Ardlui Respite House Care Home Service Children and Young People 25 Charlotte Street Helensburgh G84 7EZ Telephone:

Transcription

1 Ardlui Respite House Care Home Service Children and Young People 25 Charlotte Street Helensburgh G84 7EZ Telephone: Inspected by: Susan MacGillivray Type of inspection: Unannounced Inspection completed on: 11 April 2013

2 Contents Page No Summary 3 1 About the service we inspected 4 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: Sense Scotland Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Susan MacGillivray Telephone enquiries@careinspectorate.com Ardlui Respite House, page 2 of 22

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well Staff are very good at keeping parents up to date with their child's progress. There are good relationships between staff, parents and children. What the service could do better Children's reviews need to be more consistent. Staff need to be clear on what procedures should be followed if a child sustains an injury or arrives at the service with an injury. Medication sheets need to be up to date. What the service has done since the last inspection Staff continue to promote involvement of parents and children in the development of the service. There continues to be very good training opportunities available to staff. Conclusion Whilst there were some areas of improvement required, overall staff were sensitive and competent when caring for children. Parents told us that their children really enjoyed attending the service and were well cared for by staff. There were good trusting relationships between children, staff and parents. Who did this inspection Susan MacGillivray Ardlui Respite House, page 3 of 22

4 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations. If we are concerned about some aspect of a service, or think it could do more to improve, we may make a recommendation or requirement. * A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. * A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Ardlui Respite House had been registered on 1 October 2010 with the Care Commission to provide a respite care service to a maximum of 5 children and young adults aged 0-24 years with a disability related to communication disorder, health, physical and learning disability. It was agreed that children aged 0-5 years would only be admitted to the service under exceptional circumstances. The service operates 24 hours per day, 7 days a week. The service is run by Sense Scotland. The building is purpose built with five individual bedrooms. It is set in attractive, safe grounds in Helensburgh. The service's aim is to "provide a high quality, flexible and responsive service to enable children and young people with disabilities and/or challenging behaviour to live within their own family and within their community until they reach adulthood". Ardlui Respite House, page 4 of 22

5 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Ardlui Respite House, page 5 of 22

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by Inspector Susan MacGillivray. The inspection took place on 9/4/12. This report is a summary of the findings. We gave more detailed feedback to the manager on 9/4/12 and 11/4/12. As part of the inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us. We sent 5 care standards questionnaires to the manager to distribute to parents. 1 parent sent us back a completed questionnaires. We also asked the manager to give out 10 questionnaires to staff and we received back 3 completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: 4 young people 4 relatives of young people the manager 4 staff members We looked at: how staff worked evidence from the service's most recent self assessment personal plans and related recording of young people who used the service training records health and safety records accident and incident records medication records complaints records questionnaires that had been requested, filled in and returned to the care service Ardlui Respite House, page 6 of 22

7 from people who use the service, their relatives or advocates, and staff members. We also looked at the environment and equipment. Inspection report continued Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Ardlui Respite House, page 7 of 22

8 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 Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how the people who used the care service had taken part in the self-assessment process. Taking the views of people using the care service into account There were 4 young people using the service on the day of the Inspection. Due to the disabilities the young people had our communication was restricted. We spent time throughout the day observing staff and young people's interactions. Staff were very sensitive to young people's needs and young people were happy and relaxed with staff. We have included further comments and views from people using the service throughout the report. Taking carers' views into account We spoke with 1 parent face to face and 3 parents by telephone. They all said that their child really enjoyed attending the service. They told us that they felt their children were safe whilst attending the service. All said that staff were easy to talk with and if they had a problem they could talk with staff and the matter would be resolved. All parents felt the service offered a good quality of care. 3 of the parents told us about incidents that had happened in the past which they Ardlui Respite House, page 8 of 22

9 had not been happy with. They felt these had been resolved after they had spoken with the Manager. We have made recommendations in statement 1.3 of the report about these. Some of the comments from parents were: "The staff are motivated and helpful" "We have constant dialog with the staff about our child's needs". "The staff are flexible and accommodating". "My child is happy and excited to go to the service". "The staff manage my child's medical needs well". "Staff are good at involving parents in the development of the service". "I feel confident leaving my child at the service". "Sometimes it takes the staff a while to get back to me about things". "I would like to have more information about staff changes". "I was not informed when my child had hurt themselves". "I would like feedback on the questionnaire I filled out". Inspection report continued Ardlui Respite House, page 9 of 22

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service was "very good" at involving young people and their parents (carers) in the assessment and development of the service. We decided this after looking at support plans, newsletters, observing children and staff and talking with 4 parents, the manager and 4 staff members. We looked at 3 support plans. It was clear from these that parents had been consulted about their children's needs and what help their children required. We observed staff following these support plans, thus children's needs were being met as parents expected, and in the best interest of the child. On the day of the inspection we saw that staff were giving children a choice in what they wanted to do. For example draw, play outside or go to the shops. Although children had limited communication they were able to let staff know their preferences. This meant children were having fun and enjoying their stay at the service. When we spoke with parents they told us that staff were very good at asking them for suggestions about improvements within the service. A recent questionnaire had been sent to parents from the service. The Manager was in the process of responding to comments raised in these. There were regular newsletters sent to parents informing them of changes within the service and other relevant information. Parents had also been asked if they wanted to be involved in interviewing new staff. The Manager told us that she had used some of the questions put forward by a parent in a recent interview. Ardlui Respite House, page 10 of 22

