Care service inspection report

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1 Care service inspection report Full inspection Stoneside Flat Care Home Service 18 Stoneside Drive East wood Glasgow Inspection completed on 12 May 2016

2 Service provided by: Action for Children 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 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 Quality of environment Quality of staffing 5 Quality of management and leadership Very Good N/A Very Good N/A What the service does well Staff members had a very good understanding of the needs of the children and provided a child-centred approach which was beneficial to the children. The staff and management of the service were committed to providing the best care possible and were extremely good at advocating on behalf of the children. The service worked in an inclusive way with parents and relatives of children. What the service could do better The provider should ensure that there is a broader range of training available for staff in meeting and understanding the social and emotional needs of children with complex additional support needs. The service should hold a current up-to-date copy of the local authority child's plan and that there is an individual placement agreement held for children. What the service has done since the last inspection The service has continued to improve the living environment. Training on attachment has been provided to staff and had increased awareness of the needs of the children. page 3 of 23

4 The service is introducing new care plan formats which are in keeping with the GIRFEC (Getting it Right for Every Child) wellbeing indicators which helps promote a holistic view of the children's needs. Conclusion The care and support provided to children living at Stoneside Flat continues to be of a high standard. page 4 of 23

5 1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service has been registered with the Care Inspectorate since Stoneside Flat is registered to provide a 24 hour residential care service to 3 young people who are looked after and accommodated away from home (LAAC). The age range is between 5 and 18 years. The provider is Action for Children. At the time of the inspection there were three young people with complex additional support needs resident in the service. The service is located in a residential area in the south side of Glasgow and is near to local amenities, including shops, public transport and several local parks. The accommodation is attached to another residential service provided by Action for Children. There is a shared entrance way, with an additional front door to the flat. The accommodation is on one level and all the young people have their own bedroom. There are shared communal facilities, such as bathroom, living room and a kitchen. There is a large garden area with outdoor play equipment available for the young people to use for recreational activities. One of the stated aims of the service is: 'Action for Children vision is a world where all children and young people have a sense of belonging, and are loved and valued. A world where they can fulfil their potential, shape their destiny and experience the joy of life". A full copy of the aims and objectives are available. Recommendations 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 page 5 of 23

6 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 5 - Very Good Quality of environment - N/A Quality of staffing - Grade 5 - Very Good Quality of management and leadership - N/A 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. The inspection took place over two visits to the service on the 4 May 2016 between 1pm and 6.30pm and 5 May 2016 between 12.30am and 7.30pm. As part of the inspection we took account of the completed annual return and self-assessment forms which the service sent us. We received a written document completed by a child, with the support of an independent advocate, which gave views about the service. We also received two completed staff questionnaires. During the inspection process we gathered evidence from various sources, including the following: We met with: - Three children - Six residential workers - The service coordinator - The service manager - The social workers of two young people - The parent of a child. We spoke with: - The relative of a child - An independent advocate who supports the children living in the service. page 7 of 23

8 We looked at a range of documents at the service, some of which included: - The support plans for two young people - Service satisfaction questionnaires - Staff training records - Staff meeting records - Incident reports and incident investigations and debriefing records - Staff supervision minutes - Child protection policy - Service development plan - The personnel files for recently appointed staff members. Inspection report We considered all of the above and presented our findings to the service coordinator and manager at the inspection feedback to the inspection on the 12 May 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 page 8 of 23

9 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 Inspection report 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 service provided a self-assessment which detailed strengths and areas for development. These were in keeping with the findings to our inspection. Taking the views of people using the care service into account We spoke with two children and observed staff interactions with a third child. One child told us he liked living in the service and told us of his hobbies and interests and how these were promoted by staff members. Another young person told us he was happy living in Stoneside Flat. We observed that another child was relaxed in the company of staff and engaged well. Taking carers' views into account We spoke with the parent of one child and the relative of another. We were told that the service was very good at keeping in touch and involved them in decision making. Staff were described as caring to the children and that they felt confident their child was being cared for extremely well. We were told that the staff team were friendly, helpful and extremely welcoming. page 10 of 23

