Care service inspection report

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1 Care service inspection report Full inspection Richmondhill House Care Home Service 18 Richmondhill Place Aberdeen Inspection completed on 25 May 2016

2 Service provided by: Aberdeen Association of Social Service, a company limited by guarantee, trading as VSA Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and 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. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Inspection report page 2 of 23

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 5 Very Good Quality of environment N/A Quality of staffing 5 Very Good Quality of management and leadership N/A What the service does well The staff and management at Richmondhill House provide a high standard of care and support to the people using this unique service. A real positive is the awareness and desire within the staff team to continue to improve which is to be commended. What the service could do better We identified some areas, which could be improved upon, such as: - risk assessment processes - how staff are involved in feedback around the referral process - more access to learning disability training - ensuring the minutes and actions from team meetings are readily available. We comment further on these areas within the quality themes and statements of this report. page 3 of 23

4 What the service has done since the last inspection Inspection report Since the last inspection, the service had continued with their internal refurbishment and now had new carpets and some of the bathrooms had been updated. There were continuing plans for updating other areas of the service, such as finishing the bathrooms and updating décor in other rooms. Conclusion Richmondhill House provides an attractive and homely setting for people who use the service. There were very good opportunities for parents to develop skills for independent living and improve confidence in a supportive and nurturing environment which included their children. page 4 of 23

5 1 About the service we inspected Inspection report Richmondhill House provides support to a maximum of nine adults and up to 18 children. Support is offered to families where child protection and/or childcare issues have been identified. The service is aimed at, but not solely for those parents with a learning disability. An outreach support service is also provided from Richmondhill House. The service provider is VSA based in Aberdeen, Scotland. The VSA vision is to build a strong and caring community and to provide the best care and support to enable local communities to fulfil potential. The vision and mission are based on shared values as an organisation, such as: - Our service users' needs will be at the heart of our policies, planning and work. - We will work to provide the best care to meet our service users' needs. - We will embrace, promote and foster partnerships to deliver our services in the most appropriate way for our service users. - We will respect and value our service users, partners, volunteers and staff. The 'philosophy' for service provision is a reflection of the above agency vision, mission and values. To provide a supportive and nurturing environment aimed at offering individuals opportunities to reflect, learn and build self-esteem. Service users are treated with respect and encouraged to build on existing resilient factors and their strengths. 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 Recommendations page 5 of 23

6 A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. 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 - Grade Quality of management and leadership - N/A Inspection report 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. page 6 of 23

7 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 carried out by one inspector. The inspection started on 18 May 2016 between 12:30pm and 4:00pm, continued on the 19 May 2016 between 9.30 am and 5.45 pm, and was completed on 20 May 2016 between 9.30 am and 4.00 pm. Feedback was given to the service manager, deputy manager, the general manager for children and families directorate and director for children and families. As requested by us the care service sent us an annual return. The service also completed a self assessment. We asked the manager to give out questionnaires to staff and we received two completed questionnaires before the inspection. During this inspection process, we gathered evidence from various sources, including the following: - personal plans of people supported by the service - referral packs - various meeting minutes and action plans - risk assessments for the service - accident and incident records - communication books/diaries - staff support information - staff training records - observation of staff practice. We met with individually or spoke to in groups: page 7 of 23

8 - the manager - the depute - administration assistant - housekeeper - one general manager - two health visitors - one social worker - 11 staff - four parents. We observed staff interactions with the parent(s), their child(ren), each other and other visitors to the home. We looked at equipment and the general environment. The inspector would like to thank service users, managers and staff for making the Care Inspectorate welcome, for providing us with hospitality and giving up their time to speak to us. 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. page 8 of 23

9 Fire safety issues Inspection report 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 page 9 of 23

10 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. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. We also reviewed information we had received from the provider since our previous inspection. Taking the views of people using the care service into account We spoke to four parents throughout this inspection (one formally and the rest more casually). One parent felt they received a supportive service from staff that had lots of knowledge. They felt they were actively involved in discussing and reviewing their support. Everyone had very positive comments about the staff and the care and support they received in the service. Overall, parents felt they were kept very well-informed of what was going on. page 10 of 23

11 Parents said they were involved with the day-to-day plans and activities in the service. We observed warm interactions between staff, children and parents. Taking carers' views into account Carers include guardians, relatives, friends and advocates. They do not include care staff. We did not speak to any carers during this inspection. page 11 of 23

