Action for Children - Silverton Short Breaks Care Home Service Children and Young People Larch Grove Silvertonhill Hamilton ML3 7NF Telephone: 01698 424102 Inspected by: Aileen Quinn Type of inspection: Unannounced Inspection completed on: 13 March 2012
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: Action for Children Service provider number: SP2003002604 Care service number: CS2005110586 Contact details for the inspector who inspected this service: Aileen Quinn Telephone 01698 208150 Email enquiries@scswis.com Action for Children - Silverton Short Breaks, page 2 of 23
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 5 Very Good Quality of Environment Quality of Staffing N/A N/A Quality of Management and Leadership 5 Very Good What the service does well The manager had a clear vision for improvement which kept outcomes for the children at the heart of what they provided. Staff and the manager maintained clear records which were regularly updated and included parents/carers and young people where appropriate in their reviews. Young people were happy and had the opportunity to take part in a wide range of activities tailored to their needs. What the service could do better Incident records should include full details including all action taken, or make reference to where this information is stored. The manager should continue with his plans to upgrade the building through decoration and repairs. What the service has done since the last inspection Care Plans had been further developed and now included a summary and a more detailed review system. Staff had continued to seek and attend training to meet the needs of young people. The manager had carried out a detailed audit of the service and how effectively it was meeting the needs of young people. Conclusion The service continued to provide very good outcomes for young people using it. Parents/carers spoke very highly of the caring ethos of the service and how they Action for Children - Silverton Short Breaks, page 3 of 23
valued the skills and commitment of staff. Young people continued to feel welcomed and to enjoy their time in the service. Who did this inspection Aileen Quinn Action for Children - Silverton Short Breaks, page 4 of 23
1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS. The service is registered to provide respite care for a maximum of six children and young people between the ages of four and 18 years. Children and young people may have learning disabilities and sensory impairments. The service is provided by Action for Children Scotland who have several similar services registered with the Care Inspectorate. There are approximately 70 young people using the service over the year. There were five young people staying in the service at the time of this visit. The project aims "to offer socially valuable experiences that help extend children's life experiences and development, while enabling parents to take a break from caring." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade Quality of Environment - N/A Quality of Staffing - N/A Quality of Management and Leadership - Grade This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Action for Children - Silverton Short Breaks, page 5 of 23
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 after an unannounced inspection that took place on Monday 12 March 2012 between the times of 1.30 and 7.45pm. As requested by us, the manager sent us an annual return and completed a self assessment form. We spoke to two parents/carers after the inspection visit. In this inspection, we gathered evidence from various sources including the relevant sections of policies, procedures and records including: observing how staff work evidence from the most recent self assessment form care plans for two young people using the service incident records pre-call records newsletters daily reports home project diaries annual reviews minutes of staff meetings records of parent's meetings supervision and appraisals for staff detailed discussion with one member of staff informal discussion with the other three members of staff present detailed discussion with the manager some communication with young people present telephone discussion with two parents/carers after the inspection visit Action for Children - Silverton Short Breaks, page 6 of 23
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 report continued 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 Action for Children - Silverton Short Breaks, page 7 of 23
What the service has done to meet any recommendations we made at our last inspection There were no recommendations made at the last inspection. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The self assessment was detailed and contained very good information about the strengths of the service as well as some areas for development. We found this form very useful when planning and carrying out this inspection. The manager agreed that staff could be more involved in this process. Taking the views of people using the care service into account Five young people were staying in the service during our visit. It was clear that they were happy there, and enjoyed taking part in activities with staff. We observed young people independently using the environment where possible, and staff providing sensitive and caring support. Taking carers' views into account We spoke to two parents by telephone after the inspection visit. Both were very happy with the service and spoke very highly of staff working there. They told us that staff were "fantastic" and that they were committed to meeting their child's needs. They said that they were confident that staff could manage their child's health care needs very well. Parents gave us some examples where the service had gathered information to ensure they worked consistently, for example in the way personal care was provided. One parent told us that since their child had started using the service, they had "never looked back". They also said that they could relax when their child used the service because of the confidence they had in the staff working there. Both parents told us about the very good communication in place. The service was described as "fantastic" and the pre-calls as "great" as they gave them an opportunity to update their child's information with staff. Action for Children - Silverton Short Breaks, page 8 of 23
The views of parents/carers are included in this report. Action for Children - Silverton Short Breaks, page 9 of 23