11 Parents confirmed that when they had brought issues to the Manager these had been "quickly sorted out". Parents felt confident in the Management of the service and felt they were listened too and their suggestions acted upon. The above evidenced that the Manager was committed to involving children, parents and others in the ongoing improvement of the service. Areas for improvement The Manager had identified that she wanted to find further ways to involve children, parents and others in the self assessment. Parents thought it would be helpful if they could be kept up to date of staff changes. The Manager agreed to find ways to do this with parents. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued Children's health and wellbeing needs were being met to a "good" standard. We decided this after looking at 3 support plans and related children's recording. We observed staff administering medication and staff and children's interactions. We also spoke with 4 care staff members, the manager and 4 parents about health and wellbeing. Prior to a child coming to stay at the service staff contacted parents to get up to date health information. This included information about medication and changes in children's routines. The parents we spoke with found this really useful as it meant staff were able to respond to children's development in a flexible and responsive manner. Information about children included a "pen" picture of children's home routines and likes and dislikes. This meant if a child was unable to communicate staff had a good understanding of the child and their wider life. We thought this was beneficial as the information could be used to help children feel safe and secure in the service. For example if part of the child's night time routine was to take a favourite toy to bed, staff could made sure this happened. The 3 support plans we looked at contained detailed information about children's health needs and how staff were to support them. When we spoke with parents they told us that they were confident in the staffs' abilities to meet their children's health needs, for example children's dietary needs or daily exercises. Ardlui Respite House, page 11 of 22

12 Areas for improvement When we spoke with 4 parents 2 of them voiced concerns about some prior incidents. We spoke with the Manager about these and were assured that the issues had been resolved. The parents we spoke with confirmed this. We should have been notified about one of these incidents and the Manager has assured us that this will be done in the future. We will make a recommendation about this. (See recommendation 1 of Quality statement 1.3). Whilst we were confident that children's needs were being reviewed on a regular basis, in some cases reviews were not undertaken in a systematic and planned basis. To ensure that all parties have a clear understanding on what constitutes a review and when a review is happening we will make a recommendation. (See recommendation 2 of Quality Statement 1.3). We case tracked 1 child's medication records. There was a discrepancy in this which we discussed with the Manager. We will make a recommendation about this. (See recommendation 3 of Quality Statement 1.3). The Manager told us that they were in the process of developing children and young people's support plans so that they were more accessible to children and young people. For example if a young person could not read or speak then the support plan would be more visual. We will consider this further at the next Inspection. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 3 Recommendations Inspection report continued 1. The Provider should make sure that staff understand and follow the services procedure's when accidents and incidents happen. The Provider should also follow guidance on "notification" of accidents and incidents to the Care Inspectorate. National Care Standards care homes for children and young people. Standard 4:Support arrangements and Standard 7 Management and staffing. 2. Children and Young people's support needs should be reviewed on a minimum of a 6 monthly basis or more often if required. Parents should be made aware that a review is taking place. National Care Standards care homes for children and young people. Standard 4:Support arrangements and Standard 7 Management and staffing. 3. Medication sheets should clearly record all medication the child has been prescribed and taken with them to the service. National Care Standards care homes for children and young people. Standard :7 Management and staffing and standard :12 Keeping well - medication. Ardlui Respite House, page 12 of 22

13 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very 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 The service was "very good" at involving young people and their parents (carers) in the assessment and development of the service. We decided this after looking at support plans, newsletters, observing children and staff and talking with 4 parents, the manager and 4 staff members. See statement 1.1 for further information. Areas for improvement See statement 1.1 "areas of improvement" for further information. Grade awarded for this statement: 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 We concluded that the environment was safe and children and young people were protected to a "very good" standard. We decided this after examining the environment and looking at paperwork relating to fire safety and the service's maintenance log. We also considered what strategies were in place to keep children and young people safe. We spoke with parents and staff about safety and the environment. The environment was clean, spacious, bright and welcoming. It had been purpose built to accommodate children who required special equipment or the use of wheelchairs. Ardlui Respite House, page 13 of 22

14 There was a safe outdoor play area that could be accessed by children from the dining area. This encouraged children to explore and enjoy more active activities if appropriate. There were clear reporting procedures in place should equipment not be working. At the time of the Inspection staff told us that all equipment was in working order. Recent safety checks had been undertaken on "hoists" and "tracking" equipment. Staff undertook daily and more thorough weekly checks of the premises to ensure it was fit for purpose. The staff we spoke to told us what they would do if the fire alarm was activated. The records we looked at confirmed that fire safety checks had been undertaken and staff had undertaken appropriate fire safety training. This meant staff would feel confident and know how to keep children safe if there was a fire. Areas for improvement The Manager told us that she had recently reviewed the "fire safety plan" and was in the process of writing this up. We will look at this at the next inspection. The staff were encouraging the children to produce more art work that could be displayed on the walls. We felt this would brighten up the environment and give some of the children a sense of pride and achievement in their work. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ardlui Respite House, page 14 of 22

