspection the service has been awarded the following grade for this Statement, Quality Statement 1.1-5 Very Good. Areas for Development The following recommendation was identified in the last inspection: 1. The care provider should develop a written participation strategy which contains information on how service users and their relatives/carers can be involved in assessing the quality of care and support, the quality of the environment and the quality of staffing and management. Progress: The service manager and acting resource manager present at this inspection were unclear as to whether this recommendation had been implemented or not. Therefore this recommendation is carried forward to the next inspection. CCO Grading 5 - Very Good 7/16

Number of Requirements 0 Number of Recommendations 1 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 This follow up inspection report should be read in conjunction with the unannounced inspection report for November 2008. During this inspection the officer spent time with two residents. One was very able to decide how they spent their time. This resident had a very clear written plan in place, which they and their staff member referred to throughout the day. Although the resident was reluctant to speak with the officer, it was apparent that they were enjoying their activities that they and the staff member were engaged in. The resident was seen to have a lot of choice in the activities provided. The other resident whom the officer spent time with, also had a schedule of activities in place which the staff member evidenced was being worked through with the resident in a systematic manner. This was based upon the known likes and preferences of this resident. Staff evidenced as before that they made very good use of the activities resource folder which had been developed over time. In the last inspection the following recommendation had been made under quality statement 1.2 : 2. The medication guidance relating to the administration of covert medication should be updated to ensure that current best practice guidance has been considered and implemented. This policy had been reviewed and updated to include practice guidelines from the Mental Welfare Commission. The service was seen to be maintaining consistent practice. Based on the findings of this Inspection the service has been awarded the following grade for this Statement, Quality Statement 1.2-4 Good. Areas for Development There were no areas for development identified. CCO Grading 4 - Good Number of Requirements 8/16

0 Number of Recommendations 0 9/16

Quality Theme 2: Quality of Environment Overall CCO Theme Grading: 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 This follow up inspection report should be read in conjunction with the unannounced inspection report for November 2008. At this visit, the service was seen to be maintaining the good systems that were in place for residents and relatives to be involved in assessing and improving the quality of the environment. For example, the service continued to have staff appointed as resource representatives. The officer had the opportunity to spend time with a new resource rep who talked through their roles and responsibilities, and with the residents involved in identifying new resources and equipment for the home. Since the last inspection, a resident in one of the chalets had benefited from having his living environment re-decorated. The service was seen to be maintaining consistent practice. Based on the findings of this Inspection the service has been awarded the following grade for this Statement, Quality Statement 2.1-5 Very Good. Areas for Development There were no areas for development identified. CCO Grading 5 - Very 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 This follow up inspection report should be read in conjunction with the unannounced inspection report for November 2008. During this visit the officer observed that the service was maintaining ratio's of staff to residents in line with the assessed needs of the residents using the home at that time. 10/16

As previously reported, a variety of good safety measures were in place around the physical environment, and access to the grounds and buildings by visitors was done only on an authorised basis. The buildings were in a good state of repair internally and externally and an on-going re-decoration programme was in place. Damage to the walls in one of the chalets had been remedied through re-decoration since the last Inspection. Routine maintenance and health and safety checks continued as previously. The home was seen to be clean, tidy and fresh smelling at the time of this visit. The training of staff remained on-going with a very good schedule of dates and who was to attend being in place. During the last inspection the following recommendation had been identified in quality statement 2.2: 4. The risk assessment process, including the specific recording tool, should be reviewed and expanded upon to allow for detailed information to be recorded. The service manager stated that resident's risk assessments had been updated using the existing format. As a development, however, the Society were currently piloting a new risk assessment format. Although progress had been made, but the process was not complete, this recommendation will be carried forward to the next inspection. (See Recommendation 4 in this report) Based on the findings of this Inspection the service has been awarded the following grade for this Statement, Quality Statement 2.2-4 Good. Areas for Development During the last inspection, the following recommendation had been identified: 3. The care provider should review and update, where necessary, outdated policy and procedure documentation to bring them in line with current best practice with the document review are being a cutting employee of the service. It was found that some documents had been updated, but not all. Therefore this recommendation is carried forward to the next inspection. CCO Grading 4 - Good Number of Requirements 0 Number of Recommendations 2 11/16

Quality Theme 3: Quality of Staffing Overall CCO Theme Grading: 0 - Not Assessed 12/16

Quality Theme 4: Quality of Management and Leadership Overall CCO Theme Grading: 0 - Not Assessed 13/16

Regulations / Principles National Care Standards 14/16

Enforcement There has been no enforcement action against this service since the last inspection. Other Information The following recommendations were made following complaint activity, in October 2008: Recommendations: 1. The service should ensure that records relating to service users are accurate, up to date and detailed in content. This to include the recording of meetings held with service users' relatives. National Care Standards (NCS) for people with learning disabilities, Standard 5.1, 5.2 and 5.4 Management and staffing arrangements. 2. The staff should consider how the input from family members quickly can benefit a service user during an incident outwith normal daily activities which causes upset to a service user. NCS 9.2, Feeling safe and secure and NCS 18.3 Supporting communication. 3. The staff should consider discussing with relatives of service users timescales for contact with them in the event of an accident or incident outwith normal daily activity. This information should then be recorded in the care plan of the service user and reviewed at regular intervals. NCS 9.2, Feeling safe and secure and NCS 18.5 Supporting communication. 4. The staff should consider establishing written procedures in line with agreed care practices for occasions when restraint of a service user is required within the swimming pool. NCS 9.1 Feeling safe and secure and NCS 10.12 Exercising your rights. Progress 1, 2, 3 and 4: As detailed within the progress for Requirement 1, the service had undertaken a review of resident's care plans and through memos issued by the registered manager and through discussion at team meetings, the importance of keeping resident's documents up to date and detailed had been addressed. The management team had reviewed and updated guidelines to staff in relation to residents' use of the swimming pool and they had sought and taken advice about the feasibility of undertaking CALM restraints whilst in the swimming pool. As detailed within the progress for Requirement 2, the staff team were currently in the process of reviewing with all existing relatives when they would like to be contacted in the event of an accident or incident involving their relatives using the service. For new residents, the service manager was incorporating this discussion and recording of relative's wishes within the pre-admission documentation. - In conclusion, recommendations 1, 2 and 4 had been implemented with recommendation 3 being carried forward as staff had not as yet completed this recommendation. (Recommendation 3 which has been repeated is now numbered Recommendation 4 at the end of this report) Requirements There were no requirements identified at this inspection. Recommendations 1. The care provided should develop a written participation strategy which contains information on how service users and their relatives/carers can be involved in assessing the quality of care and support, the quality of the environment and the quality of staffing and management. 15/16

National Care Standards, care homes for people with learning disabilities, Standard 5.4 management and staffing arrangements. 2. The care provider should review and update, where necessary, outdated policy and procedure documentation to bring them in line with current best practice with the document review are being a cutting employee of the service. This is in order to consider the National Care Standards (NCS), care homes for people with learning disabilities, standard 5.4 management and staffing arrangements. 3. The risk assessment process, including the specific recording tool, should be reviewed and expanded upon to allow for detailed information to be recorded. This is in order to consider the NCS, care homes for people with learning disabilities, standard 5.4 management and staffing arrangements. 4. The staff should consider discussing with relatives of service users timescales for contact with them in the event of an accident or incident outwith normal daily activity. This information should then be recorded in the care plan of the service user and reviewed at regular intervals. This is in order to consider the NCS, care homes of people with learning disabilities, standard 9.2, feeling safe and secure and NCS 18.5 supporting communication. Annwyn Noble Care Commission Officer 16/16