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: Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service provided very good opportunities for parents/carers and young people to assess and improve the quality of care and support. They did this in a number of ways and ensured communication was appropriate to maximise feedback. The service was committed to working in partnership with parents/carers and young people. Before a young person started using the service, a member of staff met with the family and provided them with a "home visit pack". This included information about the service and gave them the opportunity to complete personal details about the young person. The home visit pack also included information about health and any other agencies involved in supporting the young person. This information was used to help staff plan for the young person's stay with them. Staff were aware of the importance of effective communication between parents/carers and themselves, and valued the knowledge they had. Care plans for young people were particularly good and reflected the partnership between home and the service. Parents/carers were fully involved in completing the care plans, and where possible, young people also participated. One parent/carer told us about their child's care plan, and how staff had amended this to allow their child to understand and share it with important people in their life. Care plans were reviewed at least every six months, and the way these reviews were carried out had been further developed since the last inspection. These were now more specific and helped staff identify aims for the future. Parents/carers had been given detailed information about the importance of reviews, which reflected that their views were very important in developing the care plan. The reviews provided an opportunity for parents/carers to identify areas of care, learning, and dreaming that they would like staff to help their child with. Care plans and reviews were linked to the principles in GIRFEC (Getting it Right for Every Child). The information in the care plan was vital in helping staff meet the needs of the young person as agreed with their parent/carer. Action for Children - Silverton Short Breaks, page 10 of 23
Both parents/carers we spoke with told us that they had been "impressed" by the amount of information requested, and that this had reassured them that staff would look after their child in a safe way. Staff and management had further developed how they worked with families. A Parent Forum had been established and meetings were now taking place and being recorded. Parents/carers had been consulted about the environment, the reviews of care plans, fundraising, purchasing new equipment, and the recruitment process. An agenda was prepared for these meetings, and parents/carers added to this as they wished. Parents/carers were currently being consulted about the environment as it was in need of some re-decoration and repair. One member of staff was working on involving parents/carers in social events, such as fun days in the service. The purpose of these was to help parents/carers feel more comfortable in the service and to help them meet other families using the service. These meetings, fun days, and the newsletters provided were useful in reminding parents/carers that their views and suggestions for improvement were welcomed. Where possible young people completed a participation form that allowed them to identify choices, dreams and goals. This included choosing their bedroom, having a respite stay with another young person they liked, and choosing activities. Staff maintained very good communication with parents/carers during their child's stay and beyond. We spoke to two parents/carers using the service and both told us that they could contact the service at any time. They felt that staff listened to them. Both parents/carers told us that staff knew their child very well, and planned their care in a way that met their needs. One parent/carer described communication as "fantastic" and gave us examples where staff had sought out training to help them meet their child's specific health needs. They said that staff "tailor activities" for their child, and that staff were "really keen" to learn about anything that would help them meet the needs of each young person. The other parent/carer gave us similar examples where staff had personalised their child's care as a result of their input. They said that staff "welcome ideas and are willing to try" any new strategies that may help improve outcomes for young people. Parents/carers were given a summary copy of their child' s stay which was a positive reflection of their time there. Overall, we assessed this Quality Statement as very good. Areas for improvement Inspection report continued The new review forms were at an early stage. The results from these, in particular where parents/carers could identify how staff could help their child will play an important role in helping the service develop. Some feedback from parents/carers did not include the year it was carried out. Although these methods were recently developed and it was clear that feedback had Action for Children - Silverton Short Breaks, page 11 of 23
been recent, it would be helpful if the year was included on further minutes and feedback from parents/carers and young people. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 0 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 Inspection report continued The service did this very well. The communication with families, and the details recorded in the care plans, as well as the regular reviews of information all helped staff to plan for each child's care and support them to achieve their potential. Care plans were particularly good. They were written in the first person, and gave a very good description of how the young person would like care to be provided. Throughout these plans it was clear that staff would provide each young person's care in a dignified and respectful manner. The manager had been working with staff to ensure care plans were focused and set out clear goals to help young people achieve their potential. We discussed the care plans with a member of staff who clearly knew the young people and was committed to ensuring their experience in the service was very good. Before each respite visit, staff made a "pre-call" to the family. This helped families share information about any changes to their child's care and support. Parents/ carers we spoke to said that these calls were "really, really important" and "great". Both parents/carers agreed that their child's needs had changed between respite visits, and that staff had taken account of this which had helped their