12 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 3 We ensure that service users' health and wellbeing needs are met. Service Strengths The service's performance in the areas covered by this statement and the relevant National Care Standards was very good. We concluded this after we talked to people and looked at records. We looked at support plans during the inspection. Some, but not all of the areas we looked at were: - referral information - application form - induction to service - child protection care plan - expected outcomes - risk assessments. The care plan set the framework for meeting outcomes, which included repeated observations of set tasks, such as feeding and bathing. This assessment period included guidance and support from a range of health care professionals. Parents were assessed for a period up to 12 weeks, but this could be longer if needed. page 12 of 23

13 Parents played an integral part in the day-to-day activities. Parents had a keyworker over their 12-week placement. The key worker met with the parent(s) on a regular basis to discuss assessments. The keyworker also assisted the supported person to complete personal plans and helped them prepare and attend meetings. Staff were observed throughout the inspection interacting with others in a respectful manner. The service worked closely with community health teams and a whole range of health professionals from the local area including the general practitioner, health visitor and other local authority and health services. There were appropriate policies and procedures for: - health and safety - control of infection - food safety - environmental risk assessments - fire safety. Inspection report Risk assessments were in place around child protection issues, and for parents if they required support due to a disability. However, we did not see risk assessments in place around risks to others using the service from visitors (see areas for improvement). The service managed medication safely and followed best practice guidance. It did this by having a medication policy and procedure in place. The manager and staff of the service was able to explain the medication arrangements currently in place. Parents were encouraged to be active and eat healthy foods. We observed a cooking class where a lunch menu had been agreed at a house meeting and with staff supervision; parents were participating in the preparation. This was to help build skills, confidence and promote independent living. From our discussions with staff, we found they were knowledgeable about adult support and protection, manual handling and whistleblowing. This helped to keep the families using the service safe and well. page 13 of 23

14 Areas for improvement Risk assessment documents should be developed and contain more detail about the risks specific to the concerns identified during assessment or soon after admission to the service. For instance, if there is a possibility a visitor to the service may pose harm to others, staff should have protocols and safeguards in place to protect others while supporting the placement. This means staff had detailed guidance on what to do and how to manage the situation appropriately and with sensitivity. We will follow this up at our next inspection. Grade Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths We found the service continued to perform at a very good level in responding to service users' care and support needs using person centred values. We saw the service has tried to encourage participation and feedback from parents and others in a variety of ways, including questionnaires, meetings and reviews of care. It was very clear through observation of parent(s), staff, and reviewing the support plans that child welfare and protection was everyone's first concern. Staff strived to provide a high standard of personalised care, which focussed on maintaining outcome based support for everyone. The service worked closely with health teams across the local area and across Scotland when referrals were made out with the Aberdeen city and shire areas. This included contact with general practitioners, dentists and social work, to name a few. page 14 of 23

15 Parent(s) were actively encouraged to develop and learn how to provide good parenting to their child(ren) through the assessment process. Individual sessions took place in order for parents to talk to staff about day-to-day life and parenting. This is an integral part of every aspect of daily life at Richmondhill House and is part of the Bonding & Attachment process used to guide parent(s) in meeting the needs of his/her baby/child both physically and emotionally. In addition to the planned sessions at the service, staff accompanied the parent(s) during some activities such as shopping, going out to the park, and medical appointments in order to observe and provide guidance in living and parenting tasks. Where a parent needed to attend individual sessions without the baby/child, staff cared for the baby/child for an agreed time period. Sometimes parents did not necessarily agree with the level of monitoring and supervision they were subject to, but did understand why this was in place. Areas for improvement We spoke to the manager about enhancing the forms used for referrals to include an area for information around risks, for example if someone needed extra support due to a disability. This way keyworkers could put safeguards in place before parent(s) arrived. We will follow this up at our next inspection. Keyworkers were assigned to parent(s) during the referral process and information on the referral was gathered and kept in a folder. After speaking to staff, we thought there could be a way to get more information from them, such as any questions or concerns they may have around the placement, so if they were not able to attend meetings their views could be taken into consideration and key questions asked. We discussed this with the manager who said she would put something into place. We will follow this up at our next inspection. Grade Number of requirements - 0 Number of recommendations - 0 page 15 of 23