15 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The service was "very good" at involving young people and their parents (carers) in the assessment and development of the service. We decided this after looking at support plans, newsletters, observing children and staff and talking with 4 parents, the manager and 4 staff members. See statement 1.1 for further information. Areas for improvement See statement 1.1 "areas for improvement" for further information. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The staff were performing to a "very good" standard in relation to being professional, motivated and trained. We decided this after examining staff records such as - supervision notes, team meeting minutes, induction workbooks and staff training. We also spoke with 4 staff members and 4 parents. We also observed staff practice. The staff we spoke with were enthusiastic and committed to the work they were doing. They had a sound understanding of the importance of promoting choice and independence for young people, whilst being aware of their safety. Staff training was up to date and, when required, health professionals provided training relating to young people's needs. There was a variety of good quality training which had been undertaken by staff. Our observations confirmed that staff were Ardlui Respite House, page 15 of 22

16 competent and knowledgeable about the needs of the young people they were caring for. This ensured that children's individual needs were met by a trained and competent staff group. The staff we spoke with were able to tell us what they would do if they had "child protection" concerns. This showed us that staff knew what was legally expected from them and how to keep young people safe. All staff had relevant qualifications to the work they were undertaking. This meant they had a good understanding of why it was important to work with young people within the care standards framework. For example promoting independence and helping young people become more confident. Parents gave us examples of when additional support to young people had been provided at short notice. This showed us that staff were flexible and were able to respond to family emergencies/requests in a sensitive and helpful manner. All the parents we spoke with felt that their children were well cared for and had fun whilst at the service. In accordance with the service's Supervision Policy, staff received supervision. The staff we spoke with and supervision records we looked at evidenced that supervision was purposeful and identified staffs strengths and areas of development. There were regular staff meetings and informal discussions where good practice guidance was discussed and staff had the opportunity to discuss any concerns they had. This meant staff practice was up to date which had a positive impact on children. For example encouraging children to eat healthy and stay active. All staff spoke highly of the style of Management within the service. They said they could discuss any issues they had with the Manager and that they felt listened to. They said they were encouraged to identify improvements that could be made within the service and these would be acted upon where appropriate. An example of this was a staff member suggesting that there could be more interesting art work undertaken with children. We saw this displayed on the walls and children enjoying making pictures on the day of our inspection. Areas for improvement Inspection report continued There had been a number of changes in respect to staffing which were outwith the Manager's control. We discussed the impact some of these changes had had on parents and young people and how this had been managed. The Manager planned to discuss this further with parents to ensure that they were clear on who the new staff were and what their roles were. Ardlui Respite House, page 16 of 22

17 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Ardlui Respite House, page 17 of 22

18 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The service was "very good" at involving young people and their parents (carers) in the assessment and development of the service. We decided this after looking at support plans, newsletters, observing children and staff and talking with 4 parents, the manager and 4 staff members. See statement 1.1 for further information. Areas for improvement See statement 1.1 "areas of improvement" for further information. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths The Provider had a number of "very good" quality assurance systems in place which involved young people and relevant others. We decided this after considering paperwork and speaking with staff and parents. Some of the ways the service quality assured are highlighted throughout the report. These included: regular reviews of young peoples support needs staff supervision, training and team meetings ongoing communication with young people and their families an open door policy to the Manager annual questionnaires which were analysed and actioned as appropriate. Ardlui Respite House, page 18 of 22

19 The parents we spoke with all said that when they had brought issues to the attention of the Manager these had been resolved. They felt confident in the Manager and her ability to make changes when necessary. The Manager had a service action plan called "Progress for the Provider". This identified areas of improvement required within the service. The Manager was continually reviewing this and making changes where appropriate. This way of working should ensure the service continues to develop and improve. An example of this was the Manager and staff making children's support plans more pictorial if a child could not speak or read. Areas for improvement The Service was involved in a "pilot scheme" for a new quality audit system. It was hoped this would be beneficial in regard to continual development and assessment of the service. When we looked at the audit trail of one young person's medication, the audit had not highlighted a discrepancy. There was no evidence that this had impacted on the young person. However staff should be reminded that when they are auditing it should not became a "tick" box task. We have made 3 recommendations in statement 1.3 of this report. When we considered these we concluded that they were partly due to the manager having to work "on the floor" due to staff shortages. This had meant the manager had been unable to fully fulfil her managerial and quality assurance role. We are confident that now the staffing issues have been resolved this will allow the Manager to focus more fully on the services ongoing development. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Ardlui Respite House, page 19 of 22

20 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in 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). Ardlui Respite House, page 20 of 22

21 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Environment Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 11 Apr 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 26 Apr 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Ardlui Respite House, page 21 of 22

22 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Ardlui Respite House, page 22 of 22