child achieve very good experiences in the service. We spoke to staff who told us that they planned for individual children. Staff worked creatively to ensure children using the service could access equipment that they enjoyed. For example, where children enjoyed sensory experiences, staff used gloop, bubbles and paints to help them express their feelings. Staff talked to us about the work they did to meet the needs of individual children. This included specific meals and eating arrangements, bathing and personal care, and communication. One member of staff had attended training on a specific communication strategy and shared this with their team members. They said that this training had been useful in helping them communicate with some of the young people using the service. Another member of staff was also working on communication methods, and was using this to help identify favourite activities young people could take part in. Staff worked well with young people to help them communicate their choices and carry Action for Children - Silverton Short Breaks, page 12 of 23
these out. Staff met weekly and young people and their needs were discussed at these meetings. The regularity of the meetings had increased to make them more effective in identifying and addressing issues. Staff had further developed how they involved parents/carers and young people in their recruitment process. A parent/carer told us that their child had been involved in this process,and that they and staff had worked together to assess questions that they young person could ask that were important to them. Staff had worked with health professionals throughout this process. The parent told us that their child had thoroughly enjoyed being involved and that it had made them feel very important. Staff spent a great deal of time in meeting with families before their child stayed at the service. This included agreeing and completing care plans, and carrying out visits. These visits included time for a young person to stay for dinner and meet some of the other young people staying at the service. This process helped young people become comfortable in the service and respond to the work carried out by staff. Staff attended regular training and sought professional advice to help them support young people. Where a young person was using the service for the first time, staff researched their health condition and spoke at length with the families to ensure they could provide appropriate care and support. Some staff from the service were taking part in a project which was centred on family relationships and values. The manager was confident that this was helping staff confidence and would further improve practice in the service. We spoke to two parents/carers using the service. The gave us very good examples where the service had helped their child achieve their potential. One parent/carer talked to us about the support that had been put in place for their child since starting the service. They told us that other agencies had become involved and provided additional support that was helping their family. They said "Silverton were vital in getting us help...they helped us access other services to provide support...silverton tried all avenues to help. As a family, we have never looked back." They said, "Staff go the extra mile." The parent/carer told us that their child enjoyed going to the service. They knew this because they talked about staff at home and became excited when talking about the service. The other parent/carer told us about training that staff had attended to meet their child's needs. They appreciated that the family and staff had a chance to work together and approach any issues with continuity. The environment helped young people make choices and achieve their potential. Corridors were wide and young people with mobility difficulties or using wheelchairs could use the space well. Rooms were spacious and comfortable. There was a range of spaces that were well used including the lounge, conservatory and soft play room. We observed young people using the dining room and watching a DVD in the lounge. Each young person had their own bedroom, and where possible they could use that bedroom for future visits. The garden was another strength of the service. We Action for Children - Silverton Short Breaks, page 13 of 23
observed young people playing on bikes and taking part in physical exercise. The garden was large and provided paths and grass areas. Some equipment had been fitted, for example, swings and roundabouts, and there was a large sand pit. Young people enjoyed playing outdoors. The information in the care plans, and how staff were using these, as well as the feedback and examples of care provided by parents/carers all provided very good evidence that children were being supported very well to make choices and achieve their potential. We have assessed this Quality Statement as very good. Areas for improvement We looked at one incident report. Although there was a clear record of what had happened, and of the action the service had taken to reduce the risk of a similar incident happening again, there was not a full report of the action taken by staff at the time of the incident. The manager advised us that this was included with the incident investigation records. There was no reference to this in the incident report. (See recommendation 1) We looked at the environment. There were some areas that were in need of decoration and repair. The manager advised us that he was consulting with parents/ carers and young people to ensure that the best use was made of all areas in the building before making any changes. (See recommendation 2) We spoke to a member of staff who described the specific strategies they were using with a young person. Although this information was clearly recorded, it was not included in the young person's care plan. We discussed this and agreed that any planned care should be included in the care plan to allow it to be reviewed and assessed for effectiveness. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. The manager should ensure that full details of any incidents are recorded, and where the information is filed elsewhere, this should be referenced for easy access. NCS Care Homes for Children and Young People, standard 6: Feeling safe and secure. 2. The manager should continue with the plans to improve the environment including carrying out minor repairs and decoration. NCS Care Homes for Children and Young People standard 5: Your environment. Action for Children - Silverton Short Breaks, page 14 of 23