11 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: 5 - Very Good 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 We found the service performance to be very good for this quality statement. There was a support plan in place for each child. The service was gradually moving the children's support plans so they would be structured around the GIRFEC (Getting It Right for Every Child) wellbeing indicators of Safe, Healthy, Active, Nurtured, Achieving, Responsible, Respected, and Included. This encouraged a holistic view to be taken of the child's needs. We looked at two support plans and found that children's needs were clearly stated with a plan in place of how these would be met. The staff team were proactive in ensuring that children received attention from primary health care services, such as general practitioners, dental services and opticians. Children were in regular contact with the LAAC (Looked After and Accommodated) children's nurses and we found that staff took action following any recommendations. An example of this included introducing healthy snack options and increased exercise for children who were overweight. As a result children's weights were within the healthy range. page 11 of 23

12 The service liaised closely with LDCAMHs (Learning Disability Child and Adolescent Mental Health services) using consultation to seek the best methods of intervention in managing more complex behaviours. This meant that a consistent approach based on best practice was adopted to support children. Staff members knew the children well and were quick to respond to any changes in the child, such as, when a child was 'off colour' and showed other symptoms of being unwell. We were able to establish that during these times, children were comforted and medical attention was sought as appropriate. Children were encouraged to be active and have hobbies and interests. A range of activities were supported, such as football, swimming, cycling and going on outdoors trips. For children who did not wish to go out alternative activities were being provided such, as play dough, arts and crafts, music, dancing, indoor ball games and playing with an Ipad. Education was valued by the team and children had access to educational toys, books and equipment. Staff members were in regular contact with educational staff. This promoted good continuity of care for children and gave a good overview of progress being made. The staff team advocated strenuously on behalf of children during any disruption to education. For one child this had brought about some improvement to the quality of educational input albeit there remained a view this could improve further. We found excellent transition planning for a child who was regarded as needing to move to a more specialist service. This had included welcoming staff from the new service to work alongside staff at Stoneside to get to know the child. Arrangements had also been made for Stoneside staff to provide support to the child in the new service during the initial weeks after the move. This had provided great reassurance to the relative of this child and it was hoped would give the child the best possible opportunity to settle into the new placement. Areas for improvement The service were continuing to update support plans so that they are framed around the GIRFEC model. With this there was a commitment to ensuring that support plans were outcomes focused with clear and coherent planning in place to achieve goals. page 12 of 23

13 We found that the frequency of visits to one child from the placing social worker did not meet with statutory requirements. We were told that this was being addressed via the monitoring meeting with the placing local authority commissioning team. We found that for two children the local authority child's plan was out-of-date and there were no placing agreements (see recommendation 1). Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations The service should ensure the local authority child's plan is current and that there is a placement agreement held for children. National Care Standards, care homes for children and young people - standard 4: support arrangements. page 13 of 23

14 Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service strengths We found the service performance to be very good for this quality statement The service used a variety of ways to communicate with the children and members of their support network. For children who had limited language skills or had difficulty expressing their views we observed that staff members had the skills and knowledge of individual children to facilitate effective child-centred communication. This included interpretation of mood and body language, using objects of reference, signing and using pictorial prompts. As a result, children were receiving the care they needed, i.e. when they wished personal care, were hungry, wished to go out, tired or stressed. Parents and relatives told us that staff members were in regular contact with them and that they were included in decision making about their child. We found that parents were regular visitors to the home and were involved in care reviews, medical appointments as appropriate. This helped children maintain important links with their family and we were told that children were benefiting from this. The service had extremely good links with advocacy services and the host local authority children's rights officer (CRO) was a regular visitor to the children in placement. The CRO told us that staff team were extremely proactive in seeking independent advocacy for children to ensure their best interests were at the heart of decision making. Consequently the children's right to good quality care and support, access to education and health services from the child's support network and from corporate parents was being upheld with challenges made as appropriate when matters of dissatisfaction arose. Areas for improvement The service identified a need to access talking mats and/or makaton training to future develop their knowledge and ability to support children's communication. page 14 of 23