16 Quality Theme 2: Quality of Environment Quality theme not assessed page 16 of 23

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths There was evidence that the manager ensured that everyone working in the service had an awareness of care standards, legislation and best practice in order to deliver quality care. The service manager was able to provide very good evidence that the service had a professional, trained and motivated workforce. We though this after we: - looked at records - read meeting minutes - attended shift handover - looked at recruitment feedback - spoke to staff and management. Members of staff spoken with at this inspection had a very good understanding of the National Care Standards and were familiar with Scottish Social Services Council (SSSC) codes of practice. Staff were found to be caring and sensitive to the needs of service users and were committed to providing a service that improved the quality of their lives. All staff were required to be registered with the Scottish Social Services Council (SSSC), and we checked the register and verified staff were registered or in the process of registering with the SSSC. Some staff still had 'conditions' on their registration, which means they have been given time to complete their qualification. page 17 of 23

18 A very good induction procedure was in place and followed an induction checklist. New staff worked alongside permanent staff during induction. A planned ongoing programme of supervision was in place for all staff. This ensures the staff knowledge and expertise to meet supported people's needs is available. The service used a communication book and a daily report to pass on information and reference important bits of documentation. Items staff needed to be aware of were highlighted/cross referenced. This was to help ensure vital information was not missed. Staff received regular training so they could put information into practice confidently. A system was in place to identify what training each staff member needed to do so that records could be kept up to date. This means guidance for staff is available and best practice and legislation can be followed. Areas for improvement Staff told us they would like more training around learning disabilities to enhance their general knowledge. We discussed this with the manager who was going to contact the training department to see what was available and access this for staff. We will follow this up at our next inspection. Grade Number of requirements - 0 Number of recommendations - 0 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths The ethos of treating service users with respect was central to the way staff practise and integral to the organisation's policies and procedures.the management and staff were able to provide very good evidence that the service enabled parents to participate in assessing and improving the quality of the page 18 of 23

19 staffing within the service. There had been some changes to the staff team over the past year, but a consistent staff group was in place. This helped ensure there was a good knowledge of the supported people at a personal level. A policy and procedure was in place for the recruitment of staff. Staff were found to be caring and sensitive to the needs of parents and their child(ren) and were committed to providing a service that improved the quality of their lives. Parents could choose to be involved in recruitment and were able to provide feedback to the manager about their views. Staff were well motivated, they showed enthusiasm and commitment in the way in which they talked about the work they did and in the observation of their interaction with the parents and child(ren). Areas for improvement There were weekly meetings where the team came together to discuss current progress and share professional assessments and how best to promote strengths for each parent. However, we noted the monthly team meetings did not always occur. Team meetings give staff a chance to challenge each other in a safe environment, discuss new ideas and service issues and share best practice. We discussed this with the manager, who was going to ensure the team meetings happened on a regular basis and if they were cancelled they would be rescheduled as soon as possible. We will follow this up at our next inspection. Grade Number of requirements - 0 Number of recommendations - 0 page 19 of 23

20 Quality Theme 4: Quality of Management and Leadership Quality theme not assessed 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. page 20 of 23

21 7 Enforcements We have taken no enforcement action against this care service since the last inspection. Inspection report 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 9 Jun 2015 Unannounced Care and support Environment Staffing Management and Leadership 17 Apr 2014 Unannounced Care and support 4 - Good Environment Staffing Management and Leadership 18 Apr 2013 Unannounced Care and support 4 - Good Environment Staffing Management and Leadership 4 - Good 4 May 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Management and Leadership 4 - Good 13 Dec 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed page 21 of 23

22 Management and Leadership Not Assessed 18 Jun 2010 Unannounced Care and support Environment Not Assessed Staffing Not Assessed Management and Leadership 30 Dec 2009 Unannounced Care and support Environment Not Assessed Staffing Management and Leadership Not Assessed 23 Apr 2009 Announced Care and support Environment 4 - Good Staffing Management and Leadership 23 Jan 2009 Unannounced Care and support Environment Staffing Management and Leadership Not Assessed 3 Jul 2008 Announced (short notice) Care and support Environment Staffing Management and Leadership page 22 of 23

23 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 23 of 23

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