Quality Theme 2: Quality of Environment - NOT ASSESSED Action for Children - Silverton Short Breaks, page 15 of 23
Quality Theme 3: Quality of Staffing - NOT ASSESSED Action for Children - Silverton Short Breaks, page 16 of 23
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 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 The manager and staff provided very good opportunities for parents/carers and young people to assess and improve the quality of management and leadership. The complaints procedure was included with the information parents/carers and young people received before they started the service. Throughout the stay and while using the service, parents/carers were consulted about their child's care, and had the opportunity to make suggestions for improvement in the service. The recent development of a parent's forum had improved the opportunities for parents/carers to have an impact on how the service operated. Parents/carers could add items for discussion to the agenda, and any issues from previous meetings were followed through at the next meeting. Newsletters reminded parents/carers that their views and suggestions for improvement were welcomed. Management and staff had included parents/carers and young people in the recruitment process. They had found this to be very beneficial and planned to continue this for future interviews of new staff. The preparation and discussion that took place before these events provided parents/carers with an opportunity to comment on the process. Action for Children as an organisation clearly reflected in their policies and procedures that they were committed to working in partnership with families, and that they welcomed their views. The manager and staff had a clear understanding on what participation meant, and were constantly working on improving their practice in this area. Overall, we assessed this Quality Statement as very good. Areas for improvement Please see Quality Theme 1, Statement 1. The manager could also consider involving parents/carers and young people in any reviews of operational policies and procedures in the service. Action for Children - Silverton Short Breaks, page 17 of 23
Grade awarded for this statement: 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 There were very good quality assurance systems and processes in place in the service. These included the regular communication with parents/carers and young people. The new reviews of the service would further help the manager identify any areas for improvement. These included a detailed explanation to help parents/carers feel confident about identifying where the service could improve. As previously stated, the service was committed to working in partnership with families to help improve the service. Staff we spoke with were familiar with the Quality Statements, and regularly assessed their own work. The manager carried out very good supervision and appraisals with staff. We sampled a record of these and saw that the manager addressed any issues openly, and provided advice and targets for action. Performance of staff was measured and objectives agreed for the next year. The manager had carried out audits of how effective the service was. He had completed a development plan for the service, identifying where changes would improve outcomes for young people using it. Quarterly monitoring meetings took place with various professionals and stakeholders. The manager was sharing the vision of the service at these meetings. He had prepared a clear report on how well the service performed, and the impact this had on people using it. Although it was not clear if these changes would be put in place, the quality assurance exercise that had taken place to devise the development plan was very good and had highlighted areas for improvement. Overall, we assessed this Quality Statement as very good. Areas for improvement Inspection report continued The manager told us that staff had not been fully involved in completing the self assessment due to lack of time. We discussed how important it was that staff were involved in this process to ensure it is effective and helps to develop the quality of the service. We advised the manager that the self assessment form was available through the year and could be accessed at any time. He agreed that this would allow him to plan time for staff to be a part of the evaluation process. (See recommendation 1) Action for Children - Silverton Short Breaks, page 18 of 23
We discussed involving other agencies such as schools and social work in the process of evaluating the service. The manager agreed that he would build this into the ongoing evaluation of the service. Although there was a clear plan for improvement that focused on the young people using the service, these improvements were planned up to 2013. We will report on the action taken in future reports. Grade awarded for this statement: Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The manager should plan time for staff to be more involved in assessing the quality of the service through the self assessment form. NCS Care Homes for Children and Young People, standard 7: Management and staffing. Action for Children - Silverton Short Breaks, page 19 of 23
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 The manager had not yet downloaded the new SCSWIS certificate of registration. He is aware that he should do this without delay and display it in place of the current certificate. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Action for Children - Silverton Short Breaks, page 20 of 23
5 Summary of grades Quality of Care and Support - Statement 1 Statement 2 Quality of Environment - Not Assessed Quality of Staffing - Not Assessed Quality of Management and Leadership - Statement 1 Statement 4 6 Inspection and grading history Date Type Gradings 24 Nov 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 20 Jul 2010 Announced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 11 Feb 2010 Unannounced Care and support Environment Staffing Management and Leadership 4 - Good 2 Oct 2009 Announced Care and support Environment Staffing Management and Leadership Action for Children - Silverton Short Breaks, page 21 of 23
27 Mar 2009 Unannounced Care and support Environment Staffing Management and Leadership 18 Jul 2008 Announced Care and support Environment Staffing Management and Leadership All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Action for Children - Silverton Short Breaks, page 22 of 23
To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@scswis.com Web: www.scswis.com Action for Children - Silverton Short Breaks, page 23 of 23