15 Grade 5 - Very Good 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: 5 - Very Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths At this inspection we found that the performance of the service was very good for this statement. Action for Children had a policy on staff recruitment which was based on the Scottish Government's safer recruitment practice guidance. We reviewed the personnel files for two newly recruited members of staff and found they had taken part in competitive interviewing; evidenced transferable skills required for the position. Satisfactory references had been provided and criminal records checks were carried out. We spoke with a newly appointed residential worker who spoke highly of the induction process both in terms of shadowing opportunities, initial training and mentoring. Formal supervision agreements were in place which meant the new workers were clear of the support and frequency of supervision and their role in the process. We found that regular supervision had been provided and gave the opportunity to reflect on practice, discuss support needs and consider future learning needs. Newly appointed staff members were subject to a probationary period. This gave further reassurance of the applicant's suitability to the role of working with vulnerable children. Policies and procedures were accessible within the service and confirmation of reading these was provided by new staff in writing throughout the induction process. page 17 of 23

18 Staff members were registered with the Scottish Social Service Council and were aware of their responsibilities in relation to the code of practice. Areas for improvement We were told the service was currently reviewing the induction process as they felt it required to be more in-depth. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 18 of 23

19 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service performance to be very good for this quality statement. The parents and relatives of children told us that they had every confidence in the team to provided good care to their children and could tell when they were upset and in need of support. We were told staff were "great and really cared" we were also told staff kept them informed about their child and made them welcome when visiting the service. During our inspection we met with six staff members, the service coordinator and the manager. We found that staff members were committed to helping children reach their potential and promoted a nurturing environment. This included a 'how can we help' approach towards the challenging behaviour exhibited by children. Staff were trained in crisis management and prevention. We found that the management ensured that there were sufficient staff members on duty to ensure that children received the care and attention they required. This had meant that the staffing levels in recent months had been increased in response to need. Staff told us they were well supported by management and that the team worked well together. We observed the atmosphere in the house during the days of inspection to be welcoming, relaxed and upbeat. The team told us that training was available either face-to-face or via the online training system 'loop'. Most staff had completed SVQ 3 and above with a plan in place for staff who had yet to attain this. The service coordinator was completing the post-graduate certificate in advanced residential child care. The team were continuing to build on the understanding of children development and had received training on the impact of neglect and trauma on attachment and development. page 19 of 23

20 We found this had strengthened the ability to understand children and how to meet their needs. Training had also been provided on GIRFEC to keep staff abreast of latest Scottish Government initiatives in relation to improving outcomes for children. Supervision and appraisal were in place for staff and we were told this was valuable time in which to reflect on practice, seek support and explore training needs. The good systems of communication meant that children were being provided a continuity of care from a well-informed staff team. Staff members were registered with the SSSC (Scottish Social Services Council) and we found that staff followed the code of practice, including whistle-blowing and reporting concerns of child protection. Areas for improvement At the inspection feedback we discussed the training programme in relation to working with children with complex needs. We were of the view that current training was weighted towards health and safety and medical issues (see recommendation 1). The staff team have not as yet had any formal training in child sexual exploitation. However, this was part of a roll out of training being accessed by Action for Children and we were told that this was to be provided. Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. A more robust training programme should be put in place which is specific to the social and emotional needs of children with additional support needs, such as, working with children and adolescents with autism and communication challenges. National Care Standards, care homes for children and young people - standard 7: management and staffing. page 20 of 23

21 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 21 of 23

22 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 29 Apr 2015 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 27 May 2014 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 23 May 2013 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 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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